Adenomyosis occurs when endometrial tissue, which typically lines the uterus, infiltrates the uterine muscle wall. Previously considered an extension of endometriosis, experts now recognise it as a distinct condition since the tissue exclusively grows inside the uterus, penetrating at least 2.5mm into the outer muscular layer.
Adenomyosis comes in three forms:
- Focal: A separate mass forms within the middle uterine wall layer (myometrium).
- Extensive/Diffuse: Endometrial tissue spreads over a large area.
- Adenomyoma Tumors: These benign tumours mimic fibroids. It can vary in size from microscopic to large. They can accompany both focal and extensive/diffuse adenomyosis.
This condition affects 1 in 10 women, primarily those of reproductive age who menstruate. It is most prevalent in women over 30, particularly those with multiple children. Adenomyosis often coexists with fibroids, found in 35-55% of cases, and endometriosis, present in 20% of cases.
The pain from adenomyosis can be severe, radiating from the pelvic area to the legs. It often results in hefty periods (menorrhagia) and fertility issues, including difficulty conceiving and an increased risk of miscarriage. Without treatment, symptoms typically worsen until menopause, when they usually subside.
Diagnosing adenomyosis based on symptoms alone is challenging. It often occurs alongside fibroids and endometriosis, which share similar symptoms. It is sometimes only identified during a hysterectomy, which resolves the condition. If adenomyosis is suspected, doctors may use an MRI, a transvaginal ultrasound, or hysteroscopy for diagnosis. Treatment generally involves hormone therapy and pain management.
Can Adenomyosis Impact Fertility?
Endometriosis and adenomyosis both affect the lining of the womb, often impacting fertility. Unfortunately, these conditions frequently go undiagnosed for extended periods.
What are Endometriosis and Adenomyosis Exactly?
The endometrium, the inner lining of a womb, thickens and regenerates each month in preparation for conception. If pregnancy does not occur, the uterus sheds this lining during menstruation.
Endometriosis and adenomyosis involve the abnormal growth of endometrial tissue.
- Endometriosis
In this condition, endometrial tissue grows outside the womb, sometimes reaching the fallopian tubes, ovaries or bladder. This abnormal growth can make conception challenging.
- Adenomyosis
Here, endometrial tissue infiltrates the muscular wall of the womb, thickening it and distorting blood vessels. This condition often results in heavy, prolonged, and painful menstruation, pain during sex, and fertility issues. Unlike endometriosis, the tissue remains within the uterus.
Symptoms of Adenomyosis
Adenomyosis occurs when endometrial tissue grows within the uterine walls, leading to an enlarged surface area that bleeds each month. This expansion causes increased pressure and discomfort. The severity of symptoms often reflects the extent of the progression. Interestingly, about one-third of women with adenomyosis do not experience any symptoms at all.
Unlike endometriosis, adenomyosis symptoms remain consistent. They do not fluctuate with the menstrual cycle because ovarian hormone production does not influence them. However, the symptoms typically subside after menopause. If you are concerned about adenomyosis, consider consulting a private gynaecologist in London for a proper diagnosis and treatment plan.
Common Symptoms of Adenomyosis
- Heavy Periods (Menorrhagia): Experience abnormally heavy menstrual bleeding.
- Painful Periods (Dysmenorrhea): Feel significant pain before and during menstruation.
- Prolonged Menstrual Bleeding (Menometrorrhagia): Suffer from extended periods that are often heavier than usual.
- Pain During Intercourse: Encounter discomfort or pain during sexual activity.
- Pain During Bowel Movements: Feel pain while passing stools.
- Abdominal Heaviness and Pressure: Notice a sensation of weight and pressure in the abdomen, often due to an enlarged and tender uterus.
- Low Energy: Experience fatigue and decreased energy levels.
- Urge Incontinence: Have a frequent and urgent need to urinate.
- Overactive Bladder (OAB): Struggle with an overactive bladder, leading to frequent urination.
You can schedule a consultation with a gynaecologist in London to discuss the best adenomyosis treatment.
What Causes Adenomyosis?
While the exact cause of adenomyosis remains unclear, it is a focal point of ongoing clinical research. This condition is neither contagious nor preventable, but certain risk factors can increase the likelihood of developing it. You might be at a higher risk for adenomyosis if you:
- Have a family history of the condition: Clinical researchers believe adenomyosis is hereditary. If your mother or grandmother had it, you may be more likely to develop it.
- Experienced traumatic childbirth: Trauma to the uterus while giving birth can cause the uterine lining to grow inward as it heals, potentially leading to adenomyosis.
- Suffer from chronic endometriosis: About 20% of individuals with endometriosis also have adenomyosis, indicating a significant overlap between these two conditions.
For effective adenomyosis treatment in London or concerns about fertility, contact an experienced and reputable gynaecologist.
Best Adenomyosis Treatments
Effective adenomyosis treatment focuses on alleviating symptoms and enhancing fertility when possible. If you also have fibroids or endometriosis, your treatment plan will address all these conditions together.
For those with mild symptoms or nearing menopause (when symptoms typically subside), opting out of treatment might be a viable choice. If you plan to conceive in the future, you might avoid specific treatments due to infertility risks.
Here are the available treatments:
- Non-Hormonal Medicines: Doctors can prescribe these to lessen pain and reduce menstrual bleeding.
- Hormonal Medicines: Similar to endometriosis treatments, options like the combined contraceptive pill and progestogen-only pill help regulate your period. GnRH hormone injections can induce a temporary menopausal state, temporarily shrinking the endometrial lining.
- Anti-Inflammatory Drugs: These medications reduce menstrual bleeding and pain (dysmenorrhea).
- Endometrial Ablation: Destroys the endometrium using heated fluid, microwaves, or electrical currents.
- Surgery: Although surgeries carry the risk of symptoms returning or persisting, additional procedures might be necessary to achieve the desired results. Pelvic surgeries also risk infertility due to the proximity of pelvic organs.
- Hysterectomy: The most common surgical treatment for adenomyosis involves removing the uterus and endometrial tissue. However, the suitability of hysterectomy for diagnosing and treating adenomyosis is debated, especially with less invasive options available.
- Uterine Artery Embolisation: This procedure involves inserting a thin tube into the groin and passing it through the arteries to the blood vessels. The blood supply to the adenomyosis is blocked, alleviating symptoms by injecting tiny particles. While effective in the short to medium term, some women experience menopausal symptoms post-procedure and may need another treatment within 9-27 months. Other risks include nausea, vomiting, fever, cramping, and the potential for particles to travel to other organs, cutting their blood supply.
To create a treatment plan that aligns perfectly with your symptoms, fertility goals, and preferences, book an appointment with a healthcare provider and discuss your individual needs.
My Final Verdict on Adenomyosis and Fertility
Understanding the impact of adenomyosis on fertility presents several challenges. Here are key points to consider:
- Research Gap: The connection between adenomyosis and fertility requires more extensive study.
- Age Factor: Many women with adenomyosis tend to be older, which can naturally affect fertility.
- Concurrent Conditions: Women diagnosed with adenomyosis often experience conditions like endometriosis, uterine fibroids, or polyps, all of which can impact fertility.
Despite these complexities, a recent meta-analysis revealed that adenomyosis negatively impacts IVF outcomes. The study highlighted significantly lower rates of pregnancy per cycle and per embryo transfer, successful embryo implantation, ongoing pregnancies, and live births among women with adenomyosis compared to those without the condition. Additionally, miscarriage rates were notably higher for those affected by adenomyosis, even after adjusting for factors such as age.
Frequently Asked Questions About Adenomyosis
Q1) Is adenomyosis different from endometriosis?
Yes. While endometriosis and adenomyosis share similarities, they are separate conditions affecting different body parts. Although some symptoms overlap, they require distinct medical attention.
However, it is worth noting that some women may experience both endometriosis and adenomyosis concurrently.
Q2) What symptoms accompany adenomyosis?
Adenomyosis is sometimes referred to as a silent condition because it can go unnoticed for a long time, presenting either mild or no symptoms. Nevertheless, adenomyosis may manifest with:
- Prolonged or heavy menstrual bleeding
- Intense menstrual cramps or sharp pelvic pain during menstruation
- Recurrent pelvic pain
- Pain during sexual intercourse
- Pressure or tenderness in the lower abdomen, often due to an enlarged uterus
Q3) How serious is adenomyosis?
Fortunately, adenomyosis is not life-threatening. However, the pain, excessive bleeding, and complications associated with it can impact your quality of life and lead to considerable stress.
Q4) What are the consequences of untreated adenomyosis?
Adenomyosis typically progresses if left untreated. Over time, symptoms such as pain may intensify and become more frequent.
Q5) How is adenomyosis diagnosed?
Gynaecologists diagnose adenomyosis commonly through ultrasound or MRI scans. It helps reveal an enlarged uterus with one wall thicker than the other. Diagnosing this condition can be challenging since its symptoms are widespread and often normalised by women. Many individuals experiencing heavy or painful periods may attribute them to being ‘normal.’ However, if you’re passing numerous clots, frequently changing protection every few hours, or experiencing symptoms of anaemia due to your periods, it’s essential to seek medical advice.