Adenomyosis
Adenomyosis is a thickening of the uterus that occurs when endometrial tissue, which normally lines the uterus, has developed within and grown into the muscular wall of the uterus (myometrium).
The cause of adenomyosis is unknown. Sometimes adenomyosis may develop into a larger swelling within the muscular wall of the uterus, and this is called an adenomyoma. Adenomyosis usually occurs in women who are older than 30 and is more likely to occur in women who have had children and those who have had a caesarean section or other form of uterine surgery.
What are the Symptoms of Adenomyosis?
Many women who have adenomyosis have no symptoms at all and it is frequently a coincidental finding during a pelvic ultrasound examination. However, some women have significant symptoms which can include;
- Prolonged or heavy menstruation
- Painful menstruation
- Pelvic pain during intercourse (dyspareunia)
Adenomyosis and Fertility
Adenomyosis is not generally thought to reduce fertility, although the association between adenomyosis and fertility has not been fully clarified. A recent study examined a small number of women (four) who had adenomyosis and who had undergone a number of unsuccessful in vitro fertilisation (IVF) cycles where good quality embryos did not implant. After treatment of the adenomyosis with medication before their next cycle of IVF, all of these women had a successful pregnancy. Given that this is such a small study, these finding need to be confirmed with a much larger randomized and scientifically robust study.
Diagnosis
During a pelvic examination, your doctor may find that your uterus is soft and enlarged. The examination may also reveal a uterine swelling and/or tenderness.
An ultrasound examination of the uterus may help tell the difference between adenomyosis and other uterine swellings such as fibroids. An MRI or CT scan can sometimes be helpful when there is doubt about the ultrasound findings.
Treatment
Many women have some adenomyosis as they near the menopause and few women have symptoms. Most women do not require any treatment.
In some cases, pain relief may be needed, and in a few cases certain types of hormone treatment may be indicated and can be helpful. Very occasionally a hysterectomy may be necessary in women who have severe symptoms. Symptoms usually go away after menopause.