Adenomyosis

Adenomyosis is endometriosis interna, the growth of endometrial implants into the wall of the uterus. It is different from endometriosis, which is endometrial tissue that migrates and implants outside of the uterus into the pelvis.

Between menstrual cycles the inside lining of the uterus, the endometrium, proliferates and continues to thicken until it sheds during menstruation. Adenomyosis occurs when endometrial tissue grows into the middle, muscular wall of the uterus, the myometrium, and sometimes the exterior wall of the uterus, the subserosal layer.

Some women with adenomyosis do not experience any symptoms, while others may have severe, debilitating symptoms.

Endometrial implants that grow into the wall of the uterus bleed during menstruation, the same as endometrial tissue bleeds and is discharged vaginally as menstrual bleeding. Endometrial implants may cause pain or pressure in the pelvis and vagina, as well as a heavy menstrual flow without large blood clots. The vaginal pressure can be severe enough to feel like the uterus is trying to push out through the vagina, like the last stage of labor when the baby’s head pushes into the cervix.

Adenomyosis does not usually occur in women who have never been pregnant, and is most common in women who have given birth more than two or three times.

It is also more common in women who have undergone a Cesarean Section than it is in women who have given birth vaginally. During a C-Section an incision is made in the abdomen and through the walls of the uterus. Endometrial tissue may become dislodged or cut from the endometrium during surgery, and then transplanted into one or more of the muscular layers of the uterus.

A collection of endometrial implants in the uterine wall may form into small nodules. These nodules are often misdiagnosed as small fibroids when seen on an ultrasound. However, a detail-oriented radiologist should be able to distinguish between fibroids and adenomyosis. Unlike other growths, fibroids have a distinctive whorled pattern that can be seen with an ultrasound. Adenomyosis does not have a whorled pattern.

The most objective and non–invasive way of diagnosing adenomyosis is with an MRI—magnetic resonance imaging—of the pelvis. Not by laparoscopy or hysteroscopy.

Rather than an invasive surgery like exploratory laparoscopy to determine if you have adenomyosis, an MRI has the benefit of not being surgical, it is non-invasive, and it provides the objective findings seen in an imaging study. These findings are reproducible and can be used to monitor progression or regression of a condition such as endometriosis.

Adenomyosis is seen on an MRI as either small nodules or a slight, diffuse thickening in the walls of the uterus, particularly at the junction where the cervix is joined to the uterus. Endometrial implants that are scattered diffusely throughout the walls of the uterus cannot be removed, but small nodules can sometimes be removed in a surgical procedure similar to a myomectomy. Removing the nodules is a major surgery, but if you cannot live with the symptoms, it is a conservative option that preserves the functions of the uterus.

Stopping menstruation with continuous progesterone or a contraceptive pill often relieves symptoms. The symptoms usually return within a few months after the medication is stopped.

Acupuncture may be effective in reducing symptoms. The best “cure, ” however, is naturally occurring menopause. The growth and symptoms of adenomyosis stop when menstruation stops.

The uterus and ovaries have many important lifelong functions. Although hysterectomy may stop the symptoms caused by adenomyosis, you may trade one set of known symptoms for another. The adverse effects of hysterectomy may be far worse. The most consistent problems women report after hysterectomy include a 25–pound average weight gain in the first year following the surgery, a loss of sexual feeling, a loss of vitality, joint pain, back pain, profound fatigue, and personality change.

Hysterectomy causes many well-documented, permanent, irreversible, and life-altering problems.

For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”