Adenomyosis

Adenomyosis, Hysterectomy Specimen

Uterine adenomyosis (1)

Linear striations of adenomyosis

Adenomyosis MRI

Adenomyosis is a medical condition characterized by the presence of endometrial tissue (the tissue that lines the inside of the uterus) within and growing into the muscular wall of the uterus (the myometrium). This condition is known to cause a thickening of the uterine wall and is associated with menstrual pain, heavy menstrual bleeding, and, in some cases, infertility. Adenomyosis is often confused with endometriosis, a related condition where endometrial tissue grows outside the uterus. However, the two conditions are distinct in their location and the nature of the tissue growth.

Symptoms

The symptoms of adenomyosis can vary significantly from one individual to another. Some women may experience severe symptoms, while others may have none at all. Common symptoms include:

• Heavy and prolonged menstrual bleeding
• Severe menstrual cramps or pelvic pain
• Pain during intercourse
• Chronic pelvic pain
• Enlargement of the uterus
• Pressure on the bladder or rectum

Causes

The exact cause of adenomyosis remains unknown, but several theories have been proposed. These include:

• Invasive tissue growth - Some experts believe that direct invasion of endometrial cells into the myometrium leads to adenomyosis.
• Developmental origins - Another theory suggests that adenomyosis may originate from endometrial tissue deposited in the uterine muscle during fetal development.
• Stem cell origins - Recent research suggests that bone marrow stem cells might play a role in the development of adenomyosis.

Diagnosis

Adenomyosis is diagnosed through a combination of patient history, physical examination, and imaging tests. The most commonly used imaging tests are:

• Ultrasound - Can provide images of the uterus, helping to identify the presence of adenomyosis.
• Magnetic resonance imaging (MRI) - Offers a more detailed view of the uterine wall and can help distinguish adenomyosis from other conditions like fibroids.

Treatment

Treatment for adenomyosis depends on the severity of the symptoms, the patient's desire for future fertility, and other factors. Options include:

• Pain management - Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage menstrual pain.
• Hormonal therapies - Birth control pills, progesterone creams, and other hormonal treatments can help reduce bleeding and pain.
• Uterine artery embolization - A minimally invasive procedure that can shrink the adenomyosis lesions by cutting off their blood supply.
• Hysterectomy - Surgical removal of the uterus is considered a definitive treatment for adenomyosis but is typically reserved for women who have completed their families or when other treatments have failed.

Epidemiology

Adenomyosis is most commonly diagnosed in women aged 40 to 50 years, but it can occur in younger women as well. The prevalence of adenomyosis is difficult to determine due to the variation in symptoms and the overlap with other gynecological conditions.

Prognosis

While adenomyosis can significantly impact the quality of life due to its symptoms, it is not a life-threatening condition. Many treatment options can effectively manage symptoms, and the condition often resolves after menopause when estrogen levels decrease.