What is adenomyosis?

What is adenomyosis?

Jen is a 42-year-old teacher and mother-of-two. Each month, she dreads the onset of her period because it’s so heavy and disruptive. It’s been that way for as long as she can remember. To avoid bleeding through her clothes, she always wears a tampon, pad and period undies. Sometimes, that’s still not enough, so she wears dark trousers or skirts, too. 

Jen’s heavy periods are hard to manage, and she becomes anxious when they are due. Along with the pain, discomfort, and constant fear of embarrassment comes the added work of washing stained clothes and bedsheets. And she’s always tired because her iron levels are so low. 

This week, Jen was supposed to go to a baby shower but sent her apologies because she was in too much pain. She skipped her friend’s pool party, too, because there was absolutely no way she was getting in the water. 

With busy jobs and young kids, Jen and her husband rarely find time to have sex – especially when there’s more than a week wiped out of each month due to Jen’s period. Then again, when they do have sex, it can be painful for Jen. 

A few years ago, Jen plucked up her courage and mentioned her periods to her doctor. The doctor suggested an iron supplement and joked that Jen was getting closer to menopause, so this would all be in the rear-view mirror soon anyway. It took Jen about 12 months to recover from that dismissive experience before she saw another doctor about her heavy periods. That doctor listened carefully, expressed sympathy with Jen’s situation and referred her to a gynaecologist. 

Jen has been invented for this blog, but she could very easily be real. Her story is echoed by countless women who have struggled with heavy periods for years, feeling increasingly isolated and often dismissed when they sought help.  Heavy menstrual bleeding has a ‘profound and debilitating effect’ on a woman’s life, as one British study put it, causing embarrassment, anxiety and low mood.

So, what’s causing Jen’s symptoms? It could be a condition called adenomyosis. 

What is adenomyosis? 

Adenomyosis is a condition where cells similar to those that line the inside of your uterus (endometrium) also grow in its muscle wall. 

Each month, the endometrium (lining of the womb) thickens in preparation for pregnancy. If you don’t get pregnant, your body sheds the endometrial lining through your vagina – this is your period. 

If you have adenomyosis, the endometrial cells that are growing where they shouldn’t be in the muscle wall of your uterus also thicken and then bleed. But this blood is trapped in the muscle layer of your uterus. With nowhere to go, it collects in pockets or puddles. And then the whole process happens again next month.

Adenomyosis vs endometriosis

There are obvious similarities between adenomyosis and endometriosis. After all, both conditions involve endometrial tissue growing in the wrong place. 

It’s the place itself that makes the difference. With adenomyosis, the tissue grows in the muscle wall of your uterus. With endometriosis, the cells can grow in your fallopian tubes, ovaries or pelvis.  

Adenomyosis symptoms 

Adenomyosis can cause symptoms such as: 

  • Heavy or prolonged periods
  • Severe cramping or sharp pain during menstruation
  • Persistent pelvic pain
  • Pain during sex
  • Low iron levels
  • An enlarged uterus in which may create a sense of pressure or tenderness in your lower abdomen. 

Diagnosing adenomyosis

There is no single, straightforward test that diagnoses adenomyosis. It can’t be diagnosed from tissue samples or biopsies. Traditionally, adenomyosis could only be conclusively diagnosed by removing the uterus and conducting pathology tests – but that was less than ideal for women who still hoped to have children!

We can now reach a diagnosis of adenomyosis by gathering the findings from: 

  • Your medical history
  • A pelvic exam to see if your uterus is tender or enlarged
  • A transvaginal ultrasound
  • An MRI scan to rule out other conditions like fibroids. 

Why do some people develop adenomyosis? 

We don’t yet fully understand the causes of adenomyosis,  traditionally it appears to be more common in women who have:

  • Given birth
    • Perhaps inflammation of the uterine lining after childbirth disrupts the normal boundary between the endometrium and the uterine wall.
  • Had previous uterine surgery like a C-section, fibroid removal or dilation and curettage (D&C) 
    • It may be that this allows endometrial cells to invade the wall of the uterus.
  • Reached middle age
    • Adenomyosis depends on oestrogen – and middle-aged women have been exposed to this for longer than their younger counterparts. 

However, with advanced imaging technologies and, more importantly, an openness to consider the diagnosis, adenomyosis has been identified in women as young as 12, suggesting these previous “causes” are more likely to be associations rather than causation. In addition, women who are diagnosed with adenomyosis at younger ages are also more likely to have a variant called adenomyoma (a localised ball of abnormal cells).

Theories suggest that adenomyosis may trace back to very early development. It could be linked to bone marrow stem cells invading the uterine wall. Or it could happen during early foetal development when endometrial tissue is mistakenly deposited into the wall of the uterus. 

Whatever the cause, adenomyosis depends on oestrogen circulating in your body. When you go through menopause, your oestrogen levels drop, and your periods stop. That puts an end to adenomyosis. 

But you shouldn’t have to wait that long. There are adenomyosis treatments available now. 

Adenomyosis treatment  

Treatment for adenomyosis depends on the severity of your symptoms and your stage of life. A younger woman who still wants children may require different treatment than an older woman who is close to menopause. 

Initial treatment options for adenomyosis could include: 

  • Anti-inflammatory medications to reduce blood flow and relieve pain
  • Bleeding-reduction medication (which may help to relieve pain too)
  • Hormone medications to lessen heavy bleeding and pain. Your doctor may recommend: 
    • The  Progesterone secreting intrauterine device: This is inserted into your uterus, where it releases progesterone, which reduces bleeding and pain and thins the endometrial cells. It lasts 5 years but can be removed at any stage if you wish to get pregnant. 
    • The combined or progesterone only pill: This is taken on a daily basis but can be stopped at any time if you wish to get pregnant. 

If you have completed your family or have more severe symptoms, your doctor may recommend: 

  • Uterine artery embolisation – a radiological treatment that blocks blood supply to part of the uterus to reduce pain and bleeding.
  • Endometrial ablation – a surgical procedure to remove the lining of the uterus to reduce heavy bleeding.
  • Hysterectomy – a surgical procedure that removes your uterus. 

As you can see, whether or not you want (more) children is a key consideration in treatment choices. It’s important to discuss this with your gynaecologist.  

How can Dr Budden help? 

Dr Aaron Budden is the only certified advanced laparoscopic gynaecological surgeon between Newcastle and the Gold Coast. He provides obstetric and gynaecological care in Coffs Harbour and Port Macquarie.

If you are struggling with heavy periods, pelvic pain or pain during sex, please ask your GP for a referral or contact us. Hopefully, we can help to relieve your symptoms and improve your quality of life. 

 

Disclaimer

All information is general and is not intended to be a substitute for professional medical advice. 

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