July 5, 2023

Insight Series: Adenomyosis

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Adenomyosis is a medical condition that affects the uterus [womb], specifically the endometrium (the inner lining of the uterus). It is characterized by the abnormal growth of endometrial tissue into the muscular wall of the uterus, known as the myometrium. This condition is typically benign but can cause significant pain and discomfort for some individuals, especially during the menses [period].

The exact cause of adenomyosis is not fully understood, but several theories have been proposed. One possibility is that it occurs due to the invasive growth of endometrial cells into the myometrium. Another theory suggests that it may result from a defect in the development of the uterus during embryonic development. Hormonal imbalances, such as an excess of estrogen relative to progesterone, have also been implicated in the development and progression of adenomyosis.

Adenomyosis primarily affects women of reproductive age, typically between their 30s and 50s, although it can occur at any age. The condition often goes undiagnosed or misdiagnosed because its symptoms can be similar to other gynecological disorders, such as endometriosis or uterine fibroids. Common symptoms include prolonged and heavy menstrual bleeding, severe menstrual cramps, pelvic pain and pressure, bloating, and pain during sexual intercourse.

To diagnose adenomyosis, a healthcare provider may perform a physical examination, including a pelvic exam, to check for abnormalities in the uterus. Imaging techniques such as ultrasound, magnetic resonance imaging (MRI), or hysteroscopy may be utilized to visualize the internal structures of the uterus and identify any signs of adenomyosis.

Treatment options for adenomyosis depend on various factors, including the severity of symptoms, the desire for future fertility, and the individual's overall health. Mild cases may be managed through conservative measures, such as over-the-counter pain relievers, hormonal medications (such as oral contraceptives or progesterone), or intrauterine devices (IUDs) that release hormones to help reduce symptoms.

For individuals with severe symptoms or who have completed childbearing, more invasive treatments may be considered. These can include surgical interventions such as a hysterectomy (removal of the uterus) or a myomectomy (removal of the adenomyotic tissue while preserving the uterus). Less invasive procedures, such as uterine artery embolization or endometrial ablation, may also be options to alleviate symptoms.

It is important to note that adenomyosis is not a life-threatening condition, and many individuals may find relief from their symptoms with appropriate treatment. However, the impact of adenomyosis on fertility and pregnancy outcomes is still a topic of ongoing research and discussion.

Treatment options range from conservative measures to surgical interventions, depending on the severity of symptoms and individual circumstances. Adenomyosis is a manageable condition, and healthcare providers can provide appropriate guidance and support to individuals affected by this condition. These treatments include the contraceptive pill, mefenamic acid or tranexamic acid or the Mirena coil.

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