You may never have heard of adenomyosis before, but it’s more common than you think! A surprising 20.9 percent of all women may be living with it right now (x). Adenomyosis is a condition that affects the uterus. It is by no means life-threatening and is sometimes hard to diagnose. In fact, many women have it and go about their lives never knowing (x, x).
Should you be worried? While adenomyosis is considered benign, it can be extremely painful and severely impact quality of a patient’s life. Depending on the patient’s age and overall health, it may also adversely impact the ability to conceive. Doctors recommend that patients seek diagnosis and treatment quickly if they are looking to have children (x). Depending on the symptoms and severity, adenomyosis can be treated with surgery or over-the-counter medications. The type of treatment depends partly on the classification, whether it’s focal, focal adenomyoma or diffuse adenomyosis (x). The most common treatment for older women suffering from severe adenomyosis is a hysterectomy (x).
What symptoms does adenomyosis cause? How do you tell if it’s adenomyosis or just an irregular period? Should you go to the doctor or just wait it out?
What is Adenomyosis?
What is adenomyosis exactly? Adenomyosis is when the inner lining of the uterus (endometrium) breaks through the inner wall (myometrium) and begins to grow within the uterus lining. The out-of-place endometrial tissue continues with its normal functions: thickening, breaking down and bleeding during the menstrual cycle. But because it’s now in the muscle wall, it causes the surrounding muscles to expand with it. This can cause severe pain and heavy periods and can impact fertility (x, x).
The symptoms of adenomyosis are sometimes readily apparent, but other times they go unnoticed. The condition often only causes mild discomfort as opposed to severe pain, so a professional diagnosis is important. Signs of adenomyosis include (x):
- Excessive menstrual bleeding (menorrhagia), with heavy clotting
- Painful period cramps (dysmenorrhea) (x)
- Pain during sexual intercourse (dyspareunia) (x)
- Inflammation in the uterus
- Bleeding between periods
- Pressure on the bladder and rectum
- Abdominal pressure and bloating
Adenomyosis symptoms will vary throughout the menstrual cycle because estrogen levels fluctuate in the body, which causes the uterus to shed its lining. Symptoms may noticeably improve or even vanish entirely after menopause due to the absence of a menstrual cycle (x).
Adenomyosis vs. Endometriosis
Most women in their lifetime have probably heard of a similar condition called endometriosis. In fact, adenomyosis and endometriosis are closely related conditions and are often confused for one another.
So what is endometriosis? It’s a condition where the inner lining of the uterus (endometrium) begins to grow outside of the uterus lining. It can also spread to other parts or organs in the body, like the ovaries and bowels. The main difference between adenomyosis and endometriosis is their location: adenomyosis occurs within the uterus wall but endometriosis occurs outside of it (x, x, x).
If a patient experiences any of the symptoms listed above, chances are they may have adenomyosis or endometriosis—or even both. It’s possible. For an accurate diagnosis, visit a physician. An MRI or transvaginal ultrasound scans the uterus for signs of either condition. A pelvic exam may also be necessary (x, x).
Causes of Adenomyosis
Regardless of the direct cause, the growth of adenomyosis depends on estrogen circulating in the body. When estrogen production declines during menopause, adenomyosis will eventually disappear. Fluctuating hormone levels in the female body may also trigger adenomyosis—estrogen, prolactin, follicle stimulating hormones and progesterone. Physicians do not know the exact cause (or causes) of adenomyosis. However, experts have come up with several theories, many of them related to pregnancy and childbirth. The most common and plausible theories include (x, x):
Invasive Tissue Growth
Some experts believe that invasive tissue growth is responsible for adenomyosis. If a patient has had any incisions into the uterine wall during operations, such as a C-section, it might cause the endometrial tissue from the lining of the uterine wall to invade the muscle tissue underneath.
Stem Cell Origins
The stem cell origins theory is one of the more recent ones. Adenomyosis may develop when bone marrow stem cells invade the uterine muscle. However, because this theory is newer, there are not many studies to prove or disprove this idea (x).
When the fetus first forms in the uterus, endometrial tissue may deposit within the uterine muscle. This may weaken the uterus wall and allow adenomyosis to form.
Uterine Inflammation Related to Childbirth
Sometimes during the postpartum period, the uterine lining can become inflamed. This may cause it to weaken and break, allowing the endometrial cells to slip into the uterus wall.
Vaginal injury may also cause adenomyosis. If the injury causes inflammation, macrophages and cytokines may travel into the myometrium.
Risk Factors for Adenomyosis
Adenomyosis may develop in all women of reproductive age. However, several studies state that the average woman with adenomyosis is between 40 and 50 years old (x).
If the patient is multiparous—has given birth more than once—then they may be especially at risk for developing adenomyosis. A high percentage of multiparous women have been diagnosed with the condition.
Uterine surgeries may disturb the endometrial-myometrial border. This may cause the endometrial glands to invade the myometrial layer or muscle wall, leading to adenomyosis.
Using antidepressants may increase the risk of adenomyosis. They may cause prolactin levels in the body to shoot up, which then overregulates the uterine prolactin receptor messenger RNA, leading to adenomyosis (x, x).
Researchers have identified a connection between postmenopausal women and breast cancer. The patients were treated with tamoxifen for the cancer and the researchers concluded that adenomyosis was more common in these patients than in those who hadn’t been treated with tamoxifen (x).
Congruent Disorders of Adenomyosis
Adenomyosis isn’t life-threatening. Still, it’s a cause for concern and may come with complications.
Approximately 40 to 50 percent of patients with adenomyosis may also have endometriosis, which negatively impacts the reproductive system. Adenomyosis patients commonly have decreased fertility or even infertility. Pregnant patients with the disease have a 50 percent miscarriage rate, 24.4 percent pre-term birth rate and nearly 12 percent rate for fetal developmental delay (x, x).
50 percent of patients also develop fibroids, which are non-cancerous tumors that grow on the muscles in the uterus (x, x). Patients may also have anemia, a condition where the body has a blood cell deficiency (x).
Treatment for adenomyosis depends on the severity of the condition. Doctors may also consider other factors like the patient’s health and age. Doctors will classify the type of adenomyosis first and recommend treatments accordingly. Focal adenomyosis and focal adenomyoma do not require a hysterectomy. Diffuse adenomyosis requires a hysterectomy (x, x).
There are three basic adenomyosis classifications:
- Focal: Focal adenomyosis is small and “focused” in a single area of the uterus.
- Focal adenomyoma: Adenomyoma is another form of focal adenomyosis. In adenomyoma, a uterine mass or benign tumor may develop in a single section of the uterus.
- Diffuse: Finally, there’s diffuse adenomyosis. Here, the adenomyosis growth spreads throughout the uterus (x).
A doctor may prescribe medication to treat adenomyosis, some of which also treat endometriosis. Anti-inflammatory drugs may relieve mild pain. Hormonal medications, such as oral contraception, can reduce adenomyosis symptoms.
Uterine Artery Embolization
The uterine artery embolization procedure is minimally invasive. The doctor inserts a tiny tube into an artery in the groin. The tube will transmit tiny particles that block the blood flow to the affected area and reduce the adenomyosis and relieve symptoms.
This procedure reduces heavy menstrual bleeding in women by removing a layer from the uterine lining itself. It is limited to patients who do not plan to conceive because they not be able to get pregnant after the procedure.
Laparoscopic surgery or myometrial excision is a minimally invasive technique that treats either focal or adenomyoma adenomyosis. The surgeon removes harmful tissue in the uterus and keeps the uterus intact.
Finally, there is the hysterectomy procedure. Most doctors consider it as a last resort to treat adenomyosis for severe cases classified as diffuse adenomyosis. The surgeon removes part of the uterus or all of it depending on how the disease has spread.
Hysterectomy Risks & Complications
Hysterectomy is the second most common surgical procedure in women of reproductive age in the United States. Doctors perform approximately 600,000 hysterectomies in the country every year. More than one-third of women in the U.S. have had hysterectomies by the time they hit 60 years old (x).
Post surgery, patients may experience infections, hemorrhaging and internal organ damage. The procedure may increase the chance of heart attacks, strokes and early menopause. The procedure may cause urinary tract infections and increase urination frequency. It may cause depression, decreased sexual sensations, decrease in lubrication and hormonal deficiencies. After a hysterectomy, a woman can no longer have a biological pregnancy because the procedure removes the uterus (x).
Supplements for Menstrual Health
Supplements may be a natural option to help promote menstrual health. However, they are not a replacement for medical treatment and it is best to consult a physician before adding any supplements to your diet.
DIM is an antioxidant that keeps free radicals from causing damage in the body. It may also strengthen the immune system. DIM may help promote menstrual health because it may regulate estrogen levels, which play a role in adenomyosis. It may also help treat premenstrual syndrome (PMS). As a dietary supplement, take 100 to 200 mg once or twice every day or as instructed by a physician.
Even though calcium is the most abundant mineral in the body, the body cannot produce it on its own. It helps promote strong bones and teeth and maintain energy levels. But it may also help with menstruation. A study concluded that calcium supplements may be an effective treatment for mood disorders related to menstruation (x). The recommended dosage for calcium citrate is 2,380 mg once or twice per day with food unless a physician recommends otherwise.
Research states that magnesium may be able to help balance menstrual processes. One study tested its effectiveness on PMS symptoms, including depression, insomnia, anxiety, headache and acne. It concluded that the magnesium supplement was more effective than the placebo (x). Magnesium is present in several different foods, but supplements can help ensure that the body gets enough of it. As a dietary supplement, take magnesium glycinate in 1,600 mg doses once or twice per day with food unless a doctor advises otherwise.
Ginger Root Extract
Originating in Southeast Asia, ginger is a powerful antioxidant and also has anti-inflammatory properties. It can protect the body from oxidation and inflammation. It is used to treat nausea and indigestion and can potentially reduce menstrual cramps. Research has concluded that it may have a significant effect on relieving pain, specifically related to menstrual cramps (x). As a dietary supplement, take 1,000 mg once a day unless a doctor recommends otherwise.
The Bottom Line
Adenomyosis is a common condition in women. Although not life-threatening, the condition is painful, negatively affects the quality of life and may cause infertility or childbirth issues. It results when the inner lining of the uterus grows toward the uterus muscle. It causes painful period cramps, painful urination and pain during sex.
Some women who have adenomyosis do not show symptoms. But if they do, a professional diagnosis will classify the type of adenomyosis and plan for appropriate treatment. Medications may treat the symptoms, but patients may require surgery in more severe cases. Supplements can also promote menstrual health, but they are not a replacement for medical treatment. Always consult a physician before implementing new supplements into your diet.
By: Prathamesh Bhoite