Adenomyosis is a condition in which the endometrial lining cells that are normally present inside the uterus, grow into its muscle wall. These displaced cells of the endometrium continue to function in the same way as the internal endometrial lining of the uterus, that is, it thickens, breaks down and bleeds with every menstrual cycle. This results in the enlarged uterus and heavy and painful periods.
The exact cause of adenomyosis is unknown. However, experts suggest one of the following causes:
- Developmental origin. Endometrial tissue may get deposited in the uterine muscle wall at the time of female foetus development, which can result in adenomyosis.
- Invasive tissue growth. Direct invasion and growth of endometrial cells from the uterus lining into the muscle wall of the uterus, may result in adenomyosis.
- Uterine inflammation due to childbirth. Inflammation of the endometrial lining after childbirth may cause a break in the normal lining of cells and can lead to adenomyosis.
Risk factors for adenomyosis are:
- Prior surgery of uterus, like C-section or fibroid removal
- Middle age
Adenomyosis is most commonly found in women of age 40 and 50. High incidence of adenomyosis in middle-aged women may be related to longer exposure to oestrogen compared to younger women.
Adenomyosis may just remain asymptomatic or may cause mild discomfort. In other cases, it can lead to:
- Prolonged and heavy menstrual bleeding
- Severe pain, cramping or knifelike pain during periods
- Menstrual cramps may last throughout periods and can worsen with age
- Passing of blood clots during periods
- Pain during intercourse
- Increased size of uterus
- Tenderness in lower abdomen
A doctor will diagnose adenomyosis by:
- Signs and symptoms
- Pelvic examination which may show enlarged and tender uterus
- Ultrasound imaging
- Magnetic resonance imaging (MRI) of uterus
Adenomyosis resolves on its own after menopause, so treatment plan depends on how far you are from menopause.
Treatment options may include:
Anti-inflammatory drugs. If you are close to menopause, the doctor may prescribe anti-inflammatory drugs like ibuprofen to relieve the pain and cramps. You may be asked to start the medication 2-3 days before the periods and continue taking it throughout periods.
Hormone medications. The doctor may also advise combined estrogen-progestin birth control pills which may help in reducing heavy bleeding and pain associated with adenomyosis.
Removal of the uterus. If your symptoms are severe in nature and menopause is expected after many years, then the doctor may suggest surgical removal of the uterus (hysterectomy).
Adenomyosis may lead to:
- Anaemia due to heavy and prolonged periods
- Severe pain and cramps may lead to anxiety, depression, irritability and helplessness
When to consult a doctor?
You should consult your doctor if you are experiencing:
- Prolonged and heavy bleeding
- Severe cramping and pain
- Abdominal pain which is interfering with your daily activities
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- Adenomyosis. https://jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/adenomyosis. Accessed on 4th Nov 2016.
- Pathophysiology of adenomyosis. http://humupd.oxfordjournals.org/content/4/4/312.full.pdf. Accessed on 4th Nov 2016.
- Adenomyosis. http://medind.nic.in/jaq/t06/i5/jaqt06i5p387.pdf. Accessed on 4th Nov 2016.