doctors working on diagnosing adenomyosis

Diagnosing Adenomyosis

Adenomyosis generally occurs in women of childbearing years who have given birth. It is characterized by the infiltration of endometrial (uterine lining) cells into the myometrium (uterine muscle). This can cause issues like dysmenorrhea, abdominal pain and swelling as a result of uterine enlargement, and other concerns. Earlier diagnosis often yields a more positive treatment result. Here’s a look at how adenomyosis is diagnosed. 

Misdiagnosis

Adenomyosis is often described as a form of endometriosis; however, endometriosis occurs on the outer lining of the uterus (and sometimes other reproductive organs) in women who have recently begun their menstrual cycle, rather than inside the muscle. This means that doctors are searching for microscopic presences -- although size makes no difference in the disease’s ability to cause damage. 

As such, a correct diagnosis can be extremely difficult and often begins with an incorrect diagnosis. Adenomyosis is often confused with endometriosis, fibroids, and similar but more common disorders. Common diagnostic tests are often inaccurate on such a minuscule level. 

Pelvic Exam

Your doctor or gynecologist will likely begin to suspect adenomyosis based on the symptoms you report and the symptoms’ onset (after childbirth). Common symptoms include extreme menstrual cramps that last the length of your period, the presence of blood clots, abdominal swelling and pain, vomiting and nausea, heavy periods, longer than normal periods, or painful intercourse. 

From this point, he or she will likely recommend a pelvic exam. From the pelvic exam, your doctor can determine if your uterus is enlarged or tender -- and this is often one of the first signs of the presence of adenomyosis. 

Imaging Tests

Not every type of imaging technology yields the same results, and only a handful are appropriate for discovering adenomyosis. Magnetic resonance imaging (MRI) is one of the most effective at determining if one of the two types of adenomyosis are present. 

One type is characterized by the endometrial cells being spread throughout the myometrium; the second type is characterized by the presence of “benign,” tumor-like formations called adenomyomas that form within clear boundaries of endometrial cells within the myometrium. According to The Institute for Female Alternative Surgery, using an MRI allows your doctor to see “a high-intensity view of the uterine muscle [which] will more clearly show the “damaged areas” within the myometrium, [and] that will render a pretty good indication of a positive diagnosis.”

Biopsy

A biopsy is virtually the only means of achieving anything close to a definitive answer regarding adenomyosis. In fact, many women undergo hysterectomies without a clear diagnosis and only find out from the post-surgical examination of the uterus that they had adenomyosis. The Mayo Clinic suggests that it isn’t possible to have a clear answer without the luxury of this post-surgical uterine examination, while The Institute for Female Alternative Surgery states that a uterine muscle biopsy is “the only true and conclusive test” for adenomyosis. They do, however, include the caveat that these biopsies are often difficult and inaccurate. Tissue removal is generally performed without any guidance, which means that the area of tissue removed may not have endometrial cells, despite the presence of adenomyosis. If you suspect you have adenomyosis, talk to your doctor about finding a specialist who can help you.