doctor who studies adenomyosis

Understanding Adenomyosis

Adenomyosis is a uterine condition in which the endometrial cells (the tissue lining of the uterus) get inside uterine myometrium (the muscular wall of the uterus). It can be very painful, occurring most commonly after having children but before menopause. Here’s a look at the types, causes, symptoms, and treatment of adenomyosis. 

Types of Adenomyosis

Adenomyosis is often used synonymously with various endometrial descriptors. However, adenomyosis is significantly different from endometriosis. Endometriosis refers to endometrial tissue that grows outside the uterus, rather than within the uterine muscle. Endometriosis also develops in the years following the beginning of menstruation, rather than in the later childbearing years. However, it is not uncommon for women with endometriosis to develop adenomyosis. 

According to the Institute for Female Alternative Medicine’s Alternative Surgery, there are two main types of adenomyosis. Less commonly, tumors called “adenomyomas” form within obviously definable boundaries of the endometrial cells. Often mistaken for fibroids, these localized tumors can sometimes be removed. More commonly, adenomyosis forms as a widespread invasion of the myometrium. This can be extremely painful and result in serious complications. 

Causes of Adenomyosis

Experts have yet to discover exactly what makes adenomyosis form. According to the Mayo Clinic, several informed speculations have been suggested by researchers, including:

  • Endometrial cells with a tendency to grow invasively. Incisions to the area during surgical procedures (such as a cesarean section) may allow these invasive cells to get into the myometrial cells more directly, much like a staph infection invades the body through an open wound. 
  • Abnormalities that form during fetal formation or following childbirth.
  • An encroachment of bone marrow stem cells into the myometrial cells.

However it begins, once the endometrial cells begin forming within the uterine muscle, they do not alter their normal patterns. When endometrial tissue stays where it is supposed to, it shares a large part of the responsibility of menstruation. Each month, the cells grow thick, fall apart, and cause bleeding. They continue to do this after they have invaded the muscle -- as a dispersed or localized set of cells -- in accordance with the flow of estrogen in a woman’s body. Additionally, estrogen (particularly an excess of estrogen) can cause the disease to grow worse with every passing month. 

Symptoms of Adenomyosis

As the displaced endometrial cells continue to follow this rhythm, the uterus itself may become enlarged or thick. Adenomyosis can cause menstrual periods to become longer or heavier than a normal period. Dysmenorrhea may develop, which is extremely painful menstrual cramps, often described as a knife-like uterine/ovarian pain. These cramps, rather than occurring as a precursor to your menstruation, may last the duration of your period and become progressively worse with age. You may notice clots of blood during your period. Additionally, sexual intercourse may become uncomfortable or even painful. 

Not all cases of adenomyosis are the same though -- in some instances a woman’s symptoms may be only a mild discomfort, while other women may not notice a change at all. If your uterus does become enlarged, your abdominal region may seem swollen or tender. This may occur all the time, rather than in tandem with your menstrual cycle. Nausea and vomiting are also potential symptoms. Adenomyosis may also interfere with pregnancy (the extent of which is difficult to say, largely because of the common co-occurrence of endometriosis), as well as lead to miscarriage. 

Treatments for Adenomyosis

Many doctors begin with symptomatic treatment -- largely prescription painkillers, nonsteroidal anti-inflammatory medication, and/or hormone therapy (such as birth control). However, treating the pain does not stop the spread of the endometrial cells, and thus allows damage to continue with every menstrual period. Using birth control to manage adenomyosis can actually increase damage because of the increased estrogen. Progesterone therapy can be helpful, but is not often effective in the later stages. 

If symptoms are uncontrollable and adenomyosis is interfering with everyday activities (and thus quality of life) a hysterectomy is generally the best recommendation. However, when adenomyomas are present, it is possible that they can be removed. The Institute for Female Alternative Surgery is one of the few places that offers an alternative procedure that reconstructs the uterus while leaving it intact. Although it will still remove the potential for pregnancy, it does prevent the artificial stimulation of menopause. If you have experienced heavy or extended menstrual periods or ongoing abdominal pain and enlargement, talk to your doctor immediately about your options. 

Last Updated: December 28, 2016