Adenomyosis Uterus: Symptoms & Treatment

What is adenomyosis?

Adenomyosis is a condition in which endometrial tissue which builds up the inside of the uterus grows into the wall of the uterus (myometrium) as a result uterus becomes bulky. Endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.

Causes

The cause of adenomyosis isn’t known.
There have been many theories, including:

Invasive tissue growth: Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.

Developmental defects : Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.

Uterine inflammation following childbirth: Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.

Stem cell origin : A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen.

Risk factors

Adenomyosis is mostly diagnosed in 30s or 40s, a smaller proportion diagnosed as early as their teens, and some diagnosed after the age of 50 years old.

2. History of surgery

History of uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C)
Uterine incisions made during an operation might promote the direct invasion of the endometrial cells into the wall of the uterus.

3. Previous Childbirth

The cause of adenomyosis is unknown but it may develop due to: Hormones. Bone marrow stem cells enter the uterine muscle. Inflammation of the uterus following childbirth.

4. Other risk factors

Adenomyosis is relatively rare in postmenopausal women but recent reports have described its occurrence in this age group in patients taking tamoxifen for breast cancer.
History of depression or antidepressant use

Diagnosis of Adenomyosis

Pelvic examination

A full physical exam should be performed.
This should include inspection of the perineum, vagina, cervix, and bimanual exam of the uterus and adnexa.
The uterine size, shape, mobility and tenderness should be evaluated. A diffusely enlarged, tender, “boggy” uterus is suggestive of adenomyosis.

Ultrasound

A transvaginal ultrasound uses sound waves to produce images of pelvic organs.
These images can sometimes show thickening of the muscle raising suspicion for adenomyosis.

MRI:

MRI is an accurate tool for the diagnosis of adenomyosis and associated conditions. Adenomyosis can be diffuse or focal. The most established MRI finding is thickening of junctional zone exceeding 12 mm. High-signal intensity myometrial foci on T2- or T1-weighted images are also characteristic.

Biopsy

As the endometrial tissue grows within the uterus walls,
The only way to biopsy tissue is after a hysterectomy, which removes the uterus.

Management of Adenomyosis

Because the female hormone estrogen promotes endometrial tissue growth, adenomyosis symptoms often go away after menopause. In the meantime, there are treatments can ease pain, heavy bleeding and other symptoms: