Adenomyosis

What is it?

Adenomyosis is where the lining of the womb (endometrium) has invaded into the muscle layer of the womb (myometrium).

What are the symptoms?

These spots of endometrium within the muscle respond to hormones in the same way as normal endometrium – they become inflamed and bleed. This causes very painful periods. Other symptoms include bloating and heavy menstrual bleeding and more rarely pain during intercourse or bowel movements.

What causes it?

The cause of adenomyosis remains unknown. It may be related to healing after pregnancy or injury to the endometrium, if regrowth happens inwards instead of outwards. The immune system, genes and hormones are also likely to be involved.

How is it diagnosed?

It can be very difficult to diagnose adenomyosis. An ultrasound scan may pick up some subtle signs of adenomyosis. Some women may need an MRI scan to help with diagnosis. The only fool proof way of diagnosing adenomyosis at present is by looking at the womb under the microscope after hysterectomy, which is often not desirable or appropriate for women.

How is it treated?

The difficulties diagnosing this condition has meant that the development of treatments has also been difficult. Options include:

• Doing nothing: this may be appropriate if you are trying for a pregnancy or are approaching the menopause
• Non-hormonal medicines: These include tranexamic acid or anti-inflammatory medications. These are taken during menstruation and can help reduce blood loss and pain.
• Hormonal medication: These include the oral contraceptive pill, contraceptive injections or implants or the hormonal intrauterine system.

• Injections to bring on a temporary menopause: GnRH agonists are injections that downregulate the ovaries. This prevents the signal to the endometrium to grow and keeps the lining thin. Side effects include hot flushes, night sweats, vaginal dryness and mood changes. This is usually a short term treatment and women may require hormone replacement therapy alongside this medication.
• Surgery: Adenomyosis cannot be seen easily by eye and therefore cannot be removed during a surgical procedure without performing a hysterectomy (removal of the womb).

Further information

www.adenomyosisadviceassociation.org

www.pelvicpain.org.uk

www.exppectedinburgh.co.uk