Today we will discuss a condition seen in women called adenomyosis which is seen more commonly seen in older women. It is frequently not diagnosed properly and treated.
What is adenomyosis?
Adenomyosis is the presence of endometrial tissue (tissue like the lining of the womb) in the muscle wall of the uterus along with surrounding thickening of muscle and inflammation.
What causes adenomyosis?
There are many theories about how adenomyosis is caused by-
- Invasion of endometrium into muscle.
- In the folding of the basal layer of the endometrium into the muscle tissue.
- Role of hormones like Prolactin, progesterone, etc.
What are the different types of adenomyosis?
Adenomyosis may be of different types-
- Focal adenomyosis– A discrete, localized form which is similar to fibroid uterus.
- Diffuse adenomyosis-Adenomyosis is spread throughout the muscle of the uterus
- Polypoid Adenomyoma- There is a polyp of adenomyosis present in the mostly lower part of the uterus.
- Cystic adenomyoma– There is the formation of a large cyst filled with blood due to menstrual bleeding in a gland.
Who are the women at risk for developing adenomyosis?
- Age- the risk increases with increasing age, more common after the age of 40 years
- The increasing number of childbirth- multiparous patients.
- Early start of menses (menarche)- ≤10 years of age
- Short menstrual cycles (≤24 days in length)
- Overweight/Elevated BMI (>24.9)
- Previous surgery of the uterus
- Concomitant Fibroid in uterus
- Concomitant Endometriosis
- Previous pregnancy termination (>1)
- Previous cesarean section has been more often associated with adenomyosis as compared to a history of previous normal vaginal delivery.
- Tamoxifen therapy – Tamoxifen can stimulate both normal and ectopic endometrial tissue leading the development of adenomyosis.
- Smoking – A history of smoking was associated with a decreased risk
What problems are caused by adenomyosis?
Adenomyosis can lead to
- Abnormal uterine bleeding
- Heavy bleeding during menses
- Pain during menses
- Pain during sexual relations
- Difficulty in conceiving
- Miscarriage- The rate of miscarriage is doubled.
- Preterm delivery
- Pressure symptoms like frequent urination, constipation, swelling of feet, etc.
How common is adenomyosis?
Adenomyosis has been found in 20-25 % of patients who have difficulty in conceiving.
How is adenomyosis diagnosed?
- Physical examination– On doing a checkup, both abdominal and pelvic, the doctor may feel the uterus is enlarged. Further confirmation can only be done with imaging studies.
- Transvaginal ultrasound– It’s the investigation of the first choice of doctor to confirm whether you have adenomyosis or not. There are typical findings seen on an ultrasound scan in case of adenomyosis with enlargement of the uterus, thickening of muscle tissue, presence of cysts, etc. in muscle.
3D dimensional transvaginal ultrasound can provide better images for diagnosing and delineating areas of adenomyosis long with color Doppler.
- MRI –Magnetic resonance Imaging– Provides excellent images for diagnosing adenomyosis. But due to cost factors, ultrasound is the first choice for doing and imaging test.
What are the treatment options available to treat adenomyosis?
So the treatment can be either with medicines or with surgery.
The main treatment can be divided into
1. Medical management
Non Hormonal therapy
• Analgesics and Anti-inflammatory agents
• Anti-angiogenic drugs
• Oral contraceptives
• Danazol – oral and intrauterine system
• Levonorgestrel Intrauterine System LNG – IUS
• Gonadotropin-Releasing hormone agonists
• Estrogen Receptor inhibitors
• Selective estrogen receptor modulators SERMS
• Selective Progesterone receptor modulators SPRMS
• Progestins and progestational agents
• Aromatase inhibitors
There are various types of hormonal and non-hormonal medicines available. Many drugs are also undergoing trials for the treatment of adenomyosis. Your doctor will decide the best course of treatment in consultation with you depending on your age, what are the problems you are facing, what is the extent of the disease, whether you want to plan a pregnancy or not.
2. Surgical management– Generally surgery is not preferred in cases of adenomyosis unless it’s a focal adenomyoma that can be removed easily.
The various surgical options are-
• Minimal surgical intervention
• Radical Procedures
So if you suspect you may have adenomyosis or are facing any of the problems mentioned above, consult your doctor today.