Adenomyosis

Introduction
Definition
Incidence
Cause
Symptoms
Intestinal Endometriosis
Infertility
Diagnosis
Treatment
Adenomyosis
Are you too young to have
a laparoscopy?
Endometriosis and cancer
Treatment summary
Endometriosis and heredity

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Adenomyosis is a common problem that usually effects women in their thirties and forties, particularly if they have had children. It is, in some respects, a variant of Endometriosis. Many women with Adenomyosis will have Endometriosis as well.

Both Endometriosis and Adenomyosis involve the growth of the endometrium - the lining of the uterus - outside the uterine cavity. In the case of Endometriosis, the endometrium is growing completely outside the uterus, involving other pelvic tissues and organs.

In the case of Adenomyosis, the endometrium actually invades the muscle wall of the uterus. However, it still remains confined within the uterus itself.

The symptoms of Adenomyosis include periods that are very heavy and/or very painful. It does not, as a rule, produce pelvic pain between periods and it usually does not produce painful intercourse - but it may.
Pelvic examination will reveal a uterus that is enlarged and usually quite tender, particularly if the woman is examined at or near the time of her menstrual period.

Vaginal ultrasound will demonstrate the uterus to be diffusely enlarged and the echo pattern of the muscle wall of the uterus (using vaginal ultrasound) will often be altered. Many times the woman is thought to have fibroids because of the enlarged uterus but ultrasound will not demonstrate them to be present.

Definitive diagnosis can usually be made by laparoscopy at which time a needle biopsy of the uterine wall is performed. Because Adenomyosis is a diffuse process, the needle biopsy will usually obtain tissue from affected areas. If the uterine biopsies are not definitive, MRI of the pelvis may aid in the diagnosis.

Because Adenomyosis usually occurs in women in their late thirties and forties who have already had children, future pregnancy is not a consideration. For these women, hysterectomy is the treatment of choice.

If the woman is not interested in undergoing hysterectomy, long term GnRH suppression with Estrogen Replacement Therapy is the next best therapy.

Most of the evidence currently available indicates that women who have Adenomyosis are infertile. Because of the diffuse invasion of the myometrium (the muscle wall of the uterus) by the endometrial tissue, surgical removal is impossible.

There are now a few reports in the medical literature of women who have successfully conceived with Adenomyosis following six months of GnRH suppression, similar to the treatment of women with severe Endometriosis. It is at least an option that should be offered rather than immediately proceeding to hysterectomy which previously was the only therapy available.

In the case of Adenomyosis, removal of the uterus alone is sufficient. Removal of the ovaries is not as important as it would be with Endometriosis.