What is uterine adenomyosis? risks, symptoms and treatment

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Adenomyosis, also known as internal endometriosis, is a uterine condition in which there is tissue from the inner lining of the uterus (endometrium) in the muscle layer of the uterus (myometrium). It can increase the risk of infertility and its treatment will depend on the symptoms that the woman presents and on whether pregnancy is sought or not.

Below you have an index with all the points that we will discuss in this article.

Index

What is uterine adenomyosis? Risks, symptoms and treatment

What are the endometrium and myometrium?

To understand what adenomyosis is, it is important to know that the uterus has two layers.

The endometrium is the innermost layer of this organ and covers the surface of the uterine cavity. It is very vascularized (that is, it has many blood vessels), because it is the part that prepares each menstrual cycle so that the implantation of the embryo occurs and the placenta forms in the event of pregnancy. If there is not, this layer falls off and causes menstruation.

You can delve into the characteristics of this layer in the following link: What is the endometrium?

On the other hand, the myometrium is the muscular layer of the uterus and is responsible for uterine contractions during labor. This layer is closely related to the endometrium, but they must be well delimited, since otherwise they may cause problems.



What is internal uterine endometriosis?

Internal endometriosis or adenomyosis is the presence of endometrial tissue in the myometrium. Occasionally, this tissue can cause a mass or tumor inside the uterus, which is called adenomyoma.

There are two types:

Focal or localized adenomyosis with adenomyomas, also called Cullen adenomyosis. Adenomyosis diffusively distributed in a large part of the myometrium, which causes the uterus to increase in size. It is the most common.

Depending on the location of the endometrial tissue in the myometrium, we also distinguish between superficial and deep adenomyosis.

Comparison between a healthy uterus and one with uterine adenomyosis

This disease is more frequent in women aged 40 to 50 who have been mothers, but it can also occur in younger patients without offspring.

Causes and symptoms

The causes of this affectation are not yet clearly known. It is known that it is dependent on estrogen and, among the factors that predispose it to develop, we have had at least one pregnancy and previous uterine surgeries (caesarean sections, curettage, hysteroscopy ...).

All these situations agree that the barrier between the endometrium and the myometrium can be broken. Some theories also defend that it is due to alterations in the embryonic development of the reproductive system of women.

Approximately two-thirds of women with adenomyosis have some type of symptom. The most frequent are the following:

  • Menstrual pain (dysmenorrhea)
  • Menstrual periods too prolonged or abundant (menorrhagia).
  • Pain during sexual intercourse (dyspareunia).
  • Bleeding not related to menstruation (metrorrhagia).
  • Anemia caused by heavy bleeding.
  • Pain in the back side of the back.

Because these symptoms depend on estrogen levels, they will improve with the onset of menopause.

Symptoms present in adenomyosis

Diagnosis

The clinical diagnosis of this pathology is difficult, because its symptoms are non-specific and it frequently coexists with other pelvic diseases. This has meant that, until recently, it has been under-diagnosed.

Currently, thanks to the technical improvement of ultrasound devices and a greater awareness of its existence by specialists, it is diagnosed more and better.

To carry out the diagnosis, in addition to taking into account the patient's clinical history, the following is carried out:

  • Pelvic examination: can detect if the uterus has increased its size.
  • Transvaginal ultrasound (ultrasound): it is cheap, simple and painless. It allows to diagnose adenomyosis with great efficiency.
  • Magnetic resonance imaging (MRI): it can be useful when we do not have enough information with ultrasound, especially in patients with myomas.
  • Other less common diagnostic methods that may be valid: hysteroscopy, hysterosalpingography, endometrial biopsy.
Diagnosis of adenomyosis

The only technique that allows the definitive diagnosis is the histopathological study of the uterus after a hysterectomy (partial or total removal of the uterus).

Treatment and possible complications

The treatment for adenomyosis must be individualized and will depend mainly on the severity of the symptoms (mild, moderate, severe), the gestational desire and the age of the patient.

Initially, symptomatic relief is sought by pharmacological methods. For this, they are administered:

  • Analgesics (non-steroidal anti-inflammatories)
  • Hormonal contraceptives
  • Danazol (antiestrogens)
  • Gonadotropin releasing hormone (GnRH) analogs

In most patients, these treatments are sufficient to end the symptomatology of the disease. However, many of them are incompatible with pregnancy.

If pharmacological methods fail or pregnancy is sought, depending on the size and extent of the lesions, surgical treatment may be indicated. It consists of eliminating the adenomiótico tissue and reconstructing the uterine wall.

In the event that the symptoms do not disappear with these methods discussed, the only treatment that is totally effective to eliminate deep adenomyosis is to surgically remove the uterus (hysterectomy). Before making this decision, we must assess the patient's reproductive desire and if it is far from menopause, since as we have said, the symptoms disappear after this.

Treatment of adenomyosis

Consequences in fertility and pregnancy

Adenomyosis can have a negative effect on fertility, since some studies have shown that it decreases pregnancy rates and increases abortion rates. It is also more frequent that implantation failures occur.

Several mechanisms have been proposed by which it can affect:

  • Alteration in genetic regulation.
  • Alteration of uterine movements (peristalsis).
  • Altered endometrial receptivity and implantation.

Adenomyosis can also hinder the transport of gametes, necessary for them to be found and fertilization occurs. In addition, it can affect the transport of the embryo to the implantation site and complicate the arrival of nutrients and oxygen.

In vitro fertilization (IVF) treatments can solve some of these limitations and help patients with adenomyosis to achieve pregnancy.

In those cases in which hysterectomy has been required and the woman wishes to become a mother, she may resort to adoption or surrogate pregnancy.

If you have to resort to an IVF treatment to achieve pregnancy, we recommend that you visit our coupons page: Discounts in assisted reproduction clinics.

You will find cheaper prices and you can benefit from the first free visit at the clinic of your choice.

On the other hand, if you decide to opt for surrogate pregnancy to achieve motherhood, in Surrofair you will find the best professionals in the sector and you can contact them directly.

Questions from users

Does adenomyosis cause cancer?

No evidence has been found that adenomyosis causes cancer. However, some symptoms of this pathology may coincide with those of some types of cancer, such as uterine hemorrhages.

Do women who have not had children have adenomyosis?

This alteration is more frequent in women of 40-50 years who have already suffered a childbirth, but it can also occur in younger women who have not been mothers yet.

Can I be an egg donor if I have adenomyosis?

You have to assess each case individually. It must be borne in mind that some of the symptomatic treatments for adenomyosis are hormonal and can complicate obtaining the ovules.

If you want more information about the process of egg donation, you can find it at the following links:

  • Information to be an egg donor
  • What are the steps to donate eggs?

Is uterine myomatosis (myomas) the same as adenomyosis?

No. In the case of uterine myomatosis, myomas are formed, that is, muscle tissue tumors. In contrast, adenomyosis is the presence of endometrial tissue in the myometrium. They only coincide in the location: the myometrium, the muscular layer of the uterus.

Is endometriosis the same as adenomyosis?

Both pathologies consist of the presence of ectopic endometrial tissue, that is, outside its physiological location: the endometrium.

However, it is necessary to distinguish between internal endometriosis or adenomyosis and external endometriosis. In the first, the endometrial tissue is found in the myometrium. In the second, it can appear in any organ of the body other than the uterus.

Generally, when we refer only to endometriosis, we are talking about external endometriosis.

On the other hand, it is also important to emphasize that, although they are not exactly the same pathology, some women can present both at the same time.

Recommended reading

We classify adenomyosis as a uterine alteration that can affect fertility. In this article you will find more information about this type of pathologies and their influence on sterility: Female sterility due to a uterine factor.

If you want to delve into what myomas are, we recommend you access the following link: What are fibroids?

Finally, we also advise you to visit our page specialized in endometriosis: Endometriosis.


doppler ultrasound in Guipuzcoa(Spain)

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