Adenomyosis is a very specific rare health condition which results from the lining cells of the uterus growing directly into the muscle wall of the uterus (into myometrium) – actually the endometrial tissue, which normally lines the uterus from inside, start growing into the muscular walls of the uterus. During adenomyosis at the time of monthly regular menstrual periods, women experience direct bleeding into the muscle of uterus which is causing severe pain.
Actually adenomyosis is active during the time of menstrual period (3-7 days) – as the blood accumulates, the surrounding muscle swells and forms fibrous tissue in response to the irritation. Medical professional call this swollen area within the uterine muscle wall “adenomyosis”. This condition can be located throughout the entire uterus or localized in one spot (disseminated or local).
Adenomyosis could be mild or severe. Lucky women with mild cases usually don’t have any symptoms (“silent” adenomyosis) but women with severe types of disease suffer from regular monthly heavy bleeding and cramping.
The causes of this pathology remain unknown, but it was noted that adenomyosis disappears after menopause. In reality it is harmless but could be severely painful.
Who is at risk for Adenomyosis?
Long-term medical observations prove that women after Cesarean section and after uterine operations or operations on reproductive organs are at high risk for adenomyosis.
Only women of reproductive age are in high risk for adenomyosis – the disease usually occurs in women older than 30 who have had children and more likely in women with previous Cesarean section or other uterine surgery.
Most common symptoms of adenomyosis include the following:
- Heavy and/or prolonged menstrual bleeding with negative impact on women’s quality of life;
- Lower abdominal pressure and bloating before menstrual periods;
- Dysmenorrhea (painful menstruation, sometimes sharp “knife-shoot” pelvic pain;
- Pain during intercourse;
- Bleeding or brown discharge between periods;
- Blood clots in menstrual bleeding;
- Infertility (not always).
In most cases discomfort during periods and dysmenorrhea increase with aging.
As adenomyosis is growing every year, the size of uterus could increase to double or triple its normal size.
As main causes of adenomyosis are not known, some scientists suggested theories which could explain the development of adenomyosis in women of reproductive age.
First theory – Invasive Tissue Grow (ITG)
This theory suggest that adenomyosis is a result of direct invasion of endometrial cells from endometrium (internal surface of uterus) into the muscle tissue (wall) of uterus. It was observed that after Cesarean section, when doctors make incision of uterus, sometimes the direct invasion of the endometrial cells into the uterus wall is happening.
ITG theory suggest that adenomyosis is a result of mechanical (medical) movement of endometrial tissue during different types of operations made on reproductive organs (mainly on uterus).
Second theory – Adenomyosis Inflammation Genesis (AIG)
According to AIG theory the adenomyosis can be developed as a result of uterine inflammation after childbirth (during postpartum period). As pregnancy and delivery could provoke inflammation in uterus lining and muscle walls, this inflammation could trigger development of adenomyosis.
Third Theory– Congenital Adenomyosis Development (CAD)
Some scientists suggest that adenomyosis is congenital health condition when endometrial tissue deposited into the uterus muscle walls during female fetus development. So girls can be born with small endometrial tissues in the uterus walls and with the increased female hormones the endometrial tissue develops adenomyosis.
Fourth Theory – Hormonal Theory
It was suggested that as adenomyosis is hormone-depending condition, primarily it could be triggered by female hormones – estrogens, progesterone, Prolactin and Follicle Stimulating Hormone (FSH).
In all cases adenomyosis is hormone-depending condition and the severity of symptoms always depends on levels of estrogen in women. Increased levels of estrogens are a risk factor for adenomyosis.
During last decades few modern medical technologies can clearly diagnose the adenomyosis. Most common methods used for diagnosis are trans-vaginal ultrasound, sonohysterography and Magnetic Resonance Imaging (MRI).
Clinical sign of adenomyosis could be enlarged and tender uterus.
It is important to mention that adenomyosis usually goes away after menopause and treatment timing should be chosen according to women age. Treatment also should be choosen based on symptoms, severity of symptoms and reproductive history.
There are few methods which can be effective for treatment.
Some anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others) can control the pain during adenomyosis (during menstrual cycle). Anti-inflammatory therapy usually starts 2-3 days before menstrual period and continues during menstruation. In some cases anti-inflammatory therapy could also reduce the menstrual blood flow.
As adenomyosis is hormone-depending, some hormonal medications could control development of adenomyosis, menstrual flow and pain. Most popular hormonal methods include Birth Control Pills, hormone-containing patches or vaginal rings.
Progestin-only contraception, such as an intrauterine device (IUD) containing progestin or non-stop use of birth control pills could stop regular menstrual periods and relief all symptoms of adeno-myosis.
In most cases natural methods can be effective in relieving symptoms of adeno-myosis. It is recommended to use warm bath and heating pads on abdomen.
Uterine artery embolization
Uterine artery embolization is an invasive method when tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis. Usually particles are guided through a tiny tube inserted into the vagina through the cervix. This method cut off “blood supply” and shrinks the adeno-myosis.
This method is not popular – it is also invasive method which destroys the endometrium (internal lining of the uterus). In some cases the endometrial ablation could be effective in treatment of this specific condition.
Hysterectomy (surgical uterus removal)
In some cases of severe symptoms and not effective other methods the hysterectomy can be recommended. Sometimes the hysterectomy is necessary for having normal life (effective work, valuable family life, etc.)
Generally speaking hysterectomy is the only definitive cure for adenomyosis.
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