What is adenomyosis?

To understand adenomyosis of the uterus, it’s important to understand normal uterine anatomy.

There are three main layers of the uterus:

  1. The outside covering of the uterus called the serosa.
  2. The muscular layer that causes cramping during menses and grows during pregnancy called the myometrium.
  3. The inner layer that responds to hormones and grows and sheds every month with menses called the endometrium.

Adenomyosis is a disease state where endometrium tissue has developed or migrated into the myometrium where it shouldn’t be.

Is it adenomyosis common?

Approximately 25-40% of reproductive age women have some spectrum of adenomyosis. This disease is most commonly diagnosed in women 40-50 years old, but likely starts years before final diagnosis is made.

What are the symptoms?

The most common symptoms of adenomyosis are heavy menstrual bleeding (60% of patients) and severe uterine cramps with menses known as “dysmenorrhea” (25% of patients). Other symptoms can include chronic pelvic pain and pressure.

When should I see a doctor?

You should seek medical advice if your periods are so heavy that you are changing your heavily absorbent tampon or pad more than once an hour on your heaviest days OR if your pain is severe enough that it is not well controlled with ibuprofen and it interferes with your daily activities. If you experience heavy bleeding and start to feel lightheaded or short of breath, seek medical attention immediately at your nearest emergency room facility.

How does my provider diagnosis adenomyosis?

Definitive diagnosis of adenomyosis is usually only made at the time of a hysterectomy. Clinical diagnosis can be made with the help of physical exam findings and imaging of the pelvis. Imaging of the pelvis will usually include a transvaginal ultrasound. Your provider may also choose to order a pelvic MRI if they believe additional imaging is needed to make a diagnosis.

Will it affect my daily life?

Adenomyosis may cause symptoms that interfere with daily life. There is some evidence that it could potentially affect your ability to become pregnant, but more evidence is needed before this is conclusive.

How is it treated?

Adenomyosis can be treated medically or surgically.

Medical treatment classically includes hormonal suppression of menses with combined-hormonal contraceptives such as birth control pills. Progesterone-only contraception is also a reasonable approach if your medical problems exclude you from using estrogen.

Additionally, new studies have shown excellent results with placement of progesterone-containing intrauterine device such as a Mirena IUD. More providers are moving toward this method as primary medical treatment for adenomyosis to control heavy bleeding and painful menses.

Surgical treatment generally involves a hysterectomy to remove the uterus, which is considered definitive treatment for adenomyosis. For women that have completed childbearing but are not candidates for hysterectomy or want to avoid major surgery, a procedure known as uterine artery embolization (UAE) may be a good option. UAE involves blocking the main arteries that supply the uterus with blood flow. This helps to decrease both the amount of menses and the pain associated with it. Certain patients will continue to have issues after UAE and may require a hysterectomy down the road.

There are select surgeons in the U.S. that are performing targeted removal of adenomyosis, a procedure known as “adenomyomectomy.” Not all patients are considered candidates for this procedure, and it is still generally considered an experimental treatment as more evidence is needed to assess its effectiveness and safety.

Are there natural treatments or prevention measures I can take?

No diets or conservative (non-medication) related measures have been consistently proven to ultimately prevent or control adenomyosis or its related symptoms.

Can adenomyosis lead to more issues if not treated?

Adenomyosis can lead to chronic heavy menstrual bleeding that may result in iron deficiency and chronic anemia if left untreated.

Contact your Women’s Care provider if you are experiencing any symptoms associated with adenomyosis.