Adenomyosis

Adenomyosis

What is adenomyosis?

Adenomyosis is a very uncomfortable and often misunderstood condition. The lining that should be on the inside of the womb becomes embedded in the muscle of the walls of the uterus. During the monthly period, this tissue bleeds leading to inflammation, severe pelvic pain and often heavy bleeding too.

Adenomyosis or endometriosis?

If you’re confused, don’t worry, you are definitely not alone. The two conditions are closely related, with both endometriosis and adenomyosis causing painful periods and painful sex. The difference is that in endometriosis the patches of endometrial lining are found outside the womb and in adenomyosis, they are within the walls of the uterus. It used to be known as ‘inside-out endometriosis’ and that’s a good way of understanding the difference between them.

Who gets adenomyosis and why?

The frustrating truth is that we don’t know why some women develop adenomyosis. But we do know that women who have had children and women who also suffer from endometriosis are more at risk.

How is adenomyosis diagnosed?

A good gynaecological surgeon will be able to suspect adenomyosis by listening to your symptoms and examining you. On examination the womb may feel big, a little boggy in texture and it can be incredibly tender and sensitive. Examination alone is not enough, though.

The presence of adenomyosis can be indicated by a special type of ultrasound scan or by an MRI scan. The only sure way to know that the diagnosis is correct is to have a look at the tissue under a microscope, this is done by the pathology department after a hysterectomy. So, although it’s believed to be a fairly common condition, it can be difficult to accurately diagnose.

Can you treat adenomyosis?

The symptoms of adenomyosis can be eased by using painkillers or by preventing the monthly period with hormonal treatments. Another effective treatment is the Mirena coil, which releases a small amount of progesterone into the uterine cavity. If all else fails, a hysterectomy is the definitive treatment of adenomyosis.

Painkillers: Adenomyosis pain can be severe and relentless. Simple analgesics like paracetamol, anti-inflammatories such as ibuprofen or mefenamic acid and stronger painkillers including codeine can help.

Hormonal Treatments: These are not a cure and the pain will return when medication is stopped, however they can offer respite and relief. Options include the Oral Contraceptive Pill, contraceptive implants or injections and the IUS or Mirena Coil, which is a type of coil that also gives out the hormone progesterone.
Gonadotrophin-releasing hormone (GnRH) analogues are synthetic hormones that cause a sort of temporary menopause. They can only be used for a short time, usually for a maximum of six months and symptoms may return afterwards. They’re usually taken as a monthly injection and although they soothe the pain of adenomyosis they can also give you the flushes, vaginal dryness and mood swings of menopause.

Surgery: Unfortunately, the only treatment that can get rid of adenomyosis is a hysterectomy, to remove the womb. Some surgeons have tried just removing adenomyosis by surgery and preserving the uterus. This method is controversial and is not suggested, except in exceptional circumstances.

In deciding the right treatment for you, your gynaecological surgeon will try to balance your pain, your preferences and whether you may plan pregnancies in the future. Don’t feel that because you don’t want a hysterectomy you will be left in pain, there are ways of controlling and coping with adenomyosis in the short term, leaving surgery until the time is right for you.