Adenomyosis is a disease that can be difficult to diagnose. Until recent years, the only way a doctor could definitively tell if you had adenomyosis was after you had a hysterectomy to treat your symptoms after which the tissue was examined under a microscope.
Adenomyosis refers to a condition that causes the endometrial tissue lining of your uterus to grow into the muscular walls of your uterus. Once the endometrial tissue is implanted in the muscle of the uterus, the tissue continues to act as it always does, growing, thickening, breaking up and bleeding out during your period. Adenomyosis can be very painful when it causes your uterus to become enlarged. It creates exceptionally heavy bleeding during your menstrual cycles. Adenomyosis should always be evaluated with a thorough consultation and examination by a physician for an accurate diagnosis and treatment plan.
Why It Happens
The cause of adenomyosis is unknown, but there are theories for this condition. It usually affects women later in life — prior to menopause, but after they’ve already had kids. It usually disappears after you go through menopause, because menstruation stops.
Some of the causes of the condition may include:
- Abnormal development in utero, meaning endometrial tissue is deposited outside your uterus while you are still forming in your mother’s womb.
- Tissue that was cut during another procedure, such as a C-section, may cause the invasive growth and actually instigate the invasion.
- A stem cell-related disease, in that bone marrow somehow seeps into the uterus and cause the unusual tissue movement.
- Following childbirth, when the uterine lining becomes inflamed. The inflammation may cause a break in the lining of your uterus, which normally forms a natural barrier for the tissue.
No matter how it develops, what is known is that estrogen feeds it. The tissue growth relies on continuing estrogen production to fuel its growth, which is why the condition goes away after you stop producing natural estrogen after menopause.
It’s possible that you could have adenomyosis and not even know it. At other times, the symptoms can be painful and obvious, such as:
- Pain while having sexual intercourse
- Above average bleeding during your period that also lasts longer than usual
- Strong cramps during your menstrual cycle that get worse as you age
- A sharp, stabbing pain through your pelvis during menstruation
- Passing blood clots with your menstrual blood
Additionally, you may notice a bulging in your abdominal area from where your enlarged uterus protrudes. You might not recognize that it’s your uterus and instead think that your belly has become enlarged and tender. But if you’re experiencing any pain in your abdominal region, it’s not normal and should trigger a visit to your OBGYN NYC specialists.
Risks Associated with Adenomyosis
Since endometrial tissue needs estrogen to grow, it makes sense that if you’re menopausal or postmenopausal, you’re at a lower risk of developing adenomyosis. Full understanding of the condition and how it starts is still under investigation, but recent studies suggest that strong pelvic pain in younger women may have its origin in adenomyosis. The condition may even appear in women as young as adolescence.
Risk factors that are clear and include:
- Being middle-aged
- Giving birth at least once
- Previous surgery that involved your uterus, such as a Cesarean section or fibroid removal
Additional risk factors related to the condition:
- Adenomyosis with endometriosis makes for a common occurrence. And although they can happen at the same time, endometriosis doesn’t always cause heavy bleeding.
- Myometrial cyst leads to a rare variant called cystic adenomyosis that may be caused by repeated hemorrhages in the uterus.
- Adenomyosis and cancer are often linked when you have to take tamoxifen to treat cancer. At the same time, adenomyosis does not necessarily relate to a higher incidence of cancer.
- Adenomyosis and pregnancy Hormonal treatments also preclude pregnancy.
Testing May Prove Helpful
To date, the only sure way to verify a diagnosis of adenomyosis is to examine the tissue after you‘ve had a hysterectomy and your uterus was removed. A hysterectomy definitely helps, though, because continued bleeding can lead to anemia, a critical complication of adenomyosis. The continual bleeding may not be painful, but it can disrupt your life enormously and lead to anemia with symptoms of depression, feelings of futility and frustration.
Tests your doctor may try to find a cause of your excessive bleeding include:
- A pelvic exam, during which he can feel for abnormalities
- A thorough history of your recent bleeding experiences
- Imaging tests such as an MRI and adenomyosis ultrasound to rule out other uterine diseases
- Endometrial biopsy
Depending on your age, the best solution may be just to wait for menopause to happen, at which time your adenomyosis symptoms will abate. Other popular treatments include:
- Hormone medicine that combines progestin and estrogen. It comes in a patch or in a vaginal ring. It may lessen your bleeding. A hormonal IUD, which primarily puts out progestin, also may help reduce your bleeding. Continuous use oral contraceptives that sometimes eliminate your periods may also provide relief.
- Anti-inflammatory drugs such as ibuprofen help to reduce the discomfort and pain associated with the heavy menstrual cycles you get and can relieve some of the discomfort of the heavy bleeding while you wait for natural menopause to take place. Many of the treatments women with heavy menstrual cycles use may provide you with some relief as well. Soaking in a warm bah may ease your discomfort, as can putting a heating pad on your abdomen when you have cramps.
- Laparoscopic Hysterectomy is one of the only sure way to rid yourself of the symptoms if they’ve become unmanageable and you’re years away from menopause. You only need a partial hysterectomy and can keep your ovaries. Without your uterus, however, you will not be able to get pregnant.
All signs and symptoms should always be evaluated with a thorough consultation and examination by a physician for an accurate diagnosis and treatment plan.
Important Reminder: This information is only intended to provide gynecology guidance, not a definitive medical advice. Please consult obgyn doctor about your specific condition. Only a trained, experienced board certified gynecologist or certified gynecology specialist can determine an accurate diagnosis and proper treatment.
Do you have questions about Adenomyosis? Would like to schedule an appointment with the NYC leading Gynecologist, Dr. Anat Zelmanovich, please contact our office.
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Midtown OB/GYN)
New York, NY 10010
☎ (212) 533-4575
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Upper East Side OB/GYN)
New York, NY 10028
☎ (212) 533-4575