If you’ve suffered from missed periods, painful bleeding, or excessive bloating, you may want to check in with your doctor. Many people have heard of endometriosis, but very few have heard of a similar condition called adenomyosis that plagues women and is incredibly difficult to diagnose. We chatted with gynecological experts to break down what adenomyosis is, how it’s different from endometriosis, and what to do if you think you have it.
What is adenomyosis?
Adenomyosis is when the uterine lining that gets shed every month during menses, called endometrial tissue, grows into the muscle of the uterus, explains Dr Jane Van Dis. The tissue is not supposed to grow into the muscle, which is why it can cause a slew of health issues.
Symptoms of adenomyosis
- Excess or abnormal bleeding
- Painful periods
- Periods with blood clots
- Pain during intercourse
Adenomyosis vs. endometriosis
Adenomyosis is classified by endometrial tissue that has grown into the uterine muscle, whereas its more well-known cousin, endometriosis, is marked by endometrial tissue growing outside the uterus, explains Dr Van Dis, in other parts of the body such as the ovary, bladder, or even as far away as the lungs, she says. Endometriosis can be debilitating, significantly impacting quality of life, she notes.
Endometriosis is also much more common, impacting one in nine Australian girls and women. In comparison, one in 10 Australian women are diagnosed with adenomyosis. However, because most women don’t even know they have this issue, the true number may be much higher.
What causes adenomyosis?
Overall, Dr Van Dis says more research is needed to truly understand why the uterine cells migrate to the uterine muscle in the first place. As of now, she says the science suggests that previous uterine surgery and childbirth are the biggest risk factors. Dr Natalya Danilyants adds it’s commonly found in people who had multiple cesarean deliveries and can often appear along with endometriosis and fibroids.
Additionally, Dr Levens says most with the condition are diagnosed later in life, in their 40s and 50s, but it can exist in younger people as well.
How is adenomyosis diagnosed?
It’s very difficult to diagnose adenomyosis—in fact, most diagnoses happen only after hysterectomies. This is why it is so drastically underreported, Dr Van Dis says. “The only way to prove adenomyosis, you have to take the uterus out and look at it under a microscope,” she notes.
She adds that sometimes a vaginal ultrasound or pelvic MRI can find things that hint toward adenomyosis, but not every radiologist or tech will know what to look for.
“Many patients go undiagnosed for years. It is very common, so for anyone who has unexplained abnormal bleeding, adenomyosis should be at the top of the list. Especially those patients with infertility or prior cesarean deliveries,” Dr Danilyants says.
How is adenomyosis treated?
To simply treat the symptoms of adenomyosis, Dr Van Dis says a regular over-the-counter anti-inflammatory can be helpful. This is typically the first step in managing discomfort and inflammation. Then, a doctor can prescribe birth control pills or a hormonal IUD, because there is some thought that oestrogen plays a role in adenomyosis. Dr Levens adds that these avenues can also help with reducing pain and bleeding during the menstrual cycle.
Alternatively, doctors sometimes prescribe medications that can put the body in a state of early menopause to effectively shut down production of oestrogen and progesterone. Dr Van Dis warns that this can’t be used for long periods of time because it can lead to bone loss, however, depending on a patient’s age and proximity to menopause, some doctors will choose this route.
Lastly, if the adenomyosis has deeply invaded the muscle, endometrial ablation—a procedure that destroys the uterine lining—or a hysterectomy are more invasive treatment options. Dr Danilyants warns that endometrial ablation, however, can cause worsening pelvic pain post-op, and may only provide temporary relief.
If you think you may have adenomyosis, consult your doctor to discuss your concerns and potential next steps.