Adenomyosis is a condition where the cells that usually grow outward into the uterus lining instead grow inward into the uterus muscle. Endometrial tissue lines the inside of the uterine wall (endometrium). Adenomyosis occurs when this tissue grows into the myometrium, the outer muscular walls of the uterus. During a woman’s menstrual cycle, these “trapped” cells become stimulated, this extra tissue can cause the uterus to double or triple in size and lead to menstrual cramps, abnormal uterine bleeding and painful periods. The condition may affect 20% to 65% of females.
Around one-third of women do not experience any symptoms at all, while for others, symptoms can get in the way of daily life.Some people experience following symptoms –
The cause of adenomyosis isn’t known. There have been many theories, including:
• Invasive tissue growth.
Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
• Developmental origins.
Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
• Uterine inflammation related to childbirth.
Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
• Stem cell origins.
A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen.
Risk factors –
Risk factors for adenomyosis include:
• Prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C)
• Middle age
Most cases of adenomyosis — which depends on estrogen — are found in women in their 40s and 50s. Adenomyosis in these women could relate to longer exposure to estrogen compared with that of younger women. However, current research suggests that the condition might also be common in younger women.
What is the difference between adenomyosis and endometriosis?
Adenomyosis and endometriosis are disorders that involve endometrial tissue. Both conditions can be painful. Adenomyosis is more likely to cause heavy menstrual bleeding. The difference between these conditions is where the endometrial tissue grows.
Endometrial tissue grows into the muscle of the uterus.
Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.
Adenomyosis symptoms can negatively affect your lifestyle. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities like sexual intercourse.
People with adenomyosis are at an increased risk of anemia, which is caused by blood loss and can result in an iron deficiency.
The blood loss associated with adenomyosis can reduce iron levels in the body. Without enough iron, the body can’t make enough red blood cells to carry oxygen to the body’s tissues. This can cause fatigue, dizziness, and moodiness.
Adenomyosis has also been linked with anxiety, depression, and irritability.
Healthcare providers often diagnose adenomyosis based on symptoms and one or more of these tests:
• Pelvic exam
During a pelvic exam, your provider may notice that your uterus has gotten larger, softer, or more painful when palpated.
A transvaginal ultrasound uses sound waves to produce images of pelvic organs. These images can sometimes show thickening of the muscle raising suspicion for adenomyosis.
• Imaging scans
Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of the uterus which can be indicative of adenomyosis.
Because tissue grows within the uterus walls, the only way to biopsy tissue is after a hysterectomy, which removes the uterus.
Without treatment, adenomyosis may remain the same or symptoms can get worse.
Treatment is not necessary if a woman has no symptoms, is not trying to get pregnant, or is nearing menopause, which is when most women find relief from their symptoms.
However, there are many different treatment options available to women with this condition:
• Anti-inflammatory medications.
Medications such as ibuprofen can reduce pain and discomfort.
• Hormonal medications.
Some hormonal treatments, such as oral contraceptive pills, progestin IUD’s, or injection (Depo-Provera), can help lessen the symptoms.
• Injectable medications.
These medications can induce false or temporary menopause. These are only used in the short-term and are not suitable for long-term use.
• Uterine artery embolization.
This involves placing a tube in a major artery in the groin and injecting small particles into the area affected by adenomyosis. This stops the blood supply reaching the affected area, which will shrink the adenomyosis and reduce symptoms.
The only definitive treatment for adenomyosis is complete removal of the uterus. It is not a good option for women who may still want to become pregnant.
The outlook for a woman with adenomyosis is excellent; it is not a life-threatening condition, but it can cause severe discomfort.
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