Adenomyosis

What is adenomyosis?

Adenomyosis is a common but under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall. During menstruation, this adenomyotic tissue also swells up and bleeds within the uterine wall which can cause severe period pain, cramps and heavy periods.

There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall where as it grows outside the uterus with endometriosis.

How is adenomyosis diagnosed?

The condition is often diagnosed on an ultrasound or MRI scan where an enlarged uterus is seen with one wall of the uterus thicker than the other.

This condition is difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women have heavy and painful periods and accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be.

You can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anemic.

What are the symptoms of adenomyosis?

Typical symptoms of adenomyosis are heavy and painful periods. Sometimes the uterus is so enlarged that a lump can be felt in the lower abdomen and can also cause pressure on the bladder and bowel causing urinary frequency and constipation. Having said that, a lot of women do not have any symptoms at all.

How does the condition impact women’s lives?

Many women live with this condition without ever having a diagnosis made. A lot of women with adenomyosis have such bad periods that they have to put their life on hold for that time of the month. It affects their work and quality of life significantly. It can lead to anemia due to heavy bleeding and lead to extreme tiredness and also affect performance at work and sports.

What are the treatment options available?

Adenomyosis can be a difficult condition to treat. Supportive treatment is often the first line of management with medication to make the periods less painful (painkillers and antispasmodic medication such as Mefenamic Acid) and to reduce the bleeding (Tranexamic Acid). Sometimes taking the minipill or the contraceptive pill back to back can also stop the periods and hence help with the symptoms. Mirena intrauterine device is also helpful in reducing the symptoms significantly. The condition also improves during and after pregnancy and after menopause.

Uterine artery embolisation (UAE) is a treatment usually reserved for fibroids but is also very effective for treating adenomyosis.  The uterine blood supply is blocked by an interventional procedure carried out through the groin blood vessels. Hysterectomy is often reserved for extreme cases where the symptoms are resistant to other forms of treatment and the family is complete.