Adenomyosis
Adenomyosis is a condition of the uterus and develops when endometriosis-like tissues grow into your uterine wall. Described for the first time in 1960 by the German pathologist Carl von Rokitansky, who found endometrial glands in the myometrium and subsequently referred to this finding as “cystosarcoma adenoids uterinum”, the current definition of adenomyosis was provided in 1972 by Bird who stated:
“Adenomyosis may be defined as the benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium”.
Adenomyosis symptoms
Adenomyosis can cause various symptoms and in some cases these are overlapping with endometriosis and/or fibroids symptoms. Adenomyosis is frequently associated with other pelvic pathologies such as endometriosis and uterine fibroids, which makes it even more difficult to understand what symptoms are caused by adenomyosis. There are also cases of asymptomatic adenomyosis.
Some of the most frequent symptoms and signs of adenomyosis are:
- Heavy or prolonged periods
- Severe cramping pain during menstruation
- Chronic pelvic pain
- Painful intercourse
- Tenderness or swelling in your abdomen
- Abdominal distension
- Back or leg pain
- Infertility
Adenomyosis types
Adenomyosis is classified into diffuse and focal:
- Diffuse adenomyosis represents the invasion of endometrial glands and/or stroma within the myometrium;
- Focal adenomyosis or adenomyoma, circumscribed tumours consisting of endometrium and muscle tissue;
How is adenomyosis diagnosed?
Adenomyosis can be diagnosed via imaging and gynaecological examination. The final diagnosis of adenomyosis is made after the histological examination of the uterus.
Abdominal and transvaginal scans can be used to diagnose adenomyosis. The diagnosis is however highly dependent on the person performing the investigation. In the hands of experienced specialists, transvaginal ultrasound is an accurate method for diagnosing adenomyosis in clinically suspected cases. The MRI is another method of diagnosis.
Adenomyosis methods of treatment
Given its localisation, adenomyosis treatment is limited surgically to patients wishing to preserve their fertility. Based on one’s symptoms and personal circumstances, treatment for adenomyosis consists of:
- Medical treatment such as birth control, mirena or hormonal treatment;
Surgical treatment represented by:
- conservative surgery where uterus can be preserved – robotic or laparoscopic adenomyomectomy
- definitive option – hysterectomy
Other surgical methods of treatment are uterine artery embolization, a procedure used to treat symptomatic fibroids which has also been shown to be effective in the treatment of adenomyosis.