What is Adenomyosis?

By | 11 April 2021

Adenomyosis is the progress of the intrauterine layer (endometrial tissue) into the muscular layer (myometrium) of the uterus. This causes the muscular layer of the uterus to thicken. Although the cause is not known exactly, it is thought to be related to the increased estrogen level. Adenomyosis usually disappears after menopause.

Adenomyosis risk factors:

  • Being between the ages of 40-50
  • have given birth
  • have had uterine surgery, such as a cesarean section or removal of fibroids

WHAT ARE THE SYMPTOMS OF ADENOMYOSIS?

Sometimes there may be no symptoms or mild discomfort in patients with adenomyosis. However, most patients have obvious complaints. The most common symptoms are:

  • Excessive and prolonged menstrual bleeding
  • Severe cramps during menstruation or stabbing pain in the abdomen
  • Continuing cramps throughout the menstrual period and increasing complaints with age
  • Pain during intercourse
  • Intermittent bleeding during periods other than menstruation
  • Clotted bleeding during menstruation

HOW IS ADENOMYOSIS DIAGNOSED?

The first step in the diagnosis of adenomyosis is pelvic examination. In the pelvic examination, it is manifested by the enlarged and sensitive uterus. In ultrasound, various parts of the fundus are observed as thick, and the intrauterine layer is irregular. Since irregular and excessive bleeding can also be seen in fibroids, it is mostly confused with fibroids. MR imaging gives the most accurate result in the differential diagnosis. Most of the time, the diagnosis is determined by the pathology to result in uterine removal operations performed for various reasons.

ADENOMYOSIS TREATMENT

Anti-inflammatory drugs:

Anti-inflammatory drugs can be given by starting 2-3 days before menstruation. These medications help reduce bleeding and relieve pain.

Hormone therapy:

Combined estrogen-progesterone-containing birth control pills, hormone-containing patches, or vaginal rings help reduce excessive bleeding and pain associated with adenomyosis. Progestin-only intrauterine device (MIRENA) or continuous use birth control pills cause amenorrhea (cessation of menstruation) and reduce symptoms. GnRH analogs can be used in treatment, but they are not preferred because they cause menopausal-like symptoms.

Uterine artery embolization:

This technique, it is aimed to reduce the lesions by cutting the blood flow in the vessels feeding the area affected by adenomyosis.

Surgical treatment:

Adenomyosis foci located on the anterior and posterior wall of the uterus can be surgically removed. Thus, the growth of the foci is stopped, the uterus returns to its normal size, painful and heavy periods return to normal. In patients with very severe symptoms, hysterectomy (uterine removal) is the definitive solution.