Your health: Uterine adenomyosis
ADENOMYOSIS is a condition that occurs when the cells that make the lining of the uterus end up within the muscle wall of the uterus. It’s where the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium).
According to obstetrician-gynaecologist(ObGyn) Dr Anna-Kay Taylor Christmas, it can be located in one spot or throughout the entire uterine wall and is very similar to endometriosis. She noted that women often have both conditions at the same time.
“The symptoms can vary among women, ranging from non-existent or mild to very severe. They commonly include heavy, prolonged menstrual bleeding, severe cramps, abdominal pressure and bloating, an enlarged uterus, and may also negatively impact fertility,” she said.
Dr Taylor Christmas said it is most commonly diagnosed in women in their 30s and 40s, and may also be seen in women who have had previous surgery on the uterus.
The ObGyn said that unfortunately, the exact cause is not clearly known at this point, but it does seem to be hormone dependent.
Of note, she said with improved imaging technology, it is now possible to diagnose adenomyosis.
“It has a typical appearance on ultrasound and MRI. On examination, the uterus is usually enlarged and may also be tender to the touch. Imaging helps to differentiate adenomyosis from other common causes of abnormal bleeding and pelvic pain, such as uterine fibroids, endometriosis or ovarian cysts.”
Further, Dr Taylor Christmas said once the diagnosis is suspected, treatment can begin, and the type of treatment chosen usually depends on the severity of the symptoms.
“It can begin with medication to help with pain (anti-inflammatory pain killers), which is timed to coincide with the most painful part of the cycle. Hormonal medication can also be used to control the pain and bleeding, and can include tablets, injections or intrauterine inserts. Sometimes stronger medications that stop the periods altogether may have to be used for a few months as part of a treatment plan,” she said.
The ObGyn pointed out that uterine artery embolisation, a radiological procedure, can also be used in some cases that do not respond to medication, and in patients who do not want to have surgery.
For patients who don’t respond to medication and whose adenomysosis is not too deeply infiltrating into the uterine muscle wall, Dr Taylor Christmas said endometrial ablation (a minimally invasive day procedure) can also be performed. However, for those patients who have a more severe disease that does not respond to any other therapy, surgery may be required.
She said the only definitive treatment for adenomyosis currently is hysterectomy, where the entire uterus is removed; however, in some patients who wish to retain their uterus, a wedge resection of the affected areas on the uterus may be attempted.
Dr Taylor Christmas said if you are having severe pain or abnormal bleeding, it is best to see your gynaecologist right away to be evaluated for an underlying cause.
