AS we strive to bring awareness to the chronic debilitating condition endometriosis, this March, I think it's also important to highlight a closely related disease adenomyosis.
In fact, the two are so closely related that they are often referred to as “medical cousins”. In adenomyosis, tissue similar to ones that line the inside of the uterus are found inside the muscle of the uterus itself. In comparison, endometriosis is where this same tissue is found outside of the uterus.
How common is it?
Adenomyosis is actually more common than endometriosis. If you keep up with the happenings in March, you'll certainly see/hear that endometriosis affects one out of every 10 women in the reproductive age group. Adenomyosis, however, has been found in at least 20 per cent of women! That's as much as one out of every five women you know. The actual numbers are hard to really tell, because the only true way of making the diagnosis is by removing a part of or all of the uterus. As with many gynaecological conditions, adenomyosis is influenced by hormones, in particular oestrogen.
What are the symptoms?
The symptoms of adenomyosis are very similar to endo, therefore making it a nightmare to differentiate based on clinical findings. Painful heavy periods are the most common features, and some women have an enlarged womb. This often confuses it with uterine fibroids, another common gynaecological condition. However the fibroid uterus tends to be irregular in shape as compared to the uniform enlargement you get with adenomyosis. There are some studies that show a link between adenomyosis and infertility (or reduced fertility), miscarriages and preterm births. Thankfully, about a third of women have no symptoms at all, and require no medical treatment.
How is it diagnosed?
Diagnosis can usually be made after an in office consultation along with some form of imaging. MRI is better to pick it up, but ultrasounds can be useful as well. As mentioned earlier, confirmation can only be done at the time of surgery. If the previous information wasn't confusing enough to sort through, the conditions adenomyosis, endometriosis and uterine fibroids can all be present in the same patient. So at times, we really don't know which condition is the main culprit for the symptoms.
Treatment : The “good news”
Compared to endometriosis, treatment of pure adenomyosis is simpler. Now this doesn't mean the treatment is necessarily easier or that the patients suffer less. It's just that adenomyosis is not widespread as in endometriosis, which can affect ovaries, tubes, bladder, bowel, lungs, belly button, kidneys, etc.
As with all chronic pain conditions, a healthy lifestyle improves symptoms. There's no specific diet that's been proven to work for adenomyosis, and most patients employ trial and error to find their balance. In general avoidance of inflammatory foods help, and regular exercise is beneficial for pain control.
Hormonal treatments aimed at reducing oestrogen tend to work best. These can be given via pills, injection or even via an intrauterine device. The latter can be placed in office without the need for surgery and kept in for up to five years. If heavy bleeding is the main complaint, then we can actually destroy the lining of the womb in a minor surgical procedure called endometrial ablation.
Other treatment options include uterine artery embolisation and focused ultrasound ablation, neither of which are available locally at this time.
A simple hysterectomy will cure the condition, which again is in contrast to endometriosis which is not cured by a hysterectomy (actually not cured at all). Vaginal and laparoscopic hysterectomies are usually the mainstay, although some adenomyosis wombs can get very large, requiring an open procedure.
If you have adenomyosis and want to get pregnant, you'll have to work with your gynaecologist to come up with a treatment plan best suited for you, as most of the above treatments prevent or impair pregnancy rates.
Dr Ryan Halsall is a consultant obstetrician gynaecologist who operates at ILAP Medical, 22 Windsor Avenue, Suite 2, Kingston 5. He can be contacted at email@example.com or 876-946-0353. Follow him on Instagram: @drhalsall
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