Everything you need to know about adenomyosis

Adenomyosis is a condition that affects menstruating peopleduring their reproductive years. It occurs when the tissue that normally lines the uterus starts to grow into the muscular wall of this organ, leading to thickening and enlargement of the uterus. 

Adenomyosis can be an extremely painful condition that impacts peoples’ quality of life. It is oftentimes seen alongside endometriosis and can cause or contribute to conditions like infertility.

In this article, we will explore:

• What is adenomyosis?
• What are adenomyosis symptoms?
• How is adenomyosis diagnosed?
• What are the fertility implications of adenomyosis? 
• What are other health risks of adenomyosis?
• What are treatment options of adenomyosis? 

What is adenomyosis?

Adenomyosis is a condition where the endometrial tissue that normally lines the inside of the uterus starts to grow into the muscle wall of the uterus. This can lead to the uterus becoming enlarged and painful, with a range of other symptoms. 

The exact cause of adenomyosis is unknown, but it is thought to be related to hormones, with estrogen and progesterone being the primary culprits.

The exact prevalence of adenomyosis is unknown, but studies suggest that it is present in approximately 20% of menstruating people of reproductive age and seems to become more common as we get older (1). However, the prevalence may be even higher among people with symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. It's estimated that 1 in 3 people with adenomyosis do not expereince any symptoms! 

What are common symptoms of adenomyosis?

Adenomyosis can cause a range of symptoms, and some women may experience more than others. Common symptoms include (2):

• Heavy menstrual bleeding
• Prolonged periods
• Severe menstrual cramps
• Pain during intercourse
• Pelvic pain or discomfort
• Bloating, fatigue, and / or constipation at specific points during your menstrual cycle

Adenomyosis can oftentimes be misdiagnosed as endometriosis due to their similar symptoms and overlap in presentation. However, it is important to understand that while adenomyosis occurs when the tissue that lines the uterus grows into the muscular wall of the uterus, endometriosis is when endometrial tissue grows outside of the uterus. While they certainly have their similarities, it is crucial for healthcare providers to carefully evaluate a patient's symptoms, perform thorough diagnostic tests like a laparoscopy, and consider the possibility of both conditions to avoid misdiagnosis and ensure appropriate treatment.

How is adenomyosis diagnosed?

Adenomyosis can be challenging to diagnose since its symptoms can be similar to other reproductive disorders. However, several methods can be used to diagnose adenomyosis, including:

• Pelvic Exam: During a pelvic exam, the doctor may feel an enlarged and tender uterus or areas of thickening.
• Ultrasound: Transvaginal ultrasound is a common method to diagnose adenomyosis. It uses sound waves to create images of the uterus, which can show if the uterus has thickened walls or if there are cysts or fibroids present.
• Magnetic Resonance Imaging (MRI): An MRI can provide more detailed images of the uterus than an ultrasound. It can show the size, shape, and location of adenomyosis and help differentiate it from other conditions.
• Biopsy: In some cases, the doctor may recommend a biopsy of the uterine lining to rule out other conditions and confirm adenomyosis.

It is important to note that these methods are not always foolproof and may not detect adenomyosis in some cases. Therefore, if you suspect you have adenomyosis, it is essential to discuss your symptoms with a healthcare professional who specializes in reproductive health.

What are the fertility implications of adenomyosis?

While some people with this condition are able to conceive easily, adenomyosis can have a significant impact on a woman's fertility. In fact, studies suggest that it may contribute to infertility in some cases. 

The condition can often causes inflammation in the lining of the uterus, making it harder for a fertilized egg to implant and grow. It can also lead to inflammation in the uterus itself, which can further impact fertility. 

Below are some things to consider if you have this condition and want to start a family at some point: 

• Seek medical attention early: It's important to seek medical attention early if you suspect you have adenomyosis and are trying to get pregnant. Early diagnosis and treatment may help improve fertility outcomes.
• Work with a fertility specialist if feasible: A fertility specialist can help evaluate your fertility status and develop a personalized treatment plan based on your individual needs. Depending on the severity of your adenomyosis, treatments may include medications, surgery, or assisted reproductive technologies such as in vitro fertilization (IVF).
• Consider the timing of treatment: If you require surgery to treat adenomyosis, it's important to consider the timing of the surgery in relation to your fertility goals. For example, if you're planning to undergo IVF, it may be best to complete the IVF cycle before surgery to avoid disrupting the natural environment of the uterus.
• Be aware of potential complications: Adenomyosis can increase the risk of certain complications during pregnancy, such as preterm labor and delivery, fetal growth restriction, and abnormal fetal position. It's important to discuss these risks with your healthcare provider and closely monitor your pregnancy.
• Maintain a healthy lifestyle: Maintaining a healthy lifestyle can help improve fertility outcomes and reduce the risk of complications during pregnancy. This includes eating a healthy diet, exercising regularly, avoiding tobacco and excessive alcohol consumption, and managing stress.

It's important to remember that every individual's situation is unique, and what works for one person may not work for another. It's important to work closely with a healthcare provider and ideally a fertility specialist to develop a personalized treatment plan that meets your individual needs and goals.

Other health risks of adenomyosis

Adenomyosis can also increase the risk of other health conditions. As mentioned, individuals with adenomyosis may be more likely to develop endometriosis and these two conditions oftentimes occur together. In fact, it's estimated that roughly one-third of endometriosis patients have adenomyosis as well (3).

Adenomyosis has also been linked to an increased risk of ovarian cancer, endometrial cancer, and colorectal cancer, although more research is needed to confirm these links (4).

Common treatments for adenomyosis

The treatment for adenomyosis will depend on the severity of the condition and the symptoms experienced. In some cases, over-the-counter pain medications such as ibuprofen may be enough to manage symptoms. Hormonal treatments, such as birth control pills or intrauterine devices (IUDs), may also be prescribed to help manage symptoms.

For people who are trying to conceive, fertility treatments such as in vitro fertilization (IVF) may be recommended. In severe cases, surgery may be necessary to remove the affected tissue. Hysterectomy, the removal of the uterus, is also an option for women who no longer wish to have children or for whom other treatments have been unsuccessful.

Although more research is needed on how diet and lifestyle impact adenomyosis, anecdotal evidence as well as more extensive research on endometriosis indicates that our day=to-day routine can also help reduce symptoms. Below are some lifestyle treatment strategies that may be beneficial:

1. Anti-inflammatory diet: Follow a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit the consumption of processed foods, sugary snacks, and caffeine, as they can exacerbate inflammation and hormonal imbalances (5).
2. Regular exercise: Engaging in regular light to moderate physical activity can help improve blood circulation, reduce inflammation, and manage stress. Choose activities you enjoy, such as walking, swimming, yoga, or low-impact exercises, and aim for at least 30 minutes of exercise most days of the week (6).
3. Stress management: Chronic stress can worsen symptoms of adenomyosis. Practice stress-reducing techniques such as deep breathing exercises, meditation, yoga, or engaging in hobbies and activities that you find relaxing and enjoyable. And be sure to not skimp on sleep! 
4. Pain management: As mentioned, over the counter medications like ibuprofen can help with adenomyosis pain. You can also use heat therapy, such as hot water bottles or warm baths, to alleviate pelvic pain and cramping.
5. Herbal supplements: Certain herbs, such as turmeric, ginger, quercetin, and cinnamon, possess anti-inflammatory properties and may provide some relief from inflammation and pain. However, consult with a healthcare professional before incorporating any supplements into your routine, as they may interact with other medications (7).
6. Mental health support: Seeking emotional support through joining support groups or online communities to connect with others experiencing similar challenges can be a powerful way to feel less isolated if you have adenomyosis. Sharing experiences and information, especially with those who have the same condition, can provide valuable insights and coping strategies. 1-1 therapy and opening up to friends and family is also helpful! 

Remember, while these lifestyle changes may help manage symptoms, it's crucial to consult with your healthcare provider for a comprehensive treatment plan. They can offer personalized guidance, prescribe appropriate medications if needed, and discuss other treatment options such as hormone therapy or surgery, depending on the severity of your symptoms.

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Conclusion

Adenomyosis is an under-discussed condition that can have a significant impact on a woman's reproductive and overall health. If you are experiencing any symptoms associated with adenomyosis, it is important to speak with your doctor. A proper diagnosis and treatment plan can help manage symptoms and improve your quality of life.

Sources

1. J. Naftalin and others, How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic, Human Reproduction, Volume 27, Issue 12, December 2012, Pages 3432–3439, https://doi.org/10.1093/humrep/des332
2. https://my.clevelandclinic.org/health/diseases/14167-adenomyosis
3. https://www.epworth.org.au/blog/2022/adenomyosis-endometriosis
4. Kok VC, Tsai H, Su C, et al The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study International Journal of Gynecologic Cancer 2015;25:968-976. https://ijgc.bmj.com/content/25/6/968.
5. Halpern G, Schor E, Kopelman A. Nutritional aspects related to endometriosis. Rev Assoc Med Bras (1992). 2015 Nov-Dec;61(6):519-23. doi: 10.1590/1806-9282.61.06.519. PMID: 26841161. https://pubmed.ncbi.nlm.nih.gov/26841161/.
6. Bonocher CM, Montenegro ML, Rosa E Silva JC, Ferriani RA, Meola J. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol. 2014 Jan 6;12:4. doi: 10.1186/1477-7827-12-4. PMID: 24393293; PMCID: PMC3895811.
7. Yalçın Bahat P, Ayhan I, Üreyen Özdemir E, İnceboz Ü, Oral E. Dietary supplements for treatment of endometriosis: A review. Acta Biomed. 2022 Mar 14;93(1):e2022159. doi: 10.23750/abm.v93i1.11237. PMID: 35315418; PMCID: PMC8972862. https://pubmed.ncbi.nlm.nih.gov/35315418/.