Adenomyosis

Definition of adenomyosis

• Endometrium (endometrial tissue): mucosa that lines the uterus internally
• Myometrium: muscular tunic of the uterine wall, between the perimetry (serous tunic of the uterus, its outermost part) and endometrium

"Adenomyosis" is a purely medical term used to indicate a benign pathological condition in which a portion of endometrial tissue * develops along the muscular walls of the uterus. In simple terms, adenomyosis occurs when the endometrium *, growing in locations where it normally shouldn't be, invades the myometrium *.
Also known by the term "internal endometriosis", "adenomyosis must not be confused with" endometriosis proper (external): in the latter case the endometrial tissue is located outside the uterus, thus growing in the pelvis ( eg in the ovaries, in the fallopian tubes, in the tract between the rectum and the uterus or in the ureter) or outside it (eg in the navel, lungs, vulva, etc.).

Although not a malignant lesion, in some women adenomyosis represents a real torment, such as to have a negative impact on life habits: for this reason, pharmacological and / or surgical treatment (above all) is of primary importance.

Causes

The exact cause of adenomyosis still remains an unsolved question. However, from the statistical analysis of some scientific works a certain correlation has been observed between the onset of the disorder and some factors, such as in particular:

• Tubal ligation
• Voluntary termination of pregnancy
• Caesarean section
• Multiple parts
• Surgery at the level of the uterus (eg for the removal of fibroids or uterine / endometrial polyps)

Some experts believe that adenomyosis in some women has a hereditary origin (presumably genetic nature of the disorder).
Considering that adenomyosis mainly affects women between the ages of 35 and 50, it is likely that the phenomenon is also influenced by hormonal variations. In fact, postmenopausal women are almost immune from adenomyosis: this is because, probably, estrogen levels undergo a physiological decline during menopause.

Symptoms

Adenomyosis can begin in a rather ferocious and debilitating way, or show no symptoms at all.
When asymptomatic, the woman may find that she is affected during a normal routine gynecological examination. On other occasions, however, adenomyosis manifests itself with disabling symptoms such as:

• Abnormal uterine bleeding (e.g. hypermenorrhea)
• Extremely painful menstrual cramps (dysmenorrhea)
• Uterine loss between periods (spotting)
• Pain during intercourse (dyspareunia)

The presence of large dense clots of uterine blood during menstruation should also alert the woman immediately.
On gynecological examination, the uterus of a woman suffering from adenomyosis can double or even triple in size; for this reason, the belly is perceived by the woman as more swollen or thicker.

Complications

A woman with adenomyosis is at greater risk of preterm birth or premature rupture of membranes during pregnancy (a condition popularly known as breaking of the waters).
It should not be forgotten, then, that a "symptomatic adenomyosis produces effects that can have a negative impact on a woman's lifestyle: for example, uterine bleeding can appear suddenly or generate very strong abdominal cramps." The hypermenorrhea seen in some women with adenomyosis could often lead to chronic anemia.

Diagnosis

The diagnosis of adenomyosis is not always immediate and simple: in fact, many times the pathology presents itself with rather non-specific signs and symptoms, which can be erroneously attributed to other gynecological disorders (such as uterine contractions, fibroids of the ovaries or endometriosis).
The classic suprapubic ultrasound does not unequivocally ascertain a suspicion of adenomyosis and, for this reason, it is not particularly reliable. The transvaginal ultrasound, on the other hand, makes it possible to diagnose the disorder more precisely; in support of this technique, the patient can undergo magnetic resonance imaging.

In-depth study: how does the uterus of a woman suffering from adenomyosis look like after a transvaginal ultrasound?
This type of examination allows to detect the appearance and structure of the uterus. In a woman affected by adenomyosis, the uterus appears enlarged while the myometrium shows a clearly inhomogeneous and thickened appearance. There are also islands of ectopic endometrial tissue (foreign, which should not be there) in the myometrium.

Therapy

Treatment options for adenomyosis vary according to the severity of the condition and the age of the woman. Therapeutic strategies to combat the disorder include:

• The so-called "pain therapy" involves the administration of analgesic and anti-inflammatory drugs (NSAIDs), such as specifically "ibuprofen and naproxen. This kind of therapeutic approach is indicated when the woman suffering from adenomyosis is young and pain during menstruation. it is relatively bearable.
• When it is believed that adenomyosis is closely related to an excess of estrogen in the blood, the gynecologist can prescribe hormone therapy to be taken by mouth (eg contraceptive pill) or to be applied in the uterus (hormonal IUD) or deeply in the vagina ( contraceptive ring). Some specialists are of the opinion that even the daily application of progesterone-based creams (taken transvaginally) can somehow alleviate the symptoms of adenomyosis.
• Surgical treatment to remove the uterus (hysterectomy) is reserved for the most complex cases, especially when the woman is young and complains of unbearable pain such as to negatively compromise daily activities. Let us briefly remember that, once the menopause border has been crossed, everyone the symptoms of adenomyosis tend to disappear. Removal of the ovaries is not necessary to stave off the symptoms of adenomyosis.