Adenomyosis is a condition that affects many women and has symptoms that are very similar to those of other women’s health conditions. Some women who have adenomyosis do not experience any symptoms at all and the diagnosis cannot be made by physical examination of the woman. This obviously makes diagnosing adenomyosis difficult.
The condition is characteristically found in women of childbearing age or in women who have had at least one child. Being diagnosed with adenomyosis after menopause is rare.
What Is Adenomyosis?
The uterus is made up of three distinct layers:
- Endometrium: the inner lining responsible for shedding every month during menstruation;
- Myometrium: the layer in the middle made up of smooth muscle cells and is by far the thickest layer;
- Serosa or Perimetrium: the thin outside layer.
Adenomyosis is caused when cells from the endometrium penetrate into the myometrium. Depending on where the growth occurs in the myometrium, the rogue cells may cause adenomyosis symptoms or the patient may exhibit no symptoms from adenomyosis.
When these same endometrial cells grow outside of the uterus the condition is called endometriosis. Most women have heard of endometriosis, but many are not aware of its “close relative” adenomyosis.
What Are The Symptoms of Adenomyosis?
Symptoms and signs of adenomyosis include:
- Excessively heavy bleeding and/or abnormally long periods are the most frequent of adenomyosis symptoms. Endometrial cells growing within the muscular wall of the uterus can interfere with the uterus’ ability to function properly. It may cause heavy bleeding and prolonged menstrual bleeding as the uterus is unable to control contractions.
- Serious and chronic pelvic pain during the menstrual cycle, severe cramping (dysmenorrhea – stabbing, shark, knifelike pain).
- Pain during sex (dyspareunia). An enlarged uterus can be tender and also put pressure on the vagina making sexual intercourse painful.
- Enlarged uterus. The myometrium normally thickens when adenomyosis is present and can enlarge and misshape the uterus.
- Fertility issues. The shape of the uterus can become distorted or enlarged. Growths on the inside of the uterus can prevent proper implantation of the embryo or inhibit the growth of the fetus and be the cause of miscarriage.
- Lower back pain. Out of all the adenomyosis symptoms, back pain is one of the most common and can be sharp or a dull ache and can radiate down the legs.
How Can You Tell If You Have Adenomyosis?
Determining the presence of adenomyosis can be problematic. The symptoms associated with the condition such as pain or heavy bleeding are also associated with endometriosis and uterine fibroids often causing women to be misdiagnosed.
Many patients with adenomyosis and fibroids suffer from both heavy periods and pelvic pain. However, in general, adenomyosis patients often feel the pain is worse than the bleeding and more often have painful intercourse (i.e. dyspareunia) than fibroid patients. With fibroid patients, we commonly hear the opposite; that the bleeding is much worse than the pain.
Some women experience infertility issues or suffer miscarriages because of the presence of adenomyosis and they typically do not realize they have the condition. One of the most publicized examples is that of the actress Gabrielle Union who suffered from the symptoms and miscarriages for years not knowing what was causing it. Eventually, years later she was diagnosed with adenomyosis. Currently, she is hard at work educating women on adenomyosis in the hopes of preventing needless suffering in other women.
It is very likely that her fertility issues were connected to the presence of adenomyosis. Perhaps if accurately diagnosed at a young age, a procedure such as uterine artery embolization (UAE) may have alleviated the condition and improved her fertility chances.
Gabrielle Union and other women with adenomyosis often suffer needlessly due to the inaccuracy of pelvic ultrasound which is the first test that is often done in women with adenomyosis symptoms. While ultrasound can show uterine enlargement, all too often the person interpreting the ultrasound images has a bias toward confirming fibroids as the diagnosis even when fibroids are not present. As mentioned previously, fibroids have very similar symptoms and are more common than adenomyosis.
A very important clue that suggests adenomyosis rather than fibroids is the correct diagnosis by ultrasound is when the ultrasound report describes the uterine echotexture to be “heterogenous”. In our experience, when we see outside ultrasound reports of uterine enlargement and heterogenous echotexture it is very common due to adenomyosis. This suspicion can then be confirmed by the most accurate non-invasive method to diagnose adenomyosis: a pelvic MRI. MRI has a much higher image resolution and easily makes the diagnosis of adenomyosis.
How Is Adenomyosis Treated?
Uterine Artery Embolization (UAE) is an outpatient, non-surgical treatment option for adenomyosis. It is the only treatment option that both successfully treats adenomyosis in the majority of patients and also allows a woman to keep her uterus and have children. The only other option for these women has been a hysterectomy.
For women suffering from adenomyosis, it is very important for them to know they have options beyond hysterectomy. Unfortunately, most women are completely unaware of UAE and often succumb to hysterectomy unnecessarily.
For more information on adenomyosis and UAE, please go to ATLii.com or schedule an appointment with an experienced Interventional Radiologist like Dr. Lipman or Dr. Ermentrout of the Atlanta Fibroid Center. Contact the Atlanta Fibroid Center today to set up a consultation.