What Is Adenomyosis?

The uterus is made up of three distinct layers:

1. Endometrium: the inner lining responsible for shedding every month during menstruation;
2. Myometrium: the layer in the middle made up of smooth muscle cells and is by far the thickest layer;
3. 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.

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.