What Is Adenomyosis and Why Didn’t the Ultrasound Show It?

To learn more about adenomyosis and its symptoms, read “What Is Adenomyosis? Symptoms and Treatment Options You Should Know About“.

Adenomyosis symptoms may be very similar to those experienced by women suffering from uterine fibroids, and it can sometimes be mistaken for endometriosis.

Endometriosis is often a painful condition. It occurs when the cells that make up the inner lining of the uterus (i.e. which shed each month and result in the menstrual period and referred to as the endometrium) are found completely outside of the uterus. It often involves the ovaries, fallopian tubes, and even the bladder and is a common cause of chronic cyclical pelvic pain.

In some women, these same cells penetrate deeper in to the muscle that makes up the majority of the uterus and lies beneath the lining (called the myometrium). Between these two layers of the uterus is the transition zone which is called the subendometrium which is usually thin (<12mm). When the subendometrium thickens (>12mm) due to these lining cells penetrating into the deeper tissues of the uterus, it is called adenomyosis. This thickening can be misdiagnosed as fibroids on pelvic ultrasound particularly in African-American women who disproportionately suffer with fibroids (expectation bias) and have symptoms similar to that seen in fibroids (heavy periods, pelvic pain).

Video: Why Adenomyosis Is Often Misdiagnosed (And What to Do About It)

To Diagnose Adenomyosis You May Need Pelvic MRI

Because ultrasound is available in the gynecologist’s office, it is typically the imaging study performed looking for a structural cause of bleeding (exs. fibroids, polyps, adenomyosis) or pelvic pain (exs. fibroids, adenomyosis, ovarian cysts). The ultrasound equipment used in these offices is of variable quality, and the technologists who perform the ultrasound study have different ability levels. This in combination with the fact that adenomyosis is typically diffuse with ill-defined boundaries, can make it difficult to diagnose adenomyosis on pelvic ultrasound. Pelvic MRI has much higher resolution than ultrasound and is the gold standard for detecting adenomyosis.

What Clues Are There to Suggest Adenomyosis?

If you have pelvic pain and heavy periods, but the pelvic pain is the more significant symptom, you may have adenomyosis. If you have endometriosis, you have a higher chance of adenomyosis. In fact, some have called adenomyosis, “endometriosis of the uterus.” If your uterus is enlarged on the pelvic ultrasound and the texture of the uterus is described in the ultrasound report as “heterogenous” with or without finding discrete fibroids, you likely have adenomyosis, and a pelvic MRI would be helpful at that point to confirm. If you suffer with heavy menstrual bleeding and/or pelvic pain, get a second opinion with an experienced Interventional Radiologist like Dr. Lipman and the team at the Atlanta Fibroid Center. Call us at 770-953-2600 to make an appointment.

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Atlanta Fibroid Center
of Atlanta Interventional Institute
John C. Lipman, MD, FSIR
3670 Highlands Parkway SE
Smyrna, GA 30082

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