Adenomyosis: Symptoms, Diagnosis and Treatment

Patients we see at Atlanta Fibroid Center often have heavy menstrual bleeding and pelvic pain. The large majority of these women have uterine fibroids and we are known globally for the non-surgical treatment of these benign tumors.

However, some women who have these same symptoms do not have fibroids at all (even though a number of these women have been misdiagnosed as having fibroids).

Adenomyosis Nature: Three Layers of the Uterus

Many women have another benign condition called adenomyosis. To understand adenomyosis, one needs to first understand the layers of the uterus (Figure 1).

Adenomyosis - Figure 1 - Sideview of Normal Uterus
Figure 1. Side View of Normal Uterus.

There are 3 layers of the uterus: endometrium, myometrium, and perimetrium. The endometrium is the innermost layer which is in contact with the uterine cavity. It is the thin lining that sheds every month with a woman’s menstrual. The myometrium (muscular portion) makes up the vast majority of the volume of the uterus and responsible for the uterine contractions. The third layer is the outer thin covering (serosa) of the uterus.

Related: How Uterine Artery Embolization (UAE) Works for Adenomyosis

When cells from the uterine lining (endometrium) are found completely outside the uterus, it is called endometriosis. Endometriosis is a common condition which often causes pelvic pain and even infertility.

When the endometrial cells penetrate in to the myometrium, it is called adenomyosis. This causes the uterus to enlarge and feel hard on physical exam (just like fibroids).

Two Forms of Adenomyosis

Adenomyosis has 2 forms: the more common diffuse form (figure 2) and less common focal form (adenomyoma, Figure 3). A number of women adenomyosis also have endometriosis and vice versa. They can also have fibroids too.

Adenomysosis - Figure 2 - Diffuse Adenomyosis
Figure 2. Diffuse Adenomyosis.
Pre-UAE Uterus
Figure 3. Focal Form Adenomyoma

As mentioned previously, the main symptoms of patients with adenomyosis are similar to fibroids (pelvic pain and heavy menstrual bleeding). However, typically for patients with adenomyosis the pain is worse than the bleeding whereas with fibroids, it is typically the reverse (i.e bleeding worse than the pain).

Adenomyosis Treatment

Fortunately for women who want to avoid surgery, Uterine Artery Embolization (UAE) is an effective treatment method for adenomyosis (as it is for uterine fibroids).1,2 When the blood flow to the treated area of adenomyosis is interrupted, that area will shrink in size leaving behind a much smaller non-enhancing cavity seen on follow-up pelvic MRI exam (Figure 4).

Adenomyosis - Figure 4 - Post-UAE
Figure 4. Post-UAE Uterus.

1. Popovic M, Uterine Artery Embolization for Treatment of Adenomyosis: A Review. JVIR 2011; 22:901-909.

2. Smeets AJ, Long-term follow up of UAE for Symptomatic Adenomyosis. CVIR 2012; 35(4):815-819.