Many women experience reproductive health issues and many of these issues present with similar symptoms sometimes making it challenging for doctors to accurately diagnose. To further complicate matters, a woman may be experiencing more than one condition at the same time. Adenomyosis is one condition that is often overlooked and confused for uterine fibroids because they share many of the same symptoms.

What Is Adenomyosis?

Adenomyosis is closely related to endometriosis and is a condition that affects a woman’s uterus. It occurs as a result of glandular cells from the uterine lining migrating and penetrating directly into the underlying muscular layer which makes up the majority of a woman’s uterus.

Adenomyosis occurs within the uterus while a similar condition known as endometriosis occurs when these same cell types grow outside of the uterus.

How Common Is Adenomyosis?

Out of the many women who have adenomyosis, only about 30% of them experience related symptoms. Many women may have adenomyosis, but they do not know it because they are experiencing no symptoms.

The reported data related to adenomyosis and the number of affected women have been reported to be from 5% to 70% which is an exceptionally wide range. This inconsistency in statistics is due to the fact that, unlike fibroids, adenomyosis cannot be diagnosed by physical examination, and it is even a very difficult diagnosis to make on pelvic ultrasound. Traditionally, the diagnosis of adenomyosis was often made by the Pathologist after the hysterectomy specimen (i.e. uterus) was removed from the woman. Many of these patients were told that their hysterectomy was due to symptomatic fibroids when actuality they had
adenomyosis which was misdiagnosed.

Today, magnetic resonance imaging (MRI) is the gold standard to diagnose adenomyosis.

Adenomyosis - Figure 1 - Sideview of Normal Uterus
MRI image of a healthy uterus

Two Forms of Adenomyosis of the Uterus

Adenomyosis can present in a few different ways that are categorized as diffuse or focal.

1. Diffuse Adenomyosis

Diffuse adenomyosis presents with generalized or “geographic” thickening of the junctional zone which lies between the endometrium (uterine lining) and the myometrium (muscular layer).

MRI image of Diffuse Adenomyosis
MRI image of diffuse adenomyosis

2. Focal Adenomyosis or Adenomyoma

Focal adenomyosis can easily be confused for uterine fibroids because the irregular endometrial cells grow in a localized area and forms a nodule that resembles a fibroid on imaging.

Focal Form Adenomyoma
MRI image of focal adenomyosis or adenomyoma

What Causes Adenomyosis?

Unfortunately, as with fibroids, no known cause for adenomyosis has been identified, but there are factors that researchers believe contribute to its development. Some of these risk factors include:

  • Premenopausal and usually between 35-50 years of age;
  • Women who have given birth to more than one child;
  • Women who have undergone previous uterine surgery:
      • Cesarean section;
      • Dilation and Curettage (D & C);
      • Women who have experienced uterine trauma;
      • Hereditary – adenomyosis may be genetic;
      • Certain drug treatments (Tamoxifen).

What Are The Symptoms Of Adenomyosis?

The most common symptoms of adenomyosis include:

  1. Unusually heavy or prolonged menstrual bleeding;
  2. Painful cramping or severe pelvic pain during menstruation (i.e. dysmenorrhea); often sharp and stabbing in character;
  3. Pain during intercourse (dyspareunia).

How Is Adenomyosis Diagnosed?

Historically, the only method of accurately diagnosing adenomyosis was by microscopically examining dissected uterine tissue after a hysterectomy. The average age of women who undergo hysterectomies is about 45, and therefore, it has been believed that adenomyosis affected primarily this age group.

As mentioned previously, transvaginal pelvic ultrasound often misses this diagnosis. While there is uterine enlargement seen, this is often ascribed incorrectly to fibroids, particularly if the junctional zone thickening is focal in nature. Magnetic resonance imaging (MRI) is the gold standard in accurately diagnosing adenomyosis. Unlike on ultrasound, the junctional zone is easily seen on MRI. When the thickness is 12mm or greater the diagnosis of adenomyosis is made. In addition, cystic changes in the sub-endometrium are also pathognomonic (diagnostic) of adenomyosis.

What Is the Treatment for Adenomyosis?

While some surgeons have tried to remove areas of adenomyosis surgically, it has not been successful due to the infiltrative nature of this condition.
Unfortunately, the most common treatment for adenomyosis is to remove a woman’s uterus through surgery – hysterectomy.

Research and studies have shown that the uterus plays a major role in a woman’s health and should be removed only as a last resort when medically necessary. Hysterectomy has been linked to long-term effects such as mental health issues, increased cardiovascular risk (e.g. heart disease, stroke, high blood pressure), sexual dysfunction, urinary leaking, and bone loss.

Post-UAE uterus
Post-UAE uterus

Uterine artery embolization (UAE) is a completely non-surgical, outpatient procedure that has been very successful in treating adenomyosis. The success rate of UAE in the treatment of adenomyosis is approximately 70-80% and every woman contemplating hysterectomy for adenomyosis should first consider UAE. If you are suffering from adenomyosis we would be happy to help you. Please contact the Atlanta Fibroid Center today to set up a consultation.