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What is Adenomyosis?

Adenomyosis is a benign gynecologic condition that is characterized by the presence of ectopic endometrial tissue in the muscular layer of the uterus, causing the uterine walls to appear thicker or cystic, and leading to menstrual problems. Symptoms include abnormal uterine bleeding, painful menses, pressure, and chronic pelvic pain. Adenomyosis can also be associated with fertility and pregnancy complications.

Risk Factors of Adenomyosis

Some of the risk factors associated with adenomyosis include:

  • History of multiple pregnancies
  • Aged 40-50 years
  • Prior uterine surgery
  • History of endometriosis

Causes of Adenomyosis

The cause of adenomyosis is unclear. Some of the other theories about the causes of adenomyosis include:

  • Invasive tissue growth due to invasion of endometrial cells from the lining of the uterus into the uterine muscle
  • Presence of stem cells in the uterine muscle wall
  • Uterine inflammation following childbirth
  • Developmental origin, such as when the uterus is first formed in the fetus

Symptoms of Adenomyosis

Some of the common symptoms associated with adenomyosis include:

  • Heavy menstrual bleeding
  • Blood clots during menstrual bleeding
  • Spotting between menstrual periods
  • Prolonged menstrual cycles
  • Painful menses
  • Pain or discomfort in the pelvic or abdominal area
  • Pelvic pressure

Diagnosis of Adenomyosis

To arrive at an accurate diagnosis, your doctor will first review your medical history and perform a thorough pelvic and physical exam. Many women with adenomyosis will likely have a enlarged or tender uterus during the pelvic exam. To confirm the diagnosis, your doctor may order further tests, such as:

  • Magnetic resonance imaging (MRI): An MRI scan is ordered to obtain high-resolution images to visualize the inner muscles of the uterus.
  • Ultrasound: An ultrasound can assist in diagnosing the condition as well as rule out the possibility of tumors in the uterus.
  • Endometrial biopsy: A small sample of the endometrial tissue in the uterus is taken for testing under a microscope to rule out other causes with similar symptoms.

Treatment for Adenomyosis

Some of the treatment options employed to treat adenomyosis include:

  • Anti-inflammatory medications such as ibuprofen can help in alleviating pain and discomfort.
  • Hormonal medications such as progestin intrauterine devices, contraceptive pills, or Depo-Provera injection can help mitigate symptoms.
  • Uterine artery embolization is a procedure that involves the placement of a tube in a major artery in the groin and injecting small particles into the sections affected by adenomyosis to mitigate symptoms.
  • MRI-guided focused ultrasound surgery (MRgFUS) or Ultrasound-Guided High Intensity Focused Ultrasound (HIFU) involves using precisely focused high-intensity waves to generate heat and destroy the affected tissue to relieve symptoms.
  • Hysterectomy is considered a major surgical intervention and is the only definitive treatment for adenomyosis that involves total removal of the uterus. This surgery is only considered for those who do not desire to become pregnant in the future.

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