ADENOMYOSIS

The uterus has three “layers”. The innermost layer is the endometrium, which is the tissue that grows and eventually sheds during a menstrual cycle. The middle layer is the myometrium, which is the muscular wall of the uterus. The contractions of the myometrium are what create the sensation of period cramps. The outermost layer of the uterus is called the serosa, which is a thin layer of cells, almost like the “skin” of the uterus.

Adenomyosis is a condition where the endometrium grows outwards, into the myometrium, where it should not be. This endometrium remains hormonally sensitive, growing and then bleeding during the menstrual cycle (in synch with the rest of the endometrium inside of the uterus, where it is supposed to be!). As you can imagine, this can be very painful. The growth of the tissue into the muscle can also result in an enlarged uterus, often described as “boggy.”

Although some women with adenomyosis may have no symptoms, many women will experience:

· Severe cramping with menstrual cycles (dysmenorrhea)

· Heavy menstrual bleeding

· Chronic pelvic pain

· Pain with intercourse

We are not 100% sure what causes adenomyosis. However, we do know that women who have a history of uterine surgery (for example, a C-section or a myomectomy) may have increased risk of developing adenomyosis.

Although symptoms and a physical exam might suggest the possibility of adenomyosis, the only way to definitively diagnose this condition is to have a hysterectomy – so that a pathologist can confirm the invasion of endometrium into the myometrium. That said, imaging with ultrasound or an MRI is a good way to diagnosis adenomyosis without surgery.

Adenomyosis can be treated medically or with surgery. Options include:

• Anti-inflammatory drugs (NSAIDs). Drugs like ibuprofen decrease the production of prostaglandins (inflammatory hormones that stimulate the uterus to cramp) which can help control pain during the menstrual cycle. The best way to use NSAIDs is 1-2 days before your period even starts, to decrease inflammation from the beginning.
• Hormonal management. Suppressing the menstrual cycle with hormones can work well for controlling adenomyosis pain. Options that are more specifically geared towards management of adenomyosis include progesterone only options:
  • Norethindrone
  • Progesterone intrauterine device (IUD) – The progesterone released by the IUD works locally in the uterus, calming down the endometrium and making it less reactive. The progesterone IUD is a great option for women who want to avoid surgery as well as avoid taking hormones that impact their entire body.
• Surgery. A hysterectomy, or complete removal of the uterus and cervix, is the most definitive way to remove or “cure” adenomyosis. There are many different method of performing hysterectomy, and one method might be more appealing or appropriate for you.