Adenomyosis- What are you Missing?

Adenomyosis- What are you Missing?

Adenomyosis is a complex disease that can cause varieties of symptoms including severe pain in the pelvic area and excessive bleeding. This condition manifests itself when the cells from the inner lining of the uterus migrate and lodge into the muscular wall of the uterus, the myometrium.

This collection of cells can lead to an increased mass of the uterus. Women who know the signs and symptoms of adenomyosis can have the benefit of early diagnosis and treatment. Keep reading to find out more about adenomyosis and how it can affect your uterus.

What is Adenomyosis?

Adenomyosis is a disease in which the cells present in the inner layer of the uterus- the endometrium- start to migrate towards the middle layer of the uterus- the myometrium. The myometrium is a muscular layer, therefore lodging of abnormal cells in this layer can cause painful cramps.

What Causes Adenomyosis?

The main cause of adenomyosis is still unknown. One theory suggests that changes in the genes of endometrium cells invoke the cells to migrate and get lodged into the normal myometrium of the uterus. Another theory suggests that the cells inside the myometrium layer of the uterus get converted into endometrial cells.

Do Adenomyosis and Endometriosis Resemble?

Although both of these diseases can occur together, however, they are different. Endometriosis occurs when the endometrial cells (cells lining the uterus) are present at any place outside the uterus. Adenomyosis is when these cells are not located anywhere else but within the uterus itself.

Both can have the same symptoms like intense cramps, but endometriosis usually presents with lesser bleeding.

Image source: step2.medbullets

How Many People Suffer from Adenomyosis?

Adenomyosis is a relatively common disease but most of the doctors are unable to diagnose the disease. An ultrasound scan is usually performed by the doctors as a differential screening for fibroids. But adenomyosis is hard to visualize on ultrasound. MRI is a confirmatory way to visualize and detect adenomyosis.

What Are the Signs and Symptoms of Adenomyosis?

Although adenomyosis cannot be termed as a malignant or pre-malignant disease, however, it can cause severe pain and excessive bleeding in women. Nearly 30% of the women suffering from adenomyosis do not feel any symptoms.

Following are some of the symptoms of adenomyosis:

  • Excessive bleeding
  • Intense pain in the pelvic area
  • Pain radiating to the legs and back; pressure in the pelvis; distention of abdomen
  • Blood clots in the legs and pelvis

Who Should Perform my Adenomyosis Surgery?

While opting for surgical ways to get rid of adenomyosis, it is preferred that a minimally invasive technique is used by GYN surgeon. Surgeons from CIGC have the required training and experience to make sure this operation goes without any complications, lesser scars, and with a rapid recovery.

Why shouldn’t an OBGYN perform an adenomyosis surgery?

Your OBGYN would be a good doctor, but this doesn’t make him/her a good surgeon. OBGYN is a generalist, not a specialist in surgery. The vast majority of the patients in OBGYN setup come with complaints related to obstetrics.

As these doctors don’t get enough patient volume to learn the best surgical techniques, it is advised that people with adenomyosis refer to specialized surgeons for the best care. On average an OBGYN performs no more than 27 hysterectomies per year.

On the other hand, a hyena specialist surgeon performs at least 400 hysterectomies a year. As a heavy surgical volume is must develop and maintain a good surgical expertise, patients can see why a specialized surgeon is a better option for their adenomyosis treatment.

Image source: contemporaryobgyn

A specialist surgeon would normally use a minimalist invasive technique to remove adenomyosis. These types of surgeons see a wider range of cases, perform high numbers of surgeries, and undergo intense training.

These surgeons are able to perform almost any type of GYN surgery with the least complication rates. Whether it is a definitive surgery or a conservative surgery, it is vital that you always refer to a specialist for better care.

How to Diagnose Adenomyosis?

The single best way to ensure adenomyosis in a patient is through the help of pathological tests. The pathologist will examine the uterus after a completed hysterectomy. Imaging studies, specifically MRI, can be used to ensure adenomyosis, but they are not that accurate as a report by a pathologist.

MRI can be the second best option to diagnose adenomyosis. The main finding on an MRI scan will be the presence of a thickened junction zone.

This junction zone can be found on the myometrium- the thinnest muscular layer of the uterus. Sometimes, adenomyosis can be mistaken for fibroids as both of them appear as large clusters of cells. An ultrasound scan can also be used to check whether or not adenomyosis is present, but its accuracy is way lesser than an MRI.

An ultrasound scan will show a large ‘globular’ uterus, a thick endometrial lining, and a heterogeneous uterine wall.

Doctors also use the history of a patient to make a preliminary diagnosis. By studying the reported symptoms, they can make a guess the presence of this disease. As adenomyosis can occur with other diseases at the same time, therefore it can be missed by some clinicians.

For example, women with a presenting complaint of heavy menstrual bleeding can have both adenomyosis and fibroids.  As fibroids are known to cause heavy bleeding, one may think it’s the fibroids that are causing the bleeding. However, if the fibroids are removed, the bleeding will still persist as adenomyosis is still there, untouched.

Image source: radiopaedia.

How to Treat Adenomyosis?

The only way to treat adenomyosis is to perform a hysterectomy. Fibroids have a clear boundary between the normal tissue and the abnormal tissue. This is the reason they can be easily scraped away. However, in the case of adenomyosis, there is no clear boundary between the normal and the abnormal tissue. This is the reason hysterectomy is the only way to treatment for adenomyosis.

It will be worth mentioning here that adenomyosis is the disease of the uterus, not the ovaries. Therefore it is suggested that the patients choose their surgeons carefully. Many untrained surgeons perform a hysterectomy and remove the ovaries along with the uterus.

This can lead to earlier menopause and other unwanted symptoms. A minimalist surgeon must always be preferred who places minimal cuts and ensures the ovaries are not damaged.

Will Menopausal Symptoms Appear after Adenomyosis Surgical Management?

Many patients suffering from adenomyosis fear that the removal of the uterus will make them menopausal. That’s not going to happen. The ovaries are organs which produce hormones that regulate the occurrence of menopause.

If after the surgery, the ovaries are left in place, the patient will never suffer from menopause and all the symptoms that accompany it. The woman will go through menopause at the time dictated by her ovaries.

The only visible change that the woman will see is the lack of menstrual cycles.

Unless there is any cancer or a risk of cancer, the ovaries will remain intact in their place. Speaking with your GYN specialist can be useful to talk about your long-term goals and how various therapies can help you get that goal effectively.

Make sure you discuss at length the transition between and after the hysterectomy and how to get past the early days.


Nancy Walker

Nancy holds a Medicine degree and a Masters of Science MS in Infectious Disease and Global Health (MS-IDGH) from Tufts University. She worked as a lecturer for three years before she turned towards medical writing. Her area of interest are infectious diseases; causes, mechanism, diagnosis, treatments and prevention strategies. Most of her writings ensure an easy understanding of uncommon diseases.

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