|What is Adenomyosis?
Adenomyosis (AD-en-oh-my-oh-sis) is a benign (non-cancerous) condition of the uterus. It occurs when the lining of the uterus (endometrium) begins to grow INTO the muscular lining of the uterus, instead of just staying on top of the muscle, as a separate layer. Adenomyosis is similar to Endometriosis, both are conditions in which the lining of the uterus grows where it shouldn't and both are progressive (will continue to grow). But unlike Endometriosis, Adenomyosis confines itself to the uterine wall. Medical science is not sure what causes Adenomyosis, but they don't feel that Adenomyosis and Endometriosis are related
What are the symptoms?
There are no Adenomyosis-specific symptoms, nothing that will definitely point to a diagnosis. Symptoms are different for every woman, but can include: irregular periods, longer than usual periods, heavy bleeding or clotting. Menstrual blood may start to have an unpleasant odor because the lining that is being shed is older than usual. Adenomyosis can also be extremely painful, causing heavy uterine cramps (not always just during the period). Anemia can also become a concern in cases of heavy or prolonged periods. For some, a sciatic-like back pain is also a symptom. Unlike a healthy uterus, a uterus with Adenomyosis may feel boggy, or squishy (during a pelvic exam) and tends to be enlarged, but again, not for every woman. If the uterus is enlarged, it may put pressure on the bladder and reduce bladder capacity, the same as pregnancy does.
How is it diagnosed?
Because Adenomyosis is more "scattered" than either fibroids or endometriosis, it is often overlooked or misdiagnosed. Some more common tests are:
Myometrial needle biopsy: This can be a hit or miss means of diagnosing such a diffuse condition as Adenomyosis.
Trans-vaginal Ultrasounds: This may detect abnormalities of the uterus, but this is not a reliable way to definitely say there is nothing wrong.
Color Doppler Sonography It is useful in determining if the detected abnormalities are Adenomyosis or fibroids, but again, is not definitive in detecting Adenomyosis, or pronouncing the uterus healthy.
MRI: By far the most likely means to diagnose Adenomyosis, but even then, microscopic Adenomyosis will not be picked up.
A Serum CA125 (blood test) This may be useful in detecting Adenomyosis. Women with Adenomyosis usually have a higher level of CA125 (over 35U/ml), than women without (less than 35U/ml).
While all of the above are useful tools, they are probably best used in some combination, rather than relying on only one test. It is estimated that only 15% of Adenomyosis cases are correctly diagnosed before surgery (hysterectomy) and the resulting pathology. Because Adenomyosis grows inside the uterine walls, it is not readily visible with a laparascope (looks inside the abdominal cavity) or a hysteroscope (which looks inside the uterus).
Since Adenomyosis is scattered/diffuse, it is usually not possible to remove only the Adenomyosis. Endometrial Ablation may miss some of the Adenomyosis, especially if the Adenomyosis is very deep into the muscular wall (over 2.5 cm). This leaves endometrial glands beneath the scar that ablation forms. These could not only bleed and cause pain, but the scar could also delay detection of potential malignancies. Synthetic steroid hormones (such as progesterones) are not helpful and may actually increase the level of pelvic pain.
With the onset of menopause, the majority of women will have a decrease in Adenomyosis symptoms.
Removal of the entire uterus (including cervix) is usually recommended as the definitive treatment. Since only the uterus is affected, healthy ovaries need not be removed.