Adenomyosis is a condition where the tissue that normally lines the uterus (endometrial tissue) grows in to the muscular wall of the uterus with resulting overgrowth of the surrounding muscle. As a result an enlarged uterus and painful, heavy periods can occur as well as pain during or after intercourse (dyspareunia). It is important to remember that adenomyosis is totally different from endometriosis, although the symptoms may be similar.
In endometriosis cells that are similar to those that line the uterus are found in other parts of the pelvis such as the ligaments of the uterus or the ovaries. The area of the uterus most commonly affected by adenomyosis is known as the endometrial/myometrial junction. This is the area where the endometrium and myometrium (which is the muscular part of the uterus) are joined. It may be localised in one area which is known as an adenomyoma or be more generalised. The causes of adenomyosis are not known but there are many theories.
HOW IS ADENOMYOSIS DIAGNOSED?
The symptoms of heavy menstrual bleeding, period pain and discomfort with intercourse usually raises suspicions. The uterus may be enlarged and tender on internal examination. Ultrasound findings of enlargement of the uterus especially the muscle layer may be diagnostic. Usually the classical triad of symptoms of heavy periods, painful periods and discomfort with intercourse together with a suggestive ultrasound makes the diagnosis.
WHAT ARE THE TREATMENTS OPTIONS?
Management of adenomyosis includes hormonal therapy or surgery. These treatments are usually targeted at reducing symptoms such as pain and heavy bleeding. Non-steroidal anti-inflammatory drugs (NSAIDS) are useful for pain. Tranexnamic acid (Cyklokapron) can be used to reduce heavy menstrual bleeding. Oral progesterone can also be used to control menstrual bleeding as can a continuous combined oral contraceptive. Progesterone releasing IUD (Mirena) is an effective form of treatment in women who do not wish to conceive.
Adenomyosis is an infiltrative lesion that is not easily removed surgically from the normal uterine wall. An endometrial ablation is a possible option. This works by destroying the lining of the uterus and results in absent or lighter periods. It often does not solve the issue of pain however. If definitive treatment is required in a woman who has completed her family and where conservative treatment has failed, laparoscopic hysterectomy may be an option.
Len will discuss this condition in detail with you and then discuss the possible treatment options.
With over three decades of experience, Dr Len Kliman has treated tens of thousands of gynaecological patients and delivered over 20,000 babies – and still counting!
In 2017, Dr Kliman was awarded an Order of Australia for his services to obstetrics and gynaecology.