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Adenomyosis - Causes, Symptoms, Diagnosis, and Treatment

What is adenomyosis?

Adenomyosis is a non-cancerous condition in which the cells of the endometrium grow into the muscular walls of the uterus. When the lining cells of the uterus bleed at the time of the menstrual period, these misplaced cells in the muscle bleed as well. And bleeding directly into the muscle causes pain. As the blood accumulates, the surrounding muscle swells and forms fibrous tissue in response to the irritation. In most cases adenomyosis is harmless and painless, but in some cases it can lead to difficulties in getting pregnant or sustaining a pregnancy.

Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis.

What are adenomyosis types?

Adenomyosis may present as a diffuse condition or it may be focal. In the latter, there are local areas of swelling that may mimic other uterine masses. Focal adenomyosis is morphological sub type of uterine adenomyosis. Some author regard this term synonymous with an adenomyoma. It is considered less common than diffuse uterine adenomyosis.

Women with diffuse adenomyosis have an enlarged and tender uterus.

What are adenomyosis causes?

The cause of adenomyosis remains unknown, but the disease typically disappears after menopause. Women who:
-  in their childbearing years are more likely to develop adenomyosis
-  over 30 years of age
-  have had previous cesarean section or other uterine surgery
are at a higher risk for developing adenomyosis.

Researching the causes of these these diseases that may be similar, or associated with Adenomyosis:
- Endometriosis
- Estrogen imbalance
- Pelvic Inflammatory Disease
- Fibroids
- Mefanamic acid

What are adenomyosis symptoms?

Women may not have any outward symptoms this has happened to them, but it may become very painful. Adenomyosis may cause:
- Heavy or prolonged menstrual bleeding
- Severe cramping or sharp, knife-like pelvic pain during menstruation (dysmenorrhea)
- Menstrual cramps that last throughout your period and worsen as you get older
- Pain during intercourse
- Bleeding between periods
- Passing blood clots during your period

How is adenomyosis diagnosed?

Until recently, the only definitive way to diagnose adenomyosis was to perform a hysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.

If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms.

Another technique sometimes used to help evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, saline solution is injected through a tiny tube into the uterus before an ultrasound is given.

MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of adenomyosis in women with abnormal uterine bleeding.

Because the symptoms are so similar, adenomyosis is often misdiagnosed as uterine fibroids. However, the two conditions are not the same. While fibroids are masses of tissue attached to the uterine wall, adenomyosis is a growth within the uterine wall. An accurate diagnosis is key in choosing the right treatment.

How is adenomyosis treated?

Treatment options for adenomyosis include:

Anti-inflammatory drugs. If you're nearing menopause, your doctor may have you try anti-inflammatory medications to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow and help relieve pain.

Hormone medications. Controlling your menstrual cycle through combined estrogen-progestin oral contraceptives or through hormone-containing patches or vaginal rings may lessen the heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device containing progestin or a continuous-use birth control pill, often leads to amenorrhea — the absence of your menstrual periods — which may provide relief.

Hysterectomy. If your pain is severe and menopause is years away, your doctor may suggest surgery to remove your uterus (hysterectomy). Removing your ovaries isn't necessary to control adenomyosis.


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