Adenomyosis is the presence of endometriosis within the uterine muscle. In other words, adenomyosis can be defined as the displacement of the endometrial tissue—the inner lining of the uterus—into the uterine muscle (myometrium). As this endometrial tissue forms masses within the muscle, it causes the uterine wall to thicken and become irregular.

What Are the Symptoms of Adenomyosis?

Symptoms of adenomyosis can range from mild to severe. In some women, it may be detected incidentally with no symptoms at all. The most common symptoms of adenomyosis include:

  • Severe menstrual pain (dysmenorrhea)
  • Intermenstrual bleeding or spotting between periods
  • Heavy and prolonged menstrual bleeding (menorrhagia)
  • Pain during sexual intercourse (dyspareunia)
  • Tenderness in the abdominal area
  • Persistent pain or a feeling of discomfort
  • Fatigue, weakness, and depressive mood

How Is Adenomyosis Diagnosed?

Since an adenomyosis patient has endometrial tissue within the uterine muscle, the uterus is larger than normal—often two or three times its typical size. Adenomyosis can be detected or suspected during an ultrasonography. If a diagnosis cannot be confirmed via ultrasound, an MRI may be requested to obtain high-resolution images of the uterus.

How Is Adenomyosis Treated?

Treatment may not be necessary for women who have no symptoms but are suspected of having adenomyosis via ultrasound. However, in cases where symptoms affect daily life, your doctor will suggest one of various treatment options. The choice of treatment depends on age, marital status, and whether the patient wishes to have children. Treatment options available to reduce patient complaints include:

Anti-inflammatory Medications

These medications help reduce blood flow during the menstrual period while also alleviating severe cramps. They are typically started 1-2 days before the onset of the period and continued throughout the duration of menstruation.

Hormonal Treatments

These include oral contraceptives (birth control pills), progestin-only contraceptives (in the form of pills, injections, or intrauterine devices/IUDs), and monthly or three-month depot hormone injections.

Hysterectomy

The only way to completely treat adenomyosis is a hysterectomy, which is the surgical removal of the uterus. This is a final-step surgical intervention and is preferred only in severe cases that do not respond to other treatments or for women who do not plan to have more children.

In summary, adenomyosis is not life-threatening. Many treatment options are available to alleviate complaints. Hysterectomy is the only treatment option that can completely eliminate the symptoms. Since the condition is driven by the hormone estrogen, the absence of this hormone will ensure that the symptoms are suppressed, even if the adenomyosis does not vanish entirely. Therefore, after menopause, the complaints caused by adenomyosis usually resolve on their own.