WHILE ENDOMETRIOSIS HAS BEEN MUCH DISCUSSED, THE MORE SEVERE FORM, ADENOMYOSIS, IS NOT often heard of. This is a strange situation as those with adenomyosis are the ones suffering the most with severe pre-menstrual cramps and, excrutiating pain during periods, usually accompanied by heavy bleeding. Many of these sufferers also have severe pain when moving their bowels during periods. Of these, some are so fearful of bowel movements that they stay constipated throughout the period. Some who do go to the toilet may have such severe pain that they faint. The medical term to describe all these symptoms is tenesmus.

This invasion of the muscles of the uterus causes the body to mount a defence to isolate the adenomyosis by depositing fibrous tissue to surround the invading tissue, similar to formation of scar tissue. Repeated breaching of the defence and the laying down of more tissue aimed at isolating adenomyosis tissue leads to an increase in size of the uterus (up to two or three times its normal size) forming what is known as an adenomyoma.

Like endometriosis, the main symptoms of adenomyosis include severe period pains and heavy periods. Women with the condition normally seek help from doctors to address these symptoms. In severe forms of adenomyosis, the uterus can be large enough to press on the bladder causing frequent visits to the toilet. A patient’s lower abdomen may also seem bigger or feel tender. Other symptoms include pain during intercourse, bleeding between periods and passing blood clots during your period. Sometimes, the disease is silent, causing no signs or symptoms.

The illness can affect one’s bowel movements as well; adenomyosis affecting the rectum (which lies just behind the vagina) can cause pain during passage of stools (tenesmus). The pain can be so intense that during menses, the suffering patient avoids passing motion and becomes constipated. The treatment for a case like this is usually laparoscopy or laparotomy to remove the tissue causing the pain. And for women who experience severe discomfort from adenomyosis, undergoing a hysterectomy is the only cure.

The cause of adenomyosis, like endometriosis, is unknown. The disease happens to patients most often during childbearing years, after having children. Prior uterine surgery such as a C-section or fibroid removal and being middle aged (40s to 50s) are also risk factors. The growth of the illness depends on the amount of estrogen in a woman’s body. Thus, adenomyosis typically disappears after menopause when estrogen production decreases.

Like endometriosis, patients with adenomyosis have lower fertility rates. This could be a problem for women who wish to children. If you have any of the aforementioned symptoms or suspect that you may have adenomyosis, seek the advice of an experienced gynaecologist.