What is adenomyosis?

The inner lining of the uterus is called the endometrium. Adenomyosis happens when the endometrium grows into the muscular wall of the uterus. This displaced endometrial tissue continues to function as it normally would, thickening, breaking down and bleeding during each menstrual cycle.

The ‘invasion’ by endometrial tissue into the muscles of the uterus causes the body to mount a ‘defence’ in order to isolate the adenomyosis. It does this by depositing fibrous tissue to surround the invading tissues, which has an effect similar to that of scar tissue formation. When this happens repeatedly, more tissue builds up, leading to an increase in the uterus size, of up to two or three times its normal size.

Symptoms

This condition is linked with severe cramps before and during periods, heavy bleeding, lower abdominal pressure and bloating. Many women also experience severe pain when moving their bowels or urinating during their period. The pain can be so intense that during menses, the suffering patient avoids passing motion and becomes constipated. Some who do go to the toilet have such severe pain that they faint. The medical term to describe all these symptoms is tenesmus. The condition can be located throughout the entire uterus or localised in one spot.

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 larger 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 condition can affect one’s bowel movements as well; adenomyosis affecting the rectum (which lies just behind the vagina) can cause pain during the passage of stools.

Causes

It is not clear what causes adenomyosis but it is associated with delayed child-bearing and is often an inherited trait linked to endometriosis. The condition happens most often during a woman’s child-bearing years, after having children. Risk factors include prior uterine surgery, such as a C-section or fibroid removal. Women in their 40s and 50s are also at risk. The progress of the condition depends on the amount of estrogen in a woman’s body, so adenomyosis typically disappears after menopause when estrogen levels decrease.

Patients with adenomyosis face lower fertility rates. Any woman experiencing these symptoms or who suspects that she has adenomyosis should seek advice from an experienced gynaecologist.

The treatment for adenomyosis is usually a laparoscopy or laparotomy to remove the tissue. In more severe cases, a hysterectomy – womb removal – is the only cure.