Adenomyosis

Adenomyosis is a relatively common condition, resulting from growth of the endometrial or uterine lining glands in the wall of the uterus. Generally, the glands of the uterine lining are limited only to the uterine cavity. Adenomyosis, unike endometriosis, is restricted to the wall of the uterus and the two conditions are discovered in the same patient less than 20% of the time. They are two different diseases however, both adenomyosis and endometriosis have the presence of endometrial glands in areas where they should not ordinarily grow. Adenomyosis usually occurs in women between ages 35 to 50. The majority of the women who have symptoms from it have had more than one vaginal delivery and the incidence seems to increase with multiple deliveries. The most common symptoms are menstrual cramps and very heavy menstrual periods. Also commonly seen is a lower pelvic fullness, low back pain, pain with intercourse (generally deep penetration) and sometimes pain with pelvic exam or Pap smear. Also, commonly seen is pre- and post-menstrual period spotting. Often on exam, the physician will note that the uterus is slightly enlarged and sometimes double the size it ordinarily would be. Ultrasound can suggest this diagnosis in many cases. Although depending on the involvement of the uterine wall, the pelvic ultrasound may appear normal. In cases where adenomyosis can be seen on ultrasound, generally what is seen is a disturbance throughout the wall of the uterus. In the past, the diagnosis was only made after hysterectomy, but now with advanced vaginal ultrasonography and careful attention to patient’s symptoms, many OB/GYN’s feel the diagnosis can be made prior to surgery. Treatment ranges from hormonal treatments, such as progestins or birth control pills. Other treatments include suppression of the menstrual cycle with medication, such as Depo-Lupron. Depo-Provera is helpful for some patients. Surgical approaches can include endometrial ablation. In this procedure, the lining ofthe uterus is ablated, which may help the symptoms of heavy periods, but may also at the same time trap some of the glands in the wall of the uterus so that pain and painful sex continues. The most definitive treatment is hysterectomy.

Many patients with adenomyosis have only minor symptoms that can be controlled with simple over-the-counter medications, such as nonsteroidal anti-inflammatory agents like Anaprox, Aleve, Nuprin or Advis. Some patients, however, are incapacitated by their symptoms and need treatment. If you feel you are suffering from these symptoms, you and your doctor should work out a careful plan to approach them, as there are many options available.