Adenomyosis is a benign (non-cancerous) condition in which the tissue that normally lines the inside of the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). This abnormal growth can cause the uterus to become enlarged and often results in heavy, painful periods. Although adenomyosis is well recognised for causing significant symptoms, it can be asymptomatic in up to one-third of patients.
Adenomyosis can present with a range of symptoms, and its severity can vary considerably among individuals. Common signs and symptoms include:
- Heavy menstrual bleeding: Unusually heavy or prolonged bleeding during their periods.
- Painful periods: Severe cramps and pain during menstruation, which can radiate to the lower back or down the legs.
- Chronic pelvic pain and pressure: Ongoing discomfort or a feeling of pressure in the pelvic region is frequently reported, this pain can be aggravated during periods.
- Pain during or after intercourse: Discomfort during intimate moments may occur.
- Enlarged uterus: A pelvic examination might reveal a tender or enlarged uterus; however, the absence of these symptoms does not rule out adenomyosis.
- Coexisting conditions: Adenomyosis can exist alongside other conditions such as endometriosis, fibroids, and polyps, which can complicate the clinical diagnosis.
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Diagnosing adenomyosis
Adenomyosis can present with a range of symptoms, and its severity can vary considerably among individuals. Common signs and symptoms include:
Medical history and symptom discussion: A conversation about menstrual patterns, pain severity, and other symptoms.
Pelvic examination: A physical exam may reveal an enlarged or tender uterus.
Transvaginal ultrasound: This first imaging test assesses the uterus and detects changes in the uterine wall.
Magnetic Resonance Imaging (MRI): MRI may be recommended if ultrasound results are inconclusive.
Treatment options
There is currently no cure for adenomyosis, but treatment can manage symptoms and improve quality of life:
Medical Management
- Pain Relief: Over-the-counter pain medications such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate discomfort.
- Hormonal Therapies
- Combined Oral Contraceptive Pill (COCP): Helps regulate hormone levels, reducing menstrual bleeding and pain
- Hormonal Intrauterine Device (IUD): Releases hormones locally within the uterus to lessen bleeding and pain
- Progestin Therapy: Can reduce or stop menstrual bleeding in some women
- Gonadotropin-Releasing Hormone (GnRH) Agonists: These drugs induce a temporary menopausal state, decreasing hormonal stimulation of the uterine tissue.
Surgical and Other Interventions
- Uterine Artery Embolisation (UAE): A minimally invasive procedure that reduces blood flow to the uterus, potentially alleviating symptoms.
- Hysterectomy: In cases where symptoms are severe and other treatments have failed, surgical removal of the uterus may be considered—generally for women who have completed their families.
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Challenges and Considerations
Adenomyosis can be difficult to diagnose due to its overlapping symptoms with other conditions like fibroids and endometriosis. Many women assume that heavy or painful periods are normal, which can delay diagnosis and treatment. Additionally, the fact that adenomyosis can be asymptomatic in up to one-third of patients means that some women may remain unaware of the condition until further complications arise.
The coexistence of adenomyosis with other conditions also adds complexity to both diagnosis and treatment. As a result, treatment often requires a personalised approach, with ongoing management and follow-up care.
Women in rural and remote areas of Australia face additional hurdles, namely less access to gynaecologists and advanced imagining facilities, lower awareness of adenomyosis, and limited access to treatment. Improving access to specialist care and increasing public education about adenomyosis are essential steps in ensuring timely and effective management for all women, regardless of their location.
