From symptoms to treatment, two women’s health experts explain this little-known condition

BBC presenter Naga Munchetty recently revealed that she has adenomyosis, a chronic condition of the uterus. She spoke about how her pain can leave her unable to move and how a recent flare-up of illness was so severe that her husband had to call an ambulance.

Still, many people have never heard of this condition, despite the fact that it affects one in five women.

Adenomyosis can cause symptoms such as irregular and heavy menstrual bleeding and pelvic pain. Symptom severity varies from patient to patient — up to a third of women with adenomyosis may have minimal or no symptoms.

The condition can also affect fertility. Women with adenomyosis who do become pregnant are at increased risk of miscarriage, premature delivery, preeclampsia, and postpartum bleeding.

What causes adenomyosis and how is it diagnosed and treated? There’s still a lot we don’t understand about this condition, but here’s a little rundown of what we know so far.

What causes adenomyosis?

There are two main layers in the uterus. The endometrium is the inner layer where embryos implant. If there is no pregnancy, this layer is shed during the period. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions. In people with adenomyosis, endometrial-like cells are in the wrong place—the myometrium.

Although many women with adenomyosis also have endometriosis, adenomyosis is a distinct disease from endometriosis. In endometriosis, too, endometrial-like cells are found in the wrong place, but in this case outside the uterus, mainly in the pelvic cavity.

Thanks to research, public engagement, and social media, awareness of endometriosis has increased in recent years. Nevertheless, adenomyosis is still relatively rare.

Diagnostic options are changing and improving

Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrial-like cells in the myometrium could only be demonstrated by a pathological examination, in which the myometrium is examined under a microscope after a hysterectomy (surgery to remove the uterus).

In recent years, the development of imaging techniques such as MRI and detailed pelvic ultrasound has led to an increase in diagnoses. Although adenomyosis is now often diagnosed without the need for a hysterectomy, physicians are still working to develop a standardized method for nonsurgical diagnosis.

Therefore, it remains unclear exactly how many women suffer from adenomyosis. Although we know that around 20% of women who undergo a hysterectomy for reasons other than suspected adenomyosis show signs of the disease on pathologic evaluation.

Adenomyosis is a complex disease

The type of adenomyotic tissue growth in the myometrium can be either a focal lesion (affecting part of the uterus) or a diffuse lesion (affecting a large muscle area). Adenomyosis can be further classified based on the depth of endometrial-like tissue invasion into the myometrium. Scientists and doctors are still investigating whether the type or depth of the lesions is related to the symptoms – the severity of the symptoms and the severity of the lesions do not always match.

We do not yet understand why some women develop adenomyosis, although there is evidence that prevalence increases with age.

The region between the endometrium and myometrium is believed to be damaged, either through the natural processes of the menstrual cycle, through pregnancy and childbirth, or through medical intervention. In some women, the damage to the lining of the endometrium does not heal as intended, and the endometrial-like cells invade and grow abnormally in the myometrium. These disrupt the normal functions of the myometrium, leading to pain and bleeding.

It is possible that different mechanisms contribute and that there is no common disease-causing factor behind adenomyosis.

How is adenomyosis treated?

Treatment strategies include hormonal medications such as oral contraceptives, progesterone-containing pills, insertion of a progesterone-releasing IUD (such as Mirena), or a drug called GnRHa, which stops the natural production of sex hormones. Non-hormonal treatments include tranexamic acid. The aim of these treatments is to minimize menstrual bleeding. Pain is often treated with nonsteroidal anti-inflammatory drugs.

Treatments that work for some women don’t work for others, supporting the argument that there is more than one type of adenomyosis. Treatment strategies should be tailored to patients, depending on their fertility desires and symptoms.

When medical treatments do not provide adequate symptom relief, surgical options include removal of the focal lesions or a hysterectomy.

What lies ahead?

Although adenomyosis is a common disease affecting many women, including those of childbearing age, it does not receive enough clinical and research attention. In addition, there is a lack of knowledge and awareness of adenomyosis among many healthcare professionals and the general public. This needs to change so that we can improve our understanding of the disease, diagnosis and treatment options.

Scientists and physicians specializing in adenomyosis are still searching for an accurate, non-invasive method of diagnosis and hopefully one day a cure.

This article has been republished by The Conversation under a Creative Commons license. Read the original article.