Overview

Adenomyosis (ad-uh-no-my-O-sis) occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscle wall of the uterus. The displaced tissue acts normally during each menstrual cycle – thickening, breakdown and bleeding. An enlarged uterus and painful, heavy periods can result.

Doctors aren’t sure what causes adenomyosis, but the disease usually goes away after menopause. Hormonal treatments may be helpful for women with severe adenomyosis symptoms. Removing the uterus (hysterectomy) cures adenomyosis

Symptoms

Sometimes adenomyosis causes no signs or symptoms or only mild discomfort. However, adenomyosis can cause:

Heavy or prolonged menstrual bleeding
Severe cramps or sharp, knife-like pelvic pain during menstruation (dysmenorrhea)
Chronic pelvic pain
Painful intercourse (dyspareunia)
Your uterus may get bigger. Although you may not know if your uterus is larger, you may notice tenderness or pressure in your lower abdomen.

Causes

The cause of adenomyosis is not known. There have been many theories including:

Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that makes up the walls of the uterus. Uterine cuts made during an operation such as a caesarean section (caesarean section) can encourage endometrial cells to penetrate directly into the wall of the uterus.
Origins of development. Other experts suggest that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
Inflammation of the uterus associated with childbirth. Another theory suggests a connection between adenomyosis and childbirth. Inflammation of the lining of the uterus during the postpartum period can break the normal boundary of the cells that line the uterus.
Stem cell origin. A recent theory suggests that bone marrow stem cells could invade the uterine muscle and cause adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the body’s circulating eses

Treatment

Adenomyosis often goes away after menopause, so treatment may depend on how close you are to this stage in life.

Treatment options for adenomyosis include:

Anti-inflammatory drugs. Your doctor may recommend anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others), to control pain. By starting an anti-inflammatory medicine one to two days before your period starts and taking it during your period, you can reduce menstrual blood flow and help relieve pain.
Hormonal drugs. Combination estrogen-progestogen birth control pills or patches containing hormones or vaginal rings can reduce heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device, or continuous use birth control pills often cause amenorrhea – the absence of your period – which may provide some relief.
Hysterectomy. If your pain is severe and no other treatment has worked, your doctor may suggest surgery to remove your uterus. Removing your ovaries is not necessary to control adenomyosis.

Diagosis

Some other uterine diseases can cause signs and symptoms similar to adenomyosis, making adenomyosis difficult to diagnose. These conditions include fibroid tumors (leiomyomas), uterine cells that grow outside the uterus (endometriosis), and growth in the lining of the uterus (endometrial polyps).

Your doctor might conclude that you have adenomyosis after ruling out other possible causes of your signs and symptoms.

Your doctor may suspect adenomyosis based on:

Signs and symptoms
A pelvic exam that shows an enlarged, tender uterus
Ultrasound imaging of the uterus
Magnetic resonance imaging (MRI) of the uterus
In some cases, your doctor may take a sample of uterine tissue for testing (endometrial biopsy) to make sure you don’t have a more serious condition. However, an endometrial biopsy will not help your doctor confirm a diagnosis of adenomyosis.

Pelvic imaging such as ultrasound and MRI can detect signs of adenomyosis, but the only way to confirm this is to examine the uterus after a hysterectomy.

Risk factor

Risk factors for adenomyosis include:

Previous uterine surgery, such as cesarean section, fibroid removal, or dilation and curettage (D&C)
Delivery
Middle ages
Most cases of adenomyosis – which depend on estrogen – are found in women between the ages of 40 and 50. Adenomyosis in these women could be linked to longer exposure to estrogen compared to that in younger women. However, current research suggests that the condition could be common in younger women as well.

Complications
If you often have heavy and prolonged bleeding during your period, you can develop chronic anemia, which causes fatigue and other health problems.

While not harmful, the pain and excessive bleeding associated with adenomyosis can disrupt your lifestyle. You may want to avoid activities that you have enjoyed in the past because you are in pain or are worried about starting to bleed.

Health condition

Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.

Though the cause of adenomyosis isn’t known, studies have suggested that various hormones – including estrogen, progesterone, prolactin, and follicle stimulating hormone – may trigger the condition.

When to see docter

A woman who is not trying to get pregnant or who does not experience symptoms may not need treatment. Any woman who suspects adenomyosis or endometriosis should see their doctor for evaluation.

If a woman is having heavy periods or severe uterine cramps, it is important that she mention this to her doctor. These symptoms can indicate other serious conditions, and it is important that the doctor run tests to determine what is causing the problem.

Heavy menstrual bleeding can lead to anemia, which is an iron deficiency. This can make someone feel tired, weak, or shabby and not well. Taking iron supplements can help treat anemia, which can be especially important during menstruation.

If during your period you have prolonged, heavy bleeding or cramping that interferes with your regular activities, make an appointment with your doctor.

Duration

It takes about 6 to 8 weeks to fully recover after an abdominal hysterectomy. Recovery times are often shorter after vaginal hysterectomy or laparoscopy. During this time, you should rest as much as possible and not lift anything heavy, like shopping bags.