By: Cassidy Revel, RN, BSN. Health and Wellness Writer and DLHA Volunteer, with editorial support and medical review by the DLHA Team.
Adenomyosis is a non-life threatening disorder of the uterus. The uterus (womb) is a hollow and pear-shaped muscular organ of the female reproductive system. It lies within the female pelvis, between the urinary bladder in front and the rectum at the back.
Anatomically, the uterus is made up of four parts that are named from top to bottom. The top of the uterus is known as the fundus, which is a curved area that connects with the fallopian tubes. This is followed by the body or corpus, which is the main part of the uterus. The body continues with a tubular neck region, called the isthmus, which connects with the lowermost part of the uterus, called the cervix. The cervix lies in the upper part of the vagina and opens into it (see figure 1).
Figure 1: Showing basic anatomy of the female pelvis and uterus. Click on image to expand.
The uterus also has three concentric and distinct layers. The single cell tissue layer forming tubular glands that are supported by a rich meshwork of blood vessels is called the endometrium and it lines the inner cavity of the uterus. Next, is the muscular layer, which is also known as the myometrium; and next to the myometrium externally is the serous layer that is also called the serosa.
The uterus functions to nurture the fertilized egg that implants in the endometrium during pregnancy and it is where the baby grows until it is born. It is also responsible for the female period or menstrual period (menstruation) each month.
So, with this background knowledge of the basic anatomy and function of the uterus, you can now have a better insight into adenomyosis.
Adenomyosis is a condition in which the lining of the uterus (endometrium) grows abnormally into and develops within the muscle wall (myometrium) of the uterus (see figure 2). It is a benign, non-cancerous condition and does not threaten a woman’s health or her life. It is possible to have no symptoms, however for the majority who do have symptoms, it can be very uncomfortable and disruptive to their daily activities. [1]
Fig. 2: Showing uterine adenomyosis, i.e., endometrial tissue growing abnormally within the myometrium. Click on image to enlare. Adapted from: Harada T et al. 2016.[4]
The exact cause of adenomyosis is unknown. It most often occurs in women between the ages of 35-50. There is an increased incidence of adenomyosis in women who have had two or more pregnancies, as well as those who have menstrual cycles that are close together with ongoing bleeding. Because of this, exposure to estrogen is thought to be a factor in developing adenomyosis. A history of uterine surgery, such as a C-section or D&C (dilation and curettage), may also increase risk of adenomyosis. Smoking is another possible risk factor that is being studied. [2]
There is a probable link between other gynecologic disorders that cause abnormal tissue growth, as adenomyosis is often seen in conjunction with endometriosis as well as fibroids. According to a population-based study in the United States, African American women have close to two times higher incidence of adenomyosis than their white counterparts. [3] The burden of adenomyosis in African women is unknown, but deserves study to inform care, given the high burden of fibroids in this population.
Studies have shown that women with adenomyosis have poorer reproductive outcomes than women without it. However, the exact reason has not been concluded, as many who have adenomyosis also have endometriosis, which is a known cause of infertility. Additionally, there is a link between women with adenomyosis and recurrent miscarriage as well as recurrent failure of a fertilized embryo to implant into the uterus. [4, 5, 6]
The heavy bleeding associated with adenomyosis increases the risk of anaemia due to heavy blood loss.
Anaemia is a medical condition characterised by a deficiency of red blood cells (RBCs) or a reduced hemoglobin level. Symptoms may include fatigue, weakness, shortness of breath, pale skin, and dizziness. Blood transfusion is necessary in some cases of severe anaemia to increase RBC count and enhance the body’s oxygen-carrying capacity.
These include:
Adenomyosis causes the uterus to grow larger than normal, often more than doubling in size.
Your gynaecologist will record your medical history with attention to your reproductive system and discuss with you any concerning symptoms. A pelvic exam will be performed, and if adenomyosis is suspected, a transvaginal ultrasound can aid in diagnosis. Undergoing an MRI (magnetic resonance imaging) might be useful for further information, as it gives a detailed image of your abdomen and uterus.
The treatment of adenomyosis includes the use of anti-inflammatory medication, hormonal therapy and surgery. Some women may choose medical options to manage their symptoms until they reach menopause or decide to stop child bearing, at which point they can consider surgical treatment.
Anti-inflammatory medications like NSAIDS are often prescribed for pain management. Hormonal therapy may be helpful in managing symptoms. Hormonal birth control may be prescribed to decrease the pain and severity of periods. Oral progesterone and IUDs (intrauterine devices) may also help with severe period symptoms.
Currently, there are no evidence based guidelines to treat adenomyosis that are minimally invasive. Surgical intervention may be necessary for severe symptoms. [7]
Endometrial ablation in which the uterine lining is permanently removed and uterine artery embolisation (UAE) which stops blood supply to the uterus can effectively stop the pain and heavy periods associated with adenomyosis. However, they both can only be performed when future pregnancy is not desired and the woman is finished having children.
A hysterectomy, or removing the uterus, is the current best option for completely curing adenomyosis.
Looking to the future, MRI guided focused ultrasound is a newer intervention that is currently being researched for the treatment of adenomyosis symptoms. It has been effective in treating some fibroids and there is evidence to show it may be a minimally invasive option in the future for treating adenomyosis. [8]
As the exact cause of adenomyosis is unknown, there is nothing specific you can do to prevent the condition.
You should not despair if you live with adenomyosis. As it is not life threatening and cancerous, the various medical options available can provide comfort and relief from the symptoms. Time itself helps to ease the pain and discomfort associated with the condition. After menopause, you may notice that the symptoms of adenomyosis fade considerably or disappear. However, do not hesitate to see your primary care doctor or gynaecologist anytime you feel that the symptoms of adenomyosis are too unbearable. [9]
1. NHS Inform. Adenomyosis. [Internet. Last update 28 Feb. 2023 (2023]). Accessed January 9, 2024. Available from: https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/adenomyosis/
2. Khan KN, Fujishita A, Mori T. Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility. Journal of Clinical Medicine. 2022; 11(14):4057. https://doi.org/10.3390/jcm11144057
3. Yu O, Schulze-Rath R, Grafton J, Hansen K, Scholes D, Reed SD. Adenomyosis incidence, prevalence and treatment: United States population-based study 2006-2015. Am J Obstet Gynecol. 2020 Jul;223(1):94.e1-94.e10. doi: 10.1016/j.ajog.2020.01.016.
4. Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The Impact of Adenomyosis on Women's Fertility. Obstet Gynecol Surv. 2016 Sep;71(9):557-68. doi: 10.1097/OGX.0000000000000346.
5. Mahajan N, Kaur S, Alonso MR. Window of Implantation is Significantly Displaced in Patients with Adenomyosis with Previous Implantation Failure as Determined by Endometrial Receptivity Assay. J Hum Reprod Sci. 2018 Oct-Dec;11(4):353-358. doi: 10.4103/jhrs.JHRS_52_18.
6. Mishra I, Melo P, Easter C, Sephton V, Dhillon-Smith R, Coomarasamy, A. Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis. Ultrasound in Obst. & Gyne. 62,(1) 2023. P 23-41. https://doi.org/10.1002/uog.26159
7. Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2013 Sep;73(9):924-931. doi: 10.1055/s-0033-1350840.
8. Dev B, Gadddam S, Kumar M, Varadarajan S. MR-guided focused ultrasound surgery: A novel non-invasive technique in the treatment of adenomyosis -18 month's follow-up of 12 cases. Indian J Radiol Imaging. 2019 Jul-Sep;29(3):284-288. doi: 10.4103/ijri.IJRI_53_19.
9. Yale Medicine. Uterine Adenomyosis: Overview. [Internet, n. d.]. Accessed January 7, 2024. Available from: https://www.yalemedicine.org/conditions/uterine-adenomyosis.
Published: January 10, 2024
© 2024. Datelinehealth Africa Inc. All rights reserved.
Permission is given to copy, use and share content for non-comercial purposes without alteration or modification and subject to attribution as to source.
DATELINEHEALTH AFRICA INC., is a digital publisher for informational and educational purposes and does not offer personal medical care and advice. If you have a medical problem needing routine or emergency attention, call your doctor or local emergency services immediately, or visit the nearest emergency room or the nearest hospital. You should consult your professional healthcare provider before starting any nutrition, diet, exercise, fitness, medical or wellness program mentioned or referenced in the DatelinehealthAfrica website. Click here for more disclaimer notice.
