Adenomyosis occurs when endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus. The displaced endometrial tissue continues to act as it normally would — thickening, breaking down and bleeding during each menstrual cycle. This results in an enlarged uterus and painful, heavy periods. Symptoms most often start late in the childbearing years after having children.
What Causes Adenomyosis?
The cause of adenomyosis remains unknown, but the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, certain treatments can help, but hysterectomy is the only cure.
Some experts believe that adenomyosis results from the direct invasion of endometrial cells from the lining of the uterus into the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) may promote the direct invasion of the endometrial cells into the wall of the uterus.
Other experts speculate that adenomyosis originates within the uterine muscle from endometrial tissue deposited there when the uterus first formed in the fetus.
Yet another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus. Surgical procedures on the uterus may have a similar effect.
A recent theory proposes that bone marrow stem cells may invade the uterine muscle, causing adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the circulating estrogen in a woman’s body. When estrogen production decreases at menopause, adenomyosis eventually goes away.
What are the Symptoms of Adenomyosis?
Sometimes, adenomyosis is silent causing no signs or symptoms or only mildly uncomfortable. In other cases, adenomyosis may cause:
- Heavy or prolonged menstrual bleeding.
- Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea).
- Menstrual cramps that last throughout your period and worsen as you get older.
- Pain during intercourse.
- Blood clots that pass during your period.
- Your uterus may get bigger. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen seems bigger or feels tender.
Treatment of Adenomyosis
Adenomyosis usually goes away after menopause, so treatment may depend on how close you are to that stage of life.
Treatment options for adenomyosis may include anti-inflammatory drugs. If you’re nearing menopause, your doctor may have you try anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow and help relieve pain.
Combined estrogen-progestin birth control pills or hormone-containing patches or vaginal rings may lessen heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device, or continuous-use birth control pills often lead to amenorrhea — the absence of your menstrual periods — which may provide symptom relief.
If your pain is severe and menopause is years away, your doctor may suggest surgery to remove your uterus (hysterectomy). Removing your ovaries isn’t necessary to control adenomyosis.