Adenomyosis: What It Is, Why It Happens and Its Symptoms
In adenomyosis, cells of the womb lining grow into the muscle wall of the uterus, which can cause painful, heavy periods. It is not cancer, and it can be treated.
In this article 5 sections
Adenomyosis is a condition in which cells from the lining of the womb (the endometrium) grow into the muscular wall of the uterus. Its exact cause is not yet fully understood, but it is thought to be linked to hormones and damage to the wall of the womb. Its main symptoms are severe pain and heavy bleeding during periods. It is not cancer, and symptoms can be controlled with treatment. In the video, Dr. Sharmin Afroz briefly explains this topic.
01What adenomyosis really is
Normally the lining of the womb thickens each month under the influence of hormones and is shed during the period. In adenomyosis, cells of this lining sit within the muscle but still respond to the monthly cycle in the same way. This causes swelling, trapped blood and pain inside the muscle, and the womb gradually becomes enlarged and tender. It may be spread throughout the womb or, sometimes, form a localised lump called an adenomyoma. It is similar to endometriosis but is a separate condition, although the two can occur together.
02Why it happens: possible causes and risk factors
Researchers suggest several possible causes, such as a weakening of the boundary between the womb lining and the muscle, and the effect of the hormone oestrogen. Factors that may increase the risk include:
- Age between 30 and 50, especially the years before menopause
- Having given birth once or more
- Previous surgery on the womb, such as caesarean section, D&C or fibroid removal
- Periods starting early or short menstrual cycles
However, many women develop adenomyosis without any risk factor, and it is not caused by anything they have done wrong.
03Symptoms
- Severe and progressively worsening period pain
- Heavy periods, passing clots or periods lasting longer
- Anaemia, tiredness and weakness from heavy bleeding
- A feeling of heaviness or bloating in the lower abdomen
- Pain during sex
- In some cases, difficulty conceiving
Many women may have no symptoms, and it is found when an ultrasound is done for another reason.
04Diagnosis and treatment
Diagnosis is based on your symptoms, a physical examination and an ultrasound scan (especially transvaginal) or, if needed, an MRI. A blood test may be done to check for anaemia.
Treatment depends on how severe the symptoms are, your age and whether you want children in the future. Medicines to reduce pain and bleeding and hormonal treatments, such as the hormonal intrauterine device (IUD), work well for many women. For women who have completed their family and have not improved with other treatment, removal of the womb (hysterectomy) can be a permanent solution. Symptoms usually ease after the menopause. Discuss with your doctor which treatment suits you best.
When to see a doctor
If period pain or bleeding is disrupting your daily life, do not put up with it as normal; see a gynaecologist. Go to hospital promptly if you have:
- Bleeding so heavy that you need to change pads every hour, or are passing large clots
- Dizziness, palpitations, breathlessness or feeling faint
- Severe lower abdominal pain, especially with fever
- New bleeding after the menopause
Q & A
Frequently asked questions
Adenomyosis is a benign condition and is not cancer. Your doctor may still do some tests to rule out other causes of abnormal bleeding.
Many women with adenomyosis do conceive. It can sometimes cause difficulties, so if you are planning a pregnancy, discuss it with your doctor early.
Fibroids are distinct lumps of uterine muscle, whereas in adenomyosis lining cells are spread within the muscle. Their symptoms can be similar and both can occur together.
Article & video by
Dr. Sharmin Afroz
Obstetrics, Gynaecology & Infertility Specialist and Laparoscopic Surgeon
Assistant Professor, Department of Obstetrics & Gynaecology, Anwer Khan Modern Medical College & Hospital.
