Adenomyosis

Adenomyosis is a disease that occurs when the cells that normally line the uterus grow into the muscular tissue of the uterine wall. It occurs most frequently in women over age 30 who have had a full-term pregnancy and is rare in women who have not had a full-term pregnancy.

Adenomyosis does not occur after menopause. However, adenomyosis that was present before menopause may be diagnosed after menopause. It may also be found in tissue samples following pelvic surgery in postmenopausal women.

Cause The cause of adenomyosis is not fully understood. Some researchers believe that it is the result of damage to the inner wall of the uterus during pregnancy, labor, delivery, or other surgical procedure.

Symptoms Most women with adenomyosis do not have any symptoms. Adenomyosis is frequently found in uterine tissue biopsies after pelvic surgery, such as laparotomy or laparoscopy, has been performed. When symptoms are present, they include:

• Heavy or prolonged menstrual periods (menorrhagia).
• Painful menstruation (dysmenorrhea).
• Recent onset of menstrual cramping that is gradually getting worse from one period to the next.

Exams and tests When symptoms occur, the evaluation of suspected adenomyosis may include:

• History of symptoms, menstrual periods, and family history.
• Routine pelvic exam, which may reveal a large, soft, or tender uterus.
• A sample of the tissue of the wall of the uterus (endometrial biopsy).
• Pelvic ultrasound, which may help distinguish adenomyosis from other pelvic tumors.
• Hysteroscopy. This test allows the doctor to examine and take samples of the lining of the uterus.
• MRI of the pelvis.

The diagnosis of adenomyosis can be made only after a pathologist examines uterine wall tissue samples. Adenomyosis is often discovered following a hysterectomy.

Treatment Most women with adenomyosis do not have any symptoms. When pelvic pain or heavy menstrual bleeding are present, suspected adenomyosis is often successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs). A hysterectomy may be needed if you have severe symptoms but are not approaching menopause. Symptoms go away after menopause is complete or following hysterectomy.

What to think about The use of birth control pills may make symptoms of heavy bleeding or pain worse. Symptoms go away after menopause is complete or following a hysterectomy.

When to call If you have symptoms of adenomyosis, call your health professional to schedule an appointment.