Tag Archives: Endometriosis

Adenomyosis: Symptoms, Causes and Risk Factors

Adenomyosis: Symptoms, Causes and Risk Factors

We’ve all heard about endometriosis, a condition in which the uterine lining (endometrium) develops outside the uterus and grows on other organs within the abdomen, including the ovaries. There is another condition that can take place with the endometrium, known as uterine adenomyosis. This condition affects women, mostly in child-bearing years, and can be quite painful. Although most women have never heard about it, near 20 percent of them are affected by it.

History and Definition of Adenomyosis

Whereas it was described as early as 1860, adenomyosis was not properly diagnosed or named until the early part of the 20th century. In 1908, Thomas Cullen investigated its causes and named it, determining it was not an inflammation of the uterus, because it did not present any signs.

Not until 1972 did a proper definition come about, made by Dr. Charles C Bird, MD. At that time, adenomysis was described a “benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma, surrounded by the hypertrophic and hyperplastic myometrium”.

What Is Adenomyosis?

What Is AdenomyosisAdenomyosis is a condition in which the endometrium, instead of growing out into the uterus, grows into the uterine wall (myometrium). Each time the lining (endometrium) is stimulated, during the menstrual cycle, the trapped lining in the myometrium is also stimulated and can make menstrual cramps and pain worse. This can disrupt the quality of life for the women who have to deal with it. And because adenomyosis symptoms vary due to he flux of estrogen levels going up and down, the menstrual cycle brings more discomfort than usual.

The condition can either be generalized adenomyosis, spread out over a large area of the uterine wall, or localized a small area or spot, also known as adenomyoma. The area that is affected by adenomyosis is called the endometrial-myometrial junction, where the endometrium and myometrium meet. It is the disruption of this junction – adenomyosis – that is considered a contributing factor in the failure of eggs to settle and stay in the uterus, thus preventing women from becoming pregnant.

Symptoms and Treatment

In spite of it being a benign condition, adenomyosis symptoms run the gamut and include:

  • Painful periods (dysmenorrhea)
  • Heavy periods (menorrhagia)
  • Bloody discharge or spotting between periods (metrorrhagia)
  • Bloating during pre-menstruation
  • Pain during or after sex (dyspareunia)
  • Chronic pelvic pain
  • Tender uterus and larger than normal in size

Women may also suffer from depression, irritability and reduced fertility or infertility. However, when women go into menopause and their estrogen levels drop, so do the symptoms of adenomyosis.

Drugs and Hormones

Adenomyosis treatments vary with the severity of the symptoms that present themselves. If the symptoms are mild enough, doctors can treat them with anti-inflammatory drugs and hormonal treatments. Usually they include contraceptive pills and IUDs. Certain surgeries can be performed that will treat the condition as well.

Uterine Artery Embolization

This procedure is usually used for uterine fibroids, but if the adenomyosis is just a small area or spots, this surgery could take care of it. The blood supply to the affected area is cut off and the adenomyosis shrinks. A 2007 study showed that after three to five years, the symptomatic pain was reduced by half and the success of the procedure was about 60 percent. This minimally invasive procedure leaves no scars.

Endometrial Ablation

Considered as a last resort procedure, endometrial ablation is conducted when other options have failed to relieve the symptoms. Because it destroys the endometrium, this is a permanent solution, like a hysterectomy and will only be done if the woman no longer wishes to become pregnant. It does, however, relieve the symptoms of adenomyosis, and the woman either has no more periods or has reduced bleeding. This may not work if the endometrium has infiltrated too far into the myometrium (uterine muscle wall).

MRI Surgery

MRI guided focused ultrasound surgery (MRgFUS) uses an MRI in real time to monitor focused high-intensity waves that create heat and destroy the targeted tissue. This is an early stage, non-invasive procedure that requires an overnight stay in a hospital or surgicenter setting. Because the uterus remains, this procedure allows a woman to still have children. The side effects are few and the prognosis is good, but it is not recommended for a woman who also has endometriosis.

Hysterectomy

Hysterectomy is the only treatment that will eliminate all adenomyosis symptoms effectively and permanently. Hysterectomies have been the treatment for years, but are only done in severe cases of the condition and if the woman no longer wants to get pregnant. To prevent early menopause, the ovaries may be left in, if they are not affected by endometriosis, which can be a co-occurring condition.

Risk Factors and Causes

Middle-aged women who already have had children (the more children, the greater the risk) or who have had uterine surgery, such as a cesarean, or an inflammation after childbirth are more at risk for adenomyosis, however it can affect any woman before menopause. But a root cause has still not been found.

One of the risks of having adenomyosis is anemia from the blood loss each month. Anemia is a condition caused by an iron deficiency. This means the body cannot make enough red blood cells to carry oxygen to the various parts of the body. Dizziness, fatigue, and irritability ensue and can lead to depression and anxiety.

Adenomyosis Diagnosis

In the past, the only way to diagnose adenomyosis was postoperatively and it had never been fully characterized nor any epidemiological studies made, mostly due to the fact that surgical removal was also the only way to get rid of the symptoms. Adenomyosis was severely understudied and understood until recently, when better diagnostic tools became available. However, doctors have done extensive studies in recent years and have discovered much from the information.

A 2008 study determined that adenomyosis was just a variant and not a disease on its own. The symptoms that are associated with this condition, are also symptomatic of endometriosis and uterine fibroids, thus the recommendation for a hysterectomy to get rid of all the symptoms has continued to be the best solution.

A paper written in 2010 cited several studies on adenomyosis, one of which was done in Italy in 2009, that concluded women who had had induced abortions, dysmenorrhea or chronic pelvic pain were more likely to have adenomyosis. A different study corroborated that dysmenorrhea and chronic pelvic pain were symptomatic of adenomyosis, adding depression as another factor. A third study determined that women who are diagnosed with adenomyosis most likely also have endometriosis.

Biopsy

One of the preoperative diagnostic tools used are biopsies, using keyhole surgery or laparoscopy in order to take a tissue sample. With the addition of a camera, it has been easier to get a sample, but still no guarantee to get the “right” sample, because adenomyosis doesn’t always present itself readily, like endometriosis. As in the past, several samples would have to be taken to get a good diagnosis. The best way is through the vagina, however that may damage the uterus and may make it more difficult to have children in the future, and going through the abdomen is still only good for endometriosis diagnoses.

Better Methods

With the advent of MRI’s, diagnoses have been easier to make. With the MRI, the endometrium and myometrium are clearly defined and the endometrial-myometrial junction is also clearly distinguishable. The thickening of the affected area of the uterine wall is now also considered confirmation of adenomyosis. An adenomyosis ultrasound or more specifically, a Transvaginal ultrasound (TVU) is another way to diagnose possible adenomyosis. TVU is able to identify myometrial cysts but most importantly, disparities of myometrial texture and composition, which signal the presence of adenomyosis.

Medical Care for Adenomyosis

Adenomyosis is one of two endometrium-related conditions that are fairly common to have. It can cause painful and heavy periods, as well as chronic pelvic pain, bloating and an enlarged, tender uterus. The causes are mostly unknown, however women who have had uterine surgery or trauma, are more at risk than others. Diagnosis can be done more accurately nowadays with MRIs and TVUs, although the best way to get rid of all symptoms, especially if they are extremely painful and risk quality of life, is getting a hysterectomy.

That may not be the best answer for someone with only minor symptoms or who wishes to still have children. There are less invasive and permanent treatments, such as hormonal treatment or minor surgery to excise the involved portion of the uterus.

If you have any of the symptoms and suspect you may have adenomyosis, it’s best to check with your doctor as soon as possible. Following a pelvic exam, he or she may schedule you for an MRI or TVU to get a better look.

Arizona Gynecology Consultants is located in the Phoenix and Mesa metropolitan areas. We provide expert and individualized health and medical services for women of every age, treating each patient as a unique person. Our team specializes in all aspects of women’s health and we are dedicated to practicing excellence in women’s care.

SCHEDULE A CONSULTATION TO SEE IF ADENOMYOSIS IS THE ROOT CAUSE OF YOUR DISCOMFORT.

The Importance in Raising Awareness of Endometriosis

The Importance in Raising Awareness of Endometriosis

This entry was posted in Ask An Expert and tagged on by .

March is Endometriosis Awareness Month, and everyone should understand the value of raising awareness of this medical condition. Although a large number of women develop this condition and it often entails severe adverse symptoms, endometriosis does not seem to receive as much public attention as other medical conditions. This March, take some time to understand this condition and do your part to raise awareness any way you can.

What Is Endometriosis?

EndometriosisEndometriosis is a complex condition that often results in serious and painful symptoms. Endometrium typically grows on the interior of the uterine walls and thickens, breaks down, and then bleeds with each menstrual cycle. When endometrium forms on the outside of the uterine walls, it can affect the ovaries, fallopian tubes, and other pelvic organs in rare cases.

During each menstrual cycle, displaced endometrium tissue acts just like normal endometrium tissue. It breaks down and bleeds, but may not have anywhere to go. Thus, endometrium tissue on the ovaries can cause endometriomas or cysts to form, eventually leading to scar tissue. The surrounding tissues may become irritated and grow fibrous adhesive tissues that bond nearby pelvic organs together. This condition commonly causes severely painful menstrual periods and other symptoms. If left unchecked, it may cause fertility problems.

Risk Factors and Symptoms

There are several indicators that may increase a woman’s risk of developing endometriosis:

  • Never having children
  • An early menarche or first period
  • Late menopause
  • Menstrual cycles less than 27days
  • Exposure to or natural development of excess levels of estrogen
  • Low body mass index
  • Uterine structuralabnormalities
  • Alcohol consumption
  • Family history of endometriosis

Symptoms usually appear within a few years of a woman’s menarche, can pause during pregnancy and then disappear with menopause. The most commonly reported symptom of endometriosis is unduly painful periods, usually starting a few days prior to menstruation and lasting for several days. Women with endometriosis may also experience excessive bleeding, painful urination, bloating, or pain during intercourse.

Treatments

The first line of treatment for endometriosis typically includes medication. Certain types of hormonal birth control medications can help regulate the growth and processing of endometrium tissue and ease symptoms. Hormonal intrauterine devices can prevent pregnancy for up to seven years, but they rarely treat endometriosis symptoms for this long.

If hormonal treatment does not appear effective, surgery is the next line of treatment for severe endometriosis. A surgeon will attempt to remove endometrium tissue deposits and then continue with hormonal treatment following surgery. Over-the-counter pain medicines, holistic treatments, and lifestyle changes can also improve symptoms.

Common Problems Facing Women with Endometriosis

One of the most challenging aspects of endometriosis treatment is the difficulty in obtaining an accurate diagnosis. Pain is subjective, and everyone experiences pain differently. A woman may complain of excessive menstrual pain during her periods, but her gynecologist may simply interpret this as the typical cramping and discomfort associated with menstrual periods.

According to an article published in Endometriosis News, some women have gone through 10 or more doctor visits before finally receiving referrals to specialists. Even more unfortunate is the typical wait time for an accurate endometriosis diagnosis — eight years or longer.

About 10 percent of women of childbearing age develop endometriosis, and while some manage their symptoms relatively effectively, this condition can cause a host of serious medical issues if left unchecked for too long. The most common of these related conditions is infertility. Endometrium tissue may prevent sperm from reaching eggs or even damage reproductive cells. Endometriosis can potentially interfere with any part of the fertilization and implantation process.

Failure to Address Symptoms

One of the most important reasons for raising awareness of endometriosis is to encourage gynecologists and other physicians to take patient complaints of related symptoms more seriously. From there, conduct more comprehensive screening procedures to catch endometriosis as early as possible and eliminate pain sooner than later. While this is by no means a rare or obscure condition, the symptoms are variable and often subjective, making it easy for a gynecologist to overlook or mistake for another condition.

Misdiagnosis and Delayed Diagnosis

Gynecologists’ not taking patients seriously is just one obstacle facing women in need of accurate endometriosis diagnoses; it is also very difficult to detect with imaging procedures. In many cases, a physician must perform a laparoscopic surgical inspection to confirm an endometriosis diagnosis, and the thought of undergoing this procedure deters some women from reporting their endometriosis symptoms.

Since endometriosis can be very difficult to accurately diagnose and shares symptoms with other common uterine medical issues, some women must contend with misdiagnoses for ovarian cysts or pelvic inflammatory disease. Irritable bowel syndrome can also accompany endometriosis, potentially misleading an attending physician to a misdiagnosis for a gastrointestinal issue rather than endometriosis.

How to Raise Endometriosis Awareness

There are many ways you can contribute to the public discussion on endometriosis and expand awareness of this condition. Women who have suffered from the symptoms of endometriosis should consider sharing their stories with others to potentially encourage other women in similar circumstances to seek treatment as soon as possible.

Local events are also great opportunities to increase awareness. Consider taking part in endometriosis advocacy events, such as the Worldwide March for Endometriosis or EndoMarch, at the end of March or any of the events for Endometriosis Awareness Week during the first week of March. Check your local community events guide to see if there is anything planned.

Social media is another great way to share advocacy materials, personal stories, and helpful resources for women struggling with endometriosis. Viral trends and hashtag campaigns can get a lot of people interested in an important topic in a relatively short amount of time. There are also countless petitions you could sign aimed at reducing diagnostic times for endometriosis patients and increasing the availability of care.

Endometriosis Awareness Month is a great opportunity to engage in meaningful advocacy for a condition affecting millions of women all over the world. Considering the significant diagnostic challenges facing women with endometriosis, increasing awareness could potentially help women seek treatment before their symptoms cause serious long-term medical complications.