Adenomyosis, Endo’s Not-So-Sweet Sister

By: Erica Ferraro

Wait.. there’s a sister? Is she cool?

NO. She’s awful. And she’s really great at disguising herself as other female health conditions, going underdiagnosed and misunderstood at large.

Adenomyosis (adeno) and endometriosis (endo), both conditions affecting the endometrial tissue within the uterus, exhibit distinct characteristics and present varying symptoms.

In the case of adenomyosis, there is an abnormal growth of endometrial-like cells within the uterine muscles. These displaced cells adhere to the menstrual cycle, resulting in monthly bleeding. This leads to thickening of the uterine wall, often accompanied by pain and heavy menstrual bleeding. Typically, this condition affects individuals in older age groups and has recently been linked to infertility.

On the other hand, endometriosis involves the growth of endometrial-like cells outside the uterus. This tissue is commonly found on the ovaries, the supporting ligaments of the uterus, and within the pelvic cavities. Similar to adenomyosis, these cells follow the menstrual cycle and cause monthly bleeding. Consequently, this can result in pain and potential impacts on fertility. Endometriosis typically manifests in adolescents and individuals of reproductive age. See my article on endo to learn more here.

It is possible for an individual to experience either one or both of these disorders. A study conducted in 2017, involving 300 women diagnosed with adenomyosis between 2008 and 2016, discovered that 42.3 percent of these individuals also had endometriosis.

What are the similarities and differences in symptoms?

The symptoms of adenomyosis and endometriosis, including pain, can range from mild to severe.

However, it is worth noting that some individuals with endometriosis may not experience any symptoms (silent endo), while approximately one-third of women with adenomyosis remain asymptomatic.

Certain symptoms can overlap with those caused by other conditions, such as ovarian cysts or uterine fibroids.

The typical symptoms associated with each condition are as follows:

Adenomyosis:

• Painful periods (dysmenorrhea)
• Painful sexual intercourse (dyspareunia)
• Chronic pelvic pain
• Abnormal bleeding (metrorrhagia) or prolonged periods
• Infertility
• Enlarged uterus

Endometriosis:

• Painful periods (dysmenorrhea)
• Painful sexual intercourse (dyspareunia)
• Painful bowel movements (dyschezia)
• Painful urination (dysuria)
• Pelvic pain
• Fatigue, nausea, and diarrhea, particularly during menstruation

What Causes Adenomyosis?

The exact cause of adenomyosis is unknown. Some of the possible causes include:

• Endometriosis: The endometrium (the lining of the uterus) grows into the myometrium (the muscular wall of the uterus)
• Trauma that causes inflammation, e.g. childbirth
• Stem cells invading the myometrium
• Developmental anomalies from the time the uterus was first formed in the fetus
• New evidence suggests that prolonged exposure to estrogen may be a contributing factor. Women may be exposed to more estrogen if their menstrual cycles are shorter than average or if they have been pregnant two or more times

What Are the Risk Factors?

• Previous uterus surgery such as a caesarean
• Fibroids removal (myomectomy)
• Complications of dilatation and curettage (D&C)
• Age – usually among middle age women, however, can be present in younger women who have not had children yet.

How is Adenomyosis Diagnosed?

There are several other uterine conditions that can present similar signs and symptoms to adenomyosis, which makes diagnosing adenomyosis a challenging task. These conditions include leiomyomas (fibroid tumors), endometriosis (uterine cells growing outside the uterus), and endometrial polyps (growths in the uterine lining).

To reach a diagnosis of adenomyosis, your doctor will first need to rule out other potential causes for your signs and symptoms.

The suspicion of adenomyosis by your doctor may be based on the following factors:

• Observing signs and symptoms associated with the condition
• Conducting a pelvic examination that reveals an enlarged and tender uterus
• Utilizing ultrasound imaging or magnetic resonance imaging (MRI) of the uterus
• Occasionally, your doctor may perform an endometrial biopsy (collecting a sample of uterine tissue) to exclude the possibility of a more severe condition. However, an endometrial biopsy does not assist in confirming a diagnosis of adenomyosis.

While pelvic imaging techniques like ultrasound and MRI can identify indications of adenomyosis, the only definitive way to confirm the diagnosis is by examining the uterus following a hysterectomy.

How is Adenomyosis Treated?

The resolution of adenomyosis often occurs naturally after menopause, which means that the treatment approach may vary depending on how close an individual is to this stage of life.

There are several treatment options available for adenomyosis, including:

1. Anti-inflammatory drugs: Your doctor may recommend anti-inflammatory medications like ibuprofen (Advil, Motrin IB, and others) to manage pain. Taking these medications one to two days before your period begins and continuing during your period can help reduce menstrual blood flow and alleviate pain.
2. Hormone medications: Combined estrogen-progestin birth control pills, hormone-containing patches, or vaginal rings may be prescribed to alleviate heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device (IUD), or continuous-use birth control pills can induce amenorrhea, the absence of menstrual periods, which might provide relief.
3. Hysterectomy: In cases where severe pain persists and other treatment options have not been effective, your doctor might recommend surgery to remove the uterus (hysterectomy). It is important to note that removal of the ovaries is not necessary for controlling adenomyosis.

If the above information resonates with you, discuss the possibility of adeno with your OB/GYN or fertility clinic.

*information for the article has been sourced from the Mayo Clinic