Adenomyosis is a condition where there are endometrial gland deposits localised within the uterus. Just as with endometriosis these areas become progressively scarred, resulting eventually in a uterus which is extremely painful around the time of each menstrual cycle.
These deposits cannot be readily suppressed and as is the case with endometriosis, there can be modest relief with the oral contraceptive pill.
In most cases, a low dose progesterone IUD is useful in suppressing these deposits and helping with associated uterine pain. As these glandular nodules are located within the wall of the uterine muscle, they cannot easily or safely be excised. So the ultimate treatment of adenomyosis is a hysterectomy procedure (usually with ovaries preserved, as hormones will not change).
Adenomyosis Symptoms and Pain
Adenomyosis can affect smooth muscle tissue in the pelvis; this condition primarily involves the uterus but of course adenomyosis can be seen in the vagina, bowel and bladder. Symptoms are therefore variable but clearly worse when there is a pending period.
Severe low cramping pain, a significant alteration in bowel habit with a tendency to constipation, and severe lower back pain with or without intercourse.
Patients with bladder endometriosis can experience cyclical haematuria (blood in urine) with pain especially when the bladder is near capacity. Bladder capacity is often reduced in patients with a large bladder wall lesions.
Treatment for Adenomyosis
The treatment options for adenomyosis are pharmacological and/or surgical. In patients with an incomplete family then suppression of the uterus between pregnancies with an IUD is the best option if breastfeeding, and in those women who have completed breastfeeding additional benefits may be gleaned by taking any oral contraceptive pills.
For women whose families are completed then laparoscopic surgery to remove the uterus and preserve ovaries is the best option. Most patients with adenomyosis also have pelvic endometriosis, so if hysterectomy is contemplated it is critical to remove the endometriosis at that same surgery.
Weight gain from Adenomyosis
Adenomyosis can significantly affect your ability to exercise; for this reason alone it may be difficult to achieve optimal fitness or weight control. The adenomyotic uterus can be larger than a “normal” uterus, but the weight difference of an affected adenomyotic uterus would be negligible.
The difference between Adenomyosis and Endometriosis
Adenomyosis is the condition where endometrial glandular cells (the ones that normally line the uterus to produce a monthly menstrual cycle) are actually present in the smooth muscle of the uterus most commonly and as described earlier, can also be present within the vagina, bowel or bladder.
Endometriosis is the condition where these cells are attached to the peritoneal lining of the abdomen and pelvis.
Both conditions cause pain.
Both conditions can respond to hormonal therapies in the short term.
While hysterectomy is the optimal treatment for adenomyosis, this is not the case for patients with deeply infiltrating endometriosis; surgical management of these peritoneal implants first is the key to improving patients quality of life.
