February 8, 2011

Adenomyosis and Pregnancy

Posted in Category : Women's Health

Adenomyosis, also known as adenomyoma or endometriosis interna, is a condition that takes place when the endometrial tissue that coats the uterus shifts to the outer walls of the uterus, resulting in a thickening of the uterus. At times the condition may also cause a mass or growth within the uterus known as an adenomyoma. What actually causes this condition remains unknown, but medical professionals suspect that adenomyosis and pregnancy are closely related since it is common in women over the age of thirty who have borne children. Women who have had a cesarean section or any other type of uterine surgery are also at an increased risk of developing adenomyosis.

Accurate estimates of the incidence of adenomyosis are difficult to come by since many women do not exhibit any symptoms, making the condition difficult to diagnose. These estimates may vary from 20% to 65% of the female population.

When symptoms do occur they can be extremely painful. The pain can be extremely intense especially during menstruation. During this period, heavy and prolonged bleeding may occur. This happens because of the abnormality in the uterine walls. During normal menstruation, the lining of the uterus sheds, resulting in bleeding and the passage of tissue from the vagina. In adenomyosis, the uterine lining has thickened due to the presence of endometrial tissue resulting in the blood getting trapped. This causes the uterus to expand, becoming inflamed and painful.

The symptoms of adenomyosis when they do occur may include long lasting and heavy menstrual bleeding, painful periods that worsen over the course of the menstrual cycle and pain in the pelvic region during sexual intercourse. A pelvic examination may reveal a soft, tender and enlarged uterus or the presence of a mass in the uterus. The doctor may call for imaging tests including ultrasound scans and MRI to help differentiate between uterine tumors and adenomyosis.

Once a diagnosis of adenomyosis has been confirmed, the doctor will have to decide on a course of treatment after taking into account various factors. These include the severity of the symptoms, the age of the woman in question, her desire to have children and any other medical conditions she may have. In most cases there are no symptoms present and no treatment is required.

In severe cases of adenomyosis where there is excessive pain, the usual treatment involves the removal of the uterus in a procedure referred to as a hysterectomy. However, this is a radical solution since it causes infertility and may lead to several other problems especially in the case of younger women. It is usually recommended in the case of women who are nearing menopause.

In cases where a hysterectomy is not an option, the doctor may treat the condition with medication. Painkillers may be prescribed if there is excessive pain, and birth control pills can be given to help decrease heavy bleeding. However, the use of gonadotropin releasing agents contained in birth control pills is just a temporary measure to provide relief from the pain. Symptoms usually return after these medications have been discontinued. Heavy bleeding can be controlled using a progesterone based intrauterine device (IUD) but in this case too, the symptoms will return after the removal of the device.

Recent surgical techniques have given hope to women who suffer from the excruciating symptoms of adenomyosis but cannot have a hysterectomy because they wish to have children. The technique involves de-bulking the endometrial tissue and provides immediate relief from pelvic pain and abnormally heavy menstrual bleeding, leaving the woman’s child bearing ability intact.


  1. http://www.umm.edu/ency/article/001513all.htm