Adenomyosis

Last updated 06 March 2017 — Last reviewed 24 February 2014

Adenomyosis is a condition of the uterus (womb) where the cells that normally form a lining on the inside of the uterus, also grow in the muscle wall of the uterus. Causes, signs and symptoms of adenomyosis, along with how it is diagnosed and treated, are all discussed.

What is it?

adenomyosisThe term adenomyosis comes from the words:

adeno – gland
myo – muscle and
osis – condition

Adenomyosis is a condition of the uterus (womb) where the cells that normally form a lining on the inside of the uterus also grow in the muscle wall of the uterus.

Although women with adenomyosis often have endometriosis they are different conditions. With endometriosis, cells similar to those that line the uterus are found in other parts of the body such as the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum).

What causes it?

The cause of adenomyosis is unknown; however there are a number of theories:

  • The lining cells invade into the muscle layer as a result of surgery
  • Lining tissue was deposited into the uterine muscle early in foetal life, before birth
  • Inflammation of the lining after childbirth causes cells to pass into the weakened muscle layer

Adenomyosis is only seen in women in their reproductive years because its growth requires oestrogen. After menopause adenomyosis usually goes away because of the lack of oestrogen.

Who is at risk of adenomyosis?

The known risks for developing adenomyosis are:

  • previous surgery of the uterus such as a caesarean section or fibroid removal
  • childbirth

Because of the link with childbirth or uterine surgery, adenomyosis is more likely to occur in women between 30-50 years.

What are the signs and symptoms?

The most common symptoms are:

  • abnormal or heavy menstrual bleeding
  • painful periods, often after years without pain
  • pain with intercourse (dyspareunia)
  • bleeding between periods
  • on vaginal examination, the uterus feels enlarged and is often tender to touch
  • excessive menstrual bleeding can lead to symptoms of anaemia (deficiency in the number of red blood cells) or iron deficiency such as:
    • tiredness
    • dizziness

Where does it occur?

Adenomyosis is most likely to occur in the muscle layer of the back wall of the uterus but can occur anywhere in the muscle layer.

If adenomyosis is concentrated in one area, it can lead to a mass called an adenomyoma. 

What happens when you get a period?

The lining cells in the muscle undergo the same changes as the lining cells of the uterus. This means when you have your period, these cells also bleed but because they are trapped in the muscle layer they form little pockets of blood within the muscle.

How is adenomyosis diagnosed?

Adenomyosis may be difficult to diagnose. The main test recommended is a transvaginal ultrasound (the ultrasound  probe is placed in the vagina). The test should preferably be performed by a gynaecologist who specialises in ultrasound, as general ultrasonagraphers may be inexperienced in the diagnosis of adenomyosis. 

MRI (magnetic resonance imaging) can be useful in diagnosing adenomyosis because it collects pictures of soft tissue such as organs and muscles that don't show up on x-ray examinations.

Adenomyosis is often only diagnosed by pathology tests conducted after the uterus has been removed (hysterectomy).

How is adenomyosis treated?

Adenomyosis is difficult to treat and it will disappear after menopause so management  will depend on your life stage.  The following are some treatment options:

Treatment How it works
Hysterectomy Hysterectomy is the complete removal of the uterus (and therefore the adenomyosis)
Progestogen releasing intrauterine device (IUD) such as Mirena

The insertion of an IUD can cause:

  • a thinning of the endometrium
  • a reduction in the size of the uterus
  • a reduction in the pain experienced with intercourse
  • reduced bleeding
GnRH agonists (an artificial hormone used to prevent natural ovulation)

GnRH agonists cause:

  • a thinning of the endometrium
  • a reduction in the size of the uterus
  • suppression of the period
  • a temporary chemical menopause

In the presence of infertility and endometriosis these may be used temporarily.

For an adenomyoma (mass of adenomyosis in one area)

Laparoscopy (keyhole surgery) An adenoyoma may be surgically removed using keyhole surgery.
Ultrasound Guided by an MRI, high intensity focused ultrasound waves cause a localised increase in temperature to the adenomyoma causing the cells to die.

When to seek help

Seek help when your symptoms are:

  • impacting on your health
  • impacting on your ability to live your life normally
  • interfering in your sexual function and relationship

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at February 2014.

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