Adenomyosis is a very common gynecological disease in women of reproductive age , but little known because it does not always present symptoms or sometimes they are mild.
It is given the nickname “internal endometriosis”, since unlike what happens with endometriosis, in this pathology the endometrial cells penetrate inside the muscular layer of the uterus, causing it to thicken.
Dr. Leysi Rodríguez, a doctor specialized in assisted reproduction at the Equipo Juana Crespo clinic , explains exactly what this disease consists of and how it can affect a woman’s reproductive health .
What is adenomyosis and what symptoms does it present?
It is estimated that approximately 20-35% of women of reproductive age suffer from adenomyosis , being especially evident after 40 years of age.
In some cases, this benign gynecological pathology is asymptomatic , but in two thirds of patients it causes abnormal uterine bleeding, intense period pain , painful intercourse and even infertility , as we will see later. In addition, according to experts, 80% of cases of adenomyosis are also associated with uterine fibroids .
Although they do not have to occur together, adenomyosis and endometriosis are two closely related diseases , since in both cases there is a migration of endometrial cells. Check out more interesting articles on our PM Blog.
“In the case of adenomyosis, the endometrial cells migrate to the myometrium, that is, from the innermost layer of the uterus, where the period comes from, to the muscular layer of the uterus.”
“And in the case of endometriosis , the cells migrate to the entire gynecological apparatus and abdominal cavity (tubes, ovaries, peritoneum, intestinal loops, uterosacral ligament… etc)” – explains Dr. Leysi Rodríguez.
These displaced endometrial cells continue to act as they would if they were in their natural place, which is why they end up causing thickening of the muscle wall accompanied in many cases by pain and profuse bleeding as they degrade in each menstrual cycle.
As Dr. Rodríguez explains, the causes that cause the appearance of this disease are unknown , although women with a lot of period pain and those who delay motherhood have a greater predisposition to suffer from it.
Likewise, some researchers associate a higher risk of developing adenomyosis among multiparous women or with uterine surgeries, such as caesarean sections, curettage or hysteroscopies.
In general, with the arrival of menopause the disease disappears.
How is adenomyosis diagnosed?
As with endometriosis , adenomyosis is underdiagnosed for several reasons . On the one hand, because it does not always produce painful symptoms, and on the other, because, unfortunately, there are still those who believe that “the rule must hurt” , so they do not pay enough attention to these signs.
Diagnosis can be made by transvaginal ultrasound (TVUS), MRI, or hysteroscopy (a test that also allows the doctor to take samples of the uterine lining for analysis).
Adenomyosis and fertility: how does this pathology affect if I want to have children?
Adenomyosis can also affect fertility in the same way that endometriosis does , favoring implantation failure and repeated miscarriages during the first trimester.
Women who suffer from adenomyosis and wish to become pregnant should see a specialist as soon as possible, who will determine the best treatment to follow depending on their symptoms and their age.
In this sense, it may be necessary to resort to in vitro fertilization treatments to help the woman achieve pregnancy.
Treatment of adenomyosis
There are various treatments that help control the disease, although these vary depending on the patient’s symptoms and the degree of involvement they have.
In this sense, if the woman experiences pain, Dr. Rodríguez explains that treatment with analgesics and anti-inflammatories could be sufficient, in addition to following a diet low in gluten and lactose. Another effective treatment is hormonal therapy with contraceptives .
However, this type of treatment is contraindicated when a pregnancy is sought , so in the case of women who wish to become mothers or who are undergoing fertility treatment, the gynecologist advises prior local surgical and medical uterine treatment to favor uterine placental implantation .
When symptoms significantly worsen the patient’s quality of life and conventional treatments do not help, the only effective solution is hysterectomy (surgically removing the uterus).