Adenomyosis

Adenomyosis is a condition of the uterus wherein endometrial tissue that lines the inner wall of the uterus breaks through and invades the muscle layers of the organ. Most commonly, the disease affects the back wall (posterior side) of the uterus. It is a benign condition that primarily affects women aged between 35 to 50. Adenomyosis is only seen in women in their reproductive years because its growth requires estrogen. Adenomyosis can occur only till a woman produces estrogen. So this condition is unlikely in menopausal women. Adenomyosis results in enlargement of the uterus; sometimes to even two or three times its original size. The condition can lead to difficulties in getting pregnant or sustaining a pregnancy.

Adenomyosis Symptoms

The extra tissue in the uterine muscles leads to painful menstrual cycle and heavy bleeding. In endometriosis, the endometrial glands live outside the uterus while in adenomyosis, the glands remain within the uterus but deeply embedded into its walls. A woman can suffer both conditions. Some of the symptoms of Adenomyosis include:

• Pelvic pain
  
  
• Abdominal pressure and bloating sensation
  
  
• Prolonged periods, lasting up to 8-12 days
  
  
• Bladder pressure with frequent urination
  
  
• Dysmenorrhea
  
  
• Abnormal discharge of blood clots during menstruation
  
  
• Pain during sexual intercourse.
  

Causes and risk factors

The causes of Adenomyosis is not known. However medical experts have identified few factors that can cause Adenomyosis.

• Invasive growth of tissue due to history of uterine surgery or through incisions made near the uterus during C-section may lead Adenomyosis.
  
  
• Postpartum uterine inflammation after childbirth, may cause a break in the boundary of the uterine wall causing endometrial cells to invade the myometrium (muscle tissue of the uterus).
  
  
• Bone marrow stem cells invade the uterine musculature leading to adenomyosis.
  

Research is still going on to identify the exact causes of Adenomyosis. However certain risk factors have been identified. Women in their reproductive age, Women over 30 years of age and Women with previous history of cesarean section or other uterine surgery carry the risk of developing Adenomyosis.

Diagnosis and Treatment

The diagnosis of Adenomyosis is tricky, as its symptoms mimic the symptoms other uterine conditions like fibroids and endometriosis. Confirmed diagnosis of Adenomyosis is only made through trans-vaginal ultrasound scan and MRI.

Mild cases of Adenomyosis are treated with analgesics to manage symptoms like pain and heavy bleeding. Doctors may also recommend intrauterine devices and hormonal treatment to reduce the symptoms.

If the woman in question does not respond to the above treatments and is still in a child bearing age, surgical resection of the adenomyosis from the muscle of the uterus can be done with preservation of the uterus. However, this is possible only if the disease is localized with well-defined borders. Hysterectomy is the common surgical option performed on women who are unable to respond to medications and hormone treatments.

Metrorrhagia

Metrorrhagia is dysfunctional uterine spotting or bleeding between menstrual cycles. This erratic bleeding can occur due to various reasons and can be inconvenient and worrying. Typical causes for Metrorrhagia include endometriosis, hormonal fluctuations, polyps, fibroids, cervical cancer and Adenomyosis. Often an ectopic pregnancy can lead to such irregular spotting. Women who are on the IUD might notice such irregular bleeding in case the contraceptive has shifted. Mid-cycle bleeding can occur sometimes during ovulation. Other causes include trauma and sexually transmitted diseases. Acute or excessive alcohol consumption and cigarette smoking can shorten menstrual cycles. In many cases, no medications are necessary for Metrorrhagia. Oral contraceptive pills are often prescribed to treat irregular bleeding. They help in regulating the menstrual pattern. Lifestyle modification might help in some cases.