Adenomyosis is when endometrial glands and stroma are found in the myometrium (the uterus muscles). Normally, these glands and stroma should only be found in the lining of the uterus.
As the myometrium gets more extensive, so does the uterus.
Most experts agree that between 20 and 35 percent of women have adenomyosis.
Adenomyosis seems to affect more women who have had children than women who have never had children. But having more pregnancies does not put a woman at a higher risk of getting the disease.
Adenomyosis also often happens along with other uterine diseases, especially uterine leiomyomas and endometriosis. Because of this, it is hard to identify the risk factors and the progression of this disease
The exact cause of adenomyosis remains unknown. But experts have found that the hormones and the area of the uterus between the endometrium and myometrium, called the endomyometrium, play a role.
Women with adenomyosis often don't have any signs or symptoms. However, some women experience the following:
Doctors perform a pelvic examination to inspect the uterus and check for the presence of adenomyosis. Patients with adenomyosis often have a uterus that is movable, diffusely enlarged (commonly called "globular" enlargement), and soft on a bimanual pelvic examination (often referred to as "boggy").
A transvaginal ultrasound (TVUS) is the imaging modality for assessing uterine enlargement, pelvic discomfort, or irregular bleeding. When an accurate diagnosis is crucial to determine care, such as when differentiating between diffuse and focal adenomyosis and leiomyomas, magnetic resonance imaging (MRI) is reserved for such patients.
A biopsy is often necessary to rule out endometrial hyperplasia or malignancy when evaluating for adenomyosis because a patient may frequently present with abnormal uterine bleeding.
The primary factor in determining the best course of treatment is the patient's desire to conceive. Currently, the only effective treatment is a hysterectomy. The remaining choices aim to alleviate the primary symptoms of monthly cramping and bleeding while leaving the uterus intact.
Minimally Invasive Treatment or Surgery
Experts agree that, presently, there is no way to prevent adenomyosis. However, there are ways to control the symptoms. These methods may help alleviate adenomyosis-related pelvic pain and cramping:
Gunther R, Walker C. Adenomyosis. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539868/
Cleveland Clinic (2022). Adenomyosis. Retrieved November 9, 2022, https://my.clevelandclinic.org/health/diseases/14167-adenomyosis
Stewart, EA. Adenomyosis. [Updated 2022 Oct]. UptoDate [Internet]. Wolters Klower; 2022 Mar-. Available from: https://www.uptodate.com/contents/uterine-adenomyosis#H1628887227