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What is Adenomyosis?
Adenomyosis (ad-in-oh-MY-oh-sis) is related to the condition endometriosis. In endometriosis, cells that normally line the inside of the uterus, and which are shed during menstruation, become implanted and grow outside of the uterus, such as on the ovaries, the fallopian tubes and in the lining of the pelvis. In adenomyosis, endometrial cells invade the muscular wall (myometrium) of the uterus itself.

Adenomyosis may cause no symptoms and be found while seeking the cause of uterine enlargement. In some instances, the condition causes prolonged and excessive menstrual bleeding and increased menstrual cramping.

Treatment of adenomyosis is determined by the extent to which it's causing symptoms or excessive blood loss. Pain medications may suffice to ease menstrual discomfort. In some instances, hysterectomy is the appropriate solution. As with endometriosis, adenomyosis generally disappears with menopause, so age may help in deciding on the best treatment option.

Known as "endometriosis of the uterus", adenomyosis is benign and does not cause cancer. Most commonly, the disease affects the back wall (posterior side) of the uterus. The endometrial cells penetrate deep within the uterine muscle (myometrium). When this occurs you have a uterus that is enlarged usually more than twice the normal size) and very hard. The disease may be localized with well defined borders or diffuse having no limits or borders. When a localized disease is found this is called adenomyoma. These adenomyomas can be located at different levels of the uterine muscle and can penetrate into the uterine cavity and become submucosal tumors.

How common is it
This disease can only be diagnosed with 100% certainty by doing a biopsy of the uterine muscle. Depending on the reported study you read, it occurs in 8-62% of women who have had hysterectomies. Also 12% of women with adenomyosis also have endometriosis in other sites like the pelvic wall, ovaries, fallopian tubes etc. The highest incidence is seen in women in their mid to upper forties, and though it may cause infertility, it does appear in women who have already had children.

What are the symptoms?
As with endometriosis, patients with adenomyosis may not show any symptoms (asymptommatic). However, most commonly women experience excessive, heavy or prolonged menstrual bleeding and painful periods (dysmenorrhea). The amount of bleeding and cramps usually is associated with the degree of involvement and depth of penetration into the uterine walls. Also, extensive involvement of the uterine muscle can interfere with the normal contractility of the muscle which leads to excessive bleeding.

How is it diagnosed?
An exact diagnosis is often difficult to establish pre-operatively because abnormal patterns of bleeding (dysfunctional bleeding) and fibroid tumors can result in similar symptom patterns. Sometimes during a D&C procedure to remove intra-uterine polyps or small fibroid tumors, tissue is removed enabling a pathologist to make the diagnosis.

Pelvic Exam Findings
Pelvic exam findings can reveal a normal, only slightly enlarged uterus to a very firm tender uterus enlarged to twice the normal size.

MRI
At times this can distinguish adenomyomas from fibroid tumors but again, experienced physicians and radiologists, with extensive training are required.

Transvaginal Ultrasound
Extensive recent work has been completed with this test, but the amount of false positive results is still high.

Tissue Diagnosis
Tissue diagnosis in some form remains the only true and sure way to diagnosis adenomyosis. If the diagnosis is suspected pre-operatively, then a laparoscopy may be performed and a long needle biopsy can be performed by inserting the needle into the back of the uterus and taking a tissue sample for pathological testing. It may also be diagnosed at the time of removal of fibroid tumors.

Can it be treated without surgery?
Some studies have shown that there is a relationship between adenomyosis and hormone imbalance, most commonly an excess of estrogen. Progesterone therapy, either in the natural or synthetic form has been known to help, but show very little long term benefits. A medication called Danzol may be helpful in treating the pain and decreasing the uterine size but long term positive results are poor.