Adenomyosis

Definition

Definition of Adenomyosis
Adenomyosis is a medical condition characterized by the presence of ectopic glandular tissue found in muscle. The term adenomyosis is derived from the terms adeno- (meaning gland), myo- (meaning muscle), and -osis (meaning condition). Previously named as endometriosis interna, adenomyosis actually differs from endometriosis and these two disease entities are found together in only 10% of the cases.

Symptoms

Symptoms of Adenomyosis
Some women with Adenomyosis do not experience any symptoms, while others may have severe, debilitating symptoms. The Endometrial implants that grow into the wall of the uterus bleed during menstruation, (the same as endometrial tissue bleeds) is discharged vaginally as menstrual bleeding. The vaginal pressure can be severe enough to feel like the uterus is trying to push out through the vagina, like the last stage of labor when the baby's head pushes into the cervix. Other symptoms include:

1. Intense debilitating pain all the time and/or
2. Acute & increasing pain at menstration and ovulation
3. Strong 'contraction' feel of uterus
4. Abdominal cramps
5. A 'bearing' down feeling
6. Pressure on bladder
7. Dragging sensation down thighs and legs
8. Heavy bleeding and flooding
9. Large blood clots
10. Prolonged bleeding ie; up to 8–14 days

Causes

Causes of Adenomyosis
The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, such as a caesarean section, tubal ligation, pregnancy termination, and any pregnancy. It can be linked with endometriosis.

Diagnosis

Diagnosis of Adenomyosis
The uterus may be imaged using ultrasound (US) or magnetic resonance imaging (MRI). Transvaginal ultrasound is the most cost effective and most available. Either modality may show an enlarged uterus. On ultrasound, the uterus will have a heterogeneous texture, without the focal well-defined masses that characterize uterine fibroids.
Histopathological image of uterine adenomyosis observed in hysterectomy specimen. Hematoxylin & eosin stain.

MRI provides better diagnostic capability due to the increased soft tissue differentiation, allowable through higher spatial and contrast resolution. MRI is limited by other factors, but not by calcified uterine fibroids (as is ultrasound). In particular, MRI is better able to differentiate adenomyosis from multiple small uterine fibroids. The uterus will have a thickened junctional zone with diminished signal on both T1 and T2 weighted sequences due to susceptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the junctional zone greater than 10 to 12 mm (depending on who you read) is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage.

Treatment

Treatment of Adenomyosis
Treatment options range from use of Natural Progesterone Cream, NSAIDs, hormonal suppression, anti inflammatory pain killers and IUD Coil for short term symptomatic relief (although IUD may cause further irritation of the uterus). Women with adenomyosis fail endometrial ablation because the ablation only affects the surface endometrial tissue, not the tissue that has grown into the muscle lining. This remaining tissue is still viable and will continue to cause pain.

Those that believe an excess of estrogen (Estrogen Dominance) is the cause of Adenomyosis, or that it aggravates the symptoms, recommend avoiding products with xenoestrogens and/or recommend taking Natural Progesterone Cream which may help balance the hormone levels.

Chinese herbal supplements DIM and Myomin are claimed to reduce excess estrogen, shrink fibroids and reduce significantly the adenomyosis symptoms. DIM is a blend of cruciferous vegetable extracts including broccoli, cauliflower, cabbage and brussel sprouts. Research shows it helps metabolize unhealthy circulating estrogens (estrone, estradiol) into the good form (estriol).

Prognosis

Prognosis of Adenomyosis
It is advocated that adenomyosis poses no increased risk for cancer development. However, since adenomyosis can invade myometrium and is related to adenocarcinoma which can itself be either benign or malignant, there is recent evidence of rare progression of adenomyosis to endometrial carcinoma. As the condition is estrogen-dependent, menopause presents a natural cure. Patients with adenomyosis often also have leiomyomata and/or endometriosis.

Prevention

Prevention of Adenomyosis
Consult with your doctor.