What is adenomyosis?
Adenomyosis is a benign gynaecological condition in which the endometrial tissue (the inner lining of the uterus) invades the depths of the myometrial tissue (the uterine muscle layer), often leading to cystic formations and, consequently, an enlarged uterus. Although it is generally seen after the age of 40, a diagnosis can be made in 5-25% of patients before the age of 39. It is possible for adenomyosis to co-occur with endometriosis (in 65-70% of cases) and fibroids (in 35-55% of cases) in the same patient.
How does adenomyosis develop?
Although there is no clear consensus on the cause of adenomyosis, the prevailing hypothesis suggests that a process leading to the migration of endometrial tissue into the uterine muscle layer plays a key role. At this stage, factors such as a history of multiple births, being over 40 years of age, a history of caesarean sections, or previous uterine surgery can be considered risk factors for the development of adenomyosis.
What symptoms are associated with adenomyosis?
Although adenomyosis causes no symptoms in approximately one-third of patients, those who do experience symptoms most commonly present with persistent lower abdominal pain, painful periods, heavy menstrual bleeding, and infertility.
How is adenomyosis diagnosed?
Although the definitive diagnosis of adenomyosis is typically made through microscopic examination of uterine tissue, nowadays a diagnosis can be made with a high degree of accuracy using ultrasound or magnetic resonance imaging without the need for uterine surgery. An enlarged uterus, cystic areas in the uterine muscle layer, thickening, and irregularities in the inner lining of the uterus are among the imaging findings used in diagnosis.
How is adenomyosis treated?
Treatment for adenomyosis should be tailored to each individual patient and planned entirely according to the symptoms and findings of the condition. For women with asymptomatic disease who do not experience infertility, regular monitoring is the appropriate approach; however, for patients with menstrual irregularities and heavy bleeding, hormonal medication, a hormonal intrauterine device (IUD), or in some cases, surgery may be an option. In patients where infertility is the primary concern, suppressive hormonal treatments or, in some cases, surgery should be decided upon following an individual assessment of each patient.