About the Disease
Adenomyosis is a benign condition, but it often requires radical interventions, such as hysterectomy (removal of the uterus). This disease is defined by the invasion of endometrial tissue (the innermost portion of the uterus) in the uterine muscle layer. For this reason, it is called by some authors “internal endometriosis”, since endometriosis presents endometrial tissue in other regions in which it should not exist.
It is important to emphasize that adenomyosis is a disease distinct from endometriosis, although both are dependent on the hormone estrogen, that is, the greater the exposure of the tissue affected by the hormone, the greater the growth of the disease. On average, it is a disease that affects 20 to 30% of women, reaching up to 47% of the female population in some studies. However, the clinical suspicion of this pathology is difficult, since 35% of patients are asymptomatic.
Abnormally long and intense menstruation, at regular intervals, is the most frequent symptom, affecting 50% of symptomatic patients. Vaginal bleeding that occurs outside the menstrual cycle associated or not with cramps, is another symptom possibly found. Pain during sexual intercourse and chronic pain in the lower abdomen, are other forms of this disease. There is evidence that adenomyosis can lead to infertility even without any other factors combined.
In general, more than 80% of patients with adenomyosis have other diseases associated with the female reproductive system, with uterine fibroids being the most frequent (up to 55% of the time), and they (fibroids) are often confused with adenomyosis, since both pathologies are found in the uterine musculature and have a mass effect.
Endometriosis can appear associated in up to 20% of cases; when it so happens it is responsible for the increased risk of infertility.
Imaging tests, such as hysteroscopy, transvaginal ultrasound and nuclear magnetic resonance are the most used in an attempt to diagnose adenomyosis, by visualizing lesions characteristic of this pathology. These tests are already able to presume this disease to a significant extent.
However, even with the advancement of imaging methods, the only way to definitely obtain the diagnosis of this pathology is through biopsy.
As in endometriosis the goal of treating this disease is to combat the ectopic endometrium – one that is present in a place where it should not be. There are several therapeutic modalities, including hormonal medications, surgeries and even a combination of both. In reality, the ideal treatment varies from patient to patient, due to the fact that it will depend on several factors, including whether there is a desire to conceive or not.
As much as it is a disease that is often asymptomatic, the important thing is that when symptoms persist, such as increased menstrual flow and uterine cramps, which usually occur in women between 35 and 50 years of age, the patient seeks care with her gynecologist.