Adenomyosis of the Uterus – Causes, Symptoms, Risk Factors and Treatment

Period cramps that simply won't let up? Heavy bleeding? Sometimes your body is telling you that something isn't right. And when it does, it's important to listen. Severe pain at that time of the month that even painkillers can't touch may be a sign of adenomyosis of the uterus.

But what does adenomyosis actually mean? Why is it so painful and – most importantly – what can you do if you receive this diagnosis? You're in the right place, because in this article we explain what adenomyosis is, how to recognise it and what treatment options are available.

What is adenomyosis of the uterus (enlarged uterus)? 

Adenomyosis is a gynaecological condition in which the lining of the womb (the endometrium, which normally lines the inside of the uterus) grows into the muscular wall of the uterus. This can cause the uterus to become enlarged, which is why adenomyosis is also referred to as an 'enlarged uterus'.

Women with this condition may experience increased tenderness in the area of the uterus and often notice heavy, prolonged menstrual bleeding accompanied by very intense period pain.

Adenomyosis – causes

Doctors and researchers have yet to identify the causes of adenomyosis conclusively. It isn't known for certain why it develops in some women, or what exactly triggers the endometrium to grow into the uterine wall.

Several factors have, however, been identified that may encourage endometrial tissue to penetrate the uterine wall. These include:

• Hormonal imbalances: As oestrogen promotes the growth of endometrial tissue, oestrogen levels that are too high in relation to progesterone have been linked to tissue growth within the uterine wall and the development of adenomyosis.
• Childbirth: It has been observed that women who have had one or more pregnancies are at greater risk of endometrial tissue penetrating the uterine wall after giving birth – as a result of the stretching and weakening of the uterine walls.
• Previous uterine procedures: particularly caesarean sections, curettage, fibroid removal or other operations on the uterus that may disrupt the normal structure of the uterine walls.

• Inflammation: If there is chronic inflammation within the uterus, it can weaken and break down the barrier between the endometrium and the myometrium, encouraging the development of adenomyosis.

  

Adenomyosis of the uterus – risk factors 

A large proportion of adenomyosis cases are identified in women over the age of 30, although any woman who menstruates can be affected. In many patients, the symptoms of adenomyosis disappear completely after the menopause, as the drop in oestrogen levels has a considerable effect.

Alongside the possible causes listed above, there are other factors that may contribute to an increased risk of an enlarged uterus:

• Age: Most diagnoses of adenomyosis are made in women aged between 40 and 50.
• Family history: Women with a family history of adenomyosis are at greater risk of receiving the same diagnosis – suggesting a possible genetic influence.
• Menstrual history: Factors relating to the menstrual cycle, such as starting periods at an early age and heavy bleeding, are also associated with an increased risk of adenomyosis.

Adenomyosis – symptoms

A look at the statistics shows that one in three affected women doesn't know she has adenomyosis because she experiences no symptoms. In the other two out of three women, however, adenomyosis may manifest itself through discomfort, cycle irregularities and severe pain:

• Heavy or prolonged menstrual bleeding: also known as menorrhagia, characterised by prolonged bleeding or very heavy periods, where pads and tampons sometimes need changing every hour.
• Pelvic pain: This may be constant or intermittent abdominal pain, ranging in intensity from mild to unbearable, which worsens during menstruation or during sexual intercourse.
• Severe period cramps: Intense period pain that worsens from month to month and cannot be eased with painkillers or natural methods such as Enroush heat patches is among the most common signs of adenomyosis.
• A feeling of pressure or discomfort in the pelvis: a sensation of pressure, discomfort or pain in the lower pelvic area.
• Urological symptoms: frequent urination, pain when passing urine (dysuria) or being unable to empty the bladder fully can also be symptoms of adenomyosis.

• Digestive problems: bloating, constipation or diarrhoea can be signs of an enlarged uterus – particularly when it presses on neighbouring organs.

  

Adenomyosis vs endometriosis – what's the difference? 

The truth is that adenomyosis and endometriosis not only sound similar, they can sometimes feel the same too. Both involve cycle irregularities and severe period pain, which is why they're easily confused. Even so, they affect the body differently.

Endometriosis occurs when endometrial tissue, which should normally line the inside of the uterus, grows outside the uterus: on the ovaries, the fallopian tubes, the bladder and in other places where it doesn't belong.

With adenomyosis, by contrast, that same endometrial tissue grows into the uterine wall, causing the uterus to enlarge and producing pain from within.

Adenomyosis of the uterus – how is it diagnosed? 

Adenomyosis is diagnosed by a gynaecologist, depending on the patient's medical history and the results of examinations.

First, your medical history will be taken. You'll be asked about the characteristics of your menstrual cycle, any previous surgery and your symptoms. A gynaecological examination may then follow to determine whether the uterus is tender or enlarged, what size and shape it is, and whether there are other signs of gynaecological conditions.

As medical history combined with a physical examination isn't enough to diagnose adenomyosis, further tests and investigations may be ordered:

• Transvaginal ultrasound, to obtain detailed images of the pelvic organs and to establish whether the uterine wall is thickened and whether there are cystic areas or other irregularities in the lining of the womb.
• MRI, recommended when ultrasound results are inconclusive – for a more precise analysis of the uterus, to assess the severity of the condition and to distinguish an enlarged uterus from fibroids, polyps or other gynaecological conditions.
• Endometrial biopsy, which isn't always necessary and isn't usually performed – only where confirmation of the diagnosis is required in order to rule out other possible conditions.

Treatment of adenomyosis of the uterus 

As oestrogen levels in the body have a strong influence on the growth of endometrial tissue, the symptoms of adenomyosis often disappear on their own after the menopause, when oestrogen levels fall.

For women who experience significant discomfort as a result of this condition, however, there are several effective treatment options. The aim is to relieve pain, reduce menstrual bleeding and improve overall quality of life.

Factors such as the severity of symptoms, the stage of the condition, general health and whether you may wish to have children are all taken into account by your doctor before a treatment is recommended.

Anti-inflammatory medication 

Non-steroidal anti-inflammatory drugs can help reduce period cramps and the feeling of pressure or discomfort in the pelvic area. If these prove ineffective, painkillers may also be recommended.

Hormonal medication

Preparations based on oestrogen and progesterone may be prescribed to treat adenomyosis, in order to reduce heavy bleeding and painful cramps.

Hormonal coil

Another hormonal treatment option is the coil. Much like contraceptive pills containing oestrogen and progesterone, the hormonal coil can help ease pain and irregular menstrual bleeding.

Uterine artery embolisation 

In this procedure, tiny particles are injected into the arteries that supply the uterus with blood. These particles block blood flow to the affected areas. The procedure is minimally invasive and is carried out by a radiologist.

Endometrial ablation 

Endometrial ablation is another procedure whose aim is to reduce menstrual bleeding and pelvic pain. It involves destroying the lining of the womb using cold, heat or other methods.

As a rule, this procedure isn't recommended for women who wish to have children.

HIFU 

Known as High Intensity Focused Ultrasound, this technique uses tightly focused high-frequency ultrasound to destroy specific areas of the uterus, with the aim of reducing its volume and easing the symptoms of adenomyosis.

Hysterectomy

Hysterectomy is generally regarded as the definitive treatment for adenomyosis. It's a surgical procedure in which the uterus is removed in order to eliminate symptoms completely.

Given the significance of this procedure, it's only recommended for women who no longer wish to have children or for whom other treatment options haven't worked.

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Adenomyosis of the uterus – possible complications 

Left untreated, adenomyosis can cause chronic pain as well as fertility problems. What's more, prolonged, heavy bleeding can over time lead to chronic anaemia, exhaustion and further health problems. These are the most likely complications of an enlarged uterus if you ignore the symptoms:

• Chronic pelvic pain, severe enough to prevent you going about your daily activities
• Heavy menstrual bleeding, which can lead to anaemia, exhaustion, weakness and breathlessness
• Dysmenorrhoea, meaning unbearable period cramps that painkillers no longer relieve
• Infertility or miscarriage, as implantation of the embryo in the uterus may be made more difficult and inflammation or adhesions may develop on the ovaries and fallopian tubes.
• Emotional distress, anxiety and depression, because living with chronic pain and constant discomfort can be hard to cope with.
• Sexual dysfunction, as pelvic pain and the associated discomfort can have a negative effect on libido and your sex life and lead to difficulties in your relationship.

Adenomyosis of the uterus – prevention 

At present, there are no known ways to prevent adenomyosis. There are, however, ways to reduce your risk of the condition and ease the symptoms:

• Maintain a healthy body weight, through an active lifestyle and a nutrient-rich, balanced diet, to avoid the hormonal imbalances associated with being underweight or overweight.
• Limit your exposure to oestrogen-like substances, such as hormone disruptors found in plastics, pesticides and other toxic chemicals that may be present in cosmetics and personal care products; opt instead for organically produced foods and care products with pure, body-friendly ingredients.
• Treat hormonal imbalances, to reduce the risk or severity of the condition.
• Minimise unnecessary injury to the uterus, by avoiding procedures that aren't as essential as curettage or fibroid removal.
• Attend regular check-ups, so that gynaecological conditions can be detected early and treated in good time – before complications arise.

Recommended diet and lifestyle for patients with adenomyosis 

Unless you're going through the menopause or have a hysteroscopy coming up, adenomyosis won't disappear overnight. But the choices you make every day can make a real difference – to how you feel and to how intensely you experience the symptoms of an enlarged uterus.

Patients with adenomyosis are therefore advised to follow an anti-inflammatory diet, rich in vegetables, fruit, nuts and sources of omega-3 fatty acids, which can help reduce inflammation and pain. At the same time, heavily processed foods and excessive consumption of sugar and alcohol should be avoided.

Stress management techniques, an active lifestyle and getting enough sleep night after night are also key to hormonal balance – and that's crucial when it comes to managing adenomyosis.

Frequently asked questions about adenomyosis 

We know that the most specific questions sometimes crop up just as you've finished reading. That's why we've gathered the most common questions about adenomyosis of the uterus here, along with the answers. So that you're left with no question marks, but rather with greater confidence in yourself and your body.

Can adenomyosis affect fertility?

Yes, adenomyosis can make it harder for an embryo to implant in the uterus. When endometrial tissue grows into the uterine wall, the persistent inflammation can hinder implantation. But 'harder' doesn't mean 'impossible'. Many women with adenomyosis go on to become pregnant.

Can adenomyosis be treated without surgery?

Yes, there are numerous non-surgical treatment options for easing the symptoms of adenomyosis. Mild pain can be reduced with anti-inflammatory medication and painkillers. Heavy bleeding and pain can be managed with hormonal treatments such as the coil or the oestrogen-progesterone contraceptive pill.

Lifestyle changes and choosing natural intimate care products free from endocrine disruptors can also have a positive effect.

Are there natural remedies that can ease the symptoms of adenomyosis? 

Some women use anti-inflammatory teas made from ginger, turmeric and raspberry leaf, or magnesium supplements, to ease the discomfort of adenomyosis. These are not, however, a substitute for a specialist's advice and appropriate treatment.

Don't ignore the signs by relying solely on natural remedies – severe cramps and heavy bleeding can lead to complications such as chronic pain, anaemia, infertility and other problems.

Can adenomyosis be confused with other gynaecological conditions?

Yes, adenomyosis is very easily confused with endometriosis, as both present with cycle irregularities and severe period pain. For this reason, thorough investigations recommended by your gynaecologist are required before a diagnosis can be made.

When is surgery necessary for adenomyosis? 

Surgery is generally only recommended in chronic cases – when the patient has unbearable pain and heavy bleeding, or doesn't respond to other treatments. If you no longer wish to have children, endometrial ablation or a hysterectomy may be recommended.

Can exercise ease the symptoms of adenomyosis? 

Yes, regular, moderate exercise (walking, swimming, Pilates, yoga and so on) supports hormonal balance, can reduce inflammation and improves circulation – helping to ease period pain and the symptoms of adenomyosis.

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