Published Oct 13, 2013 EveryDay Health
It’s beyond maddening to contend with monthly twelve-plus tampon a day bleeding and incapacitating cramps only to be told that it’s not due to fibroids, endometriosis, hormonal imbalance, or any other identifiable gynecological problem. One diagnosis that is overlooked far too often is adenomyosis, a condition in which the endometrial glands that usually line the cavity of the uterus infiltrate deep into the wall of the uterus resulting in menstrual periods that rival Niagara Falls in flow and appendicitis in pain.
Adenomyosis is essentially a cousin to endometriosis. Both conditions cause debilitating, painful periods, but while women with endometriosis have endometrial glands that live outside the uterus in locations such as the ovaries, tubes and lining of the pelvis, women with adenomyosis have glands that remain in the uterus, but have infiltrated deep into the muscular wall. And yes, you can have both adenomyosis and endometriosis.
The frustrating thing about adenomyosis is the difficulty in making a definitive diagnosis. Typically, nothing abnormal shows up on ultrasound, biopsies or blood tests.
A gynecologist can’t even see it during laparoscopy or hysteroscopy since the glands are microscopic and buried inside the wall of the uterus. Often a gynecologist will suspect adenomyosis if the uterus is enlarged, soft and tender, but the only way to absolutely know is to remove the uterus (hysterectomy) and have the pathologist cut open and look inside the uterine wall with a microscope. MRI (Magnetic Resonance Imaging) is the best non-invasive way to make the diagnosis, but is often not definitive or routinely done due to the expense.
When adenomyosis is suspected, symptoms can sometimes be adequately controlled with hormones or pain medication so that surgery is not necessary. Menstrual suppression protocols, such as continuous hormonal contraceptives, a progestin intrauterine device or GnRH, are often helpful. Endometrial ablation and uterine artery embolization have been used on a limited basis with variable results. The only definitive treatment for severe adenomyosis is hysterectomy. Symptoms do resolve with the onset of menopause, so waiting it out is also an option.
Why some women are vulnerable to adenomyosis is pretty much a mystery but a study just published in the Journal of Pathology may give some insight. A specific protein, beta-catenin, triggers changes in the cells of a woman’s uterus, which in turn cause adenomyosis to develop. This doesn’t mean the cure is around the corner, but research that leads to a solution is facilitated when the cause of a problem is better understood. So yes, hope is on the horizon for the many women with adenomyosis who schedule activities according to the calendar and live in dread of their next period.