Uterine adenomyosis is a disease that can cause debilitating symptoms. The condition develops when the tissue that normally lines the inside of the uterus invades the uterine wall. The most common symptoms include pain and abnormal vaginal bleeding. Making the diagnosis of uterine adenomyosis relies on gaining information from the patient, performing a physical examination, using imaging studies, and possibly even taking a sample of the abnormal uterine tissue. Treatment options for this condition can include medication and surgical approaches.
Understanding the basic structure of the uterus helps to explain the condition of uterine adenomyosis. The uterus is a hollow cavity that has an inner lining composed of glandular tissue, a middle layer made from smooth muscle, and an outer layer. The inner layer, often referred to as the endometrial tissue, is shed monthly as menstrual blood. In the condition of uterine adenomyosis, the endometrial tissue invades into the smooth muscle layer. Endometriosis is a similar condition because it also involves having endometrial tissue located in abnormal places; however, in endometriosis the abnormal endometrial tissue never invades the smooth muscle.
The most common symptoms of uterine adenomyosis are pain and abnormal menstrual bleeding. These symptoms develop because the invading endometrial tissue continues to be responsive to hormones, and these glands therefore successively grow and diminish in size with the menstrual cycle. The swelling and shedding of this tissue can cause pelvic pain and heavy menstrual bleeding, respectively.
Making the diagnosis of uterine adenomyosis can be done in a number of ways. The first step in diagnosing the disease is to obtain a full account of the symptoms experienced by the woman, including when the symptoms occur in relation to her menstrual cycles. Next, a physical examination can reveal a tender, enlarged uterus in affected people. A definitive diagnosis of uterine adenomyosis can be made using imaging tests such as magnetic resonance imaging (MRI) or by obtaining a biopsy of the uterine wall and examining the tissue under the microscope to see if the endometrial glands are invading the smooth muscle layer.
Often, the first step in the treatment of uterine adenomyosis is to try using medications to alleviate symptoms. Hormonal therapies such as a combined estrogen-progesterone pill or a progesterone-only pill are often given. If medications are ineffective, there are a number of surgical options. In women who don't want any more children, a hysterectomy to remove the uterus can be performed. For women who desire more children, surgeries to selectively remove the abnormal tissue or to block the artery that normally supplies blood to the uterine wall can be performed.