What is Adenomyosis?
Adenomyosis is a gynecological condition that affects a woman’s uterus. This occurs when the tissue that normally lines the uterus (endometrial tissue) starts growing into the muscular walls of the uterus. Due to this condition, the uterus becomes enlarged, leading to heavy menstrual bleeding, cramping, and chronic pelvic pain. The displaced tissues thicken, break down and bleed during every menstrual cycle. The main effect of adenomyosis is that it leads to poor fertility (difficult to conceive).
The implantation of a fertilized egg becomes challenging, when the uterus gets enlarged due to adenomyosis. This also affects embryo development, making conception difficult for women.
Causes & Risk Factors
Even doctors aren’t sure about the exact cause of, but the contributing factors include:
1. Hormonal Imbalances
Hormones, especially estrogen and progesterone, play an important role in the monthly menstrual cycle. Abnormal growth of the uterine lining into the muscle layer is stimulated by excess levels of estrogen. This worsens the condition.
2. Surgical Procedures
Increased incidence of surgical procedures like Caesarean and D&C may cause a breach in the uterine layers and cause deposition of the inner uterine lining or the endometrium into the myometrial layers. These trapped islands of endometrial tissues undergo expansion every month, but fail to shed. This cyclical process causes intense inflammation in the myometrial layer of the uterus and eventually leads to enlargement. This is one of the most important causes for adenomyosis.
3. Inflammation and Uterine Changes
Recurring Inflammation in the uterus will contribute to the development of adenomyosis. This affects embryo implantation and thus leads to conception problems.
4. High Estrogen Levels
Estrogen level encourages excessive tissue growth. Thus, Adenomyosis is often seen in women with high estrogen levels. The hormone can be triggered by factors like birth control use, hormone therapy, or conditions like polycystic ovary syndrome (PCOS).
Symptoms & Diagnosis
Adenomyosis can be tricky to diagnose because its symptoms often overlap with other reproductive disorders like endometriosis. Here’s what to watch out for:
Common Symptoms:
- Heavy menstrual bleeding lasting for days
- Extreme menstrual cramps
- Chronic pelvic pain
- Pain during sexual activity
- Difficulty in getting pregnant
How is Adenomyosis Diagnosed?
- Ultrasound: This is an imaging test used to detect abnormalities and uterine thickening.
- MRI (Magnetic Resonance Imaging): This will provide a clearer picture of the uterine walls and helps to know more about the condition
If you suspect adenomyosis, consulting a fertility specialist is crucial for proper diagnosis and treatment planning.
Treatment Options
While adenomyosis can affect fertility, the right treatment approach can help improve chances of conception. Here are some available options:
1. Hormonal Therapy
Hormonal Therapy will help you manage symptoms and slow the progression of adenomyosis.
- Birth Control Pills & IUDs: These are used to regulate hormone levels and reduce heavy bleeding.
- GnRH Agonists: These medications temporarily stop ovulation and reduce estrogen production, helping shrink adenomyotic tissue.
2. Surgical Interventions
For severe cases, surgical options may be recommended:
- Laparoscopy (Uterine-Sparing Procedure) : Laparoscopic removal of adenomyotic tissue can be done. The surgery is done through a small incision that removes adenomyotic tissue. This is a specialized surgery that can remove affected tissue while keeping the uterus unharmed. Women who want to preserve the uterus or where fertility is a concern, the uterus can be spared and only the adenomyotic tissues can be targeted and treated.
- Microwave thermal ablation – This is a procedure in which microwave heat is used to ablate the adenomyotic tissue
- Laparoscopic hysterectomy– This is a minimally invasive surgical procedure to remove the uterus. Women who have completed a family, and don’t want to preserve uterus can go for laparoscopic hysterectomy.
3. Fertility Treatments
If adenomyosis is preventing pregnancy naturally, assisted reproductive technologies can help:
- IVF (In Vitro Fertilization): A widely used fertility treatment. The eggs retrieved from the ovary are combined with sperm in the laboratory and facilitate fertilization. The resulting embryo is cultured into a woman’s uterus.
- Ovulation Induction: Medications that stimulate ovulation to enhance fertility chances.
Final Thoughts
Adenomyosis can be a frustrating and painful condition, but it doesn’t have to mean the end of your fertility journey. With the right diagnosis, treatment, and medical guidance, many women with adenomyosis can still conceive and have a healthy pregnancy. If you’re struggling with symptoms or infertility, consult a fertility specialist to explore your options.