Adenomyosis, a condition that causes the lining of the womb to bury into the muscular wall of the womb, affects as many as one in 10 women of reproductive age in the UK. Here, we look at everything you need to know about it.
What is adenomyosis?
Adenomyosis is a condition where the lining of the womb starts growing into the muscle in the wall of the womb.
The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle, leading in some cases to enlarged uterus and painful, heavy periods.
The condition is more commonly diagnosed in women over the age of 30, but it can affect anyone who has periods.
What are the symptoms of adenomyosis?
Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, according to the NHS, common symptoms can include:
- Heavy or prolonged menstrual bleeding
- Severe cramping or sharp pelvic pain during menstruation (dysmenorrhea)
- Chronic pelvic pain
- Painful intercourse
What causes adenomyosis?
The cause of adenomyosis isn’t known. You may be more likely to get it if you are over the age of 30 and have given birth.
There have been many theories, including:
- Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
- Developmental origins. Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
- Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
- Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.
Regardless of how the condition develops, its growth depends on the body’s circulating oestrogen.
How is adenomyosis treated?
Treatments include:
- the IUS (intrauterine system, also called Mirena or hormonal coil), which thins the womb lining, making your periods lighter and less painful
- other types of hormonal contraception if you cannot or do not want to have an IUS, such as the progestogen-only pill, the combined pill or the contraceptive patch
- medicines, such as tranexamic acid or NSAIDs
If these treatments do not work, women may need surgery. This could be a hysterectomy, or surgery to remove the lining of the womb, also known as endometrial ablation.
What is the difference between adenomyosis and endometriosis?
Adenomyosis and endometriosis are disorders that involve endometrial-like tissue. Both conditions can be painful. Adenomyosis is more likely to cause heavy menstrual bleeding. The difference between these conditions is where the tissue grows.
Adenomyosis occurs when endometrial tissue grows deep in the muscle of the womb, whereas endometriosis occurs when endometrial tissue grows outside the womb in places, such as the ovaries and fallopian tubes.
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