What is Adenomyosis? Symptoms and Treatment Methods
Adenomyosis is a benign gynecological condition that occurs when endometrium-like tissue lining the inner surface of the uterus is found within the muscle layer of the uterus. While it does not cause any symptoms in some women, it may cause complaints such as heavy menstrual bleeding, severe menstrual pain, chronic groin pain and pain during sexual intercourse in some women.
Istanbul adenomyosis treatmentWhen planning, only ultrasound or MRI images are not taken into consideration. The patient's bleeding amount, the effect of pain on daily life, anemia status, age and pregnancy plan are evaluated together. Assoc. Prof. in Istanbul. Dr. In the gynecological evaluation with Nazlı Korkmaz, the treatment approach is personalized according to the patient's symptoms and desire to protect the uterus.
What is Adenomyosis?
Adenomyosis is the presence of the gland and support tissue of the inner layer of the uterus within the myometrium, known as the muscle layer of the uterus. Since these tissues can respond to hormonal changes in the menstrual cycle, thickening, sensitivity and growth of the uterine wall may occur.
Adenomyosis can be seen spread throughout the entire uterine muscle, or it can be limited to only a certain part of the uterus. The disease is benign and does not constitute cancer. However, the bleeding and pain it causes can significantly affect the person's daily life and quality of life [1].
Article summary
Adenomyosis occurs when endometrium-like tissue is found within the uterine muscle layer. It may cause heavy menstrual bleeding, severe menstrual pain, pelvic pain and pain during sexual intercourse. Treatment; It is personalized according to symptoms, pregnancy plan and prevalence of the disease.
What Will You Find in This Article?
- What is Adenomyosis?:How the disease develops in the womb and its basic features are explained.
- Adenomyosis Symptoms:Heavy menstrual bleeding, menstrual pain, groin pain and other accompanying complaints are addressed.
- Adenomyosis Diagnosis:The role of gynecological examination, transvaginal ultrasound and MRI examination in diagnosis is explained.
- Adenomyosis Treatment:Medication, hormonal methods, uterine protective interventions and surgical options are explained.
What Causes Adenomyosis?
The exact cause of adenomyosis has not been fully explained. Disruption of the border between the inner layer of the uterus and the muscle layer, the development of endometrium-like cells within the myometrium and hormonal effects are among the mechanisms considered.
Previous cesarean section, uterine surgery or intrauterine procedure may be seen together with adenomyosis in some patients. However, adenomyosis does not occur in every woman who undergoes these procedures. Similarly, the disease can also be seen in women who do not have any history of uterine surgery.
What are the Types of Adenomyosis?
Adenomyosis can be generally classified as diffuse and focal according to its distribution within the uterine muscle. This classification alone is not sufficient to determine the treatment, but it may be helpful in evaluating the location of the disease and uterine protective options.
- Diffuse adenomyosis:Adenomyosis is a condition in which the findings spread to a large part of the uterine muscle layer. General growth and wall thickening of the uterus may be observed.
- Focal adenomyosis:It is a condition in which the findings are concentrated in a certain part of the uterus. When it forms a limited and mass-like appearance, it can also be called adenomyoma.
- Inner and outer localized involvement:The disease is more evident in the muscle layers close to the inner cavity of the uterus or the outer surface of the uterus.
The extent and location can be evaluated in ultrasound or MRI examination. However, the prevalence in the image and the intensity of the pain felt by the patient may not always be exactly the same.
What are the symptoms of adenomyosis?
Some women with adenomyosis may have no complaints. When symptoms occur, the most common complaints are intense and long-lasting menstrual bleeding and gradually increasing menstrual pain. The type and severity of symptoms may vary from person to person.
- Heavy menstrual bleeding,
- Prolongation of menstrual period1,
- Severe or increasing menstrual pain,
- Groin and pelvic pain that may continue outside menstrual periods,
- Feeling of pressure, heaviness or fullness in the lower abdomen,
- Deep pain during sexual intercourse,
- Iron deficiency and anemia due to intense bleeding,
- Weakness, getting tired easily, shortness of breath or palpitations,
- Difficulty getting pregnant or history of pregnancy loss in some patients.
Symptoms may increase over time, but this does not progress in the same way in every patient. Gynecological evaluation should not be delayed, especially if there is a significant increase in the amount of bleeding, pain that limits daily life, or symptoms of anemia.
“In the treatment of adenomyosis, not only imaging findings; bleeding, pain, anemia, quality of life and pregnancy plan should be considered together.”
What is the Difference Between Adenomyosis and Endometriosis and Myoma?
Adenomyosis, endometriosis and myoma are different diseases. However, they may cause similar complaints such as heavy menstrual bleeding, menstrual pain, groin pain and difficulty in getting pregnant. More than one of these conditions may be present in a patient at the same time.
| feature | adenomyosis | endometriosis | myoma |
|---|---|---|---|
| basic layout | Endometrium-like tissue is within the uterine muscle1. | Endometrium-like tissue is found outside the uterus. | It is a benign formation that develops from the muscle and connective tissue of the uterus. |
| Symptoms that can be seen in S1k | Heavy bleeding, severe menstrual pain and pelvic pain | Painful menstruation, pain during sexual intercourse, chronic pelvic pain and fertility problems | Bleeding, feeling of pressure, enlargement of the abdomen and frequent urination |
| Views | Transvaginal ultrasound and MRI when necessary | Ultrasound, MRI and surgical evaluation in selected patients | Usually ultrasound; MRI or hysteroscopy when necessary |
| Treatment approach | Drug, hormonal, interventional or surgical methods according to symptoms, age and pregnancy plan | Medical or surgical treatment according to the disease prevalence, disease prevalence and pregnancy plan | Follow-up, medical treatment, myomectomy or other interventions in selected patients |
This table is not intended for definitive diagnosis.Since similar symptoms can be seen in different diseases, diagnosis; It is determined by evaluating the patient's history, examination and imaging findings together.
For detailed information about myomas that can cause bleeding and pain complaints similar to adenomyosis.Myoma TreatmentYou can review our article.
How to Diagnose Adenomyosis?
Evaluation of adenomyosis begins with a detailed patient history. The amount and duration of menstrual bleeding, when the pain started, whether there is pain during sexual intercourse, previous pregnancies, uterine surgeries and plans to have children are questioned.
During gynecological examination, the uterus may feel larger than normal, round or tender. However, examination findings alone do not make a diagnosis. Today, transvaginal ultrasound and, when necessary, pelvic MRI are used in the diagnosis of adenomyosis [1].
- Gynecological examination:The size, mobility and sensitivity of the uterus are evaluated.
- Transvaginal ultrasound:Asymmetric thickening of the uterine wall, small intramuscular cysts, irregular transition zone and other changes in the uterine structure are investigated.
- Pelvic MRI:It can be used in cases where ultrasound findings are not clear enough, when distinguishing between myoma and myoma is difficult, or when the prevalence of the disease needs to be determined in detail.
- Blood tests:In patients with heavy menstrual bleeding, anemia can be investigated by hemogram and iron values.
- Endometrial sampling:Cannot confirm adenomyosis; However, it can be performed in selected patients to investigate another cause of abnormal bleeding related to the inner layer of the uterus.
How is Adenomyosis Seen on Ultrasound?
In ultrasound evaluation, small cystic areas within the uterine muscle, bright tissue islands and linear appearances extending from the inner layer of the uterus to the muscle layer are evaluated as direct signs of adenomyosis. Round appearance of the uterus, asymmetrical thickening of the muscle layer, and irregularity of the transition zone between the inside of the uterus and the muscle layer are among the indirect findings [2].
A single finding on ultrasound does not always mean definite adenomyosis. Interpreting the images with an experienced evaluation is important in distinguishing between myoma and other uterine diseases.
When is MRI Used in the Diagnosis of Adenomyosis?
Pelvic MRI can show the uterine muscle layer and transition zone in detail. It may be preferred in cases where ultrasound findings are not clear, there are fibroids in the uterus, or the location of the disease needs to be evaluated before surgical planning.
It is not mandatory to have an MRI in every case of suspicion of adenomyosis. Additional imaging may not be needed in patients in whom sufficient information can be obtained through ultrasound and a treatment plan can be determined.
How is Adenomyosis Evaluation Done in Istanbul?
Adenomyosis evaluation in IstanbulDuring the examination, imaging findings and the patient's complaints should be considered together. While a patient who has no complaints despite having obvious signs of adenomyosis on imaging can only be followed up, a patient with more limited imaging findings but experiencing intense pain and bleeding may require treatment.
Assoc. Dr. In the evaluation to be performed by Nazlı Korkmaz, a personalized road map is created by taking into account the bleeding pattern, the severity of the pain, anemia, the possibility of accompanying myoma or endometriosis, and the future pregnancy plan.
For information about other evaluations for uterine, ovarian and menstrual irregularitiesGynecologyYou can review our section.
How to Treat Adenomyosis?
Adenomyosis treatment is not the same for every patient. The main purpose of the treatment is to reduce heavy bleeding, control pain, correct anemia and improve quality of life. Preserving the uterus and fertility potential is also an important part of the treatment plan in patients who want to become pregnant.
When choosing treatment, the patient's age, severity of symptoms, proximity to menopause, whether the disease is widespread or focal, the presence of accompanying myoma and endometriosis, and previous treatments are also evaluated [1].
Can Asymptomatic Adenomyosis Be Treated?
Not every sign of adenomyosis requires treatment. Adenomyosis, which is detected incidentally during an ultrasound or MRI performed for another reason and does not cause bleeding or pain, can be followed up with regular check-ups.
If new heavy bleeding, gradually increasing menstrual pain, anemia, or a problem related to the pregnancy plan occurs during follow-up, the need for treatment is re-evaluated.
Can Adenomyosis Be Treated with Medication?
Drug treatments do not always completely eliminate adenomyosis tissue; It mainly aims to control symptoms such as heavy bleeding and pain. The drug to be administered should be determined by taking into account the patient's general health condition, amount of bleeding, desire for pregnancy and possible side effects.
- A r1 cutting and anti-inflammatory drugs:It can especially help reduce pain and cramps during the menstrual period.
- Drugs that reduce bleeding:It can be used in selected patients with heavy menstrual bleeding.
- Combined hormonal methods:It can be evaluated in suitable patients to reduce menstrual bleeding and pain.
- Treatments containing progesterone:The intrauterine system can help control bleeding and pain with tablets or different forms of application.
- GnRH analogues:These treatments, which temporarily suppress the effect of strogen, are generally used for certain periods of time and in selected patients due to their side effects.
Drug selection should not be made without examination and evaluating the patient's personal risks. Especially in patients planning pregnancy, the treatment target should be clearly determined, as hormonal methods may postpone pregnancy for a period of time.
Is Hormonal Spiral Used in the Treatment of Adenomyosis?
The intrauterine system that secretes levonorgestrel is one of the hormonal options that can be used to reduce heavy menstrual bleeding and pain due to adenomyosis. It may help reduce the amount of bleeding by thinning the inner layer of the uterus.
Hormonal spiral may not be suitable for every patient. The decision should be made by evaluating the shape of the uterine cavity, accompanying myomas, infection risk, pregnancy plan and previous side effects. Spotting or irregular bleeding may occur in the first months after application.
Is Uterine Artery Embolization Applied to Adenomyosis?
Uterine artery embolization is a procedure that aims to reduce the blood flow reaching the adenomyosis tissue by injecting small particles into the vessels feeding the uterus using the interventional radiology method. It may also be evaluated in some patients to reduce bleeding and pain complaints.
Symptoms may not disappear completely after the procedure, may reoccur in the future, or additional treatment may be required. Since the effects of embolization on fertility cannot be clearly explained, especially in patients who want to become pregnant in the future, the decision should be evaluated together by the gynecologist and the interventional radiologist [3].
When is Adenomyosis Surgery Required?
Surgery is not performed on every patient with adenomyosis. Surgical options may be considered in cases of pain that seriously affects daily life despite medication and hormonal treatments, heavy bleeding that cannot be controlled, recurrent anemia, or significant growth in the uterus.
Uterine-sparing surgery may aim to remove focal adenomyosis tissue. However, since adenomyosis can be intertwined with the right parts of the uterine muscle, it may be more difficult to determine the boundaries of the entire diseased tissue than myoma. For this reason, there is a possibility of recurrence of complaints after uterine-sparing surgery.
- Severe pain that persists despite medical treatment,
- Recurrent or severe anemia due to heavy bleeding,
- Significant enlargement of the uterus and complaints of compression,
- Adenomyosis, which can be evaluated focally and surgically,
- Serious deterioration in quality of life despite other treatments,
- The need for permanent treatment in a patient who does not plan to have children.
Does Hysterectomy Completely Cure Adenomyosis?
Hysterectomy is the surgical removal of the uterus and is the definitive treatment option for uterine adenomyosis. It is generally evaluated in patients whose intense bleeding and pain cannot be controlled by other methods and who do not plan to have children.
Hysterectomy is a major surgical decision and is not considered the first treatment option. The surgery is performed by open, vaginal, laparoscopic or robotic methods; It is determined according to the size of the uterus, previous surgeries, accompanying diseases and the surgeon's evaluation. It is not always necessary to remove the ovaries when performing surgery solely for adenomyosis.
To get information about surgical removal of the uterus, surgical methods and recovery processWhat is Hysterectomy?You can review our article.
Does Adenomyosis Prevent Getting Pregnant?
Not every woman with adenomyosis has fertility problems, and many patients can become pregnant naturally. However, some studies have reported that adenomyosis may be related to the attachment of the embryo to the uterus, clinical pregnancy and the continuation of pregnancy.
Studies examining assisted reproductive treatments show that the clinical pregnancy rate may be lower and the risk of pregnancy loss may be higher in some patient groups with adenomyosis. However, most of these studies are observational; The prevalence of the disease, age, accompanying endometriosis and the treatment protocol used may affect the results [4].
In patients planning pregnancy, surgical decisions should not be made based solely on the appearance of adenomyosis. Ovarian reserve, tubes, sperm values, age and previous pregnancy history should be evaluated together.
For information about assisted reproductive approaches that can be applied to patients with adenomyosis and pregnancy plans.0Istanbul In Vitro Fertilization TreatmentYou can review our article.
Does Adenomyosis Affect Pregnancy?
A diagnosis of adenomyosis does not necessarily mean that the pregnancy will be problematic. However, current studies report that adenomyosis may be associated with complications such as miscarriage, premature birth, preeclampsia, placenta placement problems and postpartum bleeding in some pregnancies.
The precision of the evidence showing these relationships may be low or very low. Therefore, risks should not be applied equally to every patient. Follow-up plan1 in pregnant women with adenomyosis diagnosis1; It should be regulated according to the prevalence of the disease, previous pregnancy history, maternal age and other accompanying risks [5].
Does Adenomyosis Cure During Menopause?
Since adenomyosis is a condition sensitive to hormones, complaints such as bleeding and menstrual pain may decrease in most patients with the end of menstruation. For this reason, the timing of menopause can be taken into consideration when making a treatment plan for patients who are close to menopause and whose symptoms can be controlled.
However, vaginal bleeding that occurs after menopause should not be considered normal. Even if there is a history of adenomyosis, other causes of postmenopausal bleeding related to the inner layer of the uterus or the cervix should be investigated.
Is Adenomyosis Cancer?
No. Adenomyosis is a benign uterine disease and does not mean cancer by itself. However, evaluation should not be postponed considering that heavy, irregular or postmenopausal bleeding is solely due to adenomyosis.
Depending on the patient's age, bleeding pattern and personal risks, additional examinations such as ultrasound evaluation of the inner layer of the uterus, endometrial biopsy or hysteroscopy may be required.
When should a doctor be consulted for adenomyosis?
Mild and short-term discomfort may occur during the menstrual period. However, it should not be considered normal if the pain gradually increases, interferes with daily life, or bleeding causes anemia.
- Bleeding heavy enough to require changing pads or tampons every hour
- Menstrual bleeding lasting longer than seven days1,
- Uncontrollable menstrual pain despite painkillers,
- Groin and pelvic pain that persists outside of menstruation,
- Recurrent deep pain during sexual intercourse,
- Symptoms of anemia such as weakness, dizziness, palpitations or shortness of breath,
- Difficulty getting pregnant or recurrent pregnancy loss
- In case of vaginal bleeding after menopause, an evaluation should be made.
Personalized Planning for Adenomyosis Treatment in Istanbul
Istanbul adenomyosis treatmentThere is no single standard method for . While follow-up may be sufficient in patients who are mild and do not cause any complaints, medication and hormonal methods may also be considered in patients experiencing heavy bleeding or pain. Uterus-preserving interventions and hysterectomy are considered according to the patient's pregnancy plan and previous treatments.
Assoc. Dr. The aim of the evaluation with Nazlı Korkmaz is to determine not only the adenomyosis area seen on imaging, but also the basic complaint that affects the patient's quality of life. Treatment decision1; Pain, bleeding, anemia, fertility desire and the patient's personal preferences should be taken into consideration together.
Frequently Asked Questions About Adenomyosis
Is adenomyosis dangerous?
Adenomyosis is a benign disease and usually does not cause life-threatening. However, intense bleeding may cause serious iron deficiency and anemia. Severe pain can also significantly affect daily life and quality of life.
Does adenomyosis go away on its own?
Adenomyosis may not disappear completely on its own during reproductive age. Symptoms may decrease or increase from time to time. As a result of the decrease in hormonal effects with menopause, bleeding and menstrual pain may ease in most patients.
Can adenomyosis be detected on ultrasound?
Yes. In an experienced evaluation, direct and indirect findings of adenomyosis can be seen with transvaginal ultrasound. However, a single ultrasound finding does not mean a definitive diagnosis. MR imaging can be used when necessary.
Are adenomyosis and myoma the same thing?
No. Myoma is a benign formation that develops from the muscle and connective tissue of the uterus. Adenomyosis is the presence of endometrium-like tissue within the uterine muscle. Although the symptoms may be similar, imaging and treatment approaches are different.
Can adenomyosis and endometriosis occur at the same time?
Yes. Adenomyosis and endometriosis can occur together in the same patient. Both conditions can be evaluated together, especially in patients with severe menstrual pain, deep sexual intercourse pain, chronic pelvic pain or fertility problems.
Does adenomyosis prevent getting pregnant?
Adenomyosis does not definitely prevent pregnancy and many patients can become pregnant naturally. However, the occurrence of pregnancy and the continuation of pregnancy may be affected in some patient groups. The evaluation should be made not only for adenomyosis, but also for all fertility factors of the couple.
Does hormonal coil cure adenomyosis?
Hormonal coil does not completely eliminate adenomyosis tissue. However, it may help reduce heavy menstrual bleeding and pain in suitable patients. It should be applied by considering the uterine structure, pregnancy plan and personal health characteristics.
Is surgery necessary for adenomyosis?
No. Follow-up in asymptomatic patients; In patients with a r1 or bleeding, medication and hormonal treatments may be sufficient. Surgical treatment is generally considered when other methods are inadequate or when complaints seriously affect the quality of life.
Does adenomyosis recur after surgery?
After surgery in which only the adenomyosis area is removed while preserving the uterus, complaints may recur due to remaining or newly developed disease tissue. Hysterectomy, in which the uterus is completely removed, is the definitive treatment for uterine adenomyosis.
Does adenomyosis cause anemia?
Yes. Prolonged or heavy menstrual bleeding can lead to iron deficiency anemia. If there is weakness, pallor, palpitations, shortness of breath and dizziness, hemogram and iron levels should be evaluated.
When should one apply for adenomyosis treatment in Istanbul?
Istanbul adenomyosis treatmentA gynecologist and obstetrician should be consulted, especially if there is increasing menstrual pain, heavy bleeding, anemia, pain during sexual intercourse, or difficulty with the pregnancy plan.
References
- [1]SOGC Guideline No. 437: Diagnosis and Management of Adenomyosis– Evidence-based clinical guidance on diagnosis and treatment options for adenomyosis.
- [2]Revised MUSA Features of Adenomyosis– International expert consensus on ultrasound findings of adenomyosis.
- [3]NICE – Uterine Artery Embolisation for Treating Adenomyosis– Recommendations regarding the effectiveness of uterine artery embolization, patient selection and fertility uncertainty.
- [4]Fertility, Pregnancy and Neonatal Outcomes of Patients with Adenomyosis– Systematic review evaluating the relationship between adenomyosis and assisted reproduction and pregnancy outcomes.
- [5]The ADELIN Analysis– Current systematic review and meta-analysis examining the relationship of adenomyosis with maternal, obstetric and neonatal outcomes.