Adenomyosis - symptoms, diagnosis, treatment and pregnancy

What is Adenomyosis

A condition in which the cells that make up the endometrium (the lining of the UTERUS) grow into the wall of the uterus (myometrium), forming benign (noncancerous) tumors that appear as thickenings or masses contained within the uterine wall. Adenomyosis nearly always occurs in women who have carried pregnancies to full term, causing doctors to believe the condition results from injury to the wall of the uterus as it stretches to accommodate the growth of the FETUS in the final weeks of PREGNANCY.

Symptoms of Adenomyosis

Adenomyosis may not cause symptoms; the doctor may discover its presence during evaluation for other health conditions affecting the uterus, such as DYSFUNCTIONAL UTERINE BLEEDING (DUB) or ENDOMETRIOSIS. The uterus may be tender to palpation (examination by touching) during PELVIC EXAMINATION. When symptoms do occur they may include PAIN during SEXUAL INTERCOURSE, unusually heavy menstrual bleeding, and intense menstrual cramping.

Adenomyosis Diagnosis

The diagnostic path may include ULTRASOUND, COMPUTED TOMOGRAPHY (CT) SCAN, or MAGNETIC RESONANCE IMAGING (MRI), though definitive diagnosis requires myometrial biopsy (laboratory examination of a tissue sample from the uterine wall). The gynecologist may use HYSTEROSCOPY to obtain the biopsy, or may examine tissue obtained through procedures to treat DUB such as DILATION AND CURETTAGE (D&C).

Treatment for Adenomyosis

The monthly surge of hormones that cause the endometrium to thicken is responsible for symptoms; the engorged endometrial tissue causes pressure where it has infiltrated the myometrium. Because this hormonal cycle ends with MENOPAUSE (cessation of the menstrual cycle), adenomyosis then goes away. Treatment thus attempts to relieve symptoms until menopause occurs and may include NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) or oral contraceptives (birth control pills) to regulate the hormonal balance that controls the MENSTRUAL CYCLE. When symptoms are severe and the woman does not desire further pregnancies, HYSTERECTOMY (surgery to remove the uterus) may be a treatment option. Because the infiltration into the myometrium is diffuse (spread out), it is not possible to surgically remove only the sites of adenomyosis. Adenomyosis does not affect FERTILITY or the capability of the uterus to again expand in pregnancy.


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