Adenomyosis. If you've never heard of it, don't worry - you're not alone. Adenomyosis is a common cause of heavy, painful periods but it definitely isn’t a famous one.

What is Adenomyosis?

Adenomyosis is a condition where the tissue that normally lines the womb (the endometrium) starts growing within the muscle wall of the uterus. Imagine the endometrium as a guest who overstays their welcome and starts moving into rooms they shouldn't be in! Endometriosis is when they sneak out of the house.

Types of Adenomyosis

- Diffuse Adenomyosis: This is when the endometrial tissue is found in small spots throughout the uterine muscle.
- Focal Adenomyosis (Adenomyoma): Here, the adenomyosis tissue forms a discrete lump within the wall of the uterus.
- Junctional Zone Adenomyosis: Sometimes, the tissue is found only at the interface between the endometrium and the myometrium (between the lining and the muscle layer of the uterus).

Who Gets Adenomyosis?

Traditionally, we thought adenomyosis was more common in women in their 30s and 40s. However, it's likely that younger women also suffer from it, but it's just harder to diagnose at that point in life (see below for why).

Symptoms to Watch For

- Heavy and/or Painful Periods: This is the most common symptom.
- Chronic Pelvic Pain: Many women with adenomyosis experience ongoing pelvic pain.

Diagnosis

In the past, diagnosing adenomyosis required a hysterectomy to examine the tissue under a microscope. Thankfully, we now have ultrasound scans and MRIs that are increasingly helpful to make this diagnosis without surgery. Even so, adenomyosis can be difficult to pick up with imaging.

We make the diagnosis when we have histology that shows adenomyosis, and we call it a presumptive diagnosis if your story, your examination findings and your imaging are consistent with adenomyosis (in the absence of another diagnosis).

Relationship with Endometriosis

Adenomyosis and endometriosis are like troublesome siblings. They often come together and create more havoc together than when apart!

Treatment Options

• Pain Relief: Mostly we rely on paracetamol and non-steroidal anti-inflammatory drugs.

• Non hormonal medication: Tranexamic acid is a medication taken during your period that can make it less heavy.

• Hormones : These are usually the first kind of treatment we offer. It can be in the form of pills or a small device that releases hormones straight into the uterus (Mirena).

• Surgery: If medications don't work and you don't plan to have more children, a hysterectomy might be a good option.

• Uterine Artery Embolisation: We usually give this option to women who have completed their families. It works by reducing the blood supply to the uterus and causing adenomyosis to shrink.

Treatment options all have their different pluses and minuses and you should get help from your doctor to choose the right one for you.

Fertility

It might be that Adenomyosis makes it more difficult to become pregnant (1,2), but we are far from being sure. It’s difficult to study this because it’s a tricky disease to diagnose, and because the study outcomes are influenced by the fact that endometriosis is often present and might be confusing the results.

Pregnancy Issues

It seems quite likely that adenomyosis is associated with a higher rate of miscarriage, small babies, and preterm birth (2,3), but again it’s hard to be sure (for the same reasons it’s tricky in fertility studies) and more studies are needed to confirm this.

 Final Thoughts

Adenomyosis is more common than we once thought, and it's important to recognise the symptoms and seek help if you're experiencing them. If you have this diagnosis, or you think you do, you don’t have to assume having babies will be a problem- there are many, many people with undiagnosed adenomyosis having babies. It would just pay to keep this information in the back of your mind and not delay having a family too much - especially if you want more than one child.

With modern diagnostic tools and various treatment options, identifying and managing adenomyosis is more achievable than ever.

I hope this very brief outline helps you understand adenomyosis a bit better. If you have any questions or concerns, don't hesitate to reach out to your healthcare provider.

1)      Maheshwari et al. Hum Reprod Update. 2012 Jul;18(4):374-92

2)       Tomassetti  et al. Semin Reprod Med. 2013 Mar;31(2):101-8.

3)       Maheshwari A. Hum Reprod Update. 2012 Jul;18(4):374-92