Adenomyosis

Overview

Adenomyosis is a condition involving enlargement of the uterus and painful, heavy periods. Uterine enlargement occurs when endometrial tissue, which normally lines the inside of the uterus, migrates to the muscular wall of the uterus.

Symptoms

Symptoms include abnormal uterine bleeding (heavy bleeding during menses or bleeding at irregular times) and painful cramping during periods (dysmenorrhea) in a woman with an enlarged and tender uterus.

Causes

The cause of adenomyosis is unknown but is likely present to some degree in many older women who have gone through childbirth.

Diagnosis

The diagnosis can be suspected based on symptoms, ultrasound findings and magnetic resonance imaging (MRI) findings. The diagnosis can be confirmed only by a pathologist after the patient has undergone a hysterectomy.

The diagnosis may be suspected if an ultrasound scan shows small cystic spaces in the uterine muscle wall, especially in a woman experiencing heavy and painful periods. However, a definitive diagnosis can be made only after a hysterectomy LINK, which allows a pathologist to examine the uterus for endometrial glands (cells from the uterine lining). Patients with adenomyosis also may have signs of endometriosis.

Complications

Adenomyosis is associated with painful periods (dysmenorrhea ) and heavy bleeding during periods (menorrhagia ). Heavy bleeding can lead to anemia, a lower-than-normal number of healthy red blood cells. Some women may need to take iron supplements to compensate for anemia or, in an extreme case, receive a blood transfusion.

Treatments

Hysterectomy is considered the best treatment for adenomyosis because it halts heavy bleeding and uterine cramping. Recently, other treatments have also been tried, with variably good results. These treatments include the Mirena IUD and endometrial ablation.

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