Adenomyosis Explained: Understanding Symptoms, Fertility Risks, and Unanswered Questions

Adenomyosis is a gynecological disorder characterized by the growth of endometrial tissue from the uterine lining into the muscular wall, resulting in the enlargement of the uterus and potentially causing excessive menstrual bleeding. Surprisingly, a significant number of individuals are unfamiliar with this condition, even though it impacts up to one in five women.

Adenomyosis: Symptoms, Causes, and Risks

Adenomyosis is a medical condition characterized by the infiltration of tissue resembling the lining of the uterus (endometrium) into the muscular wall of the uterus (myometrium). This abnormal growth leads to the thickening and enlargement of the uterus, sometimes causing it to reach double or triple its typical size.

Individuals with adenomyosis often experience painful periods, heavy or prolonged menstrual bleeding accompanied by clotting, and abdominal or pelvic pain.

Despite the impactful nature of adenomyosis, many women and individuals assigned female at birth (AFAB) may remain unaware of their condition due to the absence of noticeable symptoms. The prevalence of adenomyosis is not precisely known, but it is more frequently observed in individuals who have undergone uterine procedures, those above the age of 40, and around 2% to 5% of adolescents experiencing severe menstrual pain.

Approximately one-third of individuals with adenomyosis exhibit no signs or symptoms. For those who do, the manifestations can include painful menstrual cramps (dysmenorrhea), heavy menstrual bleeding (menorrhagia), abnormal menstruation, pelvic pain with or without severe cramping, painful intercourse (dyspareunia), infertility, an enlarged uterus, and a sensation of bloating or fullness in the abdominal region known as "adenomyosis belly."

The origins of adenomyosis remain unclear, although hormonal factors, genetics, and inflammation or trauma are considered potential contributors.

Adenomyosis is more commonly diagnosed in women and individuals AFAB aged between 40 and 50, those who have given birth at least once, and those with a history of uterine surgeries such as fibroid removal or dilation and curettage (D&C). Additionally, individuals in their 30s are increasingly being diagnosed with adenomyosis, especially if they present abnormal vaginal bleeding or painful periods.

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Types and Treatment of Adenomyosis

Adenomyosis manifests in two main types of tissue growth within the myometrium: focal lesions, which affect a specific part of the uterus, and diffused growth, which impacts a broader area of muscle.

Further classification of adenomyosis is based on the depth of invasion of endometrial-like tissue into the myometrium. However, ongoing research is exploring the relationship between the type or depth of lesions and the severity of symptoms, revealing that symptom severity and lesion extent do not always correlate.

Various treatment approaches exist for adenomyosis. Hormonal medications, such as oral contraceptives, progesterone-containing pills, the insertion of a progesterone-releasing coil (e.g., Mirena), or the use of GnRHa (a drug halting the natural production of sex hormones) are commonly employed.

Non-hormonal treatments like tranexamic acid aim to reduce menstrual bleeding, while pain management often involves non-steroidal anti-inflammatory drugs. However, treatment responses vary among individuals, reinforcing the notion that there may be different types of adenomyosis. Tailoring treatment strategies to individual patients, considering their fertility preferences and symptoms, is crucial.

For cases where medical interventions fall short in alleviating symptoms, surgical options such as the removal of focal lesions or a hysterectomy may be considered.

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