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Adenomyosis, a chronic painful condition, is the development of the inner layer of the uterus (endometrium) in the thickness of the uterine wall (myometrium).

The cause for adenomyosis is not known as yet, but there are several theories:

Adenomyosis occurs due to the extension of the deep pelvic endometriosis from the outside (abdominal-pelvic cavity, peritoneum) into the thickness of the uterine wall (myometrium). This extension does happen frequently in cases of advanced deep endometriosis when endometriosis nodules infiltrate the posterior uterine wall (cervix, uterine body).

Trauma to the uterus/vagina could trigger activation of various biochemical mediators (cytokines, interleukins, etc.). This would lead to the development of aberrant endometrial tissue (adenomyosis) within the myometrium.

Cell migration at the myometrium level due to hyperexpression of estrogen receptors or that there may be intra-myometrium lymphatic migration of aberrant endometrial stem cells.

Adenomyosis SYMPTOMS

Adenomyosis causes severe pain during menstruation, heavy bleeding and intermenstrual bleeding (metrorrhagia). Adenomyosis pain, as described by patients, seems to be much stronger than endometriosis pain. Most of the time, the pain is located in the lower abdomen (hypogastrium) zone and it radiates to the dorsal region (the lumbar-sacral region).

Adenomyosis also manifests as a dull chronic pain, a feeling of pressure and abdominal distension. Symptoms such as transit and urinary disorders, pain that may radiate to the pelvic limbs or to the anus may also occur.

Based on biopsies diagnosis, adenomyosis seems to be a very common pathology but not all cases are symptomatic. Often, when the uterus is removed for other health issues (fibroids, endometrial hyperplasia, gyn cancers) adenomyosis is also noticed/found.

While adenomyosis is more often diagnosed in patients between 30-45 years old, there are quite a lot of cases of adenomyosis in very young patients (20-25 years), and no pregnancy, diagnosed during endometriosis surgery.

Some studies mention uterus surgeries as a risk factor. Although the cause of adenomyosis is not completely elucidated, it seems that hormones (estrogen, progesterone, FSH, prolactin, etc.) act as a trigger for the disease. Etiology, as with endometriosis, is a genetic one.

Adenomyosis DIAGNOSTIC

The diagnosis of adenomyosis was until recently done after hysterectomy and histopathological examination of the uterus. Now, with the help of ultrasounds and MRI, the diagnosis (suspicion of the diagnosis) can be made without surgery.

The clinical examination reveals an enlarged uterus, painful to the palpation. Pelvic ultrasound based on some ultrasound signs that may raise suspicion of adenomyosis), however, it can exclude other gynecological pathologies – most commonly uterine fibroids.

Adenomyosis TREATMENT

As a non-surgical treatment option, there are a variety of prescription drugs for adenomyosis / to reduce the pain and heavy bleeding. Oral contraceptives, various progesterone preparations and the use of slow-release uterine progesterone devices can be used as well.

Surgical treatment for focal adenomyosis/adenomyoma is deep laparoscopic excision of the affected tissue. A great advantage of this technique is that the gynecologist can resect the affected tissue and preserve fertility, especially when fertility is desired.

Hysterectomy is considered a radical intervention and is indicated as the last option in patients with diffuse adenomyosis. This should not be done for patients with endometriosis and adenomyosis suspicion, nor for patients with focal adenomyosis/adenomyoma.

Another surgical option for diffuse adenomyosis, in patients with severe pelvic pain and hysterectomy, can be done, is the laparoscopic resection of the presacral nerve.