By Michalis Kyriakidis MD, M.Sc. Gynecologist in Reproduction at Embryolab Fertility Clinic
What is Adenomyosis?
Many things have been said and written in the past few decades about adenomyosis, but it remains a perplexing problem to this day. Adenomyosis is basically a uterine disorder where the cells that normally form a lining inside the uterus, also grow in the muscle wall of the uterus.
The displaced tissue continues to act normally every month which means thickening, breaking down and bleeding during each menstrual cycle. This eventually causes the related symptoms and makes the uterine walls grow thicker.
Is it common?
The disease may occur in as few as only a small portion of women through to 70% of women in certain age groups, although most studies suggest a 20-35% prevalence. As is often the case, the true cause of adenomyosis remains unknown. There have been many theories, including invasive tissue growth (lining cells invade into the muscle layer sometimes as a result of an operation), developmental origin (lining tissue deposited into the uterine muscle early in fetal life, before birth) or even uterine inflammation related to childbirth. Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen which is why it is seen in women in their reproductive years. Adenomyosis usually disappears after menopause.
What are the symptoms?
The main symptom of adenomyosis is pain. This can vary between mild to severe but some women may not experience any at all. Other symptoms may include prolonged menstrual cramps and heavy menstrual bleeding, pain during sexual intercourse or even tenderness in the area. Furthermore, with women often delaying pregnancy to their late 30s and 40s, there is increasing evidence that adenomyosis has an impact on fertility hindering both spontaneous and assisted pregnancy. Although some women with endometriosis often have similar symptoms, they are different conditions. In endometriosis, cells similar to those that line the uterus are found in other parts of the body.
So how do you diagnose adenomyosis?
After two decades of experience in Embryolab, we know that it is unwise to rely on clinical symptoms alone. A complete medical evaluation should be utilized. Non-invasive diagnosis is certainly possible and the main test recommended is a transvaginal ultrasound. The test should preferably be performed by a gynecologist with an understanding of both the disease and the patient’s history and goals. MRI (magnetic resonance imaging) can also be useful in diagnosing adenomyosis, although it remains substantially more expensive and less available. In selected cases, a diagnostic operation (laparoscopy) and uterine biopsy may be necessary to confirm the diagnosis.
Does adenomyosis cause infertility?
Evidence is accumulating that there is a close relationship between the occurrence of adenomyosis and infertility. This possibly relates to abnormalities in the endometrial environment that alter endometrial function and receptivity. Women that face difficulties with conception should consult a fertility specialist before deciding the best course of action.
In Embryolab we have several examples of couples achieving their goal despite adenomyosis. The key to success lies with personalized and holistic treatment. Our experience has shown that individualized treatment including medical and surgical approaches can benefit women. In this manner, you can achieve both quality of life (reducing pain and heavy menstrual bleeding) and high success rates in IVF.
It is important to understand that every woman needs support and guidance when facing a puzzling problem like adenomyosis. A well-organized fertility clinic and a specialist can guide you through the difficulties of achieving your goals.
Do you suffer from adenomyosis? We would love to hear how you are doing. Drop us a line at firstname.lastname@example.org