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Adenomyosis

Understanding Adenomyosis

Adenomyosis is a condition where the tissue lining the uterus grows into the muscular wall of the uterus. This can cause pain, heavy periods, and discomfort and significantly affect the quality of life of affected women.

Adenomyosis is common, especially among women in their 30s and 40s who have had children. While exact numbers vary, it’s estimated that around 20-30% of women of reproductive age may have this condition.

The history of adenomyosis dates back to the early 19th century when it was first described by Carl von Rokitansky, a famous pathologist. Since then, medical understanding of the condition has evolved, leading to better diagnosis and treatment methods.

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Let’s explore adenomyosis in more depth:

Etiology (Causes)

Adenomyosis is a condition where the tissue lining the uterus grows into the muscular wall of the uterus. This can cause pain, heavy periods, and discomfort and significantly affect the quality of life of affected women.

Adenomyosis is common, especially among women in their 30s and 40s who have had children. While exact numbers vary, it’s estimated that around 20-30% of women of reproductive age may have this condition.

The history of adenomyosis dates back to the early 19th century when it was first described by Carl von Rokitansky, a famous pathologist. Since then, medical understanding of the condition has evolved, leading to better diagnosis and treatment methods.

Risk Factors

  • Childbirth: Women who have had multiple pregnancies, especially cesarean deliveries, may have a higher risk.
  • Age: Adenomyosis is more common in women in their 30s and 40s.
  • Hormonal factors: Hormonal imbalances, such as excess estrogen, may contribute to adenomyosis.
  • Previous uterine surgeries: Procedures like cesarean sections or fibroid removals may increase the risk.

Types

  • Focal adenomyosis: This type involves small, localized areas of tissue growing into the uterine wall.
  • Diffuse adenomyosis: In this type, the tissue growth is more widespread throughout the uterus.
MRI scan showing a side view of a uterus with adenomyosis. The enlarged uterus is outlined in blue, and the inner cavity in pink. The yellow arrows show the bright tissue of the uterine inner lining within the walls of the uterus.

Most Common Symptoms 

  • Heavy or prolonged menstrual bleeding
  • Severe menstrual cramps
  • Pain during intercourse
  • Pelvic pain or pressure
  • Bloating or swelling in the lower abdomen

Diagnosis 

Traditionally, the diagnosis of adenomyosis was often made form pathologic analysis of uterus from hysterectomy. Often patients were misdiagnosed with fibroids and their hysterectomy specimens showed adenomyosis as the real culprit. Today, magnetic resonance imaging (MRI) is considered the best test (gold standard) for diagnosing adenomyosis.

Treatment Options

Medical Treatment:

  • Pain relief medication: Over-the-counter pain relievers like ibuprofen can help manage discomfort.
  • Hormonal therapy: Birth control pills or hormonal intrauterine devices (IUDs) can help regulate menstrual cycles and reduce symptoms.


Surgical Treatment:

  • The most common surgical treatment for adenomyosis is hysterectomy. Removal of adenomyosis only is normally not an option as it does not have clear boundaries and is difficult to differentiate from normal uterine muscle.


Uterine Artery Embolization:

  • Fortunately, Uterine Artery Embolization (UAE) (the same procedure as Uterine Fibroid Embolization), is an effective non-surgical treatment option for adenomyosis. Several studies have confirmed the safety and efficacy of this procedure for the treatment of adenomyosis. A systematic review, which is an analysis of all the prior research on this topic in 2017 that looked at 30 clinical studies on this topic with over 1,000 patients showed that UAE significant symptom relief from adenomyosis in the short term (<12 months) for 90% of patients and long term (>12 months) relief of symptoms in up to 75% patients. (Click here the read the paper).


Adenomyosis is a common condition that can significantly impact a woman’s quality of life. It is important to seek treatment and uterine artery embolization is a safe and effective non-surgical treatment option.

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