Pain During Sex? Excess Abnormal Bleeding? You Could Have Adenomyosis
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If you’ve suffered from missed periods, painful bleeding, or excessive bloating, you may want to check in with your doctor. Many people have heard of endometriosis, but very few have heard of a similar condition called adenomyosis that plagues women and is incredibly difficult to diagnose. We chatted with gynecological experts to break down what adenomyosis is, how it’s different from endometriosis, and what to do if you think you have it.
What is adenomyosis?
Adenomyosis is when the uterine lining that gets shed every month during menses, called endometrial tissue, grows into the muscle of the uterus, explains Jane Van Dis, M.D., nationally-renowned OB/GYN and medical advisor for The Flex Co. The tissue is not supposed to grow into the muscle, which is why it can cause a slew of health issues.
Symptoms of adenomyosis
Some people with adenomyosis don’t experience any symptoms, but many experience similar symptoms to endometriosis, says Eric Levens M.D., FACOG, board-certified OB/GYN. Those include:
Excess or abnormal bleeding
Periods with blood clots
Pain during intercourse
Infertility
Bloating
Adenomyosis vs. endometriosis
Adenomyosis is classified by endometrial tissue that has grown into the uterine muscle, whereas its more well-known cousin, endometriosis, is marked by endometrial tissue growing outside the uterus, explains Dr. Van Dis, in other parts of the body such as the ovary, bladder, or even as far away as the lungs, she says. Endometriosis can be debilitating, significantly impacting quality of life, she notes.
Endometriosis is also much more common, impacting one in 10 women of reproductive age. In comparison, Dr. Van Dis estimates adenomyosis is diagnosed in only 1% of women. However, because most women don’t even know they have this issue, she says the true number is likely much higher. The Cleveland Clinic estimates as many as 20 to 65% of women may actually suffer from adenomyosis.
What causes adenomyosis?
Overall, Dr. Van Dis says more research is needed to truly understand why the uterine cells migrate to the uterine muscle in the first place. As of now, she says the science suggests that previous uterine surgery and childbirth are the biggest risk factors. Natalya Danilyants, M.D., FACOG, a board-certified gynecologist with The Center for Innovative GYN Care adds it’s commonly found in people who had multiple cesarean deliveries and can often appear along with endometriosis and fibroids.
Additionally, Dr. Levens says most with the condition are diagnosed later in life, in their 40s and 50s, but it can exist in younger people as well.
How is adenomyosis diagnosed?
It’s very difficult to diagnose adenomyosis—in fact, most diagnoses happen only after hysterectomies. This is why it is so drastically underreported, Dr. Van Dis says. “The only way to prove adenomyosis, you have to take the uterus out and look at it under a microscope,” she notes.
She adds that sometimes a vaginal ultrasound or pelvic MRI can find things that hint toward adenomyosis, but not every radiologist or tech will know what to look for.
“Many patients go undiagnosed for years. It is very common, so for anyone who has unexplained abnormal bleeding, adenomyosis should be at the top of the list. Especially those patients with infertility or prior cesarean deliveries,” Dr. Danilyants says.
How is adenomyosis treated?
To simply treat the symptoms of adenomyosis, Dr. Van Dis says a regular over-the-counter anti-inflammatory like Advil or Motrin can be helpful. This is typically the first step in managing discomfort and inflammation. Then, a doctor can prescribe birth control pills or a hormonal IUD, because there is some thought that estrogen plays a role in adenomyosis. Dr. Levens adds that these avenues can also help with reducing pain and bleeding during the menstrual cycle.
Alternatively, doctors sometimes prescribe medications that can put the body in a state of early menopause to effectively shut down production of estrogen and progesterone. Dr. Van Dis warns that this can’t be used for long periods of time because it can lead to bone loss, however, depending on a patient’s age and proximity to menopause, some doctors will choose this route.
Lastly, if the adenomyosis has deeply invaded the muscle, endometrial ablation—a procedure that destroys the uterine lining—or a hysterectomy are more invasive treatment options. Dr. Danilyants warns that endometrial ablation, however, can cause worsening pelvic pain post-op, and may only provide temporary relief.
If you think you may have adenomyosis, consult your doctor to discuss your concerns and potential next steps.
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