What is Adenomyosis
It is a pathology during which cells comparable to those of the endometrium appear in the myometrium. In other terms the uterine mucosa is present in the uterine muscle. These cells will therefore be sensitive to the menstrual cycle.
Are there different Adenomyosis?
Adenomyosis is most often localized. Diffuse Adenomyosis occurs when it affects the whole myometrium. When it is near the endometriosis mucosa, we speak of superficial Adenomyosis, near the serous lining of the uterus we speak of external adenomyosis. Alternatively, we are talking about Deep Adenomyosis. Finally, when it is “active and diffuse” it is called florid Adenomyosis.
Who can have Adenomyosis
It is a common disease of the uterus muscle after 40 years of age since it is found in almost a quarter of women. There is another form that appears very early but no genetic factor has yet been identified. Finally, it seems that surgical procedures may lead to the development of adenomyosis.
Symptoms of the disease
The main symptom is the abundance of menstrual periods that increases over time. Later, bleeding may occur outside the period. Pain during menstruation is often associated (dysmenorrhea). When the uterus is large, women may experience lumbar pain, pelvic gravity and even pain during sexual intercourse.
The diagnosis can be made clinically by the gynecologist if the uterus is a little large. The ultrasound is a very good exam. MRI is used occasionally.
Adenomyosis and Endometriosis
These are two fairly similar conditions and this is why they are often associated since endometriosis is found in 25% of women with adenomyosis. Adenomyosis is called “Intrauterine endometriosis”. The symptoms may be pain during menstruation and sometimes beyond, heavy menstruation, pain during sexual intercourse.
Adenomyosis and fibroids
These are two pathologies that are often associated since adenomyosis is found in one-third of women with fibroids.
Adenomyosis and fertility
Some women with adenomyosis may have a decreasing fertility rate. This is all the more so as there are associations with endometriosis or fibroids. But many women have no problem getting pregnant!
The progesterone IUD is the reference treatment. If it is not well tolerated, progesterone-based per-os treatments may be offered. When treatments are not enough, surgery may be necessary.
It is possible to act inside the uterus during hysteroscopy. An endometrectomy can be performed, i. e. removing the mucous membrane quite deeply or burning it. A radical gesture can be proposed: a hysterectomy.