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Adenomyosis (endometriosis)



Adenomyosis 

Introduction of Adenomyosis 
Adenomyosis is a gynaecologic medical condition where the cells of the uterine lining grow into the muscular wall of the uterus. 
Adenomyosis is similar to endometriosis and can cause similar symptoms or no symptoms at all. 
Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot. 
The cause of adenomyosis remains unknown, but the disease usually resolves after menopause.  
Adenomyosis is considered a benign and not life-threatening condition but the frequent pain and heavy bleeding associated with it can have a negative impact on a woman's quality of life. 

Symptoms of Adenomyosis 
Adenomyosis varies widely among people, including the extent of the condition and the severity of the symptoms. 
Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, adenomyosis can cause: 
  • Heavy or prolonged menstrual bleeding 
  • Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea) 
  • Chronic pelvic pain 
Your uterus might get bigger. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen feels tender or causes pelvic pressure. 

Causes of Adenomyosis 
The cause of this condition is not known. It is more common in women who have had multiple children (as opposed to those who have never had a child). It is not clear if adenomyosis is a separate medical condition, or represents a normal variant found in some women. 
There have been many theories, including: 
Invasive tissue growth. Some experts believe that adenomyosis results from the direct invasion of endometrial cells from the lining of the uterus into the muscle that forms the uterine walls. Uterine incisions made during an operation such as a caesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus. 
Developmental origins. Other experts suspect that adenomyosis originates within the uterine muscle from endometrial tissue deposited there when the uterus first formed in the foetus. 
Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus. Surgical procedures on the uterus can have a similar effect. 
Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis. 

Risk factors of Adenomyosis 
Risk factors for adenomyosis include: 
  • Prior uterine surgery,  
  • Prior C-section 
  • Prior fibroid removal. 
  • Childbirth. 
  • Middle age. 
Most cases of adenomyosis — which depends on estrogen — are found in women in their 40s and 50s. Adenomyosis in these women could relate to longer exposure to estrogen compared with that of younger women. However, current research suggests that the condition might be common in younger women. 

Diagnosis of Adenomyosis 
Your doctor may suspect adenomyosis based on: 
  • Signs and symptoms 
  • A pelvic exam that reveals an enlarged, tender uterus 
  • Ultrasound imaging of the uterus 
  • Magnetic resonance imaging (MRI) of the uterus 
In some instances, your doctor might collect a sample of uterine tissue for testing (endometrial biopsy) to verify that your abnormal uterine bleeding isn't associated with another serious condition. But an endometrial biopsy won't help your doctor confirm a diagnosis of adenomyosis. 
The only way to confirm adenomyosis is to examine the uterus after hysterectomy. However, pelvic imaging such as ultrasound and MRI can detect signs of it. 

Treatment of Adenomyosis 
Without treatment, adenomyosis may remain the same or symptoms can get worse. 
Adenomyosis often goes away after menopause, so treatment might depend on how close you are to that stage of life. 
Treatment options for adenomyosis include: 
Anti-inflammatory drugs. Your doctor might recommend anti-inflammatory medications, such as ibuprofen to control the pain. By starting an anti-inflammatory medicine one to two days before your period begins and taking it during your period, you can reduce menstrual blood flow and help relieve pain. 
Hormone medications. Combined estrogen-progestin birth control pills or hormone-containing patches or vaginal rings might lessen heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device, or continuous-use birth control pills often lead to amenorrhea — the absence of your menstrual periods — which might provide some relief. 
Hysterectomy. If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus. Removing your ovaries isn't necessary to control adenomyosis. 
Lifestyle and home remedies to ease pelvic pain and cramping related to adenomyosis, try warm bath, heating pad on your abdomen and over-the-counter anti-inflammatory medication, such as ibuprofen.

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