L’adenomyosis has symptoms very similar to endometriosis, such as: painful and heavy menstruation, pelvic pain, fertility problems and can affect a third of women between the ages of 18 and 30. Obtaining a diagnosis of adenomyosis is very complicated precisely because of the similarity with theendometriosis.
Adenomyosis: what it is and how it manifests itself
Adenomyosis is a benign, that is, non-cancerous condition. It is very difficult to determine the number of women who suffer from it as many of them may not be aware that they have a gynecological condition. However, one study found that adenomyosis involves 34% of cisgender women between the ages of 18 and 30.
Cisgender is a gender identity that a person believes corresponds to the sex that a doctor assigned him at birth. This does not mean that cisgender people cannot be part of LGBTQIA + communities.
Symptoms that may be encountered are: heavy menstrual periods or abnormal uterine bleeding; painful and irregular menstruation; premenstrual pelvic pain and feelings of heaviness or discomfort in the pelvis; problems with fertility; pain during intercourse or bowel movements (less common).
Professor Andrew HorneProfessor of gynecology atUniversity of Edinburgh, United Kingdomand spokesperson for the Royal College of Obstetricians and Gynecologists (RCOG) of the United Kingdomhe has declared: “Adenomyosis occurs when the cells that make up the lining of the uterus are found in the muscular wall of the uterus. Symptoms include heavy and / or painful periods, as well as pelvic pain and discomfort. One third of people with this condition do not experience any symptoms, but those who do can have symptoms ranging from mild to severe and this condition can have a serious impact on a woman’s quality of life.
The first study on adenomyosis was carried out in 1947 after carefully studying nearly 2,000 uteri after hysterectomy, surgical removal of the uterus. Until recently, histological examination of a uterus was the only way to diagnose adenomyosis.
Thanks to new imaging technologies, specialists today can recognize adenomyosis thanks to ultrasoundor at magnetic resonance scans (MRI). Thanks to these new diagnostic investigation tools it is possible to have a more precise result and to be able to distinguish the two very similar pathologies in symptoms.
As already specified, in the past, adenomyosis could only be diagnosed after a hysterectomy, a procedure often used to treat AUB in women during perimenopause. So doctors thought the condition was limited to women reaching the end of their reproductive years, especially those who had undergone several pregnancies or uterine surgeries, such as Caesarean delivery.
Despite advances in technology, some cases of adenomyosis can be challenging to identify as endometriosis and uterine fibroids can have the same symptoms. One 2020 study stated that nearly half of women with adenomyosis also had uterine fibroids.
“Clinical diagnosis of adenomyosis is difficult, due to the non-specific nature of the symptoms. Furthermore, until fairly recently, the diagnosis of the disease required the analysis of the uterus after a hysterectomy. However, recent advances in imaging techniques have impacted disease detection, and ultrasound and MRI are now commonly used diagnostic tools.“, Specified Horne.
According to Sherry A. Rossgynecologist and women’s health expert at the Providence Saint John’s Health Center in Santa Monica, California: “Painful periods with intense and irregular bleeding can be observed for healthcare professionals in a number of other medical conditions, so putting all the pieces together can be difficult. […] Adenomyosis can also coexist with fibroids and endometriosis. Many health experts still have disagreements about the definition and classification of imaging and pathology caused by this pathology ”.
Treatments for adenomyosis are similar to those offered for other menstrual conditions, as Dr. Ross pointed out: “The best treatment options for someone with adenomyosis who still want to conceive will depend on the symptoms they are experiencing. Non-steroidal anti-inflammatory drugs will be helpful for menstrual cramps and pelvic pain. The birth control pill and progesterone IUD will control heavy, irregular periods and menstrual cramps. Hormonal treatments may also have other benefits ”.
“Long-term hormonal contraception prevents proliferation of endometrial-like tissue, which makes endometrial tissue less likely to invade the myometrium muscle wall of the uterus“, he has declared Dr. G.Tomas Ruiz, of Memorial Care Orange Coast Medical Center in Fountain Valley, CA.
Regarding the possibility of having a baby, some doctors recommend it as it can help: “Some women warn [meno] symptoms of adenomyosis after having a baby, while others don’t. Everyone with adenomyosis has a different experience with the struggles of this elusive medical condition“, noted Dr. Ross.
Dr. Ruiz explained why having a baby can help some people with adenomyosis. “Pregnancy causes something called decidualization of the endometrial tissue, which makes the endometrium less active and, therefore, a decrease in pain results“. However, among the symptoms there is also the problem of fertility.
“Some research studies suggest that the condition appears to impact fertility and can lead to an increased risk of miscarriage and premature birth. Anyone diagnosed with adenomyosis and who are concerned about their fertility can speak to their primary care doctors”, Professor Horne specified.
Prof. Horne encouraged all women with excessive bleeding or pain during or between menstruation to seek help: “We would encourage women experiencing symptoms such as chronic pelvic pain or painful periods to speak to their primary care physician and ask to be referred to a gynecologist if they are still concerned. These symptoms may not indicate adenomyosis, but may be associated with another gynecological condition ”.
Dr. Ross replied: “If you have persistent symptoms of painful periods, heavy and irregular bleeding, painful sex or infertility and are not satisfied with your health experience, be your best health advocate and raise the potential diagnosis of adenomyosis. “
As often happens, research for this type of pathology is scarce and should be encouraged: “There is a lack of investment in research focused on women’s health and we hope that the next strategy for women’s health will prioritize more research on gynecological conditions such as adenomyosis, increasing awareness of symptoms and improving diagnoses and treatments of gynecological conditions.”Concluded Horne.
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