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Alternative Names: Internal endometriosis.
Adenomyosis is a benign disease of the uterus in which endometrial tissue, which normally lines the uterus, extends outward into the fibrous and muscular tissue of the uterus (the myometrium). When the endometrial tissue bleeds during menstruation, the old tissue and blood cannot get out of the muscle and flow out of the cervix as part of normal menses. Blood and debris are thus trapped inside the uterine wall, causing swelling of the uterus, severe cramps and bleeding.
Incidence; Causes & Development
While some studies estimate that 20% of women have adenomyosis, the exact rate of incidence of adenomyosis is unknown because a diagnosis can be made only after a pathologist examines uterine wall samples obtained during surgery or biopsy.
More than 80% of women with adenomyosis have other uterine disorders as well. Some 50% have associated fibroids (benign smooth muscle tumors of the uterus); approximately 11% have endometriosis (endometrial tissue outside of the uterus); and 7% have endometrial polyps (benign outgrowths of endometrial tissue). The symptoms of these often obscure the diagnosis of adenomyosis.
The cause of adenomyosis is not known. One popular theory suggests that the barrier between the endometrium and the myometrium, which normally prevents invasion of endometrial glands into the myometrium, is compromised, allowing invasion to occur. Other reports have shown that the frequency of adenomyosis is greater in patients who have undergone cesarean sections, tubal ligations and pregnancy terminations.
Signs & Symptoms
About 50% of women with adenomyosis do not show symptoms; some women experience heavier bleeding and increased cramping as the condition worsens. Patients who do have symptoms usually experience uterine enlargement, pelvic pain, abnormal uterine bleeding and heavy menstrual bleeding. The uterus is usually boggy and uniformly enlarged; pain is most common during menstruation and occurs in 25% of cases; and 60% of patients have prolonged or heavy menstrual bleeding, with passage of clots.
Diagnosis & Tests
Adenomyosis is difficult to diagnose. For one, many patients are asymptomatic, but even when women have symptoms, it is either mistaken for another common condition, such as uterine fibroids, or overshadowed by an associated condition, such as endometriosis. Until recently, diagnoses were often made incidentally after the uterus had been removed for other reasons. Diagnostic tools include an abdominal X-ray that is taken after ingestion of contrast (a dyelike material that is visible on X-ray); MRI with contrast medium that can often distinguish adenomyosis from fibroids (although its cost precludes its routine use); and a transvaginal ultrasound, which can provide an accurate diagnosis but, like MRI, can also yield false positives especially in the presence of fibroids.
Treatment & Prevention
Treatment is determined by the extent to which the adenomyosis is causing symptoms. If pain is manageable, often no treatment is prescribed and a patient takes pain medication and/or birth control pills for the temporary relief of menstrual discomfort. If symptoms are severe, however, hysterectomy is considered the most effective treatment, especially if a woman is not approaching menopause soon (symptoms of adenomyosis generally decrease with menopause). Gonadotropin-releasing agents such as Lupron have also been used to treat adenomyosis, causing a decrease in uterine size and cessation of menstruation; however, adenomyosis seems to recur after discontinuing the therapy.
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Conditions that suggest Adenomyosis: | | | | | Uro-Genital |  Painful Menstruation (Dysmenorrhea)
Pregnancy-Related Issues | Approximately 80% of women with adenomyosis have given birth, but the incidence of adenomyosis does not correlate with increasing numbers of pregnancies. |
Counter-indicators:
 Pregnancy-Related Issues| | Approximately 80% of women with adenomyosis have given birth, but the incidence of adenomyosis does not correlate with increasing numbers of pregnancies. |
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Adenomyosis can lead to:
KEY | | Weak or unproven link |  | | Proven definite or direct link | | | Weakly counter-indicative |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Asymptomatic
Not showing symptoms.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous; they tend to grow slowly and don't spread (metastasize) like cancer tumors do.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cervix
The lower part of the uterus that opens into the vagina.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Endometriosis
A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Hysterectomy (Hysterectomies)
Surgical removal of the uterus, by way of either an abdominal or vaginal incision. Removal might include removal of the cervix (total hysterectomy) or not (subtotal / partial hysterectomy). A radical hysterectomy involves surgical removal of the uterus, upper vagina, tissues adjacent to the uterus and possibly the ovaries; usually undertaken for carcinoma of the uterus. A hysterectomy with oophorectomy involves the removal of the uterus and one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Magnetic Resonance Imaging (MRI)
A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Pathology (Pathologist)
Disease, particularly one with clear and obvious changes in structure or function; the study of same.
Polyp (Polyps)
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Smooth Muscle (Involuntary Muscle)
The human body contains 2 types of muscle - smooth muscle and striated (skeletal) muscle. Smooth muscle is found in our internal organs such as stomach, intestines, blood vessels, or uterus (womb) and causes them to contract. These muscles are involuntary - that is, we don't control their movement.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Uterine Fibroids
Fibroids are the most frequently seen tumors of the female reproductive system. Also known as uterine myomas, leiomyomas, or fibromas, they are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. In more than 99% of cases they are benign (non-cancerous). They may range in size from the size of a pea to the size of a softball or small grapefruit. Some women never have symptoms, the most common of which are: heavy or prolonged menstrual periods; abnormal bleeding between menstrual periods; pelvic pain; frequent urination; low back pain; pain during intercourse; a firm mass, often located near the middle of the pelvis, which can be felt by a physician.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Apr 13, 2008
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