Adenomyosis: What is it?

Many women in Australia and worldwide aren’t aware they have adenomyosis because the condition doesn’t always cause symptoms. The condition may affect 20% to 65% of females in Australia and USA. March is Adenomyosis and Endometriosis Awareness Month, so we will be exploring the similarities and differences between the two.

Many of our patients ask the difference between adenomyosis and endometriosis because the symptoms sometimes resemble each other or occur simultaneously. The main difference is in the location of uterine tissue. Adenomyosis occurs when uterine tissue embeds into the uterine wall. Endometriosis occurs when uterine tissue spreads in locations outside of the uterus. Although both can cause pain, endometriosis does not typically cause heavy bleeding. [1]

What is Adenomyosis?

adeno – gland

myo – muscle and

osis – condition

Adenomyosis is a condition that is very similar to endometriosis. Adenomyosis is a condition of the uterus. It occurs when the cells that normally line the uterus also grow in the layer of muscle in the wall of the uterus. [2]

Signs & Symptoms of Adenomyosis

Often, symptoms start late in the childbearing years after women have children. Women with adenomyosis might have:

• heavy periods
• painful periods
• pain during sex (dyspareunia)
• bleeding between periods [3]
• tiredness from the anaemia caused by blood loss
• infertility
• Severe menstrual cramps
• Pain in the legs and back
• Severe or chronic (ongoing) pelvic pain
• Pelvic pressure
• Swelling of the abdomen
• Abdominal bloating
• Clots in legs and pelvis

The symptoms might be mild, but they can be severe enough to interfere with work and enjoyment of life.

Many of these symptoms are similar to symptoms of other medical conditions, such as endometriosis, irritable bowel syndrome (IBS), fibromyalgia and pelvic inflammatory disease (PID).  [4]

Causes of Adenomyosis

The cause of adenomyosis isn’t known. There have been many theories, including:

• Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
• Developmental origins. Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
• 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.
• Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen. [5]

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 also be common in younger women. [6]

How is adenomyosis diagnosed?

Some other uterine conditions can cause signs and symptoms similar to those of adenomyosis, making adenomyosis difficult to diagnose. These conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps).

Your doctor might conclude that you have adenomyosis only after ruling out other possible causes for your signs and symptoms.

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 make sure you don’t have a more serious condition. But an endometrial biopsy won’t help your doctor confirm a diagnosis of adenomyosis.

Pelvic imaging such as ultrasound and MRI can detect signs of adenomyosis, but the only way to truly confirm it is to examine the uterus after hysterectomy.

[7]

Management

While adenomyosis can be treated with a minimally invasive hysterectomy, or a novel conservative surgery referred to as ‘adenomyomectomy’ (removal of the abnormal tissues), its symptoms can sometimes be temporarily managed using nonsurgical methods. These methods may include pain management, acupuncture, pelvic floor physical therapy, nutritional counselling, psychotherapy and physical training.

Physical Therapy

Pelvic pain is a common symptom of adenomyosis due to the increased levels of inflammation in the uterus. Pain in the pelvis and lower back can be relieved through pelvic floor physical therapy, which incorporates relaxation exercises, soft tissue stretching, biofeedback therapy and additional physical therapy techniques. Other types of physical therapy that may help alleviate adenomyosis symptoms include:

• Acupuncture – a safe method for relieving symptoms of painful periods and reducing pain-related anxiety
• Heat therapy – a method to ease cramping and alleviate pelvic pain
• Warm baths and heat packs
• Myofascial release – a technique used to break up soft tissue adhesions that may be contributing to pelvic pain

Medication

In some cases, certain medications may help to alleviate pain caused by adenomyosis. Some commonly prescribed medications include:

• Birth control pills
• Hormone treatment
• Mirena IUD (intrauterine device)

These hormonal suppression medications are not always effective, but they may help relieve painful symptoms in mild cases of adenomyosis.

Diet and Supplements

At Advanced Functional Medicine, our functional medicine practitioners will work with you to develop a personalised nutrition and supplement plan that is customised to your individual case.

• Anti-inflammatory foods: Foods that have anti-inflammatory properties can help relieve symptoms of adenomyosis. These foods include green leafy vegetables, tomatoes, olive oil, fatty fish, fruits and certain types of nuts are the pillars of an anti-inflammatory diet.

• Anti-inflammatory supplements: Certain supplements (such as turmeric, fish oil and ginger) have been shown to have anti-inflammatory properties. Reducing inflammation in the body through diet and supplements may have a positive effect on pain and cramping.

• Hormone-regulating supplements: Supplements like biotin, Diindolylmethane (DIM) and some herbal supplements such as vitex are thought to regulate hormone levels in the body. Lowering elevated levels of estrogen can help to reduce adenomyosis symptoms. [8]

• Iron supplements: Both conditions can lead to anemia from menstrual bleeding. This means you don’t have enough iron in your blood. Iron supplements may help.  Always ensure you have your iron assessed and sek advice from a practitioner before taking iron. 
• [9]

For women with mild cases of adenomyosis, these diets and supplements may help to alleviate some symptoms. [10] Adenomyomectomy is an option for targeted surgery to remove legions, or a Hysterectomy is an option for women with severe adenomyosis . [11]

Impact on fertility

Adenomyosis can make it more difficult to become pregnant, but conceiving a baby is possible if the condition is mild and well managed. In many cases, adenomyosis may cause infertility and increase the chance of a pregnancy loss or miscarriage.

Women in their 30s and 40s with adenomyosis may have fewer spontaneous and successful assisted pregnancies. This is because normal sperm movement and embryo implantation into the uterine lining can be affected. The risk of miscarriage may also be higher if adenomyosis if is present.

Adenomyosis may affect how the placenta and baby grow during pregnancy. Studies have shown baby’s growth may be slower, and waters may break early causing premature birth. [12]

Adenomyosis and Endometriosis: Similarities and Differences

The difference between these conditions is where the endometrial tissue grows.

• Adenomyosis: Endometrial tissue grows into the muscle of the uterus.
• Endometriosis: Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.

The following table shows both the similarities and differences between Adenomyosis and Endometriosis: [13]

Adenomyosis vs. Endometriosis Symptoms

Adenomyosis vs. Endometriosis Risk Factors

[14]

How Can We Help

At Advanced Functional Medicine, our practitioners are experienced in hormonal health and always support the overall body.  Our practitioners look at underlying imbalances, not just in hormones, but the biochemistry, gut health and other factors that may be root causes of adenomyosis or other related issues.

Feel free to get in touch to discuss your options.