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CIGC Surgeons Understand Adenomyosis

Adenomyosis is a condition in which the cells that line the inside of the uterus (endometrium) are abnormally located in cells that make up the uterine wall (myometrium). This condition can result in a somewhat enlarged uterus. This tissue thickens, breaks down, and bleeds during every menstrual cycle and can cause very painful periods and heavy bleeding1. Adenomyosis can be difficult to diagnose — and, without seeing a specialist, symptoms like heavy bleeding and pelvic pain are often dismissed. Many patients also ask the difference between adenomyosis and endometriosis, since the symptoms sometimes resemble each other or occur simultaneously.

Adenomyosis, while not a cancerous or precancerous condition, can still cause debilitating pain and severe menstrual bleeding for some women. Adenomyosis can be detected with a Magnetic Resonance Imagining (MRI) scan — and at times a transvaginal ultrasound — but it is confirmed after surgery through pathology. To be cured of adenomyosis, one must get a hysterectomy. Adenomyosis is an extremely common condition, but it is not always readily identified by many doctors, as initial imaging of the uterus is often conducted by an ultrasound.

The specialists at The Center for Innovative GYN Care® (CIGC®) are fellowship-trained and highly experienced in treating adenomyosis. They have seen many women who have had failed treatments for adenomyosis, including birth control or ablation. Neither of these treatments control the disease. The specialists at CIGC perform minimally invasive hysterectomies using DualPortGYN® with a low risk of complications, fast recovery, and less pain.

Adenomyosis Symptoms

Adenomyosis can vary greatly from woman to woman. It can be localized (to one area of the uterus), diffuse (involving large areas of the uterine muscle), scattered, or clustered. Adenomyosis can cause debilitating pain and severe menstrual bleeding for some women; however, up to 30 percent of women with adenomyosis have no symptoms at all.

The symptoms of adenomyosis may include:

  • Pain with intercourse
  • Clots in the legs and pelvis
  • Menstrual cramps
  • Abdominal pressure and bloating
  • Chronic pelvic pain
Focal adenomyosis in the uterus

Adenomyosis Causes

The causes of adenomyosis are unknown; however, some theories have been formed about its origins. One theory is that the endometrial cells are somehow able to migrate and invade the normal uterine wall. Another theory is that cells in the uterine wall develop into endometrial cells1.

Some causes may include:
  • Estrogen
    • Progesterone
    • Prolactin Hormones
    • Follicle-stimulating hormone
  • Uterine inflammation related to childbirth
    • Periods after childbirth might cause a break in the normal boundaries of uterine-lining cells
  • Stem cell origins
    • Bone marrow stem cells invade uterine muscle
Adenomyosis Risk Factors

It seems that childbearing, previous uterine surgery, short menstrual cycles, and an early age of first period may be risk factors for adenomyosis.

Additional risk factors include:
  • Cesarean section
  • Fibroid removal (myomectomy)
  • Middle age

Adenomyosis Complications
  • Chronic anemia and fatigue from heavy bleeding during periods
  • Disrupted lifestyle from pain and fear of bleeding

Adenomyosis Diagnosis

An MRI scan is the best imaging study for diagnosing adenomyosis. The characteristic feature on an MRI is a thickened junctional zone, which is the thin innermost layer of uterine muscle wall. Sometimes adenomyosis forms a mass and is mistaken for fibroids on imaging studies. An ultrasound can also be used to look for adenomyosis but is less sensitive than an MRI. An enlarged “globular” uterus, thickened endometrial lining, and a heterogeneous uterine wall are sonographic features that are indications of adenomyosis. If your OBGYN has a normal ultrasound and you suspect adenomyosis, an MRI should be obtained.

A preliminary diagnosis of adenomyosis is based on reported symptoms by the patient. Since adenomyosis can occur simultaneously with other conditions, a proper diagnosis is missed by clinicians. For example, a woman having heavy periods may have both adenomyosis and fibroids. Since fibroids are a well-known cause of heavy periods, a clinician may assume her heavy bleeding is from the fibroids.

However, if only the fibroids are removed, the adenomyosis will still be present and she will continue to have heavy bleeding.

Unfortunately, the only way to definitively diagnose adenomyosis is by having a pathologist examine the uterus after a hysterectomy has been performed. Imaging studies can be used to suggest adenomyosis but are not completely accurate.

Additional diagnostic tools include:
  • Pelvic exam
    • May reveal that the uterus is enlarged
  • Sonohysterography
    • The injection of saline solution though a tiny tube into the uterus during an ultrasound
  • Endometrial biopsy
    • The collection of uterine tissue to test whether or not uterine bleeding is associated with adenomyosis

Adenomyosis always needs to be considered in patients who have heavy bleeding and severe pelvic pain with periods. Since the condition is more common than most OBGYNs realize, patients with this condition may experience years of pain and suffering. Adenomyosis needs to be suspected in these patients, and clinical and diagnostic studies performed to diagnose or rule out adenomyosis.

Adenomyosis Treatment

The only cure for adenomyosis is a hysterectomy. Unlike fibroids, which are often surrounded by a capsule, there is no clear border between adenomyotic tissue and normal uterine tissue. Because of this, adenomyosis cannot be effectively removed the way fibroids can, and, when removed, portions of the uterine muscle are removed as well2.

Fertility and Adenomyosis

For women who are not yet finished with childbearing, the symptoms of adenomyosis can be temporarily managed through medication. Although not always very effective, hormonal suppression with continuous birth control pills, Depo-Provera, or the Mirena IUD (intrauterine device) may help to keep symptoms manageable3.

The CIGC Difference

The adenomyosis specialists at CIGC perform advanced minimally invasive surgery to treat all complex GYN conditions. While hysterectomy is the primary surgical solution for adenomyosis, any course of treatment is thoroughly discussed by the specialists, and is weighed against each patient’s goals for fertility. The CIGC state-of-the-art laparoscopic techniques make it possible to treat complex GYN conditions using just two small incisions with minimal recovery time.

DualPortGYN was developed by the CIGC minimally invasive GYN specialists to improve the outcomes of GYN surgery. DualPortGYN takes advantage of advanced surgical techniques that enhance the safety of each procedure.

Specialists Not OBGYNs

Your OBGYN may be a good physician, but an OBGYN is a generalist, not a surgical specialist. The majority of the practice of an OBGYN is dedicated to obstetrics care, so your doctor does not get nearly enough patient volume or practice to learn the best surgical techniques. The average OBGYN performs only 10 to 15 hysterectomies per year, while our surgeons average 400 per year. Since a heavy surgical volume is necessary to develop and maintain surgical expertise, it is easy to see why you should see a CIGC surgeon for your adenomyosis surgery.

At CIGC, our adenomyosis surgeons have made a commitment to minimally invasive adenomyosis removal. We perform a higher volume of cases, see a wider range of case types, and undergo comprehensive training in advanced laparoscopic techniques. Our surgeons are able to perform even the most complex GYN surgeries with the lowest complication rates. Whether you are undergoing a definitive surgery or a conservative surgery for your adenomyosis, when you have it done at CIGC, you know you are working with specialists who concentrate only on this type of procedure.

Adenomyosis FAQs

Who does adenomyosis affect?

Although it most commonly affects women in their 40s and 50s, it can occur even among teenagers. Current research suggests that adenomyosis may be common in younger women4.

How common is adenomyosis?

Adenomyosis is an extremely common condition, but it is not always readily identified by many doctors. Initial imaging of the uterus is often conducted by an ultrasound, which is commonly used to detect fibroids, but has more difficulty detecting adenomyosis. An MRI scan is a better visual test to detect adenomyosis.

What is the association between adenomyosis and infertility?

At this time, it is unclear, with some studies showing an association and others showing none. In general, it is thought that the severe inflammation caused by migration of the uterine lining into the muscle prevents implantation of the embryo into the uterine lining, thereby causing infertility.

Will menopause occur after hysterectomy?

Many women fear that removing the uterus will immediately put them into menopause, and all of the symptoms and health concerns that accompany it. This is not the case. The ovaries, not the uterus, produce the hormones that dictate menopause. If the ovaries are left in place, a woman will go through menopause when it is her time.

The only obvious change will be the lack of a monthly menstrual cycle. In many cases, unless there is a genetic risk of ovarian cancer or signs of existing cancer, the ovaries can be retained. Speak at length to your GYN specialist about your long-term goals and how hormone therapy can play a role in managing menopause symptoms, especially in the transition and early stages.

Is adenomyosis the same as endometriosis?

No. Although they can occur together, endometriosis is when endometrial cells (the lining of the uterus) are in a location outside of the uterus. Adenomyosis is when these cells are within the uterus, in the uterine wall. Although both can cause pain, endometriosis does not typically cause heavy bleeding.

Ready for a Consultation

If you think you have adenomyosis, our specialists are ready to provide an evaluation of your symptoms and conditions and recommend an appropriate solution.