The diagnosis of adenomyosis is generally made on a “clinical” basis through the patient’s history and symptoms. A specialist can typically identify adenomyosis as the cause of heavy bleeding and pain.
Unfortunately, many OBGYN’s will miss the diagnosis of adenomyosis more often than not. There are several reasons for this. OBGYN’s are mainly focused on pregnant patients and do far less gynecology than a specialist who sees the condition more often. Pelvic exams will miss the condition completely, since adenomyosis may not enlarge the uterus to any extent. Finally, ultrasound, although a very good test for fibroids, pelvic masses and other pathology, completely misses the diagnosis of adenomyosis.
Since patients access their OBGYN more commonly than a specialist and often have normal ultrasounds, the disease can be missed and patients can suffer with progressive and debilitating pain and bleeding. In some cases, an MRI is obtained, which can identify adenomyosis in up to 80% of cases and can be helpful to make the diagnosis by imaging.
Types of Adenomyosis
Types of adenomyosis can be focal, diffuse, or form an adenomyoma.
Focal adenomyosis means that the disease has involved only a small portion of the uterine muscle. MRI can measure the depth and width of adenomyosis and can identify where the focal area is in the uterus.
Diffuse adenomyosis means that the disease is involving all aspects, or almost entirely the uterine muscle. Patients with this type of adenomyosis have severe symptoms of pain and bleeding, have a high rate of infertility, and often require surgical treatment.
Adenomyoma detection on MRI means there is a large area of adenomyosis in the muscle. This is a collection of the endometrial lining that looks similar to a uterine fibroid. Adenomyomas are often mistaken by ultrasound as fibroids, and not uncommonly patients will undergo a myomectomy – removal of a fibroid – for what turns out to be an adenomyoma. Unlike fibroids, adenomyomas cannot be removed since they are invading into the muscle, and removal will remove the muscle of the uterus with the adenomyosis.
An MRI scan is the best imaging method for diagnosing adenomyosis. The characteristic feature for adenomyosis on an MRI is a thickened junctional zone where the junction of the endometrial lining with the muscle is now wider, indicating that the lining is growing into the muscle, confirming the diagnosis of adenomyosis.
An ultrasound can also be used to look for adenomyosis when it is in the advanced stages, but is less sensitive than an MRI for early or even moderate stage disease. An enlarged “globular” uterus, thickened endometrial lining and a heterogeneous uterine wall are sonographic features that can be indications of adenomyosis. If your ultrasound comes back normal but you or your doctor still suspect adenomyosis, an MRI should be obtained.
During a pelvic exam, a physician will manually examine the pelvis for enlargement of the uterus, tenderness or pain. A pelvic exam alone cannot confirm the presence of adenomyosis or any other GYN conditions, but if your OBGYN feels something abnormal they will likely order tests like an MRI or ultrasound to get better visualization of the uterus.
Because abnormal bleeding can sometimes be indicative of cancer, your doctor may conduct an endometrial biopsy. A sample of uterine tissue will be collected and tested to rule out cancer and other serious conditions. However, this small sample is usually not enough to confirm an adenomyosis diagnosis.
The only way to definitively diagnose adenomyosis is by having a pathologist examine the uterus after a hysterectomy has been performed. Looking at the entire uterus under a microscope allows a pathologist to visually confirm the diagnosis.
Getting a Diagnosis
Treating or managing adenomyosis early can greatly improve your quality of life, so it’s important to see your doctor if you suspect you may have adenomyosis. At CIGC, our team of specialists treat a significant number of patients with this disease in both early and advanced stages. CIGC specialists will provide you with a consultation and, if recommended, perform the appropriate tests to determine if you have adenomyosis or another related condition. To get started, schedule a consultation with one of our specialists.
The CIGC Difference
Unlike a standard OBGYN, CIGC’s adenomyosis specialists perform laparoscopic surgeries every day. DualPortGYN was developed by the CIGC minimally invasive GYN specialists to improve the outcomes of hysterectomies. DualPortGYN takes advantage of advanced surgical techniques that enhance the safety and lower the complication rates of each procedure.
While hysterectomy is the primary surgical solution for adenomyosis, any course of treatment is discussed thoroughly with you by the specialists and is weighed against each patient’s goals for fertility.