Featuring City Fertility Sydney CBD fertility specialist, A/Prof Michael Cooper OAM
April marks Adenomyosis Awareness Month, shedding light on a commonly misunderstood condition that affects many women and individuals assigned female at birth. Adenomyosis, often overshadowed by its more recognised counterpart, endometriosis, presents its own set of challenges. Understanding its symptoms, diagnosis, and treatment options is crucial for improving the quality of life for those affected. In this blog article, A/Prof Michael Cooper OAM will share his expertise and insights into adenomyosis.
What is adenomyosis?
Adenomyosis occurs when tissue similar to the lining of the uterus, the endometrial tissue, grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle. This infiltration can lead to various symptoms, including heavy menstrual bleeding, severe cramping, and an enlarged uterus. Understanding the underlying mechanisms of adenomyosis is essential for accurate diagnosis and effective management of this condition. It is most likely that the disorder relates to an as yet unidentified abnormality at the endo-myometrial interface (EMI) – and, in this respect, is similar to endometriosis as it is known there are abnormalities in this area also.
Despite their shared characteristics, it’s essential to differentiate adenomyosis from endometriosis due to variations in their anatomical presentation and diagnostic methods. Endometriosis involves the presence of endometrial-like tissue outside the uterus, both within the pelvis and in extrapelvic regions, whereas adenomyosis specifically refers to the presence of this tissue within the muscular wall of the uterus. Understanding these differences is crucial for accurate diagnosis and treatment planning.
Common symptoms of adenomyosis
Classically the disorder appears from the age of 35 into the 40’s, with the symptoms of adenomyosis varying widely in intensity. While some individuals may experience no symptoms at all, others may face debilitating challenges. Common symptoms include:
- Enlarged uterus
- Heavy or prolonged menstrual bleeding
- Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
- Prolonged menstrual cramps
- Longer than normal menstrual cycles
- Pain during sex (dyspareunia)
- Abdominal tenderness
- Chronic pelvic pain, often a central, heavy, cramping pelvic pain that varies in intensity
- Referred leg pain
- Anaemia or iron deficiency (due to heavy periods), leaving you feeling tired or dizzy.
- Difficulty trying to conceive
How adenomyosis affects fertility
While adenomyosis has not been directly linked as a cause of infertility, fertility concerns may accompany a diagnosis of adenomyosis, prompting individuals to explore how the condition may impact their reproductive health. In adenomyosis, the displaced endometrial tissue can create an inflammatory environment within the uterus, potentially hindering the implantation of a fertilised egg, and hormonal imbalances associated with adenomyosis may disrupt ovulation or egg quality 1, 2. Please note, there is no reason not to proceed with IVF if you have adenomyosis and many patients are still successful.
While adenomyosis can pose challenges to conception and pregnancy, it’s essential to recognise that not every woman with the condition will experience fertility issues. By consulting with fertility specialists and understanding the potential implications of adenomyosis on fertility, individuals can make informed decisions regarding family planning and pursue available treatment options to optimise their chances of conception.
How to diagnose adenomyosis
Unfortunately, diagnosing adenomyosis poses challenges, traditionally relying on an index of suspicion clinically followed by the finding of a painful (‘bulky’) uterus. Imaging techniques such as ultrasound may reveal irregular areas, most usually in the posterior aspect of the uterus, although it can at times be difficult to differentiate these from fibroids. Fibroids tend to be more discreet, whilst adenomyosis tends to be more generalised, although, at times, there can be isolated areas of adenomatous change within the uterus. More recently, MRI has been advanced as a preferred diagnostic option, although currently, within an Australian context, the cost of this has kept it out of mainstream usage.
How to treat adenomyosis
Treatment strategies for adenomyosis aim to alleviate symptoms and improve overall well-being. Treatment for adenomyosis depends on the severity of symptoms and the individual’s reproductive goals. If you are trying to conceive, your treatment options may include simple pain relievers and non-steroidal anti-inflammatory drugs. For those in whom pregnancy is not a consideration it may be possible to use Mirena, the new progestegin impregnated IUCD (although this at times may exacerbate the situation) or alternatively the oral contraceptive pill to relax the uterus. A hysterectomy is also an option.
Adenomyosis, though often overlooked, can significantly impact the lives of those affected. By raising awareness and understanding its symptoms, diagnosis, and treatment options, individuals can seek appropriate care and support. If you suspect you may have adenomyosis or are experiencing symptoms, consult with a healthcare professional for proper evaluation and management. Together, we can work towards improving the quality of life for those living with adenomyosis.
To book an appointment or learn more about A/Prof Michael Cooper OAM, visit his profile.
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1 Khan, K. N., Fujishita, A., & Mori, T. (2022). Pathogenesis of human adenomyosis: current understanding and its association with infertility. Journal of clinical medicine, 11(14), 4057.
2 Pados, G., Gordts, S., Sorrentino, F., Nisolle, M., Nappi, L., & Daniilidis, A. (2023). Adenomyosis and Infertility: A Literature Review. Medicina, 59(9), 1551.
