Gregorio Manzanera Bueno
Adenomyosis is a uterine condition that is characterised by the internal uterine layer (endometrium) growing in the muscular layer of the uterus (myometrium). A similar condition is endometriosis when the endometrial tissue appears not inside of the uterus but outside of it.
The causes remain unclear, but it is known that the level of oestrogen is directly related to adenomyosis. The symptoms tend to disappear when a woman reaches menopause.
The symptoms usually are imprecise, but generally, these are experienced by most women: prolonged or abundant menstruations, menstrual pain, anaemia provoked by abundant bleeding, and pain during intercourse.
It is difficult to diagnose adenomyosis due to its nonspecific symptoms and frequent coexistence with other pelvic conditions. Typically, the uterus is enlarged, and small “gaps” are visualised in the density of the uterus during ultrasound scans, although nuclear magnetic resonance (NMR) can help, the ultrasound is easier and quicker to perform. Hysteroscopy is useful when adenomyosis affects the internal layer of the uterus or endometrium.
Adenomyosis has an adverse effect on fertility as it diminishes the possibilities of embryo implantation due to the alteration of incoming oxygen and nutrients. The movement of the fertilised egg from the fallopian tube to the uterus is affected too. This means that adenomyosis not only affects natural reproduction but also in vitro fertilisation.
The treatment mainly depends on the severity of symptoms, the wish to become a mother and the age of the patient.
Women who plan to become parents have the only option of taking medicines which reduce oestrogen production, such as contraceptives and analogues of GnRH. Paradoxically, these medicines curb fertility but help to alleviate the symptoms and decrease the spread of adenomyosis during some time. This helps to try becoming pregnant immediately via assisted reproduction techniques, especially via in vitro fertilisation. Women with adenomyosis must be aware that shortly after finishing the treatment all symptoms will reappear.
Adenomyosis has no surgical treatment yet for women who wish to have children. Women who do not want to become pregnant can opt for a medical treatment or a complete uterus removal.
IMAGE: https://www.endometrio.net/adenomiosis/
