You may have heard this word before (and that’s probably why you’re reading this right now 😊): adenomyosis.

It’s a form of endometriosis, which affects the muscle fibres of the uterine wall. Commonly called “endometriosis of the uterus”, it causes cells of the uterine lining (endometrium) to infiltrate the myometrium (uterine muscle). It affects about 30% of women who undergo an imaging examination (vaginal ultrasound or MRI) as part of a gynecological follow-up, whether because of symptoms or not, are affected by adenomyosis.

But what is the difference with endometriosis?

Don’t be confused: having endometriosis does not always mean that you have adenomyosis. There is no systematic association.

However, this condition often goes hand in hand with infertility in women. Like endometriosis, it can be:

– diffuse (present in many places on the myometrium)

– or focal (located in one or more specific places)

– and more or less superficial or deep (depending on its location in the thickness of the myometrium).

What are the symptoms of adenomyosis?

There are three types of symptoms:

– bleeding: either heavy periods (menorrhagia) or bleeding outside the period (metrorrhagia)

– pain during the cycle in the pelvic area (dysmenorrhoea), but also during intercourse (dyspareunia)

– difficulty in conceiving, or even infertility.

How to detect adenomyosis?

It is important to question the patient correctly, bearing in mind that none of the symptoms are synonymous with adenomyosis.

Several tests can be performed to diagnose adenomyosis:

Endovaginal ultrasound

This is best performed in the 2nd period of the cycle. There are many ultrasound findings that suggest uterine adenomyosis and these have been classified in several ways.

MRI

To be performed as a secondary measure to assess the severity of the adenomyosis, and if there is any doubt, to evaluate any associated significant endometriosis.

These tests are unnecessary for the diagnosis of adenomyosis as both the ultrasound and MRI are highly efficient.

What treatments are available?

Treatments may vary depending on whether or not you want to have a child.

If you want to remain able to have children, you will be offered a prescription for anti-haemorrhagic drugs (which reduce the volume of bleeding), but this does not usually ensure that bleeding stops completely.

Conservative surgery (removal of the adenomyosis without removing the uterus) is a difficult procedure with mixed results and is therefore very rarely performed.

If the patient doesn’t want to get pregnant, one possibility is to prescribe hormonal treatments either orally or locally (hormonal IUD). Unlike medical treatments which must be taken every day, the IUD, once inserted, is effective for several years.

A hysterectomy (removal of the uterus) is effective for pain and bleeding but will only be suggested after medical treatments have failed for a patient who definitely no longer wants children.


Co-authored and scientifically validated by Pr Charles Chapron,

Head of the Department of Obstetrics and Gynaecology II and Reproductive Medicine at the Cochin Hospital in Paris


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