What is adenomyosis?

Adenomyosis is the presence of uterine lining tissue deep within the muscular wall of the uterus. The cause of adenomyosis is unknown.

Adenomyosis tissue can extend throughout the lining of the uterus (diffuse) or remain in just one spot (focal). When focal, a localized collection of adenomyosis tissue may form a mass called an adenomyoma. When adenomyosis is diffuse, the uterus becomes enlarged.

What are the symptoms of adenomyosis?

Although adenomyosis is a benign (non-cancerous) condition, it can cause significant symptoms. The most common symptom of adenomyosis is abnormally heavy menstrual bleeding, often accompanied by severe cramps.

How is adenomyosis diagnosed?

Adenomyosis and particularly adenomyomas are commonly misdiagnosed as fibroids. The conditions present similar symptoms and can be difficult to distinguish with ultrasound imaging. Misdiagnosis is a problem because it can lead to incorrect treatment and needless complications. At MedStar Georgetown University Hospital, our clinicians are equipped with expertise in both fibroids and adenomyosis, reducing the risk of misdiagnosis.

Adenomyosis may be initially suspected as the result of a pelvic exam.  The uterus may be detectably enlarged. If the adenomyosis is advanced, the uterus may also be somewhat softer than normal.

Modern imaging methods have been a great aid in accurately diagnosing adenomyosis. MRI imaging is more reliable than ultrasound for this purpose. On MRI, the area of the uterus known as the junctional zone is thickened and reflects the uterine lining tissue invasion of this part of the uterine wall.

How is adenomyosis treated?

Several non-surgical and surgical treatments are available for adenomyosis.

  • The birth control pill and other hormone therapies may help control bleeding in women with adenomyosis. A hormone-releasing intrauterine device (such as the Mirena IUD) can be effective.
  • Endometrial ablation is a procedure in which the lining of the uterus is intentionally destroyed. This can be effective in treating some cases of adenomyosis. However, if the penetration of the adenomyosis exceeds two centimeters, ablation usually fails to control bleeding.
  • Hysterectomy, or the surgical removal of the uterus, is typically the most effective therapy for adenomyosis. It is a safe procedure with a very low complication rate. However, the removal of the uterus precludes the possibility of future pregnancy. This procedure can often be avoided in favor of uterine artery embolization.
  • Uterine artery embolization (UAE) is a minimally invasive, non-surgical therapy that can be used to treat adenomyosis and other uterine conditions.

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