Most of VIVA EVE's patients complain of heavy menstrual bleeding and pelvic pain. The large majority of these women have uterine fibroids and they come to NYC fibroid specialists so that we can treat those benign tumors with uterine fibroid embolization or other methods. However, some women who have these same symptoms do not have fibroids at all. What these women have is a condition called adenomyosis (pronounced ad-uh-no-my-oh-sis). Our state-of-the-art center for uterine fibroids in NYC has the latest technology needed to make a correct diagnosis and to suggest the best course of treatment.
What is Adenomyosis?
Adenomyosis occurs when the lining of the uterus — called the endometrium — breaks through the uterine muscle wall. When the lining cells of the uterus bleed during the menstrual period, these misplaced cells in the muscle bleed as well. And bleeding directly into the muscle causes pain. As the blood accumulates, the surrounding muscle swells and forms fibrous tissue in response to the irritation. This swollen area within the uterine muscle wall, called an adenomyoma, feels very much like a fibroid during medical examination. The condition may affect your entire uterus or it can be localized to one area.
Adenomyosis differs from endometriosis and from uterine fibroids. Uterine fibroids are distinct, benign tumors that grow in or on the uterine wall. Because adenomyosis and uterine fibroid causes aren’t known, research is ongoing.
What Are the Most Common Symptoms of Adenomyosis?
Women with adenomyosis are often misdiagnosed as having fibroids, because this condition can mimic many of the symptoms of fibroids, like severe cramping and heavy bleeding. However, for patients with adenomyosis the pain is usually worse than the bleeding, while for patients with fibroids, it is typically the reverse (bleeding is worse than the pain).
Some women never experience significant symptoms and may not know they have adenomyosis. Others find the symptoms range from uncomfortable to debilitating. Symptoms may include:
- Lower abdominal pain and pressure that can be chronic
- Menstrual cramps that feel knife-like and severe
- Bloating before your period begins
- Pain during intercourse
- Enlargement of the uterus
- Blood clots expelled during menstruation
- Possible chronic anemia due to heavy bleeding
Although adenomyosis doesn’t directly cause infertility, there seems to be a link between it and other possible conditions. The issues contribute to difficulty becoming pregnant or carrying a pregnancy to term.
What Are the Possible Causes of Adenomyosis?
- Uterine inflammation during childbirth. Your uterus may become inflamed post-partum, causing a break in the boundary of cells lining the uterus.
- Invasive tissue growth. An invasion of endometrial cells into the lining of your uterus can occur from incisions during surgery, such as a C-section. These cells may take root and grow outside their normal environment.
- Developmental origins. The invading cells may have been deposited inadvertently while the uterus and other reproductive organs were forming in utero.
- Stem cell origins. Stem cells from bone marrow can migrate throughout your body. These cells may inadvertently become endometrial cells.
Getting a Proper Diagnosis
Previously, even the best fibroid doctor could diagnose adenomyosis only by examining uterine cells under a microscope after performing a hysterectomy. Today, new imaging technology allows your fibroid specialist in NYC to see and accurately pinpoint locations and amounts of the displaced cells.
After taking a thorough medical history and performing a medical exam that includes a pelvic examination, your gynecologist specializing in adenomyosis can use an MRI or a transvaginal ultrasound to rule out any other conditions — without the need for surgery. Occasionally, the best method for diagnosing your condition may be to conduct an endometrial biopsy. Advanced diagnostic tools increase the chances of accurate diagnosis and more effective treatment options.
Deciding On the Right Treatment Option
No two patients with adenomyosis are alike. And that means that treating this condition will not look the same for everyone. There are several factors that will determine which course of treatment is the best for you, including your age, your risk factors, your medical history, and how bad your symptoms are.
Treatment usually starts with ”watchful waiting“ and progresses to pharmaceutical therapy that may have some side effects but usually does not interfere with daily living. However, many patients may require additional treatment to manage more severe symptoms of adenomyosis.
Your physician should discuss with you the pros and cons of minimally invasive, uterus-sparing therapies, like UFE, which has been proven very effective in the treatment of adenomyosis. You will likely also discuss surgical interventions such as a hysterectomy.
Your physician may need to refer you to other physicians who specialize in some of the minimally invasive therapies used to treat adenomyosis. These specialists may include an office that specializes in performing uterine fibroid embolization (UFE), or a highly skilled laparoscopic/hysteroscopic gynecologic surgeon who performs hysterectomies or other procedures.
In the end, the key to choosing the right treatment for adenomyosis is to get the right diagnosis and familiarize yourself with your treatment options. Remember, asking questions and being an informed patient will help you ensure that you get the best care for you.