Adenomyosis

Adenomyosis is a chronic disease that consists of the presence of endometrial tissue inside the muscular layer of the uterus. The endometrium is the inner layer of the uterus that grows each month and then sheds with menstruation.  

Its causes are not known exactly, but it is known that it depends on the stimulation of female hormones: estrogens and progesterone. For this reason, it is more frequent in women before menopause. 

It frequently manifests with pain associated with menstruation, chronic pelvic pain, very heavy menstruation and irregular bleeding. In the most severe cases, it can cause sterility.  

Diagnosis is based on directed clinical questioning and imaging tests, the most frequent being transvaginal ultrasound. Magnetic resonance imaging of the pelvic area can complement the study. Confirmation of adenomyosis requires microscopic analysis of a sample of the uterus.

As there are different treatment options, it is advisable for the physician to offer them to the patient and jointly assess the risks and benefits in order to choose those that best suit her. Most of these options are based on hormonal treatment, notably the use of oral contraceptives or the insertion of a hormonal intrauterine device. The definitive treatment is surgical removal of the uterus, which is usually performed laparoscopically. There are surgical options aimed at preserving fertility by removing the tissue affected by adenomyosis and preserving the rest of the uterus. All these alternatives are complemented with symptomatic treatment: analgesia in case of pain; oral or intravenous iron to treat anemia derived from genital bleeding.