Adenomyosis

Chronic condition that consists of the development of endometrial tissue in the muscular wall of the uterus. The endometrium is the outermost layer of the uterus that is shed each month during menstruation.

What exactly causes this is still unknown, but we do know that it depends on the female hormones oestrogen and progesterone. This is why it is more common in pre-menopausal women.

It is usually manifested by pain associated with menstruation, chronic pelvic pain, very heavy menstrual bleeding, irregular bleeding and, in some severe cases, sterility.

Diagnosis is based on a guided clinical interview and imaging tests, most commonly transvaginal ultrasound. An MRI of the pelvis may complete the examination. Once the diagnosis is confirmed, a sample of the uterus must be examined under a microscope.  

As there are different treatments available, it is recommended that doctors offer their patients the different treatment options and consider their pros and cons in order to choose the one that suits them best. Most of these options involve hormonal treatment; the main ones being oral contraceptives or the insertion of an intrauterine device (IUD). The ultimate treatment would be complete removal of the uterus, usually by laparoscopy. Other surgical options are aimed at preserving fertility by removing only the tissue affected by adenomyosis and preserving the rest of the uterus. All these alternatives are complementary to symptomatic treatment: analgesics for pain and oral or endovenous iron to treat anaemia caused by genital bleeding.