By: Jean Johnson for Fibroids1Cheryl Anderson’s gynecologist thought she had fibroids, but after she finally decided to have a hysterectomy the pathologist who analyzed tissue from her uterus came back with the diagnoses of adenomyosis.
“As far as I was concerned,” said Anderson, “I didn’t care whether it was fibroids or adenomyosis. I just wanted the pain over and done with, and since I’ve had my children, I’m fine with a hysterectomy.”
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Symptoms of Adenomyosis
Pelvic pain
Abnormal uterine bleeding that manifests either as heavy, prolonged or irregular bleeding
Abdominal bloating
Urinary or bowel symptoms (frequent urination, feelings of pressure in the intestinal area)
It is important to visit your physician because many of these symptoms can indicate other conditions including uterine fibroids.
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Severe pain and heaving bleeding can arise from adenomyosis according to the chair of the editorial board of laparoscopy-hysteroscopy for OBGYN.net and fibroids specialist, Paul D. Indman, M.D. of San Jose, California. “Since fibroids can be removed by myomectomy, though, it is essential to differentiate between the two conditions before planning treatment.”
Adenomyosis is a benign condition that results in diffuse nonmalignant growths within the inner muscular wall of the uterus or the myometrium. Researchers do not know what causes adenomyosis, but several theories suggest that its presence might be related to cesarean section and intrauterine instrumentation. Approximately 80 percent of the women with adenomyosis have given birth, and more than 80 percent of those with the condition have other pathologic uterine conditions including fibroids, endometriosis and endometrial polyps.
As do fibroids, also a benign uterine disease, adenomyosis presents symptoms including pelvic pain, abnormal uterine bleeding that manifests either as heavy and/or prolonged bleeding or irregular bleeding outside normal cycles (menorrhagia). Most cases of adenomyosis are seen in women between the ages of 40 and 50.
Adenomyosis is so difficult to diagnose that only 15 percent of the cases are correctly identified before a pathologist analyzes uterine tissue in the aftermath of a hysterectomy. Physical examinations by gynecologists can reveal “a soft, boggy enlargement of the uterus … and an unusual type of tenderness on pelvic exam when the uterine muscle is compressed,” according to Robert B. Albee, M.D. of Atlanta in a Center for Endometriosis newsletter.
Imaging techniques are also used to diagnose adenomyosis, although the relatively new technology has had limited success to date. While transvaginal ultrasound or sonography (TVUS) is often used initially to eliminate other problems, the modality is often unable to detect subtle differences in soft inner wall of uterine tissue where adenomyomas grow, according to former director of Obstetrics/Gynecology in the Department of Radiology at the University of Massachusetts Memorial Health Care/University Campus, Karen L. Reuter, M.D., F.A.C.R..
“The second modality commonly used for diagnosing adenomyosis, MRI is more expensive than ultrasonography,” noted Reuter. The problem is, though, that MRIs have difficulty detecting ademonmyomas until the lesions grow to a “junctional zone thickness of 12mm or greater. A maximum thickness of 8mm or less usually excluded the disease,” from detection via MRI or magnetic resonance imaging.
Additionally since adenomyosis tends to be diffuse and invade multiple areas of the uterine wall, the malignancies generally do not lend themselves to uterine artery embolization procedures in the current state-of-the-art. Hysteroscopic endometrial ablation can be a treatment for adenomyosis if heavy bleeding is the presenting symptom rather than pelvic cramping. There are also hormone therapies gynecologists can try for women interested in avoiding hysterectomies.
That said hysterectomy remains the procedure of choice for long-term relief from adenomyosis if a women desires no further childbearing. As in Anderson’s case, major surgery effectively ended her pain and bleeding. “The recovery did take a while and throw me into menopause, but I was about ready anyway, so I’m glad I took that route. All the old days of worrying and running in to see my GYN every time I turned around are behind me now.”
