Adenomyosis or internal endometriosis is a common and benign uterine disease. If you are affected by this disease, know that several treatments can be considered depending on whether or not you want to become pregnant. 

Definition

Uterine adenomyosis is often defined as endometriosis internal to the uterus. It corresponds to an infiltration of the cells of the endometrium (uterine lining) in the muscle of the uterine wall (myometrium), which results in thickening of the myometrium. 

Adenomyosis can be diffuse or focal (one or a few foci within the myometrium), superficial or deep. Diffuse adenomyosis is the most common. 

Namely: there is a link between endometriosis and adenomyosis but a woman can have endometriosis without adenomyosis or have adenomyosis without endometriosis. 

This uterine pathology can affect fertility. 

Causes 

The exact causes of this disease are not known. We know that it depends on the estrogen level and that women who have had at least one pregnancy or those who have had uterine surgery (cesarean section, curettage, etc.) are at greater risk of developing adenomyosis. 

Diagnostic 

When there is a suspicion of adenomyosis, a pelvic ultrasound is performed. If it is not sufficient to make the diagnosis, pelvic magnetic resonance imaging (MRI) is done. In addition to allowing the diagnosis, the imaging examinations make it possible to determine the degree of extension, to look for an associated uterine pathology (endometriosis, uterine fibroids), in particular in the event of infertility). 

Persons concerned 

Adenomyosis affects nearly one in two women between the ages of 40 and 50. Adenomyosis and endometriosis are associated in 6 to 20% of cases. Adenomyosis is associated in about 30% of cases with the presence of uterine fibroids. 

Risk factors 

Adenomyosis appears especially in women with several children (multiparity). 

The other identified risk factors for adenomyosis are: date of first menstruation, late spontaneous miscarriage or abortion, cesarean section, treatment with Tamoxifen. 

There could be a genetic predisposition. 

In a third of cases, adenomyosis does not give any symptoms (it is said to be asymptomatic).

When it is symptomatic, the symptoms are heavy and long periods, pain related to cycles, pelvic pain.

Heavy and long periods (menorrhagia)

Very heavy and long periods are the most common symptom of adenomyosis. It is a symptom found in half of the women affected. Adenomyosis is the most common cause of very heavy and long periods in women aged 40-50. It can also cause blood to flow outside of your period (menorrhagia). 

Cycle-related pain (dysmenorrhea) 

Adenomyosis can also be signaled by menstrual pain but also pelvic pain resistant to usual analgesics and pain during sexual intercourse. 

Clinical examination shows an enlarged uterus.

The treatment of adenomyosis differs depending on whether the woman wants to keep the possibility of pregnancy or not.

If the woman wants to keep the possibility of pregnancy, the treatment consists in the prescription of anti-hemorrhagic drugs which are effective once in 1 on bleeding or in the placement of an intrauterine device (IUD) with progesterone, effective 2 out of 2 times in relieving symptoms. 

When the woman no longer wishes to become pregnant, the treatment consists of destruction of the endometrium (endometrectomy). When the infiltrations in the lining of the uterus are very large and cause severe pain and bleeding, the uterus can be removed (hysterectomy).

Interventional radiology techniques (embolization of the uterine arteries, focused ultrasound) give interesting results but their place must be clarified in the treatment of adenomyosis. 

Adenomyosis, natural solutions 

Regular consumption of vegetables from the cruciferous family (cabbage, broccoli, etc.) could reduce the symptoms of adenomyosis through their action on the levels of female hormones.

Adenomyosis cannot be prevented since the exact causes of the disease are not known. 

Regarding the prevention of endometriosis, however, we know that a healthy lifestyle, a balanced diet, good stress management and regular physical activity can limit the risk of development or recurrence of the disease.