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  • Michael Frey, MD

Adenomyosis




Adenomyosis occurs when the cells that normally line the uterus (endometrial cells) grow into the muscular tissue of the uterine wall.

Adenomyosis does not occur after menopause. But adenomyosis that was present before menopause may be diagnosed after menopause. It may also be found in tissue samples after pelvic surgery in postmenopausal women.

Cause

The cause of adenomyosis is not fully understood. Some researchers believe that it is the result of damage to the inner wall of the uterus during pregnancy, labor, delivery, or a surgical procedure.

Symptoms

Most women with adenomyosis do not have any symptoms. When symptoms are present, they include:

  • Heavy or prolonged menstrual periods (menorrhagia).

  • Painful menstruation (dysmenorrhea).

  • Recent onset of menstrual cramping that is gradually getting worse from one period to the next.

Exams and tests

When symptoms occur, the evaluation of suspected adenomyosis may include:

  • History of symptoms, menstrual periods, and family history.

  • Pelvic exam may reveal a large, soft, or tender uterus.

  • A sample of the tissue of the wall of the uterus (endometrial biopsy).

  • Pelvic ultrasound may help tell adenomyosis from other pelvic tumors.

  • Hysteroscopy to examine and take samples of the lining of the uterus.

  • MRI of the pelvis.

Treatment

Most women with adenomyosis do not have any symptoms. When pelvic pain or heavy menstrual bleeding is present, suspected adenomyosis is often successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Other options include the Mirena IUD, Depo Provera injection, or birth control pill. A hysterectomy may be needed if you have severe symptoms but are not approaching menopause. Symptoms go away after menopause is complete or after hysterectomy.

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