How is Adenomyosis diagnosed?

A doctor may suspect Adenomyosis based on symptoms, or because the uterus feels bulky during a physical examination. It may also be picked up on an ultrasound scan. An MRI scan may also be helpful, as it can provide higher resolution pictures of the uterus. Sometimes assessment by a gynaecologist may be necessary for further investigation and to confirm the diagnosis.

What is an Adenomyoma?

Sometimes Adenomyosis can occur in the form of a benign (non-cancerous) lump, in the muscle wall of the uterus.

Is Adenomyosis the same as Endometriosis?

Adenomyosis and Endometriosis are  generally considered to be separate conditions, but some experts believe they may be related or are variations of the same condition. In Endometriosis, the type of tissue that lines the uterus (endometrial tissue) forms in other places, such as the outside of the uterus, bowel or bladder. In Adenomyosis, endometrial tissue grows inside the muscle layer of the uterus. Some experts suggest that these processes are related, and that Adenomyosis is basically Endometriosis in the uterine muscle. However, others believe they are separate issues. Women can have Adenomyosis and Endometriosis at the same time, and the symptoms for the two conditions can be similar.

Does Adenomyosis affect fertility?

It is not yet clear if Adenomyosis significantly affects fertility. Some studies suggest that Adenomyosis may interfere with the movement of the fertilised egg from the fallopian tube to the uterus. It is also thought Adenomyosis may affect implantation (how the fertilised egg attaches to the lining of the uterus). However, more research is needed in this area.

What is the treatment for Adenomyosis?

Treatment may not be necessary if there are no symptoms. And if a woman is close to menopause, it should naturally get better as oestrogen levels drop.

If periods are long, heavy and/or painful, treatment for Adenomyosis may be considered:

• Anti-inflammatories can be taken just before a menstrual period and for the first day or two. This may reduce pain and make the bleeding a little lighter.
• Hormonal medications such as the pill (combined oral contraceptive pill) may also reduce heavy bleeding.
• Long acting contraceptives containing progesterone, such as an intrauterine device, “the rod” or contraceptive implant, may eliminate periods and thus symptoms of Adenomyosis.
• In severe cases, or where other treatments are not working or are unsuitable, surgery to remove the uterus (hysterectomy) may be considered.

Does Adenomyosis get better by itself?

As Adenomyosis is driven by oestrogen, it goes away once menopause occurs. Prior to menopause, hysterectomy (a procedure to remove the uterus) is the only way to get rid of Adenomyosis. Obviously, in women who wish to have future pregnancies, symptoms of Adenomyosis may be managed with medication.

When should you see a doctor?

If you have symptoms such as heavy painful periods, abnormal bleeding, pelvic pain or discomfort during sex, you should speak to your GP or gynaecologist.

Further patient resources

www.mayoclinic.org

www.jeanhailes.org.au

Article Resources

Bergholt et al Prevalence and risk factors of adenomyosis at hysterectomy. Human Reproduction. 2001;16(11):2418-21.

Di Donato N et al Prevalence of adenomyosis in women undergoing surgery for endometriosis. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 2014;181:289-93.

Harada T et al The Impact of Adenomyosis on Women’s Fertility. Obstetrical and Gynaecological Survey. 2016

How is Endometriosis diagnosed?

You or your doctor may suspect Endometriosis on the basis of your symptoms. The only way to formally diagnose Endometriosis is to undergo a laparoscopy and have a biopsy (tissue sample) taken. A laparoscopy is a surgical procedure, performed under a general anaesthetic where a thin telescope is passed through the umbilicus (belly button), allowing your doctor to see inside your abdomen. During a laparoscopy the tissues can be magnified, so even small amounts of endometriosis can be seen. If there is tissue that looks like endometriosis present, it is biopsied (sampled) and sent to a lab to be examined.

A pelvic ultrasound may show some signs if there is endometriosis on the ovaries, but is not a reliable way to detect endometriosis

Is surgery always needed to diagnose Endometriosis?

Your doctor may suspect endometriosis based on your symptoms and physical examination. The decision to have a diagnosis confirmed with a laparoscopy should be discussed very carefully with your doctor, as it is an invasive test which has some risks. The preferred management plan very much depends on a woman’s individual symptoms, and whether fertilty is a concern. In some cases a  doctor and patient may agree to try treating symptoms with medications at first, rather than undergoing surgery, but this can always be reviewed if required, or if not effective.

Is there a blood test for Endometriosis?

No, unfortunately there is no simple blood test that can diagnose Endometriosis.

Does Endometriosis cause infertility?

There are many reasons a couple may find it hard to become pregnant, but Endometriosis is one of the possible issues. This may be due to inflammation and the formation scar tissue in the fallopian tubes, though there may be other factors. It is thought that in Endometriosis the woman’s egg may be less likely to fertilise, or there may be substances produced by the woman’s body that stop sperm functioning normally.

What is the treatment for Endometriosis?

This depends on the symptoms a woman has. If there are no symptoms, or only mild ones, then no treatment may be required.  If endometriosis is present but it is not causing pain or problems with fertility, it does not need to be treated, though your doctor may recommend check ups from time to time.

There are three kinds of treatments for endometriosis: medical treatments (medications), surgical treatments (involving an operation) and complementary treatments (such as physiotherapy, psychology etc.)

• Pain relief- non hormonal medications such as painkillers or anti-inflammatories may help.
• Hormonal treatments include the oral contraceptive pill (containing oestrogen) and progestogens in a variety of forms. Hormonal treatments can be given as an injection, or continuously in a rod inserted under the skin, or released from an IUD.
• Surgery- Laser or diathermy, may be performed via keyhole surgery (laparoscopy)- in these procedures, the endometriosis is surgically removed. In more severe cases the option of surgical removal of the uterus (hysterectomy) and/or ovaries (oophorectomy) may be considered. However, this is a major operation, and is only considered in very severe cases where all other options have failed. Sometimes, unfortunately, a woman will continue to have pain or other symptoms following surgery.
• Physiotherapy can be beneficial, particularly where bowel or bladder symptoms are prominent.
• Psychological treatment can also be very effective in the management of chronic pain.

If you have further questions about Endometriosis, speak to a GP or a gynaecologist.

Additional resources for Endometriosis in Australia:

Endometriosis Australia a nationally accredited charity that raises awareness, educates and funds research for endometriosis.

Support Groups for Endometriosis in Australia

National Action Plan for Endometriosis

Royal Women’s Hospital- patient information

What’s the best treatment for period pain?

• To help with the pain, anti-inflammatories, also known as NSAIDs, are often a good place to start (assuming you have no contraindications to these meds- always check the patient information leaflet if unsure). Some anti-inflammatory medications can reduce the heaviness periods too. But here’s an important fact that a lot of women don’t know- anti-inflammatories will minimise pain only if they are taken very early in a period, or just prior to a period- before prostaglandins get a chance to form in the uterus (womb).

Other treatment for painful periods

• Hormonal treatment such as the contraceptive pill, depo injection or an intrauterine device, can be helpful in managing painful periods.
• These options obviously make sense if a woman also needs birth control, and are worth discussing with a GP.

So the take home messages- consider EARLY use of anti-inflammatories, try to exercise more, avoid smoking, maintain a healthy weight, and consult your doctor to exclude underlying problems, and perhaps to explore further treatment options.

Further Patient Information

www.clevelandclinic.org

www.acog.org