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

What causes fibroids?

It’s not entirely clear what causes fibroids. The sex hormones, oestrogen and progesterone seem to play a role- fibroids shrink during menopause, when the levels of these hormones drop.

What are the different types of fibroids?

Fibroids are described by their location in the uterus. They can be “submucosal” which means they are just under the lining inside the uterus. They can be “intramural”, which means they are in the muscle layer, or they can be “subserosal” which means they grow on the outside of the uterus. If a fibroid is “pedunculated” it means it is growing on a stalk, inside or outside the uterus.

Are fibroids serious?

No, not usually. They almost never become cancerous. Though, as mentioned above, they can lead to symptoms and complications.

How are fibroids diagnosed?

Your doctor may suspect you have fibroids based on your symptoms. The diagnosis is usually made by performing an ultrasound scan of the lower tummy. Sometimes other tests such as an MRI scan or hysteroscopy (camera test) may be needed. A blood test may show a low blood count or low iron, if periods have been heavy due to fibroids.

Are fibroids dangerous in pregnancy?

Most fibroids don’t cause any problems in pregnancy. However, large fibroids (particularly submucosal fibroids, i.e ones on the inside of the uterus) may cause issues, such as difficulty getting pregnant, miscarriage, premature labour, placental abruption and low birth weight.

What is the treatment for fibroids?

This depends on the size, number and location of the fibroids, the severity of symptoms, whether future pregnancies are hoped for, and how close a woman is to menopause.

Options include

• Monitoring- if fibroids are causing no issues, then they can just be observed
• Medications- certain hormonal medications, such as Gn-RH agonists or a progestin-releasing coil (IUD) may be used to try to reduce the size of fibroids. Other medications such as the contraceptive pill or certain anti-inflammatories can be used to make periods lighter, though they do not change the size of fibroids.
• MRI directed ultrasound- the fibroids are located by MRI and ultrasound waves are used to destroy the fibroid tissue
• Arterial embolization- a small tube is passed into the blood vessel that supplies the fibroid, and a substance is injected to create a blockage. Once the blood supply is blocked, the fibroid tissue dies and slowly reduces in size.
• Surgery- depending on size and location, fibroids can be removed surgically in different ways- by hysteroscopy (a camera is passed into the uterus via the vagina), laparoscopy (a camera is passed through the wall of the tummy) or hysterectomy (uterus is removed, future pregnancies are not possible).

If you have concerns about fibroids or think you have symptoms of fibroids, you should see your doctor.

Further patient resources

betterhealth.vic.gov.au

Article resources

www.racgp.org.au

onlinetog.org

When should you see a doctor about your heavy periods?

• If heavy periods are disrupting your usual activities or having a negative impact on your life
• If you suddenly start to get heavy periods, having had normal, lighter periods in the past
• If there is ANY bleeding between your periods or after sex
• If you notice any unusual vaginal discharge
• If you have pelvic pain or if sex is painful
• If you have fevers, chills or sweats (this may mean you have an infection)
• If you feel unwell, tired, light-headed or are losing weight for no reason

What is the treatment for heavy periods?

The treatment depends on the cause- if an underlying issue is discovered, obviously it should be treated first.

If no cause is found, options include

• Tranexamic Acid (Cyklokapron)- this medication makes bleeding slow down by increasing clotting
• NSAIDs (Non Steroidal Antinflammatory Drugs), particularly Mefenamic Acid (Ponstan)
• The contraceptive pill or mini pill
• An intrauterine device that releases progesterone, such as the Mirena coil or other long-acting contraceptives

Surgical options are less commonly needed, but may be considered if medical options fail or are unsuitable, and include

• Endometrial ablation- the lining of the uterus is destroyed during this procedure, which is performed by a gynaecologist (there are a number of different methods used). It’s not suitable if you wish to have further pregnancies.
• Myomectomy (if there are fibroids)
• Hysterectomy (usually only considered if all other measures fail)

If you have concerns about your periods or heavy bleeding, speak to your GP.

Further Patient Resources:

Menorrhagia (Heavy menstrual bleeding). mayoclinic.org

Heavy Periods. thewomens.org.au

Article Resources:

Heavy menstrual bleeding: assessment and management. nice.org.uk