What is Adenomyosis?

Adenomyosis occurs when the inner lining of the uterus (endometrium) progresses into the uterine muscles, thickening these muscles. It is a stealthy disease that causes painful and heavy menstrual bleeding. Adenomyosis is a commonly encountered gynecological problem, but its cause is unknown.

It generally does not require surgery, but there are types that may require surgery and pose risks. Most women with adenomyosis also have other disorders such as fibroids, endometriosis, endometrial polyps, and hyperplasia.

What are the Symptoms of Adenomyosis?

Some patients are asymptomatic. Asymptomatic women may be diagnosed incidentally during an examination, through imaging methods, or upon the examination of a hysterectomy.

Symptoms may include:

• Long menstrual bleeding,
• Severe and painful menstrual bleeding,
• Bleeding between menstrual periods,
• Pain during intercourse,
• Groin pain,
• Sensation of pressure on the bladder or rectum.

How is the Diagnosis Made?

There is no specific diagnostic test for adenomyosis. Imaging methods such as pelvic ultrasound, HSG, and MRI are used.

1. Pelvic Ultrasound

Transvaginal ultrasound is more useful than abdominal ultrasound in diagnosing adenomyosis. Ultrasound findings may include an enlarged uterus, asymmetric thickening of the front and back walls of the myometrium, areas with unclear boundaries, indistinct endometrial boundaries, and anechoic cysts of varying sizes.

2. HSG

The sensitivity of HSG in diagnosing adenomyosis is low. Multiple small, spiky formations extending from the endometrium to the myometrium, and the local accumulation of contrast material in the myometrium forming a honeycomb appearance, can be considered as findings of HSG.

3. MRI

In some other studies, it has been shown that MRI can be useful when ultrasound cannot provide a definitive diagnosis, or in difficult cases accompanied by pathologies like leiomyomas and endometriosis. In such cases, MRI may be more informative and increase the accuracy of the diagnosis.

How is Medical Treatment Done?

Non-hormonal treatments are aimed at symptomatic relief. Your doctor may prescribe medications for symptoms such as heavy menstrual bleeding.

Hormonal treatment aims to balance various hormone secretions. However, the effects of these treatments vary, and once the treatment is stopped, their effects disappear and symptoms may return. Hormonal treatments include progestins, intrauterine systems releasing levonorgestrel, oral contraceptives, GnRH analogs, and intrauterine devices containing danazol.

How is Surgical Treatment Done?

Due to the difficulty in determining the location and extent of adenomyosis, it is challenging to surgically remove the disease while preserving the uterus. The firm nature of adenomyotic tissue, its unclear boundaries, and the need for strong and abundant sutures in the excision area may make laparoscopic surgery less useful in cases of widespread adenomyosis. However, it may be preferred in localized cases (Adenomyoma).

The main problem with preserving the uterus in adenomyosis surgery is the uncertainty about whether removing part of the myometrium will cause problems with pregnancy and childbirth. Comparing adenomyosis surgery with myomectomy (removal of fibroids) is not accurate, as the boundaries of fibroids are clear. In adenomyosis, tissue loss can occur after surgical intervention, leading to significant myometrial loss, which can cause complications and early births.

However, if you have adenomyosis and wish to have children, do not worry. In patients who have undergone adenomyosis surgery, an increase in pregnancy and live birth rates has been observed with IVF (in vitro fertilization).

The selection of the appropriate surgical technique depends on the location and extent of adenomyosis, the patient’s age, desire for pregnancy, and whether or not they want definitive treatment. According to current data, routine conservative surgery should not be recommended for patients wishing to have children. However, conservative surgery may be recommended for younger patients who have failed medical treatment or have repeated implantation failures or recurrent pregnancy losses.

Your doctor will share the most appropriate treatment process with you.

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