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If you’ve got longer-than-usual menstrual bleeding, as well as pain during your menstrual cycle or intercourse, you could have adenomyosis – a condition of the uterus (womb). April is Adenomyosis Awareness Month, and Eve gynaecologist and laparoscopic surgeon Dr. Albert Jung explains more about this disease and what symptoms to look out for.


What is adenomyosis?

Adenomyosis is a disorder in which endometrial glands and stroma (tissues that normally line the inside of the uterus) are present within the myometrium (uterine muscle layer). The term comes from the words: adeno (gland), myo (muscle) and osis (condition). It is pronounced: ad-uh-no-my-O-sis.

Women with adenomyosis often have endometriosis. Although they are different conditions, both involve ectopic (abnormal) placement of endometrial type tissue – adenomyosis into the uterine muscle layer and endometriosis outside of the uterus.


What causes adenomyosis?

While there is no known cause, there are two main theories:


  • Stem cells being abnormally present in the uterine wall
  • Invasive growth of abnormal tissues


What are the risk factors?

Not enough is known about adenomyosis to clearly identify risk factors.  However, there are some factors that have an association with adenomyosis.   You may be at greater risk if you’ve had children, are older, have other gynaecological conditions such as endometriosis or if you’ve had uterine surgery such as a caesarean delivery or surgery to remove fibroids.


What are the symptoms of adenomyosis?

Symptoms can be mild to severe. Some women may not even experience any symptoms. The most common ones include:


  • Spotting (bleeding) between periods
  • Heavy menstrual bleeding
  • Prolonged menstrual cramps
  • Longer than normal menstrual cycles
  • Blood clots when menstruating
  • Pain during sex
  • Abdominal tenderness


How is adenomyosis diagnosed?

Adenomyosis may be difficult to diagnose.  A definitive diagnosis is based on a histopathological assessment of the uterus after a hysterectomy.  However, a clinical diagnosis can be made based on history, physical examination and investigations – namely a transvaginal (internal) ultrasound scan or a pelvic MRI (magnetic resonance imaging) scan.


What are the treatment options?

Medical treatment isn’t usually required for mild symptoms, though if the condition interferes with your day-to-day life some treatment options include:


  • anti-inflammatory medications to reduce cramping (examples include ibuprofen if you are not pregnant)
  • hormonal treatments (including birth control pills, progestin-only contraceptives and intrauterine devices)
  • uterine artery embolization (a procedure to block the uterine arteries from supplying blood to the uterus)
  • Hysterectomy (removal of the uterus)


If you are concerned you may have adenomyosis, please do not hesitate to see your GP or gynaecologist.

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