What is adenomyosis?

What is adenomyosis?

Adenomyosis is a gynecological disease that was previously considered a subtype of endometriosis. It involves tissue similar to the uterine lining growing into the muscle layer of the uterus, consisting of glands and stroma, which often leads to an enlargement of the uterus. These tissue ingrowths can be localized, as in the case of myomas, or diffuse throughout the entire uterine muscle. There are also mixed forms that show both diffuse and local ingrowths.

The prevalence of adenomyosis is difficult to determine and varies between five and 70 percent, which is due to the difficulty of distinguishing it from endometriosis and myomas as well as diagnostic methods that are often only used after (partial) removal of the uterus.

Symptoms of Adenomyosis

Adenomyosis mainly manifests itself as chronic lower abdominal pain. Other symptoms include severe menstrual pain, pain during intercourse and bleeding disorders. In some women, adenomyosis leads to retrograde menstruation, in which menstrual blood flows into the abdominal cavity. This can make reproduction more difficult and increase the risk of infertility and miscarriage. Despite this, around 30 percent of affected women remain symptom-free.

Differences and similarities between endometriosis and adenomyosis

Endometriosis and adenomyosis show similar symptoms, including chronic lower abdominal pain and menstrual disorders. While endometriosis involves the growth of uterine lining-like tissue outside the uterus, adenomyosis involves the growth of this tissue into the uterine muscles. Due to the similar symptoms, adenomyosis was long considered a subtype of endometriosis. Today, however, molecular and epigenetic differences are known that allow a clear distinction to be made. Around 22 percent of affected women suffer from both endometriosis and adenomyosis.

Causes of Adenomyosis

The exact causes of adenomyosis have not yet been fully researched. However, there are several theories:

• Disorders of the junctional zone : Injuries caused by operations or curettage could promote the ingrowth of mucosal cells into the muscle layer.
• Degenerated tissue or stem cells : These could lead to the formation of adenomyosis.
• Tissue injury and repair theory (TIAR) : Strong uterine contractions could cause micro-tears that allow cells to grow in through estrogen production.

Risk factors include uterine surgery, multiple pregnancies, older age, early menstruation, short cycles and obesity.

Diagnosis of adenomyosis

The definitive diagnosis of adenomyosis is made by histological examination of a tissue sample. However, non-invasive diagnostic methods such as sonography and magnetic resonance imaging (MRI) are often used:

• Sonography : Both 2D and 3D ultrasound can assess the thickness and structure of the uterine muscles.
• Magnetic resonance imaging (MRI) : This procedure provides reproducible results on the structure of the junctional zone and is used to differentiate myomas and before surgical interventions.

Invasive methods such as hysteroscopy and laparoscopy are used less frequently and often provide limited information.

treatment of adenomyosis

Since the causes of adenomyosis are not yet fully understood, there is no causal cure. Treatment focuses on relieving symptoms and includes both medical and surgical approaches.

Drug treatment

• Hormonal therapies : Progestins, GnRH analogues, aromatase inhibitors and levonorgestrel IUD are used to relieve symptoms.
• Painkillers : Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain.

Surgical treatment

• Hysterectomy : removal of the uterus, suitable for women who do not want children.
• Resection : Removal of the affected parts of the uterus while preserving the organ.
• Embolization : Cutting off the blood supply to the ingrown lesions, suitable for women who do not wish to have children and should be performed as part of studies.

Nutrition and Adenomyosis

Diet can play a supportive role in the treatment of adenomyosis. An anti-inflammatory diet rich in omega-3 fatty acids, antioxidants and fiber can reduce inflammation and relieve symptoms. A healthy diet also helps support hormonal balance and reduce the risk of obesity, a known risk factor for adenomyosis. Studies suggest that a diet rich in fruits, vegetables, whole grains and lean proteins can have a positive effect on uterine health.

Conclusion

Adenomyosis is a complex and often painful disease with unclear causes. Diagnosis requires a combination of imaging techniques and histological examinations. Treatment aims to relieve symptoms and includes both drug and surgical approaches. A healthy, anti-inflammatory diet can be supportive and improve the quality of life of those affected.