All you need to know about Adenomyosis – A Detailed Guide

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Are you or someone close to you suffering from heavy menstrual bleeding and severe pain during periods? Are you someone who has undergone multiple scans and tests and still doesn’t know the cause behind the worst period pains and heavy bleeding? Are you someone recently got diagnosed with Adenomyosis? Or just want to keep yourself aware of Adenomyosis, then this blog is for you.

Adenomyosis is a significantly neglected and misunderstood uterine disorder in women. Adenomyosis is not life-threatening but has adverse effects on a Woman’s quality of life. It took ages to recognise Endometriosis as a real problem now it’s time to talk about Adeno. There is a huge lack of awareness about Adenomyosis among Indian Women. This blog will help you understand Adenomyosis in detail.

What is Adenomyosis?

“Adeno” means gland, and “myosis” means reactive muscle changes. Adenomyosis is the presence of endometrial tissues within the uterine muscle wall.

What happens in Adenomyosis?

Adenomyosis can cause an enlarged uterus, prolonged menstruation, and painful heavy bleeding. In India, Adenomyosis is seen mostly in the women of age group 35 – 45 years. The prevalence of Adenomyosis in India is 27% in this particular age group.

To understand adenomyosis better, let us first understand the anatomy of Uterus.

Anatomy of Uterus:

The uterus is an upside-down pear-shaped organ in the reproductive system of females. It is about the size of your fist. It is 3 inches in length, 2 inches in width, 1 inch thick and weighs around 28 grams. Uterus has two horn-like organs at the top called the fallopian tubes. Each Fallopian tube is a channel between the Ovaries and Uterus. The uterus connects to the cervix at the bottom, which gets dilated during pregnancy.

Position Of Uterus:

The uterus is positioned in the Pelvis between the bladder and rectum. It’s supported by your pelvic floor muscles and perineal body. Ligaments in the pelvis, lower back and hips also help hold the uterus.

The four main sections of the Uterus are :

Fundus – The uppermost and widest part of the uterus which connects to the Fallopian tubes.
Corpus – The main body of the uterus where a fertilized egg implants during pregnancy.
Isthmus – The part of the uterus between the corpus and cervix, where the uterus starts to narrow.
Cervix – The lowest part of the uterus which opens to Vagina.

Function of Uterus

The Uterus plays a key role in Pregnancy, Fertility and Menstrual cycle.

Uterus In Menstruation – The endometrial lining gets thicker and rich with blood as it is near ovulation (release of an egg from the ovaries), If an egg is fertilized during that cycle, it implants into the lining of the uterus and pregnancy begins. Endometrial lining sheds if pregnancy doesn’t happen which is called Periods. This cycle repeats every menstrual cycle unless pregnancy occurs.

Uterus in Pregnancy – When the egg is fertilized by sperm it gets implanted into the uterine lining. This is when pregnancy officially begins and one misses the monthly periods. The uterus grows and stretches like a balloon to accommodate the growing baby. It contracts during labor and delivery to help push your baby out of the vagina. After about 6 weeks uterus returns to its pre-pregnancy size (slightly larger and stretched).

Normal Uterus Vs Adenomyosis Vs Endometriosis

The uterine wall is made of three layers :

Perimetrium – The outermost protective layer
Myometrium – The muscular middle layer which expands during pregnancy and contracts during delivery.
Endometrium – The inner layer or lining of the uterus (uterine lining).

NORMAL UTERUS

UTERUS IN ADENOMYOSIS

UTERUS IN ENDOMETRIOSIS

In a normal uterus, all the three layers Perimetrium , Myometrium and Endometrium are distinct and separate

· In adenomyosis, the endometrium invades the myometrium. During menstruation, these endometrial implants within the myometrium respond to hormonal stimulation and bleed into the uterine muscle causing extreme pain.

· In an Adenomyotic uterus, the endometrial tissue that lines the uterus grows into the muscle of the uterus (Myometrium layer). This makes uterine walls thicker than usual and twists the blood vessels in the uterus leading to heavy, painful and prolonged periods.

In an Endometriosis uterus, the lining similar to the uterus lining called, the endometrium is grown outside the Uterus on Ovaries, fallopian tubes etc.

Adenomyosis Symptoms

Not everyone will have all of these symptoms and not everyone will experience the symptoms to the same degree.

Menorrhagia (Heavy menstrual (Big blood clots)Bleeding, also called flooding)
Dysmenorrhea (Severe abdominal cramping, sometimes as severe as the last stage of labor)
Enlarged, bulky and heavy uterus (often double or triple in size)
Tenderness in the lower abdomen
Lower abdominal discomfort.
Severe bloating
Nausea and vomiting
Bleeding between periods.
Continuous body discharge (spotting)
Pain in legs
Pain in the lower back.
Painful Sexual intercourse.
Pressure on the bladder.
Frequent urination.
Alternating Constipation and diarrhoea.
Painful bowel movements during menstruation.
Passing large blood clots during menstruation.
Prolonged menstrual bleeding (8-14 days, even longer)
Chronic Anemia
Heart palpitations due to Anemia
Depression and/or anxiety
Infertility
Pre-disposed to myometrial ectopic pregnancy.

By seeing the above list of symptoms you can easily make out Adenomyosis can seriously impact the quality of a woman’s life. The woman with Adenomyosis is left in humiliation when a big clot is passed suddenly at a public place or event soiling clothes and seats. One has to change 10 – 12 pads per day leaving them with no energy to eat, stand or to take care of themselves. Only the person who is going through this phase will understand the amount of pain, fatigue, blood loss, social isolation and depression that is involved in this disorder.

Often these symptoms are misunderstood as Menopausal symptoms, Endometriosis or simply treated as PCOD symptoms. Women don’t take it seriously until the symptoms get unmanageable and they end up in emergency wards at night.

I request the readers if any of you are having the above symptoms (2 or more) persistently every month, please get yourself checked with a gynaecologist and not waste time with home remedies like popping over-the-counter painkillers, lying down on the bed the whole day with the warm pillow on the belly or try to solve the symptoms with home remedies.

Causes of Adenomyosis

One theory that has been accepted for many years is adenomyosis is caused by some kind of trauma that breaks the barrier between the endometrium and myometrium. However, this theory has not been proven.

Still, the exact cause of adenomyosis is unknown and research is going to understand the same. Few other studies have shown some other factors may be at play.

Estrogen Dominance – Estrogen and Progesterone need to be in a delicate balance in a woman’s body for the proper functioning of the reproductive tract. Estrogen dominance is a condition in which the progesterone-to-estrogen ratio is too low. Progesterone is required to lower the effect of estrogen. This can lead to a whole host of problems including adenomyosis, breast cancer, endometrial cancer, Dry eyes, PMS, PCOS, Uterine cancer, polyps, fibroids etc.

Both Estrogen and Progesterone can be in the normal range but the ratio can be out of range in Estrogen Dominance. For example:

Estradiol -2.3 In range (Normal is 1.3-3.3)

Progesterone – 154 In range (Normal 75-270)

Ratio: Pg./E2 -67 Out of range (Normal 100-500)

Why estrogen dominance happens?

Estrogen Dominance can happen due to –

Too much of a specific type of estrogen is broken in an unfavorable way. Estrogen is metabolized in the liver. When too many estrogen metabolites burden the liver, it becomes difficult for the liver to process the unwanted estrogen out of the body.

Most of the estrogen, like Estradiol, is formed in the Ovaries and circulates to the Brain and Pituitary gland influencing the menstrual cycle, pregnancy, weight, memory etc. Unutilized estradiol enters the liver for breakdown.

The liver is responsible for breaking down of estradiol and estrone into smaller pieces as the first step in eliminating metabolized estrogen.

Phase 1:- Oxidation

Estrogen is broken down into

2- hydroxy estrone (2-OH) a “good” estrogen that does not stimulate cell growth and can block the action of cancer-causing estrogen.
4-hydroxyesterone (4-OH) is potentially “harmful”, with increased estrogenic activity.
16 alpha hydroxyesterone (16-OH) is potentially harmful associated with an increased risk of breast cancer.

Phase 2:- Conjugation

In this phase, the broken-down toxins from phase 1 (more toxic now than before) are coupled with another compound like methyl or sulfur, that will evacuate them via several detoxification pathways.

If phase 2 doesn’t finish properly the toxic residues from phase 1 get accumulated causing hormonal imbalance and estrogen flare up.

Not having any Progesterone to balance estrogen.

Progesterone – Estrogen in balance is required to maintain good hormonal balance in women’s reproductive health. One of the important functions of progesterone is to balance the body’s estrogen levels by decreasing the number of estrogen receptors on the organs.

Hyper Prolactinemia – High levels of Prolactin play a role as several animal studies have shown adenomyosis occurs in this state. Hyper prolactin levels can be seen in Hypothyroidism, Polycystic Ovarian Syndrome, Pituitary Tumors, Liver and Renal failures, Stress, Seizures, pregnancy and Nursing. Further studies are needed to confirm Hyper prolactinemia as a factor of adenomyosis development in the human body.
Invasive growth of endometrial cells into the uterine muscles due to incisions made in the uterus during surgery like a caesarean delivery.
Stem cells in the uterine muscle cells.
Extra tissues in present during birth and growing in adulthood.

Diagnosis of Adenomyosis

Again, not enough research has been done on this uterine disorder when it comes to diagnosis. To this date a specific diagnosis of adenomyosis is unavailable. Symptoms are the same for almost all uterine disorders and that’s why the diagnosis gets delayed or misunderstood many times.

A pelvic Exam and Physical Exam are done to determine if the uterus is enlarged or tender. Examination by pressing on the surface of the body to feel the organs or tissues underneath.

To confirm Doctor can ask for a Transvaginal Ultrasound scan, MRI Or Hysteroscopy. Sometimes Adenomyosis is missed to pick up in scans or misunderstood as uterine fibroids.

How Adenomyosis is treated?

Medications: Medications given can only help to give relief from the symptoms but not remove adenomyosis. Medications like Tranexa, K stat, Mstat, and Pause are given to control abnormal bleeding. Painkillers can be given to reduce stomach aches, headaches and back aches related to adenomyosis.
Hormone Therapy: Doctors can prescribe hormones to fix hormonal imbalances which are aggravating adenomyosis. This treatment can help to control the estrogen which can aggravate the symptoms. Birth control pills, Progestin contraceptive injections, or Intrauterine Device (IUD) like Mirena loop can be prescribed in hormone therapy.
Endometrial ablation: This procedure removes the endometrium. This procedure may not help in adenomyosis as it invades the muscle more deeply.
Uterine Artery Embolization: Uterine artery embolization (UAE) prevents certain arteries from supplying blood to the affected area. When blood supply is stopped, adenomyosis size reduces.
Hysterectomy: This is the last and most effective way to completely cure adenomyosis. It involves surgical removal of the Uterus.

Potential Complications :

By now you must have understood Adenomyosis, its symptoms, diagnosis and treatment options. None of it looks less troubling, simple and easy to fix adenomyosis.
Though adenomyosis is not life-threatening but if left untreated it can lead to blood loss and Anemia which can be a potential risk.
The treatment options discussed have many side effects on the physical and mental health of women.
In case one gets tired of the side effects and decides to go for Hysterectomy or uterus removal, it can lead to many other health complications. Other than Pregnancy, Uterus does play many crucial roles. Hysterectomy can cause many short-term and long-term complications like Infertility, Vaginal dryness, Hot flashes, Bone Weakening, Bowel Blockage, Insomnia and Depression.
Sometimes women can have Adenomyosis along with other conditions like Endometriosis or PCOD or Fibroids etc.

Alternative treatment for Adenomyosis :

If you are in the early stages of Adenomyosis, You can fix it without going for permanent uterus removal by taking a Proper diet and following a healthy lifestyle. A balanced Indian diet will help in reducing estrogen dominance, and balance other hormones. This will gradually improve Adenomyosis and its related symptoms. Please consult a qualified nutritionist or clinical dietitian and healthcare provider to cure Adenomyosis.

PS: Following a balanced diet and lifestyle doesn’t mean you will stop medications or avoid procedures advised by Gynecologist. Along with medications or procedures follow natural ways to fix Adenomyosis effectively, without side effects.

Take Away :

Adenomyosis can cause debilitating heavy menstrual bleeding and severe period pain, significantly affecting a woman’s quality of life. Lack of Awareness about Adenomyosis among Women makes their physical and emotional health very Weak. Often Adenomyosis is misdiagnosed as Menopause, Endometriosis or PCOD Symptoms. It is not easily detected in normal scans. Birth control pills, IUD (Intra Uterine Device), and Hysterectomy are some treatment options suggested to relieve Adenomyosis. All these treatments come with a package of side effects. One can naturally fix adenomyosis by following a healthy Indian diet and active lifestyle. Always be conscious about health and any significant change in or during your menstrual cycle must be considered seriously, get yourself checked annually and have a happily healthy life.

References

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