Adenomyosis

Adenomyosis or adenomyosis is a condition where the endometrium or the surface layer of the uterine cavity grows inside the muscle wall of the uterus (myometrium). Although this condition is generally not dangerous, it can cause bleeding, pain, and negatively affect the quality of life of the sufferer.

Under normal conditions, endometrial tissue only lines the surface of the uterine cavity. In adenomyosis, the endometrial tissue continues to function normally, but grows into the muscle layer of the uterus. As a result, the uterus swells with each menstrual cycle.

This condition can affect women of all ages, but is more common in the 40–50s. It also usually resolves when women go through menopause.

Causes of Adenomyosis

Until now, the cause of adenomyosis has not been confirmed. However, this condition is thought to be related to the following factors:

• Suffering from obesity
• Aged 40 to 50 years
• Have had surgery on the uterus, such as curettage or cesarean section
• Ever given birth

Symptoms of Adenomyosis

Most people with adenomyosis do not experience any symptoms. However, in some cases, adenomyosis can cause the following symptoms:

• Pelvic pain
• Heavy and prolonged bleeding during menstruation (menorrhagia) even for more than 15 days
• Pain and cramps during menstruation
• Pain during sexual intercourse (dyspareunia)
• Pain and cramps during menstruation

When to see a doctor

See a doctor if you experience unbearable menstrual pain or dysmenorrhea , especially if it has occurred in 3 consecutive cycles and interferes with your activities.

Also consult a doctor if menstrual bleeding is heavier than usual or if vaginal bleeding occurs after menopause.

Diagnosis of Adenomyosis

As a first step, the doctor will ask about symptoms and perform a physical examination on the patient. The physical examination is mainly performed on the lower abdomen or pelvis, to determine whether there is an enlarged uterus or whether there is pain when the pelvis is pressed.

Please note, the symptoms of adenomyosis are similar to the symptoms of other uterine diseases, such as myoma , endometrial polyps, or endometriosis . Therefore, the doctor will perform the following examinations to confirm the diagnosis:

• Pelvic or transvaginal ultrasound: This procedure aims to check for uterine enlargement, changes in the shape of the uterine muscles, uterine cysts , or thickening of the endometrium.
• MRI of the uterus: This examination is performed to see the condition of the uterus in more detail, especially in patients who experience abnormal bleeding.
• Endometrial biopsy: In some cases, the doctor will examine a sample of endometrial tissue to make sure that the patient does not have a more serious condition.

Adenomyosis Treatment

Treatment methods for adenomyosis depend on the severity of symptoms, childbirth history, and whether the patient still wants to have children in the future.

Patients with mild symptoms can do self-therapy by soaking in warm water or using a heating pad on the stomach, and taking over-the-counter pain relievers, such as paracetamol. Meanwhile, if the symptoms are severe or there is heavy menstrual bleeding, see a gynecologist for further treatment. The doctor will provide the following actions:

1. Pain reliever

Doctors may prescribe nonsteroidal anti-inflammatory drugs , such as mefenamic acid , to reduce pain.

2. Hormone therapy

Hormone therapy is given to patients who experience heavy bleeding and unbearable pain during menstruation. One type of hormone therapy is birth control pills .

3. Endometrial ablation

Endometrial ablation aims to destroy the uterine lining that has adenomyosis. However, this procedure can only be done if the adenomyosis has not entered too deep into the uterine muscle.

4. High intensity focused ultrasound (HIFU)

HIFU aims to destroy endometrial tissue using a special ultrasound device .

5. Adenomyectomy

Adenomyectomy aims to remove adenomyosis tissue through surgery. This procedure is performed when adenomyosis has not been successfully removed by other methods.

6. Uterine artery embolization

This procedure is done to block blood flow to the adenomyosis area, so that its size will shrink and the symptoms will subside. This procedure is done on patients who cannot undergo surgery.

7. Hysterectomy

Hysterectomy or removal of the uterus is performed if adenomyosis cannot be treated in other ways. This procedure is only recommended if the sufferer no longer wants to get pregnant.

Complications of Adenomyosis

Adenomyosis with heavy and prolonged bleeding during menstruation can cause anemia or lack of blood. Adenomyosis can also interfere with the quality of life of sufferers, because of discomfort during activities due to menstrual pain and heavy menstrual bleeding.

Adenomyosis Prevention

It is not yet known how to prevent adenomyosis. However, this disease can be avoided by controlling its risk factors. Here are some ways to prevent adenomyosis:

• Implement a healthy, nutritious and balanced diet
• Maintain an ideal weight
• Lose weight if you are obese
• Undergo regular health and pregnancy check-ups

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