What are Endometriosis and adenomyosis?
Endometriosis and adenomyosis are disorders involving uterine endometrial tissue and occur in adolescents and women of reproductive age. However, they have different courses of development but may sometimes present together in a woman. These conditions can lead to pain, heavy bleeding, and infertility.
Endometriosis occurs when cells resembling endometrial cells grow outside the uterus and are mostly found on the ovaries, ligaments supporting the uterus and in the pelvic cavity. They follow the pattern of the menstrual cycle and bleed monthly.
Adenomyosis occurs when cells resembling endometrial cells grow inside the uterus. These misplaced cells follow the menstrual cycle and lead to monthly bleeding. The uterus wall thickens, causing pain and heavy bleeding. It is more frequent in older women and is associated with infertility.
The common symptoms of Endometriosis and adenomyosis
Endometriosis irritates and swells the nearby tissues leading to scarring and the following symptoms may be seen:
- Heavy or painful periods
- Pain in the back or leg, or pain during or after intercourse
- Pain while urinating or passing stool
- Nausea, vomiting or fatigue
With adenomyosis, the enlarged uterus may:
- Increase pressure on the bladder and rectum
- Cause heavy and painful bleeding during periods
- Chronic pelvic pain
Both conditions can lead to anaemia due to excessive menstrual bleeding and infertility.
What causes Endometriosis and adenomyosis?
The exact causes of endometriosis and adenomyosis are currently not known but the possible mechanisms include:
- Trauma to the uterus
- Activation of stem cells due to injury to the endometrial tissue
- Menstrual blood flowing into the oviduct may deposit cells resembling endometrial cells into the pelvis or other areas
- Genetic factors may be involved
- Immune system problems
- Hormonal system problems
- The lymph system carries cells resembling endometrial cells to other areas
How are Endometriosis and adenomyosis diagnosed?
- It is often difficult to distinguish between endometriosis, adenomyosis or other conditions like fibroids or cysts.
- Diagnosis of endometriosis often involves an ultrasound for imaging purposes. An MRI of the uterus can also aid in showing larger endometrial-like cells outside the uterus but is not adept at imaging smaller cells, for which surgical interventions are often required to confirm the diagnosis.
- In the case of adenomyosis, the uterus often feels bigger and more tender than normal. An ultrasound or MRI may be used for the diagnosis of adenomyosis.
- Often patients don't realise they have adenomyosis until a hysterectomy is performed and the uterine tissues are lab tested.
Treatment options for Endometriosis and adenomyosis
- Endometriosis and adenomyosis are treated in case of the appearance of symptoms.
- Both conditions are often managed with pain medications like non-steroidal anti-inflammatory drugs (NSAIDS).
- Medicines regulating hormones like birth control pills, progestin and progesterone, gonadotropin-releasing hormone agonists, etc may be used in case of endometriosis to prevent the formation of scar tissues.
- Scar tissues in case of endometriosis may be removed using surgery.
- An intra-uterine device is an option to manage the symptoms of adenomyosis. Other options include blocking the blood supply to the uterus through artery embolization or surgical interventions like endometrial ablation.
- The sure cure for these conditions is the removal of the uterus using a process known as a hysterectomy.
When to see a doctor?
It is essential to consult a doctor in case of:
- Heavy and painful periods
- Pain during or after intercourse
- A feeling of heaviness in the abdomen
- Experiencing severe symptoms like fatigue, nausea or vomiting, especially around the periods
Although these conditions occur in women between 30 to 50 years of age, they can also occur in adolescents. therefore, it is essential to keep a watch on the symptoms and to consult the doctor whenever something does not feel right. These conditions can be managed through a comprehensive treatment plan.
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Risk factors include older age, the presence of uterine fibroids, a history of ectopic pregnancy, and endometriosis.
It is currently unclear if adenomyosis can cause infertility. However, infertility is a clinical presentation of this disease. Since it affects the woman's ability to conceive after the first pregnancy and often occurs with endometriosis, infertility treatments may be required to conceive again.
In short, the answer is 'yes'. It might come back after surgery. The exact cause of recurrence is not known and the percentage of patients having a recurrence also varies. The best outcomes are often achieved with multi-disciplinary care of the patient in treatment and management.
