Many people who menstruate face the challenges of painful periods and heavy menstrual flow.
Painful and heavy periods can have many causes, including endometriosis and uterine fibroids, but another condition often flies under the radar: adenomyosis. Adenomyosis likely affects millions of people, but you have probably never heard about it.
With the help of Nichole Mahnert, MD, an OBGYN and gynecologic surgeon with Banner – University Medicine, we unravel the basics of adenomyosis, its causes, symptoms and available treatment options.
What is adenomyosis?
Adenomyosis is a medical condition that affects the uterus. It occurs when endometrial tissues that are typically shed during your period instead grow into the walls of your uterus – which is not where they should be.
“Adenomyosis causes tissues similar to the inside lining of the uterus to grow into the uterus,” Dr. Mahnert said. “The tissue continues to thicken, break down and shed, causing pain, cramping and heavy or irregular bleeding.”
This condition is so common that people often refer to adenomyosis as the mean cousin of endometriosis.
“Whereas endometriosis grows outside of the uterus, adenomyosis grows into the wall of the uterus and thickens it,” Dr. Mahnert said. “The uterus is made up of glandular and muscular tissue, and adenomyosis is like an abnormal glandular tissue growth.”
What causes adenomyosis?
The exact cause of adenomyosis remains unclear, but it is most often seen during your reproductive years.
“There are no risk factors, but we do see this diagnosis more commonly among those who’ve had children in the past, who’ve had prior uterine surgeries and with other gynecological conditions such as endometriosis and fibroids,” Dr. Mahnert said.
If you have adenomyosis, you are more likely to have endometriosis or fibroids.
How do I know if I have adenomyosis?
Heavy periods and painful cramps are the most typical symptoms, but about one-third of people with adenomyosis don’t have any symptoms at all.
Other symptoms may include:
- Pain during sex
- Pain during bowel movements
- Pelvic pain
- Tenderness or pressure on your lower abdomen
Will adenomyosis affect my ability to get pregnant?
“Among patients who are not able to get pregnant, adenomyosis is one of the considerations that can make getting pregnant difficult,” Dr. Mahnert said.
Since many people who have adenomyosis also have endometriosis and fibroids, it is unknown whether adenomyosis is the main culprit affecting fertility.
If you are trying to get pregnant or start a family, talk to your provider to learn more about your fertility.
How is adenomyosis diagnosed?
Because the symptoms of adenomyosis resemble symptoms of other conditions, you’ll want to be seen by your gynecologist or health care provider.
Your provider will perform a pelvic exam to see if your uterus is enlarged or tender and may also request medical imaging of your organs.
“We can see signs of adenomyosis on a pelvic ultrasound,” Dr. Mahnert said. “Sometimes we also take an MRI of the uterus.”
What are my treatment options?
When adenomyosis is diagnosed, your treatment will depend on the severity of your symptoms and your desire to maintain your fertility.
The first step is to treat your pain. This may include anti-inflammatory medication like ibuprofen and supportive care, such as soaking in a warm tub and applying a heating pad. Other options may consist of hormonal medications, including birth control pills and hormonal IUDs.
“Hormonal suppression is a mainstay of treatment for heavy bleeding and painful periods,” Dr. Mahnert said. “A Mirena IUD is a great option because, when used for heavy menstrual bleeding, it lasts for at least five years, and you don’t have to remember to take anything.”
If your pain is severe and no other treatments have worked, your provider may suggest a hysterectomy (surgery to remove your uterus). This treatment is permanent, so you should only consider it if you no longer wish to become pregnant.
Your symptoms may also improve or resolve with perimenopause and menopause, as your hormonal levels decrease.
Takeaway
Don’t let heavy, painful periods rule your life. Talk to your provider or a Banner Health specialist to learn more about adenomyosis and other possible causes of your symptoms. They can help you seek the best treatment to help you feel better.
