Modern medicine offers various therapeutic options, including medicinal and surgical interventions. Contrary to previous assumptions, adenomyosis is not limited to women in the later stages of reproductive life or post-menopause; it can also affect younger women [1].
Adenomyosis, historically categorized as a subtype of endometriosis, is a gynecological condition characterized by the infiltration of endometrial-like tissue into the muscular layer of the uterus. These infiltrations comprise both glands and stroma. Additionally, adenomyosis may entail an overall enlargement of the uterus and disturbances in the junctional zone between the uterine muscle and the endometrium. Adenomyosis can manifest as a localized condition, similar to fibroids, or diffuse throughout the uterine muscle. There is also a mixed form wherein diffuse and localized infiltrations are present [2, 3].
Accurate prevalence figures for adenomyosis remain elusive, with reported estimates ranging from 5 to 70 percent. Several factors contribute to this variability: the challenges in distinguishing adenomyosis from endometriosis and, in some instances, from fibroids (benign growths). Furthermore, these statistics are often derived from post-hysterectomy examinations, primarily conducted after the reproductive phase and typically in severe symptoms [4].
Adenomyosis and Endometriosis
A Comparison under the Microscope
Adenomyosis:
Endometriosis:
Adenomyosis often manifests as chronic lower abdominal pain, primarily attributed to the growth of endometrial-like tissue within the uterine muscle. Alongside this, individuals may experience pain during menstruation, discomfort during sexual intercourse, and various bleeding irregularities. In some cases, women with adenomyosis encounter what is known as retrograde menstruation. This not only results in abdominal bleeding during the menstrual period but can also impede an egg’s typical path, favoring transport into the abdomen rather than the uterus due to fallopian tube movement [9]. Consequently, adenomyosis can contribute to infertility and an increased risk of miscarriages due to mucosal changes [5].
However, it is essential to note that women with adenomyosis can still become pregnant. According to current research, approximately 30 percent of affected women experience minimal or no symptoms [6].
‘Endometriosis’ derives from ‘endometrium,’ the scientific name for the uterine lining. In endometriosis, clusters of cells known as ‘endometriosis foci’ form outside the uterus and resemble the uterine lining. These foci consist of glands, stromal cells, and smooth muscle supported by nerves, lymphatic vessels, and blood vessels [7].
Endometriosis typically gives rise to chronic abdominal pain, often exacerbated during menstruation, as well as bleeding abnormalities, pain during sexual intercourse, and difficulties conceiving. These symptoms closely parallel those associated with adenomyosis. Given the substantial symptom overlap and limited diagnostic means, adenomyosis was historically considered a subtype of endometriosis, differentiated primarily by its location:
Despite the shared clinical features, extensive research has unveiled numerous molecular, epigenetic, and risk factor disparities between the two conditions. Consequently, adenomyosis is no longer classified as a subtype of endometriosis. Although the term ‘endometriosis genitalis interna’ persists in some references [8], it has been largely abandoned in the contemporary medical literature.
However, current knowledge indicates that up to 22 percent of affected women contend with endometriosis and adenomyosis. The extent to which these conditions influence one another, share common causes, or even precipitate each other remains an area of ongoing investigation [1].
The precise factors that trigger the development of adenomyosis remain a subject of ongoing research, with several theories and risk factors identified. These are outlined below:
One theory suggests that mucosal cells from the uterine lining migrate into the muscular layer when the ‘junctional zone,’ an intermediate layer between the endometrium and the muscular layer, is disturbed. Such disruption may occur due to surgery or scraping, often associated with procedures like abortions or miscarriages [10].
Another theory posits that degenerated tissue or stem cells within the muscle layer of the uterine wall play a role in the development of adenomyosis [11].
A recent theory proposes that strong uterine contractions may cause micro-tears in the layer separating the mucosa from the muscle. These injuries subsequently stimulate an increased release of estrogen and permit the infiltration of cells into the muscular layer. This phenomenon, referred to as ’tissue-injury-and-repair’ (TIAR), is recognized in adenomyosis but, like other theories, has yet to be definitively proven.
Several risk factors have been associated with the development of adenomyosis, including:
Formally, the definitive diagnosis of adenomyosis relies on histology, which entails examining a tissue sample [9]. Nevertheless, non-invasive diagnostic methods are now in use.
The causal factors behind adenomyosis remain elusive, thus making it challenging to provide a definitive cure. Nonetheless, diverse treatment approaches are available, encompassing pharmaceutical and non-pharmaceutical methods. Treatment choice depends on individual factors, with particular consideration given to the patient’s age and fertility desires.
Given the close relationship between adenomyosis and endometriosis, pharmaceutical treatment strategies often draw from the experience in endometriosis therapy. However, it is essential to note that all drug treatments exhibit their effects only as long as the treatment regimen continues. Many women may not respond to these drug treatments or continue to grapple with residual symptoms.
Key pharmaceutical therapy concepts include:
The main surgical treatment options are:
Given the prolonged presence of pain associated with adenomyosis, women should consider multimodal pain management strategies to enhance their overall quality of life.
Adenomyosis uteri, commonly referred to as adenomyosis, is a condition affecting the uterus, characterized by the infiltration of endometrial-like tissue into the uterine muscular layer. These tissue growths resemble those seen in endometriosis outside the uterus. The symptoms associated with adenomyosis closely mirror those of endometriosis, including abdominal pain, menstrual irregularities, and subfertility.
While adenomyosis was historically considered a subtype of endometriosis, it is now recognized as a distinct medical condition. Nonetheless, a strong correlation exists between adenomyosis and endometriosis, with many individuals experiencing both conditions concurrently. The precise nature of this connection remains under ongoing investigation.
Treatment for adenomyosis varies depending on individual findings and circumstances, encompassing medical and surgical approaches. Additionally, multimodal pain therapy measures are often recommended to enhance the overall quality of life.
If you are grappling with adenomyosis and are curious about the suitability of the Endo-App for your needs, the answer is a resounding ‘Yes!’ Download the Endo-App to access valuable insights from experts in the field.
Reproductive Biomedicine Online. 2017Parrott E, Butterworth M, Green A, White IN, Greaves P.: Adenomyosis – a result of disordered stromal differentiation. American J Patho 2001; 159(2): 623-630.
Benagiano G, Habiba M, Brosens I.: The pathophysiology of uterine adenomyosis: an update. Fertility and sterility. 2012; 98(3): 572-579.
Hufnagel D, Li F, Cosar E, Krikun G, Taylor HS.: The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis. Seminars in Reproductive Medicine. 2015; 33(5): 333-340.
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
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