How is adenomyosis diagnosed?

Posted in Adenomyosis; Tagged Adenomyosis; Comments 1 ; Posted 12 months ago by Andreas Obermair

Adenomyosis is a medical condition where the cells of the inner lining of the uterus (endometrial tissue) grow towards the outside and into the muscle layer of the uterus.

Adenomyosis can cause pain during menstrual bleeding. This is because the cells that have travelled to within the muscle wall, but behave the same as the cells lining the uterus, where they originated. When you have your menstrual bleeding, these cells get shed (called “the period”), but because they are trapped in the muscle layer of the uterus (not the uterus lining where they should be), they are trapped and form pockets of blood within the uterine muscle wall. This causes the painful, cramping symptoms.

A definitive diagnosis can only be made by examining a hysterectomy specimen under a microscope (histopathology). The diagnosis is suspected when typical symptoms occur.

Ultrasound may provide information and in particular Doppler ultrasound may reveal some blood flow within the smooth muscle layer that is normally absent. Doctors may suspect adenomyosis if they have symptoms but do not have fibroids or cysts on ultrasound.

A preoperative diagnosis of adenomyosis is difficult to establish but can be attempted through MRI scan. It can show strong signal intensity within the myometrium on T2 weighted scans. MRI scanning is also the best to distinguish adenomyosis from fibroids.

CT scans are not useful or diagnostic because they are unreliable to diagnose or exclude adenomyosis.

Symptoms

Adenomyosis may cause heavy menstrual bleeding (menorrhagia, clots) and painful periods. Adenomyosis may cause the uterus to soften and enlarge, which in some cases can make the abdomen feel swollen and bloated.

Symptoms typically develop between 30 and 40 years of age. 

It is also possible for some women to have no symptoms at all.

What causes adenomyosis?

Unfortunately we are not sure what causes this condition.

Risk factors for adenomyosis includes prior surgery of the uterus, such as C-section, fibroid removal, or dilatation and curettage (D&C).

Can a hysterectomy help?

A hysterectomy will cure adenomyosis, but needs to be considered carefully depending on the patient’s age, health and other medical conditions. You will no longer be able to carry a pregnancy once the uterus is removed.

To note, some patients have endometriosis and adenomyosis together. A hysterectomy will not cure endometriosis, as the lining of the cells have already spread outside the uterus.

Other treatments

Before surgery medical treatment should be offered to all patients (such as Mirena, systemic Progestins, oral contraceptives, Danazole) which can provide initial symptom relief for some patients. Although symptoms will recur once treatment has stopped.

You can read more about surgical treatment options on my page Adenomyosis

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