Adenomyosis

Adenomyosis is the presence of endometrial tissue within the myometrium. (The myometrium is the medical term for the muscular portion of the uterine wall.) In the past, adenomyosis was referred to as ‘endometriosis interna’ in the medical world, and sometimes as ‘inside-out endometriosis’ in lay terms.
Adenomyoma is a 'ball' of adenomyosis which can be similar to a fibroid.

Diagnosis

The diagnosis can only be proven by the pathologists. This requires the microscopic evaluation of the uterus or tissue taken from the uterine wall.

Although it is possible for a surgeon to make the diagnosis by biopsy, this is not very useful because we would need to do approximately 8 biopsies to get the right diagnosis 80% of the time!

MRI and ultrasound can be used to diagnose adenomyosis. This, in combination with clinical symptomology can be useful.

Adenomyosis

What Are the Symptoms?

There may be no symptoms. However, as the condition worsens, many women begin to be troubled with heavy menstrual bleeding and increasing cramps. There may be bleeding in between the menses (metrorrhagia) and daily pain. On physical examination, a soft, boggy enlargement of the uterus may be detected by your gynecologist. The uterus may be quite tender.I frequently notice an unusual type of tenderness on pelvic exam when the uterine muscle is compressed.

Some adenomyomas are exquisitely tender to touch on pelvic examination and during intercourse.

What are the treatment options?

The first line of treatments for adenomyosis is a combination of hormonal therapy (birth control pills, lupron, or depo - provera) and NSAIDS (ibuprofen, naprosyn). If this fails and there are still symptoms of pain, narcotics may be used. For the bleeding symptoms, endometrial ablation may be attempted. Finally, as a last resort, hysterectomy can be performed as a definitive therapy.