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Adenomyosis: Definition, Causes & Treatment
What is the definition, causes & treatment for Adenomyosis? Adenomyosis is a disorder that causes a woman’s uterus to thicken due to the proliferation of cells resembling the endometrium (lining of the uterus) among the cells of the uterine wall (myometrium). This tissue is entirely functional in patients with this disease, but also misplaced.
Every menstrual cycle causes the tissue to thicken, shed, and bleed. This results in inflammation, pain, fibrosis, and enlargement of the uterus. Though it can also afflict younger women, the illness is most frequently diagnosed in women between the ages of 35 and 50.
Adenomyosis patients frequently have painful menstrual periods (dysmenorrhea), excessive menstrual flow (menorrhagia), or both. Other probable symptoms include pain during sex, persistent pelvic pain, and urinary bladder irritation. This misplaced tissue causes hyperplasia of myometrial fibers. Unlike the functional layer, the basal layer does not experience the typical cyclic alterations associated with the menstrual cycle.
Adenomyosis can focally affect the uterus, resulting in an adenomyoma. The uterus enlarges and weighs more with broad involvement. Endometriosis and adenomyosis can coexist, although endometriosis patients have endometrial-like tissue external to the uterus. The tissue in endometriosis resembles the endometrium but is distinct from it. Though they frequently happen individually, the two disorders are commonly observed together.
Adenomyosis was formerly known as endometriosis interna before it was recognized as a different illness. Adenomyometritis, a less popular term, is a more precise term for the disorder, indicating uterine involvement.
Causes of Adenomyosis
Adenomyosis has been linked to uterine trauma, including caesarean sections, surgical pregnancy terminations, and any pregnancy which may damage the junctional zone, which serves as a barrier between the endometrium and the myometrium. It has been associated to endometriosis, although studies comparing the two disorders; similarities and differences have shown mixed results.
Diagnosis of Adenomyosis
The size and location of adenomyosis; invasion into the uterus can differ greatly. However, non-invasive imaging methods including transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) can be used to guide treatment options, assess response to treatment, and strongly suggest the diagnosis of adenomyosis. In fact, the only two feasible methods for making a pre-surgical diagnosis are TVUS and MRI.
Transvaginal ultrasonography is thought to have an overall sensitivity of 79% and specificity of 85% for detecting adenomyosis imaging with magnetic resonance. Due to the greater ability of MRI to objectively distinguish between various forms of soft tissue, it offers a marginally higher diagnostic capability than TVUS.
The increased spatial and contrast resolution of MRI makes this possible. According to estimates, MRI has a 74% sensitivity and 91% specificity for detecting adenomyosis. The junctional zone is the primary area of investigation during MRI diagnosis. On both T1 and T2 weighted sequences, the junctional zone of the uterus will be enlarged and show a darker or weaker signal.
Adenomyosis is suspected with a junctional zone thickness of 8 to 12 mm or more. The normal range is less than 8 mm or having a junctional zone that is wider than 40% of the myometrium. higher than 5 mm of variation in the junctional zone breadth. On the T2 weighted scans, one will frequently see hyperintensity (bright spots) foci that correspond to smaller cystically dilated glands or more severe locations of microhemorrhage scattered among the thickened, darker signal of the junctional zone. Calcified uterine fibroids do not restrict MRI as other causes do (as is ultrasound). Adenomyosis is particularly easier for MRI to distinguish from uterine fibroids.
Adenomyosis Treatment: Schedule a Consultation Today
Adenomyosis is typically not a life threatening condition and will go away once a person reaches menopause. However, it can cause extreme discomfort and lead to complications prior to menopause.
Dr. Andrea Vidali
155 East 76th Street
New York, NY 10021