Painful and Boggy Uterus: Adenomyosis Greek for Distorted Uterus

Adenomyosis is a word from the Greeks. Aden, meaning gland or glandular, and myo meaning muscle. here is an aging, if you will, of the uterus that occurs that can distort the uterus. This condition is very common, in fact it may occur in at least 60% of all women as they age,and at least a third of the women with this condition will have any symptoms at all. In women with painful periods adenomyosis is always a possible diagnosis. It’s less likely to just be adenomyosis if women also have chronic pelvic pain. Adenomyosis, like other gynecologic conditions, can be responsive to hormones, but it's not specifically due to hormones being distorted, and it wouldn't have relationships to ovarian conditions, for instance, adenomyosis has no relationship we know of to ovarian cysts and should have no relationship to pains that occurred with a current or prior ovarian cyst. Adenomyosis, a condition of glands from the uterine lining being entrapped within the wall of the uterus, generally by itself causes minimal symptoms. These glands that get entrapped in the wall of the uterus don't specifically grow there spontaneously, they are thought to be entrapped, the way a splinter might get entrapped underneath a layer of skin. When there are uterine fibroids, endometriosis or prior uterine surgery the glands have a way of being caught up within the main wall of the uterus rather than staying on the inner surface of the uterus. Overall the uterus is larger with adenomyosis than normal size. When these other conditions occur, it is also more common for patients to have pain that might need treatment. Treatments that only treat the lining of the uterus, like an endometrial ablation the glands that exist remote from the endometrium wouldn’t get treated at the time of an endometrial ablation. So an endometrial ablation wouldn't treat adenomyosis, and it wouldn't treat any symptoms from the adenomyosis.The hardest part is that gynecologists cannot ever prove a patient has this condition before a hysterectomy. There are specific findings like an enlarge and boggy uterus that makes the gyno suspect the condition, but not be able to prove it. So when thinking about various treatments like endometrial ablation it's hard to factor in the possibility of adenomyosis when making your decision. So  and a gynecologist may have the impression of adenomyosis prior to an endometrial ablation, and there is not research to say that the process of the endometrial ablation would cause adenomyosis to develop. Ultrasounds do have some signs that are suggestive of adenomyosis, but it’s not too accurate for diagnosing this condition. Patients can diagnosed with adenomyosis by MRI, but this is expensive. Tissue is needed for a proof positive diagnosis, and this tissue could be obtained at the time of myomectomy, or hysterectomy, it’s almost never an option for patients to get a biopsy to prove adenomyosis. Needle biopsies are possible, as are biopsies at the time of diagnostic hysteroscopy, but it is a difficult test and no specific technique has been taught to the general gynecologists. So this ancient condition of a distorted uterus, aptly named by the Greek terms, still remains to be deciphered. For more information, or to participate in a clinical research study, please contact The Clinical Research Division of Women's Health Practice, 217-356-3736.


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