Painful Periods Adenomyosis Update

In women whom have painful periods adenomyosis, a condition of the uterus, is a possible diagnosis. It’s less likely to just be adenomyosis if the patient complains of chronic pelvic pain, more than pain with the periods which is also called dysmenorrhea. Adenomyosis doesn’t cause 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, if just a few glands, in a normal size uterus, the condition causes minimal symptoms. But a common finding in women with adenomyosis is an enlarged uterus.

Almost 90% of the cases of adenomyosis occur in women who have had children, and the first symptoms usually occur when a woman is 40 or 50 years old. When the uterus is enlarged it is more common for the woman to have uterine prolapse. Uterine prolapse lifetime risk is about 1/11; but with adenomyosis the risk of having prolapse climbs to at least 30% of women over 50. When there are uterine fibroids, endometriosis or prior uterine surgery, then it is more common for patients to be symptomatic.

Since endometrial ablation doesn’t affect the hormones of the ovaries, but only the glands that are in the lining of the uterus, the glands that exist remote from the endometrium wouldn’t get treated at the time of an endometrial ablation. There are specific findings 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. Ultrasound testing can show characteristic shadowing of the uterine wall which is known to be associated with adenomyosis, but it’s not too accurate for this condition. Patients can be diagnosed by MRI, but this would be expensive. Tissue is needed for a diagnosis, and other than 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 gyno. Call Women's Health Practice if you are interested in participating in a clinical trial of adenomyosis.

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