April 12, 2023 Author : António Setúbal What is uterine adenomyosis? Uterine adenomyosis is a form of endometriosis . In all forms of endometriosis, ectopic (that is, outside its normal location) endometrial tissue develops. In adenomyosis, the endometrium, which is the inner lining layer of the uterine wall, invades the muscular middle layer of that uterus wall; In other forms of endometriosis, there is development of extra-uterine endometrium, that is, outside the uterus, in organs of the reproductive system or not, for example, ovaries, ureters, intestines, among others. When endometrium is not in its normal location, whether intra or extrauterine, it continues to experience the same changes associated with the menstrual cycle. (Menstruation is the vaginal discharge of endometrial sloughing accompanied by bleeding.) Adenomyoma, adenomyosis and endometriosis The first references to uterine wall lesions containing ectopic tissue were made by Rokitansky at the end of the first half of the 19th century, which was followed by research activity in this area with relevant publications by many authors. About three decades later, the term ' adenomyoma ' began to be used to refer to lesions that included epithelial tissue (such as the endometrium) outside its normal location , with several hypotheses already existing to justify it, for example retrograde menstruation, cells dissemination via blood or lymphatics, and development of embryonic residues. In 1920 it was already known that in lesions with ectopic epithelial tissue this was the endometrium. From the following years, the terms ' adenomyosis ' and ' endometriosis ' began to be used to distinguish the presence of ectopic endometrium inside or outside the uterus, respectively . Symptoms and complications of adenomyosis It is estimated that more than 40% of women may have adenomyosis, which, depending on the severity, may or may not cause symptoms. The usual symptoms of adenomyosis are: Heavy menstruation; Severe menstrual pain (dysmenorrhea); Pain when defecating (dysquesia); Painful urination (dysuria); Anemia; Infertility / subfertility, spontaneous or by medically assisted procreation techniques (PMA) (41% to 50%); Chronic pelvic pain and pain during intercourse (dyspareunia) may also be associated with adenomyosis. Among the possible complications of endometriosis are: Early abortions; Premature birth; Premature rupture of membranes; Bleeding during childbirth. Adenomyosis is more common in women aged 40-50 years and who have had children, but there are more and more cases reported among young women and teenagers. Diagnosis and treatment of adenomyosis In the face of complaints suggestive of adenomyosis, imaging tests (usually ultrasound and/or magnetic resonance imaging) may be necessary, in addition to a detailed medical examination and evaluation of the past history, to exclude other causes and decide which is the best treatment for each woman. The only way to permanently eliminate adenomyosis is to have a hysterectomy , that is, to remove the uterus surgically. Hysterectomy induces menopause and makes pregnancy impossible. Therefore, the treatment approach to be adopted depends on the symptoms and their severity, age, the woman's desire to become pregnant and other particularities of each case , with the objectives of: Reduce blood lost during menstruation; Relieve pain; Eliminate or alleviate other symptoms that may be related to the disease. Treatment of adenomyosis may involve : Analgesics (for pain) and hormonal therapy , with oral contraceptives or in an intrauterine device; In the most severe cases and when there is no desire to have more children, a hysterectomy (surgical removal of the uterus) may be considered; Uterine artery embolization (which decreases the vascularity of the uterus) is another option that can be considered when there are no intentions to become pregnant, there are contraindications for a hysterectomy or hormonal treatment does not have the desired results; Conservative surgery (uterine repair) is the option in cases of persistence of symptoms, failure of PMA techniques, in women who intend to become pregnant. These are complex surgeries, most described by the Japanese school, with improvement of all symptoms and increased probability of pregnancy. Sources Habiba A. Lippi D, Benagiano G. The history of the discovery of ectopic epithelial cells in lower peritoneal organs: the so-called mucosal invasion. Reprod Med 2021;2:68-84 Stewart EA. Uterine adenomyosis. www.uptodate.com. Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
