Adenomyosis: Causes, Symptoms and Treatment Options in Delhi

About Adenomyosis

Adenomyosis is a gynecological condition where endometrial glands (tissue similar to the uterine lining) grow into the myometrium (muscle wall of the uterus). Nearly 1 in 3 patients remain symptom-free, while others may experience heavy menstrual bleeding, painful periods, pelvic pain, or even fertility challenges.

Since many women are unaware they have adenomyosis due to its often silent course, its exact prevalence remains uncertain. However, studies show it is more common in individuals who:

• Have undergone procedures on the uterus.
• Are over the age of 40.
• Are adolescents with severe menstrual pain (2–5% of cases).

What is Adenomyosis?

Adenomyosis (pronounced add-en-o-my-OH-sis) occurs when endometrial tissue infiltrates the muscular wall of the uterus. This can cause the uterus to enlarge, sometimes to double or triple its normal size.

Common symptoms include:

• Painful periods (dysmenorrhea)
• Heavy/prolonged menstrual bleeding with clotting
• Pelvic pain or fullness
• Painful intercourse (dyspareunia)
• Infertility in some cases

Types and Classification

Adenomyosis may be classified based on imaging or histopathology into:

• Diffuse Adenomyosis: Widespread tissue within the uterine wall.
• Focal Adenomyosis (Adenomyoma): Localized nodule or mass.
• Cystic/Polypoid Adenomyosis: Rare forms with cystic or polyp-like structures.

Other classifications consider depth, extent, location, and myometrial involvement (inner, middle, outer layers).

Signs & Symptoms of Adenomyosis

While one-third of patients show no symptoms, others may experience:

• Severe menstrual cramps
• Heavy bleeding (menorrhagia)
• Abnormal cycles
• Pelvic or abdominal pain
• Enlarged uterus with “adenomyosis belly”
• Bloating, pressure, or discomfort

Causes & Risk Factors

The exact cause is unknown, but hormonal imbalance, genetics, inflammation, or uterine trauma are suspected contributors.

Adenomyosis is more likely in:

• Women aged 40–50 years
• Those with prior childbirth
• Patients with prior uterine surgery (e.g., fibroid removal, D&C)
• Women with endometriosis

Increasingly, it is also being diagnosed in women in their 30s with abnormal bleeding or painful cycles.

Complications

Untreated adenomyosis may lead to:

• Severe anemia from heavy bleeding
• Chronic pelvic pain
• Fertility challenges
• Enlarged uterus with pressure symptoms

Diagnosis of Adenomyosis

Because adenomyosis mimics conditions like fibroids or endometriosis, a multi-step approach is used:

• Physical Exam: Enlarged, tender, or soft uterus.
• Ultrasound: Thickened uterine wall or cystic changes (but not always conclusive).
• MRI: The most accurate non-invasive tool for diagnosis, showing junctional zone thickening.
• Histopathology: The gold standard, usually after hysterectomy, though rarely performed solely for diagnosis.

Adenomyosis Treatment & Management

1.) Medical Management

• Hormonal contraceptives (pills, patches, rings)
• Progesterone-releasing IUDs (LNG-IUD)
• NSAIDs for pain
• Tranexamic acid (for bleeding control)
• GnRH agonists/antagonists (to suppress menstruation)

(Always under doctor’s guidance.)

2.) Minimally Invasive Surgical Management

3D Laparoscopic Adenomyomectomy

• Removes localized adenomyotic tissue while preserving the uterus.
• Ideal for women seeking fertility preservation.
• Provides significant relief from pain and heavy bleeding.

3.) 3D Laparoscopic TLH + BSO
 (Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy)

• Removes uterus, fallopian tubes, and ovaries.
• Recommended for extensive disease, recurrent cases, or suspicion of malignancy.
• 3D laparoscopy ensures precision, minimal trauma, faster recovery, and reduced complications.