By Dr. Pilar Carrillo Torres (Gynaecologist – Reg. No. 080854792).
Adenomyosis or uterine adenomyosis is a fairly common condition. It is characterized by the presence of endometrial tissue (the lining of the uterus) within the myometrium, the muscular layer of the uterus. According to the World Health Organization (WHO), one in ten women suffers from this condition. Additionally, 25% of cases affect women between the ages of 35 and 50.
Depending on the extent and location of the condition, two types are distinguished:
Additionally, depending on the location of the endometrial tissue within the myometrium, adenomyosis can be classified as superficial or deep.
The exact cause of adenomyosis is not precisely known, although it is believed to be due to a combination of hormonal, surgical, genetic, and inflammatory factors.
Until a few years ago, not much was known about adenomyosis. However, it was known to be associated with heavy bleeding, severe menstrual pain, and an increase in the size of the uterus. Although this condition is related to a wide variety of symptoms, the most common symptoms of adenomyosis are:
Some of the symptoms of adenomyosis can also appear in other benign gynecological conditions such as endometriosis, and uterine polyps and fibroids. This is why there can still be confusion in its diagnosis today. It is worth noting that approximately 30% of women with adenomyosis may be asymptomatic.
In more than 10% of cases, adenomyosis appears alongside endometriosis. Their relationship is so close that in the field of gynecology and reproductive medicine, adenomyosis is also referred to as internal endometriosis. At first glance, endometriosis and adenomyosis are two similar conditions that affect the tissues of the uterus and the endometrial lining. However, it is important to differentiate between them.
In endometriosis (one of the leading causes of infertility in women), the displacement of endometrial tissue occurs outside the uterus, causing inflammatory lesions in other organs and making natural pregnancy difficult. In adenomyosis, endometrial cells only move into the myometrium.
To understand the difference between these two conditions, it is important to know that a woman's uterus has two layers:
The endometrium or inner layer of the uterus is the part that prepares each cycle for embryo implantation. If implantation does not occur, this layer sheds, causing menstruation.
The myometrium is the middle layer located between the endometrium and the outer layer of the uterus. It is responsible for uterine contractions during childbirth and menstruation.
During menstruation, the endometrial tissue located within the myometrium behaves in the same way as the endometrium that has not been displaced. Thus, the hormones produced by the ovary cause this tissue to thicken and break down, resulting in intense pain and heavy bleeding.
According to our fertility specialists, the diagnostic process for adenomyosis begins with "the suspicion of symptoms by the specialist. Although reaching an exact diagnosis can be challenging, the appearance of certain symptoms can guide the expert." Today, thanks to advances in ultrasound technology, it is easier for experts to diagnose adenomyosis, although it still poses a significant challenge.
To ensure a good diagnosis, imaging techniques are crucial, as well as performing a 2D transvaginal ultrasound and, eventually, a 3D ultrasound, which will lead to the observation of an enlarged uterus, either diffusely or locally. A magnetic resonance imaging (MRI) scan is also necessary to confirm the condition.
Adenomyosis is a problem for many women of reproductive age, and its diagnosis remains as delayed as that of its "sister" condition, endometriosis. It is true that it occurs in a much smaller percentage, barely 1% of the female population, but we must not forget that any woman can have adenomyosis.
It has been shown that this condition can cause difficulty in conceiving, which can lead to ectopic pregnancies, where the embryo implants and grows outside the uterus, or .Additionally, in some cases, it can also complicate embryo implantation in the uterus, which is why this condition is often associated with implantation failure.
The growth of endometrial tissue caused by this condition may originate from an excessive amount of estrogen secreted by the woman's body. In these cases, a hyperestrogenic environment and progesterone resistance are generated in the woman's body, altering endometrial receptivity.
This uterine condition can lead to fertility problems in women, hindering the embryo implantation process and being the cause of recurrent implantation failures. Several studies indicate that up to 22% of women who have difficulty conceiving suffer from adenomyosis.
The treatment of this condition largely depends on its symptoms. Among the existing treatment options for adenomyosis are pharmacological methods, with anti-inflammatory medications that reduce its symptoms or hormonal medication prescribed by the specialist. In cases where medication has not been effective, surgery may be considered.
What happens in cases where women want to have children? The assisted reproduction treatment protocols at IVF-Life are tailored to the needs of each patient. The first consultation with our specialists will focus on achieving an accurate diagnosis. Only then can we determine from the outset whether the patient's infertility is due to this condition.
In the case of a woman with adenomyosis, the patient must start with proper preparation of the uterine cavity. Therefore, it is proposed to initially perform ovarian stimulation. This allows for the retrieval of oocytes and the performance of in vitro fertilization, placing the embryos with the highest implantation potential into the woman's uterus. Another option would be to consider egg vitrification to plan the appropriate treatment at another time.
The administration of contraceptive treatments or estrogen receptor medications before starting fertility treatment may be the best option to reduce the symptoms of this condition. In some cases, patients may also need to be treated with gonadotropin-releasing hormone (GnRH) agonists, which can cause a temporary state similar to menopause.
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