Adenomyosis is a condition when the endometrium or the surface lining of the uterine cavity grows inside the muscular wall of the uterus (myometrium). Although generally this condition is not dangerous, it can cause bleeding, pain, and adversely affect the sufferer's quality of life. Under normal conditions, endometrial tissue only lines the surface of the uterine cavity. In adenomyosis, endometrial tissue continues to function normally, but grows into the muscle lining of the uterus. As a result, the uterus swells with each menstrual cycle. This condition can be experienced by women in all age groups, but is more common in those aged 40–50 years. This condition also usually resolves when women go through menopause.
Causes of Adenomyosis
Until now, the cause of adenomyosis has not been determined. However, this condition is thought to be related to the following factors:
• 40 to 50 years old
• Have had surgery on the uterus, such as curettage or caesarean section
• Have given birth
• Suffering from obesity
Symptoms of Adenomyosis
Most people with adenomyosis do not experience any symptoms. However, in some cases, adenomyosis can cause the following symptoms:
• Pelvic pain
• Heavy and prolonged bleeding during menstruation (menorrhagia)
• Abdominal pain and cramps during menstruation
• Pain during sexual intercourse (dyspareunia)
Check with a doctor if you experience menstrual pain or unbearable dysmenorrhea, especially if it has occurred in 3 consecutive cycles and interferes with activities. Also consult a doctor if bleeding during menstruation is more than usual or bleeding from the vagina appears after menopause.
As a first step, the doctor will ask about symptoms and perform a physical examination on the patient. Physical examination, especially in the lower abdomen or pelvis, to determine whether there is an enlargement of the uterus or whether there is pain when the pelvis is pressed. Please note, the symptoms of adenomyosis are similar to the symptoms of other uterine diseases, such as fibroids, endometrial polyps, or endometriosis. Therefore, the doctor will perform the following examinations to confirm the diagnosis:
• Pelvic or transvaginal ultrasound.
This procedure aims to check for uterine enlargement, changes in the shape of the uterine muscle, uterine cysts, or thickening of the endometrium.
• MRI of the uterus.
This examination is done to see the condition of the uterus in more detail, especially in patients who experience abnormal bleeding.
• Endometrial biopsy.
In some cases, the doctor will examine a sample of endometrial tissue to make sure that the patient is not suffering from a more serious condition.
The method of treating adenomyosis depends on the severity of the symptoms, the history of childbirth, and whether the patient wishes to have children in the future. Patients with mild symptoms can do self-therapy by soaking in warm water or using a warm pad on the stomach, and taking over-the-counter pain relievers, such as paracetamol. Meanwhile, if the symptoms are severe or there is heavy menstrual bleeding, consult a gynecologist for further treatment. The doctor will provide actions such as:
Your doctor may give you a non-steroidal anti-inflammatory drug, such as mefenamic acid, to reduce pain.
2. Hormone therapy.
Hormone therapy is given to patients who experience heavy bleeding and unbearable pain during menstruation. One type of hormone therapy is birth control pills.
3. Endometrial ablation.
Endometrial ablation aims to destroy the uterine lining that has adenomyosis. However, this procedure can only be done if the adenomyosis has not entered too deep into the uterine muscle.
4. High intensity focused ultrasound (HIFU). HIFU aims to destroy endometrial tissue using a special ultrasound device.
Adenomyectomy aims to remove adenomyosis tissue through surgery. This procedure is performed when adenomyosis is not successfully removed by other methods.
6. Embolization of uterine arteries.
This procedure is done to block the flow of blood to the area of adenomyosis, so that its size will decrease and the complaints will subside. This procedure is performed on patients who cannot undergo surgery.
Hysterectomy or removal of the uterus is done if andenomyosis cannot be treated by other means. This procedure is only recommended if the patient no longer wishes to become pregnant.
Adenomyosis with profuse and prolonged bleeding during menstruation can cause anemia or lack of blood. Adenomyosis can also interfere with the sufferer's quality of life, due to discomfort during activities due to menstrual pain and heavy menstrual bleeding.
It is not known how to prevent adenomyosis. However, this disease can be avoided by controlling the risk factors. Here are some ways to prevent adenomyosis:
• Implement a healthy, nutritionally complete, and balanced diet
• Maintain ideal body weight
• Lose weight if you are obese
• Undergo regular health and gynecological examinations