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Adenomyosis

What is Adenomyosis?

Adenomyosis is a condition where the lining of the womb known as the endometrium, buries into the muscular wall of the womb known as the myometrium. This causes the size of one’s womb to enlarge, sometimes up to two to three sizes larger than its’ original size. Whilst it is a benign condition, patients with adenomyosis suffer from lowered quality of life when their condition is left untreated.

Adenomyosis differs from endometriosis as endometrial tissue in adenomyosis grows within the uterus. In other words, the spread of endometrium does not extend to different organs in the body as it does with endometriosis. If left untreated adenomyosis may cause infertility and miscarriages. Despite the significant risks of the condition, adenomyosis lacks general awareness and may take up to 10 years to obtain a diagnosis.

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What causes Adenomyosis?

The exact cause of adenomyosis is still unclear and definitive. Below are some popular theories about the formation of adenomyosis:

  • Congenital factors: it is presumed that some women may have had endometrial lining within their myometrium even before birth.
  • Inflammation: this theory hypothesises that extreme inflammation of the uterine lining may have resulted in endometrial cells penetrating through the myometrium.
  • Invasive growth: it may be possible that the endometrial cells “invade” the uterine muscle wall during surgery.

What are the common symptoms of Adenomyosis in Singapore?

One-third of women with adenomyosis tend to be asymptomatic. However, when symptoms are present, they may manifest as:

  • Menstruation problems: some women with menstruation problems may have problematic periods that are heavy and prolonged with the presence of blood clots.
  • Infertility problem: women with adenomyosis may struggle with infertility issues. Issues could include difficulty in conceiving, frequent miscarriages, or ectopic pregnancies.
  • Anaemia: excess blood loss during menstruation could lead to anaemia which may cause frequent lethargy and a sensation of dizziness.

Is Adenomyosis painful?

Women with adenomyosis tend to deal with various types of pain. For one, they tend to deal with excruciating menstruation. These may develop into persistent and chronic pelvic pain. Additionally, patients with adenomyosis also frequently complain about pain during sex and high levels of discomfort. Generally, it can be deduced that adenomyosis is a painful condition and poses a significant threat to one’s quality of life.

What are the treatment options for Adenomyosis in Singapore?

Treating adenomyosis does not just alleviate pain and discomfort but could also improve one’s fertility. Some of the treatment options that may be explored  include:

  • Oral medication: anti-inflammatory drugs are prescribed to alleviate pain. These, however, do not provide any improvement in adenomyosis.
  • Hormone therapy and contraceptives: may be prescribed as treatment to reduce symptoms such as heavy menstrual flows. These may include levonorgestrel-releasing IUDs, aromatase inhibitors, and GnRH analogues.
  • Uterine artery embolisation: a radiological procedure where the main blood supply to the uterus is blocked. This starves and deprives the adenomyosis of blood supply, subsequently causing it to shrink. It may not be suitable for those who are looking to conceive/get pregnant as the blood supply to the uterus is affected.
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How is Adenomyosis diagnosed in Singapore?

Adenomyosis can be easily diagnosed (compared to other reproductive disorders) and the diagnostic methods are rather straightforward. To be diagnosed with adenomyosis, you may be required to undergo:

  • Physical examination: a pelvic examination would be administered to identify an “enlarged” or tender pelvic area.
  • Imaging tests: a transvaginal ultrasound or pelvic magnetic resonance imaging (MRI) would definitively provide an adenomyosis diagnosis. The junctional zone which is the area between the inner lining of the uterus and the outer muscular layer of the uterus is typically thicker than normal in cases of adenomyosis.

What are the treatment options for Adenomyosis in Singapore?

Treating adenomyosis does not just alleviate pain and discomfort but could also improve one’s fertility. Some of the treatment options that may be explored  include:

  • Oral medication: anti-inflammatory drugs are prescribed to alleviate pain. These, however, do not provide any improvement in adenomyosis.
  • Hormone therapy and contraceptives: may be prescribed as treatment to reduce symptoms such as heavy menstrual flows. These may include levonorgestrel-releasing IUDs, aromatase inhibitors, and GnRH analogues.
  • Uterine artery embolisation: a radiological procedure where the main blood supply to the uterus is blocked. This starves and deprives the adenomyosis of blood supply, subsequently causing it to shrink. It may not be suitable for those who are looking to conceive/get pregnant as the blood supply to the uterus is affected.

Frequently asked questions

Can you have both adenomyosis and endometriosis?

Yes, one may in fact have both conditions. However, the exact percentage still remains unclear. Currently, the medical community has estimated that one-third of adenomyosis patients may also be dealing with endometriosis.

Can you heal adenomyosis naturally?

Adenomyosis cannot be healed naturally. However, you can alleviate symptoms by taking some measures such as consuming anti-inflammatory diets and consuming zinc and magnesium supplements to alleviate mood and improve overall well-being.

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