What is adenomyosis? The little-known disease that affects 1 in 5 women

BBC presenter Naga Munchetty recently revealed that he suffered from adenomyosis , a chronic disease that affects the uterus. She explained how her pain can leave her unable to move and how a recent outbreak was so intense her husband had to Call an ambulance . However, many people have never heard of this condition, even though it affects one in five women .

Adenomyosis can cause symptoms such as irregular, heavy menstrual bleeding and pelvic pain. The severity of symptoms varies between patients: until a third of women with adenomyosis, they may have minimal or no symptoms.

The condition can also affect fertility . Women with adenomyosis who become pregnant have a higher risk spontaneous abortion, premature birth, preeclampsia and bleeding after delivery.

So, what causes adenomyosis and how is it diagnosed and treated? There’s still a lot we don’t understand about this disease, but here’s a little bit of what we know so far.

What causes adenomyosis? There are two key layers in the uterus. The endometrium is the inner layer where embryos implant. If there is no pregnancy, this layer disappears for a while. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions. In people with adenomyosis, the cells that look like the endometrium are not in the right place: the myometrium .

Although a large number of women with adenomyosis also have endometriosis, adenomyosis is a separate disease from endometriosis . In endometriosis, Endometrial-like cells are also found in the wrong place, but in this case outside the uterus, mainly in the pelvic cavity.

Thanks to investigation there public participation And social networks , awareness of endometriosis has increased in recent years. However, adenomyosis remains relatively unknown.

Diagnostic options are evolving and improving. Adenomyosis is a difficult disease to diagnose. Historically, the presence of endometrial-like cells in the myometrium could only be verified by pathological evaluation during which the myometrium was examine under a microscope after a hysterectomy (surgery to remove the uterus).

In recent years, diagnostics have increased with the development of imaging technologies such as magnetic resonance and the Pelvic ultrasound detailed. Although adenomyosis is now commonly identified without the need for a hysterectomy, doctors are still working to develop a method standardized for non-surgical diagnosis.

As a result, it is unclear how many women suffer from adenomyosis. Even though we know that about 20% of women who undergo hysterectomy for reasons other than suspected adenomyosis have evidence of the disease on pathologic evaluation.

Adenomyosis is a complex disease. The type of adenomyosis Tissue growth in the myometrium can be focal lesions (affecting part of the uterus) or diffuse lesions (affecting a large part of the muscle). Adenomyosis can be classified based on the depth of invasion of endometrial-like tissue into the myometrium. . Scientists and doctors are still studying the type or depth of injuries. are linked to Symptoms: The severity of symptoms and injuries do not always coincide.

We still don’t understand why some women develop adenomyosis, although the evidence shows that there is an increasing prevalence with age.

The region between the endometrium and myometrium is thought to be damaged, either by natural processes menstrual cycle, pregnancy and childbirth, or medical procedures. In some women, damage to the endometrial tissue layer does not heal as it should and endometrial-like cells enter and grow abnormally in the myometrium. These disrupt normal functions of the myometrium, which causes pain and bleeding.

It is possible that various mechanisms contribute, and that there is no common pathogenic factor behind adenomyosis.

How is adenomyosis treated? Treatment strategies include hormonal medications such as birth control pills, progesterone-containing pills, insertion of a progesterone-releasing intrauterine device (like Mirena), or a medication called GnRHa which stops the natural production of sex hormones. Non-hormonal treatments include tranexamic acid . These treatments aim to minimize menstrual bleeding. Pain is often treated with non-steroidal anti-inflammatory drugs .

Treatments that work for some women don’t work for others, strengthening the argument that there is more than one type of adenomyosis. Treatment strategies should be tailored to patients, based on their fertility wishes and symptoms.

If medical treatments do not provide adequate relief of symptoms, There are surgical options, namely removal of focal lesions or hysterectomy.

What does the future hold? Although adenomyosis is a common disorder affecting many women, including those of childbearing age, it does not receive sufficient clinical and scientific attention. There is also lack of knowledge and awareness on adenomyosis among many healthcare professionals and the public. This needs to change so that we can improve our understanding of the disease, diagnosis and treatment options.

Scientists and doctors specializing in adenomyosis are still searching for an accurate, non-invasive diagnostic method and, hopefully, a cure one day.

* Jen Southcombe is Principal Investigator/Group Leader, Nuffield Department of Women’s and Reproductive Health, University of Oxford.

** Nura Topbas is PhD Candidate, Nuffield Department of Women’s and Reproductive Health, University of Oxford.