Adenomyosis

What is Adenomyosis?

Adenomyosis is a non-cancerous uterine disorder where the presence of endometrial glands and stroma that should only be located in the endometrium (uterine lining) layer are instead located deep within the muscle layer, called the myometrium.

In addition to the presence of endometrium within the myometrium, there's also muscle hyperplasia, or an increase in the number of muscle fibers which enlarges  the total muscle mass of the uterus. Parts of the typical myometrium are destroyed through this infiltration. A uterus with adenomyosis is more likely to be enlarged and push up against other organs due to inflammation.

Basic Structures of the Uterus

Endometrium - the lining of the uterus that is built up by estrogen and supported by progesterone during a cycle. If conception occurs, the fertilized egg will implant in the endometrium. If conception does not occur, the endometrium is shed during menstruation. It's also known as the mucous membrane lining the uterus, which thickens during the menstrual cycle in preparation for possible implantation of an embryo.

Myometrium - The smooth muscle tissue of the uterus. The myometrium is what causes rhythmic contractions and releases during childbirth.

Perimetrium - The outer serous layer of the uterus. The serous layer secretes a lubricating fluid that helps to reduce friction

Causes

  • Adenomyosis shows strong correlations to immune changes.

    Immune responses are more activated which induce changes in immunity.

    Adenomyosis correlates to a higher macrophages or immune cells, immunoglobulins and natural killer cell presence -- shown through association with miscarriage statistics, leading to the theory that infertility in this case may be an immunological, as well as physical implantation issue.

  • Autoimmune antibodies may also be high - contributing to endometrial cells remaining under constant immunological stress 

  • There are correlations between those with HSV-1 or HSV-2 having herpes or other viral flares correlating with adenomyosis flares

  • There is also a preponderance of ureaplasma and unusual vulva secretions in patients with adenomyosis which should be screened.

Symptoms and Risk Factors

  • heavy menstrual bleeding (90-100% of those with adenomyosis) / blood loss of 120 mLs per day or higher

  • bleeding and spotting at non-menstruating times

  • near constant bleeding

  • heavily clotted blood (85% of those with adenomyosis)

  • severe cramping and pelvic pain

  • painful menstruation

  • pain in the pelvis

  • pain with bowel movements

  • pain with sex

  • peripheral nerve weakness

  • hemoglobin deficiency

  • uterine inflammation and burning uterus sensation

  • infertility and miscarriage

  • Most common in middle aged people and those who have already had a child, but can happen to younger childless people as well

  • May be concurrent with other issues like fibroids and endometriosis

Diagnosis

  • MRI, 3D, or transvaginal ultrasound imaging

  • Defined according to histological criteria obtained from a hysterectomy

Adenomyosis in this ultrasound showing the "classic venetian blind appearance" (dotted lines).

Treatment

  • Hysterectomy is the only recommended clinical treatment after the use of anti-inflammatory drugs to control pain and bleeding.

    Many people with adenomyosis want children or simply do not want their uterus removed. 

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    • There are many anti-inflammatory herbs to choose from. Turmeric and curcumin is one place to start. Pulsatilla, Shatavari, and Shepherds Purse for uterine swelling.

    • Proteolytic Enzymes - addresses blood coagulation and stabilizes cellular turnover

    • Astringent Herbs - Blackberry root or leaf, Rose-hips, Yarrow

  • Berberine , Uva Ursi and other antimicrobials may be of use. Watch cervical secretions for changes indicating better regulation. Sexual partner’s microbiome can also have an impact.

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  • A better understanding of your ratios of estrogens through tracking cervical fluid will help you see if this is a factor for you and the heavy bleeding. This metabolism is supported through the health of the liver and gut.

    • Castor Oil packs improve blood circulation, help stagnant tissue and reduce inflammation, both should be administered while not bleeding 

    • Several kinds of pelvic floor strategies can be employed such as soft tissue mobilization, Sobada abdominal massage, mayan abdominal massage, Mercier therapy, and others that warm the womb and move blood

Similarities, Differences, and Coexistence of
Adenomyosis and Endometriosis

  • Coexistence is common - about 50% of patients also have endometriosis

  • No evidence one condition causes the other

  • Both are diagnosed through imaging techniques, but obtaining a biopsy for adenomyosis without hysterectomy is much more difficult and therefore discouraged

  • In 15% to 57% of cases, uterine fibroids coexist with adenomyosis

  • Surgical management is much more available for endometriosis, adenomyosis is not treated surgically without hysterectomy

  • Endometriosis may be more associated with pain and adenomyosis may be more associated with abnormal bleeding, although both conditions can encompass either symptom 

  • Some people call adenomyosis a "form of endometriosis" because of the strong relationship - but the correct classification is unclear 

  • Both are correlated with changes to the immune system and a dysregulated microbiome 

How Charting Helps with Adenomyosis

  • Chart heavy and intermittent bleeding patterns

  • Chart your symptoms and pain triggers

  • Keep track of your health regimen

  • Pregnancy planning with adenomyosis

  • Track emotional health

Adenomyosis and Infertility

Inconclusive if adenomyosis itself leads to infertility

  • Adenomyosis can result in a 50% higher risk of miscarriage, a 24.4% risk of premature birth, and 12% risk of delayed fetal development 

  • Propensity towards early miscarriage due to lack of implantation, but second trimester and third-trimester loss is possible because of intrauterine growth restriction from adenomyosis.

  • Can affect the ability to have children after the first child 

  • Dilation and cuttrage procedure can be utilized with holistic strategies to reduce inflammation in order to pull out existing endometrium in an attempt to help clean the space for a potential future fertilization. This should be approached with caution as it can cause some scarring, but can be a useful strategy for treating adenomyosis infertility.