I have been told I have adenomyosis. Can you please tell me about the cause of this, its treatment, and if there is cure for it?

Carol

Adenomyosis is a condition similar to endometriosis. In both conditions, cells of the endometrium (inner uterine lining) can be found where they don't belong. Normally these cells grow in the endometrial cavity, the hollow central portion of the uterus. In women with endometriosis, these cells grow on the peritoneum (abdominal lining), the ovary, the bowel, bladder, surgical incisions and even some locations outside of the abdomen. In adenomyosis, however, the misplaced cells are found growing deep in the muscular wall of the uterus.

Symptoms generally are abnormal uterine bleeding, painful intercourse, pelvic pressure or cramping associated with periods. We don't really know what causes women to develop this condition. The older you are and the greater the number of periods you have, the higher your risk. Uterine surgery, such as myomectomy (fibroid removal), may predispose you to this condition. On the other hand, the use of birth control pills may reduce your risk of developing this condition later in life.

Adenomyosis may be found spread throughout the uterine wall, or it may form small nodules. Adenomyosis may interfere with fertility either directly, by compressing the uterine lining, or indirectly, by compressing blood vessels in the uterine wall that supply blood to the uterine lining and nourish an early pregnancy.

The diagnosis of adenomyosis is most often made after it's no longer a problem -- in the pathology lab when the uterus is examined after being removed in a hysterectomy. In a woman who still has her uterus, adenomyosis is typically discovered during an ultrasound procedure to diagnose the cause of infertility or to monitor ovulation induction treatment. Although I may suspect this condition when I perform an ultrasound examination, rarely do I see this condition mentioned in reports from earlier ultrasound examinations. Often adenomyosis is confused with fibroids on ultrasound. An MRI (magnetic resonance imaging) scan, if properly performed, can confirm the presence of adenomyosis, but this test is costly and not usually necessary.

Few studies have looked at this condition. As adenomyosis is quite often diffusely spread throughout the wall of the uterus, surgical treatment options are limited. And, since we often cannot be certain of our diagnosis, few medical trials have been carried out. Case reports have suggested that some patients may benefit from GnRH-a (Lupron, Zoladex or Synarel) treatment, which suppresses normal hormonal activity, for a period of approximately three months. This treatment is followed by ovulation induction with injectable gonadotropins. However, patients with extensive involvement of the uterine wall may be unresponsive to GnRH-a treatment, and adenomyosis will usually recur within a few months of stopping medical therapy. For these women, in vitro fertilization with embryo transfer to a gestational carrier (surrogate mother) may be required to achieve a pregnancy.