I was diagnosed with something called "adenomyosis" several years ago. I have just started having the symptoms again. What is "adenomyosis," and what can be done to relieve the pain, the heavy flows, etc.?

-- Marcia

Adenomyosis refers to the normal uterine lining tissue penetrating into the wall of the uterus an abnormal amount. It is most often focal, meaning it only happens here and there within the uterus, or it can be global, occurring throughout the entire uterus. Adenomyosis may cause heavier bleeding with periods as well as more cramps.

Diagnosis of adenomyosis has traditionally been difficult; because the diagnosis depends on how far the uterine lining tissue extends into the wall of the uterus, a definite diagnosis could be made only after a hysterectomy was performed. Without that, doctors could only presume adenomyosis based on symptoms and a boggy, globular feel to the uterus. Today, we may more accurately diagnose adenomyosis either by MRI or by doing a core biopsy of the uterus via hysteroscopy.

Treatment of adenomyosis is generally divided into medical and surgical approaches. Medications such as Depo-Provera seem to help alleviate the symptoms by thinning the uterine lining, often preventing menstruation. Depo-Provera seems to be more effective than birth control pills. Use of nonsteroidal antiinflammatory drugs, or NSAIDS (such as Motrin, Advil, Anaprox) may also help.

Surgical options are usually limited to women who have completed their families. These options include hysterectomy (the most definitive treatment by far) and hysteroscopic endomyometrial resection. This latter procedure is done on an outpatient basis; it entails inserting a telescope-like instrument into the uterine cavity and removing the uterine lining and a portion of the underlying uterine wall muscle. Because the uterine lining tissue may penetrate into the uterus so deeply that it can't be safely removed during the hysteroscopy, this procedure may not always be effective.

You and your gynecologist should review your individual symptoms and earlier attempts at treatment. The two of you need to discuss all options, along with their risks and benefits, and then together you can decide on the best approach for you.