The female health Unfortunately, it continues to be one of the great forgotten, although luckily in Spain we are already on the right track with advances such as sick leave due to painful menstruation, which is already contemplated in the workplace. Be that as it may, there is still a lot to be done and an example of this is the low visibility that still exists with diseases such as endometriosis or adenomyosistwo great unknowns and that More than 190 million women suffer from in the world, according to the World Health Organization and the American College of Obstetrics and Gynecology (ACOG).
And it is that, although in the case of adenomyosis there are many women who suffer from it asymptomatically or with hardly any symptoms, many others come to present severe pain with painful menstruations, and can even cause fertility problems in the future. We tell you everything about adenomyosis, its symptoms, diagnosis and treatment.
What is adenomyosis
Did you know that one in ten women in the world suffers from this disease and that in addition 25% of cases affect women between the ages of 35 and 50? At least that is what emerges from the figures transferred by the World Health Organization.
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And it is that, adenomyosis or uterine adenomyosis is a pathology that is manifested by the presence of endometrial tissue (tissue corresponding to the lining of the uterus) in the myometrium or what is the same, the muscle layer of the uterus.
An endometrial tissue that during menstruation does not behave in the same way as the endometrium that has not been displaced. In this stage the hormones produced by the ovary cause this tissue to thicken and degrade, causing intense pain and profuse bleeding. But, how then to differentiate adenomyosis from endometriosis?
Differences between adenomyosis and endometriosis
The truth is that more than 10% of cases experience adenomyosis accompanied by foci of endometriosis. In fact, they are so closely related that adenomyosis is often referred to as internal endometriosis.
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Even so, there are differences and the main one has to do with the fact that endometriosis is the displacement of the endometrial tissue outside the uterus. A factor that causes inflammatory lesions in other organs and makes natural pregnancy difficult.
While adenomyosis is the displacement of these endometrial cells only towards the area of the myometrium (central layer located between the endometrium and the outer layer of the uterus).
Types of adenomyosis in women
Depending on the extension and location, they can be differentiated two types of adenomyosis:
- Focal: This variety is also known as adenomyoma and manifests as tumors located within the myometrium.
- diffuse: This is the most common and affects a large part of the myometrium, causing the uterus to enlarge excessively.
In addition to these two varieties, it can also be differentiated based on the location of the endometrial tissue between superficial adenomyosis and deep adenomyosis.
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Most common symptoms of adenomyosis
Although this condition can have a great variety of symptoms different, some of the most common are:
- Pelvic pain during menstruation.
- Metrorrhagia or bleeding not related to menstruation.
- Excessively long and heavy menstrual periods
- Impaired reproductive potential.
- infertility.
- Pain when maintaining relationships.
- Anemia caused by heavy bleeding.
It is important to note that many of the symptoms associated with adenomyosis may also be associated with other benign gynecologic conditions. This coupled with the fact that 30% of women are usually asymptomaticwhich makes it even more difficult to get the diagnosis right.
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How is adenomyosis diagnosed?
As we have already told you, the diagnosis of this condition is difficult, since its symptoms can be common to other types of diseases and this is something that until recently has caused it to be underdiagnosed. In fact, its diagnosis could only be made after extracting part or all of the uterus of the woman. But luckily, diagnoses have improved a lot and such invasive surgery is no longer necessary.
Currently and thanks to the technical improvement of ultrasound equipment and to the greater awareness of its existence that there are more and more on the part of specialists, adenomyosis can already be diagnosed more reliably and better.
For this, it is necessary to take into account medical history of the patient and depending on her, specialists usually request the following tests:
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- Pelvic examination: This allows detecting if the uterus has increased its size.
- Transvaginal ultrasound (ultrasound): a simple and painless test that provides useful information for detecting adenomyosis.
- Magnetic resonance: this can be useful when ultrasound does not provide enough information, especially in patients with fibroids.
Is it possible to treat adenomyosis?
Each treatment for adenomyosis is individualized and personal, since it will depend on the severity of the symptoms, the gestational desire and the age and state of health of each patient.
The most usual thing is that the relief of the symptoms is first sought through pharmacological methods such as anti-inflammatory analgesics, hormonal contraceptives, danazol (antiestrogens), analogues…
Normally in most patients, this type of treatment is enough to end the symptoms, but unfortunately many of them are incompatible with pregnancy.
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In the event that pharmacological methods fail or pregnancy is sought, depending on the size and extent of the lesions, it could be indicated surgical treatment. A therapeutic option that consists of removing the tissue and rebuilding the uterine wall.
Only in the most serious cases in which the symptoms do not disappear with the previous methods mentioned, it would be considered surgically remove the uterus (hysterectomy) to end deep adenomyosis.
How adenomyosis affects fertility in women
Studies suggest that 22% of women with difficulty conceiving have adenomyosis. And it is that, it is confirmed that this disease can cause difficulties in pregnancy, being able to cause ectopic pregnancies or repeated abortions. In addition, in other cases it can also make it difficult for the embryo to implant in the uterus.
As for the growth of endometrial tissue that causes this disease, this may have its origin in the excessive amount of estrogen secreted by the woman’s body. Cases in which the body generates a hyperestrogenic environment and resistance to progesterone, something that alters endometrial receptivity.
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