Adenomyosis

Adenomyosis is a uterine disorder that causes menstrual pain and excessive bleeding in women. It primarily involves invading endometrial cells into the uterine muscle layer, leading to an enlargement of the uterus. Adenomyosis can be classified based on the extent and distribution of the lesions:

• Diffuse Adenomyosis: Adenomyosis affects the entire uterus, causing swelling of the uterine muscle layer. Diffuse adenomyosis typically results in an overall uterus softening, with abnormal endometrial tissue scattered throughout the uterine muscle layer.
• Focal Adenomyosis: Adenomyosis only affects specific regions of the uterus rather than the entire organ. In this case, abnormal endometrial tissue is confined to a particular part, forming nodular areas.

The exact causes and risk factors of adenomyosis are not fully understood, but there are some potential factors and associations:

• Invasion of Endometrial Cells: This may be due to the invasion of endometrial cells into the uterine muscle layer, leading to abnormal growth and changes.
• Uterine Surgery History: Previous uterine surgeries, such as caesarean sections or hysterectomies, may increase the risk of developing adenomyosis.
• Reproductive History: Women who have had multiple pregnancies and childbirths may be less likely to develop adenomyosis, while those who have not experienced pregnancy may be more susceptible to this condition.
• Hormonal Factors: Changes in hormones, especially variations in oestrogen levels, may be associated with adenomyosis.
• Age: Adenomyosis is more common in older women, particularly those approaching menopausal age.

The diagnosis of Adenomyosis typically involves a series of assessments and examinations. Here are some standard diagnostic methods:

• Clinical Examination: Doctors may conduct a gynaecological examination, usually including palpation of the uterus, to assess its size and shape and detect any abnormalities.
• Ultrasound Examination: Ultrasound is used to generate images of the uterus, helping doctors examine whether the uterine structure is abnormal and if there are tumours or other issues.
• MRI: MRI provides more detailed images of the uterine structure, assisting in confirming the presence of adenomyosis.
• Biopsy: In some cases, doctors may recommend a histological examination, often through procedures like endometrial biopsy or hysteroscopy, to confirm the diagnosis.
• Abdominal or Pelvic Laparoscopic Examination: Doctors might use abdominal or pelvic laparoscopy to observe the uterus and adjacent tissues directly, performing necessary treatments.

The treatment for adenomyosis depends on the severity of symptoms and the patient's medical history. Here are some possible treatment options:

• Pain Relievers: Over-the-counter or prescription pain relievers alleviate menstrual pain and other related symptoms.
• Anti-inflammatory Medications: These medications may help reduce inflammation and associated discomfort.
• Hormone Therapy: Hormone therapy, especially with oestrogen and progestin, is sometimes used to regulate the menstrual cycle and alleviate symptoms.
• Intrauterine Device (IUD): In some instances, the use of an IUD can help reduce menstrual pain and blood flow.
• Surgical Treatment: Surgery may be necessary in some cases. Surgical options include hysterectomy (partial or complete), endometrial ablation, or uterine artery embolization, where blood vessels affecting the uterus are closed off to reduce symptoms.
• Ablation Therapy: High-Intensity Focused Ultrasound (HIFU) is a technique that uses ultrasound to ablate abnormal tissue in the uterus. Ultrasound reaches the uterus through the skin, subcutaneous tissue, and peritoneum, destroying the abnormal tissue affecting the uterus. One advantage of HIFU is the preservation of the uterus, allowing for the retention of fertility. However, HIFU may only be suitable for some patients.