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Understanding Adenomyosis: When Pelvic Pain Isn’t Endometriosis

Of the many gynecological conditions that can cause chronic pelvic pain, adenomyosis is one of the least understood. Luckily, diagnostic advances and effective treatment options are helping many women get the relief they need. Learn more here.

Heavy bleeding, pelvic pain, pressure, bloating, and intense cramps during your monthly period are just a normal part of being a woman, right? Not when these menstrual symptoms cross the line from “typical” to abnormally severe. 

At New Beginnings OB/GYN, we want you to know that menstrual symptoms that disrupt your life or make you feel concerned aren’t normal; we should evaluate them. More often than you might realize, these symptoms point to an underlying gynecological condition that can be improved with treatment.

In this month’s blog, Dr. Rania Ibrahim takes a closer look at adenomyosis, a lesser-known cause of female pelvic pain that — like endometriosis — involves the uterus. 

Noncancerous uterine growths

Abnormal growths within, on, or around the uterus are a primary cause of chronic pelvic pain and pressure — along with heavy or long periods, excessive bloating, pain during sex, and other symptoms. Common noncancerous uterine growths include:

Uterine fibroids 

Made from the smooth muscular wall tissue of the uterus, fibroids are common: Up to 80% of women have them by the age of 50. While uterine fibroids often remain small and don’t cause symptoms, those that grow larger can become problematic.

Endometrial polyps

Heavy periods and mild pelvic pain — much like an ongoing sensation of fullness — are the most frequent signs of polyps, or small “overgrowths” of the endometrial cells that line the uterine cavity. While most uterine polyps are benign, they can be cancerous.  

Endometriosis

Endometriosis causes tissue that’s similar to uterine lining (endometrium) to grow outside of the uterus. These “endometrial implants” may develop anywhere within the pelvic cavity, including on the ovaries, uterus, pelvic floor, or diaphragm.

Like normal endometrial tissues, these abnormal implants thicken with blood and break down in response to the hormonal cycle. Unlike the endometrium in your uterus, however, shedding implants can’t exit your body; instead, they form adhesions in an ongoing inflammatory cycle.       

Adenomyosis

Like endometriosis, adenomyosis also involves the abnormal growth of tissues from the uterine lining. But with this condition, endometrial cells grow into the muscular wall (myometrium) of the uterus, causing the organ to thicken and enlarge.  

A closer look at adenomyosis 

When endometrial-like tissues start growing into the muscular uterine wall, they still thicken with blood and break down every month with your menstrual cycle. 

Like endometrial implants, they have no way to exit the body; but in this case, they stay trapped within the uterus rather than the wider pelvic cavity — causing a monthly buildup inside the organ’s outer muscle layer. 

As a result, adenomyosis can cause the uterus to swell, thicken, and enlarge, sometimes doubling or tripling in size. While mild cases may not cause symptoms, moderate to severe adenomyosis can lead to:

  • Severe pelvic pain and period cramps
  • Pelvic pressure, fullness, or tenderness
  • Ongoing bloating (adenomyosis belly)
  • Heavy or prolonged menstrual bleeding 
  • Frequent passage of large blood clots  
  • Discomfort during sexual intercourse 

The effects of adenomyosis don’t end with heavy periods and abdominal tenderness; the condition can also make it harder for an embryo to implant in your uterus, leading to fertility problems. And if you do get pregnant, adenomyosis carries an increased risk of miscarriage and preterm birth. 

Adenomyosis isn’t well studied

Until recently, the gold standard diagnostic method for adenomyosis was a hysterectomy, or the surgical removal of the uterus, followed by organ dissection and tissue examination. This is why the condition — which remains understudied and poorly understood to this day — is largely thought of as a problem of middle age (when most hysterectomies take place). 

Today, new noninvasive imaging techniques make it possible to detect adenomyosis without having to remove the uterus, leading to a rise in adenomyosis diagnosis among younger adults and even adolescents. 

Pelvic pain evaluation and care

Anytime you have persistent pelvic pain, heavy periods, and other related symptoms, see Dr. Ibrahim. Uterine conditions like endometriosis and adenomyosis often present with a similar set of symptoms, making expert evaluation vital for a prompt, accurate diagnosis. 

Advances in diagnostics mean that patients with adenomyosis are more likely than ever before to receive timely, fertility-preserving care. Treatment may include: 

  • Pain relief medications (e.g., NSAIDs) to ease cramping
  • Hormonal contraceptives to control menstrual bleeding
  • Non-hormonal medications to alleviate heavy periods 
  • Surgery to remove adenomyosis from the uterine muscle
  • A curative hysterectomy, if future fertility isn’t a concern  

Because problems like endometriosis, adenomyosis, and fibroids often co-occur, Dr. Ibrahim carefully checks for signs of each. That way, she can tailor your treatment plan to your exact needs, ensuring an optimized approach for the best possible results.  

Are you living with persistent pelvic pain? Don’t delay: Contact New Beginnings OB/GYN in Shenandoah, Texas, to schedule a visit with Dr. Ibrahim today.