What is adenomyosis?

Q: I have been diagnosed with adenomyosis and am having a hysterectomy. Can you tell me more about this condition?

A:  Adenomyosis is an interesting medical condition, and it is difficult to diagnose. Basically, it is endometriosis of the wall of the uterus. That is, the endometrial glands, which line the uterus, bury themselves into the muscular wall of the uterus. When you get your period, you are bleeding into the muscular wall of the uterus; this can cause you a lot of pain and a heavy flow.

Unfortunately, there are very few diagnostic tests to confirm this diagnosis before the woman has a hysterectomy. On a pelvic exam, the uterus usually feels a bit enlarged and can be a bit boggy, or firmer to the touch. Ultrasounds don’t help us make the diagnosis. Fancy technology such as an MRI might help, but that can be expensive. Gynecologists usually suppose the diagnosis from clinical history and an exam, but the only true proof of the diagnosis comes when the pathologist looks at the uterus under the microscope and sees the glands digging into the uterine wall.

The good news is that adenomyosis is cured with a hysterectomy. It is a benign condition, and once a hysterectomy is performed, you should have no further bleeding or pain.

The bad news is that, short of a hysterectomy, you might get only minor relief with such medicines as ibuprofen or naproxen. Doctors will often try hormonal medicines such as lupron or birth control pills (the same treatment as for endometriosis), but results are variable. The other good surgical news is that, unlike endometriosis, adenomyosis can be cured without removing your ovaries.

What you have in your mind?