Adenomyosis

Some women who are told that their symptoms of abnormal bleeding, pressure, and pain are from fibroid disease actually have a different disease of the uterus – adenomyosis. Adenomyosis is caused by the development of nests of endometrial tissue (that should be only on the inner lining of the uterus) within the uterine muscle. It is similar to endometriosis, which occurs when this same type of tissue grows outside the uterus (on the outer surface of the uterus, on the tubes, on the ovaries, elsewhere in the abdominal cavity). While many people have heard of endometriosis, most have never heard of adenomyosis.

Adenomyosis is a BENIGN condition. Like fibroids, it is not, and does not become, cancer. It causes many symptoms similar to fibroids – heavy menstrual flow, pressure symptoms, and increased pain with menstruation.  It also enlarges the uterus, as does fibroid disease.

Because fibroid disease is much more common than adenomyosis, most women with these symptoms are assumed to have fibroid disease. When interviewing women, those who consider their menstrual pain to be worse than their increased bleeding are more likely to have adenomyosis – although this is far from 100% accurate.

The most common way to image the uterus is ultrasound. Unfortunately ultrasound does not reliably separate adenomyosis from fibroids. Many women who eventually prove to have adenomyosis have had numerous ultrasound studies which were interpreted as showing fibroids. MRI is the only imaging study that routinely can distinguish between these two disease processes.

There currently are no effective nonsurgical treatments for adenomyosis. There have been a number of research studies done on embolotherapy for adenomyosis – all using the same embolization techniques that work so well for fibroids. These have shown mixed results in the short term and rather poor results in the long term. In Dr Kirsch’s experience, patients who have adenomyosis have a longer and more difficult post-embolization recovery, a much lower rate of symptom relief (only about 50%), and a much higher symptom recurrence rate (with just about all those who do get relief after UAE having symptoms return within about 2 years). While there might be some modification of the UAE technique that will allow it to become a reliable and durable treatment for adenomyosis, that has yet to be discovered. Ongoing research does continue.

In general, the best treatment for women with adenomyosis continues to be hysterectomy. Dr. Kirsch does not offer UAE to women whose MRI studies show adenomyosis instead of fibroids, with one exception. That exception is young women who want to try to preserve their uterus for a pregnancy in the near future. In those few cases, they may experience sufficient relief of symptoms to allow them to have a pregnancy before the adenomyosis recurs.

There are also women who have both adenomyosis and fibroids at the same time. In those cases, the treatment recommendation depends on which is the dominant process. If a woman has multiple fibroids and a small area of adenomyosis, they usually respond well to UAE. If a woman has a few scattered fibroids and extensive adenomyosis, she is best treated by surgery rather than embolization.

Sorting this out does require a good contrast-enhanced MRI study and a consultation with Dr. Kirsch or another Interventional Radiologist with extensive UAE experience.