Adenomyosis

What it is

Adenomyosis is a condition in which the tissue that lines the inside of the uterus (endometrium) grows within the muscular wall of the organ, leaving the uterus enlarged and more sensitive. It is more common from age 35 onward and in women who have already had children, and can cause intense menstrual cramping, heavy and prolonged menstrual bleeding, pelvic pain and pain during intercourse; some women have no symptoms. Diagnosis is based on symptoms, gynecological examination and imaging tests, such as transvaginal ultrasound and magnetic resonance imaging. Treatment depends on symptoms, age and the desire to become pregnant, and may include pain medication, hormonal methods — such as the hormonal IUD — and, in selected cases, surgery.

Most common symptoms

• Intense and progressively worsening menstrual cramps
• Heavy and prolonged periods, with clots
• Pelvic pain outside the menstrual period
• Pain during intercourse
• A feeling of an enlarged uterus or heaviness in the pelvis
• Anemia, fatigue and weakness

Causes and risk factors

• Age over 35 and previous pregnancies
• Previous uterine surgeries, such as cesarean section and curettage
• Prolonged estrogen stimulation of the uterus
• Association with endometriosis and fibroids
• Genetic predisposition

How it is diagnosed

Suspicion arises from reports of intense cramping and heavy periods, especially in women over 35. On gynecological exam, the uterus may be enlarged, softened and tender to the touch. Transvaginal ultrasound, performed by a professional attentive to the signs of adenomyosis, shows thickening of the uterine wall and characteristic changes; MRI is indicated when the ultrasound is inconclusive or to differentiate from fibroids. A complete blood count assesses for anemia, and hysteroscopy can rule out other causes of bleeding.

How we treat it at Femi Saúde

Treatment aims to control pain and bleeding and is chosen according to age, symptom intensity and the desire to become pregnant. The Femi Saúde gynecology team may recommend anti-inflammatory drugs, medications that reduce flow, and hormonal methods, such as continuous-use contraceptives, progestins and, frequently, the hormonal IUD, which acts directly on the uterus. Iron replacement treats the anemia and pelvic physical therapy helps control the pain. In selected cases, conservative surgeries may be considered; hysterectomy is reserved for women with significant symptoms who no longer wish to become pregnant. The plan is individualized and followed periodically.

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