Pelvic pain is a common problem among the women I see in clinic. They’ve often been suffering FOR YEARS before a diagnosis has been made. Many people have heard of endometriosis, but have you heard of adenomyosis?
Adenomyosis is sadly not very well known, and there’s a lot myths and lack of understanding floating around about it too.
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What exactly is Adenomyosis?
It is a condition that affects the womb. In people with adenomyosis, endometrium-like cells are found in the wrong place, within the walls of the womb itself (the myometrium).
For a quick anatomy lesson, there are two key layers in the uterus. The endometrium is the inner layer where a pregnancy implants. If there is no pregnancy, this layer is shed during a period. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions.
We used to think that to have adenomyosis, you’d need to have endometriosis first, but we now know that adenomyosis is a distinct disease from endometriosis. In endometriosis, endometrium-like cells are also found in the wrong place, but in this case outside of the uterus, mainly in the pelvic cavity, but can be found anywhere in the body.
What causes Adenomyosis?
We don’t yet understand why some women develop adenomyosis, though evidence shows that it is more common as we get older. It can however affect anyone of any age.
Other risk factors include previous trauma to the uterus causing trauma between the endometrium and myometrium either by the natural processes of the menstrual cycle, pregnancies and childbirth, or medical procedures.
It’s likely though that there is not one common disease-causing factor behind adenomyosis and it will be a different cause in different people.
What are the symptoms of Adenomyosis?
Some women have no symptoms, and some women have crippling, painful symptoms.
Adenomyosis symptoms may include:
- Enlarged uterus
- Feelings of abdominal bloating, fullness or heaviness
- Heavy bleeding during periods
- Pain during sex (dyspareunia)
- Pelvic pain
- Severe cramps during periods
How is Adenomyosis diagnosed?
I would have a strong suspicion of adenomyosis if a woman has any of the risk factors listed above and she is having painful periods. My first port of call would be to organise a scan to check the pelvic organs looking specifically for signs of adenomyosis. There is currently no blood test that can help in diagnosis.
It can be diagnosed by an ultrasound scan and/or MRI as long as the deposits of adenomyosis are large enough and the person reviewing the scan pictures is skilled enough to spot the signs.
Often though, it is found after a woman has had a hysterectomy and it is seen in the laboratory.
How is Adenomyosis treated?
Treatments focus around using hormones to settle bleeding and hormonal fluctuations, or removing the uterus completely.
Hormones
Taking hormones in the form of pills, coils, injections etc. can help by reducing the amount of blood loss (and painful contractions of the uterus as a result). They tend to keep the lining of the uterus thin. They don’t cure the disorder, but can certainly help with the symptoms.
Not everyone can have hormones though, especially if taken with medications that can interact with eachother.
Those with blood clotting disorders can’t have anything containing oestrogen, so would have to have progestogen-only contraception. This can often be helpful because in many women, it can stop periods entirely.
Pain relief
For those who don’t want to use hormones, or they would like more than just hormones, pain relief in the form of anti-inflammatories (such as ibuprofen) can be very helpful. The best time to take them is in the 2-3 days before your period is due to start and continue to take them throughout the period. However, they can cause stomach ulcers and in asthmatics, they can cause a worsening of their condition, so they aren’t for everyone.
TENS machines (Transcutaneous Electrical Nerve Stimulation) works on the idea that I’ve heard good things about this one* from patients that you might want to try. The benefit is that this is medication free and can be used again and again!
Lifestyle Approaches
Reducing intake of caffeine, processed foods, salt, sugar and alcohol in the second half of the cycle (the 2 weeks before the period is due) can be helpful. Getting enough sleep, exercise and down-time is also important for our mental health. Without good mental health, all types of pain can feel much worse.
Surgery
If all else fails, then a hysterectomy (removal of the womb) can be a lifesaver. Many women gain absolute relief once the cause of their pain is removed. It is not without it’s risks though and should be careful considered with the help of a gynaecologist to make sure it is the best option for you.
Something new?
Mifepristone is a medication traditionally used for termination of pregnancy. However, new studies how suggested that it could also be good for adenomyosis.
134 patients were randomly assigned to taking mifepristone or a placebo (an inactive pill).
The study found that painful periods improved significantly in 91.8% of the mifepristone group vs only 23.1% of the placebo group, and they improved completely in 88.5% of the mifepristone group women vs just 6.2% of the placebo group.
That’s huge!
Not only that, the study demonstrated no serious adverse events which is great news.
Sadly this isn’t mainstream practice yet and 134 patients isn’t really enough to base this on, but it’s certainly promising. Hurry up NICE and make this happen!!
Final Thoughts
If you’re struggling to get the help you need, get in touch with me for a consultation and we can look at investigations if needed, medication and referral to a gynaecologist for surgery if you feel this is going to be the right move for you. Don’t suffer in silence! Severe period pain is NOT normal and should not be tolerated. It can also be really helpful to find some good support groups such as The Adenomyosis Advice Association to help you on your journey.
Until next time,
Dr Nikki x
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