Early Adenomyosis: Symptoms, Diagnosis & Treatment Options

Introduction

Adenomyosis is a common problem, but it is often not understood properly. Many women are affected during their reproductive years. It occurs when tissue that lines the uterus begins to grow into the muscular wall of the uterus. In severe cases, women may experience severe pain, heavy bleeding, and fertility problems. Early adenomyosis does not present with recognisable symptoms, making it difficult to diagnose at an early stage. Knowing the early signs can help to get timely treatment and improve fertility outcomes.

What is Early Adenomyosis?

Early adenomyosis is the early stage of the condition in which endometrial tissue has just started invading the muscular wall of the uterus. In early adenomyosis, the uterus looks normal or slightly enlarged, and symptoms are mild to moderate. Many women confuse endometriosis and adenomyosis, but these are two different conditions. In endometriosis, it occurs outside the uterus, and adenomyosis is limited to the uterine wall only.  Diagnosis of adenomyosis at an early stage can help obtain immediate treatment that can slow disease progression and prevent complications.

What Are the Causes and Risk Factors For Adenomyosis?

The real cause of adenomyosis is unknown, but some risk factors increase the chances of developing this problem:

• Multiple childbirth increases uterine trauma during delivery, which can lead to adenomyosis.
• Chronic inflammation of the uterine tissue
• Excess of estrogen
• Previous uterine surgeries such as dilation and curettage, C-section, and fibroid removal.
• Age between 30 and 40 years

Diagnosis of Early Adenomyosis

It is challenging to diagnose adenomyosis at an early stage because symptoms may mimic other gynaecological problems such as endometriosis or fibroids.

• A doctor will perform a pelvic examination to estimate the size. A uterus may be slightly enlarged or tender to the touch.
• A Transvaginal ultrasound is used to check thickened uterine walls and asymmetry of the myometrium. Small cystic spaces may be present within the uterine muscle wall.
• MRI is used to differentiate between adenomyosis and fibroids.
• A doctor may recommend blood tests to check haemoglobin levels and rule out hormonal disorders and infections.

Treatment Options For Early Adenomyosis

Treatment of adenomyosis depends on age, severity of symptoms, and fertility issues. Early adenomyosis can be treated using non-surgical methods:

• A doctor may prescribe hormonal therapies, including combined oral contraceptive pills, progestin-only pills or injections, hormonal intrauterine devices, and gonadotropin-releasing hormone analogues. These medicines help reduce menstrual bleeding and pain, and slow disease progression.
• Non-steroidal anti-inflammatory drugs are prescribed to manage pain. Heat therapy can also be used to reduce pain.
• Lifestyle modifications such as regular exercise and stress management can also help to manage early adenomyosis symptoms.
• Women who are young and want to conceive may be given medicines to balance hormones, ovulation monitoring, and assisted reproductive techniques may be suggested if required.
• If medication fails to give relief, doctors may advise uterine artery embolisation and high-intensity focused ultrasound to relieve symptoms.
• Surgical methods are the last resort, in which hysterectomy is considered when a woman suffers from severe symptoms and other treatments fail to respond.

Difference Between Early and Advanced Adenomyosis

How Does Adenomyosis Affect Fertility?

Women with adenomyosis may experience problems in conceiving. The uterine environment becomes less supportive for conception and implantation. This increases the risk of miscarriage and pre-term birth. Adenomyosis can affect fertility in the following ways:

• The deformed uterine lining caused by thickening may prevent conception due to improper implantation of the fertilised embryo.
• The endometrium's function and receptivity decrease due to inflammation and increased estrogen production.
• Implantation becomes difficult or may fail due to the inflamed endometrial tissue that invades the muscular uterine wall.

Tips to Manage Symptoms

Women with early adenomyosis can make lifestyle changes to manage symptoms and prevent complications:

• Obese women must exercise to maintain a healthy body weight
• Include foods rich in iron to prevent anaemia
• Reduce alcohol intake and smoking habits
• Manage stress using yoga, meditation, and deep breathing
• Get adequate sleep to relax and balance hormones

When to Visit a Doctor?

You must visit a doctor if you experience the following symptoms:

• Chronic pelvic pain
• Pain during periods that interferes with daily activities
• Heavy and prolonged bleeding during periods
• Difficulty in achieving pregnancy
• Weakness or dizziness due to anaemia

Conclusion

Adenomyosis affects many women throughout their reproductive life as it causes heavy bleeding, chronic pelvic pain, and prolonged periods. This condition is often overlooked because its symptoms mimic those of other conditions. If diagnosed early, symptoms can be managed, and complications can be prevented. Diagnosis can be made by using advanced ultrasound and MRI techniques. Therefore, if you experience constant pelvic pain, heavy and prolonged bleeding, or difficulty in conceiving, you must visit a doctor for the diagnosis of the condition to get immediate intervention and treatment.