Adenomyosis occurs when the tissue from the internal lining of the uterus grows into the muscle layer of the uterus. This can lead to an enlarged or bulky uterus.
It usually causes heavy menstrual bleeding and therefore painful periods. Adenomyosis may not cause any problem in some women.
Severe adenomyosis may be detected through an ultrasound scan or MRI. It can only be confirmed after surgery through pathological examination.
Endometriosis occurs when the cells from the internal lining of the uterus (endometrial cells) are found outside the uterus, while adenomyosis occurs when these cells are found within the muscle of the uterus itself. Endometriosis and adenomyosis can exist together in the same woman. Although both may cause pelvic pain, endometriosis does not in itself always cause heavy menstrual bleeding.
Treatment aims to stop the heavy menstrual bleeding and relieve pain.
This may include:
Hysterectomy is the only definite cure for adenomyosis. While hysterectomy stops any menstrual bleeding and pain from the uterus, other pain from the pelvis will need to be managed for the longer term.
The only form of surgical removal of adenomyosis is a hysterectomy as it is usually widespread and involves the whole uterus rather a discrete mass.
Adenomyosis can form a large cluster in one location of the uterus – forming an adenomyoma. Adenomyoma can be mistaken for fibroids on ultrasound scan. However, unlike fibroids which can be surgically removed from its capsule within the muscle of the uterus, adenomyoma cannot be effectively removed from the uterus as there is no clear border or capsule between the adenomyotic tissue and normal uterine tissue.
Most hysterectomy can be done laparoscopically through a few key-hole incisions. This allows less pain, bleeding, infection, scarring, and quicker recovery. If you have been recommended to have an open incision on the abdomen, ask your doctor or gynaecologist for another opinion if this can be done through ‘key-hole’ surgery.
Laparoscopic hysterectomy should be performed by specialist gynaecologists who have completed additional training either in minimally invasive gynaecology surgery, or in surgical gynaecological oncology in order to learn techniques and procedures to complete the most complex surgeries with lower complication rates and quicker recovery period. They also perform higher volume of more complex cases.