Because the symptoms are quite similar, adenomyosis is often misdiagnosed as uterine fibroids. However, the two conditions are not the same. While uterine fibroids are benign tumors growing in or on the uterine wall, adenomyosis is where the cells of the lining of the womb are found in the muscle wall of the womb. In many cases, there are no symptoms for the condition. An accurate diagnosis is key in choosing the right treatment.
What is adenomyosis?
Causes of enlarged uterus can be adenomyosis, uterine fibroids, or malignant tumor. The most commone one is adenomyosis. Adenomyosis occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus. The displaced tissue continues to act normally (thickening, breaking down and bleeding) during each menstrual cycle. The cause of adenomyosis remains unknown. Some studies suggest that women who have a family history of the condition or have had prior uterine surgery may be at risk for adenomyosis. Also, changes in estrogen hormone level may trigger the condition. The disease usually resolves after menopause.
Symptoms
While some patients with adenomyosis have no symptoms, the disease can cause:
- Heavy, prolonged menstrual bleeding
- Severe menstrual cramps
- Pass clots of blood during periods
- Chronic pelvic and abdominal pain
- Abdominal distension
- Painful sexual intercourse
In addition, enlarged uterus can cause constipation, frequent urination, bloating, fertility problems, abnormal vaginal bleeding, and back pain.
Diagnosis
- History taking by a gynecologist
- Pelvic examination
- Transvaginal ultrasound or transrectal ultrasound (if the patient never have a sexual intercourse)
- MRI of the lower abdomen (for confirmation of diagnosis or evaluate severity of the condition)
Treatment
Treatment options depend on severity and patient’s symptom.
- Anti-inflammatory drugs such as ponstan or ibuprofen to control the pain and inflammation
- Combined estrogen-progestin birth control pills or progestin-only contraception – lessen heavy bleeding and pain
- If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus. Nowadays, this can be done by advanced minimally invasive surgery (MIS). The surgical wound is only 5-10 mm. This technique reduces blood loss, complications, and recovery time. The patient will recover within 1-2 days and can get back to normal life within 1 week.
Prevention
As the exact cause of adenomyosis is unknown, it is recommended that every women have an annual physical examination, pelvic examination, and cervical cancer screening in order to detect the abnormality early.
Menstrual bleeding: what is normal, what is not
Normal is as below:
- Blood flow less than 80 cc per day
- Heavy flow only in the first 3 days
- Not last longer than 7 days
- Blood clots in bean size
If you have an enlarged uterus, you will not necessarily notice it yourself. Therefore, having a regular check-up with a gynecologist is important.
