Adenomyosis wasn't always an infertility issue. This condition wasn't a big problem for women in the past. The reason? Adenomyosis doesn't usually cause problems until women are 35 or older, and are done having children. But times have changed. In case you haven't noticed, women are now waiting until our 30s, or even later, to have children. For this reason, adenomyosis problems may be on the rise.
What is adenomyosis, anyway?
About 1 in 100 women will have adenomyosis. Adenomyosis causes endometrial tissue to grow into the muscle layers of the uterus. Normally, this endometrial tissue lines the uterus. But if you have adenomyosis, the tissue will implant into the uterine muscle. This can cause pain, cramping, bleeding, bloating, and sometimes infertility. Do not confuse this disorder with similar conditions like endometriosis and uterine fibroids. Endometriosis occurs when endometrial tissue, which usually lines the uterus, spreads outside of the uterus to other areas of the body. The tissue then can invade the pelvic region, including the ovaries, fallopian tubes, bladder, and other areas. Fibroids are benign growths that appear in the uterus. Adenomyosis is unique as it invades the muscles.
Who is at risk for adenomyosis?
The primary risks for the condition are:
- Age
- Previous childbirth
Many women with adenomyosis are in their 30s and 40s. Often, they have already had one or more children. For these women, adenomyosis may cause secondary infertility. Secondary infertility occurs when you have previously given birth without fertility assistance.
Do you have adenomyosis?
Are you concerned that you might have adenomyosis? Here is a list of common adenomyosis symptoms:
- Painful cramping and heavy bleeding during your period
- Passing blood clots during menstruation
- Unexplained bleeding between your periods
- Pain during sex, especially around the time of your period
- Swelling or tenderness in your lower belly
- Infertility
If you have adenomyosis, your uterus may be two or three times larger than normal. If these symptoms sound familiar and you are trying to get pregnant, talk to your doctor.
Treatments for adenomyosis
Before adenomyosis treatment, your doctor will want to make an accurate diagnosis. He or she will run a number of tests, including blood work, a pelvic exam, an ultrasound, or magnetic resonance imaging (MRI) scans. If your adenomyosis symptoms are mild, and your doctor approves, try pain relief medication. This might help reduce any discomfort. If you are unable to achieve pregnancy after six months, see your doctor for adenomyosis hormonal and surgical treatments. You may need to start one of the following regimens to treat your condition:
- Birth control pills
- Intrauterine devices (IUD)
- Gonadotropin-releasing hormone (GnRH) agonists
Some women are able to conceive within a few months after completing hormonal therapy. If these treatments don't help, your doctor may recommend surgery to help you conceive.
Questions for your doctor
Talk openly with your doctor if you are concerned about adenomyosis and infertility. Here are some questions you can ask:
- Does your doctor have experience with medication or surgical treatments for adenomyosis?
- Will these treatments help you conceive?
- What are the side effects, risks and benefits of the different adenomyosis treatments?
- Would you be able to start with just medication treatment?
Help is available
Some women with adenomyosis will have trouble getting pregnant. Thankfully, medical and surgical treatment options exist. These treatments can help to restore your fertility. If you are done having children, a hysterectomy often cures adenomyosis. And, if left untreated, adenomyosis often goes away when you reach menopause.
Reviewed March 2011 by Dr. Steven Lindheim from the Center for Reproductive Health - Cincinnati, Ohio.
Sources: Devlieger, R., D'Hooghe, T., & Timmerman, D. (2003). Uterine adenomyosis in the infertility clinic. Human Reproduction Update. 9(2), 139-147; Matalliotakis, I., Katsikis, I., & Panidis, D. (2005). Adenomyosis: What is the impact on fertility? Current Opinion in Obstetrics & Gynecology. 17(3), 261-264; MayoClinic.com: Adenomyosis.
