Adenomyosis in women over 40: Symptoms, diagnosis and treatment options

Learn how adenomyosis affects women over 40 — from heavy bleeding and pain to diagnosis with ultrasound or MRI — and available treatment options. (Image: Canva)

What is AdenomyosisAdenomyosis is a condition that leads to the growth of the endometrium, the innermost layer of the uterine wall, and the stoma’s contents, of the myometrium (middle layer of the wall). It can either be diffuse or it may be focal in some other cases. (Image: Canva)

Causes and Risk FactorsThe cause for the ingrowth of the endometrium into the myometrium is not always known, but it may be because of repeated childbirths or vigorous curettage. In some cases, the effect of excessive estrogen can also lead to this condition. Some females affected may also have pelvic endometriosis. (Image: Canva)

Symptoms and SignsIn almost one-third of the cases, the affected females remain asymptomatic, and the diagnosis is made on histological examination. It affects women who have had at least one pregnancy and are above the age of forty years. Multiple symptoms may accompany this condition. (Image: Canva)

Excessive Menstrual BleedingOne of the most common symptoms is menorrhagia, which refers to excessive bleeding. This occurs due to an increase in the uterine cavity and the associated hyperplasia (enlargement of the organ) of the endometrium. Inadequate contractions may also be a cause. (Image: Canva)

Pain Symptoms: DysmenorrheaDysmenorrhea is the progressively increasing colicky pain that occurs during the period, and it is due to the retrograde pattern of the uterine contractions. The pain becomes severe when the depth of the endometrium into the myometrium becomes more than eighty per cent. (Image: Canva)

Dyspareunia and Urinary ChangesOther symptoms include dyspareunia and changes in the frequency of urination, which occur because of the enlarged and tender uterus. There may also be a high incidence of infertility and miscarriage in those affected with adenomyosis, which has multiple reasons. (Image: Canva)

Physical Examination FindingsInfertility and miscarriages may be due to retrograde myometrial contractions and interference in sperm transport, along with an abnormal endometrial immune response. An abdominal examination is usually done by the gynaecologist, which may reveal a mass in the pelvis. (Image: Canva)

Recommend InvestigationsThe investigation recommended for adenomyosis usually includes a transvaginal ultrasound, which may reveal a bulky uterus, along with myometrial cysts. It may also show a heterogeneous echotexture. An MRI may be advised in some cases, which has a higher accuracy, and can show thickening of the junctional zone. (Image: Canva)

Medical ManagementNon-steroidal anti-inflammatory drugs are often used to control pain and bleeding. However, definitive treatment is usually surgery. An LNG-IUS has been found to improve excessive bleeding and dysmenorrhea. Danazol can also improve the symptoms in some cases. (Image: Canva)

Conservative Surgeries and HysterectomyConservative surgeries like adenomyomectomy and uterine mass reduction can be performed through either laparotomy or laparoscopy, or by uterine artery embolisation. In women who have had multiple childbirths, a hysterectomy (surgical removal of the uterus) may be recommended. (Image: Canva)Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.