Adenomyosis is a disease that is caused by the settling of the uterus lining in between the uterine muscle group. In general, this disease can cause severe menstrual cramps, contractions in the lower abdomen, and regional swelling during the PMS (Pre-menstrual Period).

Although it is called a benign condition, adenomyosis disease affects the patient's life negatively and interferes with daily life activities, so it is a disease that needs to be treated. Severe pain and accompanying bleeding are negative effects that make it necessary to be treated.

How Does Adenomyosis Develop?

In adenomyosis, the tissue that covers the surface of the uterus, called the endometrium, grows into the muscle wall of the uterus. As a result of this phenomenon, the endometrial layer begins to thicken during the menstrual period, thins, and sheds with bleeding. Against this abnormality, adenomyosis tissue continues to behave like normal internal tissue, causing growth in the size of the uterus.

What Are the Types of Adenomyosis Disease?

Adenomyosis disease varies from person to person and is seen in 2 different ways:

Diffuse Adenomyosis

It is the most common type of adenomyosis. It is seen in the form of fibrosis and endometrial tissue islets in the uterine muscle layer as hard tissue.

Focal Adenomyosis

It is a type of adenomyosis that can grow into the inner cavity of the uterus. The tissue may be in the image of fibroids.

What Are the Symptoms of Adenomyosis?

The symptoms of adenomyosis disease vary from person to person, and in some cases, it may not cause symptoms because it does not cause any complaints. While it causes symptoms by causing minor ailments in various individuals, severe complaints may occur in some individuals, these are:

• Groin pains,
• Pain during sexual intercourse,
• Clotted menstrual bleeding,
• Prolonged menstrual bleeding that goes beyond the normal process,
• Severe levels of menstrual bleeding,
• Decal hemorrhages,
• Severe menstrual pains,
• Feeling of pressure in the breech,
• Feeling of pressure in the bladder,

In addition to all these, it also causes such phenomena as depression, anxiety, fatigue, weakness, dizziness, tense mood, and anemia. It is not yet known whether adenomyosis disease is one of the causes of infertility.

Why Does Adenomyosis Occur?

Although there is no definite statement as to why estrogen-based adenomyosis disease occurs, some trigger elements have been revealed by research, although they are not certain.

• Adenomyosis – Birth Connection: This possibility, which is considered as a theory, is based on the fact that the cells that provide uterine regulation as a result of inflammation of the inner membrane structure of the uterus in the postpartum period come out of their natural limits.
• Stem Cell Theory: The possibility discussed in the stem cell theory, which is another theory, is that the bone marrow stem cells may have surrounded the uterine muscle.
• Theory of Developmental Phenomena: In the theory of developmental factors, it is thought that endometrial tissues accumulating between the muscles during the initial formation of the uterus cause adenomyosis.
• Endometrial Tissue Growth Theory: Incisions made in surgeries that involve intervention in the uterine region, such as cesarean delivery, is seen as one of the conditions that can cause adenomyosis since they trigger the entry of endometrial cells into the uterine wall.

How Is Adenomyosis Diagnosed?

In the diagnosis of adenomyosis, patient complaints are primarily addressed. If there is a suspicion of adenomyosis after the complaints are transferred to the doctor, a physical examination is performed. Conditions that occur in the uterus are detected by gynecological examination. The medical imaging methods used for the definitive diagnosis of adenomyosis are as follows:

• Ultrasonography: Although adenomyosis cannot be diagnosed definitively, the endometrium, muscle wall, and uterus are examined by ultrasonography imaging.
• MRI (Magnetic Resonance Imaging): MRI can be used to confirm the diagnosis of adenomyosis for patients with high levels of vaginal bleeding.
• Sonohysterography: In this diagnostic method, saline is injected into the uterus using a small tube.
• Endometrial Biopsy: In this method where a tissue sample is taken from the uterus, the main point is to reveal whether serious vaginal bleeding is due to other disorders.

What Are the Treatment Methods for Adenomyosis, What Treatment Can Be Applied For Those Who Want to Get Pregnant?

Although the treatment methods vary from person to person, they are performed based on the expectation of pregnancy and the intensity of the symptoms. The method applied to patients presenting with mild symptoms and complaints is generally to give painkillers and apply heat to relieve cramps. The treatment methods used in patients with severe symptoms are as follows:

• Hormone Therapy: In hormone therapy that can be applied to patients who experience severe pain and heavy bleeding, devices that secrete hormones are placed in the uterus.
• Hysterectomy: In this treatment method, which is known as the definitive solution to adenomyosis, the uterus is surgically removed. It is a treatment method applied to patients experiencing the most severe symptoms.
• Anti-Inflammatory Drug Treatment: Non-steroidal drugs, which should be used in the 1-2 days before menstruation and are expected to treat mild pain, stand out as a frequently used method for patients with mild symptoms.
• Uterine Artery Embolization: It is a treatment method based on the occlusion of blood vessels that provide blood flow to adenomyosis tissue by embolization. The blood flow is interrupted by small particles placed in the inguinal veins of the patient, and as a result, the adenomyosis tissue begins to shrink.
• Endometrial Ablation: In this treatment method, in which the uterine lining is destroyed, it is aimed to alleviate the complaints. It is used in cases where adenomyosis tissue does not penetrate the uterine muscle walls at a high level.
• Birth Control Pills: Birth control pills with anti-ovulation effects can help reduce bleeding.

The treatment method that can be applied for individuals who want to get pregnant but have adenomyosis disease is pain-relieving drugs. Patients with severe pain and bleeding can use intrauterine devices containing progesterone only for as long as they want pregnancy.

How Often Does Adenomyosis Occur and in Which Individuals, Is It an Obstacle to Conception?

Adenomyosis is a disease that is seen at a rate of 20% in general, and it is most commonly seen in women between the ages of 40 and 50. However, according to the data revealed by the latest researches, their incidence in young girls has also increased.

Adenomyosis, which is a disease that reduces the chance of conception, can prevent having a baby as a result of some secreted substances. In addition, it stands out as a negative factor for in vitro fertilization treatment because as a result of surgical removal of adenomyosis, deterioration in the structure of the inner surface of the uterus occurs, making it difficult for the fertilized embryo to adhere. In addition, ruptures that may occur in the uterus during pregnancy or childbirth are among the important risk factors.