Adenomyosis is a condition where the walls of your uterus are thicker than they should be. This thickened lining reduces blood flow, which makes it harder for the egg to implant. The thickness can affect your entire uterus, or just one area. For most patients, some areas are affected worse than others. When the top of your uterus (the “fundus”) is affected, it’s more of a concern because that’s where the embryo is supposed to implant.
Adenomyosis is usually diagnosed with a transvaginal ultrasound. It can also be diagnosed with a pelvic MRI, which helps the doctor determine how extensive the problem is and where the damaged tissue is.
Your doctor may also pick up adenomyosis when you’re having a sonohystogram. In that test, water is placed in your uterus. It passes through your lining and into your muscles. If you have adenomyosis, it’ll hurt more than it should.
One of the tricky parts of diagnosing adenomyosis is that it can seem really similar to a fibroid (a dense growth that’s made of muscular tissue). Usually adenomyosis will affect a few areas, whereas a fibroid is more concentrated. However, it’s not always clear cut.
In fact, sometimes that’s how adenomyosis is caught: surgeons would start operating on a woman to remove her fibroid, only to realize the issue was actually adenomyosis. That’s why surgeons will often order an MRI prior to an myomectomy: it helps them confirm that the fibroid isn’t actually a case of adenomyosis!
There’s no known treatment for adenomyosis. However, there are some therapies being used today.
Some doctors believe there’s a similarity between adenomyosis and endometriosis, a condition where the lining of the uterus grows in places it shouldn’t. The treatment for endometriosis is to reduce the hormone estrogen (since estrogen can trigger the tissue growth). Similar treatments are used for adenomyosis.
This may include several months of continuous birth control pills or Lupron Depot injections. It’s kind of like being in menopause for a few months (no periods). This hopefully will make your future cycles more successful.
Unfortunately, there’s no surgical option. Adenomyosis causes such scattered changes in your uterus that no specific area can be safely removed.
If you have severe adenomyosis, the important question is whether there’s any chance an embryo can still implant. The best way to determine this is to run an IVF cycle, transferring one or two high-quality embryos to maximize your odds. If it’s unsuccessful, you’ll want to consider other options, like working with a gestational carrier (surrogacy).