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Adenomyosis can cause irregular, heavy menstrual bleeding, pelvic pain and it can affect fertility. Women with adenomyosis who do become pregnant have an increased risk of miscarriage, pre-term delivery, pre-eclampsia and bleeding after delivery. So what causes adenomyosis, and how is it diagnosed and treated? Dr Jen Southcombe & DPhil student Fitnat Topbas Selcuki discuss this complex condition and how diagnosis options are changing and improving in an article in The Conversation.

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BBC presenter Naga Munchetty recently revealed that she suffers from adenomyosis, a chronic condition that affects the uterus. She spoke of how her pain can leave her unable to move and how a recent flare-up was so intense her husband had to call an ambulance.

Yet many people have never heard of this condition, despite it affecting as many as one in five women.

What causes adenomyosis?

There are two key layers in the uterus. The endometrium is the inner layer where embryos implant. If there is no pregnancy, this layer is shed during a period. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions. In people with adenomyosis, endometrium-like cells are found in the wrong place – the myometrium.

Although a large number of women with adenomyosis have endometriosis as well, adenomyosis is a distinct disease from endometriosis. In endometriosis, endometrium-like cells are also found in the wrong place, but in this case outside of the uterus, mainly in the pelvic cavity.

Thanks to research, public engagement and social media, awareness of endometriosis has increased in recent years. Yet adenomyosis is still relatively unheard of.

Diagnosis options are changing and improving

Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrium-like cells in the myometrium could only be verified by pathology assessment where the myometrium is examined under a microscope after a hysterectomy (surgery to remove the uterus).

Recent years have seen increased diagnoses with the development of imaging technologies such as MRI and detailed pelvic ultrasound. Although adenomyosis is now commonly identified without the need for a hysterectomy, doctors are still working towards developing a standardised method for non-surgical diagnosis.

As a result, it remains uncertain exactly how many women have adenomyosis. Although we know that around 20% of women having hysterectomies for reasons other than suspected adenomyosis are found to have evidence of the condition on pathology assessment.


Read the full article in The Conversation here

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