What is adenomyosis? Can I get pregnant?

Adenomyosis is a gynecological disease in which the endometrial tissue penetrates the muscular wall of the uterus and thickens it. It can cause symptoms such as chronic pelvic pain, dyspareunia (pain during sexual intercourse), dysmenorrhea (painful periods), or heavy vaginal bleeding during periods.

In some cases, there are no symptoms.

Although there is no indication that it is hereditary, there is no established cause. It usually occurs in women aged 35 to 50 who have had at least one pregnancy.

Diagnosis and treatment of adenomyosis.

Adenomyosis can be misdiagnosed and confused with other diseases, delaying its detection. This requires a gynecological ultrasound (usually transvaginal), palpation of the uterus, or a nuclear magnetic resonance (MRI).

This disorder, which usually disappears with menopause, can be treated with hormonal and anti-inflammatory medications that help control symptoms. In addition, a hysterectomy, or removal of the uterus, is also possible. In general, medical treatment depends on the symptoms and age of the patient.

What causes adenomyosis?

Although experts are not sure what causes adenomyosis, risk factors may include:

• Age: most women with adenomyosis are of childbearing age, between 35 and 50 years old. The main symptoms of adenomyosis disappear after menopause.
• Childbirth: Many women with adenomyosis have given birth to more than one child. The endometrial tissue could invade the myometrium when an embryo implants in the uterine wall. However, more research is needed to confirm this hypothesis.
• Previous surgeries: studies suggest that previous surgical procedures on the uterus, such as a cesarean section or dilation and curettage (D&C), may increase the risk of adenomyosis. Research is being conducted on this risk factor.

Symptoms of adenomyosis

Symptoms of adenomyosis may include:

• Enlargement of the uterus
• Feelings of bloating, fullness, or abdominal heaviness
• Heavy bleeding during periods (menorrhagia)
• Pain during sexual intercourse (dyspareunia)
• Pelvic pain
• Severe cramps during periods (dysmenorrhea)

Adenomyosis vs. endometriosis vs. uterine fibroids

Adenomyosis, endometriosis, and uterine fibroids are disorders of the female reproductive system. They cause very similar symptoms, making it easy to confuse them. However, they are different pathologies that require different treatments.

• Adenomyosis occurs when diffuse endometrial tissue (spread) grows in the uterine wall.
• Endometriosis occurs when endometrial tissue grows outside the uterus. It can develop in the fallopian tubes, ovaries, vagina, or intestines.
• Uterine fibroids are caused by benign tumors (solid masses of noncancerous cells) that develop in different parts of the uterus.

Treatment of adenomyosis

Treatments for adenomyosis include hormonal contraceptives, medications, and surgery. Some women with mild symptoms choose to treat adenomyosis without surgery until menopause. Women with severe symptoms should undergo a hysterectomy.

Hormonal treatment

First-line treatment for controlling adenomyosis symptoms is usually hormonal contraception. These include the birth control pill or progesterone-releasing intrauterine devices (IUDs).

Tranexamic acid

Tranexamic acid is a non-hormonal medication that helps reduce heavy bleeding during periods. This is a pill that is taken during your period. This treatment can help women who cannot or choose not to receive hormonal therapy.

Hysterectomy

The only way to completely stop adenomyosis is through a hysterectomy (surgical removal of the uterus).

A hysterectomy can involve removing only the uterus or the uterus and cervix, depending on the patient's preference and surgeon's recommendations. The ovaries and fallopian tubes can remain in place.

Hysterectomies can be performed in different ways:

• Abdominal: an open hysterectomy involves an incision in the abdomen.
• Laparoscopic: a surgeon makes small incisions in the abdomen to remove the uterus using a special tool that contains a video camera (laparoscope).
• Vaginal.

Does adenomyosis affect fertility and can pregnancy be achieved?

Adenomyosis makes natural and spontaneous pregnancy difficult. This condition contributes to implantation failure and recurrent miscarriages.

However, in adenomyosis, in vitro fertilization (IVF) or egg donation can be considered with positive results. Careful consideration of its presence in the choice of protocol allows for satisfactory results.

Special attention should be paid to endometrial preparation and the timing of embryo transfer. The use of techniques such as GnRH analogs can help optimize the conditions of the endometrium, increasing the chances of successful implantation and a healthy pregnancy. This strategic approach allows women with adenomyosis to become pregnant.

At NatuVitro, we can help you. Our team of experts understands the complexities of adenomyosis and will help you achieve a pregnancy.