Picture

Endometriosis and Adenomyosis

Published 31st March 2022 | Dr Ujwala Parashar

Endometriosis and adenomyosis are both disorders of the female reproductive system involving the endometrial tissue which lines the inside wall of the uterus. In endometriosis the tissue grows outside of the uterus and may involve the ovaries, pelvic walls, fallopian tube, or the bowel. In adenomyosis, the endometrial tissue grows into the muscle of the uterus and can cause the uterus to double or triple in size. Both conditions can be painful.

How common is endometriosis and adenomyosis?

While both endometriosis and adenomyosis are fairly common.  It is estimated 10 % of women of child-bearing age are affected by endometriosis. Less is known about the prevalence of adenomyosis as it is harder to diagnose and doesn’t always have symptoms. However, it is believed that it may affect as many as 20% to 65% of women.

Who might be at risk of developing endometriosis and adenomyosis?

Risk factors differ for each disorder.
Endometriosis : affects women who have menstrual periods and most often occurs in women between the ages of 25 to 40, and in rare instances may persist after menopause.  It also occurs less commonly in younger women.
Adenomyosis: although it has been found in adolescents, adenomyosis is most commonly found in women between the ages of 35 to 50 who have:
  • Had at least one pregnancy
  • Uterine fibroids
  • Endometriosis

What causes endometriosis and adenomyosis?

It is not known what causes women to develop either of these disorders.  
In the case of endometriosis, some experts believe that pieces of the endometrial tissue go back through the fallopian tubes and enter into the pelvic cavity; and that tiny pieces of the tissue may then lodge on the surfaces of the reproductive organs located there. During menstruation, the tissue then bleeds just as the endometrium tissue in the uterus bleeds. This may cause the surrounding tissue to become inflamed and can result in the formation of scar tissue and cysts.
Adenomyosis is more commonly found in women who have had children.

What are the symptoms of endometriosis and adenomyosis?

The symptoms for each condition vary, and it is not uncommon for women with either condition not to have symptoms. However there is no connection between the symptoms and the severity and extent of the disorders;  meaning that women with very mild symptoms may have significant disease, whilst those with severe symptoms may have mild disease.
When symptoms are present, they may include the following.
Endometriosis symptoms:
  • Very painful menstrual cramps
  • Difficulty becoming pregnant
  • Painful bowel movements
  • Painful sex
  • Back pain or abdominal cramps during menstruation
Adenomyosis symptoms:
  • Heavy menstrual bleeding
  • Enlarged uterus
  • Painful menstrual cramps
  • Infertility
  • Abnormal menstruation
  • Pelvic pain
  • Painful sex

How is endometriosis and adenomyosis diagnosed?

Dr Parashar will undertake a medical history, discuss symptoms, and conduct a pelvic examination at your consultation. If she suspects you have either condition, she may recommend further investigation to confirm the diagnosis through:
  • Ultrasound - This uses sound waves to produce images of the reproductive organs.
  • MRI - This can show uterine enlargement.
  • Laparoscopy - This is a surgical procedure where a small camera is inserted through the abdomen allowing Dr Parashar to look for endometrial implants. She will then often take a small sample of these implants for biopsy purposes to confirm the diagnosis or in some instances, she may be able to remove the implants during the surgery.

What are the complications of endometriosis and adenomyosis?

Each of these conditions can affect fertility. Other complications can include:
For endometriosis:
  • Chronic pelvic pain
  • Adhesions and cysts that can disrupt organ systems
For adenomyosis:
  • Increased risk of anaemia from heavy menstrual bleeding
  • Chronic feelings of fatigue or cold due to anaemia
  • Miscarriage
  • Premature labour

How is endometriosis and adenomyosis cured or treated?

There is no known cure for either condition, however symptoms of both disorders often go away after menopause. There are some treatments available that Dr Parashar will discuss with you for each condition. These are:
For endometriosis: treatments are based on reducing the size of tissue growth and to reduce painful symptom and may include:
  • Birth control pills
  • Non-steroidal anti-inflammatory drugs
  • IUD
  • Other medications
Medical therapy for some women who have endometriosis will relieve pain, and in some instances both medical therapy and surgery will be recommended to improve pain symptoms.  However, medical therapy will not increase fertility rates. 
If your reason for seeking medical assistance is to become pregnant, Dr Parashar will recommend surgery or other fertility options to improve your chance of pregnancy and will discuss this at your consultation.
For adenomyosis: treatments vary according to the severity of the disease and may include:
  • Pain medications
  • Hormonal contraceptives such as birth control pills, injections, and hormonal IUDs such as Mirena
  • Hysterectomy. This is a surgical procedure that removes the uterus. After this surgery is performed, women no longer have a menstrual cycle and are not able to become pregnant.

When should you arrange for a specialist consultation with Dr Parashar?

You may not know if you have endometriosis or adenomyosis as many women with these conditions don’t experience symptoms. However, if you do experience any of the symptoms listed in this article and wish to confirm a diagnosis and seek treatment, please ask your GP for a referral to Dr Parashar and call our team to arrange for a consultation on 1300 811827.

Dr Ujwala Parashar, Obstetrician & Gynaecologist

Sam Samant

Dr Ujwala Parashar is a highly trained female obstetrician and gynaecologist with over 12 years of experience, practicing in Sydney's North Shore and Barangaroo. If you would like more information on conception, or if you are seeking obstetric options and advice, please contact us or call 1300 811 827 to arrange a consultation with her.