What is Adenomyosis?

The uterus has three layers: Endometrium – the inner layer which is shed during a period Myometrium – the thick middle layer which is composed of muscle Perimetrium or serosa – the outer thin covering of the uterus Adenomyosis is a condition where the endometrium or the inner lining grows into the underlying muscle layer.

What causes Adenomyosis?

We do not know the reason why some women develop adenomyosis. Hormonal, genetic and epigenetic factors have been postulated.

How common is adenomyosis?

Adenomyosis was previously thought to occur in older women who had children but now we understand that it occurs in women of reproductive age. In the reproductive age group, it affects almost 20% of women.

What are the symptoms of adenomyosis?

Some women with adenomyosis have no symptoms at all. The commonest symptom is pain during periods. This can be very severe and last throughout the period and sometimes be present all the time (chronic pelvic pain). Some women have pain during intercourse as well. The other important symptom is heavy bleeding. Women can have difficulty in conceiving and adenomyosis can cause a 30% reduction in pregnancy rate.

How does adenomyosis affect conception?

An adenomyotic uterus can produce abnormal uterine contractions interfering with egg and sperm transport. Also, the environment within the endometrium is altered leading to a decrease in implantation rate. About 30-50 % of women with adenomyosis have co-existent endometriosis which can also decrease your chance of conception.

What is the treatment for adenomyosis related infertility?

Pain – if the pain is severe, we often prescribe pain killers. Adenomyosis is not an indication for immediate IVF. We take all factors into consideration- namely your age, duration of infertility, ovarian reserve and your husband’s semen parameters to decide on the treatment plan. We may advise IUI or IVF depending on your overall history and examination.

Does adenomyosis need surgical treatment?

If the adenomyosis has caused your uterus to become very large, if you have repeated pregnancy losses or repeated failures after IVF treatment or intolerable pain during periods – surgery may be advised. The surgical treatment involves removal of the adenomyotic area alone and preservation of your uterus.

Can medical treatment be used for adenomyosis?

We can use a group of medications called GNRH agonists to shrink the adenomyosis and reduce the uterine size and also reduce symptoms of pain and excessive bleeding. But these medications cannot be used in women wanting to conceive.

However, we use a short course of GNRH agonists before we transfer an embryo into the uterus, to improve your chance of getting pregnant.