Endometrium is the name given to the inner wall of the uterus, a very vascularized region and full of glands. It endometrial bleeding that menses occurs.
For reasons still unknown, small pieces of endometrium can arise outside the uterine cavity, such as fallopian tubes, ovaries or in the abdominal cavity. When this occurs, every time a woman is menstruating, this small endometrium fragment also bleeds, causing great irritation around. This anomalous presence of endometrial tissue outside the uterus is called endometriosis.
The adenomyosis is a similar disease, but in this case the presence of the endometrium does not occur in other organs, but within the myometrium which is the muscle layer of the uterus itself. In adenomyosis, every time a woman is menstruating, there is also a bleeding within the muscle of the uterus, which causes great irritation of the same. Therefore, we can say that adenomyosis is endometriosis that occurs in the uterus itself.
To understand adenomyosis is important to know what are the endometrium and myometrium.
The uterus is an organ that can be divided into two layers:
1. Endometrium: the inner wall which lines the uterine cavity, or hollow portion of the uterus. The endometrium there is lot of blood vessels and glands. This is where the embryo implants and is where it forms the placenta.
During each menstrual cycle, the body prepares the endometrium for a possible pregnancy. About 7 days before ovulation occurs by hormonal stimuli, the endometrium is transformed, getting thicker, richer in vascularized and glands. All this so that it becomes a suitable place to receive an embryo if the egg is fertilized.
However, if the egg released is not fertilized, hormone stimulation to the endometrial proliferation cease, and all that thick wall collapses, causing menstruation.
2. Myometrium: is the layer of the uterus where there is only muscle. The myometrium is responsible for uterine contractions during labor, causing the fetus is expelled from the uterus. In the period, the myometrium also contracts, helping to expel the endometrium remains collapsed. Intense myometrium contractions are the cause of menstrual cramps.
As explained in the introduction, adenomyosis is a disease that occurs when endometrial pieces appear in the myometrium, causing cyclic bleeding within the muscle layer of the uterus.
The adenomyosis can be confined to a small part of the myometrium (adenomyosis located) or may be a diffuse process, with endometrial tissue scattered throughout the muscle layer of the uterus (diffuse adenomyosis).
The causes of adenomyosis are still unknown. Some theories suggest that the disease has congenital, like a malformation of the uterus in the embryonic stage. There is also a current believes adenomyosis can be an acquired disease during life, caused by lesions of the cervix, for example, a surgical incision caesarean section.
It is known that there is influence of female hormones in the formation of adenomyosis. The longer exposure to female hormones explains why the higher incidence of this disease in women around the age of 40. For the same reason, the symptoms of adenomyosis often worsen over the years, but then improve in menopause.
Besides age, other factors seem to contribute to the appearance of adenomyosis, such as having had more than one pregnancy during life, first menstruation (menarche) early and short menstrual cycles.
It is estimated that 20% of women have adenomyosis. However, the true incidence may be much higher, since many women are asymptomatic and the diagnosis of adenomyosis can only be made with certainty by careful histopathological evaluation of the entire uterus, which is only possible if the woman is subjected to a hysterectomy (surgical removal of the uterus).
About 1/3 of women with adenomyosis has no symptoms. In the 2/3 who develop symptoms, the main ones are great menses and severe cramping. Pain during intercourse and bleeding outside the menstrual period are other common symptoms.
If the presence of endometrial tissue diffusely by the myometrium, the uterus may increase in size, reaching have a similar volume to 11 or 12 weeks of pregnancy. Pain and a small distension of the lower abdomen are possible symptoms. When adenomyosis is located, endometrial tissue can form nodules becoming like a myoma.
Adenomyosis and pregnancy
Although not yet proven to be a totally given, it is believed that adenomyosis is related to an increased risk of infertility. This does not mean, however, that women with adenomyosis can not get pregnant.
The increased risk of miscarriage or premature birth in pregnant women with adenomyosis is also still a controversial issue, with opinion of disagreement among experts.
In women with no symptoms and no increase in uterine volume, with absolute certainty the diagnosis can only be done by evaluating the uterus following hysterectomy. On the other hand, women with cramps and heavy menstrual flows associated with an increased size of the uterus, imaging tests such as transvaginal ultrasound or magnetic resonance imaging of the pelvis can help establish the diagnosis.
The only 100% effective for treating adenomyosis is surgical removal of the uterus (hysterectomy). Because the symptoms usually worsen only after 40-45 years of age, and disappear after menopause, most women just do not need to resort to such a radical treatment.
The anti-inflammatory institution to control the cramps and the contraceptive pill to control the release of hormones during the menstrual cycle usually causes relief of symptoms in most patients. Continuous use of contraceptives in order to suspend menstruation or IUDs are valid options for some patients.
However, if the patient is at a distance of menopause already have children and do not want others to have, and can not control the symptoms of adenomyosis, hysterectomy is an alternative that should be considered.
