No one really knows for sure what causes adenomyosis. Many theories have been offered, but none have been proven. However, studies are ongoing, and some interesting facts have come forth regarding this disorder.
One of the most useful findings has involved a part of the uterus called the junctional zone. As described previously, the uterus is made up of the endometrial layer which is shed every month in the form of a menstrual period and the myometrial layer which is the muscular layer. The innermost layer of the myometrium is called the junctional zone, or JZ. Studies have shown that the JZ in women who suffer from adenomyosis tends to be thicker than in women who do not suffer from the disorder. In general, a JZ thickness of less than 8 mm means that adenomyosis is unlikely whereas a JZ thickness of greater than 12 mm indicates that adenomyosis is highly likely. This finding, which can be picked up on MRI, is a huge step in being able to diagnose adenomyosis prior to hysterectomy!
Studies have indicated that this disorder involves an impared response to sex hormones. Also, women who suffer from adenomyosis tend to have a higher level of the COX-2 prostaglandin present in their bodies. This would explain why NSAIDs such as Advil or Aleve can give some relief in some cases.
On a genetic level, some progress has also been made. Studies have indicated that alterations in the vascular endothelial growth factor gene (VEGF) may play a role in the development of adenomyosis. This gene is located on chromosome 6 at p16. More research needs to be done regarding this genetic finding.
There are two reasons for infertility associated with this disorder. Studies are suggesting that 1) sperm transport in somehow compromised, and 2) JZ contractility is increased. JZ contractility is very important for the uterus to maintain a pregnancy.
Painful menstrual bleeding (dysmennorhea)
Heavy menstrual bleeding (menorrhagia)
Prolonged menstrual bleeding (8 to 14 days)
Bleeding between periods (spotting)
Passing large blood clots
Continuous bloody discharge
Chronic anemia due to excessive blood loss
Severe abdominal cramping (sometimes can be as severe as the last stage of labor)
Enlarged, bulky and heavy uterus (often doubling or tripling in size)
Tenderness during pelvic exam
A “bearing down” sensation
Heaviness in the legs
Nausea and vomiting
Pressure on the bladder
Painful bowel movements during menstruation
Alternating constipation and diarrhea (can mimic IBS)
Lower back pain
Depression and anxiety
Myometrial ectopic pregnancy
Increase in pain over time – can be debilitating
Symptoms usually resolve after menopause because of lower estrogen levels in a woman’s body.
Symptoms of adenomyosis can present as either a gastrointestinal problem or a urological issue! My symptoms were primarily gastrointestinal which led to the misdiagnosis of IBS for many, many years. It is so important for not only gynecologists to be aware of adenomyosis and its symptoms, but also general practitioners since they are usually the first doctor a patient will see. Also gastroenterologists and urologists need to be aware of this disorder and refer patients to specialists who treat adenomyosis if they suspect the patient may be suffering from this uterine disorder.