Adenomyosis, this “intrinsic endometriosis” is poorly recognized by medicine

Health – Have you ever heard of adenomyosis? This pathology, which can affect more than 10% of women according to statistics from the Endofranc Association, is also often called “internal endometriosis”. Because if endometriosis spreads outside the uterine cavity, adenomyosis is internal to the uterus.

Like endometriosis, there are no life-threatening consequences for a person suffering from adenomyosis, but it can be very painful and can cause fertility problems. Focus on this pathology that is still little understood and little studied.

What is adenomyosis?

According to the multidisciplinary Franco-European Institute of Endometriosis, a private care structure dedicated exclusively to the management of endometriosis, adenomyosis is defined by a. “A series of changes that occur strictly within the uterus, leading to the presence of the lining of the uterus (endometrium) within the muscular layer of the uterus (myometrium). Although it is known to mainly affect people in their forties who have already had several children, a third of adenomyosis diagnoses concern women under the age of 30.

The High Authority of Health emphasizes that even if the two pathologies are different, adenomyosis and endometriosis are often associated, suggesting that they have “common origin” Not identified. They do not necessarily go together: adenomyosis is possible without endometriosis, and vice versa.

Symptoms of adenomyosis

The MSD Manual of Medical Knowledge describes the recognized symptoms of adenomyosis, including: “Heavy and painful menstruation (dysmenorrhea)”No “Unexplained pain in the pelvic region” And “Feeling of pressure on bladder and rectum”. Pain during sexual intercourse and pain during menstruation are also mentioned among the symptoms of adenomyosis.

A study published in the Journal of the Canadian Medical Association states that 30% of women with adenomyosis are asymptomatic. Other forms can be extremely painful and disabling, although research has not yet established why. Additionally, a study conducted on 1,865 patients undergoing IVF reported a higher rate of miscarriage in those suffering from adenomyosis. On this point, the High Authority of Health remains cautious, and warrants it “Adenomyosis appears to have a negative effect on pregnancy rates, but it is difficult to assess the role of adenomyosis in cases of associated endometriosis. Furthermore, the diagnosis of adenomyosis remains poorly defined. »

The report conditionally specifies that “ Miscarriage rates seem to be higher in adenomyosis cases.”

Diagnosis of adenomyosis

Adenomyosis is one of the pathologies that are difficult to recognize. Indeed, to make a diagnosis with certainty, it is necessary to analyze the tissue of the uterus, which can only be obtained by hysterectomy (removal of the uterus), which is not possible for people who want to become pregnant.

Some indicators can still make it possible to diagnose adenomyosis with certain precision, especially in pelvic ultrasound and MRI images. Indeed, adenomyosis causes an overall increase in uterine volume that then takes on a rounded appearance, which can be identified on imaging.

Treatment of adenomyosis

Currently, treatment against adenomyosis makes it possible to limit the symptoms without affecting the root of the pathology. Patients may be offered a hormonal intrauterine device or even the use of birth control pills to regulate their cycles. If these treatments fail, a hysterectomy may be recommended for people who do not (or want) pregnancy for a long time.

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