Endometriosis & Adenomyosis: Symptoms, Diagnosis, Treatment

What is endometriosis?

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus, such as on the ovaries, fallopian tubes, or other organs in the pelvic cavity.

Approximately one in ten women are affected by endometriosis. If your mother or sister had endometriosis, you are more likely to develop the condition. Endometriosis typically affects reproductive-aged women. It may be a chronic condition that significantly affects your general physical health, emotional well-being, and daily routine.

What is adenomyosis?

In adenomyosis, the tissue that normally lines the inside of the uterus grows into the muscular wall of the uterus. It may affect the entire uterus or one part of the uterus.

Adenomyosis is not a life-threatening condition; however, the symptoms can impact your daily life. Hence, it is crucial to receive proper medical attention.

So, is endometriosis the same as adenomyosis?

Endometriosis and adenomyosis are two distinct medical conditions that affect the uterus and can cause similar symptoms, but they are not the same.

In endometriosis, the endometrial tissue that normally lines the inside of the uterus grows outside of the uterus.
In adenomyosis, the endometrial tissue that normally lines the inside of the uterus grows into the muscular wall of the uterus.

It is possible for a woman to have both conditions simultaneously. While the two conditions share some similarities, they have distinct differences too.

What are the risk factors of endometriosis and adenomyosis?

Endometriosis and adenomyosis are both conditions that affect the uterus and can cause significant pain and discomfort. While the exact causes of these conditions are not fully understood, several potential factors may contribute to their development.

Condition	Endometriosis	Adenomyosis
Risk factors	Age: Commonly seen in younger women. Family history: Endometriosis often occurs in families. Women with a first-degree relative (mother, sister) with endometriosis have a higher risk of developing the condition. Uterine abnormalities: Some uterine abnormalities, such as a retroverted uterus, may increase the risk. Hormonal imbalances: Elevated oestrogen levels or an imbalance between oestrogen and progesterone may contribute to endometriosis.	Age: Women aged between 40 and 50. Previous pregnancies: Women who have had multiple pregnancies may be at higher risk. Uterine surgery: Women who have had a previous uterine surgery may be at higher risk. Hormonal imbalances: Some hormonal imbalances, such as excess oestrogen production, may increase the risk. Genetic factors: Genetic predisposition plays a role, with adenomyosis often occurring in families.

What are the symptoms of endometriosis and adenomyosis?

The symptoms of endometriosis and adenomyosis can vary from person to person, and some women may not experience any symptoms at all.

Endometriosis	Adenomyosis
Pelvic pain that worsens during your period Painful periods (dysmenorrhea) Pain during or after sexual intercourse Painful bowel movements or urination, especially during menstruation Difficulty getting pregnant (infertility) Fatigue, bloating, constipation, diarrhoea, or nausea, especially during menstruation	Pelvic pain that worsens during your period Heavy or prolonged menstrual bleeding during menstruation, which can last longer than usual Painful periods (dysmenorrhea) Pain during or after sexual intercourse

How are endometriosis and adenomyosis diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Pelvic examination
- Your doctor would manually palpate the pelvic area to check for abnormalities or tender areas.
Imaging tests
- Ultrasound: Transvaginal ultrasound is often the initial imaging test to evaluate the uterus and pelvic organs. It can help identify structural abnormalities, such as uterine enlargement or the presence of uterine masses.
- Magnetic resonance imaging (MRI): May be recommended for a more detailed assessment of the uterus and surrounding tissues. It can provide clearer images of the extent and location of endometrial tissue or adenomyotic lesions.
Laparoscopy
- Laparoscopy is a minimally invasive surgical procedure.
- The doctor will insert a thin, lighted tube with a camera through a small incision in the abdomen to view the pelvic organs and take a tissue sample for biopsy.
Biopsy
- A tissue sample taken during laparoscopy can be examined under a microscope to confirm the presence of endometrial tissue outside the uterus or within the uterine muscle.

What are the treatment options for endometriosis and adenomyosis?

The treatment options for endometriosis and adenomyosis depend on the severity of the symptoms and the individual's goals, such as improving fertility or relieving pain.

Here are some treatment options for endometriosis and adenomyosis:

Pain medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help relieve menstrual pain associated with endometriosis and adenomyosis.
Hormonal therapy: Hormonal treatments such as birth control pills, progestins or Gonadotropin-Releasing Hormone (GnRH) agonists can help regulate hormonal imbalances that cause endometriosis and adenomyosis symptoms.
Surgery:
- Laparoscopy: Excision or removal of endometriotic lesions through laparoscopy can provide long-term relief from symptoms and improve fertility in some cases. This approach is often considered for endometriosis.
- Hysterectomy: In severe cases of endometriosis or adenomyosis, when other treatments have not been effective or fertility is no longer a concern, a hysterectomy (removal of the uterus) may be recommended.
Fertility treatments: If endometriosis or adenomyosis is causing infertility, fertility treatments such as medication to induce ovulation, intrauterine insemination (IUI) or in vitro fertilisation (IVF) can be used to improve the chances of pregnancy.

Can I get pregnant if I have endometriosis or adenomyosis?

Yes, it is possible to get pregnant if you have endometriosis or adenomyosis, but it may be more challenging. Both conditions can affect fertility due to scarring, inflammation, and hormonal imbalances that interfere with ovulation and implantation of a fertilised egg.

If you have endometriosis or adenomyosis and are trying to conceive, you should consult a doctor specialising in fertility or reproductive health. They can assess your situation, provide guidance on potential fertility challenges, and discuss available treatment options or assisted reproductive technologies that may improve your chances of getting pregnant.

Book an appointment at Pantai Hospitals

Take charge of your reproductive health today. Early detection of endometriosis and adenomyosis paves the way for effective and appropriate treatment.

A dedicated and expert team of obstetricians and gynaecologists at Pantai Hospital is available for consultation to provide patients with the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions about endometriosis and adenomyosis.

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