Adenomyosis (or internal endometriosis) occurs when the tissue lining the uterus penetrates the myometrium (or muscular layer) of this organ. This condition affects fertility by interference with sperm transport or the embryo implantation process.
In-Vitro Fertilization (IVF) is the recommended treatment to achieve pregnancy in patients suffering from adenomyosis, since it allows our specialists to obtain the eggs directly from the patient’s ovaries.
These eggs are fertilized under controlled laboratory conditions to generate embryos with a higher implantation potential, which are then transferred back into the patient’s uterus.
In some cases, however, the patient will have to go through a previous gonadotropin-releasing hormone (GnRH) agonist treatment before proceeding with IVF.
During menstruation, the endometrial tissue inside the myometrium swells and bleeds in the same manner as the uterine wall. This causes blood to accumulate within the uterine muscle, where benign tumors, known as adenomyomas, can form.
Adenomyosis affects 1 percent of women, particularly those over 40 years of age who have given birth more than once.
It is important to understand that adenomyosis is not the same as endometriosis; however, over 10 percent of cases are accompanied by this disorder.
Although some adenomyosis cases do not affect fertility, this condition can interfere with sperm transport or the embryo implantation process.
Main adenomyosis symptoms
While adenomyosis may be asymptomatic, it is usually manifested through:
- Menorrhagia (excessively abundant/prolonged menstrual periods)
- Dysmenorrhea (painful menstrual periods)
- Dyspareunia (painful intercourse)
- Metrorrhagia (uterine bleeding between the expected menstrual periods)
- Anemia caused by heavy and frequent bleeding
- Lower back pain
The intensity of symptoms is related to the degree of endometrial tissue penetration into the uterine wall.
Although the specific cause of adenomyosis is unknown its growth is associated with ovarian hormonal activity and particularly with estrogen production
Women over 40 who have given birth more than once are more prone to develop adenomyosis, particularly if they have had a cesarean section or other uterine surgery.
How is adenomyosis diagnosed?
In addition to a physical examination and analysis of the medical history of the patient, diagnostic procedures for adenomyosis include:
- A pelvic examination, which may reveal an abnormally enlarged uterus and the presence of adenomyomas
- A transvaginal (or pelvic vaginal) ultrasound, in which the specialist carefully introduces an ultrasound probe into the patient’s vagina to examine her reproductive organs (uterus and ovaries). The transvaginal ultrasound is simple, painless and generally facilitates a clear diagnosis; however, additional tests may be required in some cases.
- Magnetic resonance imaging (MRI) can be useful when the ultrasound does not reflect a clear result.
Given that conditions such as endometriosis, uterine fibroids and uterine polyps can be confused with adenomyosis, these tests should be performed and interpreted by an experienced specialist, who will get the most information from these procedures.
Treatments to achieve pregnancy when you have adenomyosis
While adenomyosis affects sperm transport or the embryo implantation process, In-Vitro Fertilization (IVF) is the recommended treatment to achieve pregnancy in patients suffering from this condition, since it allows our specialists to obtain the eggs directly from the patient’s ovaries. These eggs are fertilized under controlled laboratory conditions to generate embryos with a higher implantation potential, which are then transferred back into the patient’s uterus .
Generally, adenomyosis does not affect In-Vitro Fertilization results of or the normal pregnancy progress; however, in some cases, women must undergo agonist gonadotropin-releasing (GnRH) hormone treatment, which provokes a temporary condition similar to menopause, in which the ovarian function and menstruation cease and the adenomyotic tissue reduces.
Generally, adenomyosis does not affect the results of in vitro fertilization and normal development of pregnancy. In some cases; however, the patient will have to go through a previous gonadotropin-releasing hormone (GnRH) agonist treatment, which causes a temporary state similar to menopause in which ovarian function and menstruation ceases and adenomyotic tissue reduces.
Once childbirth is achieved, women with severe symptoms may require a hysterectomy (surgical removal of the uterus); however, it is important to consider that adenomyosis symptoms disappear on their own after menopause.