Adenomyosis

The severity of symptoms varies greatly from one patient to another. In about one-third of cases, the disease remains asymptomatic. However, when symptoms are present, they can be particularly debilitating. The most commonly reported complaints include very heavy and prolonged periods, as well as intense pelvic pain during menstruation (dysmenorrhea). Some women also report chronic pelvic pain or pain during sexual intercourse (dyspareunia). In advanced cases, the uterus may become palpable due to its enlargement, causing a feeling of heaviness or pressure in the lower abdomen.

To date, the exact cause of adenomyosis has not been formally identified. Several explanations have been put forward by specialists. The most widely accepted hypothesis is that the inner lining of the uterus—which renews itself with each menstrual cycle—could, for various reasons, abnormally penetrate the muscular layer of the uterus. This can occur following surgery on the uterus (such as a cesarean section or curettage), which weakens the natural boundary between these two tissues.
Another theory suggests that, as soon as the uterus forms in the fetus, some cells remain “misaligned” and later turn into endometrial tissue in the wrong place, i.e., in the uterine muscle. This could explain why some very young women also have forms of adenomyosis.
Recent research has also shown the presence of small genetic abnormalities in the endometrial tissue of some affected women. These alterations, present only in the cells concerned, may play a role in the onset and persistence of the disease by promoting local inflammation or making hormonal treatments less effective.

Current research reveals a clear association between adenomyosis and several reproductive, hormonal, and surgical factors. One of the most frequently reported factors is a history of uterine surgery, including cesarean sections, dilation and curettage, or procedures for fibroids. These procedures may weaken the junction between the endometrium and myometrium, facilitating cell invasion.
The number of pregnancies, particularly those carried to term, also appears to play a role. The more pregnancies a woman has had, the higher her risk, especially if the first pregnancy occurred before the age of 25. This prolonged exposure to high levels of estrogen during pregnancy may promote the myometrial changes associated with adenomyosis.
Other hormonal factors are involved, such as early menarche (before age 11), short menstrual cycles (less than 24 days), or previous use of combined oral contraceptives. Finally, a high body mass index is also correlated with increased prevalence.

The diagnosis of adenomyosis remains a clinical challenge due to the non-specific nature of its symptoms, which are often confused with other gynecological conditions such as uterine fibroids or endometriosis. Traditionally diagnosed after hysterectomy via histological analysis, it can now be suspected non-invasively using imaging techniques.
A gynecological examination may reveal an enlarged uterus that is sensitive to palpation. Transvaginal ultrasound is often the first step in the assessment. It may reveal a thickened, heterogeneous myometrium or intramyometrial cysts. Pelvic MRI is more accurate, particularly in measuring the thickness of the junctional zone, a key indicator for diagnosis. A thickness greater than 12 mm is highly suggestive of adenomyosis.
However, histology remains the only formal means of confirmation, performed on surgical specimens after hysterectomy, which limits its usefulness in conservative diagnoses. Endometrial biopsies, on the other hand, have no diagnostic value in this context.

The treatment of adenomyosis depends largely on the patient's age, the severity of symptoms, and the desire to preserve fertility. In mild cases or cases close to menopause, a wait-and-see or symptomatic approach may be sufficient. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended as a first-line treatment to relieve menstrual pain and reduce blood flow.
Hormonal treatments play an important role. Progestin-based intrauterine devices (such as levonorgestrel), continuous combined oral contraceptives, and GnRH analogues can control symptoms and even induce beneficial amenorrhea. However, these solutions are temporary and their effects cease when treatment is stopped.
For patients who no longer wish to become pregnant and suffer from severe forms of the condition, hysterectomy is the definitive treatment. It is the only known curative option to date. Less invasive techniques such as uterine artery embolization or radiofrequency ablation are still being studied and used with caution. As each situation is different, a thorough discussion with a specialist is essential in order to choose the best option.

Adenomyosis is a benign condition, but it can significantly impair quality of life when symptomatic. Without treatment, symptoms may worsen over time, particularly in premenopausal patients. Heavy menstrual bleeding can lead to chronic iron deficiency anemia, which is often responsible for persistent fatigue and difficulty concentrating.
Chronic pelvic pain is another common complication, which can sometimes be debilitating on a personal and professional level. Some patients also develop dyspareunia, which affects their sex life. In addition, recent studies have highlighted a link between adenomyosis and infertility. Ectopic endometrial tissue impairs uterine contractility, interferes with embryo implantation, and contributes to higher rates of spontaneous miscarriage.
Adenomyosis is often associated with other gynecological conditions such as uterine fibroids or endometriosis, which complicates management. This association multiplies the symptoms and requires a multidisciplinary therapeutic approach.

There is no sure way to prevent adenomyosis. However, limiting certain procedures on the uterus (such as repeated curettages or surgeries) when they are not strictly necessary could reduce the risk. Similarly, regular medical check-ups can help detect abnormalities earlier and adapt treatment accordingly.
Finally, adopting a balanced lifestyle, with a healthy diet, regular physical activity, and good hormonal monitoring, could also help limit certain risk factors, although this does not guarantee the absence of disease.

It is recommended to consult a gynecologist if you experience very heavy, prolonged, or irregular periods, intense pain during menstruation or sexual intercourse, or persistent discomfort in the lower abdomen.
You should also consult a doctor if you have been trying to conceive for several months without success, or if you experience unusual fatigue due to heavy blood loss. Prompt treatment can often relieve symptoms and prevent more serious complications.

At Hôpital de La Tour, women with adenomyosis receive comprehensive, personalized care. The hospital provides specialized medical teams trained in complex gynecological conditions and state-of-the-art equipment to ensure accurate and rapid diagnosis.

Thanks to collaboration between gynecologists, radiologists, anesthesiologists, and fertility specialists, each patient receives personalized care tailored to her symptoms, age, and desire to become pregnant. Treatment options may include regular medical follow-up, hormonal options, or, when necessary, surgery.

Is adenomyosis the same as endometriosis?
No. Although they are often associated, adenomyosis and endometriosis are two distinct conditions. Adenomyosis is characterized by the presence of endometrial tissue in the myometrium, the muscular wall of the uterus, while endometriosis involves endometrial implants outside the uterus, often in the pelvic cavity. Both can coexist in the same patient, but they require specific diagnostic and therapeutic approaches.

Is it possible to get pregnant with adenomyosis?
Yes. Many women with adenomyosis are able to conceive naturally. However, this condition can complicate fertility by altering the structure of the uterus and disrupting embryo implantation. In cases where infertility is observed, a specialized evaluation is recommended in order to propose appropriate treatments.

What is the most effective treatment?
The most effective and definitive treatment is hysterectomy, which is reserved for women who no longer wish to become pregnant. However, there are many medical alternatives available to relieve symptoms, including hormonal intrauterine devices, continuous oral contraceptives, GnRH analogues, etc. The choice depends on the severity of the symptoms and whether the woman wishes to become pregnant.

How is adenomyosis diagnosed?
The diagnosis is based mainly on pelvic imaging. Transvaginal ultrasound allows for an initial assessment, while MRI provides a better view of the uterine junction area. In some cases, a formal diagnosis is still based on analysis of the uterus after hysterectomy.

At what age does adenomyosis usually appear?
It is most commonly diagnosed between the ages of 35 and 50, but it can also affect younger women, particularly in its juvenile cystic form. Improvements in imaging techniques now make it possible to detect the disease earlier, including in symptomatic adolescents.

Does adenomyosis disappear after menopause?
In most cases, yes. Adenomyosis is a hormone-dependent disease, stimulated by estrogen. After menopause, the drop in hormone levels often leads to a regression of symptoms or even the complete disappearance of lesions.