April is adenomyosis awareness month, so there is much discussion around the place about the condition. But what the ouch is adenomyosis? Gynaecologist Dr Nicole Edge explains the condition and how it can affect fertility in women.

Adenomyosis is a gynaecological condition where the lining of the uterus (endometrium) invades into the muscle of the uterus (myometrium). There are two types: it is called an ‘adenomyoma’ if only a section of the muscle is involved, and ‘diffuse adenomyosis’ when all the uterine muscle is involved.

We think 20 – 35 % of women have adenomyosis, but the true rates aren’t really known, as originally it was only diagnosed when a pathologist assessed the uterus after a hysterectomy (surgical removal of the uterus). This also led us to believing it was a condition of older women, but it may just be older women are more likely to have a hysterectomy than younger women.

How is adenomyosis diagnosed?

As ultrasound quality improves and MRI becomes more accessible, a greater number of younger women are being diagnosed with adenomyosis. You are more likely to have adenomyosis if you have had a baby before, are a smoker or have had uterine surgery such as a caesarean or curette.

What are the symptoms and treatment of adenomyosis?

Symptoms often include heavy periods, painful periods or painful sex. However about 1 in 3 women with the condition don’t have any symptoms.

Treatment for adenomyosis has traditionally been to stop menstruation by using the ‘the pill’, some types of IUCDs, or having a hysterectomy. Clearly these are not appropriate treatment options if you are trying to get pregnant or want to have a baby in future.

There are some surgical techniques being studied that are aiming to treat the adenomyosis but preserve the uterus; they are still considered ‘experimental’. It is not yet confirmed if they are beneficial and they are associated with possible complications during pregnancy such as uterine rupture and the placenta attaching abnormally.

Another option for symptom management is non-steroidal anti-inflammatories, such as ibuprofen. If taken regularly during menstruation they can help ease pain and may even reduce the volume of your bleeding. Do not use them if you think you might actually be pregnant but they are safe to use during your period.

What is the impact of adenomyosis on fertility?

The impact adenomyosis may have on fertility has been hard to study as, not only was diagnosis difficult, but it often happens in women who also have endometriosis or fibroids. So it can be tricky to determine which condition, or combination of conditions, is causing the problem.

While further investigation is needed to confirm, there is building evidence that adenomyosis is associated with more trouble getting pregnant, higher chances of a miscarriage in the first trimester and lower success rates with IVF.

There are many theories as to why adenomyosis might cause these problems, including distorting the uterine cavity leading to the fallopian tube(s) becoming blocked, disrupting the way the uterine cavity ‘contracts’ to help sperm move towards the tubes, producing too much oestrogen in the endometrium and causing an inflammatory reaction which ultimately reduces the likelihood of an embryo implanting.

There is promising research that IVF success rates can be improved by using a medication to suppress your hormones for a few months prior to an embryo transfer. Unfortunately, this does not work for women trying to conceive naturally.

If you are concerned you may have adenomyosis, or wish to discuss this condition further, please talk to your GP, Gynaecologist, or get in touch with the doctors here at Embrace Fertility.

– Dr Nicole Edge Gynaecologist / Fertility Specialist / Obstetrician MBBS FRANZCOG GCertBiostat MRMed