Adenomyosis vs. Endometriosis

Endometrial cells that line the uterus may grow outside the organ, leading to menstrual pain.

Uterine adenomyosis is a condition in which the inner lining of the uterus grows into the muscle wall of the uterus (myometrium) causing heavy, painful menstrual periods.

Adenomyosis is often seen with other uterine problems such as endometriosis. Endometriosis is a condition in which endometrial cells (the lining of the uterus) grow outside of the uterus. Both adenomyosis and endometriosis cause pain, but endometriosis does not usually result in heavy menstrual periods.

Symptoms of adenomyosis and endometriosis that are similar include painful menstrual cramps, pelvic pain, back pain, and painful sexual intercourse.

Symptoms of adenomyosis that are different from endometriosis include heavy periods, prolonged menstrual bleeding, lower abdominal pain or tenderness, leg pain, pelvic pressure, abdominal bloating/swelling, and blood clots in the pelvis and legs.

Symptoms of endometriosis that are different from adenomyosis include intestinal pain, painful bowel movements, painful urination during menstrual periods, bleeding or spotting between menstrual periods, infertility, digestive problems (diarrhea, constipation nausea, and bloating), infertility, and blood in the stool or urine (rare).

Along with a medical history and pelvic examination, diagnoses of adenomyosis or endometriosis are made through imaging such as transvaginal ultrasound or magnetic resonance imaging (MRI).

The only true diagnosis of adenomyosis can be made based on pathology of the uterus which is evaluated after a hysterectomy (removal of the uterus). For endometriosis, laparoscopic surgery may be performed to look inside the pelvic area to see endometriosis tissue. Surgery is the only way to confirm endometriosis.

The only cure for adenomyosis is surgical removal of the uterus called a hysterectomy. Treatment options for adenomyosis that may reduce heavy bleeding include intrauterine devices (IUDs), specifically one which releases the hormone progestin, endometrial ablation, and uterine artery embolization. Treatments for adenomyosis pain include birth control pills, over-the-counter (OTC) pain medications such ibuprofen (Advil and Motrin) or naproxen (Aleve), and the prescription medication leuprolide (Lupron, Eligard).

There is no cure for endometriosis, but there are treatments for the symptoms. Hormonal birth control is generally the first line treatment. Over-the-counter (OTC) pain medications such ibuprofen (Advil and Motrin) or naproxen (Aleve) and alternative treatments such as acupuncture, chiropractic, and herbal supplements may be recommended. Surgery is reserved for severe symptoms, whereby areas of endometriosis are removed.

Women with adenomyosis may be at higher risk of developing endometrial and thyroid cancers and women with endometriosis may be at higher risk of developing ovarian and breast cancers.

Adenomyosis

A hysterectomy to remove the uterus will cure adenomyosis, and women will have no further symptoms.

Women with adenomyosis may be at higher risk of developing endometrial and thyroid cancers.

In women who do not have a hysterectomy, it is not clear whether adenomyosis affects fertility. Some studies show it decreases fertility and other studies show it has no effect on getting pregnant. It is believed the severe inflammation caused by adenomyosis may inhibit implantation of an embryo into the uterine lining, preventing pregnancy from occurring.

Endometriosis

Endometriosis is a chronic condition. If a woman develops this disease, she will benefit from developing a long-lasting relationship with her doctor or gynecologist, who can direct her treatment and follow her response to therapy.

Women experience a wide variety of responses to medical and exercise therapy. Responses range from complete resolution of symptoms to no relief and further progression of the disease. Hysterectomy with removal of the ovaries essentially causes menopause, and women who have this procedure can expect a considerable decrease in symptoms.

Studies have shown women who have endometriosis are more likely than other women to have disorders in which the immune system attacks the body's own tissues. These include:

• Lupus
• Sjögren syndrome
• Rheumatoid arthritis (RA)
• Multiple sclerosis (MS)

Researchers also found that women with endometriosis are more likely to have chronic fatigue syndrome and fibromyalgia (a disease involving pain in the muscles, tendons, and ligaments).

• Women with endometriosis are more likely to have asthma, allergies, and eczema (a skin condition).
• Hypothyroidism (an underactive thyroid gland) is more common in women with endometriosis.

Women with endometriosis also have a mildly increased risk for development of certain types of cancer of the ovary. This risk seems to be highest in women with endometriosis and primary infertility (those who have never borne a child), but the use of oral contraceptive pills appears to significantly reduce this risk.

• Infertility: Endometriosis is known to be a common cause of infertility in women, but it does not always cause infertility.
• Research has shown that many women with untreated endometriosis have a decreased ability to conceive.
• Issues concerning infertility are best discussed with a doctor, gynecologist, or fertility specialist; who can guide a woman toward appropriate treatment options.