Adenomyosis and Fertility

When adenomyosis strikes, here's what's going on: A woman's uterus is lined with endometrial tissue (called the endometrium), and when a woman has adenomyosis, her endometrium is growing in the wrong place -- into the muscular layer of the uterine wall (called the myometrium). This abnormal growth may cause heavy menstrual bleeding (sometimes with blood clots called menorrhagia), pelvic pain, painful menstruation and severe menstrual cramps (called dysmenorrhea) and painful sex, as well as vaginal bleeding between menstrual cycles [source: Mayo Clinic]. Sometimes, the condition causes an abnormal mass called an adenomyoma to grow in the uterus. And yet, some women have mild symptoms such as tenderness or bloating in the pelvic region, and as many as 35 percent of those affected actually don't seem to have any apparent symptoms at all [source: Levgur].

And the cause behind the condition? Here's where things begin to get a little fuzzy.

Women who have gone through childbirth seem to be at a higher risk for developing adenomyosis, possibly due to inflammation in the lining of the uterus after giving birth. The risk also appears to increase for women who have given birth via cesarean section (c-section), terminated a pregnancy, undergone fibroid removal or had any other type of uterine surgery.

Current research is exploring a few possible causes behind the disorder, including uterine inflammation as mentioned above, invasive tissue growth and a theory known as developmental origins. The developmental origins theory suggests women with adenomyosis suffer from the condition because of how their uterus formed during fetal development. The invasive tissue growth theory suggests that when a woman undergoes uterine surgery, such as a c-section or a myomectomy to remove fibroids, cells from her uterine lining may unintentionally get pushed into the myometrium, triggering the condition.

Adenomyosis may also be hormone-triggered, an estrogen-dependent disorder caused by high levels of estrogen, progesterone, prolactin and follicle-stimulating hormone (FSH) circulating in the body. Women with the hormone-triggered version of the condition usually find it resolves itself once they hit menopause and their estrogen levels drop.

There are treatments for the condition, or at least ways to ease the symptoms.

What studies have shown is that adenomyosis occurs most often in women who are between 40 and 50 years old, at the very end of their childbearing years or beyond them, but as many as 15 to 25 percent of women who are still in their reproductive years, usually in their 30s, may have the condition as well [source: The Center for Reproduction & Women's Health Care].

Adenomyosis is not harmful, but when women in their childbearing years develop the condition it may affect their fertility. Recent research has found that women with adenomyosis have higher miscarriage rates than women without the condition, as much as double the risk of pregnancy loss, and they also appear to have an increased risk of premature labor and abruptio placentae (a condition when the placenta detaches from the uterine wall during pregnancy) [source: Martinez-Conejero, Levgur, Maheshwari]. While there seems to be a link between impaired fertility and adenomyosis, researchers have yet to put their finger on what about adenomyosis reduces the chances of conception and a good pregnancy outcome.

At this time, the only treatment available to cure adenomyosis is a hysterectomy. But, for women who want to try to avoid or delay such a radical treatment (for example, women who want to try to become pregnant as well as women who are approaching menopause), there are more conservative ways to try to mitigate some of the symptoms.

Alternative treatments often include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help lessen the pain and lighten monthly periods. Some women successfully ease their symptoms and can even shrink an enlarged uterus with hormones, including birth control pills, anti-estrogens and/or progesterone supplements. Women trying to get pregnant may find that gonadotropin releasing hormone agonists (GnRH-a), such as Lupron, or aromatase inhibitors help reduce symptoms, while preserving and perhaps improving fertility.

Women who want to get pregnant may also consider non-hysterectomy surgical options such as cytoreductive surgery, laparoscopic surgery, uterine artery embolization (which shrinks the damage by cutting off the blood flow to the affected area) and endometrial ablation (which reduces or removes the lining of the uterus). A relatively new non-invasive procedure called magnetic resonance-guided focused ultrasound (MRgFUS) -- in which a concentrated burst of ultrasound energy destroys damaged cells without harming surrounding tissue -- also shows promise as a fertility-restoring treatment for women with adenomyosis who want to become pregnant.