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.
More Great Links
- American Society for Reproductive Medicine (ASRM). "GnRH Analogs." (June 8, 2012) http://www.asrm.org/topics/detail.aspx?id=465
- American Society for Reproductive Medicine - ReproductiveFacts.org. "Quick Facts About Infertility." (June 8, 2012) http://www.reproductivefacts.org/detail.aspx?id=2322
- Centers for Disease Control and Prevention - National Vital Statistics System. "Estimated Pregnancy Rates by Outcome for the United States, 1990-2004." National Vital Statistics Reports. Vol. 56, no. 15. 2008. (June 8, 2012) http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_15.pdf
- Center for Reproduction & Women's Health Care. "Adenomyosis." (June 8, 2012) http://www.houstonfertilityspecialist.com/articles/art_adenomyosis.html
- Devlieger, Roland; D'Hooghe Thomas; and Dirk Timmerman. "Uterine adenomyosis in the infertility clinic." Human Reproduction Update. Vol. 9, no. 2. Pages 139-147. 2003. (June 8, 2012) http://humupd.oxfordjournals.org/content/9/2/139.full.pdf
- Levgur, Michael; Abadi, Maria A.; and Andrew Tucker. "Adenomyosis: Symptoms, Histology, and Pregnancy Terminations." Obstetrics & Gynocology. Vol. 95, no. 5. Pages 688-691. 2000. (June 8, 2012) http://journals.lww.com/greenjournal/fulltext/2000/05000/adenomyosis__symptoms,_histology,_and_pregnancy.11.aspx
- Lin, Jinfang; Sun, Cuixiang; and Huaimei Zheng. "Gonadotropic-releasing hormone agonists and laparoscopy in the treatment of adenomyosis with infertility." Chinese Medical Journal. Vol. 113, no. 5. Pages 442-445. 2000. (June 8, 2012) http://www.cmj.org/Periodical/paperlist.asp?id=LW7173
- Maheshwari, Abha; Gurunath, Sumana; Fatima, Farah; and Siladitya Bhattacharya. "Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes." Human Reproduction Update. 2012. (June 8, 2012) http://humupd.oxfordjournals.org/content/early/2012/03/22/humupd.dms006.full
- Martinez-Conejero, Jose A.; Morgan, Maika; Montesinos, Manel; Fortuno, Sara; Mesequer, Marcos; Simon, Carlos; Horcajadas, Jose A; and Antonio Pellicer. "Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation." Fertility and Sterility. Vol. 96, no. 4. Pages 943-950.e1. 2011. (June 8, 2012) http://www.fertstert.org/article/S0015-0282(11)02185-6/fulltext
- Mayo Clinic. "Adenomyosis." 2012. (June 8, 2012) http://www.mayoclinic.com/health/adenomyosis/ds00636
- The Merck Manual for Health Care Professionals. "Vaginal Bleeding" 2010. (June 8, 2012) http://www.merckmanuals.com/professional/gynecology_and_obstetrics/symptoms_of_gynecologic_disorders/vaginal_bleeding.html
- Newton-Wellesley Hospital. "Infertility." (June 8, 2012) http://www.nwh.org/clinical-centers/migs/conditions-treated/infertility/
- Taylor, Alison. "Extent of the problem." British Medical Journal. Vol. 327, no. 7412. Pages 434-436. 2003. (June 8, 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC188498/
- U.S. National Library of Medicine - MedlinePlus. "Adenomyosis." 2010. (June 8, 2012) http://www.nlm.nih.gov/medlineplus/ency/article/001513.htm
- Wang, Chin-Jung; Yuen, Leung-To; Chang, Shuenn-Dyh; Lee, Chy-Long; and Yung-Kuei Soong. ""Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosos." Fertility and Sterility. Vol. 86, no. 2. Pages 462.e5-462.e8. 2006. (June 8, 2012) http://www.fertstert.org/article/S0015-0282(06)00682-0/fulltext
- Wang, Peng-Hui; Su, Wen-Hsiang; Sheu, Bor-CHing; and Wei-Min Liu. "Adenomyosis and Its Variance: Adenomyoma and Female Fertility." Taiwanese Journal of Obstetrics & Gynecology. Vol. 48, no. 3. Pages 232-238. 2009. (June 8, 2012) http://download.journals.elsevierhealth.com/pdfs/journals/1028-4559/PIIS1028455909602953.pdf
- WebMD. "Endometriosis - Symptoms." 2009. (June 8, 2012) http://women.webmd.com/endometriosis/endometriosis-symptoms
- WebMD. "What Is Adenomyosis" 2010. (June 8, 2012) http://women.webmd.com/adenomyosis-symptoms-causes-treatments