Adenomyosis is a gynecological condition that often flies under the radar, with many women suffering in silence. It occurs when the endometrial tissue, which normally lines the uterus, begins to grow into the muscular wall of the uterus. This can cause a myriad of symptoms, some common and others less so, leading to a journey filled with challenges and the quest for relief. In this blog, we’ll explore the symptoms, diagnosis, traditional and non-traditional treatments for adenomyosis, and how to advocate for yourself if you suspect you have this condition.

Symptoms: The Known and The Lesser-Known

Adenomyosis is known for causing severe menstrual cramps, heavy menstrual bleeding, and pain during intercourse. However, it can also manifest in less common ways such as chronic pelvic pain, extended menstrual cycles, and pain during bowel movements or urination. Some women may experience bloating and pressure in the lower abdomen, often described as a feeling of heaviness or fullness. Others explain it like something is tugging and pulling, this occurs with period and outside of this time. 

Diagnosing Adenomyosis

Diagnosing adenomyosis is notoriously difficult. It often starts with a detailed medical history and a physical examination. Ultrasound imaging can hint at adenomyosis, but it’s not definitive. Magnetic Resonance Imaging (MRI) is more accurate, as it can show the characteristic thickening of the uterine walls and the presence of endometrial tissue within the muscle. Again, it should be clear these are not the way to make or rule out this disease. A definitive diagnosis is only made during a laparoscopic procedure with an excision specialist and for others, it can be after a hysterectomy, when the uterus can be examined histologically.

Traditional Treatments

Traditional treatments for adenomyosis aim to alleviate symptoms since there is no cure for the condition itself outside of a hysterectomy. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain relief. Hormonal therapies, such as birth control pills, intrauterine devices (IUDs) with progestin, or GnRH agonists, aim to reduce menstrual bleeding and pain. In severe cases, surgical options like endometrial ablation or uterine artery embolization may be considered, although they can affect fertility. Far too often in my practice, I see the tragedy, yes tragedy, of young women in their 20s and 30s who have never had children OR never had intercourse before falling to a provider who jumped to a hysterectomy. I have so many ethical concerns on this topic, but I will save that for a different day. 

Non-Traditional Treatments

Non-traditional treatments for adenomyosis focus on managing symptoms and improving quality of life. Dietary changes, such as reducing inflammatory foods and increasing intake of omega-3 fatty acids, and other supplements, may help some women. Acupuncture and herbal remedies are also explored for pain management and hormonal balance. Physical therapy can be beneficial in managing pelvic pain. Low dose naltrexone is a compound prescription therapy used in our practice that yields successful results. A team approach to your care with this disease is key.

Low-dose naltrexone (LDN) is emerging as a promising option for managing adenomyosis and endometriosis pain and inflammation, despite being traditionally used for different indications. LDN works by temporarily blocking opioid receptors in the body, which in turn increases the production of endorphins—natural painkillers produced by the body. This increase in endorphins can help modulate the immune system and reduce inflammation, potentially alleviating some of the pain associated with endometriosis. Furthermore, LDN is thought to inhibit the growth of endometrial tissue by reducing the pro-inflammatory environment that allows endometriosis to thrive. While research on LDN for endometriosis is still in its early stages, initial findings and anecdotal evidence suggest it could be a valuable part of a comprehensive treatment plan, especially for those seeking alternatives to traditional hormonal therapies.

Advocating for Yourself

If you think you have adenomyosis but face challenges in getting diagnosed or finding treatment, advocating for yourself is crucial. Here are some steps to take:

  – Educate Yourself: Knowledge is power. Understand the symptoms, treatments, and diagnostic procedures related to adenomyosis.

  – Document Your Symptoms: Keep a detailed record of your symptoms, menstrual cycle, pain levels, and how they affect your daily life. Make sure to think back to when you first got your period as a young girl, what did that look like? If you were placed on birth control, what were the symptoms that caused you to be placed on it? This can be invaluable during medical appointments.

  – Seek Specialists: Consider seeking out a gynecologist who specializes in adenomyosis or endometriosis. An excision specialist may be more familiar with the condition, especially if you feel you may have endometriosis in addition to adenomyosis. Nancy’s Nook is a great place to start to learn more and find a surgeon.

  – Be Persistent: If you feel your concerns are not being taken seriously, don’t hesitate to seek a second opinion (or third, fourth, or fifth!). Your health and well-being are important, and YOU know your body best. What you are experiencing is real and valid.

  – Online communities and support groups can also provide a network of understanding and advice. Education is empowering—learning as much as possible can equip you for the best possible care.

Adenomyosis is a complex condition, but with the right approach, it’s possible to manage symptoms and improve quality of life. By understanding the condition, exploring all treatment options, and advocating for yourself, you can navigate the journey through adenomyosis with hope and resilience.