ADENOMIOSIS: DOES IT IMPACT FERTILITY?

Adenomyosis is a condition that affects a relatively large proportion of women of reproductive age. It presents with symptoms that include painful, heavy periods, unusually long periods, severe pelvic pain and painful intercourse. Adenomyosis also causes an enlarged uterus and can lead to infertility, recurrent miscarriage or preterm birth. In adenomyosis, endometrial tissue that forms in the lining of the uterus invades and grows into the wall of the uterus, specifically into the myometrium, which is the muscular wall of the uterus. This tissue causes the uterus to swell to twice or even three times its normal size.

Diagnosing adenomyosis

Adenomyosis is most often diagnosed when a woman seeks medical help for one of its symptoms, such as severe pain, irregular periods, inability to conceive or repeated miscarriages. If adenomyosis is suspected, the specialist will confirm the diagnosis using the following tests:

• Pelvic examination: Your doctor may notice that you have an enlarged uterus that is softer and tender on palpation.
• Transvaginal ultrasound: Using sound waves to image your pelvic organs can show thickening of the muscular wall of the uterus.
• MRI scan: An MRI scan can show thickening of the uterine wall or enlargement of the uterus, which is usually suggestive of adenomyosis.
• Biopsy: In severe cases and as a last resort, a biopsy of the uterus proves adenomyosis, but this can only be done after a hysterectomy (removal of the uterus).

Causes, treatment and possible risks

Because the symptoms of adenomyosis are similar to those of other conditions, such as endometriosis and uterine fibroids, a medical diagnosis is essential. Most cases of adenomyosis occur in women over 35. The growth of the tissue inside the uterine wall depends on oestrogen, so treatment may include hormonal medication. Doctors also consider other treatment options, including uterine artery embolisation.

The exact cause of adenomyosis is not known; however, many researchers believe the condition could be due to the following:

• Invasive tissue growth, which occurs when cells invade the muscle of the uterine wall.
• Inflammation of the uterus after childbirth may cause a break in the lining of the uterus and allow cells to invade.
• Fetal development may lead to abnormal placement of endometrial tissue.

Risk factors for developing adenomyosis include:

• Previous uterine surgery, such as a D&C, removal of uterine fibroids or a caesarean section.
• Childbirth
• age over 35; recently, however, doctors have seen an increase in diagnoses of adenomyosis in younger women.

How adenomyosis affects your fertility

Recent studies show that adenomyosis often occurs alongside other conditions that affect fertility, such as endometriosis, uterine polyps and fibroids. Adenomyosis on its own can affect implantation and the receptivity of the uterine lining, and could potentially distort the fallopian tubes, preventing fertilisation. As mentioned above, if you become pregnant, you are at a much higher risk of miscarriage or preterm birth than normal. That is why it is so important to work with a specialist if you have been diagnosed with adenomyosis.

The most successful way to conceive and carry a pregnancy is through IVF combined with GnRH agonists (Lupron). Lupron is a successful way of reducing oestrogen and slowing the growth of adenomyosis, improving the chances of implantation through IVF. However, because the condition carries twice the risk of miscarriage, in many cases surrogacy is indicated, together with IVF using your own eggs and your partner's sperm.

Living with adenomyosis

If you have been diagnosed with adenomyosis, you know that the condition itself can bring changes to your life. The pain and heavy bleeding make it hard to make plans, those gruelling periods leave you exhausted, and worries about fertility are added on top of it all. This is the time to be as kind to yourself as possible and, by all means, to seek specialist medical help. Although much is still being discovered and understood about adenomyosis in the medical community, it is important to find a team who will care for you and help you on your journey. As with any medical diagnosis, your experience is your own and unique to you. Contact the “Dr. Alexandros Traianos” Reproductive Medicine Centre today and together we will help you find the answers you are looking for. For information, call ☎️(+30) 2310 277 032 or send a message to 📧email alexandrostraianos@gmail.com.