The uterus is one of the most important organs of the female reproductive system and it is the key to a healthy pregnancy. In some cases, however, changes in the structure of the uterus can both lower a woman's quality of life and reduce her chance of conceiving. Adenomyosis is one of these conditions. It causes the wall of the uterus to thicken and its function to deteriorate, and it affects the lives of a great many women. For couples who are planning a pregnancy, the relationship between adenomyosis and pregnancy is a particular source of curiosity. In this article, Prof. Dr. Mehmet Çınar looks in detail at what adenomyosis is, its symptoms, how it differs from endometriosis, how it is diagnosed and how it affects the chance of pregnancy. Our aim is to shed light on the subject for patients who want to understand it, and to offer a hopeful journey guided by accurate information.
Symptoms of Adenomyosis
Adenomyosis is a condition in which the cells that make up the inner lining of the uterus (the endometrium) grow into the muscular wall of the uterus (the myometrium). This causes the uterus to enlarge and thicken. The symptoms of adenomyosis vary from person to person: some women have no symptoms at all, while others experience quite severe complaints. The most common symptoms are:
- Severe and painful menstrual bleeding (dysmenorrhoea): The pain felt during menstruation may be cramping in nature and is far more severe than ordinary period pain. It can spread from the groin to the lower back or the legs.
- Heavy and prolonged menstrual bleeding (menorrhagia): Periods may be heavier and last longer than usual, which can lead to anaemia.
- Pelvic pain: Chronic pelvic pain, which can also be felt outside menstruation, is common in women with adenomyosis. Pain during sexual intercourse (dyspareunia) may also occur.
- Enlargement and tenderness of the uterus: Adenomyosis can cause the uterus to enlarge and to feel tender on examination. This may create a sensation of fullness or pressure in the abdomen.
- Infertility or recurrent pregnancy loss: By disrupting the internal structure and function of the uterus, adenomyosis can make it harder for a pregnancy to occur or to continue.
Women who experience one or more of these symptoms should always consult a specialist so that the correct diagnosis can be made and appropriate treatment started.
How It Differs from Endometriosis
Although adenomyosis and endometriosis both involve problems with endometrial tissue, the two conditions are different and are often confused with one another. The essential difference lies in where the endometrial tissue is found:
- Adenomyosis: Endometrial tissue settles within the muscular layer of the uterus (the myometrium). In other words, the growth takes place inside the uterine wall itself. This causes the uterus to grow and thicken from the inside outwards.
- Endometriosis: Endometrial tissue settles outside the uterus, on other organs within the abdominal cavity (such as the ovaries, the tubes, the bowel or the bladder). In endometriosis the uterus itself is usually of normal size, but the tissue lying outside it also bleeds with the menstrual cycle and can lead to inflammation, cyst formation (chocolate cysts) and adhesions.
Both conditions can produce similar symptoms (painful periods, pelvic pain, infertility), but the approach to diagnosis and treatment may differ. Many women have adenomyosis and endometriosis at the same time, which can make the picture more complex. A detailed assessment is therefore essential for an accurate diagnosis.
Diagnostic Methods
A diagnosis of adenomyosis is made by combining the patient's complaints, a physical examination and imaging studies. Although a definitive diagnosis is usually made through pathological examination of uterine tissue removed at surgery, non-surgical methods can also diagnose the condition with a high degree of accuracy:
- Physical examination: During a gynaecological examination the uterus may feel larger than normal, tender and soft.
- Transvaginal ultrasound (TVUS): This is the most frequently used and first-choice imaging method in the diagnosis of adenomyosis. An experienced ultrasound specialist can detect thickening of the uterine wall, cystic areas or a heterogeneous appearance. Three-dimensional ultrasound in particular can increase the accuracy of the diagnosis.
- Magnetic resonance imaging (MRI): MRI is preferred when a diagnosis cannot be made with ultrasound or when a more detailed assessment is required. It supports the diagnosis by showing the adenomyosis foci within the muscular layer and the overall structure of the uterus more clearly.
- Hysteroscopy: In this procedure the inside of the uterus is inspected with a camera, and it can be used to rule out possible polyps or fibroids on the inner wall. Because adenomyosis itself lies within the muscular layer, however, hysteroscopy alone is usually not enough to make the diagnosis. It is nevertheless useful for assessing accompanying pathologies inside the uterus. (You can find out more about our Laparoscopy & Hysteroscopy services.)
- Biopsy (rare): Rarely, when a diagnosis cannot be reached by other means or when another accompanying pathology is suspected, a biopsy may be taken from the uterus. Because adenomyosis is deep-seated, however, this does not always give a definitive result.
An accurate and detailed assessment during the diagnostic process is critically important for treatment planning. Prof. Dr. Mehmet Çınar and our team at the Ankara IVF Center use modern diagnostic methods with the aim of giving our patients the most accurate diagnosis possible.
Treatment and Pregnancy Planning
Once adenomyosis has been diagnosed, the treatment plan is tailored to the individual according to the patient's age, the severity of her symptoms, her wish to have children and her general state of health. Because adenomyosis affects the chance of pregnancy, treatment approaches may differ for couples who are planning to conceive.
Symptom Management and Medical Treatments
- Painkillers: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to relieve period pain.
- Hormonal treatments: Hormonal medications such as the contraceptive pill, progesterone-releasing intrauterine devices (IUDs) or GnRH analogues can help reduce menstrual bleeding and bring pain under control. Although these treatments relieve the symptoms, they do not eliminate adenomyosis completely.
Surgical Treatment
Surgical options for adenomyosis are limited, and complete removal of the uterus (hysterectomy) is generally regarded as the definitive solution. For women who wish to have children, however, this is not an option. Uterus-preserving surgical approaches (adenomyomectomy) have been developed, but because adenomyosis is diffuse it can be difficult to remove all the lesions and there is a risk of recurrence. Operations of this kind should be carried out by experienced surgeons and only after careful assessment.
Adenomyosis and the Chance of Pregnancy
Adenomyosis can have a negative effect on the chance of pregnancy through several mechanisms:
- Structural abnormalities in the muscular layer of the uterus can make it harder for the embryo to attach to the uterus (implantation).
- By increasing uterine contractions it can prevent the embryo from implanting or lead to early pregnancy loss.
- Inflammation and hormonal imbalance in the intrauterine environment can adversely affect the continuation of the pregnancy.
Approaches for Couples Planning a Pregnancy
Although adenomyosis can reduce the chance of pregnancy, having a child is possible thanks to modern reproductive techniques. At our Ankara IVF Center we offer personalised treatment plans designed specifically for patients with adenomyosis:
- IVF treatment: One of the most effective methods for women with adenomyosis is IVF treatment. In this method the eggs and sperm are fertilised in the laboratory and the resulting embryos are transferred into the uterus. The IVF process may include various protocols intended to bring the uterus into the best possible condition before transfer.
- Preparing the uterus: Before the embryo transfer, certain drug treatments may be given to make the uterus receptive to implantation. The aim is to reduce uterine contractions and increase the embryo's chance of attaching.
- Embryo freezing and repeated transfers: In some cases embryos can be frozen and transferred in a different cycle, once treatment has brought the uterus into its most favourable state. (You can find out more about our Embryo & Egg Freezing service.)
It should not be forgotten that every case is different and that a detailed assessment is essential in order to determine the most suitable treatment plan. Prof. Dr. Mehmet Çınar and the Ankara IVF Center team offer hope to couples who have been diagnosed with adenomyosis and are seeking a pregnancy, by providing the most up-to-date and effective treatment options. In the light of scientific evidence, and with an approach that is realistic yet full of hope, we work so that every one of our patients can reach their dream.
Although adenomyosis is a complex condition that can affect the chance of pregnancy, with an accurate diagnosis and modern treatment methods the dream of having a child can become reality. At our Ankara IVF Center, our experienced team carefully assesses each patient's individual situation and draws up the most appropriate treatment plan. If you have been diagnosed with adenomyosis, or if you have concerns about this in your pregnancy plans, please do not hesitate to contact us so that we can discuss solutions tailored to you and map out your route forward. To take the first step towards a healthy pregnancy journey, you can book an appointment for a free initial consultation.