Adenomyosis is characterized by the infiltration of endometrial tissue into the muscular wall of the uterus, called the myometrium. This condition is often referred to as a form of endometriosis within the uterus. This condition, often misunderstood, presents with various manifestations and can affect the quality of life of affected women. 
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Definition and Types of Adenomyosis
Adenomyosis can present in several forms, the most common of which are:
- Diffuse Adenomyosis: This form is characterized by the presence of multiple foci disseminated throughout the thickness of the myometrium, thus causing extensive involvement of the uterus.
- Focal Adenomyosis: Unlike the diffuse form, focal adenomyosis presents one or more foci located in a specific area of the myometrium.
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External Adenomyosis: When deep pelvic endometriosis extends to infiltrate the myometrium, it is called external adenomyosis. This form is often associated with more severe symptoms.
It should be noted that these different forms can present varied symptoms and require a diagnostic and therapeutic approach adapted to each case.
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Etiology of adenomyosis
The main cause of this condition is still unknown. Many hypotheses have been formulated to determine the risk factors. Thus, adenomyosis is thought to be caused by relative hyperestrogenism. This means that the presence of this condition is due to a significant production of estrogen within the endometrium. It is important to know that when estrogen (a female hormone) is synthesized in the endometrium, it thickens.
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Prevalence and Risk Factors
Adenomyosis affects approximately 11 to 13% of the female population, with a higher prevalence in women aged 36 to 40. In 6 to 20% of cases, adenomyosis and endometriosis are associated, according to Endo-France.
Although its exact origins remain unclear, certain factors appear to increase the risk of developing this condition, including:
- Multiparity : Women who have had multiple pregnancies are at increased risk of adenomyosis, suggesting a link between hormonal changes associated with pregnancy and the development of this condition.
- Endometrial hyperplasia : This is the excessive increase in the thickness of the uterine lining (endometrium). This phenomenon is associated with an increased risk of adenomyosis.
- Obstetric history : Placental abnormalities observed in some patients who have delivered by cesarean section or undergone other surgical procedures may also be linked to the development of adenomyosis.
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Symptoms and Clinical Manifestations
Symptoms of adenomyosis vary from patient to patient, but the most common manifestations include:
- Menorrhagia: Excessively heavy and prolonged periods, affecting up to 50% of women with adenomyosis, which can lead to iron deficiency anemia and associated complications.
- Dysmenorrhea: Severe pelvic pain during menstruation, affecting approximately 30% of patients, can lead to a significant deterioration in quality of life.
- Metrorrhagia: Bleeding outside of the menstrual period, observed in approximately 20% of women with adenomyosis, which can be a source of discomfort and anxiety.
- Dyspareunia: Pain during sexual intercourse. In adenomyosis, dyspareunia manifests as painful sensations in the lower abdomen. This symptom affects the majority of women with adenomyosis.
- Most often, there are no symptoms and it is diagnosed during an infertility assessment by systematic hysterosalpingography or during a hysteroscopy.
It should be noted that some cases of adenomyosis may be asymptomatic, making diagnosis more difficult.
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Diagnostic Methods
The diagnosis of adenomyosis is based on a combination of clinical examinations and medical imaging, including:
- Pelvic Ultrasound : This non-invasive examination allows visualization of uterine abnormalities such as an enlarged uterus, thickened walls and nodular lesions, thus aiding in the early diagnosis of adenomyosis.
- Pelvic MRI : MRI offers better resolution than ultrasound and allows a more detailed assessment of the extent of adenomyosis, particularly when there is suspicion of associated endometriosis.
- Endometrial biopsy : Although less common, a biopsy of the uterine lining may be performed to confirm the diagnosis of adenomyosis in some cases.
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Impact on Fertility
Adenomyosis is often associated with fertility problems in women of reproductive age. The exact mechanisms are not fully understood, but it is suggested that the chronic inflammation associated with adenomyosis may alter the uterine environment, affecting embryonic implantation and increasing the risk of miscarriage by twofold. This disease may also be linked to recurrent spontaneous abortions and complications during pregnancy that can lead to adverse outcomes for the mother or fetus. In other words, women with adenomyosis may have an increased risk of spontaneous abortions (before 20 weeks of pregnancy) on several occasions and may also be more likely to experience problems during their pregnancy, such as medical complications or adverse outcomes for the baby, such as premature delivery or developmental abnormalities (information from the Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 6 , June 2023, Pages 430-444.e1)
When adenomyosis is suspected in a woman with fertility problems, further investigations, including imaging assessments such as MRI, may be performed to guide therapeutic management.
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Therapeutic Approaches
Management of adenomyosis often depends on the severity of symptoms and the patient's preferences. Treatment options include:
- Symptomatic treatment : Medications to relieve symptoms, such as analgesics for menstrual pain and hemostatic agents for heavy bleeding, may be prescribed as first-line treatment.
- Hormonal therapies : Hormonal therapies, such as GnRH analogues and hormonal contraceptives, can help reduce the thickness of the uterine lining and alleviate symptoms associated with adenomyosis.
- Surgical interventions : In severe cases or when other treatments prove ineffective, surgical interventions such as uterine artery embolization or hysterectomy may be considered to relieve symptoms and improve quality of life.
Naomi's personal testimony:
“As CEO of Zehnia, I share my story with you. I am a woman living with deep endometriosis and diffuse adenomyosis. These conditions have changed my life in ways I never imagined. It is precisely this daily struggle that inspired the creation of Zehnia.
I wanted to offer a message of hope to all women going through similar ordeals. Because I firmly believe there is hope in knowing our bodies and understanding the mechanisms of disease. For me, this knowledge was brutally revealed when I discovered that conventional treatments, such as birth control pills, weren't working for me. In fact, these medications only increased my bleeding, making it constant (caused by the hormonal imbalance it causes due to high estrogen levels and adenomyosis).
Last summer, this condition deprived me of the carefree experience of swimming. The constant but light bleeding (spotting) made it impossible to use internal protection, such as tampons. A whole year of continuous bleeding was a real challenge. But it's from these challenges that sometimes the greatest inspirations emerge. This is how Zehnia's menstrual swimsuits were born. They are symbols of resilience and acceptance.
With Zehnia, I want to encourage each of you to embrace your own beauty, your own strength, and to find peace in the knowledge that we are never alone in our struggles. Together, we can overcome obstacles and light the way for future generations.”
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