Adenomyosis and its relation to infertility
Adenomyosis is a condition that is characterised by the presence or invasion of the endometrium (the layer that lines the uterine cavity) into the muscular layer of the uterus.
Although there are few studies that show its impact on fertility, proper treatment can improve a female’s reproductive prognosis.
What is the endometrium?
The endometrial tissue, or endometrium, is the lining that covers the inside of the uterus. It undergoes significant changes throughout the female’s menstrual cycle, all of which are aimed at the successful implantation of an embryo and the achievement of a pregnancy.
This means that the endometrium has the ability to regenerate itself with each menstrual cycle in order to prepare the uterus for a possible pregnancy, and to shed (if conception has not occurred), resulting in menstruation.
When can we say that a female has adenomyosis?
When the endometrial tissue grows not only in the inner layer of the uterus, but it is also able to enter deeper and invade the muscular layer of the uterus (the myometrium), we are talking about adenomyosis.
Adenomyosis can affect the entire thickness of the uterine myometrium, or just certain areas of it. In other words, it can be focal, meaning it affects only a specific area, forming nodules or resulting in an increase in the thickness of the uterine wall. Or it can be diffuse, meaning the entire uterus is affected and enlarged as a result.
The incidence of adenomyosis is around 11-12% in females. Generally speaking, females affected by adenomyosis are over 40 years of age and have had a caesarean section delivery and/or some type of uterine surgery.
Adenomyosis may or may not cause any symptoms. Studies confirm that 35% of cases can be asymptomatic.
The most common adenomyosis symptoms include:
- Heavy periods.
- This is the most common symptoms and it affects over 50% of females who suffer from this condition.
- Dysmenorrhoea.
- This is the name for menstrual pain, which affects around 30% of patients and is believed to be related to heavy periods, as well as to the correlation of this pathology with endometriosis (around 24% of patients have both conditions).
- Pain during intercourse.
- Bleeding between periods.
- Infertility.
Adenomyosis and how it relates to infertility
Although adenomyosis is a condition that develops mainly in patients who have gone through childbirth, there are published clinical cases that show a relationship between adenomyosis and infertility, especially in cases of secondary infertility, and due to associated endometriosis.
It is believed that it may be due to an abnormality in the union between the endometrium and the uterine myometrium that could interfere with embryo implantation, in addition to having a negative impact on sperm transport.
Adenomyosis diagnosis and treatment
Upon physical examination of the female, an enlarged uterus will be found and confirmed with an ultrasound or magnetic resonance imaging, techniques that also make it possible to diagnose the presence of adenomyomas or adenomyosis cysts in the thickness of the uterus.
Treatment will depend on the patient’s symptoms and future plans for pregnancy. Treatment options range from hormonal medical treatments to complex surgical interventions.
Fortunately for females who suffer from this disease and wish to become mothers, proper treatment could improve their likelihood of conception and a viable pregnancy.
For that reason, the team at URE Centro Gutenberg advises you to discuss your case with a reproductive specialist if you know or think you may have this condition. Request an appointment with us and we’ll be happy to help you.