BBC presenter Munchetty Dragon She said last year that she was suffering adenomyosis, a chronic disease affecting the uterus. She talked about how her pain had left her unable to move and how violent her husband had been in a recent conflict. Call an ambulance.

However, many people have never heard of this condition, even though it affects many. One in five women.

Adenomyosis can cause symptoms including irregular and heavy menstrual bleeding and uterine pain. The severity of the symptoms varies between patients – up to One third of women With adenomyosis, there may be little or no symptoms.

The situation can affect him Fertility. Women with adenomyosis become pregnant increased risk Miscarriage, preterm birth, preeclampsia and postpartum hemorrhage.

So what causes adenomyosis, and how is it diagnosed and treated? There’s still a lot we don’t understand about this situation, but here’s what we know so far.

What causes adenomyosis?

There are two key layers in the uterus. The endometrium is the inner lining where the embryo implants. If there is no pregnancy, this cover is discarded during menstruation.

Myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for stiffness. In people with adenomyosis, endometrial-like cells are located in the wrong place – myometrium.

Although a large number of women with adenomyosis have endometriosis, adenomyosis is a separate disease Endometriosis.

In endometriosis, endometrial-like cells are also located in the wrong place, but in this case outside the uterus, especially in the pelvic area.

thanks to Research, Public participationAnd social mediaAwareness of endometriosis has increased in recent years. However, adenomyosis is still relatively unknown.

Diagnostic options are changing and evolving

Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrium-like cells in the myometrium could only be confirmed by pathological evaluation of the myometrium. It was examined under a microscope After hysterectomy (surgery to remove the uterus).

Recent years have seen more investigations as imaging technologies progress MRI And in detail Pelvic ultrasound.

Although adenomyosis is currently diagnosed without the need for hysterectomy, doctors are still working to develop a standardized method for non-surgical diagnosis.

As a result, it is not known exactly how many women have adenomyosis. Although we know that. 20 percent of women The presence of hysterectomy for reasons other than suspected adenomyosis was found to be evidence of the condition on pathological evaluation.

Adenomyosis is a complex condition

The type of adenomyosis tissue growth in the myometrium can be focal lesions (affecting the uterus) or diffuse (affecting a wide area of ​​the muscle).

Adenomyosis can be further classified based on the depth of invasion of endometrial-like tissue into the myometrium.

Scientists and doctors are still investigating the type or depth of the wounds It is related to the symptoms – The severity of symptoms and injuries are not always considered.

Although we do not yet understand why some women develop adenomyosis. The evidence shows There is an increasing prevalence with age.

The region between the endometrium and myometrium is thought to be affected, by natural processes Menstrual cycle, pregnancy and childbirth, or medical procedures.

In some women, damage to the lining of the endometrial tissue does not heal normally and endometrial-like cells grow abnormally into the myometrium. These disrupt normal functions the myometrium It leads to pain and bleeding.

Various mechanisms can contribute, and there is no single common cause behind adenomyosis.

How is adenomyosis treated?

Treatment methods Include hormonal medications such as oral contraceptives, progesterone-containing pills, progesterone-releasing coil inserts (eg, Mirena), or the pill. GnRHa It stops the natural production of sex hormones.

Non-hormonal treatments include Tranexamic acid. These treatments aim to reduce menstrual bleeding. Pain is often treated Non-steroidal anti-inflammatory drugs.

Treatments that work for some women do not for others, adding weight to the argument that there is more than one type of adenomyosis. Treatment strategies should be tailored to patients, according to their fertility wishes and symptoms.

If medical treatments do not provide sufficient relief from the symptoms, there are surgical options, which include removal of focal lesions or hysterectomy.

What lies ahead?

Although adenomyosis is a common disease affecting many women, including those of reproductive age, it has received insufficient medical and research attention.

There is also Lack of knowledge and understanding Around adenomyosis among many health care professionals and the public. This needs to change to improve our understanding of the condition, diagnosis and treatment options.

Scientists and doctors specializing in adenomyosis are still searching for an accurate, non-invasive diagnostic method and, one day, a cure.The Conversation

Southcombe onlyPrincipal Investigator/Team Leader, Nuffield Department of Women’s and Reproductive Health; University of Oxford And Nura Fitnat Topbas SelcukiPhD Candidate, Nuffield Department of Women’s and Reproductive Health; University of Oxford

This article was reprinted from The conversation Under a Creative Commons license. Read Original text.

An earlier version of this article was published in May 2023.