Your heavy periods could be down to ‘ugly sister’ of endometriosis – adenomyosis, expert warns
IF you struggle with heavy periods, painful cramps and uncomfortable sex, you've probably considered the fact that you might have endometriosis.
And you may well have - but you might also have a lesser-known about condition too.
Gynaecologist Dr Anita Mitra calls adenomyosis endometriosis' "ugly sister".
Both conditions share similar symptoms and women can have both at the same time, they're caused by different issues.
Like endometriosis and PCOS, adenomyosis is thought to affect one in ten women and it's caused when the endometrium grows into the muscle layer of the uterus.
The endometrium is the muscle layer that contracts when you have a period to allow blood to escape.
Diet is important
Because women with "adeno" can experience bloating and feelings of fullness, they're at risk from having their symptoms written off as IBS (which is another chronic and debilitating condition altogether).
And because it can lead to excess bleeding, women are also at risk of becoming anaemic.
Dr Mitra says although there have been no studies looking into the link between diet and adeno, what you eat is still important in managing the symptoms.
If you're bleeding loads, you need ot make sure that you're really stocking up on fibre and leafy green veg.
"Why is that? So that you can do a good poo to help your body excrete the old oestrogen that it doesn’t need, as well as preventing constipation which could be worsening the pain of adenomyosis by putting extra pressure on your already inflamed uterus," she told .
"My advice would be to keep a symptom diary if you think there’s a particular food that is affecting your symptoms, but seek advice from a nutrition professional before you seek to cut out entire food groups to make sure that you aren’t running into nutrient deficiencies. "
Hysterectomies aren't always necessary
She also stresses that despite the fact that hysterectomies are often promoted as a cure for the condition, they definitely shouldn't be your first thought.
Painkillers, oral contraceptive pills and the Mirena coil are all primary options.
Because the cause of the condition is still unknown, there's not a lot out there other than hormonal treatments and very invasive surgeries.
But Dr Mitra stresses that the initial options can be "quite life-changing for many women".
They work by reducing the monthly thickening and shedding of the uterus - which is the main source of pain experienced by adenomyosis sufferers.
How to get diagnosed
Unlike endometriosis, which can only be definitively diagnosed through a key-hole surgery, a diagnosis of adenomyosis can be done through both invasive and non-invasive methods.
The most common invasive method is a uterine biopsy (tissue sampling).
A biopsy of the uterus can also be performed to make the diagnosis by an abdominal key-hole surgical procedure (laparoscopy) but this remains limited to clinical trials.
Biopsies going through the vagina up to the uterus may have a role in the diagnosis of adenomyosis, but can potentially damage the uterus and therefore are avoided in women wishing to fall pregnant.
Ultrasound is also commonly available and can be done either using the probe on the abdomen or, preferably, placing the probe in the vagina.
However, ultrasound isn’t always the best choice as it only detects adenomyosis about 50-87 per cent of the time.
Magnetic resonance imaging (MRI) is a better choice as there are a number of typical features seen during MRI.
These vary throughout the cycle and in response to hormonal therapy but can reliably predict adenomyosis.
Does it affect fertility?
There is some evidence adenomyosis can reduce fertility, but this is still controversial.
Clinical studies are limited by difficulties and differences in diagnosis and their study designs have problems.
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Some MRI studies show changes consistent with infertility, but because patients presenting with infertility in their 30s and 40s are more likely to be diagnosed with adenomyosis, it’s difficult to say if adenomyosis is the cause of their fertility issues.
When couples are undergoing assisted reproduction (such as IVF) there is limited evidence to support a negative impact on oocyte and embryo quality, implantation and pregnancy rates.
Overall, there appears to be limited negative impact of adenomyosis on allowing the embryos to implant or overall pregnancy rates.
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