Many women consider severe menstrual pain or heavier bleeding to be normal. However, these symptoms can be a sign of a uterine disorder that requires further examination.
One condition that's often confused is adenomyosis versus fibroids. Both can cause pelvic pain, excessive menstruation, and even affect quality of life. Because they have similar symptoms, many women find it difficult to distinguish between the two conditions.
However, adenomyosis and fibroids are two distinct conditions. The differences lie in the location of the tissue growth, the cause of the disease, and the treatment methods used. Understanding these differences can help patients receive an early diagnosis and appropriate treatment.
Why Can Adenomyosis and Myoma Occur?
Although they both occur in the uterus, the causes of adenomyosis and myoma are not the same.
Causes of Adenomyosis
Adenomyosis occurs when endometrial tissue, the lining that normally lines the inside of the uterus, grows into the muscle layer of the uterus (myometrium). As a result, this tissue undergoes changes throughout the menstrual cycle, leading to inflammation, uterine enlargement, and pain.
The exact cause of adenomyosis is unknown. However, several factors are thought to play a role, such as:
- Changes in estrogen hormones.
- History of childbirth or surgery on the uterus.
- Increasing age, especially in women aged 40–50 years.
Causes of Myoma
Uterine fibroids, or myomas, are benign growths of uterine muscle tissue. They can grow in various parts of the uterus and vary in size, from very small to large.
The cause of myoma is not yet known for certain, but several factors that can increase the risk include:
- Hormonal factors, especially estrogen and progesterone.
- Family history of fibroids.
- Obesity.
- Excessive consumption of red meat.
Both adenomyosis and fibroids are more common in women of reproductive age. Furthermore, hereditary factors and pregnancy history can also influence the risk of developing both conditions.
Recognize the Often Ignored Symptoms of Adenomyosis and Myoma
Because they have almost the same complaints, it is important to understand the characteristics of the symptoms of each condition.
Symptoms of Adenomyosis
Some symptoms that often appear in adenomyosis sufferers include:
- Menstrual pain that is getting worse than before.
- Menstrual bleeding is heavier or longer.
- Pain or pressure in the pelvic area.
- Pain during sexual intercourse in some women.
Symptoms of Myoma
Meanwhile, myomas can cause symptoms such as:
- Menstruation with a blood volume that is heavier than usual.
- A feeling of fullness or pressure in the lower abdomen.
- The stomach appears enlarged if the size of the myoma is large enough.
- Increased frequency of urination due to pressure from the fibroid on the bladder.
- Pelvic pain or discomfort in the area around the uterus.
It's important to note that not all women with adenomyosis or fibroids experience symptoms. Some cases are only discovered during routine health checkups or pregnancy tests. Therefore, changes in menstrual patterns, increased pain, or unusual bleeding should not be ignored.
How to Differentiate Adenomyosis and Myoma Through Medical Examination
Because the symptoms can be similar, doctors require several examinations to confirm a diagnosis. Some common tests include:
1. Health history and menstrual patterns
The doctor will ask about the complaints you are experiencing, your menstrual cycle, the amount of bleeding, your pregnancy history, and your family's medical history.
2. Physical and pelvic examination
A pelvic examination is performed to determine whether there is an enlarged uterus or lumps that indicate myoma or adenomyosis.
3. Transvaginal ultrasound
A transvaginal ultrasound is the most commonly used imaging test to assess the condition of the uterus. This exam can help identify fibroids and signs of adenomyosis.
4. MRI
In certain conditions, a doctor may recommend an MRI to obtain a more detailed image of the uterine tissue, especially if the ultrasound results do not provide a definitive diagnosis.
Adenomyosis and Myoma Treatment Options According to Patient Condition
Treatment will be tailored to the severity of symptoms, the size of the abnormality, the patient's age, and future pregnancy plans.
Adenomyosis Treatment
Some therapy options include:
- Pain reliever to reduce menstrual complaints.
- Hormonal therapy , such as birth control pills or hormonal contraceptives, to control bleeding and pain.
- Certain medical procedures if symptoms are severe and do not improve with conservative therapy.
- Hysterectomy, or removal of the uterus, may be an option in certain cases, especially if the patient is no longer planning a pregnancy and the symptoms are very bothersome.
Myoma Treatment
Myoma therapy options can include:
- Regular monitoring , especially if the myoma does not cause complaints.
- Medications , including hormonal therapy to help reduce symptoms.
- Myomectomy , which is surgery to remove myomas while preserving the uterus.
- Uterine artery embolization (UAE) , which is a procedure to reduce blood flow to fibroids so that they shrink in size.
- Hysterectomy or removal of the uterus , which is an operation to remove the uterus in certain conditions if other therapies are ineffective or the patient no longer plans to have children.
An obstetrician and gynecologist will determine the appropriate treatment and therapy according to each patient's condition.
Don't Ignore Symptoms, When Should You See a Doctor?
Immediately consult an obstetrician and gynecologist if you experience the following conditions:
- Menstruation with very heavy bleeding that requires frequent changing of sanitary pads.
- Menstrual pain that is getting worse and disrupts daily activities.
- Persistent pelvic pain.
- The lower abdomen feels enlarged without any clear cause.
- Difficulty getting pregnant or experiencing fertility problems.
- Symptoms of anemia include fatigue, dizziness, and weakness due to excessive menstrual bleeding.
Early diagnosis with an obstetrician and gynecologist can help determine the right treatment and prevent complications that can affect quality of life and fertility.
This article was written by Dr. Rahmedi Rosa, Sp.OG (Obstetrics and Gynecology Specialist at EMC Alam Sutera Hospital).