Menstrual cramps are often considered a normal part of the monthly menstrual cycle. However, not all menstrual cramps are considered normal. If the pain becomes more severe, lasts longer, or is accompanied by heavy menstrual bleeding that interferes with daily activities, this condition should be addressed.
One cause that often goes unnoticed is adenomyosis, a uterine disorder that can cause severe menstrual pain and excessive bleeding. Because the symptoms often mimic normal menstrual symptoms, many cases of adenomyosis are not detected until the condition has progressed.
What Is Adenomyosis and How Does Uterine Tissue Grow Into Uterine Muscle?
Adenomyosis is a condition in which endometrial tissue, the lining of the uterus, grows into the muscle layer of the uterus, or myometrium. Normally, endometrial tissue is found only on the inside of the uterus. However, in adenomyosis, the tissue infiltrates the muscle wall of the uterus.
Despite being in an inappropriate location, the endometrial tissue still responds to hormonal changes during the menstrual cycle. As a result, the tissue thickens, sheds, and bleeds each month. This can trigger inflammation, pain, and cause the uterus to enlarge.
Adenomyosis is most commonly found in women aged 35–50. The risk is also known to be higher in women who have given birth or have had uterine procedures, such as cesarean sections or curettage.
Adenomyosis Symptoms Aren't Just Typical Menstrual Pain
Adenomyosis symptoms can vary from woman to woman. Some may not experience significant symptoms, but in some cases, symptoms can significantly impair quality of life.
Some symptoms of adenomyosis that you need to be aware of include:
- Severe menstrual pain that gets worse over time.
- Menstrual cramps that last longer than usual.
- Excessive or prolonged menstrual bleeding.
- Blood clots appear during menstruation.
- Pelvic pain or pressure in the lower abdomen.
- The lower abdomen feels enlarged, full, or uncomfortable.
- Pain during intercourse.
- The body tires easily due to anemia triggered by excessive blood loss.
- Daily activities are disrupted due to pain and heavy bleeding.
Because the symptoms are often similar to other conditions, such as endometriosis or uterine fibroids, a medical examination is necessary to confirm the diagnosis.
Adenomyosis Examination is Performed Through a Comprehensive Evaluation
To confirm a diagnosis of adenomyosis, a doctor will conduct a medical interview, a physical examination, and additional tests as needed. Some commonly used examination methods include:
1. Transvaginal ultrasound
A transvaginal ultrasound examination is often used as the first examination to determine the condition of the uterus and identify changes in the uterine wall that cause adenomyosis.
2. MRI of the uterus
Magnetic resonance imaging (MRI) can provide a more detailed picture of the structure of the uterus, thus helping to differentiate adenomyosis from other gynecological disorders.
3. Endometrial Biopsy
In certain circumstances, a doctor may perform an endometrial biopsy to evaluate uterine tissue and rule out other possible causes of abnormal bleeding.
4. Blood Test
Blood tests are performed to assess whether the patient is anemic due to excessive and prolonged menstrual blood loss.
Adenomyosis Treatment is Adapted to the Patient's Symptoms and Condition
Adenomyosis therapy options will be tailored to the patient's age, symptom severity, overall health, and future pregnancy plans.
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Doctors may prescribe non-steroidal anti-inflammatory drugs to help reduce menstrual pain and relieve bothersome menstrual cramps.
2. Hormonal Therapy
Hormonal therapy, including progestin (dienogest), GnRH agonist, hormonal contraception and suppressing endometrial tissue activity.
3. High Intensity Focused Ultrasound (HIFU)
HIFU is a non-surgical procedure that uses focused ultrasound waves to destroy adenomyosis tissue without the need for surgical incisions.
4. Endometrial Ablation
This procedure aims to destroy the endometrial lining to help reduce excessive menstrual bleeding in certain patients.
5. Hysterectomy
In severe cases or when other therapies haven't yielded adequate results, doctors may consider a hysterectomy, the surgical removal of the uterus. This procedure is usually a last resort after considering various medical factors and the patient's needs.
Don't Delay Checking If Menstrual Pain Gets Worse
Consult a doctor immediately if you experience:
- Menstrual pain that gets worse and doesn't get better.
- Very heavy menstrual bleeding for three consecutive cycles.
- Menstruation lasts more than seven days.
- Complaints that begin to interfere with work, school, or daily activities.
- Symptoms of anemia include fatigue, dizziness, and weakness.
Early recognition of adenomyosis symptoms is crucial for patients to receive a proper diagnosis and treatment. With appropriate treatment, symptoms can be managed, maintaining quality of life, and minimizing the risk of complications from prolonged bleeding.
This article was written by Dr. Ervina Ningsih, Sp.OG (Obstetrics and Gynecology Specialist at EMC Pulomas Hospital).