Adenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it

Adenomyosis is a condition of the uterus (womb), where the tissue that grows on the lining of the uterus (also known as the endometrium) is also present on the inside muscular wall of the uterus. Adenomyosis can cause symptoms such as heavy bleeding during your period, bleeding when you are not due for your period, period pain (dysmenorrhea), pain during or after sex (dyspareunia) and infertility.

Although women with adenomyosis often also have endometriosis, they are different conditions. With endometriosis, cells similar to those that line the uterus are found in other parts of the body such as the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum).

The area of the uterus affected by adenomyosis is known as the endometrial-myometrial junction, which is where the endometrium and the myometrium (the muscular part of the uterus) meet.

Disruption in the endometrial-myometrial junction is now considered an important contributor to reproductive problems such as recurrent implantation failure, a condition that can prevent women falling pregnant. Adenomyosis can either be quite spread out, known as generalised adenomyosis or localised in one place, also known as an adenomyoma.

Adenomyosis can have a number of causes though none have been definitively identified. There is an association between the presence of adenomyosis and the number of times a women has given birth: the more pregnancies, the more likely you are to have adenomyosis. Women with adenomyosis have also often had a trauma to the uterus such as surgery in the uterus, like during a caesarean section.

How common is adenomyosis?

Like endometriosis, we don’t know exactly how many women may be affected by the condition. What makes the impact of adenomyosis so tricky to determine is that it is quite commonly found during regular screening tests, even when women are not complaining of any symptoms, which means many women may have it and not know about it.

Because it’s often found in women with other conditions like endometriosis, it’s difficult to determine which condition caused the symptoms. We don’t currently know why some women with adenomyosis have symptoms and others don’t.

There are also a number of different criteria for diagnosing adenomyosis, which can differ in important factors. For instance, the number of sections of adenomyosis that need to be affected for a diagosis when looking at tissue samples under a microscope. This makes it a problem when we try to work out how common adenomyosis is.

There can also be differences of opinion among the experts who look at these tissue samples. Experts can look at the same slides and come to very different conclusions.

How is it 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. The ultimate biopsy is a hysterectomy (the removal of the uterus). This is the most accurate method but is obviously a significant surgical procedure and will prevent women having children. A diagnosis of adenomyosis has been made in between 10-88% of hysterectomy specimens showing how common this condition is.

Non-invasive diagnosis can be made by different types of imaging. Ultrasound is 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% 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.

What are the treatments?

Management options for adenomyosis include hormonal therapy and surgery. These are mainly targeted at reducing symptoms such as pain. There isn’t much research into whether these increase the chance of getting pregnant.

Hormonal treatments focus on suppressing menstruation. This can be achieved by combined oestrogen and progesterone therapy (such as the combined oral contraceptive pill), progestogen-only treatment (such as a Mirena) or placing women into an “induced” menopause (through GnRH analogs).

Surgical treatment is most effective when the adenomyosis is localised to a smaller area and can be removed, and this type of surgery doesn’t prevent women falling pregnant in the future. If the adenomyosis is spread throughout a larger area then treatments include destroying the lining of the uterus (endometrial ablation) provided adenomyosis is not too deep, and hysterectomy, both of which will prevent further pregnancy.

Other treatment options are interventional radiology such as uterine artery embolisation, where the blood supply to the uterus is cut off and magnetic resonance-guided focused ultrasound where the adenomyosis is destroyed with ultrasound energy.

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.

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.

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How to Teach Your Kids That Voting Matters — but So Does Compassion

Look, we know. We really know. It’s 2018, and you don’t know what to tell your kids about the actual state of the union anymore. Your Facebook feed is clogged with politics and nasty word wars about immigration and border control. You’re dreading Thanksgiving dinner because it’s pretty much a given Uncle Frank will get drunk and talk about arming preschool teachers and rabbis while your sister and her wife rage-cry into the mashed potatoes. Some mornings, you can’t remember why you thought it was a good idea to bring kids into this world. 

And that’s exactly why your vote matters today more than ever. Take your kids. Slap on an "I Voted" sticker. Just keep caring, OK? Caring is a revolutionary act when you’re slipping into a CNN or Fox News coma and all seems hopeless.

And no matter what your politics are, no matter what your religion is, you can choose to care — actively. Even if you’re feeling like your vote doesn’t count for much, your compassion still does. And there are many ways to help create a world for our children that is kinder and far better than this one. But it takes action — and one simple rule most of us were taught as children: Treat others as you would want to be treated. 

So on this voting day, put yourselves in the shoes of parents who are fleeing appalling, dangerous conditions in Central America. Whatever you feel about immigration, remember the caravan you’ve heard about is made up of families just like you and yours. Like you, these are parents who love their children more than anything. They are trekking hundreds and thousands of miles to try to keep their children safe and out of harm’s way. They are trying to escape poverty, violence, hunger and homelessness and find a better life for their families. 

Will the U.S. grant them asylum? It seems doubtful. But you can help these families. You can choose nonpartisan kindness today. Because kindness isn’t red or blue. 

Make compassion your platform. 

Here’s how:

Educate yourself & your kids 

Read about the caravan and reject xenophobia and fearmongering. Our country is better than that. Our kids deserve better than that.

Donate together 

Here are just a few nonprofit humanitarian organizations offering assistance and care on the frontlines. 

  • Save the Children’s Border Crisis Children’s Relief Fund: This fund provides emergency services and legal aid and works to reunite families.
  • UNICEFThis organization is working with the government of our neighbor Mexico to provide safe drinking and bathing water, hygiene essentials, sunscreen, access to support and much-needed training to authorities on child welfare, protection and nutrition.
  • Amnesty International Americas: Amnesty International is working overtime to document and monitor the situations and devastating conditions the families in the caravan are fighting against.
  • Pueblo Sin Fronteras: This immigrant rights group organized the caravan.

Help your kids call or email your congressperson or senator

If you’re not sure where to start, go to the U.S. House of Representatives website and enter your zip code. Looking for a senator? Just choose your state here. These sites will provide your elected officials’ names and contact information. 

Another route: Identify your reps at Democracy.io, and email with ease.

Voting matters. But compassion might matter even more these days. Make kindness your platform, and you’ll raise kids who care too. 

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