Uterine adenomyosis: the different types and their impact

What is uterine adenomyosis: overview and characteristics

Adenomyosis is a medical condition in which the tissue that normally lines the inside of the uterus, called the endometrium, grows into the muscular wall of the uterus (the myometrium). This condition can cause the uterus to enlarge, leading to a series of symptoms, particularly during menstruation. Adenomyosis can affect women of all ages, although it is more frequently diagnosed in women in their forties and fifties, particularly those who have had children.

The growth of endometrial tissue in the uterine wall can lead to changes in the structure and function of the uterus, causing pain, heavy menstrual bleeding and other symptoms. Although the exact cause of adenomyosis is not fully understood, it is assumed that hormonal factors, particularly estrogen, play a role in its development.

Adenomyosis symptoms and prevalence

The most common symptom of adenomyosis is pelvic pain, often described as "adenomyosis pain", which can be severe and disabling. Other symptoms include heavy or prolonged menstrual bleeding, bloating in the abdomen, and in some cases, infertility. Indeed, someuterine adenomyosis may have difficulty conceiving due to structural changes in the uterus and disturbed ovulation. Hormonal imbalances, notably insufficient progesterone production, can also aggravate the condition. In addition, ovarian cysts may coexist with adenomyosis, contributing to similar symptoms.

Adenomyosis affects around 20 to 30 % of women of childbearing age, although the prevalence is higher in those who have had multiple pregnancies. However, it often goes undiagnosed, as many women with adenomyosis have no symptoms, or their symptoms may be confused with other gynaecological conditions, such as endometriosis, fibroids or tumours in the uterine cavity. Occasionally, problems with frequent urination can also be associated with this pathology, due to the pressure exerted on neighboring organs. Early and thorough diagnosis is therefore essential to differentiate adenomyosis from other similar conditions.

What types of uterine adenomyosis are there?

Adenomyosis can be classified into three main types based on the extent and pattern of invasion of endometrial tissue: focal adenomyosis, diffuse adenomyosis, and adenomyoma. Each of these types has unique features and implications for diagnosis and treatment.

1. Focal adenomyosis

In focal adenomyosis, endometrial tissue develops in the muscular wall of the uterus in isolated or localized areas. This type usually presents as small, well-defined lesions within the uterine muscle. Although less common than diffuse adenomyosis, focal adenomyosis can nevertheless cause significant symptoms, particularly when lesions are close to other reproductive organs or nerves. Pain associated with focal adenomyosis is often localized in the area of the lesion, and heavy menstrual bleeding may occur if the lesion affects certain parts of the uterus. If focal adenomyosis is located near the ovary or vagina, it may cause pain during intercourse or menstrual cycle disorders.

2. Adenomyosis diffusa

Diffuse adenomyosis involves extensive infiltration of endometrial tissue through the myometrium (muscular layer of the uterus). This form of adenomyosis affects a larger part of the uterus, resulting in more generalized symptoms. Women with diffuse adenomyosis often experience intense, generalized adenomyosis-related pain due to the extent of uterine involvement. This condition can lead to significant enlargement of the uterus, abnormal bleeding, and pain during menstruation. Symptoms are often more severe than those seen in focal adenomyosis, and treatment may require more aggressive surgery, especially if there is a complication in the uterine cavity. Pelvic pain may also be experienced when adenomyosis affects surrounding structures, such as the ovaries and vagina.

3. Adenomyoma

An adenomyoma is a form of adenomyosis in which the endometrial tissue forms distinct nodules or rounded masses within the uterine muscle. These masses are often surrounded by normal myometrial tissue, making them identifiable on imaging tests. Adenomyomas can cause symptoms similar to those of focal and diffuse adenomyosis, including adenomyosis-related pain and heavy bleeding. The difference lies in the formation of these well-defined nodular structures, which may require surgery to remove them if they cause significant symptoms or complications, such as infertility or the presence of tumors.

Impact of different types of uterine adenomyosis

The impact of adenomyosis varies according to its type. Women with focal adenomyosis may experience localized pain or discomfort, often related to the size and location of the lesions. Diffuse adenomyosis, on the other hand, causes more generalized pain and significant enlargement of the uterus, which can lead to complications such as abnormal uterine bleeding and pain during intercourse. Adenomyomas, with their nodular structure, can cause intense pelvic pain and potentially interfere with fertility, depending on the size and location of the adenomyomas.

In general, the severity of symptoms and available treatment options depend on the type and extent of adenomyosis, as well as each patient's reproductive health and goals, including ovulation and ability to conceive.