Adenomyosis Treatment Specialist in Los Angeles

Adenomyosis is a common medical condition that causes heavy menstrual bleeding and chronic pain. It is often misdiagnosed as fibroids, endometriosis, or routine menstrual cramps. The reason for this misdiagnosis is that these conditions usually share similar and overlapping symptoms, which makes it very difficult for doctors who do not have much experience diagnosing and treating adenomyosis. As a result, many women face diagnostic delays, which may lead to reproductive, physical, and financial strain.

Diagnosis can generally be made by an ultrasound examination in the office, along with a detailed history and physical exam. MRI can be helpful in some situations.

Treatment options are usually medical, but many outpatient surgical treatment options are also available to control the heavy bleeding and pain.

Dr. Tahery is a specialist in ultrasound evaluation of adenomyosis and has devised treatment plans that have been very successful in relieving its debilitating symptoms.

Adenomyosis is the condition in which the glands from the lining of the uterus grow into the muscle of the uterus. Once they penetrate the uterine muscle, the glands bleed as they would during the menstrual cycle and cause the uterus to feel spongy and boggy during a pelvic exam. The blood inside the muscle causes pain, heavy menstruation, and at times infertility. Adenomyosis also causes the uterus to become sensitive and results in pain during intercourse, a feeling of heaviness and fullness in the lower abdomen. Fibroid tumors and adenomyosis can be present together at the same time.

While some people with adenomyosis may remain asymptomatic, adenomyosis symptoms are similar to those of fibroids and endometriosis, such as heavy menstrual bleeding, chronic pelvic pain, painful intercourse, and a bloated feeling in the abdomen.

Heavy Menstrual Bleeding

Heavy menstrual bleeding is by far the most common symptom of adenomyosis. The condition develops when tissue similar to the uterine lining is found within the muscular wall of the uterus, which can cause inflammation, uterine enlargement, abnormal contractions, and heavier or longer periods. Some women may need to change pads or tampons frequently, pass large blood clots, or experience severe cramping and pelvic pain. Over time, repeated blood loss may lead to iron-deficiency anemia, causing fatigue, dizziness, weakness, or shortness of breath.

Chronic Pelvic Pain

Chronic pelvic pain may feel like persistent aching, pressure, heaviness, sharp pain, or intense cramping in the lower abdomen and pelvis. The pain often becomes worse before or during menstruation, but some women also experience discomfort between periods. Adenomyosis can cause inflammation, painful uterine contractions, and enlargement or tenderness of the uterus.

Painful Intercourse

Painful intercourse or dyspareunia may occur when adenomyosis makes the uterus enlarged, inflamed, or tender. The discomfort is usually felt deep within the pelvis during penetration and may continue as aching or cramping afterward, especially around the time of menstruation. Because endometriosis, fibroids, pelvic-floor problems, and other conditions can cause similar pain, persistent discomfort during sex should be evaluated by a gynecologist. Identifying and treating the underlying condition can help improve comfort, intimacy, and overall quality of life.

Fullness in The Lower Abdomen

Fullness in the lower abdomen is a possible symptom of adenomyosis and may feel like pressure, heaviness, tightness, or persistent bloating in the pelvic area. This sensation can develop as adenomyosis thickens the muscular wall of the uterus, sometimes causing it to become enlarged or more rounded. The lower abdomen may appear more prominent, and the discomfort can become more noticeable before or during menstruation. Unlike digestive bloating, the pressure is often felt lower in the pelvis and may not improve after eating, passing gas, or having a bowel movement. In some cases, an enlarged uterus may also place pressure on the bladder or rectum, contributing to urinary urgency, frequent urination, rectal pressure, or discomfort with certain movements and fitted clothing.

The exact cause of adenomyosis is still not known, but several factors, such as procedural scars, Inflammation, dysfunction of the immune system, and migration, can increase the likelihood of developing adenomyosis. Each of these factors is believed to contribute to the development of adenomyosis:

Surgical Scaring

Scarring or tissue injury from previous procedures involving the uterus may increase the risk of adenomyosis. Procedures such as C-sections, uterine surgery, myomectomy, or dilation and curettage may disrupt the boundary between the uterine lining and muscular wall, potentially allowing endometrial glands and stromal tissue to grow into the uterine muscle and develop adenomyosis.

Inflammation

Chronic inflammation also plays an important role in the development and progression of adenomyosis by altering the environment within the uterus. Inflammatory chemicals and abnormal immune activity may support the survival of adenomyotic tissue, encourage the formation of new blood vessels, and contribute to fibrosis and thickening of the uterine muscle. Inflammation may also increase nerve sensitivity, worsen uterine contractions, and contribute to symptoms such as pelvic pain, heavy menstrual bleeding, and fertility problems.

Dysfunction of the Immune System

Abnormal regulation of the immune system can also contribute to adenomyosis by allowing abnormal endometrial tissue within the uterine muscle to avoid removal and continue growing. Changes in natural killer cells, macrophages, T cells, and other immune signals may weaken normal immune surveillance, promote cell migration, support new blood-vessel formation, and encourage fibrosis within the uterus. This altered immune environment may help adenomyotic tissue survive and progress, although immune dysfunction is considered a possible contributing factor rather than a proven direct cause.

Cell Migration

In a proposed mechanism, cells from the deepest layer of the uterine lining become unusually mobile and invasive. They may then cross a weakened or disrupted boundary between the uterine lining and muscular wall, allowing endometrial glands and stromal tissue to become established within the uterine muscle. Once there, the tissue may promote inflammation, fibrosis, and thickening of the surrounding muscle, forming adenomyosis. Laboratory studies suggest that hormonal signals, altered cell-adhesion proteins, and immune cells such as M2 macrophages may increase this migration or collective invasion. 

Adenomyosis is diagnosed using a combination of symptoms, pelvic examination, and imaging because no single test can identify the condition on its own. A doctor may first review symptoms such as heavy menstrual bleeding, severe cramps, pelvic pain, and abdominal fullness, then examine the uterus for enlargement, tenderness, or a rounded shape. Transvaginal ultrasound is usually the first imaging test, while MRI may be used when ultrasound findings are unclear or more detailed evaluation is needed. Blood tests may detect anemia caused by heavy bleeding. Still, they cannot diagnose adenomyosis, and an endometrial biopsy is generally used to rule out other uterine conditions rather than confirm it. 

Treatment options are usually medical, but many outpatient surgical treatment options are also available to control the heavy bleeding and pain. Treatment depends on the symptoms, severity, and the patient’s unique situation, such as future pregnancy goals or menopausal status.

NSAIDs

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are usually used to manage pain for mild to moderate adenomyosis. They are used because they reduce prostaglandins, which are chemicals that contribute to inflammation, uterine contractions, pain, and heavy menstrual bleeding. They only help with easing the symptoms and do not cure or remove the adenomyosis.

Hormonal Contraceptives

Hormonal contraceptives are used to manage heavy menstrual bleeding, painful periods, and pelvic pain because they regulate or suppress menstruation, and continuous use may reduce the number of periods or stop them altogether, providing symptom relief. Options can include combined birth-control pills, patches, vaginal rings, progestin-only pills, injections, and hormone-releasing intrauterine devices. Just like NSAIDs, hormonal contraceptives do not cure adenomyosis but instead help manage the symptoms.

Uterine Artery Embolization or UAE

UAE is a non-surgical radiologic procedure that cuts off the blood supply to the tissue affected by adenomyosis. Studies show it can shrink the uterus by 37.8% after one year. Arteries feeding the adenomyosis are located or mapped, and then tiny particles are added to the arteries so that they can block the blood flow, therefore depriving the adenomyosis and shrinking it. UAE is one of the most effective and preferred ways to treat adenomyosis because it is minimally invasive and usually offers lasting relief compared to NSAIDs and hormonal contraceptives. Unlike surgery, UAE preserves the uterus for those with to get pregnant, keeps the scarring minimal, and is generally less painful.

Hysterectomy

Hysterectomy is used to treat adenomyosis as a last resort because it involves surgically removing the uterus. While this is the only way to permanently treat adenomyosis, it also causes permanent fertility loss. Hence, this procedure is not suitable for people who wish to get pregnant in the future. 

Book an appointment with Dr. Michael Tahery to discuss your options for adenomyosis diagnosis or treatment. He is a gynecologist and urogynecologist in Los Angeles with over 30 years of experience in diagnosing and treating women who are suffering from adenomyosis.