Adenomyosis may sound like a complicated term, ‘Adenomyosis is when cells similar to the lining of the uterus grow in the muscle layer of the uterus’.

You might be wondering if Endo & Adeno aren’t the same? Adeno sets up in the uterine muscle, while Endo prefers to wander outside the uterus. So, next time someone mixes up Adeno and Endo, just remind them: location, location, location! They might look like cousins or siblings, but they sure ain’t twins.

Let’s understand what adenomyosis is and how it can make getting pregnant a bit more challenging.

What exactly is Adenomyosis: 

Imagine the uterus as a cosy home where a baby grows during pregnancy. Normally, the lining of the uterus, called the endometrium, stays put inside the uterine cavity. However, in adenomyosis, some of this endometrial tissue starts to grow into the muscular wall of the uterus, called the myometrium. This infiltration disrupts the usual structure of the uterus and can create several hurdles for conception.

What causes Adenomyosis: 

While experts remain uncertain about its precise factors, certain trends have emerged regarding its occurrence. Typically, adenomyosis affects women in their later childbearing years, with a predominant demographic between the ages of 35 and 50. 

35-50yrs old…that’s perimenopause too. Peri starts in our mid 30’s and ramps itself up in our early to mid 40’s. This is the time we lose 75% of our progesterone, leaving oestrogen relatively dominant or unoppsed (not high, as oestrogen is declining too, but not at such a rapid rate). Unopposed oestrogen is a driver for Adenomyosis, so perimenopause exacerbates its presence, and its symptoms. 

Notably, symptoms often diminish post-menopause. 

Childbirth appears to be a common factor among those with adenomyosis, particularly in women who have experienced multiple pregnancies. It is theorised that during implantation, endometrial tissue may inadvertently infiltrate the myometrium. 

Additionally, emerging research suggests a potential association between adenomyosis and prior uterine surgeries, such as caesarean sections or dilation and curettage (D&C). These procedures may increase susceptibility to adenomyosis, though further research & investigation is warranted to validate.

Symptoms of Adenomyosis: 

Symptoms of adenomyosis can vary, but commonly include:

• Abdominal bloating, heaviness or fullness 
• Bulky uterus 
• Heavy / prolonged menstrual bleeding (menorrhagia)
• Severe menstrual cramps (dysmenorrhea)
• Chronic fatigue 
• Pelvic pain 
• Pain during sex (dyspareunia)
• Back pain

However, some women with adenomyosis may experience no symptoms at all, making diagnosis challenging without imaging studies or medical evaluation.

Understanding Diagnostic pathways:

Diagnosing adenomyosis typically involves a pelvic exam to check for uterine abnormalities, alongside imaging tests like transvaginal ultrasound or MRI to visualise the uterus’s internal structures. In some cases, additional procedures such as hysteroscopy or biopsy may be necessary to confirm the diagnosis by directly examining the uterine lining for signs of adenomyosis. Despite the lack of a definitive test, a comprehensive approach involving medical history, physical examination, and imaging studies aids in accurate diagnosis, enabling tailored treatment strategies for managing adenomyosis-related fertility concerns.

Why is conception difficult with Adenomyosis?

One significant issue is oxidative stress. Picture it like having too many troublemakers, known as reactive oxygen species, hanging around in the uterus. These troublemakers can wreak havoc on the delicate balance needed for a fertilised egg to implant and grow. Essentially, even if fertilisation occurs, the embryo may struggle to find a suitable environment for implantation due to the disrupted endometrial lining. 

Moreover, adenomyosis often leads to an increase in the thickness of the uterine wall, particularly in the area where the endometrial tissue has invaded the muscular layer. This thickening can make the uterine environment less receptive to embryo implantation. It’s akin to trying to plant seeds in overly compacted soil—it’s difficult for the seeds to take root and thrive. Similarly, embryos may encounter challenges adhering to the thickened uterine lining, thereby reducing the chances of successful pregnancy.

Beyond structural changes, adenomyosis can also disrupt hormonal balance. Throughout the menstrual cycle, the body undergoes hormonal fluctuations that prepare the uterus for potential pregnancy. However, adenomyosis can interfere with this process, leading to irregular hormone levels and impaired endometrial receptivity. As a result, the window of opportunity for embryo implantation may be narrower, making conception more challenging.

Furthermore, adenomyosis can create obstacles for sperm as they journey through the female reproductive tract. The altered uterine environment and disrupted anatomy can impede sperm transport, hindering their ability to reach and fertilize the egg. 

Understanding and managing fertility issues related to adenomyosis remains a challenge due to several factors. Adenomyosis often coexists with other conditions like endometriosis and uterine fibroids, making it tricky to study and treat. Also, there’s no universal way to diagnose adenomyosis, which makes it hard to know how many women have it and how to research it properly.

To make progress, we need to study adenomyosis and its effects on fertility more closely. By doing well-planned studies, we can learn about the specific reasons why adenomyosis makes it harder for women to get pregnant. This knowledge will help develop better treatments and care plans for affected women, improving chances of bringing your baby home sooner.

Visit Freyja Health Clinic  to engage in a meaningful conversation about your fertility goals and explore personalised solutions tailored to your individual needs. Our team is committed to providing comprehensive care, ensuring you are equipped with the tools to optimize your health and achieve your fertility aspirations. Your well-being is our priority, and we look forward to assisting you on your path to a healthier and more fulfilling life.