How adenomyosis puts women at risk of infertility

Mrs Abiodu, 30, (not real name) was having pelvic pains and sometimes menstrual bleeding before she was diagnosed to be suffering from adenomyosis. She said she suffered pains and emotional stress before she was treated for the ailment. Nigeria as global ICT investment hub ASUP strike: Another time bomb in Nigeria According to Dr. Victor […]

Mrs Abiodu, 30, (not real name) was having pelvic pains and sometimes menstrual bleeding before she was diagnosed to be suffering from adenomyosis.

She said she suffered pains and emotional stress before she was treated for the ailment.

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According to Dr. Victor Ohenhen, a Consultant Gynaecologist with Central Hospital Benin, adenomyosis is a condition in which the inner lining of the uterus (endometrial tissue) now exists within and grows into the muscular wall of the uterus.

He said though its cause is largely unknown but some proposed theories include, invasion tissue growth, developmental origins and uterine inflammation related to childbirth and stem cell origin.

Invasive tissue growth is invasion of endometrial cells from the lining of the uterus into the muscular wall of the uterus.

The developmental origins is the deposition of endometrial tissue in the uterine muscle during formation of the uterus in the developing fetus.

He added that uterine inflammation is related to childbirth.

According to him, the stem cell origins propose that bone marrow stem cells might invade the uterine muscle and cause adenomyosis.

Dr. Ohenhen identified some risk factors for adenomyosis to include previous uterine surgeries (such as C-section, D/C, myomectomy), childbirth and middle age.

However, obesity has been identified as an independent risk factor, possibly due to exposure to elevated estrogen levels.

“But irrespective of how adenomyosis develops, its growth depends on the body’s circulating levels of estrogen.”

Difference between fibroids and adenomyosis

The gynecologist explained that fibroid is different from adenomyosis, adding that symptoms of adenomyosis that are different from uterine fibroids include prolonged menstrual bleeding, chronic pelvic pain, leg pain, and passage of blood clots.

Dr. Ohenhen, who is the chairman of Medical and Dental Consultants Association of Nigeria (MDCAN), Edo State Specialist Hospital Management Board branch, explained further that some studies have shown a link between adenomyosis and infertility.

He said several studies have demonstrated that the presence of adenomyosis may impair fertility by affecting the transport of the fertilized egg from the fallopian tubes to the uterus, or by changing how the endometrium (the mucus membrane that lines the uterus) functions.

He said, “Some indirect proofs have shown that women with adenomyosis have poor reproductive outcomes compared with those without adenomyosis.

“But adenomyosis by itself doesn’t seem to cause that much of a decrease in fertility.”

He said though adenomyosis sometimes causes no signs or symptoms or only mild discomfort, it may however cause heavy or prolonged menstrual bleeding, severe cramping, pain during intercourse or blood clots that pass during a period.

“Adenomyosis is often hard to diagnose, as it is mostly a diagnosis of exclusion but investigations such as abdominal and transvaginal ultrasound scan might be of help.

He added that definitive diagnosis of it is mainly through biopsy/histology of the uterus after surgical removal.

On prevention, he said though a healthy diet is always recommended, but “no diet has been found to cause or prevent the development of adenomyosis.”

He said pain medications might help with the discomfort, while birth control methods that contain progesterone may be given to help decrease bleeding.

“An adenomyomectomy (which removes the abnormal tissue but preserves the uterus) may also be offered,” he added.

Dr. Ohenhen, however, noted that the only definitive cure for adenomyosis is a hysterectomy, or the removal of the uterus.

“This is often the treatment of choice for women with significant symptoms. But, without surgery, symptoms often go away with menopause,” he said.