Adenomyosis is a benign uterine condition, where the uterine lining is found infiltrating into the muscle wall of the uterus.
This condition affects about 1 in 5 women. One of the biggest risk factors is being a female over 40 years old other risk factors include having more than 2 pregnancies or a history of uterine surgery.
On physical examination, the uterus feels quite enlarged and bulky. With a bulky uterus comes a larger surface area within the uterus and this brings longer, heavier, and more painful clotty periods. Some women may experience up to 2 weeks of heavy periods with large balls sized clots plus additional spotting and throughout the cycle. You can imagine with isn’t fun. The associated anemia from the heavy bleeding and the ability to perform your usual daily tasks would be reduced. Depression and fatigue can also be factors. Unfortunately, penetrative sexual activity can be a very painful experience, adding to the frustrations of this condition.
Many describe the pain of adenomyosis as a burning pain. I often compare it to an internal fire, as this condition is so inflammatory. We know certain factors act as fuel for the flames but we also want to consider if we can find what sparked the fire in the first place.
Fuel sources for the continued development of adenomyosis include estrogen dominance and insulin-like growth factors.
Many women in peri-menopause aren’t regularly ovulating and this reduces the amount of progesterone in their system. Progesterone helps keep estrogen in check, without it you may benefit from starting estrogen regulating strategies. Some examples include the use of Sulforaphane from broccoli, calcium d glucuronate, or even DIM. There are also conventional drug options that suppress estrogen, Zoladex is an example but these drugs come with side effects like depression and bone loss. Another option is progesterone therapy. This can be in the form of a Mirena IUD or oral progesterone.
The other common fuel source is insulin-like growth factors which occur due to imbalanced blood sugar levels and insulin resistance. Dietary changes to reduce sugar and intermittent fasting to reset insulin levels are recommended.
The spark varies from woman to woman and it's not always identifiable. But when it is this is a priority to correct. The most common spark I see is immune dysregulation and infection. With Ureaplasma being one of the infectious troublemakers. If you have adenomyosis it's worth having a vaginal microbiome test or a menstrual blood test to investigate for infections.
It is common to have additional diagnoses with adenomyosis, some women also have endometriosis a similar but different condition. This time the uterine lining has grown in other places such as the fallopian times or around the ovaries. But links with irritable bowel syndrome and interstitial cystitis can also be found.
Adenomyosis is usually diagnosed with an MRI, it may be seen on ultrasound but this technology isn’t as advanced and you may be misdiagnosed as having fibroids. The gold standard treatment is a hysterectomy and if your quality of life is that bad, it might be worth having but there are also less invasive procedures like endometrial ablation or getting a Mirena IUD fitted, that may be helpful.
Medication wise we have discussed a few but just to summarise your options they include: hormone suppression, progesterone treatment, antihistamines may help reduce blood flow and pain as can anti-fibrinolytic medication like tranexamic acid. If infections are found - antibiotics may be warranted.
As a naturopath, I’m looking at the whole woman and how I can help rebuild her blood supply, address any infections, boost her energy levels, improve her mood, reduce her inflammation and pain, reduce insulin issues and regulate her hormones, improve her cycle while reducing her clotty menstrual flow.
Or help her prepare and support her if she chooses one of the surgical options, so she gets the most out of her surgery and heals and recovers as fast as possible.
There are also a couple of lifestyle considerations. Due to the link with infections, public swimming pools and spas are off-limits, but natural waters are generally ok. If you test and find an infection please also test and if necessary treat your sexual partner to prevent re-exposure to the infection.
Adenomyosis is a complex condition and for the woman suffering, it's best to have a team of different practitioners working with you. Here a few suggestions of practitioners you may like on your team: a GP, a Gynocologist, a Naturopath, a Pelvic Physiotherapist, an Acupuncturist, a Chiropractor or Osteopath, a Psychologist
My final thought is in regards to xenoestrogens or environmental compounds that have an estrogen-like effect on the body. You may like to go back and read previous articles or listen to these podcasts on environmental health, for more details on how to avoid these dangerous substances.
Episode 77 - Mould, Water damaged homes and menopause
Episode 61 - Environmental Health