Heavy and painful periods are typically thought to be due to leiomyoma (uterine fibroids) or abnormal bleeding that happens to all Perimenopausal women. But there is another potential explanation: adenomyosis. This condition is not commonly used as a clinical diagnosis but this changing since recent research indicates that it may be the culprit in more situations than previously thought. Adenomyosis is defined as the benign invasion of the endometrium into the myometrium.
It was first described in 1860 and is a condition where the lining of the uterus (endometrium) has somehow started to grow into the muscle of the uterus (myometrium). It is a similar concept as endometriosis in which endometrial tissue is growing in places outside the uterine lining such as on the ovaries, in the tubes, in the peritoneum or even in tissue distant from the pelvis such as the lungs. It causes a diffuse enlargement of the uterus and is sometimes confused with leiomyoma. It can exist is conjunction with fibroids but is distinct histopathologic entity.
Symptoms associated with this condition include heavy bleeding with menstruation (menorrhagia), painful periods, pelvic pain, and pain with intercourse. The cause is unclear but some theories are being studied. Adenomyosis has been noted to be present more often in women who have had a uterine procedure such as a cesarean section, D&C or myomectomy. Surgical trauma is therefore considered to be the inciting factor that triggers this disorder. Another theory considers the trophoblastic invasion of the placenta into the uterine wall that occurs during pregnancy as a possible initiating factor.
In the past, adenomyosis could only be diagnosis at the time of a hysterectomy when the uterine specimen was examined microscopically. Now ultrasound and magnetic resonance imaging (MRI) can provide detail views of the uterus, allowing for the diagnosis. MRI is the preferred imaging technique since it is much more sensitive (88%) and specific (93%) in its detection.
The condition appears to be more prevalent in women in their 40-50s. This certainly could be due to the fact that women in this age group are more likely to undergo a hysterectomy where 20-47% of the uterine specimens are noted to have adenomyosis. Younger women are more likely to be treated conservatively and detailed imaging with MRI is rarely done. In either case the symptoms of heavy bleeding, painful periods and pelvic pain can be managed with hormonal contraceptive medication, analgesic medications and other hormonal injections just as in the treatment of endometriosis. If conservative treatment fails then surgical therapy is the next alternative. In women who wish to preserve their fertility, resection of the involved area has been tried but the efficacy is only about 50%.
Adenomyosis is a possible explanation for heavy, painful menses and pelvic pain. The treatment of the condition is similar to the treatment of endometriosis, dysmenorrhea and unexplained menorrhagia so even if you have the condition and are experiencing problems, you are most likely receiving the appropriate treatment. It is worth understanding if you are not having any improvement despite treatment or are considering surgery.
I hope this article has provided you with information that will help you make wise choices, so you may:

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