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"What is adenomyosis?"


I'm 25 and I just had an ultrasound to determine why I was having problems with menstruation and intercourse. My obgyn decided that I have adenomyosis. She tried to explain, but I could not understand what this is. And will I have to get a hysterectomy?


Adenomyosis is a disorder in which uterine glands are present in the muscle of the uterus and this can cause the uterine muscle to swell and get larger. Some women have enlargement of the whole uterus and others have areas that swell and get larger. It is unclear how this happens and is thought to involve some abnormal signals from estrogen and progesterone.

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Due to the swollen uterus, women can have heavy menstrual bleeding and chronic pelvic pain. There are ways to assess this condition with a pelvic MRI or pelvic ultrasound but definitive diagnosis can only be made by looking at the cells from the uterus under the microscope. Sometimes, these cells can be sampled by a small needle. This technique can have sampling error, however, because the entire uterus may not be involved and there may be areas that are "skipped' and appear normal under the microscope. The only way to treat this condition definitively is to get a hysterectomy, or remove the uterus. Hormonal manipulation and oral contraceptives have been attempted but are less successful. Some women use these therapies for symptomatic relief. There is also the possibility of myometrial ablation or excision, but the long term follow-up on this is difficult and the surgery is technically challenging. You should discuss additional treatment options with your doctor prior to proceeding with a hysterectomy, which will limit your ability to have children.

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