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Endometrium is the tissue that lines the uterus and changes in response to hormonal changes. Menstruation (also known as a period) is the regular discharge of the endometrium of the uterus through the vagina. For most people with a uterus, menstruation happens every 28 to 35 days.
Sometimes endometrium can grow in other parts of the body where it shouldn’t. There are two separate conditions for this called endometriosis and adenomyosis.
What is endometriosis and adenomyosis?
The difference between endometriosis and adenomyosis is that they develop differently and have differing symptoms.
- Endometriosis is a condition where the type of cells that normally line your womb are found elsewhere in your body, such as your ovaries, fallopian tubes, bowel and your bladder. These cells react the same way to those in the womb – building up, breaking down and bleeding. The tissue bleeds but unlike the period blood on the lining of your uterus, the blood has no way to escape or leave the body. This can cause inflammation, pain and the formation of scar tissue.
- Adenomyosis, similar to endometriosis, is a condition where endometrium grows in other parts of the body where it should not be growing. The main difference is that adenomyosis is a condition where the endometrium grows within the muscles of the uterus.
It is important to note that both conditions are not an infection, nor are they contagious.
What are the symptoms?
Endometriosis and adenomyosis do have slightly differing symptoms.
For endometriosis:
- Painful periods (dysmenorrhea)
- Pain during penetrative sex (dyspareunia)
- Painful bowel movements (dyschezia)
- Painful urination (dysuria)
- Pain in back or leg
- Chronic pelvic pain
- Heavy or painful menstrual bleeding
- Fatigue, nausea, and diarrhoea, especially during periods
For adenomyosis:
- Painful periods (dysmenorrhea)
- Pain during penetrative sex (dyspareunia)
- Pain after sex
- Chronic pelvic pain
- Abnormal bleeding or prolonged periods
- Difficulties with fertility or infertility
- An enlarged uterus
Although, the two conditions are different in where they develop, they do share some similarities with symptoms, such as chronic to mild pain, fertility difficulties or can both lead to anaemia from heavy menstrual bleeding. In such cases where people feel anaemic, having iron supplements can help with increasing iron levels in your blood.
Some people with endometriosis may not have any symptoms and around 1/3 of women who have adenomyosis have no symptoms.
What are the causes?
The exact causes for endometriosis and adenomyosis are unknown; however, researchers have found that there are likely risk factors to consider.
For endometriosis:
- In your 30s or 40s
- Family history of endometriosis
- Heavy periods that last more than 7 days
- Periods are less than 27 days apart
- Started your period before you were 11 years old
For adenomyosis:
- In your 40s or are older
- Having had more than one child
- Having had surgery of the uterus
How is someone diagnosed?
Both endometriosis and adenomyosis are difficult conditions to diagnose unless you show many of the symptoms listed above. From your first consultation, you might be referred to an ultrasound clinic to assess whether there are other reproductive health conditions that might be causing your symptoms, such as fibroids, cysts or PCOS. In most cases, endometriosis and adenomyosis cannot be diagnosed through an ultrasound.
For endometriosis:
Receiving a diagnosis can take a long time (research shows it takes an average of 7.5 years between people first seeing a doctor about their symptoms and receiving a firm diagnosis). It’s important to share as much information with your doctor as possible.
From your first initial consultation, a GP will refer you to a gynecologist. Upon meeting the gynecologist, they will complete an assessment and potentially refer you to an endometriosis specialist. If the endometriosis team find that you show the symptoms for endometriosis, they will refer you for a laparoscopy, which could be a 6 month to a year wait.
Laparoscopy is an operation in which a camera is inserted into the pelvis via a small cut near the navel. The surgeon uses the camera to see the pelvic organs and look for any signs of endometriosis. A small telescope is inserted into the abdomen to look directly at the internal tissue. This procedure is carried out under general anaesthetic.
If diagnosed, the endometriosis may be treated or removed for further examination during the procedure. Various procedures can take place to destroy or remove the endometriosis, endometriosis cysts or scar tissue.
For adenomyosis:
Adenomyosis can enlarge the uterus, so it may feel tender when you push on your belly. Doctors may perform a physical exam to feel whether your uterus is enlarged or swollen. For a more precise diagnosis, doctors may forward you for a sonohysterography. The sonogram can capture images of the inside of your uterus.
Are there treatments available?
Endometriosis and adenomyosis sometimes don’t require treatment unless they are causing someone difficulties, such as persistent pain or heavy bleeding.
For pain management, doctors may recommend paracetamol or ibuprofen.
Endometriosis and adenomyosis responds and grows when exposed to the hormone oestrogen. There are a number of hormone treatments that can attempt to block or reduce the production of this hormone. These treatments can control the hormonal cycle and slow the growth of the endometrial tissue. However, they will not be able to remove endometrium tissue that has already formed. Progesterone hormonal methods are often used to manage the growth of endometrium. These methods can include the IUS, mini pill, combined pill, arm implant, patch, vaginal ring or depot injection.
Gonadoropin-releasing hormone (GnRH) is another hormonal treatment for managing endometrium growth. GnRH are hormones that are injected into the body and work by stopping the ovaries from producing oestrogen. GnRH can stop menstrual cycles but are not a contraceptive method and won’t affect your chances of getting pregnant.
For endometriosis, there are surgical procedures that can help remove or destroy the deposits of endometriosis tissue done via laparoscopy. Doctors are either able to cut out or destroy the endometrium tissue using heat or laser. It can provide relief, but it might recur in time. Sometimes, depending on the severity of the endometriosis, complex surgery is done. This involves removing endometrium from different organs within the body such as the bowel or the bladder. This will include a multi-disciplinary team, such as a colorectal surgeon.
In cases where the endometriosis or adenomyosis has not responded to either any previous surgery or hormonal treatment, a hysterectomy might be suggested. A hysterectomy is when the entire womb is removed. This can be done with or without removing the ovaries. Some people might decide to remove the ovaries at a later date as they do not want to cause early onset menopause. There is also the option for an oophorectomy (removal of the ovaries) to prevent any further release of oestrogen.
Hysterectomies that include removing the ovaries should always be considered as a last resort as these procedures are irreversible.
SASH can provide you with wellbeing support
At SASH, we offer counselling, coaching and peer support for anyone having difficulties with their sexual and mental health. Living with endometriosis or adenomyosis can have an impact on your social life, romantic and sexual relationships as well as impact your overall mental health.
If you do need further mental health and wellbeing support in regards to living with endometriosis or adenomyosis, please get in touch with us at SASH.