Struggling with abnormally painful periods, heavy flow, bleeding at irregular times or feeling like your lower abdomen is growing despite the same diet and exercise habits may be a sign that there are more than the run of the mill period problems happening. In some cases these wickedly painful periods can be due to elevated prostaglandins, endometriosis, estrogen dominance and a condition we'll be discussing in this article called adenomyosis.
What Is Adenomyosis?
Adenomyosis is a condition in which there are endometrial glands and stroma tissue (tissue similar to the endometrium) within the muscle layer of the uterus (the myometrium). It was once regarded this was simply endometrial lining (the lining of the uterus) in the wrong place, but as we begin to learn more about adenomyosis (and endometriosis for that matter) we’re coming to understand that it may be a bit more complicated.
Signs and Symptoms of Adenomyosis
- Heavy periods (menorrhagia)
- Painful periods (dysmenorrhea)
- Pain with sex (dyspareunia)
- Prolonged bleeding
- Clots in the period blood
- Chronic pelvic pain
- Bleeding between periods
If your main issue is heavy bleeding, I also encourage you to check out this article for a better understanding of what causes heavy periods and what to do about.
Why is Adenomyosis so Painful?
Heavy periods are thought to occur in more than half of women with adenomyosis, whereas pain is present in about a quarter of women with the condition. Up to a third of women are asymptomatic or in other words, they don’t have symptoms.
The tissue that is within the muscle wall of the uterus responds to hormones in the same way as your normal uterine lining does. This means it can expand, grow and bleed, all of which can be quite painful.
What’s the Difference Between Adenomyosis and Endometriosis?
Endometriosis has similar symptoms as adenomyosis, including pelvic pain and painful periods. The big differentiating factor is where the lesions or endometrial like tissue are found. In endometriosis the tissue occur outside the uterus. In adenomyosis, the tissue is inside the muscle wall of the uterus.
Both are painful, can result in heavy bleeding and it is possible to have both endometriosis and adenomyosis at the same time.
How is Adenomyosis Diagnosed?
Sadly, it is often more difficult to diagnose adenomyosis than it is to diagnose endometriosis. The first step is to rule out any other causes of abnormal uterine bleeding (AUB) and painful periods (dysmenorrhea).
You will need to partner with a doctor who can perform a physical exam, order imaging and possibly refer for surgery to rule out other conditions, like endometriosis.
How to Treat & Manage Adenomyosis
Adenomyosis treatment is focused primarily on symptom management, as the cause is not well understood. There are nutrition and lifestyle practices that can help reduce pain, improve hormonal health, lower inflammation, and improve health outcomes. In some cases, surgical intervention may be necessary.
How Is Adenomyosis Treated?
- Anti-Inflammatory Medications (NSAIDs)
- Pain Reduction Therapies
- Anti-Inflammatory Diet & Nutritional Therapy
- Support Estrogen Metabolism
- Mental Health Support for Chronic Pain Condition
- Hormone Therapy (eg hormonal IUD, bioidentical progesterone)
- Uterine Artery Embolization
Get Out of Pain
We all know that over the counter pain meds like NSAIDs are available, but I want to give you a couple of other options too. If you're currently using NSAIDs to manage your adenomyosis, I encourage you to read this article on how that can potentially impact ovulation.
Use a Hot Water Bottle
Applying heat to the abdomen for no more than 20 minutes at a time can help reduce cramping.
Try Cramp Bark
This is an herb you can pick up at the local health food store. Using tincture form, a couple of droppers for pain can help, but I find it best if women start it at least a day or two before her period and use it 3-4 times a day.
Support Estrogen Detox Pathways
Excess estrogen, also known as estrogen dominance, can cause heavy, painful periods with clots on its own. If the tissue that are within the uterus are responding to estrogen in the same way then you better believe excess estrogen can be an issue.
Supporting your body’s natural process of creating more beneficial estrogen metabolites within the liver and moving it out via the bowels and urine is an important step in managing adenomyosis.
You can do this by drinking plenty of water, avoiding environmental toxins that disrupt hormones, eating a hormone balancing diet like the one you’ll find in this free meal plan, and leveraging an estrogen balancing supplement.
Balance Women's Hormone Support is formulated with DIM, broccoli seed extract, B vitamins, and calcium d-glucarate, which are all nutrients that support your liver in detoxing estrogen and your gut in helping move it out.
Create a Healthcare Team
Counselor or Mental Health Support
Anyone in chronic pain needs a mental health expert to support them. No shame in that. Chronic pain can take away any sense of joy in your life.
In addition, working with an excellent gynecologist who can educate you on your options is necessary as this is a complex condition. They may recommend more invasive therapies like hysterectomy, endometrial ablation, and uterine artery embolization. In some cases they may also recommend a hormonal IUD.
A Holistic Provider
It’s important to keep in mind that we don’t really understand why adenomyosis occurs. This means that while the medical procedures discussed here can help, it is also important to address what individual factors may be driving your condition.
Find a naturopathic physician or functional medical provider who is licensed to practice medicine. They can help you explore your root cause, order and interpret necessary labs, and prescribe medications when needed. For example, bioidentical progesterone therapy can help some women with this condition.
Adenomyosis Surgical Treatment
This is the removal of your uterus, which addresses the organ most affected by adenomyosis, but it doesn’t necessarily address the underlying cause of the condition. This is because we don’t really know the cause. Like other conditions, removal of an organ can address the symptoms, but the why it developed isn’t addressed with this approach.
Does it mean no woman should have a hysterectomy with this condition? No and for some women, it will be the only thing that gives her relief in what can be a debilitating condition. Unlike other growths in the uterus, adenomyosis isn’t easily removed, especially if it is diffuse (spread over a larger area). Depending on the extent of the condition, hysterectomy may be the only option for symptom relief.
But just because we have a surgical option doesn’t mean science and medicine shouldn’t keep exploring what causes this condition in the first place. When we understand why this condition develops then we can begin to explore how women can prevent this condition and perhaps develop better treatments to address it.
There’s no evidence that your ovaries need to be removed in this condition, which means you should be able to retain these important endocrine (hormone making) organs.
This is a procedure that essentially destroys the endometrial tissue lining the uterus so it is no longer functional. This is a therapy that is debatable in the treatment of adenomyosis because the endometrial-like tissue is actually within the uterine wall. It isn’t regarded as the best treatment option, but I mention it here because it may be something your doctor discusses with you and you'll definitely find it in your search on google.
Uterine Artery Embolization
This is a procedure in which the blood supply is essentially cut off from the affected tissue. While this procedure can be helpful, there are studies that have shown a high rate of additional interventions are needed after and there can be other complications.
For example, in one study it was found that 3% had premature ovarian insufficiency within 3 months of the procedure. On a positive note, in the same study it was found that 70% of women have improved periods (less pain and lighter flow) at a 5 year follow up.
While no one certainly likes the idea of having an invasive procedure or losing an organ to surgery, it is important to evaluate your particular needs given the progression of your condition. A great doctor can help you navigate this.
Adenomyosis Mirena IUD & Levonorgestrel IUDs
In some cases, a doctor will recommend a progestin based IUD to manage the symptoms of adenomyosis. I've covered hormonal IUDs in this article, along with what you should know about the side effects and risks so you can have a more informed discussion with your doctor.
Birth Control in the Treatment of Adenomyosis
From UpToDate, an evidence-based clinical resource: “While estrogen-progestin contraceptives are frequently used as primary treatment for dysmenorrhea, there are little data on the efficacy of these contraceptives specifically for adenomyosis.”
If you're considering birth control to manage adenomyosis, I want to encourage you to track your symptoms, gather your family history, and discuss with your doctor the potential side effects of birth control as they apply to your health.
Eat an Anti-Inflammatory, Hormone-Friendly Diet
Decreasing inflammation can help improve many pain related conditions. Using nutrition to replenish nutrients lost by heavy periods and support optimal hormone balance is an important aspect of managing adenomyosis.
While nutrition can be tremendously helpful in women’s health, it is still important to partner with a doctor to get the right diagnosis and explore all your options.
I have a free meal plan with recipes to help you get started in using nutrition to support your body. In it, you’ll get the tools to bring in more nutrient dense foods that help you build better hormones and eliminate the ones you don’t need.
Have you struggled with adenomyosis? Let me know in the comments what your experience has been and please share what you've found to be helpful in managing your condition.