Adenomyosis versus Endometriosis
Both adenomyosis and endometriosis present with similar symptoms of heavy menstrual bleeding and period pain. They may even be presentations of the same disease, we just don’t know for sure yet.
Adenomyosis (adeno) affects the uterus, where endometrial-like tissue grows inside the muscle layer of the uterus (the myometrium). These cells should only be in the endometrium layer, not the muscle. This makes the uterus grow thicker ‘bulkier’ and can result in period pain (dysmenorrhea) and heavy menstrual bleeding.
In endometriosis (endo), the endometrial-like tissue grows outside the uterus. It can be anywhere but commonly found on bowel, ovaries, kidneys, bladder and the supporting ligaments.
Symptoms
As mentioned – both conditions can result in heavy, clotted and painful periods; painful sex and can lead to infertility. One discerning symptom according to Leah Hechtman, is that adenomyosis pain may present as a cramping burning pain like a “uterus on fire”. Both conditions can exist side by side in a lot of cases.
Investigations
A good quality MRI or internal trans-vaginal ultrasound carried out by a highly experienced sonographer may be able to diagnose adenomyosis. *This must be done at a specialist imaging centre as all ultrasounds are NOT equal. This is different to endometriosis which in most cases will need laparoscopic surgery to diagnose. An internal ultrasound may be able to diagnose endo but not in all cases. So the first step to detect adeno is a (good) internal ultrasound..
Risk Factors & Causes
Unfortunately, we still don’t know what causes adenomyosis, and much like endo, there are theories that are being explored. We do know that the condition affects up to 35% of women in Australia. Risk factors for adeno include caesarean (this can damage the uterus), smoking, weight, and exposure to oestrogen over time.
It is thought, as with endo - that there is an infective component to adneomyosis - such as a triggering infection (see more about this in my last blog entry on endo). As with endo, research has demonstrated that toxic lipopolysaccharide (LPS) from translocated bacteria from the gut may induce adenomysosis (1). This is why some women may get better with antibiotics or antimicrobial herbs.
There are other hypothesis about the causes of adeno such as sex steroid hormone issues, inflammation, and neuro-angiogenesis. Another theory of adenomyosis proposes that the disease arises from out of control proliferation of embryonic or adult stem cell in the myometrium. But this research is in its infancy and we still don’t know yet.
What about oestrogen?
We do know is thats there is an oestrogen-dependent component to adenomyosis. Oestrogen promotes the growth of endometrial-like tissue via VEGF and angiogenesis (creation of a blood supply). This is why oestrogen blockers like Zoladex or progesterone suppresses adenomyosis, and why working on oestrogen metabolism is a key part of our treatment plans as natural practitioners.
Treatment for adeno will depend on severity of symptoms. Almost always an integrated approach is needed. Often the role of a naturopath is to ensure a women with this condition has a good care team supporting her, such as and acupuncturist, naturopath, specialist gynaecologist, pelvic floor physiotherapist.
Medical Treatment
Combine oral contraceptive pill
Anti-inflammatory medications like NSAIDS.
Mirena
Drugs such as Zoladex or aromatase inhibitors
High intensity ultrasound
Surgery ranging from conservative to non-conservative like hysterectomy. The conservative surgery requires a specially trained surgeon with a high degree skill.
Natural Treatments
Natural progesterone
Uterine tonic herbs
Styptic herbs (reduce blood flow)
Anti-inflammatories (high dose)
Antimicrobial herbs
Protelytic enzymes (break down scar tissues)
Pelvic microbiome modulation (uterus, vagina, cervix, peritoneal cavity, gut)
Antioxidant herbs and nutrients
Hormonally modulating nutrients and herbs
Comprehensive hormones testing like DUTCH to ascertain oestrogen pathways to modify
Fix leaky gut
Nutrition: Anti-inflammatory diet or elimination diet, fibre, phytoestrogens, fresh fruits and veggies. This will be individualised
Exercise and relaxation
As the root cause of adenomyosis is not known, natural medicine favours treating the whole person. Adenomyosis - like endometriosis - is a complex condition. Women need to ensure they have a professional to advocate for a proper diagnosis and an informed, holistic treatment strategy. Email me your questions or book a consult or 10-minute discovery call if you need support.
Karen xx
References
1 Berberine inhibits the LPS-induced proliferation and inflammatory response of stromal cells of adenomyosis tissues mediated by the LPS/TLR4 signalling pathway doi: 10.3892/etm.2017.5316
