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Adenomyosis and Pregnancy: Can Adenomyosis Cause Pregnancy Complications?

Adenomyosis is a uterine condition that may affect fertility and pregnancy. Lots of people who are planning to get pregnant or are already pregnant wonder if this condition could affect them or the baby. Read on to learn more about adenomyosis and pregnancy complications.

What is adenomyosis?

Adenomyosis is a condition in the uterus that makes it get thicker. Adenomyosis causes the tissue that lines the uterus to grow into the surrounding tissues.

Normally, the inside of the uterus is lined with endometrial tissue. During a period, this tissue is shed by the body. For someone with adenomyosis, this tissue doesn’t remain inside the uterus. Instead, it grows into the muscular wall of the uterus (the myometrium) and makes it thicker. Even though the tissue is growing in the wrong place, it continues to respond to the cycles of hormones. During each menstrual cycle, it thickens, sheds, and bleeds. This can lead to an enlarged uterus and painful, heavy periods.

This condition is similar to endometriosis. In endometriosis, the endometrial tissue grows outside of the uterus. It may grow on the ovaries or fallopian tissues. It’s possible to have both adenomyosis and endometriosis at the same time.

How common is adenomyosis?

Adenomyosis doesn’t get as much attention as endometriosis, but it’s not a rare condition. Adenomyosis occurs in 22 to 24.4 percent of people who can’t get pregnant and around 20 percent of the general population. 

The exact number of those who have adenomyosis isn’t known, but it’s estimated that between five and 70 percent of people who have a uterus have the condition in some form. 

What are the symptoms of adenomyosis?

The symptoms of adenomyosis can vary from one person to another. Some people don’t have any symptoms at all, while others experience only mild discomfort.

Other people can experience more severe symptoms. These may include prolonged, heavy bleeding during menstruation. Severe cramps or a sharp, stabbing pain in the pelvic area during a period is also a possible symptom of adenomyosis. Some people experience chronic pelvic pain and/or painful sex (dyspareunia). Sometimes, the main symptom is infertility.

In people who have adenomyosis, the uterus may grow to two to three times its normal size. This could cause symptoms like pelvic pressure or tenderness in the lower abdomen.

How to diagnose adenomyosis

Adenomyosis can be difficult for health care providers to diagnose. Many other uterine conditions cause similar symptoms. A health care provider may perform various tests to diagnose someone with adenomyosis.

Heavy periods, severe period cramps, and other symptoms can be associated with many uterine conditions, not just adenomyosis. These conditions include endometrial polyps, which are growths in the lining of the uterus, endometriosis, and fibroid tumors.

If a health care provider notices an enlarged, tender uterus during a pelvic exam, they may suspect adenomyosis. Imaging tests, such as ultrasounds and MRIs, can also help a health care provider detect signs of the condition. To rule out serious conditions, they may recommend a biopsy (tissue sample) of the uterine tissue. However, a biopsy doesn’t help diagnose adenomyosis. The only definitive way to diagnose the condition is to examine the uterus after a hysterectomy (surgical removal of the uterus).

Does adenomyosis affect pregnancy?

Adenomyosis is common among people who have given birth before, and studies confirm that it has an effect on infertility and reproductive issues. Some studies have reported a higher rate of pregnancy complications in women with adenomyosis. 

A recent study published in the journal Fertility and Sterility reported pregnancy complications experienced by pregnant women with adenomyosis. The most common complication — preterm delivery — affected nearly one-quarter of women. This means their babies were born before 37 weeks of pregnancy. Preterm birth can be concerning because babies’ brains, lungs, and livers fully develop during the last weeks of pregnancy. 

Other studies have reported that adenomyosis during pregnancy may come with a greater risk of miscarriage, postpartum hemorrhage, or infections in the uterus. Fetal growth restriction — when babies are smaller than they should be — is another complication that’s been linked to adenomyosis. Adenomyosis is also associated with labor complications.

Can adenomyosis cause infertility?

People who are trying to conceive may be concerned about the effect of adenomyosis on fertility. Directly, infertility is one of the clinical presentations of adenomyosis. Some studies have suggested that in vitro fertilization (IVF) is less effective in women with adenomyosis. 

Recently, the journal Reproductive Biomedicine Online published a study that examined pregnancy outcomes in women with adenomyosis. While 34.55 percent of the control group got pregnant through IVF, only 23.44 percent of women with adenomyosis did. This suggests that it may be harder for people with this condition to get pregnant.

How to treat adenomyosis

Many treatments are available for adenomyosis. The condition frequently goes away by itself after menopause, so treatment might depend on the stage of life someone is in. To treat the condition, a health care provider may recommend home remedies, medications, or surgery.

While adenomyosis often goes away during menopause, there are many treatments that can be used in the reproductive years. Home remedies, such as heating pads and warm baths, can provide some relief. A health care provider may also recommend medications. Taking anti-inflammatory medications (like ibuprofen) a couple of days before a period starts and during a period can reduce menstrual blood flow and help control the pain. Hormonal medications like oral contraceptives can help reduce bleeding and pain. 

If other treatments don’t work and the pain is severe, a health care provider may recommend a hysterectomy. This procedure involves the removal of the uterus; removing the ovaries isn’t necessary to control adenomyosis. Someone who has had a hysterectomy can no longer get pregnant, so a hysterectomy is not a good option for those who want to preserve their fertility.

Adenomyosis may make it harder to get pregnant, and it may increase the risk of some pregnancy complications. If you think you have this condition, talk to your health care provider for advice and treatment. 

“Adenomyosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 June 2020, www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138.

Vannuccini, Silvia, and Felice Petraglia. “Recent advances in understanding and managing adenomyosis.” F1000Research vol. 8 F1000 Faculty Rev-283. 13 Mar. 2019, doi:10.12688/f1000research.17242.1

Taran, F A et al. “Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy.” Geburtshilfe und Frauenheilkunde vol. 73,9 (2013): 924-931. doi:10.1055/s-0033-1350840

Liu XY; Zhang Y; Wei Y; Li R; Zhao YY; “Perinatal Outcome of Pregnant Women with Adenomyosis.” National Library of Medicine, National Center for Biotechnology Information, PubMed.gov, 25 Nov, 2020, pubmed.ncbi.nlm.nih.gov/33228344/.

“Adenomyosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 June 2020, www.mayoclinic.org/diseases-conditions/adenomyosis/diagnosis-treatment/drc-20369143.

Tamura, Hiroshi et al. “Complications and outcomes of pregnant women with adenomyosis in Japan.” Reproductive medicine and biology vol. 16,4 330-336. 21 Aug. 2017, doi:10.1002/rmb2.12050

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