Adenomyosis Ultrasound: Diagnosis and Management

What is an adenomyosis ultrasound?

An adenomyosis ultrasound test is a non-invasive imaging technique used to diagnose and assess adenomyosis, a condition affecting the uterus. It's a type of pelvic ultrasound that is performed transvaginally, which allows healthcare professionals to visualise the uterine structure and identify characteristic signs of adenomyosis.

What does an adenomyosis ultrasound detect?

An adenomyosis ultrasound can detect various features that indicate a uterine condition, including:

1. An irregular or uneven inner layer of the uterus (called the junctional zone).

2. An enlarged or asymmetric uterus.

3. Linear shadowing in the uterine wall.

4. Bright lines or streaks within the muscle of the uterus (myometrium).

5. An uneven appearance of the muscle layer of the uterus on an ultrasound.

6. Small fluid-filled sacs within the muscular wall of the uterus (myometrial cysts). 

7. An unclear boundary between the uterine lining and muscle wall of the uterus (endometrial-myometrial border).

It can also help to check for the presence of other conditions, such as endometriosis and uterine fibroids.

What is adenomyosis, and what causes it?

Adenomyosis is a noncancerous (benign) uterine condition where the endometrial tissue (the lining of the uterus) starts to grow into the myometrium (the muscular wall of the uterus). It causes your uterus to thicken and enlarge in size.

This misplaced tissue will react to different hormonal changes during the menstrual cycle, leading to symptoms such as heavy menstrual bleeding, severe cramps, and pelvic pain.

As adenomyosis does not always cause symptoms, its exact cause is unknown. However, this condition is more prevalent in women older than 40 years old who have had previous procedures on their uterus, such as uterine fibroid dilation and curettage (D&C), those who have had multiple pregnancies, and those in their 30s with abnormal vaginal bleeding or painful periods.

If you’re experiencing any of these symptoms, don’t hesitate to request an appointment with Thomson Medical. Our specialist will help you to assess your underlying condition and provide you with tailored recommendations.

How do I need to prepare for my adenomyosis ultrasound?

The preparation required for an adenomyosis ultrasound is minimal. However, your healthcare provider may ask you to:

1. Drink water and have a full bladder for a transabdominal ultrasound.

2. Empty your bladder before a transvaginal ultrasound.

3. Wear comfortable, loose-fitting clothing.

What happens during the ultrasound?

During the ultrasound:

1. You'll lie on an examination table

2. For a transvaginal ultrasound, a lubricated probe will be gently inserted into the vagina

3. The sonographer will move the probe to capture images of your uterus

4. The procedure typically takes 15-30 minutes

There are usually no known risks or side effects associated with an adenomyosis ultrasound. After the procedure, the ultrasound images will be sent to a specialist, also known as a radiologist, for analysis. There is no downtime required, and you can resume your normal activities immediately.

How do I interpret my results?

After the radiologist analyses the images, they will share their findings with your healthcare provider, and your doctor will interpret the results for you.

Ultrasound signs of adenomyosis may include:

1. A heterogeneous or enlarged uterus

2. An irregular or interrupted junctional zone

3. Linear shadowing in the uterine wall

4. Myometrial cysts

5. Increased vascularity on colour Doppler ultrasound imaging

If you have any further questions or concerns, such as which medications to take or how to relieve certain symptoms, feel free to ask your doctor directly.They will advise you best on what to do with your current situation.

How is adenomyosis treated?

Adenomyosis usually goes away after menopause, so treatment depends on how close you are to that stage. Some treatment options for adenomyosis include:

• Anti-inflammatory drugs

  • Your doctor may recommend anti-inflammatory medications such as ibuprofen to be taken 1 to 2 days before your menstrual cycle begins and during your period to reduce menstrual blood flow and relieve pain.

• Hormone medications

  • Hormone medications such as combined oestrogen-progestin birth control pills and hormone-containing patches or vaginal rings might lessen heavy bleeding and pain associated with adenomyosis. 

  • Progestin-only contraception, such as an intrauterine device or continuous-use birth control pill, often causes amenorrhoea, the absence of your menstrual periods, which might provide some relief.

• Hysterectomy

  • If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus (hysterectomy). However, the removal of your ovaries isn't necessary to treat adenomyosis.

Other ways you can manage and ease the pelvic pain and cramping related to adenomyosis are through self-care methods such as soaking in a warm bath, using a heating pad on your abdomen, or taking over-the-counter anti-inflammatory medications.

To find out more about which adenomyosis treatment test is suitable for you, request an appointment with Thomson Medical. Our specialists can provide further assessments, including adenomyosis ultrasounds, and give you a personalised recommendation.

What happens if adenomyosis is left untreated?

Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo can't implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain, leading to an overall decreased quality of life.

Hence, adenomyosis ultrasound is a valuable tool for diagnosing and assessing this common uterine condition. Early detection and appropriate management can significantly improve quality of life for those affected by adenomyosis.

FAQ

How is adenomyosis diagnosed?

Adenomyosis is primarily diagnosed through pelvic exams where your doctor will check if your uterus has gotten larger, softer or painful to the touch, and imaging techniques, with transvaginal ultrasound being the first-line method. MRI scans may also be used in some cases to show uterine enlargement and thickening of certain areas of your uterus.

What’s the difference between adenomyosis, endometriosis, and uterine fibroids?

All three are disorders of the female reproductive tract which may cause similar symptoms. However, adenomyosis involves endometrial tissue growing into the walls of the uterus. Endometriosis involves endometrial tissue growing outside the uterus. Uterine fibroids are benign tumours growing in or on different parts of the uterus.

Does adenomyosis affect my fertility?

Yes, adenomyosis can negatively affect fertility, potentially leading to lower pregnancy rates, increased miscarriage risk, and complications during pregnancy. For example, adenomyosis can disrupt the normal uterine environment, making it harder for an embryo to implant and for a pregnancy to develop.

What are the ultrasound signs of adenomyosis?

On ultrasound, adenomyosis can show up with a heterogeneous myometrium, a globular or enlarged uterus, myometrial cysts, and an irregular or indistinct endometrial-myometrial junction, often with "venetian blind" shadowing.

What happens if you have adenomyosis?

Some women may be asymptomatic. However, severe symptoms of adenomyosis can include debilitating pelvic pain, heavy or prolonged menstrual bleeding, painful intercourse, and infertility.

How to differentiate between fibroids and adenomyosis on ultrasound?

On ultrasound, differentiating between uterine fibroids and adenomyosis can be challenging, but key features to look for include the presence of a well-defined border and a pseudocapsule for fibroids, while adenomyosis may show ill-defined margins, heterogeneous areas, and increased vascularity.

What are the four stages of adenomyosis?

Adenomyosis typically progresses through four stages, each marked by varying symptoms and levels of uterine tissue infiltration: early (Stage 1), moderate (Stage 2), severe (Stage 3), and advanced (Stage 4).

Here's a more detailed breakdown of each stage:

• Stage 1 (Early Adenomyosis): The initial stage is characterised by minimal infiltration of endometrial tissue into the uterine wall, with mild symptoms.

• Stage 2 (Moderate Adenomyosis): In this stage, the uterine wall experiences significant infiltration, leading to symptoms like heavy menstrual bleeding and painful periods.

• Stage 3 (Severe Adenomyosis): The symptoms intensify as uterine infiltration increases, potentially affecting the shape and size of the uterus and daily activities.

• Stage 4 (Advanced Adenomyosis): This stage is characterised by extensive tissue infiltration and potential damage to the uterus, with symptoms like chronic pelvic pain, nausea, intermenstrual bleeding, and painful intercourse.

Can adenomyosis become cancerous?

While adenomyosis itself is generally considered a benign condition and doesn't typically lead to cancer, in very rare cases (less than 1%), endometrial tissue within the myometrium can develop into endometrioid adenocarcinoma, a type of uterine cancer.
The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.