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Endometrial cells, normally found only on the interior surface lining of the uterus, sometimes work their way into the muscle wall of the uterus, and then grow within the muscular uterine wall. This condition is called adenomyosis, or internal endometriosis. Though this is a distinct condtion from endometriosis, patients with adenomyosis often also have endometriosis. The condition is more common in women who have had children-or who have had prior uterine surgery, such as a C-section or fibroid removal-due to stresses on the uterine lining.

The misplaced endometrial tissue can cause severe cramps and pain both before and during menstruation. In some patients, it can cause severe menstrual bleeding. It is also associated with infertility but the relationship between adenomyosis and fertility remains a matter of research. The condition may mimic the symptoms or uterine fibroids.

When the uterine lining grows into the muscular wall of the uterus, the resulting symptoms may be severe enough to require treatment.

Surgical and Nonsurgical Solutions

Adenomyosis is difficult to diagnose. Evalutaion includes careful medical history and physicial examination. X-rays, pelvic or transvaginal ultrasound, or MR imaging can significantly improve diagnosis; however, often adenomyosis can only be definitively diagnosed through surgery.

Treatment for adenomyosis is similar to treatment for endometriosis. Patients may undergo standard treatments for abnormal bleeding. Hormonal treatment often brings this condition under successful management, but symptoms will usually return once the medication is discontinued.

For patients whose primary symptom is heavy bleeding, endometrial ablation can sometimes be a successful treatment. This is most likely the patient with adenomyosis that is more superficial (closer to the interior lining of the uterus). But endometrial tissue that lines the uterus has a strong propensity to regenerate, and some patients will continue to have heavy, cyclical bleeding. For these patients or those whose primary symptom is menstrual cramping-who also tend to be those whose adenomyosis is more deeply seated or more diffusely present within the uterine wall–surgical intervention may be the only treatment with long-term effectiveness.

Experienced Removal of Problem Tissue

Virtua’s experienced gynecologic surgeons can remove sections of the uterus and repair the uterus. The can do so laparoscopically, including with the aid of robotic technology. Or, for some patients, they may need to perform the uterine resection using open surgery. These treatments almost always mean that bearing children is no longer an option.

For patients in which removal of only the adenomyosed portions of the uterus is unsuccessful or ultimately fails because the internal endometrosis grows back-or for patients in whom it can be initially be determined that the adenomyosis affects the majority of uterus-hysterectomy may be the treatment of choice. This operation relieves the pain in a majority of cases.

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