Is It Possible to Get Pregnant with Adenomyosis?

Reviewed on 5/3/2021

In uterine adenomyosis, tissue from the inner lining of the uterus grows into the muscle wall of the uterus (myometrium), which can cause heavy, painful menstrual periods. It is unclear if adenomyosis causes infertility because there are not enough studies done on the matter, many women with adenomyosis may have other complications such as endometriosis or fibroids, which can also cause infertility, and women who have adenomyosis tend to be older.
In uterine adenomyosis, tissue from the inner lining of the uterus grows into the muscle wall of the uterus (myometrium), which can cause heavy, painful menstrual periods. It is unclear if adenomyosis causes infertility because there are not enough studies done on the matter, many women with adenomyosis may have other complications such as endometriosis or fibroids, which can also cause infertility, and women who have adenomyosis tend to be older.

Uterine adenomyosis is a condition in which tissue from the inner lining of the uterus grows into the muscle wall of the uterus (myometrium) causing heavy, menstrual painful periods. 

Adenomyosis is frequently seen along with other uterine problems such as endometriosis, a condition in which endometrial cells (the lining of the uterus) grow outside of the uterus. Both adenomyosis and endometriosis cause pain, but endometriosis does not usually result in heavy menstrual periods. 

It is unclear if adenomyosis causes infertility for several reasons:

  • There are not many studies on the impact of adenomyosis on fertility 
  • Many women who have adenomyosis also have endometriosis, uterine polys, or fibroids, which are conditions known to cause infertility 
  • Many women who have adenomyosis are older

For women who do have adenomyosis, it is possible to become pregnant. Treatment for women with adenomyosis to improve pregnancy and live birth outcomes may include: 

  • Gonadotrophin-releasing hormone agonists (GnRH-a) 
  • Conservative surgery or combination surgery with GnRH-a , which can be more effective in controlling symptoms and increasing pregnancy and live birth rates than GnRH-a alone
  • High-intensity focused ultrasound ablation (HIFU

What Are Symptoms of Adenomyosis?

Symptoms of adenomyosis include:

  • Painful periods/menstrual cramping (may be severe)
  • Prolonged menstrual bleeding
  • Heavy periods
  • Lower abdominal pain or tenderness
  • Chronic pelvic pain
  • Pelvic pressure
  • Abdominal bloating/swelling
  • Blood clots in the pelvis and legs
  • Painful sexual intercourse
  • Pain in the back and legs

What Causes Adenomyosis?

The cause of adenomyosis is unknown but it may develop due to:

  • Hormones
  • Bone marrow stem cells enter the uterine muscle
  • Inflammation of the uterus following childbirth

Risk factors for developing adenomyosis include:

  • Early age of menstrual onset
  • Short menstrual cycles
  • Cesarean section
  • Childbirth
  • Previous uterine surgeries 
  • Removal of uterine fibroids (myomectomy)
  • Middle age

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How Is Adenomyosis Diagnosed?

If adenomyosis is suspected, a medical history and pelvic examination is performed. A pelvic exam may find an enlarged and soft uterus, and a uterus that moves around and is not fixed in place. 

Imaging tests may include:

An ultrasound may indicate a suspected diagnosis of adenomyosis, but the only way to confirm a diagnosis of adenomyosis is based on pathology of the uterus which is evaluated after removal of the uterus (hysterectomy). 

Blood tests may be used to rule out pregnancy, check for anemia, or exclude other conditions.

In some cases, an endometrial biopsy is performed in which a small piece of tissue from the lining of the uterus is removed and sent to a lab for examination. It is usually performed to rule out endometrial hyperplasia (thickening of the lining of the uterus) or cancer.

What Is the Treatment for Adenomyosis?

Treatment for adenomyosis is aimed at managing or relieving the symptoms. 

Treatments that may reduce heavy bleeding due to adenomyosis include:

  • Endometrial ablation, which surgery to scar the lining of the uterus to make periods lighter
  • Intrauterine devices (IUDs) that release the hormone progestin
  • Uterine artery embolization to block the blood supply to the uterus and help shrink uterine adenomyomas

Treatments for pain due to adenomyosis include:

The only cure for adenomyosis is the surgical removal of the uterus (hysterectomy). 

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Reviewed on 5/3/2021
References
https://innovativegyn.com/conditions/adenomyosis/

https://www.adenomyosisadviceassociation.org/What-Should-I-Eat-.html

https://www.uptodate.com/contents/uterine-adenomyosis-the-basics?search=Adenomyosis&source=search_result&selectedTitle=1~55&usage_type=default&display_rank=1

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194011

https://www.contemporaryobgyn.net/view/adenomyosis-and-its-impact-fertility