Uterine fibroids and adenomyosis are two of the most easily missed or mistaken conditions many menstruating women suffer from. Let’s take a deeper look at both conditions and understand how they are different from one another.
Also known as uterine Leiomyomas or Fibromyoma, uterine fibroids are non-cancerous growths in or on a female’s uterus. These tumours may or may not cause any symptoms. Small fibroids may not cause any disturbance and may not need any treatment either. However, the bigger fibroids can cause issues and may need to be treated through medications or surgery.
Uterine fibroids can grow as a single nodule or in a cluster. They can vary in size and can grow anywhere in the uterus – inside the uterine cavity, within the uterine wall or even on the outer surface of the uterus.
The exact reason for uterine fibroids is still unknown. Many studies and doctors believe the sex hormones – estrogen and progesterone play a role in the formation of such fibroids.
Uterine fibroids are quite common and affect most women between the ages of 30 and 50 years. They can be classified into different types depending on their size and location. Uterine fibroids can be classified into the following four types:
1. Intramural – The most common type of uterine fibroids, that are embedded into the muscular wall of the uterus.
2. Submucosal – these grow under the inner uterine lining.
3. Subserosal – These grow under the lining of the uterus’ outer surface. These can grow large in size and into the pelvis too.
4. Pedunculated – These fibroids resemble mushrooms as they attach to the uterus through a stem or a stalk. These are not very common.
Fibroids in the uterus are very common among menstruating women and most of them don’t cause any obvious symptoms. Many women may not know about the fibroids inside until they take a scan of their uterus. Fibroids are generally not present in women before attaining puberty, and once they attain menopause, the symptoms fade away.
Some common symptoms of uterine fibroids are:
1. Painful periods
2. Excess bleeding during periods
3. Bleeding between menstrual cycles
4. Abdomen feels full or bloated
5. Pressure on the rectum or feeling constipated
6. Pain during sexual intercourse
7. Pain in the lower back
8. Need to urinate frequently (this happens when the fibroids put pressure on the bladder)
9. Unable to empty the bladder fully or pass urine
10. Chronic vaginal discharge
11. Enlargement of the abdomen – may make you look pregnant
If you do not experience any symptoms, there is no need for treatment. In the case of small or even medium-sized fibroids, just close monitoring will suffice until the fibroids start causing any pain, discomfort or other complications.
The treatment for uterine fibroids will vary from case to case as it will depend on the following factors:
● The size and location of the fibroids
● Number of fibroids
● How the fibroids are affecting your overall health
● Are the fibroids interfering with your pregnancy attempts?
● Do you want to retain your uterus in case of big fibroids?
● What your future plans are regarding having babies or pregnancy
The size and location of the fibroids play a major role in the woman’s fertility. If the fibroids are small and do not obstruct any path, the woman can conceive and have a healthy baby successfully.
However, if the fibroids are too big or obstruct the path the sperm travels on, to meet the egg, it can cause issues with fertility and pregnancy. The location of the fibroids can also interfere with the implantation process. So, even if the sperm fertilises the egg successfully, the implantation may not happen easily, which is necessary for pregnancy.
Uterine fibroids can also cause complications during labour and childbirth. Women suffering from uterine fibroids are at a higher risk of having a caesarean delivery. In some cases it can even cause placental abruption, preterm delivery or prevent labour from progressing smoothly, thus requiring medical intervention.
In many cases, a successful pregnancy is possible with the help of medications, surgery or assisted reproductive technology.
Adenomyosis is a condition where tissues similar to the endometrial lining inside the uterus start growing into the uterine wall. This, in turn, will cause the uterus to expand. The uterus can expand up to double or even triple its usual size.
Adenomyosis can cause very painful and heavy periods, usually accompanied by blood clots and abdominal or pelvic pain. Women suffering from this condition can also experience prolonged periods. This condition is common among women over the age of 40 but can affect adolescent girls too. The symptoms can be very difficult to read with younger girls.
In some cases, adenomyosis can occur along with endometriosis – a condition where the uterine lining grows outside the uterus.
Many women may not experience any obvious symptoms when suffering from adenomyosis. Some common symptoms that can indicate adenomyosis are:
1. Dysmenorrhea – Very painful menstrual cramps that can even interfere with one’s daily activities.
2. Menorrhagia – Heavy bleeding during periods. The bleeding can be heavier than typical periods or last more than seven days.
3. Abnormal Menstruation – Periods can last longer or be shorter than usual. The menstrual cycle can be more than 28 days or less than 21 days, and periods can be irregular or even light.
4. Pain in the pelvic region with or without cramps.
5. Pain during sexual intercourse.
6. Fertility issues – Difficulty in getting pregnant even after trying for a year.
7. Enlarged uterus - The uterus can be double or triple its usual size.
8. Your stomach may feel full or bloated all the time.
Many women suffering from this condition may dismiss the symptoms due to ignorance or lack of awareness. They may dismiss the pain, irregularity, change in bleeding, etc., as common period-related issues.
There is not enough data about getting pregnant with adenomyosis. Studies and research suggest that adenomyosis may interfere with a woman’s pregnancy attempts, especially if she is undergoing IVF. The excess growth can prevent the embryo from implanting on the uterine wall.
When women with adenomyosis want to get pregnant, their doctor may suggest medications, hormone therapy or even surgery like hysterectomy. If pregnancy is not a concern, women can manage the symptoms without any surgery or treatment until they attain menopause. Once you reach menopause, adenomyosis will resolve on its own.
Both uterine fibroids and adenomyosis can cause pelvic or abdominal pain during menstruation. They have similar symptoms and impact on one’s fertility but are very different conditions. With timely diagnosis and the right treatment, the pain and the impact on pregnancy can both be reduced. If you notice any of the above-mentioned symptoms, consult your gynaecologist instead of ruling them out as common PMS and suffering from it every month.
Uterine fibroids grow from the muscle layers of the uterus, and adenomyosis causes the uterine lining to grow into the muscle wall of the uterus. Both can be painful and interfere with a woman’s menstrual cycle and attempts at pregnancy.
Common symptoms of uterine fibroids include pain in the pelvis or abdominal region, heavy menstrual bleeding and Pressure around the abdominal or lower back area.
Yes, both can occur together. Many women suffering from adenomyosis will have uterine fibroids too.
Common treatment options for adenomyosis are medication, surgery or hormonal contraceptives like birth control pills, IUDs or vaginal rings.
