Adenomyosis treatments that may help ease symptoms

Adenomyosis is a gynaecological condition that affects the uterus. Cells that normally form the lining of the uterus (the endometrial tissue) also grow within the muscle walls of the uterus (the myometrium). These endometrial cells remain sensitive to menstrual hormone signals and act as if they are still located within the lining of the uterus. This means the tissue becomes thicker and breaks down every month, and bleeds during the period. Because the cells are trapped within layers of muscle, small pockets of blood can form within the muscle.

Adenomyosis cells are found in various patches throughout the layers of the muscle at the back of the uterus. If there is a large concentration of adenomyosis, it may form a mass called an adenomyoma.

Signs & Symptoms of Adenomyosis

• Heavy or abnormal menstrual bleeding
• Painful periods – this may start suddenly
• Pain during intercourse
• Bleeding or spotting between periods
• Anaemia due to heavy blood loss during periods
• Chronic pelvic pain, occurring throughout the month even when not menstruating, may develop
• Constipation
• Unexplained “weight gain” in lower belly
• Frequent urination
• Bloating

Diagnosis is usually made through a transvaginal ultrasound and/or an MRI. Even with these tools, diagnosis may be difficult, and adenomyosis is often mistaken for endometriosis.

Adenomyosis and Fertility

Adenomyosis may increase the risk of issues with fertility. It may interfere with the beneficial contractions that help sperm reach the egg in the fallopian tubes and may promote contractions that disrupt embryo implantation in the uterus.

It is difficult to know whether fertility issues are caused by adenomyosis alone. Undiagnosed endometriosis, a similar condition with low fertility outcomes, is often found alongside adenomyosis.

Adenomyosis vs Endometriosis?

Adenomyosis and endometriosis have many similarities, including symptoms and underlying gynaecological changes. They are both conditions that involve the presence of uterine cells beyond the lining of the womb, and both present with heavy, painful periods. 

The main difference is location. In adenomyosis, the cells from the lining of the uterus have “spread” to the walls of the muscles of the same organ; in endometriosis, these cells exist beyond the uterus to other parts of the body (usually the fallopian tubes, ovaries, or the lining of the pelvis).

Adenomyosis is often diagnosed during an examination for suspected endometriosis, and the conditions often exist alongside each other.

Causes of Adenomyosis

The cause of adenomyosis is still being researched, but it may be associated with any kind of trauma in the uterus that causes a break in the barrier between the uterus and the muscle layers. 

This may include:

• Inflammation from childbirth: Postpartum uterine inflammation may cause a break in the boundary between the endometrium and the myometrium, allowing the cells of the uterine lining to move to the muscle space. 
• Surgeries, including caesarean section or pregnancy terminations. Any mechanical incisions made during surgery may cause direct movement of the endometrial cells into the muscle layers beneath.
• Abnormal uterine development: The formation of the cells of the endometrium may become relocated to the area of myometrium development in utero. If you have adenomyosis, have never been pregnant or had uterine surgery, you may have had it since birth. 
• Researchers are looking at the involvement of different body systems to explain the onset of adenomyosis. Possible factors include immune system dysfunction, blood clotting and scarring issues, and inflammatory pathways.

Natural therapies and treatment for Adenomyosis

There is no known cause of adenomyosis, so it is difficult to prevent or completely eradicate. Doctors may recommend a hysterectomy if the bleeding is heavy and long-term or if the pain is extreme. Natural therapies may help reduce heavy menstrual flow, manage pain, and improve uterine health.

Turmeric for Adenomyosis

Turmeric is a bright orange root that is used in Ayurvedic medicine for many menstrual issues. Turmeric and its active constituent, curcumin, have potent anti-inflammatory effects throughout the body. It may reduce the inflammatory signals that may initiate the spread of endometrial cells into the myometrium.

A 2013 in vitro study found that curcumin could suppress the spread of endometrial cells by inhibiting excess oestrogen production. It has also been shown to reduce platelet aggregation and clotting in adenomyosis, which may further reduce inflammation and pain. The positive effects of turmeric may take weeks to be felt, and more research is needed in humans to confirm its effect on adenomyosis. 

Acupuncture for Adenomyosis

Whilst research is limited for acupuncture and adenomyosis, there is some data on its efficacy in controlling the symptoms of endometriosis. A 2017 systematic review and meta-analysis of all the available literature concluded that acupuncture may reduce pain associated with endometritis. 

While adenomyosis and endometriosis are different conditions, the underlying mechanisms behind the pain may be similar. Acupuncture may help to relieve pain by boosting the release of feel-good chemicals from the brain, such as dopamine, opioids and noradrenaline, and a 2008 study showed that acupuncture may suppress excessive oestrogen levels, which may help to reduce the severity of menstrual pain in adenomyosis.

Vitamin D for Adenomyosis

Vitamin D is an important nutrient for regulating cell migration, reducing inflammation and supporting the immune system. Research for vitamin D and adenomyosis is limited. However, vitamin D deficiency has been associated with endometriosis and higher reports of bleeding and pain. 

Antioxidants for Adenomyosis

Pain and excessive bleeding in adenomyosis may be driven by inflammation and oxidative stress. Antioxidants in the diet or through supplementation may help to reduce inflammation and alleviate pain in the long term.

Key antioxidants include:

• Vitamin A
• Vitamin C
• Vitamin E
• Zinc
• Copper

Iron for Adenomyosis

If you are suffering from adenomyosis, it is important to get your iron levels tested due to excessive blood loss from heavy menstruation. Low iron may cause secondary symptoms of fatigue, shortness of breath, and lethargy, but it could also have a role in exacerbating adenomyosis.

Iron is a key nutrient that is needed for the healthy regulation of the metabolism and genetic and DNA expression of endometrial tissue. 

Related reads:

• Your complete guide to a diet that supports fertility
• Menstruation: What it is, what’s normal and how to help to manage any pain
• Endometriosis, IBS and the low FODMAP diet

References

1. McNeeley, S. G. (2017) Uterine Adenomyosis. Merck Manual Online Database Professional. https://www.msdmanuals.com/en-au/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/uterine-adenomyosis
2. https://www.healthdirect.gov.au/adenomyosis 
3. Dueholm, M. (2017) Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstetrica, 96:9. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13158
4. Harada, T., et al. (2016) The Impact of Adenomyosis on Women's Fertility. Obstet Gynaecol Surv., 71:9, 557 – 568. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049976/
5. Vannuccini, S., & Petraglia, F. (2019). Recent advances in understanding and managing adenomyosis. F1000Research, 8, 283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419978/
6. https://www.healthdirect.gov.au/adenomyosis#treated 
7. Zhang, Y., et al. (2013) Curcumin inhibits endometriosis endometrial cells by reducing estradiol production. Iran J Reprod Med., 11:5, 415 – 422. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941414/
8. Xu, Y., et al. (2017) Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS ONE: 12:10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659600/
9. Miyashita, M., et al. (2016) Effects of 1,25-Dihydroxy Vitamin D3 on Endometriosis. The Journal of Clinical Endocrinology & Metabolism., 101:6. https://academic.oup.com/jcem/article/101/6/2371/2804763
10. https://www.betterhealth.vic.gov.au/health/healthyliving/antioxidants#sources-of-antioxidants 
11. Bernardi, L. A., et al. (2016) The association between subjective assessment of menstrual bleeding and measures of iron deficiency anemia in premenopausal African-American women: a cross-sectional study. BMC Womens Health., 16.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983800/