Adenomyoma

The womb (uterus) is composed essentially of 2 types of tissues:
1.  The lining (endometrium) which sheds off regularly every month in menstruation and
2.  The muscle layer (myometrium) which gives rise to contraction pain during labor.

Fibroid is a colloquial term describing growth in the muscle wall. There are two forms of fibroid: the myoma which can be shelled out easily and adenomyoma. Adenomyoma is a localized swelling of adenomyosis.

Adenomyosis is a troublesome disease where endometrium is abnormally present in the myometrium. The cause is unknown although there are theories trying to explain it. The symptoms are heavy periods with abdominal cramps. The uterus is usually uniformly enlarged and big or irregular in shape if there are localized adenomyma. There may be pain during sexual intercourse and they are tender when examined by the gynecologist.

Diagnosis

Ultrasound may not differentiate adenomyosis from fibroid. To make matter worse, the two conditions often co-exist. MRI may be helpful. Blood test CA125 may be raised in adenomyosis. The final diagnosis is by microscopic examination after the tumor is removed.

Treatment

Conservative treatment: If the growth is localised, it can be removed by laparoscopy. Unfortunately, unlike myoma the disease is usually scattered invisibly throughout the uterus and thus difficult to remove completely.

Medical drugs such as gestrinone and danazol have been tried with limited success. Injections like Depo-Provera and GnRH agonist have also been used to stop the bleeding temporarily.

Hysterectomy (removal of the womb) is done as a last resort when the bleeding and pain become unbearable and affecting the quality of life.