Adenomyosis is a common condition, often only seen as an incidental finding when a pathology evaluation is performed following hysterectomy.
The condition is best understood if one has a basic understanding of the uterine anatomy. How the uterine musculature relates anatomically to the endometrial lining. The endometrial lining or menstrual lining, is shed each month resulting in menses due to cyclic hormonal changes, while the uterine musculature remains intact.
With Adenomyosis the well-defined anatomic separation between the endometrium and myometrium is maintained; however, there are crypts of endometrial tissue that grow into the myometrial wall.
The amount of adenomyosis will determine the severity of the symptoms (ie. cramping and bleeding). On pelvic exam the condition can cause a softness to the uterus as a result of the displacement of the firmer uterine muscle with endometrial tissue. This is a physical finding that is not diagnostic but consistent with Adenomyosis .
It used to be that Adenomyosis was a diagnosis of exclusion and it still is in some cases. Now , with the evolution of high level studies ( MRI etc.) and findings described on hysterosopic evaluation, the condition can be defined more often preoperatively.
The definitive finding is seeing the pathologic changes when cross-sectional views are taken of the uterine specimen showing crypts of endometrial tissue growing into the wall of the uterus .
Adenomyosis is managed individually, based on symptoms, one may go through hormonal trials or endometrial ablation (when fertility is not a concern).
I hope this information helps one to understand adenomyosis. It is not a life-threatening condition and thus management can be based on the entire clinical picture.
If fertility is not a factor, endometrial ablation using various techniques (resection etc.) may not be effective. Personally, I have taken this step initially if one wishes to try and manage conservatively. If ablation is not successful then either repeat ablation or hysterectomy is the option to consider. You may ultimately have to weigh the risk of repetitive operative procedures, including anesthesia etc. versus definitive treatment by hysterectomy.
Ablation can actually result in more cramping as there can be scarring over crypts of endometrial tissue. There is also a very small risk of harboring an underlying endometrial cancer. Thus screening of endometrial tissues should be done during the course of one's preoperative evaluation.
I hope this information is helpful and again I must state that it is intended to be educational and cannot be interpreted as suggesting a cure, treatment or preventive measure as it is crucial to know the entire medical history of a patient to make decisions about management.