Diagnosing Adenomyosis

Telling The Difference

As with any illness, the medical history of the patient is important to the diagnosis of the disease. The problem with diagnosing adenomyosis is that the symptoms, which include painful sex, menstrual pain, painful bowel movements and abdominal discomfort, all bear a remarkable resemblance to the symptoms of endometriosis. In order to distinguish one from the other, it is important the right questions are asked and the answers are closely observed.

The Signs Are Subtle And Easily Missed

At times, a woman might describe the pain she is experiencing as similar to that of labor and delivery, which isolates the uterus as opposed to the other reproductive organs. Some women are able to point a finger directly to the spot their uterus would be and explain that the pain is generated from that area. It would do the doctor well to listen to what she's saying.

Another useful bit of information would be if the woman is 30 years of age or older. Adenomyosis usually begins later in a woman's life, as opposed to endometriosis, which begins in the early teens, with the onset of menstruation. Uterine source pain encompasses lower back and even some high abdominal pain since the uterus is attached by ligaments to the back, thighs, and to the umbilical area through arteries. Pain that is described as radiating from this region may be another indication that the problem is adenomyosis rather than endometriosis.

The Difference Is Discovered Through An Examination

The areas of tenderness are often different when it comes to comparing adenomyosis and endometriosis. The physical exam can give some important information to the doctor if he will view the palpation of the uterus apart from checking the rear of the pelvis (where endometriosis tends to be most prevalent). Often the doctor is only checking for the size, shape, and position of the ovaries and uterus rather than determining if there is increased pain in the uterus or rear of the pelvis. As a result, adenomyosis can be overlooked.

Scans Don't Cut It

The various diagnostic scans, such as ultrasound, MRI, or CT scans, often miss adenomyosis because the density of the tissue is not so great as to be picked up. On occasion, the uterus may have a round appearance rather than oval, and there may be fuzzy shadows appearing-but otherwise, it is difficult to see adenomyosis on scans. Frequently, when nodular adenomyosis (clumps of the disease) are visible in the scans they are mistaken for uterine fibroids, which also present with pain and bleeding.

Ultimately, in most cases of adenomyosis, the diagnosis is made by the doctor's clinical impression and his judgment has its basis in the presented evidence. It is really a trust issue.

The Catch-22 Of Adenomyosis

Since the adenomyosis is contained within the uterus and most scans and biopsies do not yield adequate information, it is difficult to diagnose the disease outside of a physical exam and history. What continues to be a catch-22 in all of this is the fact that the only "sure" way to diagnose adenomyosis is by removing the uterus. Even at that, up to 15 percent of women who undergo a hysterectomy in order to obtain a diagnosis, are discovered to have no obvious findings of the disease. If there is some good news at all, it would be that with the hysterectomy, the pain goes and the woman is finally free of the chronic pain and bleeding she had been suffering.

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