Frederick R. Jelovsek MD
"I am 46 and every month before I start my period, I have really painful cramps. They are so painful that I can barely function. What could be the cause of this?" Carolyn
The new occurrence of cyclic menstrual pain in the decade of the 40's could be due to endometriosis, uterine fibroids, partial cervical stenosis or adenomyosis. By far the most likely cause of these painful menstrual cramps at this time is adenomyosis. This is sometimes called endometriosis interna or internal endometriosis.
Since this is the most likely problem that your doctor will want to rule in or rule out with diagnositic tests, let us focus on adenomyosis. What is adenomyosis?
Adenomyosis is defined as the presence of endometrial glands and supporting tissues in the muscle of the uterus where it normally would not occur. When that gland tissue undergoes growth during the menstrual cycle and then subsequent sloughing, the old tissue and blood cannot get out of the muscle and flow out of the cervix as part of normal menses. This trapping of the blood and tissue causes uterine pain in the form of menstrual cramps. It also produces abnormal uterine bleeding as some of the blood finally escapes the muscle and results in prolonged spotting. For a picture of what adenomyosis schematically looks like, see the (images) at one gynecologist's site.
Adenomyosis occurs more often in the decade of the 40's, perimenopausally. In hysterectomy specimens, adenomyosis can be found from 15% to 25% of the time (1, 2). The glandular change of the endometrial cells in adenomyosis are often incomplete in the second half of the menstrual cycle (luteal phase) and as a result, adenomyosis may not be very responsive to suppression by progesterone. About 50% of adenomyosis is asymptomatic although as it goes deeper into the uterine muscle it tends to be more likely to produce symptoms (3, 4). It is also often associated with fibroids (5 and often associated with other conditions such as ovarian cysts, prolapse and even gynecological cancers (6) that can cause pelvic pain. How is adenomyosis diagnosed?
Up until recent years it was said that adenomyosis was only diagnosable by the pathologist looking at a hysterectomy specimen. Now magnetic resonance imaging (MRI) can more accurately diagnose adenomyosis although many physicians feel this is too expensive a test to use routinely. Patterns of adenomyosis as recognized by MRI seem to either be diffusely spread throughout the uterus (about 66%) or focal lesions (33%) that only occur in one or two places (7). If a non hysterectomy treatment is being considered for adenomyosis, then MRI should be used for the diagnosis and if focal disease were shown, then surgical resection of the endometriosis without doing a hysterectomy could be considered.
Ultrasound especially using color flow doppler can also be used to diagnose adenomyosis (8) . Sometimes it has difficulty differentiating smaller fibroids (leiomyomas) from adenomyosis but it is able to pick up about 80% of the existing lesions. For an in depth discussion on pre surgical ultrasound imaging and diagnosis of adenomyosis, see (The Presurgical Diagnosis of Diffuse Adenomyosis by Helen Bickerstaff, MB, BChir.
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1 comment:
I have suffered from adenomyosis with severe cramps during and after my period. It was very painful and heavy bleeding and severe lower back pain my pain was unbearable to a point of being not able to move and a stabbing like pain on the left of my ovaries. Pain goes away when a clot comes out. But it took a while for the clot to come out. After several meetings with my gynaecologist which she suggested "Hysterectomy" but I refused I know what Hysterectomy is and how heart aching it can be then she stated that Allopathic treatment will help in pain management but it will not cure the disease. I started treatment with a drug named "endoheal 2 mg". This gave me pain relief but reduced my periods almost to no periods with numerous side effects - spotting and fluctuation in my dates. I was not mentally satisfied to bear the side effects so I came across ''Ayurvedic doctor" who started my treatment with herbs. Though I continued above drug 'endoheal 2 mg'" parallel for nine months for easy pain management. From then I continued taking the treatment. It reduced the size of my lesion but did not reduce it further after few months. And there was no relief in pain during menstruation but my Dr. Advised me to continue it during 3 months without any gap. I had noticed a quick ageing of my skin in the last 2 years. I am a smoker but for some reason I feel my quick ageing has to do with something else because I have been smoking for a long time and it's only recently that I noticed a fast decline of my skin elasticity. After then pain radiates very badly in my left leg, lower left back and left side of my vagina. The pain normally start anytime during 3, 5,6 days, but at time I had to take a painkiller for this also as it irritates whole day. Then pain disappears after fews day. My digestion was slow but Dr. Ronnie's supplements has improved it impossible situations is becoming possible miracles gradually.
I was lucky to read in the internet about a lady who was cured from Adenomyosis through Herbal Medication. I contacted Ronnie through an email address I got from a testimony shared on the internet. Without further delay I made an order, I switched over to it. I had great breakthrough, that in the first month, I was already testifying of the effective of the Herbal medication. After 3months course of taken the medicine, all symptoms were gone. It has been 1 year and four months since I became free from adenomyosis. Anyone who is not in my position would not understand what I went through, the heart break, the pain and how frustrated I was for 6 odd years. Believe me, it was hell. I am so happy; I never believed I will be this happy again in life. My story is quite lengthy, it might help you too. You may contact Dr. Ronnie to know more via his email on. ronniemd70@gmail.com
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