Endometrial hyperplasia, adenomyosis and endometriosis are all conditions affecting the endometrial lining, which is discarded monthly unless pregnancy occurs.
The terms adenomyosis and endometrial hyperplasia are often used interchangeably. Both affect older women, generally between 40 and 50 years old, and seldom below the age of 35. For women in the childbearing range, endometrial hyperplasia or adenomyosis can make it harder to conceive or carry a pregnancy to term. Endometriosis can begin in adolescence and extend throughout the childbearing years. The main difference between adenomyosis and endometriosis is the location of abnormal cell growth. Adenomyosis causes endometrial cells to embed themselves deep into the uterine walls, while endometriosis produces an abnormal proliferation of these cells outside the uterus.
Endometrial hyperplasia is a rare condition that affects the female reproductive system. Only about 133 out of 100,000 women are affected by endometrial hyperplasia. Although the excess cells are not cancerous under the microscope, they can lead to the development of endometrial cancer (a form of uterine cancer).
Most women who develop endometrial hyperplasia are in their 40s or 50s, with the condition rarely affecting anyone under 35 years old. Most women are in the perimenopausal or menopausal stage when endometrial hyperplasia begins.
Other factors that increase the risk of endometrial hyperplasia:
- Certain treatments for breast cancer, including Tamoxifen
- Gallbladder disease
- Family history of uterine, ovarian or colon cancer
- Early menarche or late menopause
- Hormone therapy
- No pregnancies
- Thyroid disease
Symptoms of Endometrial Hyperplasia
- Missed periods
- Exceptionally long periods
- Short menstrual cycles
- Heavy bleeding during menstrual periods
- Postmenopausal bleeding
When cells from inside the endometrial lining become embedded in the uterine wall, they continue to multiply, just as they would in the uterine cavity. The uterine wall becomes thick and heavy, causing enlargement of the uterus. Pressure increases with resulting pain often described as a stabbing sensation.
Normal menstruation allows for the endometrial lining to be shed when hormones signal that conception did not occur. However, the menstrual blood gets trapped in the thick, muscular uterine walls and becomes harder to expel. Resulting swelling and inflammation may lead to heavier cramping with increased flow and possibly large clots. The blood will be expelled, but menstrual periods may exceed seven days and may be accompanied by spotting throughout the month.
Symptoms of Adenomyosis
- Menstrual pain, possible stabbing sensation
- Increased cramping due to swelling and inflammation
- Painful intercourse due to swelling of the uterus
- Prolonged menstrual periods with heavy bleeding
- Spotting throughout the month may be due to exercise or sexual intercourse
Some Ways Adenomyosis Affects Infertility
Statistics show that women who develop adenomyosis double their risk of miscarriage due to the increase in cramping and heavy bleeding, making it harder for the fertilized egg to remain in the uterus long enough to become a viable fetus. Some women try unsuccessfully for months or years to get pregnant.
Modern technology can help, with doctors being able to do laser ablation of some of the uterine lining, resulting in less cramping and lighter periods. Other women may be helped by hormone pills or injections.
With endometriosis, cells from the uterine lining (endometrium) grow outside the uterus, possibly spreading into the ovaries, fallopian tubes, cervix and vagina. Other places in the lower body may be affected as well. Patchy abnormal growth of cells may be found on endometrial biopsy, ultrasound or MRI scan.
Severe pain during menstrual periods is often the first sign of the condition. Milder pain and inflammation can be treated with pain relief medications. Hormone therapy can help by slowing the abnormal growth of the endometrial lining already in progress and restricting new growth.
Slowing or preventing the abnormal growth of endometrial cells outside the uterine cavity can prevent scarring that often leads to infertility.
Symptoms of Endometriosis
- Mild to severe pain in the lower abdomen
- Acute menstrual cramps
- Heavy monthly periods
- Spotting between periods
- GI symptoms such as nausea, vomiting or diarrhea
- Difficulty with urination or bowel movements during menstruation
Endometriosis and Infertility
First the good news. Many women with this condition become pregnant spontaneously.
The American Society for Reproductive Medicine tells us that 24% to 50% of women with endometriosis have issues with infertility. These issues include:
- Endometrial tissue in the fallopian tubes can prevent eggs from reaching the uterus to attach to the uterine wall.
- Inflammation can make implanting more difficult.
- The development and maturation of eggs in the ovary may be adversely affected by the condition.
Modern medical science offers help and hope, so consult with your physician to find the best plan for you.
These three medical terms describing similar medical conditions provide a starting place to research and gain information about issues vital to women’s sexual and reproductive health. Young women contemplating starting a family would do well to educate themselves about issues that they might encounter along the way.