Endometrial Hyperplasia, Adenomyosis and Endometriosis: Understanding the Differences

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.