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What Is 'Inside-Out' Endometriosis?

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'Inside-out' endometriosis may be the cause of your extremely painful periods

The Uterus User's Guide

While getting your period is never really a picnic for people who menstruate, some have a little-known painful condition called adenomyosis that can make matters much worse. The good news is adenomyosis isn’t life-threatening. The bad news is it can cause heavy and lasting menstrual bleeding, intense bloating and abdominal pain and severe cramps. It sounds awful because it is. So, what is adenomyosis, and how does it differ from endometriosis?

What is adenomyosis?

According to Dr. Robert B. Albee Jr., founder emeritus of the Center for Endometriosis Care,  adenomyosis was once referred to as endometriosis interna, or in layman’s terms, "inside-out endometriosis." Similar enough to endometriosis that it is called a sister disease, adenomyosis is a condition that causes the endometrial tissue of the uterus cavity to grow into the uterus muscle, which damages the uterine wall. The difference is that with endometriosis, the endometrial tissue grows outside the uterus, while with adenomyosis, it grows inside the uterus.

With adenomyosis, the displaced endometrial tissue continues to thicken, break down and then bleed out during each menstrual cycle, which could result in an enlarged uterus and painful, heavy periods.

More: If Nothing Works to Treat Your Period, Endometrial Ablation Could Be an Option

According to the Seckin Endometriosis Center, between 40 and 50 percent of patients with adenomyosis also have endometriosis, and 50 percent of people with adenomyosis also having fibroids at some point.

There are three different classifications of adenomyosis — focal, adenomyoma and diffuse. Focal adenomyosis is focused in only one area of the uterus. Adenomyoma is similar to focal in that it is focused, but has grown to the point of being a mass or benign tumor. Diffuse adenomyosis is when the endometrial tissue has spread throughout the uterus.

What causes it?

Adenomyosis isn’t yet a fully understood condition, and at present, doctors and researchers aren’t sure what even causes it. One theory, per the Mayo Clinic, is that the endometrial tissue has existed in the person's uterus since they were a fetus. Another theory proposes that stem cells from bone marrow could potentially make their way into the uterus and eventually become adenomyosis. It may also be caused by uterine inflammation related to childbirth. The Seckin Endometriosis Center also speculates that tissue trauma or any vaginal injury could potentially cause the condition.

More: Physical Therapy Could Help With Your Unbearable Pelvic Pain

What are the symptoms?

Symptoms of adenomyosis include:

  • Heavy or prolonged bleeding or both
  • Dysmenorrhea, which are severe menstrual cramps
  • Menstrual cramps every day of your period
  • Cramps that worsen as you get older
  • Having blood clots while on your period
  • Pain during sex
  • Spotting between periods
  • Tenderness in your stomach
  • Pain during bowel movements
  • Uncomfortable or burning urination or blood in the urine
  • Anemia
  • Decreased fertility
  • Increased miscarriage and preterm birth

Much of the time, people with adenomyosis don’t have any noticeable symptoms or believe their symptoms to be normal parts of menstruation. Dr. Tamer Seckin of the Seckin Endometriosis Center confirms this, saying that many girls are made to believe that pain during menstruation is normal.

"We need to do a better job of defining the difference between normal and abnormal," she explains. "It must be understood that pain is not normal. Chronic pain has a reason, a physical cause, and is valid.”

Many symptoms of adenomyosis are very similar to those of other conditions like fibroids, endometriosis and polyps, so it is very important to get checked out by your doctor. If your period is causing heavy bleeding and cramps that interfere with your daily life, seeing your doctor is a necessity because it could cause you to become anemic. Dealing with the pain and other symptoms can also lead to or exacerbate depression.

More: A Quick (but Important) Introduction to Pelvic Inflammatory Disease

What are the risk factors associated with adenomyosis?

There have been certain factors that seem to increase the risk of getting adenomyosis, like previously giving birth or being middle-aged. Having a uterine surgery, like a C-section or getting fibroids removed, is also linked to increasing the likelihood of developing adenomyosis.

Typically, adenomyosis is a condition that goes away after menopause, so if nearing that age, a doctor may prescribe anti-inflammatory medicine to help curb pain and the amount of bleeding during your period. Birth control is another option to help decrease symptoms. Birth control pills with estrogen and progestin and the patch often decrease bleeding and pain, while IUDs can cause periods to cease. Results with birth control vary, and sometimes take a bit of trial and error. A hysterectomy is another potential treatment, especially for people with worse cases and those still years away from menopause.

The bottom line is that if you are having heavy, painful periods, this may be another cause to be aware of and potentially bring up with your doctor.

By Kelley O'Brien

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