What Are the Differences Between Endometriosis and Adenomyosis?

Adenomyosis and endometriosis are two gynecological diseases that affect many women around the world. Although they are often confused, these two pathologies have notable differences, both in terms of their symptoms and their treatment. In this article, we will explore the differences between adenomyosis and endometriosis in detail, to better understand these two conditions.

Definition and origin of adenomyosis and endometriosis

Adenomyosis and endometriosis symptoms

To fully understand the difference between adenomyosis and endometriosis, it is first necessary to understand what these two diseases are.

Criterion Adenomyosis Endometriosis
Definition Presence of endometrial cells in the uterine muscle (myometrium). Presence of endometrial cells outside the uterus, such as the ovaries or peritoneum.
Main Symptoms Pelvic pain, abnormal uterine bleeding, heavy periods, enlargement of the uterus. Pelvic pain, menstrual problems, pain during sexual intercourse, adhesions or cysts.
Impact on Fertility May cause fertility problems. May affect fertility, including the formation of cysts or adhesions.
Impact on the Rules Menses often very heavy and prolonged. Heavy and/or irregular periods.
Diagnostic Clinical examination, pelvic ultrasound, MRI, biopsy rarely. Clinical examination, pelvic ultrasound, MRI, laparoscopy.
Treatment Contraceptive pills, anti-inflammatories, hysterectomy as a last resort. Anti-inflammatories, hormonal treatment, conservative surgery, PMA for infertility.

What is adenomyosis?

L'adenomyosis is a condition of the uterus, characterized by the presence of endometrial cells (the inner lining of the uterus) inside the uterine muscle, called myometrium. This infiltration of cells can cause thickening of the uterine muscle, leading to pelvic pain and abnormal bleeding. Adenomyosis mainly affects women of childbearing age and can cause fertility problems.

What is endometriosis?

L'endometriosis is a chronic disease characterized by the presence of endometrial cells outside the uterus, in areas such as the ovaries, fallopian tubes, peritoneum and sometimes even other more distant organs. Endometriosis causes severe pelvic pain, irregular bleeding and can also affect fertility.

Symptoms of Adenomyosis and Endometriosis

While adenomyosis and endometriosis share some common symptoms, such as pelvic pain and heavy or irregular periods, other manifestations are specific to each of these conditions.

Symptoms of adenomyosis

  • Pelvic pain: The pain of adenomyosis is generally located in the lower abdomen and can be continuous or occur during menstruation (dysmenorrhea).
  • Hemorrhages: Women with adenomyosis are frequently subject to abnormal uterine hemorrhages, with very heavy and prolonged periods (menometrorrhagia).
  • Infertility: Adenomyosis can reduce the chances of conceiving naturally due to thickening of the uterine muscle and abnormal bleeding.
  • Increase in the volume of the uterus: Infiltration of endometrial cells into the myometrium can lead to an increase in the volume of the uterus.

Symptoms of endometriosis

  • Pelvic pain: The pain associated with endometriosis is often more intense and more diffuse than that of adenomyosis. They can occur at any time during the menstrual cycle, during sexual intercourse (dyspareunia) or during certain physical activities.
  • Menstrual disorders: Women suffering from endometriosis may experience heavy and/or irregular periods.
  • Infertility: Endometriosis can also affect fertility by causing adhesions or cysts on the ovaries.
  • Other events: Symptoms of endometriosis can also include digestive problems (constipation, diarrhea, bloating), urinary pain and back problems.

Diagnosis of Adenomyosis and Endometriosis

Diagnosis Adenomyosis and Endometriosis

The diagnosis of adenomyosis and endometriosis can be complex, due to the similarity of symptoms and the absence of specific signs for each of these diseases. However, additional examinations often make it possible to distinguish them.

Diagnosis of adenomyosis

The diagnosis of adenomyosis is generally based on:

  • The clinical examination: The doctor may detect a bulging and painful uterus on palpation.
  • Imaging tests: Pelvic ultrasound is the first-line examination in cases of suspected adenomyosis. It may reveal an enlarged uterus, with an abnormally thick lining. In some cases, an MRI may be required.
  • The biopsy: Although rarely performed, biopsy helps confirm the diagnosis by removing a piece of the myometrium containing endometrial cells.

Diagnosis of endometriosis

To diagnose endometriosis, several tests are performed, including:

  • The clinical examination: Depending on the location of the endometriotic lesions, the doctor may notice nodules or adhesions in the pelvis.
  • Imaging tests: Pelvic ultrasound, particularly transvaginal ultrasound, is a key test to detect ovarian cysts (endometriomas) and/or adhesions. In some cases, an MRI is also performed.
  • Laparoscopy: This surgical examination allows endometriotic lesions to be directly visualized and, if necessary, to be removed.

Treatment of these two gynecological pathologies

There is no single treatment for adenomyosis and endometriosis. Management depends on the patient's symptoms, her age, her desire to become pregnant and the stage of the disease.

Treatments for adenomyosis

  • Contraceptive pills: Some hormonal medications like oral contraceptives can help control bleeding and pain.
  • Non-steroidal anti-inflammatories: These medications reduce inflammation and relieve pelvic pain.
  • Hysterectomy: As a last resort, a hysterectomy (removal of the uterus) may be considered to treat severe adenomyosis that is resistant to medical treatment.

Endometriosis Treatments

  • Non-steroidal anti-inflammatories: These medications are prescribed to relieve pelvic pain.
  • Hormonal treatment: Medications such as oral contraceptives, GnRH agonists or progestins are used to control the growth of endometriotic lesions and limit symptoms.
  • Surgery : In some cases, conservative surgery (laparoscopy) is performed to remove endometriotic lesions. If the disease is very severe, a hysterectomy with removal of the ovaries may be considered.
  • PMA: For women suffering from infertility linked to endometriosis, medically assisted procreation techniques (artificial insemination, in vitro fertilization) can be offered.

In summary, even if they share certain characteristics (presence of endometrial cells outside their usual location, pelvic pain, menstrual disorders and infertility), adenomyosis and endometriosis are two distinct pathologies which require different diagnostic and therapeutic approaches.

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The articles on the site contain general information which may contain errors. These articles should in no way be considered as medical advice, diagnosis or treatment. If you have any questions or doubts, always make an appointment with your doctor or gynecologist.

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