Adenomyosis is a condition where the endometrium, the tissue that normally lines the uterus, grows into the muscular uterine wall. This misplaced tissue continues to thicken, break down, and bleed during a menstrual cycle. Because it is embedded within the muscle, it can cause the uterus to become enlarged and tender, leading to heavy menstrual bleeding and pelvic pain. The condition is most often diagnosed in women in their 40s and 50s, but modern imaging is identifying it in younger individuals more frequently.
Effects on Fertility and Conception
Adenomyosis can create a uterine environment less conducive to conception. One factor is altered uterine contractility; the disruption of the normal uterine muscle leads to disorganized contractions. These contractions can impede sperm transport or interfere with an embryo’s journey to the uterine wall, making conception more challenging.
The condition can also affect the uterine lining’s receptivity to an embryo. Adenomyosis is associated with an inflammatory environment that may be toxic to embryos and negatively impact the molecular signals for successful implantation. This inflammation can alter the expression of genes and proteins necessary for an embryo to attach to the uterine wall, disrupting the implantation process.
The extent of adenomyosis can influence its impact on fertility. While many women with the condition conceive without medical assistance, it is found in a notable percentage of those seeking evaluation for infertility. This suggests a clear association with reproductive challenges.
Potential Pregnancy Risks and Complications
Once conception occurs, adenomyosis can increase the risk of certain complications, particularly during the first trimester. A primary concern is a higher rate of miscarriage, as the inflammatory uterine environment and altered blood flow can interfere with the establishment of an early pregnancy. Studies indicate that women with adenomyosis may have more than double the risk of miscarriage compared to those without the condition.
In the second and third trimesters, risks shift toward uterine function and placental health. The altered structure of the uterine wall can increase the likelihood of preterm labor and premature rupture of membranes, with some research suggesting this risk is twice as high. The condition is also linked to a higher incidence of preeclampsia, a hypertensive disorder of pregnancy. These complications arise because adenomyotic tissue disrupts the changes the uterus must undergo to accommodate a growing fetus.
Adenomyosis can also affect fetal growth and placental function. Irregular blood flow to the placenta may lead to fetal growth restriction, and there is a greater chance of complications like placenta previa or placental abruption. The type of adenomyosis matters; diffuse adenomyosis, which is spread throughout the uterine muscle, is associated with a higher risk for complications like second-trimester miscarriage and preeclampsia compared to the focal type.
Management and Monitoring During Pregnancy
A pregnancy with adenomyosis is managed with heightened surveillance due to the potential for complications. Early and consistent prenatal care allows for proactive monitoring and timely management of any issues. Management focuses on careful observation rather than specific treatment for the adenomyosis, as options are limited during gestation.
A primary monitoring tool is more frequent ultrasound examinations. These tests allow providers to track fetal growth, assess placental health, and measure cervical length to screen for preterm labor. Noting the location of the adenomyosis in relation to the placenta also helps in assessing risk. Regular check-ups using these tools enable the medical team to intervene quickly if fetal growth slows or if signs of preeclampsia or preterm labor appear.
Women are also counseled on recognizing the symptoms of potential complications. This includes awareness of the signs of preterm labor, like regular contractions, and preeclampsia, such as severe headaches or vision changes. Management may involve consultations with a maternal-fetal medicine specialist, particularly for those with severe adenomyosis or a history of prior pregnancy complications.
Considerations for Labor, Delivery, and Postpartum
Adenomyosis can affect labor and the postpartum period. The structural changes in the uterine muscle can lead to dysfunctional labor, where contractions are not effective at dilating the cervix. This may result in a prolonged labor process and increases the likelihood of requiring a cesarean section, which occurs at a higher rate among women with this condition.
A concern during the postpartum period is an elevated risk of postpartum hemorrhage (PPH), or excessive bleeding after childbirth. The risk is higher because the affected uterus may have difficulty contracting effectively after delivery, a condition known as uterine atony. These contractions are necessary to clamp down on blood vessels where the placenta was attached, and poor contractions can lead to dangerous blood loss.
After delivery, symptoms like pelvic pain and heavy bleeding may temporarily improve. This relief is attributed to the hormonal changes of pregnancy and the absence of menstruation, particularly if breastfeeding. However, symptoms often return once menstrual cycles resume. The risk of complications like PPH in a future pregnancy can persist if the condition is untreated.