Myoma, Adenomyosis, Adenomyoma.

Is It a Word Game Made from Letters? No, Each One Is a Different Disease!

The most common diseases related to the uterus in gynecology—which we hear quite often—are Myoma, Adenomyosis, and Adenomyoma. Each of these is a different disease. They can easily be confused and, in fact, they can often be found together as well.

In this article, I will try to explain to you what these diseases—myoma, adenomyosis, and adenomyoma—are and what their differences are. However, I will not explain the treatment details. But before moving on to these different diseases, let us first get to know the uterus, which is called uterus in medical terminology:

The uterus (uterus) is a very important part of the female reproductive organs. The uterus (uterus) is the organ where the baby attaches in the mother’s womb, is nourished and grows, and where contractions make childbirth possible. It is an organ sensitive to hormones. The uterus has a mouth part (cervix, servix) and a body part (corpus). From its corners, there is one tube extending on each side. Likewise, the ovaries are suspended from its corners by one stalk on each side.

The uterus has three layers; the innermost is the uterine lining surrounding the potential cavity (endometrium). It is a magnificent tissue; every month it is shed with menstruation, thickens and differentiates under the influence of hormones—mainly estrogen and progesterone—as if preparing in case a baby comes. If there is no pregnancy, it is shed together with the decrease of hormones. Surrounding this is the uterine tissue, which is the strongest part of the uterus, the muscle tissue (myometrium). It is dense in the body part and less so in the cervix. The uterine muscle is smooth muscle. During childbirth, contractions of this muscle allow the baby to be born. Outside the uterine muscle (that is, actually the part noticed when viewed from inside the abdomen) there is a very thin shiny membrane-like tissue, and we call the membrane covering this organ in medicine the visceral peritoneum. After reviewing the layers of the uterus, let us move on to these 3 different diseases of the uterus...

Myoma (leiomyoma, fibroid): It is a benign tumor originating from the uterine muscle (smooth muscle). In fact, when examined under a microscope, it appears as a bundle of irregularly arranged, tangled muscle fibers. From a physician’s perspective, its important feature is that it has a limited structure. Actually, this boundary called a capsule is an apparent capsule; it is formed by the myoma pressing on the surrounding normal muscle tissue and creating a boundary. It can be seen in different parts of the uterus; close to the uterine lining and protruding into the inner cavity (submucosal), embedded only in the muscle layer (intramural), under the thin membrane covering the uterus (subserosal), and in other different locations. Its cause is not known (although many ideas have been proposed to explain it!). It is seen in approximately 25% of women of reproductive age (and even around 70% in women aged 40 and above!). Ultrasound is very helpful in the diagnosis of myomas. However, if there is uncertainty in ultrasound due to changes in its internal structure (for example calcium deposition, etc.), magnetic resonance imaging, namely MRI (or MR), may be requested. Blood tests have no place in diagnosis. The DEFINITE diagnosis of myomas is based on the pathological examination of the myoma removed during surgery. Detecting the “irregular arrangement of muscle fibers” mentioned above under the microscope is diagnostic. Of course, informing the pathologist about the characteristics and location of the removed myoma is appropriate for diagnosis.

Myomas do not always require intervention; if they cause excessive bleeding, pain, pressure complaints on surrounding organs, are excessively large, or sudden growth is detected during follow-up, surgery may be recommended. Unfortunately, there is no medical treatment; with medication, only some shrinkage and reduction of blood supply are attempted. This is generally preferred in some cases before surgery to ensure that the surgery proceeds with less bleeding.

Adenomyosis (Adenomyosis): It is the condition in which endometrial cells are found as islands within the uterine muscle. By this definition, adenomyosis can be seen as a “relative” of endometriosis, meaning that in both diseases, “the uterine lining is located outside where it should normally be.” Again, it is a disease whose exact cause we do not fully know.

While approximately 1/3 of adenomyosis cases have no complaints at all, in the remaining patients “excessive bleeding” and/or “severe groin pain” occur. Sometimes there may be pregnancy losses or difficulty getting pregnant.

Ultrasound and Magnetic Resonance Imaging (MRI) are helpful in the diagnosis of adenomyosis. In fact, in recent years, “diagnostic criteria” have been defined in ultrasound. However, the definite diagnosis can still only be made by pathological examination. Detecting under the microscope that “endometrial islands are located within the uterine muscle” means a DEFINITE diagnosis.

Since the cause of adenomyosis is also unknown, its treatment is aimed at symptoms. For bleeding, medications (pills or medicated intrauterine device, sometimes suppression injections) are used to temporarily stop complaints. Surgical treatment, that is surgery, may also be tried to provide a solution in some cases.

Adenomyoma: This diagnosis is exactly a mixture of the above two diseases; that is, there is a myoma, but inside it there are also clusters of endometrial cells. Strange, isn’t it? Why does it happen? Again, we do not know… Complaints are a mixture of myoma and adenomyosis; generally pain and bleeding. Since adenomyoma has the limitation brought by myoma, it can be removed surgically if necessary. Medications are generally ineffective, but suppression injections may be used before surgery.

Why did I write this article, which is more technical than my previous articles? Of course, because of a recent patient of ours with adenomyosis. How important are the differences between them? Knowing the technical details makes it easier to explain and understand treatment approaches and the resulting pathology report. I would be happy if you share your questions and opinions on this subject with us.

Stay healthy, happy, and full of love.

Prof. Dr. Ümit İnceboz