The Difference Between Adenomyosis and Endometriosis

When a woman experiences painful periods, heavy bleeding, and chronic pain in the pelvic region, this constellation of symptoms could suggest endometriosis, a condition in which endometrial tissue spreads and implants beyond the uterus. During every menstrual period, this misplaced endometrial tissue can shed blood into the pelvic region and beyond, causing cysts, scar tissue, and adhesions to form over time.

But if the endometrial tissue burrows deep into the muscle of the uterus, and not outside the uterus, the diagnosis is actually adenomyosis, a condition that is related to endometriosis but has a few key differences.

In endometriosis, the endometrial tissue escapes from the uterus and might implant on the surface of the bladder, bowels, or other organs throughout the body. In adenomyosis, the endometrial tissue gets pushed into the myometrium muscle of the uterus, which is located between the inner and outer layers of the uterus organ. Once embedded in the muscle, this endometrial tissue sheds when the rest of the endometrium sheds during a period, which causes extra bleeding, pain, and cramping.

Adenomyosis vs. endometriosis symptoms

Both diseases can cause pain, Sanjay Agarwal, MD, director for the Center for Endometriosis Research and Treatment at the University of California, San Diego, tells Health. But women with adenomyosis generally tend to have pain related to their periods, while women with endometriosis might also feel pain with bowel movements and at other times in the cycle.

“With adenomyosis, the main impact on quality of life is a painful period,” Dr. Agarwal says. “Perhaps this is because endometriosis goes further afield.”

These two conditions don’t cause symptoms for everyone, however. It’s estimated that about one-third of women with adenomyosis experience no symptoms at all. And when it comes to asymptomatic endometriosis, it’s estimated that as many as 43% of women who end up undergoing sterilization for other reasons also show signs of mild endometriosis and were completely unaware of it.

Diagnosing adenomyosis vs. endometriosis

While more doctors are beginning to treat endometriosis based on symptoms like pelvic pain and painful periods, the most definitive diagnosis is made during a surgery called a laparoscopy, which is when doctors insert a thin tube with a light and camera into a small incision in the abdomen. With the tube, they can see endometrial lesions, cysts, and adhesions that make up endometriosis.

Diagnosing adenomyosis is much less invasive. Magnetic resonance imaging can help doctors see whether the myometrium is thicker than normal—one sign of the condition. MRIs and transvaginal ultrasounds can also help doctors identify cysts in the walls of the uterus, as well as myometrium with an abnormal texture. If the growths are limited to just a few cysts, the adenomyosis is classified as focal, while abnormal myometrium throughout the uterus is called diffuse adenomyosis.

Infertility in adenomyosis and endometriosis

Both conditions can also raise the risk for impaired fertility, or the inability to either conceive or carry a pregnancy to term.

When it comes to adenomyosis specifically, embryos can struggle to implant in the enlarged and “hard” uterus. Pregnancy losses are also more common. One study showed that women with adenomyosis undergoing in vitro fertilization had double the rate of miscarriages compared to women with both adenomyosis and endometriosis.

Adenomyosis also puts women and their babies at a higher risk of preterm birth and the premature rupture of the amniotic sac, as well as intrauterine growth restriction, pregnancy-related hypertension, and uterine infection.

If IVF doesn’t work, doctors might suggest a drug protocol called a gonadotropin-releasing hormone agonist, which suppresses the production of reproductive hormones like progesterone and estrogen in order to reduce the size of the uterine growths. Doctors may also attempt a surgery to remove the growths, known as adenomyomas, and reconstruct the uterus. These two alternative treatments have been shown to increase the chances of spontaneous pregnancy among women with adenomyosis, while the drug protocol may also help make IVF more successful.

However, depending on the size and spread of the condition, women with extensive adenomyosis might end up needing a surrogate to carry their pregnancy, Dr. Agarwal says.

Adenomyosis vs. endometriosis treatment

Treatment options for both conditions are similar and escalate in intensity from birth control pills to suppress the release of reproductive hormones to surgery to remove endometrial cysts, scar tissue or implants, adenomyomas, or even the entire uterus.

In between those two ends of the spectrum, women can try other hormonal medications to drive down the production of estrogen, a hormone that makes both adenomyosis and endometriosis worse. These drugs, delivered through injections, hormonal IUDs, or pills, have been shown to reduce menstrual cramping, pain during sex, and chronic pelvic pain in both conditions.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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What Exactly Is Endometriosis? Here's What an Ob-Gyn Wants Every Woman to Know

In recent years, Julianne Hough, Jillian Michaels, Lena Dunham, Whoopi Goldberg, and other stars have shared their experiences with the chronic and often painful disease endometriosis.

According to the United States Department of Health and Human Services, the condition may affect more than 11% of women between ages 15 and 44. Still, many women are confused or embarrassed about their symptoms or feel ashamed of their diagnosis, says Mamie McLean, MD, assistant professor of obstetrics and gynecology at the University of Alabama Birmingham.

Here’s what Dr. McLean wants every woman to know about this debilitating—but often very treatable—condition.

It starts when tissue grows in the wrong place

Endometriosis occurs when the endometrium—the tissue that lines the inside of a woman’s uterus—begins to grow in places it shouldn’t: the ovaries, fallopian tubes, and the lining of the pelvis, for example. (In rare cases, it can grow in other organs throughout the body, as well.)

But endometrial tissue doesn’t function like tissue in the rest of the body. Because it’s involved in menstruation, it thickens, breaks down, and bleeds once a month or so. And that continues to happen, no matter where the tissue is in the body.

In the uterus, broken down endometrial tissue leaves the body each month during a woman’s period. In other parts of the body, it becomes trapped and can irritate surrounding tissues and organs.

It can be extremely painful—or completely painless

When this happens, cysts (called endometriomas) and scar tissue can form. For many women, this can cause severe pain—during their periods, during sex, or during bowel movements or urination. They might also experience symptoms such as heavy bleeding, fatigue, diarrhea, constipation, bloating, or nausea during their periods.

But the disease is different for everyone, says Dr. McClean, and scientists’ understanding of how it affects pain sensation is still poorly understood.

“We’ll see patients who have very advanced disease and lots of scar tissue, and they had no idea they had this condition,” she says. “Either they’ve had no pain, or they figured it was normal and learned to live with it. For others, they’ll have very minimal disease and very severe pain.”

It's a common cause of infertility

Scarring and tissue growth in the ovaries can make it difficult for a woman to get pregnant. “The normal process by which the sperm travels up the fallopian tube to meet the egg simply can’t happen, because there’s too much structural distortion,” says Dr. McClean.

Even if the sperm is able to get through, she adds, underlying inflammation can sometimes lead to poor implantation or poor egg quality.

She does note, however, that not everyone with endometriosis has trouble conceiving—so if a woman is not trying to get pregnant, she should always use protection even if she does have the disease.

It may be caused by "retrograde menstruation"

Doctors don’t know exactly what causes endometriosis, or why certain women are affected. In many cases, doctors think it has something to do with “retrograde menstruation,” when blood containing endometrial cells flows backward into the abdominal cavity rather than out of the body.

“Most women are able to absorb that tissue,” says Dr. McClean. “But in some women, due to immune circumstances or genetic circumstances that we don’t really understand yet, that tissue can implant inside the abdomen and lead to many of these symptoms.”

In any case, endometriosis is not caused by anything a woman did or could have prevented. “That’s what feels so frustrating about this condition,” says Dr. McClean. “When I tell a woman that her ability to conceive will be very challenging and there’s nothing she could have done differently, it really feels like an unfair situation you’re simply just born into.”

Treatments do work for many women

Endometriosis is a chronic condition, and there is no absolute cure, says Dr. McClean. But for many women, treatments can relieve pain and discomfort, improve fertility, and help them live normal lives.

Depending on the severity of endometriosis and its symptoms, treatments can vary from pain medications and hormonal therapies (like birth control pills) to surgery. Women who want to get pregnant may also need to use assistive reproductive technology, such as in vitro fertilization.

Surgery for endometriosis can range from laparoscopic “keyhole” procedures, in which endometrial tissue is cut away or burned with a laser, to a full hysterectomy. For many women, surgery will greatly reduce pain and symptoms. But for about 20% of patients, endometriosis will come back.

Unfortunately, says Dr. McClean, some women do require multiple surgeries—and each subsequent surgery is less likely to solve the problem. “It’s often the first surgery that gives the best relief,” she says.

“Each additional surgery tends to increase your risk of complications and decrease the reward in terms of reduction in pain,” she adds. Complications, especially for women who have had repeat procedures, can include bowel injury, pelvic infection, or damage to blood vessels or nerves.

Other therapies can help too

Therapies today are able to attack endometriosis from hormonal, musculoskeletal, and neurological standpoints, says Dr. McClean, and an experienced physician can help women find the combination of treatments that best addresses their symptoms and needs. This could include medication, surgery, and even pelvic physical therapy.

Dr. McClean recommends that any woman who’s struggling with pelvic pain that’s bad enough to limit their daily activities seek an evaluation from her doctor.

“Women take it very personally when they have a condition or disease that causes this kind of pain or may limit their ability to have children,” she says. “But I think with National Infertility Awareness Week and the availability of support groups—and with celebrities like Lena Dunham speaking publicly about their experiences—more women are now talking about it and getting the help they need."

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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What is a silent heart attack? How to recognize the warning signs

• Silent heart attacks are just as dangerous and common as traditional heart attacks.
•  
• Silent heart attacks are milder than traditional heart attacks and may not come with any symptoms.
•  
• People who have a silent heart attack may not know it and therefore don't seek necessary treatment.

Heart attacks often have a classic roster of symptoms: chest pain, shortness of breath, and the sensation of something heavy on the chest. 

But not always. Silent heart attacks, more formally known as a silent myocardial infarction (SMI), are "silent" because symptoms are so mild that people often do not realize they occurred. 

But that doesn't mean you can ignore a silent heart attack — medical experts say it's just as dangerous as a traditional one. Here's how to tell if you're having a silent heart attack and what to do about it.

What is a silent heart attack

A 2015 study published in the journal Circulation of nearly 10,000 participants compared silent heart attacks and traditional ones, and found that silent heart attacks accounted for nearly half of all heart attacks. 

A cardiologist  says there can be situations where people have no symptoms with a silent heart attack. But often, there are a few mild symptoms that can be difficult to recognize.  

These include fatigue, heartburn, discomfort in the chest, back, or jaw, and shortness of breath, according to the doctors. A traditional heart attack can have similar symptoms, but also often includes a sensation of pressure or pain in the chest, arms, neck, back, and/or jaw.

Furthermore, the symptoms of a silent heart attack can easily be mistaken for something else, such as indigestion, a challenging workout, or even a toothache. And even though the symptoms may not feel severe, Weinberg says a silent heart attack is just as serious as any other heart attack. 

Silent heart attacks are dangerous

Heart attacks — both silent or traditional — occur when insufficient blood flows to the heart. And, a silent heart attack is just as dangerous as a traditional one. It increases your likelihood of another heart attack, as well as the potential for heart failure. 

"It's critical to open up a blocked heart artery as soon as it's blocked so we're not in a situation where there's decreased blood flow and ultimately scar tissue that would impair somebody's ability to have normal heart function," Weinberg says. 

While the  Circulation study found that silent heart attacks were more common in men than women, it also found that women were more likely to die as a result of one. This may be due to women — and their doctors — not necessarily taking symptoms seriously enough, according to the doctors.

Also, researchers have found that silent heart attacks are more common in older adults with diabetes. For example, in a study published in 2012 in the Journal of the American Medical Association, 14% of the 337 participants with diabetes experienced a silent heart attack compared to 9% of the same population that had a traditional heart attack.

And with a traditional heart attack, doctors can recommend treatments that include surgery, medications, and lifestyle adjustments. That's why silent heart attacks are so worrisome: If you don't know you had a heart attack, you won't take advantage of treatment and prevention tactics. 

Moreover, you may only realize you had a heart attack after the fact when you start to experience symptoms of heart failure because the silent heart attack has damaged the heart muscles.

How to recognize silent heart attacks 

If you think you might be experiencing symptoms of a heart attack, you should go to the emergency room immediately. But in most cases of silent heart attacks, the symptoms are so mild or nonexistent that a person wouldn't necessarily think to go to the ER. 

Often, the diagnosis occurs in a routine physical or during a doctor's visit prompted by lingering symptoms such as fatigue, shortness of breath, and indigestion. 

The risk factors are the same for a traditional and silent heart attack: A family history of heart attacks, older age, lifestyle choices such as smoking or insufficient exercise, obesity, and conditions such as high blood pressure, high cholesterol, and diabetes. 

If your doctor suspects you had a silent heart attack, the likely next step will be for you to get an electrocardiogram (EKG), which will show your heart's electrical activity and reveals damage to the heart caused by a heart attack, says the experts.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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