Friday, June 1, 2012

What's wrong with me, Part I: Adenomyoma

Adenomyosis is a condition in which the endometrial tissue in the uterus goes crazy, invading the muscular wall of the uterus. Like its cousin, endometriosis, it causes severe pain with menstruation.

Instead of diffuse adenomyosis all around my uterus, I have an adenomyoma, a focused growth in one, large, painful place at the top of my uterus.

Some women have pain from adenomyosis all the time. I'm relatively lucky; I have mild pain the week before my period, severe pain and vomiting on day one, and mild pain that I control completely with Aleve days 2-3.

It's unclear whether and how such an adenomyoma affects fertility. In endometriosis, the endometrial tissue grows outside of the uterus, causing a toxic environment for fertilization and affecting ovarian health. In adenomyosis, the endometrial tissue is more or less where it's supposed to be. Thus, most doctors will tell you that women with adenomyosis might have a higher chance of miscarriage, but that it shouldn't otherwise affect fertility. Anecdotally, I've seen many women on fertility forums get pregnant with adenomyosis.

On the other hand, this paper suggests that some women with adenomyosis have trouble getting pregnant (this article suggests the same). On the fertility forums, not every woman with adenomyosis gets pregnant. It seems self-evident to me that if my 5x7mm polyp could cause implantation difficulties, then surely my enormous adenomyoma could.

I would hazard a guess that since it affects the structure of the uterus itself, fertility depends on the extent of the adenomyomas/adenomyosis, as well as the unpredictable nature of fertility itself. In other words, some women with adenomyomas can get pregnant naturally, others need medical intervention, others will never get pregnant.

Although the above articles present surgery as a treatment for both pain and infertility, my pelvic pain specialist has warned me that surgery carries with it the risk that my uterus will scar closed, ending my chances at carrying a pregnancy to term. His advice last year was to wait, get pregnant, then have the surgery when I'm done with child bearing.

That was April 2011; it has been a year and obviously, I am not pregnant. Every month, the pain, vomiting, and blood loss continue. Every month I fall into despair. Some months, the pain is better than others, but emotionally, the pain gets harder to deal with.

If I continue to not get pregnant, at some point, I will have to gamble: a chance at restored fertility or infertility. All or nothing.