Gabrielle Union’s Comments About Adenomyosis & Reproductive Health Shed Light On Living With The Condition

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In a recent interview with Women's Health, Gabrielle Union discussed the fact that she had been diagnosed with adenomyosis, a condition that can cause very heavy periods and difficult menstrual cramps. She believes the diagnosis, which only took place "after years of searching for answers," may be linked to the miscarriages she went through before having baby Kaavia James Union Wade via surrogate in late 2018. Adenomyosis is more prevalent than you might believe — and if you have extremely heavy bleeding and cramps during your periods, or have mysterious difficulties getting pregnant, it may be the right diagnosis for you

While Union is one of the only celebrities out there with a public adenomyosis diagnosis, a lot of celebs have been willing to talk about their experiences with reproductive health issues such as endometriosis in recent years, including Julianne Hough, Halsey, and Lena Dunham. Breaking the taboo on these topics is a huge step forward; the more we know collectively about these disorders, the more people can understand their symptoms and feel empowered to seek treatment. While there's no long-term cure for adenomyosis, there are a lot of treatment options available. Here are six things you should know about the condition.

1. It Involves Your Uterine Lining

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Adenomysosis is a condition of the uterus. The lining of your uterus is called the endometrium, and in adenomysosis, cells from the endometrium migrate to the uterus's muscle wall, or myometrium, explains Guy's & St. Thomas' Hospital. Often the endometrium actually 'breaks through' into the muscle wall behind it. Endometrial cells shed every month when you have your period, and in people who have adenomyosis, the cells in the muscle wall shed too, which can cause a lot of blood loss and serious cramps. In some people, it can involve either small or large nodules of endometrial cells called adenomyomas. This is similar to endometriosis, where endometrial cells grow outside the uterus, but adenomyosis means the cells stay within the walls of the uterus.

The uterus itself may actually swell in people who have the condition, too, causing feelings of pelvic pressure, according to the Mayo Clinic. However, adenomysosis can also have no symptoms; you may have it and not know.

2. It's More Common Than You Might Think

Medicine first gave the condition a name in 1972, but scientists still don't know very much about how common it is. The National Health Service has estimated that it happens in about one in 10 women, but a study of 958 women in 2012 found it was present in 20.9 percent. Some estimates even say it could affect up to 35 percent of the female population. Chances are that it affects a lot of people worldwide.

3. It's Linked To Other Conditions

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Adenomysosis is also related to endometriosis, where cells from the lining of the womb migrate to other organs and shed every month, causing internal bleeding, cramps and, in extreme cases, organs "growing together." Adenomyosis, wrote Jason Abbott, the medical director of Endometriosis Australia, "is a common cause of pain and abnormal bleeding in women and its features often overlap the symptoms of endometriosis and in fact the two may co-exist in the same woman."

It's not known whether the two conditions are actually linked or caused by the same thing, but you're definitely more likely to have adenomyosis if you have endometriosis, and vice versa. Unfortunately, if you have adenomyosis, you're also more at risk of endometrium and thyroid cancers, according to a study in 2018.

4. It Might Affect Your Fertility

When it comes to adenomysosis's impact on fertility, the picture is mixed. Gynecologists Anthony Imudia and Rachel Sprague wrote for Contemporary OBGYN in 2018 that "most evidence that links adenomyosis to infertility is limited to case reports and small case series. There is also the potential for confounding in these studies as adenomyosis commonly coexists along with other pathologic processes linked to infertility, such as endometriosis, polyps, or leiomyoma."

Because adenomyosis can overlap with other conditions, it's difficult to know how it specifically affects fertility. However, Imudia and Sprague noted, a study in 2017 had found that adenomyosis had a negative impact on the success of IVF cycles.

5. It Can Be Caused By A Variety Of Things

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It's not clear where adenomyosis comes from. The Mayo Clinic named four theories: that cells from the endometrium collect in the muscle wall after there's some womb muscle damage, like in a C-section; that it forms like that when we're conceived; that it can develop during childbirth; and that it might be triggered by stem cells from bone marrow. Having children and being between 40 and 50 also raise your risk of adenomyosis overall; Healthline has noted that it may be associated with estrogen levels, and tends to go away when menopause happens and our estrogen levels drop.

There might also be underlying biological factors we don't understand yet. For instance, a study in 2013 found that adenomyosis in mice is linked to a protein called beta-catenin that changes cell structure in the uterus, but it's not clear whether this is the case in women as well.

6. There Are A Number Of Ways To Diagnose And Treat It

So how can it be diagnosed and treated? Non-invasive diagnosis is encouraged; Abbott writes that "there is good scientific support for the use of either ultrasound or MRI." Biopsies can also help to diagnose it, though it can be possible for a doctor to biopsy a spot where there aren't any cells and so miss the fact that it's there.

When it comes to treatment, there are a range of options available. According to an overview of adenomyosis published in 2013, NSAIDS, or non-steroid anti-inflammatory drugs, and hormone therapies like oral contraceptives or IUDs are very common treatment for the pain and cramps of adenomyosis, but some people require more intensive treatment, including having the endometrium lining removed, cutting off blood supply to the cells, or having a hysterectomy.

In people who are facing fertility issues because of adenomyosis, treatment with gonadotrophin-releasing hormone agonist, which is often used to help endometriosis, seems to raise the likelihood of healthy pregnancies.

It can take a while to get a diagnosis of adenomyosis, because it can be easily confused with other issues. The good news is that there's a big range of possible treatments. With celebrities like Gabrielle Union being vocal about this condition, it brings us one step closer to breaking stigma and empowering people to take their health into their own hands.