A couple of months ago, we wrote about Kate Seear’s research findings that menstrual etiquette is a frequent cause of delayed diagnosis of endometriosis. In related news, medical researchers writing in a recent issue of the Journal of Obstetrics and Gynaecology have found that adenomyosis, the presence of endometrial tissue embedded within the muscular wall of the uterus, is under-diagnosed.

S. Basak and A. Saha, the study’s authors, examined the data of more than 1000 hysterectomies performed for pelvic pain or abnormal uterine bleeding (in other words, hysterectomies for cancer and uterine prolapse were excluded from the data set) in the UK in a three-year period. In 26 of those cases, adenomyosis was identified post-surgery via tissue analysis.

The medical histories in these 26 cases were then examined more closely. The majority of the women had sought medical attention for menorraghia (excessive menstrual bleeding) and dysmenorrhea (painful periods). Eleven of the women’s uteruses were enlarged, and 16 underwent pelvic ultrasound exams. But adenomyosis was suspected clinically in only one case; the others were identified as uterine fibroids (five cases) or “dysfunctional uterine bleeding” (20 cases).

Examination of patients’ case histories found that the medical consultations focused on menstrual flow. The researchers found that other symptoms of adenomyosis, such as pelvic pain, pain during intercourse, painful periods, and feelings of pelvic pressure, were not adequately addressed – even when examination or ultrasound findings indicated an enlarged uterus.

Basak and Saha ask,

Does failure of preoperative suspicion of adenomyosis matter? In the absence of an accurate diagnosis, appropriate treatment is unlikely to be offered, or may be delayed. This results in failure of treatment and continued suffering.

To identify adenomyosis earlier, they recommend more careful discussion with patients of pelvic symptoms, MRI, and follow-up care with women who elect for conservative management of their symptoms. Once again, open communication about all aspects of menstruation isn’t about challenging taboos just for the sake of challenge; it’s critical for women’s health and well-being.