Some lab tests are routinely run on women with menstrual irregularities. Two of the most common are FSH and LH levels. Taran et al. (2010, Introduction section, para. 2) report that animal models have shown that elevated FSH levels and prolactin levels “appear to induce adenomyosis”.
It is imperative to know the levels of estrogen in adenomyosis patients. Adenomyosis is known to be an estrogen dependent disease. In addition, estrogen dominance has been noted to be a possible factor in the development of this disorder. It is important to note that estrogen dominance can be present with normal FSH and LH levels. Estrogen dominance occurs when the ratio of progesterone to estrogen is too low.
Progesterone has been found to be an issue in adenomyosis as noted below:
- Adenomyotic lesions produce progesterone, but they contain lower levels of progesterone receptors. Progesterone cannot exert its influence if it cannot lock into its receptor.
- Only half of adenomyosis patients benefit from progesterone use.
Hyperprolactinemia (high levels of prolactin) are commonly seen in women with adenomyosis. Taran et al. (2010) noted that the use of antidepressants known to cause hyperprolactinemia was seen more frequently in women with adenomyosis as compared to women with fibroids. The types of antidepressants known to increase prolactin levels are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs).
Testosterone is a hormone found in very small amounts in women. This hormone can be transformed into estrogen via the enzyme aromatase; therefore, it is informative to know the level of testosterone in women with adenomyosis. Aromatase inhibitors are a possible treatment for adenomyosis patients since they create a hypoestrogenic state which helps to slow the growth of adenomyosis.
These tests measure the amount of oxygen transported through the body via red blood cells. Low levels indicate anemia.
Anemia is defined as a deficiency of red blood cells or hemoglobin in the blood. This results in weakness and pallor. This condition is very common in adenomyosis due to heavy menstrual bleeding associated with the disorder.
Thyroid (TSH, T3, T4)
One study done by Taran et al. (2010) at the Mayo Clinic showed that history of thyroid disease was more common in women with fibroids than in women with adenomyosis. In their study, 5.3% of women with adenomyosis had thyroid disease compared to 15.8% of women with fibroids.
It has been increasingly noted that CA125 levels are increased in adenomyosis patients. CA125 is a marker for ovarian cancer (it stands for “cancer antigen 125). It is important to know that just because your CA125 level is elevated, it does NOT mean that you definitely have cancer. This marker is elevated in many disorders such as fibroids, endometriosis, and adenomyosis.
According to Goh et al. (2008), CA125 levels are positively correlated with uterine size. Also, patients with adenomyosis have a higher CA125 positive rate than in patients with fibroids. Since adenomyosis and fibroids are sometimes difficult to differentiate, CA125 levels may be useful for the differential diagnosis between the two disorders. However, Jeng et al. (2007, Discussion section, para.2) caution, “…because it is non-specific, the CA125 level is only suggestive rather than definite in the diagnosis of adenomyosis.”
Dr. Natalya Danilyants from the Center for Innovative GYN Care has stated that she does not routinely test for CA125 in adenomyosis patients. She says that the level is usually only mildly elevated which would only cause increased anxiety for the patient, and that the results of this test would not change any treatment plan (see blog entry about my interview with her).
Goh, S., Chua, N., & Chern, B. (2008). Adenomyosis with extremely elevated CA125 levels. The Internet Journal of Gynecology and Obstetrics, 10 (2). Retrieved from print.ispub.com/api/0/ispub-article/3559
Jeng, C.Y., Huang, S.H., Shen, J., Chou, C.S., & Tzeng, C.R. (2007). Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis. Human Reproduction, 22(7), 2016-2019. doi: 10.1093/humrep/dem084
Taran, F.A., Weaver, A.L., Coddington, C.C., & Stewart, E. (2010). Understanding adenomyosis: a case control study. Fertility & Sterility, 94(4), 1223-1228. doi: 10.1016/j.fertnstert.2009.06.049
Tsui, K.H., Lee, W.L., Chen, C.Y., Sheu, B.C., Yen, M.S., Chang, T.C., & Wang, P.H. (2014). Medical treatment for adenomyosis and/or adenomyoma. Taiwanese Journal of Obstetrics and Gynecology, 53(4), 459-465. doi: 10.1016/j.tjog.2014.04.024