Adenomyosis is one of the most common gynaecological condition causing period problems in women. It is often difficult to diagnose but its presence can be hinted at through symptoms and ultrasound. Ultimately however, the only way of diagnosing it clearly is when the womb is removed and the pathologist checks looks for it.
The symptoms caused include:
- Painful periods
- Heavy periods
- Pelvic pain
- Pain with sex.
It can be co-exist with other conditions that also cause similar symptoms like fibroids and endometriosis. Fibroids can easily be diagnosed on ultrasound but unfortunately endometriosis and adenomyosis may not be. Hence determining its importance in a person can be difficult if other causes also are present.
This condition happens when the glands from the lining of the womb called the endometrium, becomes deeply embedded in the muscle of the wall of the womb. It is more common in women who have had children and tends to manifest with one’s maturity!
The management will be dependent on the type and severity of the symptoms present.
If found on ultrasound in an otherwise asymptomatic woman, then it should be left well alone.
However, if it is causing symptoms, then management will be to manage the symptoms, as it is not curable unless by hysterectomy. For many, symptom control will require the following, either individually or in combinations:
- Hormonal therapy to reduce severity of bleeding, pain and to provide cycle control include
Oral contraceptive Pills can work very well
Cyclical progesterone tablets
Progesterone injections like Depo-Provera
Mirena IUD - Anti-inflammatory agents like Neurofen, Ponstan etc. to help with pain. Sometimes it can alleviate heavy bleeding
- Tranxaemic acid to control heavy bleeding
- Simple analgesia should not be forgotten. The humble panadol and codeine products can be very effective in providing pain relief
Unfortunately in some cases, medical therapy is not sufficient and surgery may be required. In my experience only 2 options are helpful:
Endometrial ablation. This involves burning or resecting deep into the muscle of the womb. Performed through the vagina, it does not involve any cuts in the tummy. It can be very effective in reducing period loss and pain. However, its effects may only be temporary.
Hysterectomy: Ultimately this is the cure for the condition as it removes the womb. It is a major step for most women but it does resolve the problem once and for all. It does carry more risks than an ablation. With most hysterectomies being performed through keyhole methods, the recovery in uneventful cases can be as short a 2 weeks. Most only require an overnight stay. Hence it is now becoming a viable option and should not simply be discarded.
The findings on ultrasound of adenomyosis should not cause fear. There are many options of management if required. The good news is that it resolves with menopause.
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation. No part of these notes can be used or reproduced in any manner without my express consent