What is adenomyosis?
Adenomyosis is gynecological condition, yet many have never heard about it. It occurs when tissue from the inner lining of the uterus (endometrium) invades the muscular middle layer of the uterus (myometrium).
The list below is not an exhaustive list of the symptoms that a person with adenomyosis can experience. We are each unique and as such, how adenomyosis affects us will vary. However, severe pain is a common symptom experienced by many persons with adenomyosis. The pain is more severe than “normal” period cramps, is not relieved with basic pain medication, and can persist for days. It is important to note that experiencing extreme pain with your period is not “normal”.
Heavy and/or prolonged menstrual bleeding
Chronic pelvic, lower back and leg pain
A feeling of pressure or heaviness in the pelvis
Painful sexual intercourse
Gastrointestinal symptoms such as nausea, vomiting, constipation and/or diarrhea
An enlarged or bulky uterus on examination
The only cure for adenomyosis is a hysterectomy as it removes all of the disease. Symptom management is available in the form of medication and limited surgical options.
Medication options for the treatment of symptoms for adenomyosis include:
Pain medicines, such as NSAIDs – nonsteroidal anti-inflammatory drugs (eg. Ibuprofen, Ponstan, Difene).
Tranexamic Acid (Cyclokapron) which is used to reduce bleeding volume.
Surgical treatment options for adenomyosis include:
Endometrial ablation. This is a minimally invasive surgery to cause scarring in the lining of the uterus, which makes periods less heavy. It is unlikely to reduce pain symptoms. It has been found to be effective in relieving symptoms in some patients when adenomyosis hasn’t penetrated deeply into the muscle wall of the uterus.
Uterine artery embolization – This is a treatment that blocks the blood supply to the displaced tissue that is causing adenomyosis. For those who do not wish to have any future pregnancies, uterine artery embolization (UAE) may be effective for reducing symptoms related to adenomyosis. It is also an option for those who choose not to have, or cannot have, a hysterectomy or have found hormonal treatment unsuitable due to side effects or ineffective control of symptoms.
Uterus sparing surgery. Uterus-sparing resection of adenomyosis is an investigational approach that can be considered in individuals with extensive adenomyosis who are actively pursuing pregnancy. The disadvantage of this approach is that even when performed by expert surgeons, there is a risk of uterine rupture in a future pregnancy. This is a highly skilled surgery and should only be carried out by someone who has proven experience of this procedure.
Persons with adenomyosis need to discuss fertility and pregnancy with their doctor and work with them to find treatment options that can lead to their goals.