Adenomyosis Uterus

Adenomyosis Uterus: Facts to Know

What is adenomyosis uterus?

Adenomyosis is a benign disorder in which endometrial glands are abnormally placed in the muscle layers of the uterus. Earlier it was described as a classic condition of women over 40 years old with heavy bleeding diagnosed at hysterectomy. Now it is increasingly seen in young women with heavy bleeding, pain and infertility. However, in most cases there is no symptom and it is identified at ultrasound of the uterus. This disease often coexists with other gynecological conditions, such as endometriosis and uterine fibroids.

Is adenomyosis a serious condition?

 Adenomyosis uterus is generally a benign (not life-threatening) condition affecting women of reproductive age. However, the frequent pain and heavy bleeding associated with it makes women suffer a lot with decreased quality of life. Often women thrive on pain killers during the menstrual period which has a negative psychological impact.

Can adenomyosis be cancerous?

Usually, adenomyosis is considered a benign disease involving inflammation of the uterus. However, in recent years researchers have found a correlation with endometrial cancer in a few cases. In majority it is a mild disease that is diagnosed in USG and subsides without any complications.

What are the complications of adenomyosis uterus?

Heavy blood loss from menstrual bleeding increases your risk of anemia. Subsequently, it reduces the iron-rich red blood cells in circulation and you may feel easily tired or fatigued. In the long term it may give rise to heart failure if not treated.

What are the risk factors for developing adenomyosis?

  • Age
  • Ectopic pregnancy
  • Depression and antidepressant use
  • Tamoxifen treatment
  • Smoking
  • Prior uterine surgery
  • Multiparity

How does adenomyosis affect pregnancy?

Adenomyosis tends to affect women with or without childbirth. In addition, the condition may make it difficult to conceive for the first time leading to infertility in women or to have another child.  In pregnant women this condition increases the risk of:

  • Miscarriage
  • Premature labor

What happens if adenomyosis is left untreated?

Adenomyosis worsens in young women and women around 40 yrs.

This is a chronic condition that needs medical treatment in majority cases. If left untreated it may lead to infertility or other gynecological problems. In women over 30 yrs this condition is seen more frequently.

Can you have a baby with adenomyosis?

For women who wish to conceive with an adenomyosis uterus, it is possible without any intervention in most cases. Subsequently, few cases may require fertility treatment with ovulation induction and IUI treatment. Very rarely they require IVF or ICSI treatment. Especially, when there is endometriosis causing tubal blockage or poor ovarian reserve due to chocolate cysts in the ovary.

What causes infertility in adenomyosis uterus?

Adenomyosis related infertility may occur due to

  • Tubal blockage
  •  Deranged endometrial receptivity
  • Hormone disturbances
  • Distortion of endometrial cavity

Is adenomyosis a risk for pregnancy?

Adenomyosis can cause complications during pregnancy due to the inflamed muscles of the uterus. Sometimes, early loss of pregnancy is occurs. in others it may cause poor pregnancy outcomes. Complications like preterm delivery, preterm premature rupture of membranes (PPROM), and fetal growth restriction (FGR) are common in women with adenomyosis. However, the potential direct impact of adenomyosis on the course of pregnancy is under research.

What foods to avoid if you have adenomyosis uterus?

Better to avoid these foods: 

  • Wheat and gluten.
  • Artificial sugars.
  • Dairy.
  • Bananas.
  • Tea, coffee & fermented products like alcohol.
  • Chaste berry and red raspberry leaf & teas.

Can exercise help adenomyosis?

Regular exercise can help lead a healthy life. In addition, it relieves the symptoms of dysmenorrhea in women with adenomyosis uterus by increasing blood flow. Exercise regularizes menstrual cycle and flow, it can help reduce the inflammatory changes in the uterus.

How can I know the presence of this problem?

Diagnosis of adenoma uterus is depends on your clinical symptoms and ultrasound. Your doctor will suggest USG to know the cause of heavy bleeding and pain during the cycle. Ultrasound detects the size and position of adenomyotic changes in the uterus. In addition your doctor can detect associated endometriosis in other organs and presence of cysts in ovaries. At times she studies the blood flow pattern of endometrium if you are suffering from infertility.

What is the best treatment for adenomyosis?

Treatment of adenomyosis requires a plan to manage pain and bleeding, preserve fertility, and avoid pregnancy complications. Your doctor will suggest a long term therapy to avoid the negative impact on quality of life. Similarly, she may advise tests and start therapy to avoid complications during pregnancy. Medical therapies are available to control the symptoms and temporary regression of the disease.

Some women may require aggressive therapy due to the severity of illness. Surgical management gives hope for them. Hysterectomy or removal of the uterus is the best option for women with severe symptoms. However, hysterectomy is also not appropriate if you wish to have future fertility. In other words, for those who have completed their family planning, hysterectomy remains the best option.

What surgical options other than hysterectomy are available for adenomyosis uterus?

Hysteroscopic endometrial ablation/resection -It is used to treat patients with heavy bleeding. This can help patients with adenomyosis by destroying the endometrial bed.

Focal excision of adenomyosis – Removing the localized lesion may be difficult in adenomyosis. But your specialist may go for this with medical management.

Uterine artery ligation – Your doctor may suggest laparoscopic uterine artery ligation if you are bleeding heavily. Clipping both the uterine arteries controls acute bleeding.

Myometrial electrocoagulation -Laparoscopic electrocoagulation is another method to shrink adenomyosis by destroying tissue.

Uterine artery embolization – Uterine artery embolization is another method of blocking the blood flow to the uterus. This is effective in women with heavy bleeding.

Does adenomyosis have any natural treatment options?

 It is not possible to control the symptoms of adenomyosis by natural methods. But exercising regularly and taking a balanced diet helps maintain a normal hormone balance. This in turn reduces the symptoms and its severity.

Cost of adenomyosis treatment

Since this disease takes a long term process the sufferings and cost both are more than any gynecological disorder. Since surgical therapy in the form of hysterectomy procedures is the major treatment option it costs around one lakh in India. Other medical options are also equally costly as it requires long period to heal. Each injection of depot agonist is around 4000 to 5000. You may have to take 2-4 such doses.

Symptoms of adenomyosis uterus

Women affected by adenomyosis usually present with abnormal uterine bleeding. In addition some women present with dysmenorrhea, pain during intercourse and infertility. But one third of women don’t have any symptoms and are detected during ultrasound only.

Tests and diagnosis

  • A transvaginal pelvic sonogram can diagnose this condition.
  • Sono hysterography may be useful for diagnosis in cases of thick endometrium. 
  • When there is any doubt over diagnosis your doctor will suggest a MRI. 
  • Blood tests – CA -125

IVF treatment success in patients with adenomyosis

If you have adenomyosis this may negatively affect your IVF treatment. Even if your ovarian reserve is good, implantation may fail. Your doctor may suggest an ultra long protocol for stimulation in order to achieve better success.

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