Adenomyosis

Adenomyosis is one of the disease spectra or variants of endometriosis. It is called adenomyosis when the endometrium tissue infiltrates the uterus’s muscle layer, causing muscle breakdown, fibrosis formation, and an island of blood cysts within a confined area of the uterus or it might even affect the entire uterus. It causes severe menstrual cramps, heavy and prolonged menstrual bleeding, and even infertility.

Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life. Adenomyosis is a common condition and most often diagnosed in middle-aged women and women who have already had children.

Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.

What we can do for you?

  • Diagnosis of Adenomyosis
  • Assess and evaluate the severity & stage of the disease
  • Assess fertility potential
  • Medical treatment of adenomyosis to control symptom
  • Surgical treatment
    – Laparoscopic adenomyomectomy (fertility-sparing)
    – Laparoscopic hysterectomy for older women
  • Monitor and follow up

While some women diagnosed with adenomyosis have no symptoms, the disease can cause:

  • Heavy, prolonged menstrual bleeding
  • Severe menstrual cramps
  • Abdominal pressure and bloating
  • Infertility
  • Painful sexual intercourse

The following steps can diagnose adenomyosis:

  • History taking and evaluation
  • Pelvic examination – to assess the size and mobility of the uterus
  • Ultrasound of the pelvis – to see the lining and the muscle wall of the uterus
  • Magnetic Resonance Imaging (MRI) – to confirm, detect location and severity of adenomyosis

There are three different types of adenomyosis:

  • Focal adenomyosis occurs in one particular site of the uterus.
  • Adenomyoma is a form of focal adenomyosis, but it is more extensive, resulting in a uterine mass or benign tumor, similar to uterine fibroma.
  • Diffuse adenomyosis, unlike the other two types, spreads throughout the uterus.

It is essential to correctly identify the type of disease as the treatment approach will depend on the type of disease. For example, if operated on correctly, focal adenomyosis and adenomyoma will not require a hysterectomy in most cases.

There are few options for adenomyosis that can be considered depending on the severity of the symptom, the age of the patient, and desire for pregnancy.

Medical treatment
aims to control pain and menstrual blood loss

There are options to be considered:

  • Anti-Inflammatory drugs (NSAIDs)
  • Progestin (Dienogest, Norethisterone, Medroxyprogesterone acetate, MPA)
  • Levonogestrel IntraUterine System (MIRENA IUS)
  • Gonadotrophin Releasing Agonist (GnRH)

High-Intensity Focused Ultrasound (HIFU)
a new conservative minimally invasive treatment to preserve the uterus and fertility-sparing

Surgical Treatment
aims to excise the disease and for long term disease control

  • Laparoscopic adenomyomectomy for fertility-sparing
  • Total laparoscopic hysterectomy for older women to completely cure the disease
  • Subtotal laparoscopic hysterectomy for normal sexual function
  • Endometrial ablation – to destroy the lining of the uterus

Laparoscopic image of the uterus with adenomyosis

MRI Image of Focal Uterine Adenomyosis

Laparoscopic image of the uterus with adenomyosis

2022, All Rights Reserved © Copyright -Dr Sharifah Clinic for Women & Laparoscopic Surgery
Translate »
error:
×