Managing Heavy Menstrual Bleeding with Uterine Adenomyosis: Treatment Options - Obstetrics and Gynecology

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Managing heavy menstrual bleeding (HMB) associated with uterine adenomyosis can be challenging, especially when conventional treatments have not yielded satisfactory results. Adenomyosis is a condition where the endometrial tissue grows into the muscular wall of the uterus, leading to painful and heavy menstrual bleeding. Given your history of using hormonal contraceptives like the combined oral contraceptive pill (OCP) for three years without significant improvement, it may be time to explore additional treatment options.


Treatment Options for Heavy Menstrual Bleeding with Adenomyosis
1. Hormonal Treatments:
- Higher-Dose Hormonal Contraceptives: If the current contraceptive pill (美適儂) is not effective, a higher-dose formulation or a different type of hormonal contraceptive may be beneficial. Some women find that progestin-only pills or hormonal IUDs (like Mirena) can help reduce bleeding significantly. However, as you mentioned having issues with the IUD, it may be worth discussing other options with your healthcare provider.

- Progestins: Medications like medroxyprogesterone acetate (Depo-Provera) can help manage heavy bleeding by thinning the endometrial lining.
2. Non-Hormonal Medications:
- Tranexamic Acid: This medication can help reduce menstrual bleeding by promoting clotting. It is often used in conjunction with other treatments for HMB.

- NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen can help reduce menstrual flow and alleviate pain. They work by reducing the production of prostaglandins, which are responsible for uterine contractions and pain.

3. Surgical Options:
- Endometrial Ablation: This procedure destroys the lining of the uterus and can significantly reduce or eliminate menstrual bleeding. It is typically considered for women who do not wish to become pregnant in the future.

- Hysterectomy: In cases where other treatments fail and the bleeding is severe, a hysterectomy (removal of the uterus) may be recommended. This is usually a last resort, especially for younger women who may wish to preserve their fertility.

4. Iron Supplementation: Given your severe anemia, it is crucial to address your iron levels. Even if your hemoglobin levels have improved, continuing iron supplementation may be necessary to replenish your iron stores. Discuss with your healthcare provider about the best form of iron supplement for you, as some can cause gastrointestinal discomfort.

5. Lifestyle Modifications:
- Dietary Changes: Incorporating iron-rich foods (like red meat, leafy greens, and legumes) and vitamin C (to enhance iron absorption) can be beneficial.

- Regular Monitoring: Regular follow-ups with your healthcare provider to monitor your hemoglobin levels and overall health are essential.


Conclusion
It is important to have an open discussion with your healthcare provider about your ongoing symptoms and the impact they have on your quality of life. Given your history and current challenges, a tailored approach that may include a combination of hormonal treatments, non-hormonal medications, and possibly surgical options should be considered. Each woman's experience with adenomyosis is unique, and finding the right treatment may take time and adjustments. Your health and well-being are paramount, and addressing both the physical and emotional aspects of living with adenomyosis is essential for your overall quality of life.