Uterine Adenomyosis: Symptoms, Risks, and Treatment Options

Adenomyosis

Hello Doctor, I went to the hospital today for an abdominal ultrasound and found out that I have a uterine adenomyoma, located around the uterus and measuring approximately 9.6 centimeters (but the doctor mentioned something about subtracting six centimeters for the uterus).
Is this size considered large? However, when I had an abdominal ultrasound about six months ago, this issue was not detected, so how could it have grown so quickly in such a short time? Over the past year or two, I have experienced dull pain during my menstrual periods (though it is bearable), and I also have some light bleeding before my period, with my cycle not being very regular.
After researching online, I am quite scared that it might be endometrial cancer.
What is the likelihood of it being cancer? Or is it indeed just the adenomyoma as the doctor mentioned today? How can I differentiate between these two conditions? If it is adenomyoma, does this size require surgery? If I don't have surgery, will it worsen or have any other effects? I am very worried and anxious, and I have quite a few questions.
I appreciate your help in answering them.
Thank you very much.

Xiao Cen, 40~49 year old female. Ask Date: 2019/04/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

An abdominal ultrasound at the hospital revealed a uterine adenomyoma located around the uterus, measuring approximately 9.6 centimeters (but the doctor mentioned that 6 centimeters should be subtracted for the uterus itself).
Is this considered large? Answer: It's not very large, but I didn't have this issue detected during an abdominal ultrasound about six months ago.
How could it have grown so quickly in such a short time? I've been experiencing discomfort and pain during my menstrual periods over the past year or two (though it's bearable), and I also have slight bleeding before my period, along with irregular cycles.
After researching related information online, I'm worried it might be endometrial cancer.
What is the likelihood of it being cancer? Answer: The likelihood is low; as the doctor mentioned during today's consultation, it is likely a uterine adenomyoma.
How can these two conditions be differentiated? Answer: That's a big question.
If it is indeed a uterine adenomyoma, does its size necessitate surgery? Would not having surgery lead to worsening conditions or other impacts? Answer: Surgery is not necessary.

Reply Date: 2019/04/29

More Info

Uterine adenomyosis is a condition where the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). This can lead to various symptoms and complications, and understanding these can help you make informed decisions about your health.

Symptoms of Uterine Adenomyosis
The symptoms of adenomyosis can vary widely among individuals. Common symptoms include:
1. Pelvic Pain: Many women experience chronic pelvic pain, which can be severe during menstruation.

2. Heavy Menstrual Bleeding: This condition often leads to heavy menstrual bleeding (menorrhagia) and prolonged periods.

3. Irregular Menstrual Cycles: Women may notice changes in their menstrual cycle, including irregularities in timing and flow.

4. Pain During Intercourse: Some women report pain during sexual activity.

5. Other Symptoms: Fatigue, bloating, and gastrointestinal symptoms can also occur.

Risks and Concerns
While adenomyosis itself is not cancerous, it can cause significant discomfort and may lead to complications. The risk of developing uterine cancer is generally low in women with adenomyosis, especially if there are no other risk factors present. However, the symptoms can be distressing, and the rapid growth of uterine fibroids (as you mentioned, a size of approximately 9.6 cm) can be concerning.

Distinguishing Adenomyosis from Uterine Cancer
Differentiating between adenomyosis and uterine cancer can be challenging, as both can present with similar symptoms such as heavy bleeding and pelvic pain. However, there are key differences:
- Imaging Studies: Ultrasound and MRI can help distinguish between adenomyosis and other conditions, including fibroids and cancer. Adenomyosis typically shows a diffusely enlarged uterus with a heterogeneous myometrium on imaging.

- Biopsy: In some cases, a biopsy may be necessary to rule out cancer, especially if there are abnormal cells detected during imaging or if there are other risk factors.

Treatment Options
The treatment for adenomyosis depends on the severity of symptoms and the desire for future fertility. Options include:
1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain. Hormonal treatments, such as birth control pills, progestins, or GnRH agonists, can help regulate menstrual cycles and reduce bleeding.

2. Minimally Invasive Procedures: In some cases, procedures like uterine artery embolization (UAE) or endometrial ablation may be considered to reduce symptoms.

3. Surgery: If symptoms are severe and other treatments are ineffective, surgical options may include a hysterectomy (removal of the uterus) or myomectomy (removal of fibroids). The decision to proceed with surgery should be made in consultation with a healthcare provider, considering the size of the adenomyosis and the impact on your quality of life.

Conclusion
Given your concerns about the rapid growth of the fibroid and the symptoms you're experiencing, it is essential to have a thorough discussion with your healthcare provider. They can provide personalized advice based on your medical history, current symptoms, and imaging results. Monitoring the situation closely is crucial, as adenomyosis can sometimes lead to complications if left untreated. Regular follow-ups and imaging can help ensure that any changes in your condition are addressed promptly. Remember, it is always best to seek a second opinion if you feel uncertain about the recommended treatment plan. Your health and peace of mind are paramount.

Similar Q&A

Understanding Uterine Adenomyosis: Size, Risks, and Treatment Options

Hello, I have a question on behalf of my family member. They had a hospital examination and their CA-125 level is as high as 204. After a gynecological examination, it seems to be a case of adenomyosis, with a size reaching 9 centimeters, which explains the significant abdominal ...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, the explanation of adenomyosis is as follows: Adenomyosis is defined as the presence of endometrial tissue (including glands and stroma) growing into the muscular layer of the uterus, leading to uterine enlargement. This condition occurs in approximately 10-20% of women,...

Managing Uterine Adenomyosis: Alternatives to Hysterectomy and Dietary Tips

Hello Dr. Zhang, I would like to consult you regarding the issue of uterine adenomyosis. My older sister (currently 43 years old and has three children) has recently been experiencing severe abdominal pain before and after her menstrual period, requiring pain relief medication t...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, the surgical approach generally involves only the removal of the uterus while preserving the ovaries, so it will not accelerate aging. If symptoms are severe or if menopause is expected to be a long way off, this may be considered. For medical management, oral progesterone...

Understanding Adenomyosis: Symptoms, Treatment Options, and Management

My most recent menstrual period left me so weak that I didn't even have the strength to eat. On the fifth day, I visited a traditional Chinese medicine practitioner, and after my menstrual flow slightly decreased, I went to the obstetrics and gynecology department for an exa...

Dr. Chen Zhiyu reply Obstetrics and Gynecology
In response to your concerns, most cases of anemia in women are associated with gynecological disorders. If a specialist diagnosis indicates adenomyosis, while surgery is one of the treatment options, it is advisable for women of childbearing age to consider additional alternativ...

Understanding Hormonal Medications and Their Effects on Uterine Adenomyosis

For over a year, I have been experiencing severe abdominal pain and lower back discomfort during my menstrual periods. After consulting a doctor, I was diagnosed with mild adenomyosis. The doctor prescribed hormone medication, stating that my body is unable to effectively expel m...

Dr. Li Guanghan reply Obstetrics and Gynecology
Hello: 1. Adenomyosis can cause the uterine muscle wall to gradually thicken, leading to an enlarged uterus, which can result in dysmenorrhea and increased menstrual bleeding. If it becomes severe enough to cause significant uterine distortion, it can certainly hinder implantatio...