Uterine Adenomyosis: Pain Management and Pregnancy Concerns

Q: Uterine Adenomyosis: Pain Management and Pregnancy Concerns

Hello Ms. <br>JJ： Your question can be summarized as follows： A chocolate cyst, also known as endometriosis, is a diagnosis often given to women experiencing dysmenorrhea or infertility. <br>Normally, the endometrium exists only within the uterine cavity, but when it is found in

Uterine adenomyosis

Hello Dr.
Chen,
I started experiencing menstrual cramps when I got my first period at the age of 12.
By the time I was 25, the pain became unbearable, and I began receiving monthly pain relief injections at the obstetrics and gynecology department.
In May of this year, I went to Chi Mei Medical Center in Tainan for an examination, where I was diagnosed with endometriosis (chocolate cyst) and was advised to undergo laparoscopic surgery.
However, I did not proceed with the surgery as I got married and became pregnant.
I initially thought that pregnancy would resolve my issues, but I experienced premature rupture of membranes at 14 weeks and underwent induction on October 15.
The doctor informed me that the rupture was caused by uterine adenomyosis, which led to bleeding and infection during the pregnancy.
After the induction, I asked the doctor if the adenomyosis could be surgically removed before trying to conceive again.
The doctor said that there is no method to remove it except for a hysterectomy and also mentioned that the chocolate cyst had disappeared.
I would like to ask Dr.
Chen the following questions:
1.
Is it true that uterine adenomyosis cannot be surgically removed? Why did the previous cyst disappear on its own, but the adenomyosis does not?
2.
After the induction, I had my period three times on November 12, 16, and 21, each time accompanied by severe abdominal pain, for which I still needed pain relief injections.
Is it harmful to my body to rely on pain relief injections and medications long-term? Could this affect my uterine function? (I only take pain relief when I have menstrual cramps and rarely get sick.)
3.
If I become pregnant again and have a successful delivery, will the adenomyosis disappear, alleviating my monthly menstrual pain? If it does not disappear, is a hysterectomy the only solution to my pain?
4.
I received the German measles vaccine on October 31.
Should I also get the varicella vaccine? I have never had chickenpox (I’ve heard it’s best not to get vaccinated at my age?).
5.
I have not had sexual intercourse since the induction.
When is it safe to resume? I have been experiencing persistent pain in my lower right abdomen, and my doctor has not yet resolved this issue.
Thank you very much, Dr.
Chen, for taking the time to answer all my questions.
I am at a loss in Tainan regarding which doctor can provide such detailed responses.
Thank you.

jj, 20~29 year old female. Ask Date: 2002/11/23

Dr. Chen Fuhao reply Obstetrics and Gynecology

Hello Ms.
JJ: Your question can be summarized as follows: A chocolate cyst, also known as endometriosis, is a diagnosis often given to women experiencing dysmenorrhea or infertility.
Normally, the endometrium exists only within the uterine cavity, but when it is found in abnormal locations, the most common being the ovaries, it can also appear in the rectouterine pouch, uterus, fallopian tubes, bladder, or the surface of the pelvic cavity.
The presence of endometrial tissue in these inappropriate locations leads to what is known as endometriosis.
The exact cause of this condition is not fully understood, but it may be related to retrograde menstruation, where menstrual blood flows backward through the fallopian tubes into the pelvic cavity.
This condition can occur in young women shortly after menarche, as well as in women who marry later or have long-term infertility, as they may have a higher chance of retrograde menstruation, thus increasing the likelihood of developing this condition.
Patients may experience dysmenorrhea due to the accumulation of blood in the ovaries, and as the chocolate cyst gradually enlarges, it can damage normal ovarian tissue, leading to severe adhesions of the fallopian tubes and surrounding surfaces, which obstructs ovulation and fertilization, making infertility a significant concern for these patients.

In terms of diagnosis, it is based on medical history and physical examination, with typical symptoms including dysmenorrhea and infertility.
A pelvic examination may reveal tenderness or enlargement behind the uterus, and a definitive diagnosis may require laparoscopic examination or exploratory laparotomy.
Ultrasound can also provide significant assistance.
Adenomyosis is a form of endometriosis where endometrial glands are found within the uterine muscle layer.
Clinically, patients often experience severe menstrual pain, particularly pain that begins about a week before menstruation and lasts until it ends, along with dyspareunia, heavy menstrual bleeding, difficulty with bowel movements, and infertility concerns.
Physicians can initially suspect adenomyosis based on the patient's symptoms, and a pelvic examination may reveal an enlarged but slightly soft uterus.
Ultrasound scanning may show widespread thickening of the uterus, with abnormal ultrasound imaging of the muscle layer.
A definitive diagnosis of adenomyosis can only be confirmed through pathological examination after a hysterectomy, so preoperative suspicion is often the best that can be achieved.
Adenomyosis involves extensive changes in the uterine muscle layer and rarely transforms into malignancy.
Complete resolution is not easy, and treatment should depend on the patient's age and reproductive needs.
For older patients who do not wish to conceive, a hysterectomy is the most effective treatment.
If the patient desires to retain fertility, medication may be used, although its effectiveness varies and may not alleviate all symptoms.
If pregnancy is desired, conceiving as soon as possible may help alleviate symptoms of adenomyosis.

If you are experiencing persistent pain in the lower right abdomen after an induced labor, it may indicate chronic pelvic inflammatory disease or some psychosomatic issues, and you should seek medical treatment.
Regarding dysmenorrhea, you may refer to the information available on our obstetrics and gynecology medical website for further guidance.
Wishing you a speedy recovery in both body and mind.

Reply Date: 2002/11/23

More Info

Understanding uterine adenomyosis and its implications for pain management and pregnancy can be quite complex, especially for individuals who have experienced significant menstrual pain and complications during pregnancy. Your situation highlights several important aspects of this condition, and I will address your questions in detail.

1. Can uterine adenomyosis be surgically removed?
Adenomyosis is a condition where the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). Unlike fibroids, which can often be surgically removed, adenomyosis is more challenging to treat surgically. In many cases, the only definitive treatment is a hysterectomy (removal of the uterus), especially if the symptoms are severe and other treatments have failed. However, some women may benefit from less invasive procedures, such as endometrial ablation, but these do not remove the adenomyosis itself. The disappearance of your chocolate cyst (endometrioma) may be due to hormonal changes or other factors, but adenomyosis typically does not resolve on its own.

2. Is long-term use of pain medication harmful?
Using pain medications, such as NSAIDs or opioids, for menstrual pain can be necessary for many women. However, long-term use of these medications can have side effects, including gastrointestinal issues, kidney damage, and potential impacts on reproductive health. It is crucial to discuss with your healthcare provider the best pain management strategy for you, which may include lifestyle changes, physical therapy, or hormonal treatments that can help reduce the frequency and severity of your pain without relying solely on medication.

3. Will pregnancy affect adenomyosis?
Pregnancy can sometimes lead to a temporary reduction in symptoms for some women with adenomyosis, but it does not guarantee that the condition will resolve. After childbirth, many women report a return of their symptoms. While some studies suggest that pregnancy and childbirth may lead to a decrease in adenomyosis symptoms, this is not universally true. If the adenomyosis is severe, it may continue to cause pain and discomfort. Surgical options, such as hysterectomy, may be considered if symptoms are debilitating and other treatments have not provided relief.

4. Vaccination considerations post-pregnancy:
Regarding vaccinations, it is generally safe to receive vaccines after childbirth, but specific recommendations can depend on your health status and any recent vaccinations you have received. The varicella (chickenpox) vaccine is typically recommended for individuals who have not had chickenpox, as it can prevent future infections. However, it is best to consult with your healthcare provider about the timing and necessity of this vaccine based on your individual health history.

5. When can you resume sexual activity?
After a medical procedure such as an induction of labor or miscarriage, it is typically recommended to wait at least two weeks before resuming sexual activity. However, this can vary based on individual recovery and any ongoing symptoms. Since you are experiencing persistent pain, it is essential to consult your healthcare provider before resuming sexual activity to ensure that you are healing properly and to address any concerns you may have.

In summary, managing adenomyosis and its associated symptoms requires a comprehensive approach that includes pain management, potential surgical options, and careful consideration of future pregnancies. It is crucial to maintain open communication with your healthcare provider to develop a personalized treatment plan that addresses your specific needs and concerns. If you feel that your current provider is not meeting your needs, seeking a second opinion from a specialist in reproductive health or a gynecologist with experience in managing adenomyosis may be beneficial.

Similar Q&A

Understanding Adenomyosis: Symptoms, Diagnosis, and Treatment Options

Hello, when I was in my teens, I had heavy menstrual bleeding, but the pain was manageable. However, about four to five years ago, my menstrual cycle became very irregular, occurring approximately every three to four months, and sometimes it would be quite painful. Three years ag...

Dr. Dong Yuhong reply Obstetrics and Gynecology
Hello; I can understand your pain, and you have seen doctors multiple times as a result. Based on your description, the outcomes seem to be similar. Access to healthcare in Taiwan is quite easy, and I believe that the doctors in Taiwan are very competent, so you should be able to...

Managing Pain from Uterine Adenomyosis: Effective Strategies

Hello Doctor: Recently, my girlfriend went for an examination and was diagnosed with adenomyosis. She has been experiencing abdominal pain every day, but recently the pain has intensified in the mornings, especially after waking up. She experiences severe pain for a while after g...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, if you are still feeling unwell, it is recommended to visit a hospital for a detailed examination by an obstetrician-gynecologist. Wishing you good health.

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 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,...