Managing Adenomyosis: Navigating Symptoms and Treatment Options

Q: Managing Adenomyosis: Navigating Symptoms and Treatment Options

Hello： If menstruation occurs, you can stop the medication and observe. <br>If there is abnormal bleeding, you should see a doctor to determine the issue. <br>Adenomyosis can lead to heavy menstrual bleeding, dysmenorrhea, and lower abdominal pain without causing anemia. <br>It i

Adenomyosis

I have been diagnosed with adenomyosis for two years, and I didn't take treatment seriously before.
This year, after getting vaccinated and testing positive for COVID-19, my menstrual cycle became irregular.
I didn't have my period from January to February, had it for half a month in March, didn't have it in April, tested positive on May 7, and had my period from May 1 until July for almost three months.
In mid-July, I went for a consultation and underwent a minor procedure to remove endometrial blood clots.
The doctor did not think my body needed rest and said I could return to work.
However, I vomited everything I ate or drank and felt completely weak.
The next day, I went to work, but due to excessive blood loss, I became very weak and had to go to the emergency room for a blood transfusion.
My hemoglobin dropped to 5.
The next day, I switched hospitals for treatment, rested for a week, and was prescribed hemostatic medication and progesterone for half a month.
Can I still take progesterone during my menstrual period?

An Baobei, 30~39 year old female. Ask Date: 2022/08/05

Dr. Lin Xinwang reply Obstetrics and Gynecology

Hello: If menstruation occurs, you can stop the medication and observe.
If there is abnormal bleeding, you should see a doctor to determine the issue.
Adenomyosis can lead to heavy menstrual bleeding, dysmenorrhea, and lower abdominal pain without causing anemia.
It is recommended to take estrogen (E) and progesterone (P) during the first week after menstruation, and then take progesterone from day 14 to day 21.
After stopping the medication, observe the menstrual situation; this can help regulate for three months.
If the condition does not improve, the last option would be surgical treatment.

Reply Date: 2022/08/05

More Info

Adenomyosis is a condition where the tissue that normally lines the uterus (the endometrium) begins to grow into the muscular wall of the uterus. This can lead to a variety of symptoms, including heavy menstrual bleeding, severe cramping, and chronic pelvic pain. Given your experience with adenomyosis and the complications you've faced, it's crucial to approach your treatment and management carefully.

From your description, it seems that you have been experiencing significant menstrual irregularities and heavy bleeding, which have led to severe anemia (as indicated by your hemoglobin dropping to 5). This is a serious condition that requires immediate medical attention, as low hemoglobin levels can lead to fatigue, weakness, and other complications.

In terms of treatment options for adenomyosis, there are several approaches that can be considered:
1. Hormonal Therapy: Hormonal treatments, such as birth control pills, progestins (like the yellow hormone you mentioned), or hormonal IUDs, can help regulate menstrual cycles and reduce heavy bleeding. However, the use of progestins during menstruation can be complex. Generally, progestins are used to help manage bleeding and can be continued during your period, but this should be discussed with your healthcare provider to tailor the treatment to your specific needs.

2. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain associated with adenomyosis. However, given your recent history of heavy bleeding and potential gastrointestinal issues (as indicated by vomiting), it's essential to consult with your doctor before taking any medication.

3. Surgical Options: In cases where symptoms are severe and other treatments have not been effective, surgical options may be considered. This can include procedures to remove the adenomyosis or, in more severe cases, a hysterectomy (removal of the uterus). Since you mentioned having a minor procedure to address blood clots, it's important to follow up with your doctor about the next steps in your treatment plan.

4. Lifestyle and Dietary Changes: Maintaining a balanced diet and staying hydrated can help manage symptoms. However, if you are experiencing vomiting and inability to keep food down, this is a significant concern. You may need to work with a nutritionist or your healthcare provider to ensure you are getting the necessary nutrients, especially after experiencing significant blood loss.

5. Monitoring and Follow-Up: Regular follow-up appointments with your healthcare provider are crucial. Given your history of severe anemia and the complications you've faced, your doctor may want to monitor your blood levels closely and adjust your treatment plan as needed.

In conclusion, while hormonal therapy can be beneficial in managing adenomyosis, the specific use of progestins during your menstrual cycle should be discussed with your healthcare provider. They can provide personalized advice based on your current health status and treatment history. Additionally, if you continue to experience severe symptoms or complications, do not hesitate to seek immediate medical attention. Your health and well-being are paramount, and it's essential to have a comprehensive management plan in place for your adenomyosis.

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