Uterine Adenomyosis: Symptoms, Diagnosis, and Treatment Options

Q: Uterine Adenomyosis: Symptoms, Diagnosis, and Treatment Options

Hello： In response to your question... <br>More than half of patients with severe uterine leiomyomas experience heavy menstrual bleeding, and one-third may have increasingly severe dysmenorrhea. <br>The treatment for uterine leiomyomas generally follows a surgical approach; myome

Uterine adenomyosis

Twelve years ago, I underwent laparoscopic surgery for endometriosis at a central clinic.
I was completely normal for about five years, but then I started experiencing severe dysmenorrhea.
After an examination at Renai Hospital, I was diagnosed with adenomyosis.
This year, I had an examination at Keelung Hospital, where it was found that the anterior wall of my uterus measures approximately 3.8 cm and the posterior wall measures 1.5 cm, with a retroverted position.
The dysmenorrhea is extremely severe, requiring pain medication to alleviate the symptoms.
The doctor has suggested surgery, but I am unsure how to proceed with this condition.

Hui, 30~39 year old female. Ask Date: 2004/10/23

Dr. Wang Jionglang reply Obstetrics and Gynecology

Hello: In response to your question...
More than half of patients with severe uterine leiomyomas experience heavy menstrual bleeding, and one-third may have increasingly severe dysmenorrhea.
The treatment for uterine leiomyomas generally follows a surgical approach; myomectomy can lead to recovery for some patients.
However, the definitive treatment remains hysterectomy, as medical hormonal therapy is typically ineffective.
In your case, the size of the uterus is only 5 centimeters when the anterior and posterior walls are combined, indicating that the uterus does not appear to be large, and the condition does not seem severe.
However, the clinical symptoms seem to significantly affect your quality of life.
Whether to proceed with surgery should be discussed in detail with your attending physician.
Response by Jian Bo-Hsien, Department of Obstetrics and Gynecology, Keelung Hospital, Ministry of Health and Welfare.

Reply Date: 2004/10/23

More Info

Uterine adenomyosis is a condition where the endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus. This can lead to a variety of symptoms, including severe menstrual pain (dysmenorrhea), heavy menstrual bleeding (menorrhagia), and pelvic pain. In your case, it appears that you have been experiencing worsening menstrual pain and have been diagnosed with adenomyosis following a history of endometriosis and previous laparoscopic surgery.

Symptoms of Adenomyosis
The symptoms of adenomyosis can vary widely among individuals. Common symptoms include:
- Severe menstrual cramps: Pain may be more intense than typical menstrual cramps and can last longer.

- Heavy menstrual bleeding: Many women with adenomyosis report heavier periods, which can lead to anemia over time.

- Pelvic pain: Chronic pelvic pain that may not be directly related to menstrual cycles.

- Pain during intercourse: Discomfort or pain during sexual activity can also occur.

- Enlarged uterus: In some cases, the uterus may be visibly enlarged, which can be detected during a pelvic exam.

Diagnosis
Diagnosis of adenomyosis typically involves imaging studies such as transvaginal ultrasound or MRI, which can help visualize the condition. In your case, the ultrasound findings indicating the size of the uterine walls suggest the presence of adenomyosis. The measurements you provided (anterior wall 3.8 cm and posterior wall 1.5 cm) indicate that there is a significant thickening of the uterine wall, which is consistent with adenomyosis.

Treatment Options
The treatment for adenomyosis can vary based on the severity of symptoms, the size of the uterus, and whether you wish to preserve fertility. Here are some common treatment options:
1. Medications:
- Pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain.

- Hormonal therapies: Birth control pills, hormonal IUDs, or other hormonal treatments can help regulate menstrual cycles and reduce bleeding. These methods may also alleviate pain by suppressing the endometrial tissue.

2. Surgical Options:
- Hysterectomy: This is the most definitive treatment for adenomyosis, especially if you are not planning to have children in the future. A hysterectomy involves the removal of the uterus and can provide significant relief from symptoms.

- Adenomyomectomy: In some cases, if the adenomyosis is localized, a surgeon may be able to remove the affected tissue while preserving the uterus.

- Uterine artery embolization (UAE): This minimally invasive procedure can reduce blood flow to the adenomyosis, potentially alleviating symptoms.

3. Lifestyle and Home Remedies:
- Regular exercise, heat application (like heating pads), and dietary changes may help manage symptoms.

Conclusion
Given your history and current symptoms, it is understandable that your doctor has suggested surgical intervention. A hysterectomy may be the most effective way to alleviate your severe pain and heavy bleeding, especially since you have already undergone previous surgeries and treatments without long-term relief. However, it is crucial to have a thorough discussion with your healthcare provider about the risks and benefits of surgery, as well as any alternative treatments that may be appropriate for your situation.

If you have concerns about the surgery or wish to explore other options, seeking a second opinion from another gynecologist may provide additional insights and help you make a more informed decision regarding your treatment plan.

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