Uterine Adenomyosis: Size, Risks, and Treatment Options

Q: Uterine Adenomyosis: Size, Risks, and Treatment Options

Hello, the explanation of adenomyosis is as follows： <br>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. <br>This condition occurs in approximately 10-20% of

Regarding the size of adenomyosis?

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 distension.
They are also nearly 50 years old and cannot conceive anymore.
The doctor has prescribed progesterone.

1.
Is surgical removal necessary for this condition?
2.
If not removed, is there a possibility of further enlargement?
3.
Is there a risk of it transforming into a malignant tumor?
Thank you for your assistance!

Xiao Jie, 20~29 year old female. Ask Date: 2011/09/25

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, predominantly after the age of 30, and is considered benign.
Patients often experience symptoms such as heavy menstrual bleeding, prolonged menstrual periods, and dysmenorrhea, although the severity of these symptoms can vary.
Diagnosis is typically made based on ultrasound findings and clinical symptoms.
If necessary, further evaluation may include hysteroscopy, endometrial biopsy, dilation and curettage (D&C), or blood tests to differentiate from other conditions.
Treatment options include:
1.
Initial management with medications to alleviate symptoms, with the addition of progestins or gonadotropin-releasing hormone (GnRH) analogs if needed.
2.
Hysteroscopic procedures for endometrial ablation or resection may be effective for certain patients.
3.
If the above methods are ineffective or if there are other complicating factors, a total hysterectomy may be considered.
The decision to proceed with surgery should be based on the severity of clinical symptoms and the presence of any adverse changes in the tumor.
Generally, the likelihood of worsening is low, and patients should discuss their situation with their healthcare provider for monitoring and follow-up.
Wishing you peace and health,
Dr.
Chang

Reply Date: 2011/09/25

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 heavy menstrual bleeding, severe menstrual cramps, and pelvic pain. In your case, the elevated CA-125 level and the size of the adenomyosis (9 cm) are indeed concerning and warrant a thorough discussion regarding treatment options.

1. Surgical Intervention: The decision to surgically remove the uterus (hysterectomy) or to perform a less invasive procedure depends on several factors, including the severity of symptoms, the size of the adenomyosis, and the patient's overall health and preferences. Given that your family member is approaching 50 and is unlikely to conceive, a hysterectomy may be a viable option to alleviate symptoms and prevent further complications. However, it is essential to have a detailed discussion with the healthcare provider about the risks and benefits of surgery, as well as any alternative treatments.

2. Potential for Growth: If the adenomyosis is not surgically removed, there is a possibility that it could continue to grow. Hormonal factors, particularly estrogen, can influence the growth of adenomyosis. The use of hormonal treatments, such as progestins (like the prescribed yellow hormone), can help manage symptoms and potentially slow the growth of adenomyosis. However, the effectiveness of these treatments can vary from person to person.

3. Risk of Malignancy: Adenomyosis itself is not considered a precancerous condition, and the risk of it transforming into a malignant tumor is low. However, the elevated CA-125 levels can be indicative of other conditions, including ovarian cancer or endometriosis, which may require further investigation. It is crucial to monitor CA-125 levels and consult with a gynecologic oncologist if there are concerns about malignancy.

In summary, the management of uterine adenomyosis should be individualized based on the patient's symptoms, age, and reproductive plans. A hysterectomy may be the most definitive treatment, especially for those who are not planning to have children. However, hormonal therapies can also provide relief from symptoms and may be appropriate for some patients. It is vital to have open communication with the healthcare provider to explore all available options and make an informed decision.
Additionally, it may be beneficial to seek a second opinion from a specialist in gynecology or reproductive endocrinology, especially if there are concerns about the diagnosis or treatment plan. Regular follow-ups and monitoring of symptoms and CA-125 levels are essential to ensure the best possible outcomes.

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