Adenomyosis: Symptoms, Diagnosis, and Treatment Options

Adenomyosis

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 ago, it became even more severe; on the fifth day of my period, I would fill a super absorbent tampon within an hour, and even overnight pads would be saturated, causing significant discomfort.
I consulted a doctor who mentioned that my uterine lining was still five centimeters thick, but at that time, I hadn't undergone detailed examinations.

Since then, every menstrual cycle has been painful.
This July, when my period started, the pain was unbearable.
Previously, I would only take painkillers or receive pain injections, but this time I went to the hospital for a vaginal ultrasound, which revealed polycystic ovaries and adenomyosis.
At that time, I was only prescribed pain medication.
When my period came again in August, the pain was again intolerable, so I returned to the hospital for further evaluation.
On the sixth day of my cycle, I went to another hospital for another ultrasound.
Both hospitals indicated that my condition was diffuse.
The second hospital reported that my uterus measured 8.3 cm in width and 6 cm in length.
The doctors advised against surgical removal but also mentioned that my chances of conception were low, with a risk of preterm birth or miscarriage.
They suggested that I take birth control pills to suppress the growth, but I inquired about the possibility of recurrence after stopping the medication, and they confirmed that it could happen.
I would like to ask for a recommendation for another doctor in Taipei for a second opinion, particularly to discuss my chances of conception.
The pain during my menstrual cycles continues to worsen, and even if I take birth control pills to suppress growth, I am concerned about recurrence when I decide to stop the medication to try for a child.
I apologize for the lengthy message and appreciate your assistance.
Thank you.

Qiu, 20~29 year old female. Ask Date: 2012/08/30

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 trust the physicians you have consulted.
You should discuss with your doctor how to cope with your condition, as well as your fertility plans and the treatments you are willing to accept.
Thank you!

Reply Date: 2012/08/30

More Info

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 a variety of symptoms and complications, particularly concerning menstrual health and fertility.

Symptoms of Adenomyosis
The symptoms of adenomyosis can vary widely among individuals, but common symptoms include:
1. Heavy Menstrual Bleeding: Many women with adenomyosis experience heavy menstrual bleeding (menorrhagia), which can lead to the need for frequent changes of sanitary products.

2. Severe Menstrual Cramps: Painful periods (dysmenorrhea) are common, and the pain can be severe and debilitating, often worsening over time.

3. Irregular Menstrual Cycles: Women may experience irregular periods, which can include cycles that are longer or shorter than usual.

4. Pelvic Pain: Chronic pelvic pain is another symptom, which may occur outside of menstruation.

5. Pain During Intercourse: Some women report pain during sexual intercourse (dyspareunia).

6. Enlarged Uterus: In some cases, the uterus may become enlarged, which can be detected during a physical examination.

Diagnosis of Adenomyosis
Diagnosis typically involves a combination of the following:
1. Medical History and Symptoms: A thorough review of symptoms and menstrual history is essential.

2. Pelvic Examination: A healthcare provider may perform a pelvic exam to check for an enlarged uterus.

3. Imaging Tests:
- Ultrasound: This is often the first imaging test used. It can help visualize the uterus and identify any abnormalities.

- MRI: Magnetic resonance imaging is more definitive and can provide detailed images of the uterus, helping to confirm the diagnosis of adenomyosis.

4. Histological Examination: The definitive diagnosis is often made post-surgery, where a biopsy of the uterine tissue can confirm the presence of endometrial tissue within the myometrium.

Treatment Options
Treatment for adenomyosis can vary based on the severity of symptoms, the desire for future fertility, and individual patient preferences. Options include:
1. Pain Management: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen) can help manage pain.

2. Hormonal Treatments:
- Birth Control Pills: Hormonal contraceptives can help regulate menstrual cycles and reduce bleeding.

- Hormonal IUDs: Devices like the Mirena IUD can help reduce menstrual bleeding and pain.

- GnRH Agonists: These medications can help shrink the endometrial tissue and reduce symptoms.

3. Surgical Options:
- Uterine Artery Embolization: This procedure can reduce blood flow to the adenomyosis tissue, alleviating symptoms.

- Hysterectomy: In severe cases, particularly when other treatments have failed and if the woman does not wish to preserve fertility, a hysterectomy (removal of the uterus) may be recommended.

Fertility Considerations
Adenomyosis can impact fertility, although many women with the condition can conceive. However, it may be associated with an increased risk of complications such as miscarriage or preterm labor. If you are considering pregnancy, it is essential to discuss your specific situation with a healthcare provider who specializes in reproductive health.

Seeking Further Evaluation
Given your symptoms and the complexity of your case, it is advisable to seek a second opinion from a specialist in gynecology, particularly one with experience in managing adenomyosis and related conditions. In Taipei, you may consider visiting a university hospital or a specialized women's health clinic where you can receive comprehensive care and discuss your concerns about fertility and treatment options in detail.

Conclusion
Adenomyosis can significantly impact quality of life, and understanding your options is crucial. It is essential to work closely with your healthcare provider to develop a treatment plan that addresses your symptoms and future reproductive goals. Don't hesitate to seek further evaluations to ensure you receive the best care possible.

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