Adenomyosis: Effective Treatments for Severe Pelvic Pain

Consultation: Uterine Adenomyosis

Hello, my friend is currently not in Taiwan and is experiencing the following troubling symptoms.
She is 42 years old and has been suffering from recurrent severe lower abdominal pain and coccygeal pain for nearly ten years.
She has undergone examinations and treatments at a local hospital (in mainland China), and all laboratory tests have returned normal results.
A transvaginal ultrasound suggested "possible adenomyosis." Doctors in mainland China have treated her with medications including Marvelon, Medroxyprogesterone, and traditional Chinese medicine, but her symptoms have been inconsistent.
Currently, she can only manage the pain with frequent use of analgesics, and during flare-ups, the pain is severe.
She is wondering if hospitals in Taiwan have effective treatment experiences and methods for such gynecological conditions.
She previously used the Mirena IUD, which worked well in the first month, but her symptoms recurred afterward, and the pain became unbearable.
After a year, she followed the advice of a pain specialist and had the Mirena removed.
Thank you!

Ms. Chien, 20~29 year old female. Ask Date: 2014/10/23

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if your friend is not improving with treatment there, it is advisable to return to Taiwan for a thorough examination, as it may be more appropriate.

Reply Date: 2014/10/23

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 severe pelvic pain, heavy menstrual bleeding, and other symptoms that can significantly impact a person's quality of life. Your friend's experience of recurrent severe lower abdominal pain and sacral pain over the past decade, along with the ultrasound findings suggesting adenomyosis, aligns with the typical presentation of this condition.

Effective Treatments for Adenomyosis
1. Pain Management: Since your friend has been relying on painkillers, it's important to note that while over-the-counter analgesics like ibuprofen or acetaminophen can provide temporary relief, they do not address the underlying condition. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended for managing pain associated with adenomyosis.

2. Hormonal Therapies: Hormonal treatments are commonly used to manage adenomyosis symptoms. Medications such as hormonal birth control (like the pill, patch, or ring) can help regulate menstrual cycles and reduce bleeding. Your friend has tried medications like Mifeprex and progesterone, which are also used to manage symptoms. These treatments work by thinning the endometrial lining and can help alleviate pain.

3. Intrauterine Devices (IUDs): The Mirena IUD, which releases levonorgestrel, can be effective in treating adenomyosis. It appears that your friend had some initial success with it, but the symptoms returned after a year. It may be worth discussing with her healthcare provider the possibility of re-trying the IUD or considering other types of hormonal IUDs.

4. Surgical Options: If conservative treatments fail to provide relief, surgical options may be considered. This can include:
- Hysterectomy: This is the definitive treatment for adenomyosis, especially in women who have completed their families and are seeking long-term relief from symptoms. It involves the removal of the uterus and can provide significant relief from pain.

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

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, physical therapy, or dietary changes. While these may not be scientifically validated as primary treatments for adenomyosis, they can provide additional support for pain management.

6. Lifestyle Modifications: Encouraging your friend to maintain a healthy lifestyle, including regular exercise, a balanced diet, and stress management techniques, can also help in managing symptoms.

Conclusion
It is crucial for your friend to have an open discussion with her healthcare provider about her ongoing symptoms and the effectiveness of her current treatment plan. Given the complexity of adenomyosis, a multidisciplinary approach involving gynecologists, pain specialists, and possibly physical therapists may yield the best outcomes. If she is considering surgical options, it is essential to consult with a specialist who has experience in treating adenomyosis to discuss the potential benefits and risks associated with each treatment option.

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