Uterine Adenomyosis: Fertility Concerns and Diagnosis Options

Uterine fibromatosis

I have endometriosis and, wanting to conceive, I received a long-acting contraceptive injection (Leuprolide) on October 5th last year, as per my doctor's recommendation.
The medication is effective for three months (from 10/05 to 01/05).
Now, on March 12th, two months after the medication's effect has ended, my period has still not arrived, and I have taken two pregnancy tests, both of which were negative.
I would like to ask Dr.
Tsao about my basal body temperature, which ranges between 35.8°C and 36.3°C, with some readings as low as 35.5°C.
Is this too low? I measure my temperature sublingually.
Additionally, besides ultrasound, what other methods are available for diagnosing endometriosis? Also, does Leuprolide increase the risk of ectopic pregnancy?

Li Xiaoting, 30~39 year old female. Ask Date: 2016/03/12

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the primary diagnosis of adenomyosis is through ultrasound and medical history.
Sometimes, after receiving leuprolide, menstruation may not come immediately and may take some time.
Leuprolide does not increase the risk of ectopic pregnancy.
Your basal body temperature is a bit low; if you wish to conceive, you might consider taking ovulation medications.
Wishing you good health.

Reply Date: 2016/03/12

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 various symptoms, including heavy menstrual bleeding, severe menstrual cramps, and chronic pelvic pain. When it comes to fertility, adenomyosis can complicate the ability to conceive and maintain a pregnancy, although many women with this condition can still become pregnant.

In your case, you mentioned receiving a long-acting contraceptive injection (Leuprolide) to manage your adenomyosis. This medication is often used to reduce symptoms by suppressing estrogen production, which can help shrink the endometrial tissue. However, it can also lead to a temporary cessation of menstruation, which may cause concern when trying to conceive. It’s important to note that after stopping such medication, it may take some time for your menstrual cycle to normalize, and this can vary from person to person.

Regarding your basal body temperature (BBT), a range of 35.5 to 36.3 degrees Celsius is generally considered on the lower side, especially if you are trying to conceive. A typical BBT after ovulation is usually above 36.5 degrees Celsius and can rise to about 37 degrees Celsius. Low BBT can indicate that ovulation may not be occurring regularly, which could affect your chances of conception. It may be beneficial to track your BBT over a few cycles to identify any patterns and discuss these findings with your healthcare provider.

As for diagnosing adenomyosis, while ultrasound is a common method, other diagnostic options include MRI (Magnetic Resonance Imaging), which can provide a more detailed view of the uterus and help confirm the presence of adenomyosis. In some cases, a hysteroscopy or laparoscopy may be performed, which involves inserting a camera into the uterus or abdomen to directly visualize the condition. These methods can help differentiate adenomyosis from other conditions that may present with similar symptoms, such as endometriosis or fibroids.

Regarding your concern about the risk of ectopic pregnancy associated with Leuprolide, current evidence does not suggest that this medication increases the likelihood of ectopic pregnancy. Ectopic pregnancies typically occur when a fertilized egg implants outside the uterus, often in the fallopian tubes. Factors that increase the risk of ectopic pregnancy include previous pelvic inflammatory disease, surgery on the fallopian tubes, or certain fertility treatments. It’s essential to discuss any concerns about ectopic pregnancy with your healthcare provider, especially if you have a history of reproductive issues.

In conclusion, while uterine adenomyosis can pose challenges for fertility, many women with this condition can still conceive. It’s crucial to work closely with your healthcare provider to monitor your symptoms, track your menstrual cycle, and explore appropriate diagnostic options. If you continue to experience difficulties or have concerns about your fertility, consider seeking a referral to a reproductive endocrinologist who specializes in fertility issues. They can provide tailored advice and treatment options based on your specific situation. Remember, patience and open communication with your healthcare team are vital as you navigate this journey toward conception.

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