Adenomyosis is when the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). This can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods. It can also result in heavy periods. Adenomyosis can be located throughout the entire uterus or localized in a single area.
Whilst doctors describe adenomyosis as a benign (not life-threatening) condition, the frequent pain and heavy menstrual bleeding associated with it can blight women’s daily activities and negatively affect their quality of life.
Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at greater risk. Although the cause of adenomyosis is not known, studies have suggested that various hormones such as oestrogen, progesterone, prolactin and follicle stimulating hormone may all play some role in triggering the condition.
MRI is used to see the characteristics of the disease in the uterus and confirm the diagnosis. Adenomyosis can be misdiagnosed as uterine fibroids because the symptoms are so similar. However, the two conditions are not the same. An accurate diagnosis is the key to choosing the right treatment.
Treatment for adenomyosis depends in part on the severity of your symptoms and whether you have completed your family:
1. Conservative measures; Mild symptoms may be treated with simple over-the-counter pain medications and the use of a heating pad to ease cramps.
2. Anti-inflammatory medications; Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild pain associated with adenomyosis.
3. Hormonal treatments; Symptoms such as heavy or painful periods can be controlled with various hormone hormone medications or a hormone secreting uterine coil such Miraena.
4. Uterine Artery Embolisation; This is the same minimally invasive image guided technique as used to treat fibroids though the particles used might be smaller as there is some evidence that adenomyosis responds better when treated this way. Tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis in the uterus. The particles are guided through a tiny tube inserted by an Interventional Radiologist via the patient’s groin artery. With the blood supply cut off, the adenomyosis shrinks. Please see the fibroid section and the patient information leaflet for more details of this procedure.
5. Endometrial ablation; This procedure done by a Gynaecologist destroys the lining of the uterus. Endometrial ablation has been found to be effective in relieving symptoms in some patients when adenomyosis is relatively mild and has not penetrated deeply into the muscle wall of the uterus.
6. Hysterectomy; This surgical treatment to remove the uterus is undertaken by a Gynaecologist and is the only definitive cure for adenomyosis. It is often reserved for women with particularly severe symptoms.
If you have a diagnosis of Adenomyosis and wish to discuss your treatment options including Uterine Artery Embolisation, please arrange an appointment so we can advise the best way forward for you.