Adenomyosis is an affliction of the uterus in which endometrial (uterine lining) cells begin to develop inside the uterine muscle (myometrial cells). This occurs most frequently after childbirth and can cause a host of problems, including abdominal pain and swelling, dysmenorrhea, and long or heavy menstrual periods. While adenomyosis may sometimes be asymptomatic, it can still cause problems if it is allowed to progress unchecked. Here’s a look at some of the treatment options for adenomyosis.
Many doctor/patient teams choose to treat the symptoms that develop as a result of adenomyosis -- namely discomfort or severe pain. In many cases, nonsteroidal anti-inflammatory medication begun a few days before the start of the period can be sufficient to alleviate this pain; in other cases, more serious medications may be necessary, although these can be habit-forming so most modern doctors try to veer away from narcotics.
The problem with this approach is that it does not stop the problem. Adenomyosis can continue to get worse; the circulation of estrogen tends to encourage further production of misplaced endometrial tissue. Eventually, this can cause serious damage to the uterus and interfere with fertility.
Another potential treatment method is to manage adenomyosis through hormone therapy. Some doctors prescribe birth control as a means of controlling symptoms like dysmenorrhea, heavy or long periods, or the presence of blood clots during your period. Birth controls that introduce more estrogen into the system can actually make the issue worse. However, progesterone-based hormone medications can be very effective. They can inhibit the normal menstrual cycle, leading to amenorrhea (absence of menstruation), thus providing relief as well as slowing down the progression of adenomyosis. Advanced adenomyosis is generally not alleviated through hormone therapy.
There are a few procedures that can be attempted in lieu of the singularly permanent hysterectomy. Many of these procedures are dependent on the particular symptoms and other aspects of an individual case. For example, if you have adenomyomas (localized tumors that form within obvious areas of endometrial cells within the myometrium), uterine artery embolization may be effective. This procedure is performed by limiting blood supply from blood vessels in the uterus to adenomyotic areas and is generally used for fibroids.
Another alternative for women with adenomyosis that is not advanced and deep is endometrial ablation; this procedure involves destroying the endometrial cells.
The only tried and true “cure” for adenomyosis is a hysterectomy, or the removal of the uterus. Most experts maintain that it is extremely important for you to choose a surgeon who will remove only the uterus -- not the ovaries -- because adenomyosis is restricted to the uterus (as opposed to endometriosis, which can spread to other female organs). This will usually allow you to enter menopause as usual, without the hormonal interference that can occur (causing virtually immediate menopause) as a result of the removal of all reproductive organs. However, it is important to note that menopause will also “cure” adenomyosis; it nearly always ceases once you hit menopause. If you are close to menopausal years, symptomatic treatment may make more sense than a serious surgical procedure. Talk to your doctor about which options are best for you.