Adenomyosis Treatment in Delhi, India

Adenomyosis is a medical condition where the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). This can cause the uterus to become enlarged and tender and can lead to heavy or prolonged menstrual bleeding, as well as pelvic pain or discomfort, especially during menstruation or sexual intercourse. Adenomyosis is somewhat similar to endometriosis, but in adenomyosis, the endometrial tissue exists within the muscle wall of the uterus rather than outside it.

The exact cause of adenomyosis is not fully understood, but several factors may contribute to its development. Some potential causes and risk factors include:

• Endometrial invagination: This theory suggests that adenomyosis develops when endometrial tissue invaginates or grows into the myometrium, the muscular layer of the uterus.
• Hormonal influences: Adenomyosis is caused by hormonal factors, particularly oestrogen. Hyperestrogenic states seen in women with PCOS and obesity may stimulate the growth of endometrial tissue within the muscle wall of the uterus.
• Hormonal imbalances: Disorders that cause hormonal imbalances, such as polycystic ovary syndrome (PCOS) or hormonal therapies like oestrogen replacement therapy, may increase the risk of adenomyosis.
• Prior Uterine surgery: Uterine surgeries like myomectomies and LSCS can lead to disruptions in the uterine lining, potentially allowing endometrial tissue to invade the muscle wall.
• Age: Adenomyosis is common in women who are in reproductive age group mostly in 30s and 40s, although it can occur at any age.
• Inflammation: Chronic inflammation within the uterus may contribute to the development of adenomyosis, although the exact relationship is not fully understood.
• Genetic factors: There may be a genetic predisposition to adenomyosis, as it tends to run in families.

It's important to note that while these factors may increase the risk of developing adenomyosis, the condition can still occur in women without any known risk factors. Additionally, the exact interplay between these factors in the development of adenomyosis is still an area of ongoing research.

Adenomyosis can cause a variety of symptoms, although some women with the condition may not experience any symptoms at all. Common signs and symptoms of adenomyosis include:

• Menstrual changes: Heavy or prolonged menstrual bleeding is a common symptom of adenomyosis. Some women may also experience irregular bleeding between periods or clots during menstruation.
• Pelvic pain: Many women with adenomyosis experience pelvic pain or discomfort, which may range from mild to severe. The pain is often described as dull, aching, or cramp-like and may worsen during menstruation.
• Pelvic pressure: Adenomyosis can cause a sensation of pressure or fullness in the pelvic region, particularly during menstruation.
• Pain during intercourse: Some women with adenomyosis may experience pain or discomfort during sexual intercourse, known as dyspareunia.
• Enlarged uterus: Adenomyosis can cause the uterus to become enlarged, which may be noticeable on physical examination or imaging studies such as ultrasound or MRI.
• Back pain: Adenomyosis-related pelvic pain may radiate to the lower back or thighs.
• Bloating: Some women with adenomyosis may experience abdominal bloating or swelling, particularly during menstruation.
• Fatigue: Heavy menstrual bleeding and chronic pelvic pain associated with adenomyosis can lead to fatigue or low energy levels.

It's important to note that the severity and combination of symptoms can vary widely among women with adenomyosis. Additionally, some symptoms, such as heavy menstrual bleeding and pelvic pain, are nonspecific and can be caused by other gynaecological conditions. Therefore, a comprehensive evaluation by a healthcare provider is necessary to diagnose adenomyosis and develop an appropriate treatment plan.

Diagnosis of adenomyosis can be challenging, as there is no single test that can definitively diagnose the condition. However, there are a number of tests that can be used to help diagnose adenomyosis, including:

• Pelvic examination: During a pelvic examination, your doctor will feel your uterus to see if it is enlarged or tender.
• Ultrasound: An ultrasound uses sound waves to create images of your pelvic organs. A transvaginal ultrasound, which is inserted into the vagina, is the most common type of ultrasound used to diagnose adenomyosis. Ultrasound can sometimes show thickening of the uterine wall, which may be a sign of adenomyosis.
• Magnetic resonance imaging (MRI): An MRI scan can provide more detailed images of your uterus than an ultrasound. MRI is often the best way to confirm a diagnosis of adenomyosis. It can show uterine enlargement and thickening of certain areas of the uterus.
• Biopsy: In some cases, a biopsy may be performed to confirm the cause of abnormal uterine bleeding which may be due to associated endometrial hyperplasia which is commonly associated with adenomyosis. This involves removing a small sample of tissue from the uterine lining (endometrium) for microscopic examination. However, biopsy is can not diagnose adenomyosis because the abnormal tissue is usually deep within the uterine wall and will not be adequately sampled.

If a person thinks they may have adenomyosis, it is important for them to see your doctor for diagnosis and treatment. Early diagnosis and treatment can help to improve symptoms and quality of life.

Treatment for adenomyosis depends on the severity of symptoms, the patient's age, desire for future fertility, and overall health. The goal of treatment is to alleviate symptoms and improve quality of life. Here are some common treatment options:

Pain Medication

Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate menstrual cramps and pelvic pain associated with adenomyosis.

Hormonal Therapy

• Estrogen + Progesterone Pills: These pills can help regulate menstrual cycles, reduce menstrual bleeding, and alleviate symptoms such as pain.
• Progestin Therapy: Progestin-only medications, such as the levonorgestrel-releasing intrauterine device (IUD), or progestin pills can help reduce heavy menstrual bleeding and pain.
• Gonadotropin-Releasing Hormone (GnRH) Agonists: These medications induce a temporary menopause-like state by suppressing ovarian hormone production, which can help relieve symptoms. However, long-term use is limited due to side effects such as bone loss and menopausal symptoms.

Uterine Artery Embolization (UAE)

In this minimally invasive procedure, small particles are injected into the arteries that supply blood to the uterus, blocking blood flow to the adenomyosis lesions. UAE can help reduce symptoms such as heavy menstrual bleeding and pelvic pain.

Surgical Options

• Endometrial Ablation: This procedure involves destroying the lining of the uterus to reduce menstrual bleeding. It may provide relief for some women with adenomyosis, but it is not suitable for those who desire future fertility.
• Hysterectomy: Removal of the uterus is the definitive treatment for adenomyosis, and it can effectively alleviate symptoms. Hysterectomy is recommended for women who have completed childbearing and have severe symptoms that do not respond to other treatments.

Lifestyle Modifications

Eating a healthy diet, exercising regularly, and managing stress can help improve overall health and may alleviate symptoms of adenomyosis.

It's essential for individuals with adenomyosis to discuss treatment options with their healthcare provider to determine the most appropriate approach based on their individual circumstances and preferences.

Adenomyosis, while not typically life-threatening, can lead to various complications that may impact a woman's health and quality of life. Some potential complications associated with adenomyosis include:

• Chronic Pelvic Pain: Adenomyosis can cause severe and chronic pelvic pain, especially during menstruation. This pain can significantly impact daily activities and quality of life.
• Heavy Menstrual Bleeding (Menorrhagia): Adenomyosis often leads to increased menstrual bleeding, which can result in anaemia due to excessive blood loss. Anaemia can cause fatigue, weakness, and other symptoms.
• Infertility: Adenomyosis has been associated with infertility, although the exact mechanisms are not fully understood. 
• Pregnancy complications: The condition may also increase the risk of complications during pregnancy, such as preterm birth and miscarriage and postpartum haemorrhage
• Endometrial Hyperplasia or Adenocarcinoma: Adenomyosis may increase the risk of developing endometrial hyperplasia (abnormal thickening of the uterine lining) or adenocarcinoma (a type of uterine cancer), although the risk is relatively low.
• Impact on Mental Health: Chronic pain and other symptoms associated with adenomyosis can have a significant impact on mental health, leading to anxiety, depression, and decreased quality of life.
• Impact on Relationships and Sexual Function: Adenomyosis-related symptoms, such as pain during intercourse, can strain intimate relationships and negatively affect sexual function and satisfaction.
• Impact on Work and Daily Activities: Severe symptoms of adenomyosis, such as pelvic pain and heavy bleeding, may interfere with work, social activities, and daily responsibilities.

It's important for individuals with adenomyosis to seek medical evaluation and appropriate management to help alleviate symptoms and reduce the risk of complications. Treatment options, including pain management, hormonal therapy, and surgical interventions, can help improve symptoms and quality of life for those affected by adenomyosis. Regular follow-up with healthcare providers is essential for monitoring symptoms and addressing any potential complications that may arise.

Adenomyosis Prevention

Preventing adenomyosis entirely may not be possible since the exact cause of the condition is not fully understood. However, there are some strategies that may help reduce the risk of developing adenomyosis or alleviate symptoms:

• Maintain a Healthy Lifestyle: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, along with regular exercise, can help maintain overall health and potentially reduce the risk the morbidity associated with adenomyosis.
• Manage Hormonal Imbalance: Hormonal imbalances, such as excess oestrogen, may contribute to the development of adenomyosis. Managing hormonal fluctuations through methods like hormonal contraception or hormone replacement therapy (HRT) may help reduce symptoms.
• Avoid Excessive Oestrogen Exposure: Minimise exposure to substances that may disrupt hormone balance or mimic oestrogen in the body, such as certain environmental toxins and endocrine-disrupting chemicals found in plastics and household products.
• Limit Uterine Trauma: Although the link between uterine trauma and adenomyosis is not fully established, reducing the risk of uterine injury or surgery (such as caesarean section) may potentially lower the risk of developing adenomyosis.
• Pregnancy and Breastfeeding: Some studies suggest that pregnancy and breastfeeding may have a protective effect against adenomyosis. The hormonal changes that occur during pregnancy and lactation may help regulate oestrogen levels and reduce the risk of adenomyosis.
• Regular Medical Check-ups: Regular gynaecological exams and screenings can help detect adenomyosis early and facilitate prompt management and treatment.

While these strategies may help reduce the risk of adenomyosis or alleviate symptoms, it's essential to consult with a healthcare provider for personalised advice and appropriate management based on individual circumstances. Additionally, research into the prevention of adenomyosis is ongoing, and further advancements may lead to additional preventive measures in the future.

What are the stages of adenomyosis?

There are no universally recognized stages of adenomyosis like those seen in some other medical conditions. Adenomyosis is generally classified based on the extent and severity of the condition, which may vary from mild to severe. However, staging systems similar to those used for endometriosis have been proposed by some researchers, but they are not widely accepted or used in clinical practice.

Can adenomyosis lead to cancer?

Adenomyosis itself is not considered a precursor to cancer. However, it may slightly increase the risk of developing endometrial hyperplasia (abnormal thickening of the uterine lining) or adenocarcinoma (a type of uterine cancer), particularly in postmenopausal women. The overall risk of cancer associated with adenomyosis is relatively low.

How does adenomyosis affect pregnancy?

Adenomyosis can affect pregnancy in various ways. It may increase the risk of infertility, miscarriage, preterm birth, and other complications. Adenomyosis can cause uterine enlargement, which may interfere with the implantation of a fertilised egg or disrupt normal uterine contractions during labour.

What is the difference between adenomyosis and endometriosis?

Adenomyosis and endometriosis are two distinct but related conditions. Adenomyosis involves the presence of endometrial tissue (the tissue lining the uterus) growing into the muscular wall of the uterus. Endometriosis, on the other hand, occurs when endometrial-like tissue grows outside the uterus, commonly on pelvic organs such as the ovaries, fallopian tubes, and peritoneum.

Does adenomyosis cause infertility?

Adenomyosis has been associated with infertility, although the exact mechanisms are not fully understood. The condition may impair fertility by affecting the uterine environment, disrupting embryo implantation, or interfering with normal uterine contractions. However, not all women with adenomyosis experience infertility and many can conceive naturally or with fertility treatments.

Can adenomyosis be cured?

There is currently no known cure for adenomyosis. Treatment aims to alleviate symptoms and improve quality of life. Options include pain medication, hormonal therapy, minimally invasive procedures such as uterine artery embolization, and surgical interventions like hysterectomy.

Is adenomyosis a serious problem?

Adenomyosis can cause significant discomfort and adversely affect quality of life for some individuals. While it is not typically life-threatening, the symptoms can be challenging to manage, and the condition may impact fertility and pregnancy outcomes in some cases.

Can I live a normal life with adenomyosis?

Many individuals with adenomyosis can lead normal lives with appropriate management and treatment. However, the severity of symptoms can vary widely among affected individuals. It's essential to work closely with healthcare providers to find effective strategies for symptom relief and support overall well-being.

What is the permanent solution for adenomyosis?

Hysterectomy, or surgical removal of the uterus, is considered the definitive treatment for adenomyosis. It offers a permanent solution by eliminating the source of symptoms. However, hysterectomy is typically reserved for women who have completed childbearing or for whom other treatments have been ineffective or not tolerated.

What is the long-term outlook for people with adenomyosis?

The long-term outlook for individuals with adenomyosis depends on various factors, including the severity of symptoms, response to treatment, and individual health considerations. With appropriate management, many people with adenomyosis can achieve symptom relief and lead fulfilling lives. Regular follow-up with healthcare providers is important for monitoring symptoms and addressing any potential complications or changes in condition over time.

Reviewed By Dr Meenakshi Sharma- Senior Consultant Obstetrics And Gynaecology, Infertility & IVF on 11 Sept 2024.