From the Guidelines
Adenomyosis is a condition where the inner lining of the uterus (endometrium) grows into the muscular wall of the uterus (myometrium), causing painful, heavy periods and chronic pelvic pain, and is typically managed with medical therapy or uterine artery embolization (UAE) as initial therapy, especially in patients with concurrent uterine fibroids and no desire for future fertility, as supported by recent evidence from the Journal of the American College of Radiology 1.
Definition and Symptoms
Adenomyosis can cause a range of symptoms, including:
- Painful periods
- Heavy bleeding
- Chronic pelvic pain
- Pressure or fullness in the pelvic area
Treatment Options
Treatment options for adenomyosis depend on the severity of symptoms and whether future pregnancy is desired:
- For mild symptoms:
- Over-the-counter pain relievers like ibuprofen or naproxen
- Heat therapy
- For moderate to severe symptoms:
- Hormonal treatments: a. Combined oral contraceptives b. Progestin-only pills c. Levonorgestrel intrauterine device (Mirena)
- GnRH agonists (e.g., leuprolide) for short-term use
- Tranexamic acid for heavy bleeding
- For severe symptoms or when fertility is not desired:
- Endometrial ablation
- Uterine artery embolization (UAE)
- Hysterectomy (definitive treatment) As noted in a recent study, UAE has been shown to improve symptom scores and quality of life in patients with adenomyosis, with a recent meta-analysis reporting short-term and long-term improvement in symptoms in 94% and 85% of patients, respectively 1.
Importance of Consultation
It's essential to consult with a gynecologist to determine the best treatment plan based on individual symptoms, age, and fertility desires, as medical management should be trialed prior to pursuing more invasive therapies, especially in reproductive-age patients with uterine fibroids and concurrent adenomyosis 1. Regular follow-ups are necessary to monitor the condition and adjust treatment as needed.
From the Research
Definition of Adenomyosis
- Adenomyosis is a condition where endometrium-like tissue spreads within the myometrium 2, 3, 4, 5, 6
- It is a benign uterine condition affecting women at various ages with different symptoms 4
- Adenomyosis is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia 6
Clinical Manifestations
- The clinical manifestations of adenomyosis include pelvic pain, dysmenorrhea (painful periods), heavy menstrual bleeding, and subfertility 2
- Patients can also be asymptomatic 3
- Adenomyosis often coexists with other gynaecological conditions, such as endometriosis or fibroids, and may cloud the clinical presentation 2