What Is Adenomyosis, a Disease That Is Difficult and Late to Diagnose?
Adenomyosis is a disease that occurs when the inner lining of the uterus settles towards the muscle wall lying deeper in the uterus. This problem can cause severe groin pain, abnormal vaginal bleeding and bloating especially during menstruation, while at the same time affecting the person’s quality of life negatively. Pelvic pain occurs at first only during menstruation and can later continue throughout the whole month. Pain during sexual intercourse can also accompany the complaints. Adenomyosis can occur throughout the whole uterus or it can appear in only one part of it. Adenomyosis is accepted as a benign condition, but its consequences can affect women’s quality of life quite negatively and for this reason it needs to be treated in patients who have complaints.
How Is Adenomyosis Treated?
For the diagnosis of adenomyosis the patient’s history is very important. The patient complains that both the duration and the amount of her painful periods and bleeding are excessive. Pain during sexual intercourse can also be seen. The complaints have generally been present for a long time. They do not appear suddenly. The complaints come on slowly, but tend to increase gradually. In the gynaecological examination it is important that the uterus is soft and painful and that the pain increases further when the uterus is moved. Being unable to become pregnant despite wanting to have a child is also one of the frequently seen situations. The diagnosis is easily made with ultrasonography. For the diagnosis alone it is important that the doctor is experienced in this field. If there is doubt in the diagnosis, magnetic resonance imaging (MRI) can also be used.
The treatment of adenomyosis can vary according to what symptoms the person experiences and how severe they are. In addition, a determining factor in the treatment is whether or not the person wants to have children.
Adenomyosis with mild symptoms can be kept under control with simple painkillers, magnesium and hot water bottles or heat pads used to relieve the cramps that occur. In addition, the use of medication, hormone treatment, medicated coils, uterine artery embolisation, endometrial ablation and, in individuals who have had children, hysterectomy are also among the methods used in the treatment of adenomyosis.
Anti-inflammatory Drug Treatment
Non-steroidal anti-inflammatory drugs can be used to relieve the pain caused by adenomyosis. The use of these drugs is generally started 1-2 days before the beginning of menstruation and continued during the first few days of the period.
Hormone Treatment
With levonorgestrel-releasing coils placed in the uterus (intrauterine device – IUD), severe painful periods and abnormal vaginal bleeding can be brought under control.
Uterine Artery Embolisation
This procedure, which is actually used in the treatment of fibroids to shrink them, can be used in the presence of adenomyosis to block the vessels that supply the blood flow. The particles used for this procedure are directed through a tube placed in the person’s femoral artery. With the cutting off of the blood flow, the adenomyosis shrinks.
Endometrial Ablation
This is a minimally invasive procedure and basically means the destruction or removal of the inner surface of the uterus. It is used to relieve the symptoms in situations where the adenomyosis has not penetrated deeply into the muscle wall of the uterus. It is preferred before a hysterectomy in order to preserve fertility.
Hysterectomy
All the treatments mentioned above are aimed at relieving the symptoms of adenomyosis. The only definitive treatment for adenomyosis is the removal of the uterus with a hysterectomy. In situations where the symptoms are at very severe levels, this is the treatment method that will be preferred. However, since the chance of pregnancy will disappear with the complete removal of the uterus, women with this problem need to have completed their childbearing or to have decided not to become pregnant again.
Does Adenomyosis Cause Infertility?
There are no definite findings regarding the relationship of adenomyosis with infertility. Most women with this problem also have a chocolate cyst, that is, endometriosis. For this reason, although it is difficult to link adenomyosis directly with infertility, it is accepted as an important factor for infertility. Studies suggest that this problem may have a role that contributes to infertility.