Adenomyosis

Adenomyosis, a variant of endometriosis, causes severe menstrual symptoms and potential infertility, impacting the quality of life for middle-aged women or those with a history of uterine surgery.

What is Adenomyosis?

Adenomyosis is one of the disease spectra or variants of endometriosis. It is called adenomyosis when the endometrium tissue infiltrates the uterus’s muscle layer, causing muscle breakdown, fibrosis formation, and an island of blood cysts within a confined area of the uterus or it might even affect the entire uterus. It causes severe menstrual cramps, heavy and prolonged menstrual bleeding, and even infertility.

Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life. Adenomyosis is a common condition and most often diagnosed in middle-aged women and women who have already had children.

Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.

Laparoscopic image of the uterus with adenomyosis.

Detection, Treatment & Surveillance Services of Adenomyosis

Diagnosis of Adenomyosis

Assess and evaluate the severity & stage of the disease

Assess fertility potential

Medical treatment of adenomyosis to control symptom

Surgical treatment
– Laparoscopic adenomyomectomy (fertility-sparing)
– Laparoscopic hysterectomy for older women

Monitor and follow up

What are the symptoms of adenomyosis?

While some women diagnosed with adenomyosis have no symptoms, the disease can cause:

Heavy, prolonged menstrual bleeding
Severe menstrual cramps
Abdominal pressure and bloating
Infertility
Painful sexual intercourse

How is adenomyosis diagnosed?

The following steps can diagnose adenomyosis:

History taking and evaluation
Pelvic examination – to assess the size and mobility of the uterus
Ultrasound of the pelvis – to see the lining and the muscle wall of the uterus
Magnetic Resonance Imaging (MRI) – to confirm, detect location and severity of adenomyosis

What are the type of adenomyosis?

There are three different types of adenomyosis:

Focal adenomyosis occurs in one particular site of the uterus.
Adenomyoma is a form of focal adenomyosis, but it is more extensive, resulting in a uterine mass or benign tumor, similar to uterine fibroma.
Diffuse adenomyosis, unlike the other two types, spreads throughout the uterus.

It is essential to correctly identify the type of disease as the treatment approach will depend on the type of disease. For example, if operated on correctly, focal adenomyosis and adenomyoma will not require a hysterectomy in most cases.

Options of treatment for Adenomyosis

There are few options for adenomyosis that can be considered depending on the severity of the symptom, the age of the patient, and desire for pregnancy.

Medical treatment
aims to control pain and menstrual blood loss

There are options to be considered:

Anti-Inflammatory drugs (NSAIDs)
Progestin (Dienogest, Norethisterone, Medroxyprogesterone acetate, MPA)
Levonogestrel IntraUterine System (MIRENA IUS)
Gonadotrophin Releasing Agonist (GnRH)

High-Intensity Focused Ultrasound (HIFU)
a new conservative minimally invasive treatment to preserve the uterus and fertility-sparing

Surgical Treatment
aims to excise the disease and for long term disease control

Laparoscopic adenomyomectomy for fertility-sparing
Total laparoscopic hysterectomy for older women to completely cure the disease
Subtotal laparoscopic hysterectomy for normal sexual function
Endometrial ablation – to destroy the lining of the uterus

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