ADENOMYOSIS

Heavy and painful periods, could it be adenomyosis??

 

Adenomyosis is the presence of lining of the womb cell glands outside theirnormal locations

  • Adenomyosis  is common in women with many children

  • Adenomyosis is common in women who historically had painful and heavy periods

  • Adenomyosis can reduce chance of falling pregnant

  • Most common age of adenomyosis – 35+ onwards, but can be seen in young also

  • 40% of patients with endometriosis also have adenomyosis.

 

Why do women see a doctor?

 

  • Feeling of heaviness and bloated feeling  in the belly

  • Infertility; impaired attachment of the embryo to the uterine wall

  • 50% of patients with adenomyosis have heavy periods

  • 1 in 3 women have painful periods

  • 1 in 3 have it but are not aware of it

 

Investigative tools

  • Clinically uterus will be found to be uniformly enlarged, soft and globular

  • The ultrasound appearance is that of thickened posterior uterine wall

  • And tiny fluid filled areas of 1–5 mm in in the uterine muscle

  • An MRI scan remains the gold standard

 

Treatment

  • Anti -inflammatory tablets such as ibuprofen can help to reduce heavy periods and pain in one third

  • Oral contraceptives pills can help both heavy periods and pelvic pain.

  • Mirena (hormonal intrauterine device can reduces heavy periods and  and pain in up to 90% of patients.

  • Short course of GnRH injections (Such as Zoladex or Prostap) can also be considered

  • Uterine artery embolization reduces menorrhagia related to adenomyosis and the number of bleeding days as well as apin and is recommended by NICE (in the UK)

  • Surgical excision of a localised adenomyoma  can be considered

  • The new MRgFUS – Magnetic Resonance guided Focussed Ultrasound is available in few centres, but at the time of writing it is mainly in the research setting. This treatment can alleviate pain and heavy periods, but, no one sure about its impact on future fertility

  • Hysterectomy is the best and final treatment for women who have completed the family and have severe symptoms in whom routine conservative treatments are not effective

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© 2020 by Mahantesh Karoshi.