Gynecologic Surgery
ADENOMYOSIS

ADENOMYOSIS

Adenomyosis, also called uterine endometriosis is a common gynaecological disorder and is believed to exist in 10 to 20% of women in the reproductive age group. The exact number of adenomyosis cases is difficult to estimate as there is no one definition criteria to define the disease. Adenomyosis may be frequently -found co existing with other diseases like endometriosis, fibroids and endometrial cancer.

Dr Mayur Pai is well trained in the diagnosis and treatment of adenomyosis and adenomyosis related infertility. He often performs laparoscopic surgeries and other non surgical treatments related to adenomyosis.

This page will highlight various aspects of adenomyosis like:

What is an adenomyosis?

What are the warning symptoms of adenomyosis?

Can adenomyosis affect my fertility?

Why is it important to diagnose and treat adenomyosis?

Can ultrasound help in diagnosis of adenomyosis?

What is the role of laparoscopy in the treatment of adenomyosis?

What are the chances of recurrence of adenomyosis in the future?

What is medical or non surgical management of adenomyosis?

Keep reading till the end of the page in order for better and near complete understanding of adenomyosis and the treatment of adenomyosis. This will help you understand whether surgery or other non surgical treatments are best suited for you.

What is an adenomyosis?

Adenomyosis is a gynecological disorder in which small pockets of endometrial glands are found within the muscle layer of the uterus. This is an abnormal location for these endometrial glands.

What are the warning symptoms of adenomyosis?

Ladies with adenomyosis often have complaints of chronic pelvic pain (pain in lower abdomen and lower back), painful menses and painful intercourse. Several ladies may be affected with infertility.

In severe cases, the uterus may be very much enlarged and may present as a mass in the lower abdomen.

Can adenomyosis affect my fertility?


Adenomyosis is commonly associated with infertility. Most ladies with adenomyosis are above the age of 35 years.

Adenomyosis distorts the normal uterine shape and size. It also affects the normal uterine functioning and blood flow. The embryo implantation rates after an IVF cycle are also lower in ladies with adenomyosis.

Why is it important to diagnose and treat adenomyosis?

As mentioned above, adenomyosis can negatively affect the fertility. If diagnosed early, the couple/ lady can plan conception early or begin treatment early.

Many cases with neglected adenomyosis have and enlarged symptomatic uterus and this often needs uterus removal (hysterectomy).

Can ultrasound help in diagnosis of adenomyosis?

Ultrasound examination is a very good tool for the early detection of adenomyosis. Ultrasound also helps in the routine follow-up of the patient after treatment is started.

Ultrasound frequently show a diffusely enlarged uterus or focal area of distorted myometrium called an adenomyoma. The endometrial lining and the uterine blood flow may be distorted in some cases.

 

MRI is also an important tool in the diagnosis of adenomyosis. MRI is of great value in a case of enlarged uterus or in cases of associated fibroids in the same uterus.

 

 

What is the role of laparoscopy in the treatment of adenomyosis?

Laparoscopy is often used in the surgical management of adenomyosis. There are various types of surgeries that can be done for adenomyosis. The choice of the surgery depends on the ultrasound and MRI findings in the individual case.

Laparoscopy can also help in the treatment of co existing diseases like endometriosis, fibroids and pelvic infections. In cases of infertility, laparoscopic tubal patency test and diagnostic hysteroscopy can also be performed in the same sitting.

Laparoscopic hysterectomy can be done in women who want to remove the uterus (laparoscopic hysterectomy)

What are the chances of recurrence of adenomyosis in the future?

Adenomyosis is an ongoing disease and cannot be permanently cured.

In uterus preserving procedures, most of the adenomyosis or adenomyoma is removed and the uterus is reconstructed. Some amount of adenomyosis does remain behind in the uterus as the disease does not have a well-defined capsule or pseudocapsule.

The only way to ensure complete removal of the disease is to remove the uterus. This is the most frequent choice made by ladies who have completed their reproductive career.

 

What is medical or non-surgical management of adenomyosis?

Medical treatment involves treatment with medications like long term progesterone, GnRH analogs, long term aromatase inhibitors and mifepristone.

Progesterone releasing intra uterine device is the most popular among these treatment for those not aiming at fertility at the moment. A progesterone device can be kept in place for 5 years and has the highest convenience. It is most suited in less severe cases with a normal size or just bulky uterus.

The other treatments (other than progesterone) may be used in well selected cases of infertility. These treatments cannot be used for more than 3 to 6 months.

Patients aiming at fertility should begin fertility treatment as soon as possible due to the high chances of recurrence.

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