ADENOMYOSIS

What is adenomyosis?

 There are 3 layers of the uterus:

• Outer layer called serosa

• Middle layer called myometrium

• Inner layer called endometrium

 Every month when you have your period, the endometrium is shed. Sometimes the endometrium grows into the myometrium. When this happens, you can get a condition called adenomyosis. When you have adenomyosis, you can also have other conditions like fibroids and endometriosis at the same time.

How do I know if I have adenomyosis?

 If you have adenomyosis, you might experience:

• Painful periods

• Pain with sex

• Heavy menstrual period

How is adenomyosis diagnosed?

Usually, adenomyosis can be suspected based on your symptoms and a physical examination. You can start treatment without doing any other tests. Your doctor might get you to do an ultrasound to see if there are any other causes of your symptoms. Adenomyosis can be hard to detect on ultrasound or MRI.  

I have adenomyosis. What medications can I use to treat my symptoms?

Treatment of adenomyosis depends on how bad your symptoms are and if you want to have children. Most women need long-term treatment to control symptoms because symptoms might come back if medications are stopped.

You should talk to your doctor to see what medication is best for you and what the side effects are.

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Here are some options for treatment:

(1) Birth control pills: these hormone-based drugs decrease pain that is caused by adenomyosis and can stop your menstrual period from coming.

(2) Progestins: these hormone-based drugs decrease pain that is caused by adenomyosis and can stop your menstrual period from coming.

(3) Gonadotropin-releasing hormone (GnRH) agonists: these medications decrease your hormone levels to reduce the pain that is caused by adenomyosis. They can also stop your menstrual period from coming.

(4) Progestin-releasing intrauterine device: this T-shaped device can stay in the uterus for up to 5 years. It releases a hormone called progesterone to decrease pain with periods. It may also stop or lighten your menstrual period.

(5) Non-steroidal anti-inflammatory drugs (NSAIDs): this non-hormonal medication can help to relieve pain.

(6) Tranexamic acid: this non-hormonal medication can be used to decrease the amount of bleeding from your periods. It does not stop your period from coming.  

Can I have surgery to remove the adenomyosis?

Currently, the recommendation to surgically treat adenomyosis is a hysterectomy. If uterine-sparing options are desired, you can ask your doctor if an endometrial ablation is appropriate for you. There is on-going research on the surgical removal of adenomyosis whilst still keeping the uterus.

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What else can I do to control adenomyosis symptoms?

 Some believe that changing your lifestyle can help treat your adenomyosis.  There is no scientific evidence to support this but there are also no known harms. Exercise and dietary changes can be helpful. 

Diet: a macrobiotic diet, such as eating whole grains, vegetables, beans and lentils, can help control the endometriosis. You can also have fish, seafood, seeds and nuts. You should avoid processed foods, milk, cheese, red meat, and refined sugar.

Qigong: this is a traditional Chinese practice of body movement, meditation, deep breathing and a calm state of mind. If this is not available, then yoga and mindful meditation are good alternatives.