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Sunday, September 14, 2025

Adenomyosis


Adenomyosis – Treatment Options

Introduction
Adenomyosis is a benign gynecological condition characterized by the presence of endometrial glands and stroma within the myometrium. It leads to uterine enlargement, heavy menstrual bleeding, dysmenorrhea, pelvic pain, and sometimes infertility. It often coexists with uterine fibroids or endometriosis and primarily affects women in their 30s–50s. Diagnosis is usually clinical, supported by ultrasound or MRI. Treatment is individualized based on symptom severity, fertility desires, and patient age.

1. General and Supportive Measures

  • Analgesics:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) for menstrual pain.

  • Lifestyle adjustments: Heat therapy, regular exercise, and stress reduction to improve pain management.

  • Iron supplementation: For patients with anemia from heavy bleeding.

2. Medical Therapy

  • Hormonal treatments (first-line for symptom control):

    • Combined oral contraceptives (COCs): Regulate cycles and reduce bleeding.

    • Progestins (oral, injectable, or intrauterine):

      • Levonorgestrel-releasing intrauterine system (LNG-IUS) is highly effective for reducing menorrhagia and dysmenorrhea.

    • GnRH agonists/antagonists: Induce hypoestrogenic state, used short-term for refractory cases.

    • Aromatase inhibitors (letrozole, anastrozole): Off-label, may reduce uterine volume and pain.

  • Tranexamic acid: Non-hormonal option to reduce heavy menstrual bleeding.

3. Interventional and Surgical Options

  • Minimally invasive procedures:

    • Uterine artery embolization (UAE): Reduces uterine blood flow, effective in selected patients not seeking fertility.

    • High-intensity focused ultrasound (HIFU): Non-invasive ablation of adenomyotic tissue.

  • Surgical options:

    • Adenomyomectomy: Local excision of adenomyotic tissue, fertility-sparing but technically challenging.

    • Hysterectomy: Definitive treatment for women with severe symptoms who have completed childbearing.

4. Fertility Considerations

  • Adenomyosis may impair implantation and increase miscarriage risk.

  • Conservative treatments (hormonal suppression, adenomyomectomy) may improve fertility outcomes.

  • Assisted reproductive technologies (ART), including IVF, may be considered in infertility.

5. Monitoring and Long-Term Care

  • Symptom reassessment: Menstrual bleeding, pain, and quality of life.

  • Imaging follow-up: Ultrasound or MRI in women on conservative management.

  • Treatment adjustment: Based on fertility goals, response to therapy, and age.

6. Multidisciplinary Care

  • Gynecologists: Diagnosis, hormonal therapy, surgical options.

  • Radiologists: For imaging diagnosis and interventional procedures (UAE, HIFU).

  • Fertility specialists: For women desiring conception.

  • Primary care providers: For anemia management and long-term follow-up.




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