Many women in the United States are affected by adenomyosis, but the exact number is difficult to pinpoint because many cases are not diagnosed or are misdiagnosed. This condition shares common symptoms like heavy menstrual bleeding, painful periods, and pelvic pressure with many other gynecological conditions, so it can be tricky to figure out the root cause. There is a surgery called adenomyomectomy that is sometimes used to treat this condition, but it is not often used, and many women may be candidates for a much less invasive form of treatment, but they may never learn of this option.
Today, we are going to talk about the adenomyomectomy procedure, what it is, when it can be used, and how it compares to a hysterectomy. We will also provide some information about a non-surgical treatment option called UAE (uterine artery embolization) that can be used to treat adenomyosis symptoms in some cases.
Is Adenomyosis a Common Issue for Women?
Studies show that about 20% of the women who see a gynecologist for the type of symptoms mentioned above have adenomyosis. This condition happens when the tissue that normally lines the uterus (and sheds every month during a period) begins to grow into the muscle wall and causes heavy bleeding, chronic pain, and pressure.
How Does Adenomyomectomy Compare to a Hysterectomy?
Some women struggle with severe symptoms that interrupt their lives and do not respond to other types of treatment. Their OB/GYN may recommend surgery to alleviate their symptoms, such as a hysterectomy or adenomyomectomy procedure, but these are drastic forms of treatment and require a significant recovery time.
- Adenomyomectomy is a surgery that removes only the parts of the uterus affected by adenomyosis. It can help relieve heavy bleeding and pelvic pain but allows a woman to keep her uterus, and in some cases, it will preserve her fertility.
- Hysterectomy is a surgery that removes the uterus completely and permanently ends menstrual bleeding and eliminates the possibility of pregnancy. Sometimes it is the best treatment to stop the symptoms of severe adenomyosis when other options do not work.
An Overview of Adenomyomectomy
An adenomyomectomy is a surgery that is performed that removes adenomyosis growths from the uterus, without removing the entire uterus, unlike a hysterectomy. An adenomyomectomy usually removes the parts of the uterine muscle that contain the rogue tissue to reduce or eliminate painful symptoms and to preserve fertility for women who desire to have children.
The surgery is complicated and requires a gynecologist who is specifically trained and experienced in treating adenomyosis through surgery. It can be performed laparoscopically or as an open procedure, and the technique chosen by the surgeon will depend upon the extent of the growth and where it is located.
How Is Adenomyomectomy Usually Done?
Most surgeons prefer to perform an adenomyomectomy laparoscopically, if possible, because it usually involves less blood loss, smaller scars, and a faster recovery compared to open surgery. The choice will depend on how much of the uterus is affected, how deep the abnormal growth goes into the muscle, and how experienced the surgeon is.
Laparoscopic adenomyomectomy can be used when the areas of abnormal tissue growth are small enough to be safely removed through small abdominal incisions. Open surgery that uses a larger incision may be needed to remove larger areas of adenomyosis when the surgeon needs more access. In some cases, a special technique called a double-flap method is used after the diseased tissue is removed to help rebuild the uterine wall, which can help with symptoms and with a future pregnancy.
Adenomyomectomy Recovery Time
The recovery time after an adenomyomectomy will depend on the type of surgery performed and how extensive and involved the tissue removal was.
After a laparoscopic adenomyomectomy, many women are able to go home the same day or after spending only one night in the hospital. It is normal to experience pain and fatigue for a few weeks after the surgery, and most can return to normal light activities in three to four weeks. It may take around six weeks before the uterus is fully healed, and it is possible to return to a normal, full schedule that includes vigorous exercise.
After open adenomyomectomy surgery, women may have to remain in the hospital for 2 or 3 nights, and it can take longer to recover. Most women are able to return to light activities like a desk job in about two to three weeks, but it may take between 8 and 12 weeks to return to their normal routine, including an aggressive exercise regimen.
The surgeon will provide clear aftercare instructions based on your exact surgery.
What Are the Risks of Adenomyomectomy?
As with any kind of surgery, there are common risks and also some that are specific to this type of surgery. Some of the risks that are common to uterine surgery include:
- Bleeding and infection;
- Adhesions or internal scar bands that can cause pain or interfere with conception later;
- A situation that causes a need to convert from a laparoscopy to an open surgery or a last-minute hysterectomy;
- Issues with a future pregnancy, like uterine rupture;
- Regrowth or additional growth of adenomyotic tissue that causes symptoms to return.
What Is the Success Rate of Adenomyomectomy?
The answer to this question depends on what is meant by the results you are looking for. Many studies report large improvements in pain and bleeding after adenomyomectomy, and some report high percentages of short-term relief of symptom improvement. The long-term results that have been reported vary greatly, so it is hard to provide a definitive answer because adenomyosis can recur or continue to spread.
This type of surgery is not normally effective for women who have diffuse adenomyosis, which is where the abnormal tissue grows in a spiderweb-like pattern rather than in solid masses.
Pregnancy after Adenomyomectomy
Some women who have an adenomyomectomy attempt to get pregnant in the future, and the reported success rates are widely different, ranging from 20% to 50% based on their age, the type of adenomyosis treated, and the treatment used.
Pregnancy after adenomyomectomy surgery is considered a higher risk than a normal pregnancy and requires an increased level of monitoring, as the risks for experiencing uterine rupture, placenta problems, and preterm birth are elevated.
What Could Be a Better Option Than Adenomyomectomy Surgery?
Adenomyomectomy surgery can improve a woman’s quality of life, but it is a complex operation and is not the best solution for everyone. UAE is non-surgical, much less invasive, and can treat about 80% of adenomyosis cases without compromising your uterus.
Uterine artery embolization (UAE) is a minimally invasive procedure that does not involve cutting or removing any or all of your uterus. This 45-minute outpatient procedure is done to block off the tiny blood vessels that are supplying the rogue tissue with the blood it needs to stay alive and to grow. When the life source is cut off, the tissue begins to shrink down and die, taking the nasty symptoms with it. You can go home the same day to begin your recovery in about a week, which is much quicker than surgery.
If you are suffering from heavy bleeding, pelvic pain, and other painful symptoms that dictate your schedule and interrupt your work and social life, UAE may be just the treatment you are looking for. Set up a consultation with our experts at the Atlanta Fibroid Center, Dr. Lipman and Dr. Banerjee, and find out more about uterine artery embolization. You will be back on your feet and living your best life much faster than undergoing surgery.
