Which Medicine Is Best for Adenomyosis?
The honest answer is that there is no single best medicine for adenomyosis that works for everyone. Some medications may help control symptoms, like pain or heavy bleeding, but they do not cure or eliminate adenomyosis. The best choice for you will depend upon your specific circumstances and needs.
How Does Adenomyosis Develop?
Researchers have been unable to provide a single root cause that triggers the condition, but it happens when tissue that is meant to grow inside the uterus as part of the lining instead goes rogue and begins growing inside of the muscular wall of the uterus.
As the rogue tissue continues to grow, it can create a host of symptoms, including heavy periods, pelvic pain, cramping, and pressure. Medication is often used as a first step in treatment because it does not require surgery and can be managed by their OB/Gyn.
Why Is Adenomyosis So Painful?
Adenomyosis tissue responds to monthly changes in the hormone levels of estrogen and progesterone and behaves just like the cells that line the uterus. During your menstrual cycle, this tissue swells and becomes irritated, much like the lining of the uterus does right before your period. That swelling causes inflammation inside of your uterus and also inside the uterine muscle where the rogue tissue is growing, which causes cramping, pressure, and deep pelvic pain.
Then on top of that, the normal lining of the uterus sheds and exits your body during your period, but the adenomyosis tissue is trapped inside of the muscular wall of the uterus, so it cannot shed or drain normally. Instead of bleeding and exiting your body like the uterine lining does, the adenomyosis tissue can leak small amounts of blood into the muscle layer of the uterus.
This trapped blood and inflammation can make the uterus thicker and tender to the touch, and it often becomes enlarged. Each month the cycle of swelling, inflammation, and trapped bleeding repeats, which is why pain often gets worse during the menstrual cycle and why heavy and prolonged bleeding is so common with adenomyosis.
What Kinds Of Medications Are Available For Adenomyosis?
Most adenomyosis medications fall into two main groups: pain relief medications and hormone-based treatments.
Pain Relief Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, can help reduce inflammation and lessen period pain and cramping. They work best for mild symptoms and are usually taken right before or during your menstrual cycle. NSAIDs do not treat the underlying cause of adenomyosis, but they can ease the symptoms for some people.
Hormonal Medications
Hormonal medications are commonly used to manage adenomyosis symptoms because the condition reacts strongly to estrogen and progesterone.
When your estrogen levels rise, the tissue inside the uterus and inside the uterine muscle reacts and becomes more active. This causes swelling, inflammation, pain, and pressure. Progesterone helps to balance out estrogen, but for many people with adenomyosis, this balance of hormones does not always work like it is supposed to, and as a result, symptoms may become worse.
Hormonal medications work by changing how much estrogen the tissue is exposed to or by blocking its effects.
Which Pill Is Best For Adenomyosis?
Birth control pills are often the first hormonal option doctors recommend because they are easy to use and help regulate periods, reduce bleeding, and ease cramps.
Birth control pills help keep hormone levels steady instead of letting them rise and fall sharply each month. This can reduce how much the adenomyosis tissue is able to grow or become inflamed.
These pills can be a combination of estrogen and progestin, or they can contain only progestin. For women with adenomyosis, progestin-only pills can be especially helpful because progestin counteracts estrogen. Counteracting the effects of estrogen helps reduce swelling, inflammation, heavy bleeding, and other symptoms linked to adenomyosis.
Other Hormone-Based Medication Options
Hormonal intrauterine devices (IUDs) release a low dose of progestin directly into the uterus, which helps calm the local tissue and can also help neutralize the adenomyosis tissue within the muscle wall. Many women experience major improvements in bleeding and cramping with hormonal IUDs.
Gonadotropin-releasing hormone agonists (GnRH agonists) temporarily shut down your body’s estrogen production. These medications can shrink adenomyosis tissue and reduce pain, but they have unpleasant side effects that mimic those of menopause, such as hot flashes and bone loss. They are only approved for short-term use and no longer than 12 months.
Do Adenomyosis Medications Really Work?
Medication only works for symptom control, but it does not treat the adenomyosis itself. Some patients get some relief from their pain and heavy bleeding, especially when using the hormone-based options. But for other women these options cannot adequately alleviate their symptoms, so they are often referred by their OB/GYN for hysterectomy surgery.
What Is the Most Effective Treatment For Adenomyosis?
The most effective treatment can vary for each person and depends on the extent of your symptoms. If your symptoms are just minor, over-the-counter medications or hormone based medications may be sufficient to keep you comfortable for a while.
The problem comes in because adenomyosis does not go away on its own during your childbearing years, and it can continue to build up and enlarge your uterus, which can increase the severity of your monthly symptoms. When you enter menopause, adenomyosis will naturally begin to subside because your estrogen production gradually goes down.
The Atlanta Fibroid Center in Atlanta, Georgia, offers uterine artery embolization (UAE), which is a safe and effective procedure that takes about 45 minutes to perform and can treat the adenomyosis at the source.
How Does UAE Treat Adenomyosis?
Dr. John Lipman and Dr. Sima Banerjee are board-certified interventional radiologists who specialize in the UAE procedure. Their expertise spans almost 3 decades, and they have performed over 10,000 procedures that have significantly reduced or eliminated monthly symptoms and improved patients’ quality of life.
The procedure uses tiny particles to block the blood flow from the uterine artery to the adenomyosis tissue so it can no longer thrive. Gradually, this rogue tissue shrinks to be smaller and smaller, and monthly symptoms are significantly reduced or eliminated. UAE has proven to be about 80% effective in treating adenomyosis tissue and offers a short recovery of only a week to ten days.
Adenomyosis is often treated by OB/GYNs with hysterectomy, but this should be reserved for only the most severe cases. If you are suffering from adenomyosis and you would like a more permanent solution than adenomyosis medication, UAE may be the most effective treatment for adenomyosis that preserves your uterus.
Not every patient is a candidate for UAE, and the decision will depend on the diagnostic imaging results, symptom severity, and your specific circumstances.
Set up your consultation today with the Atlanta Fibroid Center and learn more about UAE and how it may help you.
