Hysterectomy For Adenomyosis: Is This The Best Solution?

Many women suffer from conditions that are related to their reproductive organs. These issues are often the source of painful, and sometimes debilitating, recurring symptoms. These may include excessive bleeding that lasts longer than normal during their period, breakthrough bleeding between periods, pressure in the abdomen, pain during sex, infertility, anemia, and more.

There are several conditions that can prompt these unpleasant symptoms, so sometimes it is tricky to uncover the root cause. Today, we are going to concentrate on a condition called adenomyosis, which can cause these symptoms. We will provide a brief overview of what it is, its cause, and the treatment options available for adenomyosis. Hysterectomy surgery is often recommended to the patient by their OB/GYN, but this is not the best or only option available for treatment.

What Is Adenomyosis And Why Does It Occur?

Most people are familiar with endometriosis, as it is very common, and research has suggested that 1 out of 4 women in the United States are living with endometriosis. Adenomyosis is often referred to as the sister of endometriosis, but only around 1 out of 9 women are diagnosed with the condition.

Both conditions are caused by cells that are growing outside of their normal boundaries. The cells that make up the lining of the uterus begin to grow in places they are not supposed to. This causes issues because these cells still continue to function as they would if they were part of the uterine lining. They begin to build up and then begin to bleed during the woman’s normal cycle; however, there is no outlet for this shedded material.

The difference between these two conditions is where the abnormal cell growth is occurring. Endometriosis is the result of these cells growing outside of the uterus, and adenomyosis occurs when they grow within the walls of the uterus.

Unfortunately, a cause for these conditions has not been identified, but research is still ongoing as to what makes these cells go off the grid and take up residence outside their normal location.

Why Is Adenomyosis Often Missed?

Historically, this condition could only be diagnosed by examining the patient’s uterus after it was removed. Because the average age of the patients undergoing a hysterectomy for adenomyosis was around 45 years old, it was believed at the time that adenomyosis only affected older women who were approaching menopause and who either had previous cesarean sections or multiple pregnancies.

It is tricky to detect adenomyosis for several reasons, including:

  • It can’t be detected through a routine pelvic exam;
  • It is often missed on an ultrasound, and if it is detected it requires a technician who is specially trained to know what to look for;
  • Its symptoms are shared with many other gynecological conditions;
  • It is often incorrectly diagnosed as fibroids or endometriosis because it is very common for a woman with adenomyosis to also have some or all of these conditions at the same time;
  • Adenomyosis can enlarge the uterus, and it can even begin to cause a protruding abdomen, which is a symptom that it also shares with uterine fibroids.

One case study that was published in 2021 discussed a 30-year-old woman who had experienced fairly normal periods from the onset at age 14 until recently when her periods had become progressively worse. She began experiencing dull and pulsating pain that became worse at night and required pain medication to ease her discomfort. First, she went to her GP to see what was going on, who provided her with a prescription for progesterone and referred her to a specialist. During her quest to find out what was going on, she saw three different doctors, and had a pelvic ultrasound, a couple of CT scans, and an MRI. She also underwent two separate diagnostic D&C procedures done by each OB/GYN she went to for answers.

The radiologist who looked at the first ultrasound and CT scan noted an enlarged uterus with endometrium thickness and cysts, which he noted may be malignant. A different radiologist looked at the second CT scan and noted hyperplasia, necrosis of a submucosal fibroid, and 4cm ovarian cysts. There was also a note made by the second radiologist about malignancy.

Fortunately, the second OB/GYN she saw ordered an MRI, which was shared with a fresh set of eyes in the form of a multidisciplinary team that included a radiologist, a pathologist, and an oncologist who carefully reviewed the MRI scans. This is when they correctly diagnosed her adenomyosis. The case study also stated that a confirmed diagnosis of this condition would normally be done through an adenomyosis hysterectomy, but this was not an option due to the patient’s age and her desire to retain her fertility.

This case showed how difficult it can be to diagnose adenomyosis. First, the patient didn’t fit the stereotypical profile for this condition, and second, the ultrasound and CT imaging tests did not provide clear answers. It was not until the MRI was done that the doctors could see the signs of adenomyosis. Her diagnosis was further complicated because there was poor communication and collaboration among the doctors.

Alternatives To Hysterectomy For Adenomyosis

There are a few different treatments that doctors normally use initially to help treat the symptoms of adenomyosis, including:

  • Non-steroidal anti-inflammatory medications that help with inflammation and offer pain relief;
  • Birth control pills or an IUD can help control heavy bleeding and ease cramping discomfort;
  • GnRH medications (gonadotropin-releasing hormone agonists) can help control the release of hormones that can lessen bleeding but often have bad side effects, so these can only be used temporarily;
  • Prescriptions such as tranexamic acid and other similar medications that do not contain hormones can help reduce bleeding.

The drawback of using these types of treatments is that they do not eliminate the condition of adenomyosis, they do not provide lasting results, and many have associated side effects.

The Best Alternative To A Hysterectomy For Adenomyosis Is UAE

While a hysterectomy will cure adenomyosis, it can put you at risk for many other serious conditions. Research has discovered that a woman’s uterus plays a vital role in both her physical health and her mental health. Many women also experience issues with sexual dysfunction after undergoing a hysterectomy or the prolapse of other organs such as the bladder or vagina.

Also, an adenomyosis hysterectomy requires about six to eight weeks of recovery time, and there are always risks of complications when you undergo surgery, especially when general anesthesia is used.

UAE (uterine artery embolization) is not a surgical procedure and is done as an outpatient by an interventional radiologist. This procedure has been around for over 25 years and is a safe and effective treatment that can eliminate uterine fibroids and adenomyosis. Since about 70% of the women who are diagnosed with adenomyosis also have one or more uterine fibroids, UAE offers superior treatment with a success rate of between 80% and 90% and treats both conditions during the same procedure.

During the UAE procedure, a special technique is used to block the blood flow that the adenomyosis cells need to remain alive. Once their lifeline is cut off, the inflammation begins to dissipate, and the uterus will gradually revert to its normal size. This will eliminate the heavy bleeding and pain caused by the condition. There are no stitches necessary and the patient can go home after the procedure with just a bandaid.

Pros And Cons Of Hysterectomy For Adenomyosis

When compared with UAE, a hysterectomy for adenomyosis offers more cons than pros. See the chart below for details.

Disadvantages Of Hysterectomy For Adenomyosis vs. UAE
Hysterectomy Uterine Artery Embolization
Surgical procedure Non-surgical procedure
Removes the uterus The uterus is left intact
Causes sterilization Retains fertility
Requires a hospital stay of 1-3 days No hospital stay is required
General anesthesia is necessary Mild sedation is used, not general anesthesia
Can prompt prolapse of organs such as the bowels, bladder, and a weakened pelvic floor. Taking out the uterus removes part of their support system. It does not affect other organs
Negatively affects hormone balances Does not impact hormones
Has many associated long-term side effects, such as:

  • Instant menopause;
  • Sexual dysfunction;
  • Risk of organ prolapse;
  • Bowel issues;
  • Ureter damage;
  • Memory issues;
  • Depression;
  • At greater risk for heart disease and other serious health conditions.
When performed by an expert interventional radiologist who has extensive experience performing UAE, there is a less than 1% chance of experiencing long-term side effects.
Recovery can take 4 to 8 weeks The average recovery is a week to 10 days

Finding Non-Surgical Treatment For Adenomyosis In Atlanta, GA

If you are experiencing heavy bleeding, pain, or other symptoms of adenomyosis that are keeping you from living life the way you desire, please contact the Atlanta Fibroid Center for help. Our expertly trained doctors have over 25 years of experience in performing the UAE procedure and an excellent track record. We have helped numerous women local to our community and from all over the world break free from the pain and debilitation that adenomyosis and uterine fibroids can cause.

If you are dealing with symptoms similar to the patient in the case study and would like to know if you have adenomyosis, contact the experts at the Atlanta Fibroid Center today for more information. If you have been told by your doctor that you need a hysterectomy to treat adenomyosis, please set up an appointment today and let us look over your case. You may be an excellent candidate for UAE. and you will not have to undergo an adenomyosis hysterectomy or deal with the long recovery, risks, or side effects of surgery.

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