adenomyosis treatment options

Understanding Adenomyosis Treatment Options

Adenomyosis is not as common as uterine fibroids but because these two conditions have similar symptoms they are often misdiagnosed. While women with fibroids have several treatments to choose from, adenomyosis treatment options are limited to just three: temporary symptoms relief with medications, surgical removal of the uterus, and a non-surgical procedure called uterine artery embolization (UAE).

Dr. Lipman of the Atlanta Fibroid Center® has over 25 years of successful experience in the non-surgical treatment of both adenomyosis and fibroids with uterine embolization. He performed more UAE/UFE procedures than any other physician in the world. Dr. Lipman stands firmly with patients and is committed to educating them about all available treatment options and the importance of preserving the uterus.

What Is Adenomyosis and What Does It Feel Like?

To understand what adenomyosis is, we should know just a little about the anatomy of the uterus. Particularly, the uterine layers named endometrium, myometrium, and perimetrium. These three layers make up the uterine wall:

  • the inner layer called the endometrium consists of glandular cells;
  • the middle, thickest layer is called the myometrium and is made of smooth uterine muscle cells;
  • the outer, thinnest layer is called the perimetrium and is made up of serous cells – cells that secrete specialized substances.

Adenomyosis is a condition that occurs when glandular cells of the endometrium (the uterine lining) grow into and are found in the myometrium – the muscular wall of the uterus. A closely related condition called endometriosis happens when the same type of cells are found growing outside of the uterus.

Sometimes these rogue endometrial cells are localized (confined to one area), in which case it is referred to as adenomyoma. When adenomyoma is present it is sometimes misdiagnosed and confused with uterine fibroids (leiomyomas). The most common presentation of adenomyosis occurs when the glandular cells spread within the myometrium irregularly and result in a condition referred to as diffuse adenomyosis.

Adenomyosis occurs for unknown reasons but a few factors are believed to increase the chances of developing adenomyosis. The risk group includes:

  • women of premenopausal age,
  • women that have already given birth,
  • women that have had uterine surgery or trauma.

Only about 30% of females with adenomyosis have symptoms associated with their condition and the other 70% are asymptomatic. The symptoms that most frequently appear with adenomyosis are similar to other female gynecological conditions so women are often misdiagnosed and not provided with effective adenomyosis treatment options.

What Are Symptoms of Adenomyosis and How to Distinguish Them From Fibroid Symptoms?

While the symptoms of adenomyosis and uterine fibroids are very similar there are a few factors that may help distinguish one condition from the other.

Adenomyosis most frequently presents in women of premenopausal age between 40 and 50 years of age. The symptoms most often reported are severe pain during periods or heavy menstrual bleeding and are very similar to the symptoms of uterine fibroids.

One indicator that the symptoms may be a result of uterine fibroids is the presence of significant or heavy bleeding while pelvic pain is more closely associated with adenomyosis for most patients.

Both conditions can cause heavy bleeding and menstrual pain and both may cause pain during intercourse. Uterine fibroids are known to cause fertility issues and although fertility issues may occur due to adenomyosis, it is not as common. Women who are having trouble conceiving and also suffer from severe menstrual pain and chronic heavy bleeding should be evaluated for several conditions.

What Are Adenomyosis Treatment Options?

Women whose adenomyosis is not causing any symptoms do not need to seek any adenomyosis treatment. The best treatment for adenomyosis may depend on the severity of the symptoms and progression of the disease.

The first course of action when seeking adenomyosis of the uterus treatment is to undergo a diagnostic test to positively identify the condition. Undergoing a transvaginal ultrasound or an MRI can provide your doctor with the information they need to positively confirm the presence of adenomyosis.

The most widely used diagnostic tool is a pelvic ultrasound because most OB-GYN offices already have one on-site. The reliability of the results returned from an ultrasound can vary due to:

  • Age and condition of the equipment;
  • Low-resolution imaging;
  • Qualifications and training of the sonographer (are they expertly trained in the patterns to look for in determining adenomyosis).

Patients are often diagnosed with uterine fibroids after an ultrasound but when scanned using an MRI, which offers higher resolution and clarity, are shown to have adenomyosis. An Incorrect diagnosis of fibroids results in the ineffective treatment of adenomyosis.

Uterine Fibroid Embolization in Atlanta, GA

What Is The Best Treatment For Adenomyosis?

Generally speaking, there are three ways to address symptoms of adenomyosis:

  • Medical management;
  • Surgical treatment;
  • Interventional radiology treatment.

1. Medical Management To Treat Adenomyosis Symptoms

It is important to understand that medical treatment may provide some symptom relief but does not cure the underlying problem. When the treatment stops, the symptoms will reoccur. Women who opt for medical management are usually those who have mild symptoms or are in the process of choosing a definitive solution and require first-line treatment.

Commonly, non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen or Motrin are prescribed to relieve pain in adenomyosis patients. The next thing that is often tried is hormonal therapy with hormonal IUDs, e.g. Mirena, or oral contraceptives.

2. Surgical Treatment for Adenomyosis

Women are often only presented with the option of adenomyosis surgery to treat their condition. Unfortunately, it is difficult to isolate and “cut out” or remove adenomyosis because it does not contain discrete boundaries. A myomectomy is not an option to remove an adenomyotic part of the uterus as it is when removing a uterine fibroid. Historically, the only surgical option available for women was a hysterectomy, i.e. removal of the uterus.

Even though hysterectomy eliminates any potential health issues in the uterus, it provokes other significant physical, mental, and emotional issues for women. Research has determined that the uterus plays a role in many vital functions in a woman’s body and therefore, hysterectomy should be reserved for situations of medical necessity.

Alternative surgery for adenomyosis using the triple flap method may be an option for some patients, depending on the nature of their adenomyosis; however, it is not always effective in eliminating the entire lesion. Asymmetric dissection is an alternate surgical technique that has been used to remove adenomyosis lesions, and the uterus is reconstructed afterward. With open surgery, the risk of infection and complications increases, and with either of these surgical techniques, although rare, there is a risk of uterine rupture during pregnancy.

A case report from Japan relayed the results of the first laparoscopic surgery for adenomyosis that was performed using a newer imaging technology called elastography. While an MRI offers clarity and the image quality far surpasses that of ultrasound, elastography can go a step further and assess the physical characteristics of tissue and determine how stiff it is. This helps distinguish normal myometrium tissue from fibroids and adenomyosis.

The authors of this laparoscopic adenomyomectomy case report noted that surgical techniques used to treat adenomyosis are very complex, and to date, there is no consensus among medical professionals regarding the best techniques to use during the operation.

Adenomyosis laparoscopic surgery has limitations related to the movement of the instruments and limited access for the surgeon to perform palpation. Also, treating diffuse-type lesions requires extensive resections and advanced techniques, so open adenomyomectomy is most often used. Another potential issue with laparoscopic surgery for adenomyosis is that it carries a higher risk of future uterine rupture.

While there has been progress in adenomyosis laparoscopic surgery, it may not be a viable option for many women. Fortunately, there is no need for an unnecessary hysterectomy or risky surgical procedure because many cases of adenomyosis can be safely and effectively treated without surgery.

3. Interventional Radiology Treatment

Interventional radiology is a medical specialty that uses minimally invasive techniques under imaging guidance to treat a number of medical conditions in different areas of the body without surgery.

Uterine artery embolization is a non-surgical treatment of adenomyosis and a much more preferable alternative to undergoing a hysterectomy.

You may be familiar with uterine fibroid embolization (UFE), which uses a similar approach to effectively eliminate fibroids. The procedures are the same with only a few technical differences.

Uterine Artery Embolization – An Effective Treatment For Adenomyosis

UAE has several advantages over medical management or hysterectomy and can treat adenomyosis without surgery, compromising the integrity of the uterus, or prompting negative side effects common with hormonal therapy.

Uterine artery embolization works by cutting off the blood supply to the adenomyosis tissue and it can not survive without it. The tissue shrinks and the symptoms are alleviated. The procedure only takes about 45 minutes and does not require a hospital stay. Patients are discharged to go home the same day with only a bandaid.

Recovery is much faster than after undergoing a hysterectomy and usually takes only 5-7 days for most patients. Most patients find noticeable relief as early as their first menstrual cycle. UAE is done in Atlanta Fibroid Center’s state-of-the-art facility and not in a crowded hospital.

We are fortunate today with the availability of internet platforms and social media that we can connect with others and learn and be inspired. There are countless testimonials from women who are sharing their inspiring stories of how uterine artery embolization finally brought them adenomyosis pain relief and gave them back their lives.

Many women have found relief from their debilitating adenomyosis symptoms and regained their quality of life through UAE and the help of Dr. John Lipman and The Atlanta Fibroid Center. This video is one woman’s story of how UAE cured adenomyosis without surgery.

To learn more about uterine artery embolization (UAE) for treating symptomatic adenomyosis, reach out to one of the nation’s leading UAE experts Dr. John Lipman of Atlanta Fibroid Center at 770-953-2600 or make an appointment online at

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