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Understanding Adenomyosis Treatment Options

Understanding Adenomyosis Treatment Options

Adenomyosis is not as common as uterine fibroids. However, these two conditions can have similar symptoms and get misdiagnosed. Remarkably, both adenomyosis and uterine fibroids are treated effectively with Uterine Artery Embolization, without surgery. Today, we are going to discuss the nature of adenomyosis and currently available adenomyosis treatment options.

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 a smooth muscle;
  • the outer, thinnest layer is the perimetrium, it’s made up of serous cells.

Each layer has its own function and, if healthy, it performs well and grows where it is supposed to. If unhealthy, some dysfunctions may happen in these layers.

Adenomyosis is a condition when glandular cells of the endometrium appear within the myometrium.

The endometrial cells can be localized, then the adenomyosis is called adenomyoma. And for this reason, it’s sometimes misdiagnosed and confused with uterine fibroids (leiomyomas). However, more frequently, glandular cells spread within the myometrium irregularly. This type of irregularity is called 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.

Adenomyosis most commonly does not cause any symptoms. Statistically, about 70% of females with adenomyosis are asymptomatic. The other 30% of women experience symptoms of adenomyosis.

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

Adenomyosis is often diagnosed in women of premenopausal age, i.e. 40-50 years old. Their main complaint is either heavy pain during periods or heavy menstrual bleeding. These symptoms are very similar to the symptoms of uterine fibroids. The difference is that women suffering from fibroid tumors typically have more significant bleeding. Whereas in adenomyosis patients, the pain generally is the more significant symptom.

Along with menstrual pain and heavy bleeding, women with adenomyosis might experience pain during intercourse. Fertility issues might occur due to adenomyosis, but it’s not as common. Therefore, infertile women with menstrual pain and heavy bleeding should be checked for several conditions.

What Are Adenomyosis Treatment Options?

As mentioned above, adenomyosis often causes no symptoms and hence, can stay untreated. The severity of adenomyosis symptoms depends on the progression of the disease, which can only be diagnosed by imaging like a transvaginal ultrasound or MRI. Unfortunately, due to the much lower resolution of pelvic ultrasound (compared to MRI), adenomyosis is commonly missed on ultrasound. In addition, many patients who are diagnosed with fibroids on ultrasound, are shown to have adenomyosis (or adenomyoma) when imaged by the higher resolution MRI study.

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

  1. Medical management;
  2. Surgical treatment;
  3. Interventional radiology treatment.

 

1. Medical Management to Treat Adenomyosis Symptoms

Always remember that medical treatment can provide symptom relief and does not cure the underlying problem meaning that when it’s stopped, the symptoms reoccur. Women who opt for medical management are usually those who have mild symptoms or are in the process of choosing the 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 with adenomyosis can undergo surgery. Unfortunately, there’s no way to cut out adenomyosis. It’s a very diffuse process, and there are no discrete boundaries. Surgeons can’t cut out an adenomyotic part of the uterus as they can do with a fibroid (myomectomy). Therefore, the only surgical option available for women is a hysterectomy (removal of the uterus).

Despite the fact that hysterectomy eliminates any potential health issues in the uterus, it provokes other significant physical, mental, and spiritual problems in women. Therefore, hysterectomy should be avoided as much as possible. Fortunately, it is unnecessary in the case of adenomyosis as there is a nonsurgical treatment to address this condition.

3. Interventional Radiology Treatment

Interventional radiology is a medical specialty that uses minimally invasive techniques under imaging guidance (often x-ray) to treat a number of medical conditions all over the body without any surgery. Uterine Artery Embolization (or UAE) is a non-surgical treatment alternative to hysterectomy. The procedure is performed similarly to Uterine Fibroid Embolization (UFE), although there are some minor technical differences between the two. For example, the embolic particle size used for adenomyosis is smaller than that used for uterine fibroids.

Effectiveness of Uterine Artery Embolization for Adenomyosis Treatment

UAE has several advantages over medical management and major surgery for adenomyosis (hysterectomy) including eliminating the negative side effects of hormonal therapy and the physical and psychologic trauma of hysterectomy. The procedure treats adenomyosis quickly and nearly painlessly, and it’s effective in roughly 80% of cases. It spares women from complications and long recovery of surgery. Recovery after UAE usually takes between 5-7 days, much faster than after a hysterectomy. Also, at the Atlanta Fibroid Center, UAE is done in our state-of-the-art, covid-19 free Center, rather than the covid-19 positive environment of the hospital.

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 ATLii.com.