Have you ever experienced debilitating menstrual pain that seems to take over your life? Or perhaps you find yourself struggling with heavy and prolonged periods, affecting your daily activities and overall well-being. If these symptoms resonate with you, you may have encountered a condition called adenomyosis.
Dr Asha Dalal, Director, Obstetrics and Gynaecology, explained adenomyosis, its symptoms, management and treatment measures.
What Is Adenomyosis?
Adenomyosis manifests when the tissue lining the uterus, known as the endometrium, infiltrates the muscular walls of the uterus itself. This invasion can lead to a range of distressing symptoms that can leave women feeling bewildered. Dr Dalal added that adenomyosis causes the uterus to enlarge in size and may lead to heavy bleeding and severe pain during periods. The pain may start premenstrually and is relieved after two or three days after the start of the period. Dr Dalal said that sometimes the patients come with a complaint of pain in the lower abdomen, which also may be more around the time of the periods.
Symptoms Of Adenomyosis
- You may experience painful periods (dysmenorrhea) and heavy menstrual bleeding (menorrhagia).
- You may experience painful intercourse (dyspareunia).
- There may be chronic pelvic pain with or without cramping.
- You may experience bloating and abdominal pressure.
Diagnosis Of Adenomyosis
Dr Dalal explained that the doctor will perform a pelvic examination to check if the uterus is uniformly enlarged. Sometimes a pelvis MRI scan may be required, especially if pelvic endometriosis is also present or you want to differentiate between an adenomyoma and a fibroid.
Management Of Pain
Dr Dalal said that Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can be prescribed to curb pain and reduce inflammation. Apart from this, oral contraceptives, dienogest (steroid hormone), or only progesterone tablets can also help decrease pain. She also added that sometimes GnRH (Gonadotropin-Releasing Hormone) analogous can also be given for a few months.
Management Of Infertility
If you are planning to conceive, it is best to talk to your gynaecologist to check if natural conception is possible or if you need some form of Artificial Reproductive Technology (ART).
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Treatment Of Adenomyosis
IntraUterine Device ( IUD)
This is a small device fitted into the uterus by a doctor which releases progesterone locally to act on the endometrium, commonly called a 'Mirena'. This decreases the bleeding and works for four years after insertion and can be changed after 4-5 years. The advantage of this is that it also acts as a contraceptive.
This is a surgical procedure done with an operative hysteroscope where the endometrium is shaved off till the basal layer. This can make the period less heavy while conserving the uterus.
Uterine Artery Embolisation
It is reserved for very heavy bleeding where the other two methods are not possible or the patient does not want them. This markedly reduces the bleeding during the periods.
If you experience these symptoms you should reach out to your doctor immediately to avoid complications and risk of infertility. Dr Dalal also mentioned that the definitive treatment is a hysterectomy, which should not be done if the patient is planning to conceive or if there is time in menopause.