Diagnosing Adenomyosis

Women with suspected adenomyosis should be evaluated by their doctor using their menstrual and symptom history, pelvic examination, and imaging. Laboratory testing may be performed to evaluate for anaemia (from heavy periods). The uterus can feel "boggy" or enlarged on examination. Women can also display abdominal swelling. Imaging can help with identification, definitive diagnosis is made by examination of the uterus after it has been removed.

Transvaginal ultrasound is the first-line imaging choice for evaluation of an enlarged uterus, pelvic pain, and/or abnormal bleeding. The images should be reviewed by a radiologist experienced in evaluating adenomyosis.

Magnetic resonance imaging (MRI) can help distinguish diffuse and focal adenomyosis from fibroids. If the patient is planning conservative surgery for adenomyosis or fibroids, an MRI is often performed to assist in surgical planning.

 

Management of Adenomyosis

The only proven treatment for adenomyosis is surgery to remove the uterus, called a hysterectomy. Hysterectomy is the only way to remove diffuse adenomyosis. Even in women with adenomyomas, hysterectomy is generally preferred to the removal of the adenomyomas with uterine conservation except where future pregnancy is desired.

There are other treatment options that may reduce the heavy bleeding caused by adenomyosis, including:

• IUD – An intrauterine device (IUD) is a small device that fits inside the uterus and is normally used to prevent pregnancy. One type of IUD, which releases the hormone progestin, might help with the symptoms of adenomyosis. (Mirena)
• Endometrial ablation – This is surgery to cause scarring in the lining of the uterus, which makes periods less heavy. It is unlikely to reduce pain symptoms. This is not the same procedure as ablation of endometriosis.
• Uterine artery embolization – This is a treatment that blocks the blood supply to the uterus. For women who have completed childbearing, uterine artery embolization (UAE) may be effective for reducing symptoms related to adenomyosis.
  UAE is also an option for women who decline, or have contraindications to, a hysterectomy or have failed hormonal treatment.
• Uterus sparing surgery. Uterus-sparing resection of adenomyosis is an investigational approach that can be considered in women with extensive adenomyosis who are actively pursuing pregnancy.
  The disadvantage of this approach is that even when performed by expert surgeons, there is a risk of uterine rupture in a future pregnancy.  This is a highly skilled surgery and should only be carried out by someone who has proven experience of this procedure.

Treatments that can ease the pain of adenomyosis include:

• Pain medicines, such as NSAIDs (Ibuprofen, Ponstan, Difene)
• Oral Contraceptive Pills
• GnRHa drugs (brand names: Decapeptyl, Zoladex, Synarel), which cause the ovaries to stop making the hormones estrogen and progesterone. There are side effects similar to menopause with this treatment.

Pregnancy and Adenomyosis

If you want to get pregnant, you should not have a hysterectomy, endometrial ablation, or uterine artery embolization. You will need to work with your doctor to find other treatment options until after you have your children.

Adenomyosis may contribute to infertility and pregnancy complications. Discuss this with your gynaecologist/obstetrician.