Adenomyosis is the condition where the tissue similar to the Endometruim ( Innermost layer of the uterus ) grows and proliferates within the Myometrium ( second layer of the Uterus)
As a result, thickening of the uterus occurs.
There is no any classical symptom caused because of Adenomyosis, hence many women keep on suffering in silence considering Menstrual pain is a part of normal menstrual cycle.
Typically Found among the women between 30 to 50 years but also affects younger women. Most of the time, Adenomyosis seen together with Endometriosis.
The causes of Adenomyosis are unclear.
Adenomyosis can be identified alongside or coexist with other gynaecological conditions, including Endometriosis and Fibroids.
Approximately 35%–55% of patients with Adenomyosis also have Fibroids and 16%– 62% of women having surgery for Fibroids are reported to have Adenomyosis.
It is likely that factors associated with Endometriosis development may also apply to Adenomyosis including-
Genetic Factors .
Estrogen Dependence.
Metaplasia of Mullerians remnants
While it is often cited that approximately one-third of patients with Adenomyosis have no associated symptoms, this figure is uncertain.
Symptoms may include :
1. High Index Of Suspicion : Every woman with excessive, gradually increasing menstrual pain / cramp , chronic pelvic pain needs to be evaluated from a gynaecologist.
2. History And Clinical Examination : Detailed history taking and clinical examination can help in provisional diagnosis of Adenomyosis, which can be confirmed by –
3. Ultrasonography: Helps to confirm the diagnosis and also to differentiate between Focal or Diffuse adenomyosis.
4. MRI: The Help of MRI may be taken for mapping of Adenomyosis and planning the surgical steps.
MRI can differentiate adenomyosis from Fibroids with greater certainty.
MRI has a sensitivity of 77 % with specificity of 89%, making it a better confirmatory diagnostic test than transvaginal sonography (TVS).
5.Diagnostic Laparoscopy :
Although Laparoscopy is a gold standard technique for the diagnosis of Adenomyosis but it is not recommended only for diagnostic purposes.
Laparoscopy helps in dthe iagnosis of Adenomyosis as well as inspect pelvis and abdomen for other associated conditions like Endometriosis.
1. Anemia : Low levels of hemoglobin can be the result of neglected heavy bleeding.
2. Infertility and Sub fertility :
Impaired sperm transfer due to altered Uterine peristalsis activity.
Impaired Endometrial receptivity due to abnormal vascular proliferation.
Changes in Endometrium as well as Myometrium.
3. Severe Adenomyosis can affect physical, mental, social, sexual, economical and psychological well being of a woman and results into poor quality of life
Adenomyosis is a PROGRESSIVE disease.
Hence, earlier diagnosis of Adenomyosis is necessary to halt the progression of disease and prevent complications and provide good quality of life to the lady suffering from Adenomyosis.
Treatment of Adenomyosis depends on age, severity of disease and planning for the pregnancy. So, every patient needs an individual plan of management .
1. Counseling: Counselling and understanding of disease is very essential not only for patients but also the family members as,support of family members is very crucial because the sufferings of women due to Adenomyosis is difficult to understand.
2. Diet : Avoiding fast food, restricting estrogen containing foods, vegetables, legumes, fibrous fruits, whole grains, leafy dark green broccoli, beans, fortified grains, nuts, seeds are recommended .
Essential fatty acid fruits salmon, trout, walnuts, chia seeds, flak seeds are useful.
Antioxidant-rich fruits and vegetables – oranges, berries, spinach, beetroot .
Foods needs to be avoided :
Estrogen influencing foods – cheese, oil, fatty foods should be avoided.
Inflammatory foods should never be consumed like alcohol, caffeine, GLUTINE,red meat, saturated and trans fat .
3. Exercise :
1.Kegel’s exercise : For strengenthing pelvic floor muscles and strengenthing of core muscles and regular exercise like walking, running, swimming .
2. Yoga and Medication : Yoga and meditation can improve blood flow and promote overall well being. Regular physical exercise can reduce inflammation . Endorphin release after exercise results in mood elevation.
4.Weight Reduction : Normal BMI helps in regulating blood estrogen level.
5. Early Pregnancy: Early pregnancy is suggested as soon as diagnosis of Adenomyosis iis made and the couple is desirous for planning the pregnancy . because during pregnancy and breastfeeding there will be no menstruation and the level of estrogen in the blood will be very much low and progesterone levels are on the higher side. Hence, it helps in curing the disease in quite a good number of patients.
Adenomyomectomy.
Hysterectomy.
Radio Frequency Ablation.
Uterine Artery Embolisation
Adenomyomectomy is a surgical option for Adenomyomas and is performed in the same manner as a myomectomy.
After the location of the Adenomyoma has been identified as well as possible using imaging techniques, the Adenomyoma can be removed via laparoscopy or robotic assisted surgery.
For larger, more severe cases of Adenomyoma and Adenomyosis, wedge resection of the uterus can be performed.
Multiple different techniques exist for uterine reconstruction after resection of diffuse Adenomyosis or Adenomyoma.
Hysterectomy is currently considered the only definitive management for Adenomyosis and is still the recommended method if desired future fertility is not a factor.
Radiofrequency Ablation ( RFA ) :
Laparoscopic guided RFA is a emerging minimal invasive technique
for focal Adenomyoma where the heat used to destroy the targeted tissue.
Uterine artery embolization (UAE) has long been used as conservative treatment for women with symptomatic uterine Fibroids.
More recently, it has been considered as a treatment for symptomatic Adenomyosis for women who are not candidates for surgical management.
After UAE, patients with Adenomyosis have reported significant improvement in the symptoms like heavy menstrual bleeding, painful periods, chronic pelvic pain etc. However, the overall efficacy of UAE for Adenomyosis remains unknown.
Consultant Gynecologist with specialisation in laparoscopic and robotic-assisted surgeries.
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