Uterine adenomyosis is a medical condition that often goes undiagnosed due to its overlap of symptoms and similarities to other reproductive health issues. Lack of MRI facilities is one of the factors in under diagnosis of this crippling disease. This condition occurs when the tissue lining the uterus, called the endometrium, grows into the muscular walls of the uterus. While adenomyosis is not life-threatening, it can cause significant pain and discomfort with major impact on person’s quality of life.
Adenomyosis Causes:
The exact cause of adenomyosis of the uterus remains unclear. There are several theories about the etiology of this condition. The most commonly accepted one says that when the boundary between endometrium (the innermost layer of uterus) and myometrium (the middle layer of uterus) is disrupted a series of inappropriate cell proliferation happens. The endometrial cells start growing into the myometrium resulting in adenomyosis. Here are some risk factors for uterine adenomyosis that may disrupt the boundary between two layers.
Hormonal Influences:
Changes in hormonal levels, particularly an excess of estrogen relative to progesterone, are believed to play a role in the development of this disease. Estrogen promotes the growth of the endometrial tissue.
Inflammation:
Inflammation within the uterus may lead to the development of adenomyosis. This inflammation can cause a breakdown in the normal boundaries between the layers of the uterine wall.
Childbirth:
Women who have undergone multiple pregnancies and childbirths may have an increased risk of developing this condition. The stretching and contractions of the uterus during childbirth could contribute to the displacement of endometrial tissue.
Invasive Procedures:
Uterine surgeries, such as cesarean sections or fibroid removal, may increase the risk of adenomyosis. These procedures can disrupt the normal structure of the uterine walls.
Symptoms of Adenomyosis:
Adenomyosis often presents with symptoms that overlap with those of other reproductive health issues, making it challenging to diagnose. Common symptoms include:
Menstrual Pain:
Increased and prolonged menstrual cramps, often beginning before the period and lasting throughout its duration, are hallmark symptoms of adenomyosis.
Heavy Menstrual Bleeding:
Women with adenomyosis may experience heavier than usual menstrual bleeding, leading to anemia in some cases.
Pelvic Pain and Discomfort:
Persistent pelvic pain or a feeling of fullness in the lower abdomen may occur, especially during menstruation.
Painful Intercourse:
Adenomyosis can contribute to pain or discomfort during sexual intercourse.
Menstrual Irregularities:
Changes in menstrual patterns, such as irregular periods or spotting between periods, may be indicative of adenomyosis.
Diagnosis and Treatment:
Diagnosing adenomyosis can be challenging due to its nonspecific symptoms. However, healthcare providers may use a combination of medical history, physical examinations, imaging studies such as ultrasound (both abdominal and transvaginal) or MRI, and, in some cases, exploratory surgery to confirm the diagnosis.
The difference between a normal uterus vs adenomyosis ultrasound is the uterus appears globally enlarged and bulky. The walls are thicker and more heterogeneous in contrast to normal homogenous appearance. if the lesion is focal, there may be localized thickening. Sometimes the advanced disease can distort the shape of the uterus.
How is uterine adenomyosis treated?
Treatment options vary based on the severity of symptoms and the individual’s reproductive goals. Common approaches include:
Pain Management:
Over-the-counter pain relievers or prescription medications may help manage pain associated with adenomyosis.
Hormonal Therapy:
Hormonal treatments, such as birth control pills or intrauterine devices containing hormones, may help regulate menstrual cycles and alleviate symptoms.
Surgery:
Sometimes when the medical treatment fails and the family is completed doctors may recommend surgery. This surgery requires removal of the uterus.
Dr Imtiaz Ahmed believes that the uterus is as necessary as any other organ of the body and should never be removed like an appendix, regardless of the family status. He introduced a minimally invasive nonsurgical procedure for treating adenomyosis in Pakistan. This procedure is called 3-D Precison Guided Uterine Artery Embolization (UAE).
UAE as the name indicates is an embolization of the vessel. The basic principle of this procedure is to cut off the blood supply to the lesion by embolizing. Once the disease is no longer receiving the blood, it dies. The procedure starts with a thorough evaluation of the lesion. Firstly, the patient is comforted by giving some sort of conscious sedation. Then a catheter is inserted through a small skin hole, usually in the groin, no skin incisions are given, small catheter is guided through the blood vessels to the uterine arteries. The embolizing material is then injected through the catheter into the uterine arteries. It blocks the blood flow to the areas affected by adenomyosis.
The progress of the procedure is monitored using 3-D imaging techniques including digital fluoroscopy, to ensure accurate delivery of embolic particles. After the embolization is completed, the catheter is removed, and hemostasis is achieved by applying gentle manual pressure or by applying a closure device. Patients are typically monitored overnight or for a few hours before being allowed to go home.
This procedure has several benefits when compared with the conventional hysterectomy. The symptoms alleviate quickly, no additional pain and trauma of the major surgery, conservation of the uterus and quick recovery time are some of the advantages of the UAE.
For more information about the non-invasive treatment of adenomyosis email us at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.
