Even with improvements in the medical diagnostic technologies with their high resolution, adenomyosis remains a highly under-recognized and under-researched gynecological disease which affects about 20% to 88% of women of reproductive age. Therefore, it is important to shed light on this condition that many of us live with even without having any diagnosis. It can significantly affect the work and quality of life of those suffering, to the extent where it causes extreme tiredness and also affects daily performance. However, this condition resolves by itself as women reach menopause.
A Brief Overview of Adenomyosis
Adenomyosis is a benign uterine condition characterized by an enlarged uterus. It is a condition in which the endometrium, which is the inner lining of the uterus, grows into the outer muscular wall of the uterus (myometrium). The development of this extra tissue thus causes the uterus to grow in size, leading to abnormal uterine bleeding. Where, adenomyoma of endometrium is a type of adenomyosis are focal benign lesions or growths that blend with the myometrium and is rather difficult to distinguish from fibroid growth.
Adenomyosis and endometriosis are both uterine diseases that affect endometrial tissues that can be confused with one another or coexist in females that have been diagnosed with endometriosis. In both conditions the symptoms overlap considerably however, they are not the same. In endometriosis, the inner lining of the womb (endometrium) grows outside of the uterus and can breach the organs nearby, making it hard to conceive. Whereas in adenomyosis, the endometrium grows inside the uterine muscular wall. Thus, they affect different body parts while sharing a number of symptoms making it unavoidable to confuse them with one another.
What Causes Adenomyosis
Although the etiology and pathogenesis of adenomyosis are largely unknown till date, researchers have pinned down a few theories. It’s been observed commonly in women over 40 years of age, who have had children or undergone any fibroid surgery, are more likely to be suffering from this disease.
- Invasion of endometrial cells into the uterine walls. This could be either due to an incision made during uterine surgery or during normal conditions as well.
- Inflammation associated with childbirth.
- Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
- Metaplasia (differentiation of one type adult cell into another type) of stem cells in the uterus.
Adenomyosis Associated Symptoms
Adenomyosis symptoms vary from women to women. While some might not feel any symptoms at all, other may have it hard for them to endure. Several main symptoms associated with adenomyosis that include:
- Heavy menstrual bleeding
- Bloating
- Menstrual cramps
- Pelvic pain
- Dyspareunia (painful sexual intercourse)
- Anemia or iron deficiency due to heavy bleeding
Adenomyosis and Cancer
Although adenomyosis is generally considered a benign condition, studies have suggested increased potential of developing uterine cancer such as endometrial and ovarian cancer in such patients due to the risk of malignant development of endometrium. Generally, the symptoms associated with uterine cancer include weight loss, painful intercourse, unusual vaginal discharge, pain in the pelvic region and painful urination.
Adenomyosis Treatment Options
Before treatment, definitive adenomyosis diagnosis is necessary for which your healthcare professional will want to perform a diagnostic evaluation which will include a physical exam and diagnostic imaging test such as an ultrasound or MRI scan to determine uterus enlargement, tenderness to palpation and location of invasive growths respectively.
Your treatment plan will in part depends on your symptoms, disease severity and personal preferences. The available adenomyosis treatment options are discussed briefly, herein:
- Medications: You might be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve adenomyosis associated pain. Which are prescribed to be taken one to two days before the beginning of menstrual bleeding and is continued through the first few of the cycle.
- Hormone Therapy: Hormonal therapies are suggested to control symptoms such as heavy or pain during by prescribing medicines like levonorgestrel-releasing intrauterine device (a contraceptive method), aromatase inhibitors, Gonadotropin-releasing hormone analogs and estrogen-progesterone treatment.
- Endometrial Ablation: In this minimally invasive procedure, lining of the uterus is destroyed. Even though, the procedure does not involve surgery, the process will result in infertility, which is what most women of childbearing age would not prefer.
- Uterine Artery Embolization: UAE, today, is the most minimally invasive adenomyosis treatment available, which helps in shrinking down fibroids, adenomyosis or muscular growths. It uses nanoparticles which block the blood flow to the adenomyosis affected area guided through a tiny tube inserted into the femoral artery. This will eventually cut off the blood supply and hence the adenomyosis will shrink as a result.
- Hysterectomy: If you have surpassed child-bearing age or are ready to undergo surgery that removes the whole uterus to relieve the symptoms once and for all then this adenomyosis treatment is also an available option for you.
Uterine Artery Embolization, also known as Uterine Artery Embolization, is now available in Pakistan for the first time since 2017, as a 3-D precision guided endovascular treatment in two of its major cities; Karachi and Lahore. The embolization procedure is carried out using an FDA approved drug and performed by Dr. Imtiaz Ahmad, who is a renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up up to 6 months. There are numerous success stories of patients who underwent UAE procedures performed by Dr. Imtiaz Ahmad, which is what speaks for his expertise in this area. The procedure relieves you of your symptoms without compromising your fertility.
