If you or anyone you know struggles with painful periods and have been diagnosed with adenomyosis, Dr Imtiaz Ahmad performs non-surgical adenomyosis treatment which can solve your miseries.
Adenomyosis: The Biology Behind it
In order to fully understand adenomyosis, it is important to first break down the word itself. Adeno meaning glands, while myosis can be further divided into myo for muscle and osis referring to condition. A more specific term for adenomyosis is also adenomyometritis, but it is not as commonly used. The uterus, which is part of the reproductive system in the females, is normally made of three layers of tissue; endometrium(inner), myometrium (middle muscular layer) and Perimetrium (outer epithelial layer). Each layer serves an important function in maintaining the integrity of the reproductive system. Altogether, adenomyosis is a condition wherein the tissue of the endometrium comprised of luminal and glandular cells rapidly divide (hyperplasia) and extend or invaginate into the myometrial layer.
A key point to remember while discussing adenomyosis is to not confuse it with endometriosis. The two conditions may co-exist amongst others and present similar symptoms, but they are different to one another in terms of their pathophysiology. While endometriosis is the growth of endometrial tissue in places near to but outside of uterus and adenomyosis exists only within the uterine muscular layer. Adenomyosis treatment may be necessary in cases where symptoms start interfering with day-to-day matters. This majorly includes severe pain between periods.
When to see a doctor?
Every 1 in 31 women who have adenomyosis remain largely asymptomatic, and therefore undiagnosed. Those who do experience discomfort are also often misdiagnosed due to non-specificity of symptoms, especially in the case of a co-existing problem like uterine fibroids. Nevertheless, adenomyosis may present itself in the form of painful menstruation (dysmenorrhea) accompanied with prolonged bleeding (menorrhagia) and discomfort during sexual intercourse, too. This is commonly known as dyspareunia. On the imaging, the specialist might be able to see an enlarged uterus, but it will be felt by the patient as pressure around the lower abdominal region.
How will you be Diagnosed?
Diagnosis of Adenomyosis usually follows a trans vaginal ultrasound imagining which may be able to reveal the unusually thick lining of the myometrium. Sometimes, it is difficult to distinguish between adenomyosis and fibroids. In that case, an MRI reveals the incidence of adenomyosis. Most of the time,adenomyosis is confirmed after hysterectomy has been performed. This may be when the specialists are not sure of the condition, but the symptoms are too painful or when they suspect that the tissue may also comprise cancerous cells in which case it would be adenocarcinoma.
Adenomyosis Treatment
Women with severe adenomyosis symptoms are usually looking for a period pain treatment. The definitive treatment of adenomyosis is through hysterectomy, which is the complete removal of the uterus. This may be okay for some women but a very upsetting news for most. Since adenomyosis occurs under the influence of estrogen, it is usually at the peak reproductive age. The condition often resolves itself after menopause due to the same reason. Hence, women who still want to conceive may be appalled by hysterectomy. Moreover, the surgical process of removing the uterus is invasive and is slowly becoming obsolete.
Advancement in interventional radiology has now made it possible to alleviate period pain with a non-surgical and noninvasive approach. Adenomyosis treatment now follows a systematic approach which offers little to no post operative complications or care and maximum patient compliance is guaranteed.
Endovascular Adenomyosis Treatment
Three-dimensional precision guided endovascular treatment is a non-invasive approach to provide adenomyosis treatment and alleviate period pain without putting the fertility at risk. The rationale behind the treatment is to precisely block the arteries supplying blood to adenomyosis which is essentially just endometrial tissue. The entire procedure comprises not only uterine artery embolization but also, a complete set of steps to increase patient compliance and comfort. These include post embolization syndrome management, superior hypogastric nerve plexus block and intra-arterial pain management. As a prerequisite, complete health analysis is done to assess the medical fitness status of the patient before moving on to the treatment. Once the procedure is completed, you should also expect a thorough follow-up for up to one year. In cases where the goal is to restore fertility, a more thorough follow up should be expected.
The procedure employs live imaging to accurately locate the blood vessels supplying blood to adenomyosis. The imaging also helps assess the number of arteries involved and their sizes. This makes the procedure accurate and reduces complications. The blood supply to these growths is blocked using miniature but programmed and specially engineered permanent devices. To begin, mild conscious sedation is achieved. Following, microcatheters are introduced in the patient’s body through the femoral/radial artery in the leg or wrist. This is achieved without causing any pain as a result of topical cold spray anesthesia followed by local anesthesia. Once the blood vessels are located, the FDA approved medical particles are then administered through the catheter. These embolic agents are small micron-sized particles that are engineered/programmed to block the blood supply to only adenomyosis while sparing the normal uterine wall. Medical particles/drugs used in the endovascular treatment are highly specific and are only issued to Licensed/Registered practitioners in United States of America. In this way, embolization is successfully achieved.
Adenomyosis treatment is now available in Pakistan byDr Imtiaz Ahmad, who is an interventional radiology specialist and endovascular surgical specialist. He offers his services in two major cities of Pakistan: Karachi and Lahore. If you or your loved one is suffering from severe period pain and other symptoms that point toward adenomyosis, a consultation by Dr Imtiaz Ahmad or his team of highly qualified consultants available daily is the first step to bring an end to your misery.
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.
