If you’re not familiar with the term “adenomyosis” and are still confused about it, then you’re at the right place. This article will take you through the important information that you must know about adenomyosis. The more you know about the human body and the diseases, the greater would be the chance for you to make a timely and educated decision. A similar is true for Adenomyosis. Women must understand the gravity of the situation of the disease. According to statistics, 20% to 88% of women of reproductive age suffer at the hands of adenomyosis. The greatest paradox is in how little attention is paid to it. Being common in women of all age groups, adenomyosis still remains an under-researched disease condition that poses an array of major impacts on your day-to-day life. Eventually, this goes on to affect your overall productivity, mental health, and life choices. But need not worry, there are non-surgical adenomyosis treatment plans that can be opted.
In gynecology and healthcare economics, adenomyosis is a great clinical challenge. It is defined as a benign uterine disorder in which the endometrial glands and stroma grow abnormally within the myometrium. Adenomyosis is usually misunderstood with uterine fibroids or leiomyomas however, they both differ in their pathophysiology. Contrary to leiomyomas that have characteristic defined boundaries, a concerning issue with adenomyosis is that once it develops, it keeps on growing like a chafing fungal growth with no defined boundaries.
Coming towards the root cause of adenomyosis, it is believed to be originated due to either, the invasion of endometrial cells into the uterine walls, inflammation associated with childbirth, or metaplasia (differentiation of one type of adult cell into another type) of uterine stem cells. Symptoms of adenomyosis vary greatly amongst its victims. Where some might not show any symptoms while for others it is hard to endure them to a point where it impedes their daily activities. These symptoms include extreme menstrual bleeding, bloating, unrelenting abdominal cramps, and pelvic pain. If you or anyone you know has these symptoms, it is the right time to schedule a visit to the doctor.
Adenomyosis Treatment Options
A definitive adenomyosis diagnosis is necessary before your doctor prescribes a medication regime or procedure. For its diagnostic evaluation, a physical exam or an ultrasound is not enough. A magnetic resonance imaging (MRI) scan with contrast is necessary for its definitive diagnosis.
In part, your treatment plan will depend on the spectrum of your symptoms and the severity of the disease. The treatment options for adenomyosis span from prescribing specific adenomyosis medications, and undergoing hormonal therapies and invasive procedures such as endometrial ablation to surgical removal of the uterus (hysterectomy) in the worst-case scenario. No matter what the condition, considering a hysterectomy is not something to be taken lightly. This is especially true if you’re young, and plan on having children. Before you go down this road, you should be well versed in all the consequences that it might bring with it. Understand that it’s not the ultimate solution and once done, you will no longer be fertile and able to conceive children. In order to avoid such a situation, you must first consider the best treatment plan for your adenomyosis. The good news is, that there is a non-surgical procedure to cure adenomyosis through a procedure known as 3-D precision guided uterine artery embolization (UAE). UAE has been around since 1995 as a preferable treatment option for a number of diseases. With research and knowledge, it is now possible to use it to treat adenomyosis, too.
Cure Adenomyosis Without Surgery
Uterine artery embolization is an outpatient and minimally invasive 3-D precision-guided endovascular treatment procedure. The treatment can only be performed by an expert in the field of interventional radiology. Dr. Imtiaz Ahmad is amongst the pioneers in Pakistan to have brought 3-D precision guided UAE to the people here. The procedure employs radiology in the form of real-time fluoroscopy to guide the specialist to the exact location and ensure precision. With the aid of an anesthetic spray and local anesthesia, the patient’s groin area is numbed. The femoral artery is then accessed from this area through a tube. Further, the FDA-approved micron size particles that block the blood flow to the affected area is administered through the guided tube inserted into the femoral artery. This will eventually cut off the blood supply and hence the adenomyosis outgrowths will shrink due to ischemic infarction.
The preference of the 3-D precision guided UAE over any other method for treating adenomyosis comes greatly from the level of patient compliance achieved. Being noninvasive in nature, patients need not worry about post-procedural complications. Other than minimal pain associated with the procedure which too subsides after a short while, there is no other reason for the patient to feel discomfort. The symptoms of adenomyosis will also qualify, further reducing the pain that the patient had pre-surgery.
3-D precision guided UAE is available in Pakistan in two of its major cities; Karachi and Lahore. The embolization procedure is carried out using an FDA-approved medical devices by Dr. Imtiaz Ahmad and his team of specialists. 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 that underwent 3-D precision guided UAE performed by Dr. Imtiaz Ahmed and his team that speak for their expertise in this regard. After undergoing the procedure, the patients have been observed to go back to their daily normal lives without any obstructions.
Uterine artery embolization (UAE) is a great alternative to conservative surgical procedures like hysterectomy with its highly promising results, low recurrence, and considerably shorter hospitalization period.
Uterine artery embolization is a minimally invasive procedure that is performed to stop pelvic bleeding that might be caused by either uterine adenomyosis, uterine fibroids, cancerous tumors, trauma or injuries amongst other conditions. Among these, adenomyosis is a common pathophysiological condition in women of reproductive age that leads to distressing conditions which affect our daily performance and interactions. Although a major chunk of our population of approximately 20% to 80% are affected by this gynecological problem, adenomyosis still remains highly under-recognized and under-researched disease. Therefore, it is important to spread awareness regarding this condition and its treatment plans to help those that are suffering in silence.
Uterine Adenomyosis – Overview
Adenomyosis is an often-misunderstood benign gynecological condition in which the lining of the womb or uterus that should be on the inside invades and get embedded into the muscular wall of the uterus and is primarily seen in women of ages between 30 and 50 years.
Uterine Adenomyosis Symptoms
As all of us act differently in similar situations, women affected by adenomyosis may be completely asymptomatic, which allows the disease to go unnoticed until the case becomes severe. However, on the contrary, a bunch amongst us experience symptoms that vary in severity, making it hard for them to go on about their daily business without any discomfort and difficulty. Since the symptoms of adenomyosis overlap considerably with those of uterine fibroids, people tend to confuse one with each other. Adenomyosis symptoms that are most frequently noticed in the affected women include intense fatigue, menorrhagia (heavy menstrual bleeding), dysmenorrhea, pelvic pain, and irritation in the bladder due to inflammation caused by the shedding of the invasive adenomyosis tissues in the uterus. Other symptoms may include abdominal bloating due to uterus enlargement, dyspareunia (painful intercourse), anemia and iron deficiency due to heavy monthly bleeding, irregular menstruation cycle while some also experience fertility issues.
Uterine Adenomyosis Causes
Being as under-researched as it is contrary to the affected population, the definitive root cause and pathogenesis of adenomyosis is yet to be discovered. Regardless, researchers have pinned down quite a few theories that could be the culprit behind its origin.
Age: Since this condition has been observed commonly in women over 40 years of age, it has might be linked with the aging process.
Surgical Procedures: It’s been seen that women who have had children especially through caesarean delivery or have previously undergone any uterine fibroid surgery or any intrauterine procedure are more at risk of developing uterine adenomyosis.
Invasionof Uterine Cells: Adenomyosis could develop due to the invasion of endometrial cell into the uterine muscular walls due to either an incision made during uterine surgery or during normal physiological conditions.
Inflammation: Inflammation associated with tears and incisions made during normal childbirth.
Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
Metaplasia of stem cells in the uterus, which is the differentiation of one type of adult cell into another type.
Adenomyosis Treatment
Earlier to deciding the treatment regime, it is necessary that definitive diagnosis of adenomyosis is performed. This may include physical examination to check for any uterine enlargement and tenderness, along with different imaging techniques like ultrasound and MRI. There are two options for its treatment, medically and procedurally depending on different factors such as your symptoms, severity of the disease and personal preferences. Below are a few treatment plans described that are used frequently to treat adenomyosis symptoms.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to relieve adenomyosis associated pain.
Hormonal Therapy: Hormonal therapies have been 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-progestin therapy.
Endometrial Ablation: This is a minimally invasive procedure in which the lining of the uterus is destroyed.
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 hysterectomy is another option.
Uterine Artery Embolization: Also known as uterine fibroid embolization (UFE), is an innovative outpatient procedure that has been established in 1995 as a beneficial treatment option for symptomatic uterine fibroids. Since then, the procedure has been established and is also used for the treatment of adenomyosis through adenomyosis embolization, which has shown favorable outcome.
It is a highly effective and essentially pain-free procedure performed by an interventional radiologist. Local anesthesia at the groin is applied, which may not even sting as prior to giving local anesthesia anesthetic spray is used over the access site.Specialized micron size particles are injected through a tiny tube inserted into the uterine artery that block the blood flow to the adenomyosis affected area. The procedure is guided through real-time fluoroscopy to direct the tube. The micron size particles then aid in shrinking down the invasive muscular growth that is the characteristic of adenomyosis by cutting off the blood supply to the affected area. Soon after embolization, pain (menstrual pain) may be experienced, however it will subside. You could feel the symptoms alleviate after the procedure. Being minimally invasive in nature, risks associated with surgical procedures such as wound infections and post-procedure complications are eliminated.
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 devices and medications 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 that underwent UAE procedures performed by Dr Imtiaz Ahmed that speak for his expertise in this area without compromising your fertility.
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.
It is a blessing and a huge honor for Dr Imtiaz Ahmad and his team to offer a “totally” non surgical definitive treatment for Adenomyosis; offered first time in Pakistan since Nov 2017.
A brief outlook on Fibroids and Adenomyosis
Fibroids and adenomyosis often occur together, but are distinct in their characteristics. The fibroid is a benign tumor that can grow in different layers of the uterus while in Adenomyosis, the uterine inner lining itself grows into the myometrium (The outer layer of the uterus which is muscular). Intersecting symptoms of adenomyosis and fibroids include menorrhagia accompanied by pains and cramps, abdominal and lower back pain and abdominal swelling. However, while uterine fibroids are commonly asymptomatic, adenomyosis comprises excruciating and crippling painful cramps and may also accompany more chronic prolonged symptoms such as heavy bleeding and blood clots especially if fibroids coexist with adenomyosis. It is substantial to ensure that the two are not misdiagnosed, since an inaccurate treatment may prove more detrimental for the patient. Ultrasound imaging is sufficient to diagnose fibroids but to rule out adenomyosis, an MRI is advised. Once the specialist is able to differentiate between fibroids and adenomyosis, he has a clear picture regarding the treatment approach to be taken. At present, the most advanced method available under the non-surgical treatment for fibroids and adenomyosis is the 3-dimensional endovascular treatment. 3-D endovascular treatment for fibroids in Pakistan has been introduced by Dr Imtiaz Ahmad, an endovascular Surgical Specialist, and an Interventional Radiologist, who is well experienced in this field and has bagged thousands of success stories so far.
Treatment for Fibroids and Adenomyosis
Surgical interventions for the treatment of fibroids and adenomyosis have, time and again, proven to be invasive and are slowly becoming obsolete for that reason. Hysterectomy (removal of the uterus) or myomectomy (removal of fibroids) are the two most common traditional surgical approaches taken towards fibroids and adenomyomectomy for adenomyosis treatment. Surgical treatments also include endometrial ablation, wherein the inner lining (endometrium) is destroyed using either heat, cold, electricity, or microwaves. Women undergoing surgical procedures to sort their miseries regarding fibroids and adenomyosis must also give up on the idea of conceiving in most cases or be mentally prepared for recurrence. On the contrary, an innovative approach under the umbrella of endovascular procedures has recently gained accolades as being a noninvasive treatment, ensuring that the uterine wall is not damaged, while still being able to get rid of fibroids and adenomyosis completely. More specifically, the best treatment for fibroids and adenomyosis available is known as Uterine Artery embolization, which is a 3-D endovascular treatment that aims at selectively targeting fibroids and adenomyosis.
3-D Precision Guided Endovascular Treatment
Endovascular treatment using 3-dimensional imaging to locate the arteries supplying blood precisely to fibroids or adenomyosis ensures an accurate treatment. The entire procedure does not only comprise the 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. Before the endovascular treatment is performed, a complete health analysis is done to assess the medical fitness status of the patient. Once the procedure is finished, you should also expect a thorough follow-up for up to 1 year, depending on the case. In cases where the goal is to achieve pregnancy, fertility status is also kept in check. In short, the treatment in itself is incomplete if the follow-up is not diligently done and as advised.
The 3-D precision-guided endovascular treatment uses live imaging to accurately locate the blood vessels supplying blood to the fibroids or adenomyosis. The imaging also helps assess the number of arteries involved and their sizes. The goal is to block the blood supply to these growths 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 anaesthesia followed by local anaesthesia. 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 fibroids or adenomyosis while sparing the normal uterine wall. Medical particles/Drugs used in the endovascular treatment are highly specific and are only issued to registered practitioners in America. In this way, embolization is successfully achieved.
The uterine artery embolization constitutes a major portion of the 3-D guided endovascular and may constitute approximately 60-70% of the entire treatment, through this technique management of the post embolization syndrome is also done. Specific medications are administered at the exact location of the fibroid or adenomyosis, using microcatheters, to avoid post embolization syndrome, which may prolong the recovery time if not addressed at the right moment. Moreover, intra-arterial pain management is also attempted, medications at the specific location are administered so that the extent of pain felt by the patient is reduced by many folds. Finally, to further reduce the pain, the nerves to the pelvis are relaxed using a fluoroscopic guided superior hypo gastric nerve block approach. The analgesic effect is maintained for up to 20 hours.
To conclude, this new treatment for fibroids without surgery, also targeting adenomyosis, has become the talk of the town, and it is with great pride that the best treatment for fibroids and adenomyosis was introduced in Pakistan by Dr Imtiaz Ahmad, which is now helping thousands of patients since November, 2017.
