Adenomyosis: General Information, Evaluation, and Treatment
Adenomyosis is a condition where the lining of the uterus, known as the “endometrium”, grows into the underlying muscular layer (the “myometrium”), and forms small pockets of endometrial tissue.
![adenomyosis](https://gynqi.com/wp-content/uploads/2022/12/m-34.jpg)
These pockets of adenomyosis are NOT cancer or pre-cancerous, and adenomyosis is a benign condition.
Symptoms of Adenomyosis
Symptoms of adenomyosis can vary from person to person, but some may include:
- Menstrual Symptoms – The most common symptoms of adenomyosis are painful periods (“dysmenorrhea”) and heavy menstrual bleeding. Adenomyosis alone does not typically not cause bleeding between periods (“intermenstrual bleeding”) or postmenopausal bleeding.
- Bulk Symptoms – Adenomyosis can cause the uterus to be enlarged and “bulky”, which may cause symptoms such as bloating.
- Fertility-Related Concerns
Diagnosis of Adenomyosis
Adenomyosis is frequently diagnosed on transvaginal/pelvic ultrasound. An adenomyotic uterus can appear larger than expected and bulky.
Often, adenomyosis can co-exist with other gynaecologic conditions and
may be coincidentally identified on imaging to investigate the presence or absence of another condition such as fibroids or endometriosis.
![adenomyosis](https://gynqi.com/wp-content/uploads/2022/12/m-35.jpg)
Treatment of Adenomyosis
Management of Symptoms
Oral Pain Medications (including Non-steroidal Anti-Inflammatory Medications/NSAIDs)
- First-line therapies can include oral pain medication such as Acetaminophen or an anti-inflammatory for pain. NSAIDs include medications such as Ibuprofen or Naproxen
Tranexamic Acid (Cyclokapron)
- Tranexamic acid (Cyclokapron) can be used on days of heavy bleeding to reduce the amount of blood flow; this is a non-hormonal treatment option.
Estrogen and Progesterone Containing Medications (Combined Hormonal)
- Medications containing both estrogen and progesterone include those such as the Oral Contraceptive Pills (OCPs), vaginal ring, transdermal patches
Progestin Only
- Intrauterine device (e.g. Mirena): significantly reduces menstrual bleeding by acting locally on the uterine cavity lining to keep it thin.
- Subdermal implant (e.g. Nexplanon): prevents pregnancy and reduces amount of
menstrual bleeding. It is implanted under the skin in the inner upper arm. - Dienogest (Visanne): causes amenorrhea (absence of menses) in almost 40% women after 6 months of use. Possible side effects include headaches, depression, irritability, nausea, and breast discomfort.
- Other forms of Progestin: Medroxyprogesterone Acetate (Depo-Provera, Provera), Norethindrone Acetate (NETA)
Gonadotropin-Releasing Hormone (GnRH) Agonists or Antagonists
- These medications cause ovaries to stop producing estrogen and progesterone, causing a reversible, medical menopause. Therefore, patients may require “add-back therapy” in the form of estrogen and progesterone, in order to maintain bone health. These types of medication include Leuprolide Acetate (Lupron) and Elagolix (Orilissa).
Definitive Management
Hysterectomy
- Definitive treatment of adenomyosis is surgical management through a hysterectomy. However, this option is not typically required and is also not appropriate for most patients (e.g. those with future plans for pregnancy).