What are the recent advances in treating adenomyosis? (2020)

Doctor's Answers (1)

Adenomyosis is a benign condition of the uterus where the glands of the lining of the uterus (endometrium) are found within the muscle (myometrium) of the uterus. Women with this condition may suffer from heavy menses, severe menstrual cramps or infertility. In some women, if the adenomyosis is mild, there may not be any symptoms hence treatment may not be required.  

Treatment options will depend on the severity of the symptoms, how it affects lifestyle as well as how close to menopause when the problem is diagnosed. The symptoms of adenomyosis would usually go away after menopause.  

Treatment options for adenomyosis include: 

1) Non- Surgical (Most common)

a. Pain relief medication  

The use of anti-inflammatory medication such as NSAIDs to control pain is commonly prescribed. It may also help to reduce bleeding as well. 

b. Hormonal treatment 

Birth control pills (combined estrogen-progestogen pills) can be used to help reduced bleeding and pain.

Progestogen only methods such as oral preparations or the levonorgestrel intrauterine devices are effective and can help with the symptoms by causing amenorrhoea.

Among the oral progestogens, Dienogest has been shown to significantly reduce pain in women with adenomyosis in a randomised double blind, placebo controlled trial.

The use of gonadotropin-releasing hormone analogues (GnRHa) have also been used to manage the pain and bleeding caused by adenomyosis and is also before fertility treatment to improve chances of pregnancy in infertile women with adenomyosis.   

2) Surgery

a. Definitive treatment is a Hysterectomy.

However, removing the uterus is the last resort if the symptoms are very severe and no other treatments work. Removal of the ovaries might not be necessary.  

b. Resection of the Adenomyoma or Wedge resection of the Adenomyosis.

This refers to the partial removal of the adenomyosis and is performed to conserve the uterus for those who still desire fertility.  

3) Others 

a. Ablation of the lining of the uterus (endometrial ablation) if the main problem is heavy menses 

b. Uterine artery embolisation

c. MR-guided focused ultrasound treatment 

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