Adenomyosis: Causes, Symptoms, Diagnosis & Treatment Options

What is Adenomyosis?

Adenomyosis is a condition where the endometrium blood lining that typically grows on the uterine wall, starts to grow inside its own muscles.

With no space to flow out, the blood deposit continues to collect in the uterine wall, hence, enlarging the uterus more than its normal size. It thus causes unbearable and sharp, knife-like pain during menses and chronic pelvic pain that increases during sexual penetration. It is also known to make natural conception substantially difficult.

Why Does It Happen?

While adenomyosis is a fairly common disease and both doctors and bioscientists have different theories on why it happens, there is yet not a commonly agreed theory on its exact cause.

Hence, the exact cause for adenomyosis remains uncertain in medical sciences.

Adenomyosis - Risk Factors and Symptoms

Adenomyosis – Risk Factors

• Genetic pre-disposal
• Reproductive age
• At least 1 pregnancy

Adenomyosis – Symptoms

• Heavy menstrual bleeding (menorrhagia)
• Sharp and knife-like painful cramping (dysmenorrhagia)
• Chronic pelvic pain
• Pain during sex
• Difficulty in conception (female factor infertility)
• Enlarged uterus on the ultrasound report

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Diagnosis - Adenomyosis Treatment

Diagnosis Tests

Ultrasound (An imaging test that uses high-frequency sound waves to produce images of the internal body organs.)

Procedure: Ultrasound is a simple, 7-10 minutes procedure. A trained technician or doctor applies some water-soluble gel at the lower abdomen and presses a small handheld device against the area. The sound waves sent through the device help print the image almost immediately. You can get up and change thereafter.

(The test does not require fasting. You can eat and drink however you like.)

Confirmation: An enlarged uterus on the ultrasound report is suggestive of adenomyosis.

Self Diagnosis

Self-diagnosis is next to impossible in the case of adenomyosis. The only symptoms include abnormal cramping, excessive menstrual bleeding, abdominal pain, pain during sex, or difficulty in conception. However, these are common for multiple other reproductive diseases or conditions. Therefore, a doctor must be consulted at the earliest.

Diagnosis by Doctor

The doctor diagnoses the condition through your explained symptoms, a brief pelvic exam, and after reading the ultrasound report. Based on same, your age, and desire for further childbirth, the best treatment method is suggested.

Adenomyosis Treatment Options

Non-Surgical

Unfortunately, adenomyosis cannot be treated. It’s only the pain that can be relieved through pain killers, or the rate of growth that can be managed through hormonal medicines, devices, or therapies.

Typically, doctor consultation and medications for adenomyosis cost an average of INR 2000- INR 3000 in India.

Surgical Treatment

The only surgical treatment for adenomyosis is hysterectomy, that is, uterus removal. However, it permanently ends the woman’s capability to give childbirth.

Therefore, it is only performed at later ages when the family is complete and there is no desire for further childbirth or the condition severs and the pain becomes extremely unbearable. It can be performed through either of the two methods-

Open-cut Hysterectomy: This is a conventional method of uterus removal, done through an open-cut incision and stitches. Typically, it costs an average of Rs. 55,000 to 65,000 in India.
Laparoscopic Hysterectomy: This is an advanced and minimally invasive method of uterus removal. The surgery is commonly called keyhole surgery and costs an average of Rs. 75,000 to 1,00,000 in India.

Before and After Adenomyosis Treatment

Surgery Preparation

Following are a list of ways through which you can prepare well for hysterectomy surgery:

• Confirm all your current medications, supplements, and herbal potions to your doctor. Certain medicines, such as ibuprofen, insulin, or blood thinners may be required to halt for a few days. This is because they can hamper the surgery and risk excessive bleeding during the procedure.
• No surgery can be performed with imbalanced BP or sugar levels. This is why they must first be brought under control to proceed with the surgical treatment.
• Do not eat or drink anything at least 4-6 hours before the surgery. Else, it may cause anesthesia-related complications.
• Limit smoking/ drinking and use of recreational drugs at least two weeks before the surgery.
• Do not shave the surgical site yourself. A simple cut may infect the site and cause complications.
• Carry a pair of loose cotton clothing to change into after your surgery.
• Carry a pack of soft sanitary pads to use for post-surgical bleeding.

What to Expect During Surgery?

• Hysterectomy surgery is always performed under the influence of general anesthesia. Hence, it is completely painless.
• The surgery may take anywhere between 60-90 minutes.

Before and After Adenomyosis Treatment

Adenomyosis Treatment - Risks & Complications

During The Surgery

The only surgical solution for adenomyosis is hysterectomy, that is, the removal of the uterus. While hysterectomy is infamous for its complications, it is a fairly safe, common, and standardized surgery with only mild-moderate chances of risks or complications. These too, are lessened drastically with the new age laparoscopic method.

However, some of the rare complications of hysterectomy include-

• General anesthetic complications
• Excessive bleeding
• Blood clotting
• Damage to the surrounding organs, such as the bladder, ovaries, ureter, or rectum.

If Left Un-treated

Adenomyosis is an extremely painful condition that in most cases warrants immediate treatment. However, if left untreated, it continues to grow severe and advance to stages II and III, leading to even more pain and discomfort.

Myths and Facts About Adenomyosis

• Adenomyosis is the same as endometriosis: No. While both adenomyosis and endometriosis are diseases of the uterus and cause similar symptoms and complications, the condition itself, its diagnosis, and treatments are different for both.In adenomyosis, the endometrial blood lining grows and deposits in the uterus’s muscle wall, whereas in endometriosis, the blood lining sheds, and deposits outside the uterus.Therefore, while adenomyosis leads to an enlarged uterus identifiable on an ultrasound report, the endometrial blood deposits outside teh uterus in endometriosis are extremely minuscule and diagnosable only through laparoscopy.
• Period pain is the same for all women: False. The pain and cramping felt during menses differ between every two women, and there is no standardized quantification of pain. This is especially true for women with adenomyosis or endometriosis. The pain can become strikingly high with a knife-like sensation, nausea, and fever. Delay in treatment can severe the condition, leading to a similar pain being felt even in-between the periods.
• Pregnancy cures adenomyosis.: No. Pregnancy only temporarily pauses the symptoms of adenomyosis. This is because, with no periods, the menstrual pain and cramping pauses too.
• Adenomyosis does not cause any symptoms: False. Adenomyosis thus causes symptoms. Its most common symptom is- extreme pain during menses. However, since women have different thresh holds at tolerating pain, the symptom may not seem alarming.
• Women with adenomyosis cannot become pregnant: False. Adenomyosis affects fertility only in severe, grade III cases. Otherwise, healthy and natural pregnancy is extremely common in patients with adenomyosis.

Insurance Coverage and Recovery

Insurance Coverage

Yes, insurance covers the surgical treatment cost for hysterectomy done because of adenomyosis as it falls under the ‘medically necessary’ list of treatments. However, the cost capping may vary from case to case. Please confirm the same from your healthcare or insurance provider.

Recovery Rate

For laparoscopic hysterectomy, the recovery period runs between 7-10 days. Whereas open-cut hysterectomy surgery requires a rest period of a minimum of 5-6 weeks.