Adenomyosis Treatment -Procedures, Side effects, Recovery time, Costs and alternatives

Adenomyosis is a medical condition that occurs when the endometrial tissues that line the uterus move into the uterus muscles. This condition makes the walls of the uterine grow thicker. A patient who is suffering from the condition of adenomyosis can complain about longer and heavy bleeding during the menstrual period, excruciating pain during the menstrual cycle, and painful sexual intercourse.

It is very difficult to determine the exact cause for the occurrence of this condition however, it is usually presumed to be associated with high estrogen levels in the patient. It has been observed that the condition of adenomyosis generally vanishes after the menopause as the estrogen levels fall after menopause. Several theories are present which relate the cause of adenomyosis to a person being born with extra tissues in their uterine wall that grow during the adulthood of that person, presence of stem cells in the wall of the uterine muscles, inflammation of the uterine after childbirth, and growth of adenomyoma which force themselves into the muscle of uterine.

A woman is at a greater risk of suffering from adenomyosis if she belongs within the age group of 40 to 50 years old, has given birth to children, and has undergone cesarean surgery in the past for the removal of fibroids. The uterus of a woman would be either two times or three times the size of the normal uterus if she is suffering from adenomyosis. The condition of adenomyosis can be diagnosed through physical examination, MRI and ultrasound. A woman suffering from adenomyosis has an increased risk of suffering from anemia.

There are several treatment options at the disposal of the doctor for treating adenomyosis. A choice for the treatment would be made based on the severity of the adenomyosis condition. A doctor may opt for anti-inflammatory medications, hormonal treatments, endometrial ablation, and hysterectomy.

Among the several treatment options available a doctor may choose a treatment that is best for the patient based on the medical history of the patient and severity of adenomyosis.

• Anti-inflammatory medicines: A doctor may prescribe the use of anti-inflammatory medications for treating the condition of adenomyosis. Anti-inflammatory medicines would assist in restricting the flow of blood during the regular menstrual cycle. These medications would also alleviate pain associated with cramps of the menstrual cycle. A doctor may advise the patient to start this medication nearly two days before the commencement of the menstrual cycle and may recommend continuing taking this medication during the entire menstrual cycle.
• Hormonal Treatment: Some doctors advocate the use of hormonal treatment for adenomyosis. A hormonal treatment would be advocated if the doctor believes that the patient is suffering from adenomyosis due to increased estrogen levels. For hormonal treatment, a doctor may advise oral contraceptives, intrauterine devices like Mirena, and progestin-based contraceptives.
• Surgical treatment ( Hysterectomy): The only permanent solution to the problem of adenomyosis is a hysterectomy. This is a surgical procedure where the uterus is removed from the body of the patient. However, this surgical method is only prescribed by the doctor when a patient is suffering from severe adenomyosis and does not want any children in the future. There are various types of hysterectomy surgeries which can be performed. If a patient undergoes abdominal hysterectomy then first a 7 inches incision is made in the lower abdomen, then all the blood vessels and supporting tissues around the uterus are cut out surgically and then the surgeon removes the uterus and closes the incision made. If a patient undergoes vaginal hysterectomy, then first an incision is made near the top of the vagina, then all the blood vessels, ligaments, and fallopian tubes are excised and uterus is removed through vagina. If a patient undergoes laparoscopic vaginal hysterectomy then the entire process is done in the same way as vaginal hysterectomy with the only difference of a doctor being assisted by laparoscope in this surgery.

The eligibility of a patient for treatment is decided by the doctor. However, if a person is exhibiting following symptoms then she is eligible for the treatment:

• Agonizing pain during sexual intercourse.
• Heavy bleeding during the menstrual cycle.
• Unusually long menstrual cycle.
• Presence of blood clots in the menstrual bleeding.
• Severe abdominal cramping.

The presence of the above symptoms in a patient confirms the doctor’s diagnosis of adenomyosis thereby making the patient eligible for the treatment.

A patient is ineligible for the treatment of adenomyosis if she is not suffering from this condition. Often patients suffering from uterine fibroids are mistakenly diagnosed for adenomyosis as the symptoms of both the conditions are similar. A patient having uterine fibroid is not eligible for adenomyosis treatment. A patient is not eligible for the treatment of adenomyosis with anti-inflammatory drugs if she is allergic to them. A patient is not eligible for treatment with hysterectomy surgery if the patient is suffering from aninfection, has a fever, and wants to have kids in the future.

Any treatment that involves medication or surgery has some side effects associated with it. It is possible that a patient may or may not experience any side effect. A patient may sometimes experience a minor side effect which gradually vanishes after a period of time. If any serious side effect is experienced then emergency medical attention is needed by the patient. The side effects of the use of anti-inflammatory drugs for the treatment of adenomyosis include acidity, ulcers in the stomach, a headache, allergic reactions, increased blood pressure, and nausea. Undergoing hormonal treatment for adenomyosis has the following side effects

• A patient might feel tiredness
• A patient might encounter digestive problems
• A patient might experience a change in bones or muscles
• A patient might gain weight
• A patient may experience a bout of depression
• A patient may experience thinning of hair.

A patient undergoing hysterectomy for the treatment of adenomyosis exhibits the following side effects

• A patient might develop problems associated with anesthesia like a breathing problem.
• A patient might get infected.
• Heavy bleeding may be experienced by the patient.
• There is a chance of premature menopause.
• Surrounding organs of the patient might get damaged. In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

After the treatment of adenomyosis is complete a patient is required to follow a set of post- treatment guidelines. These post-treatment guidelines help the patient in preventing the relapse of the disease in the future. For a patient undergoing treatment with anti-inflammatory drugs or hormonal therapy have no specific set of post-treatment guidelines as these treatments are not permanent and might be required in the future. In patients undergoing treatment with hysterectomy the post-treatment guidelines that are required to be followed are given below:

• A patient must be monitored for any discomfort.
• A complete course of antibiotics must be done by the patient.
• The pain medications must be taken as prescribed by the doctor.
• A patient must avoid any kind of strenuous activity.
• A patient may be required to avoid a bath for a few days after surgery.
• The dressing at the surgical site must be done with clean hands.
• A patient may be required to take a liquid meal for a few days.

In patients taking medications like anti-inflammatory drugs, the recovery starts as soon as the medicine has been administered orally. In hormonal therapy as well the recovery starts as soon as the medicine is taken orally. For patients undergoing treatment with a surgical procedure like hysterectomy the average recovery period is of 6 to 8 weeks. However, a patient might take a little longer to recover if any post-surgical complications occur.

The oral contraceptive pills for hormonal treatment cost around 50 rupees per strip in India. Intrauterine device in India is available for a cost of 300 to 500 hundred rupees. In the government setup of family planning, it is available free of cost. The average price of anti- inflammatory drugs in India ranges from 40 to 100 rupees. The cost of hysterectomy in India ranges from 1,75,000 to 2,40,000 rupees based on the type and location of the surgery.

The results of the treatment with anti-inflammatory drugs are not permanent. Anti-inflammatory drugs only provide immediate relief in the condition as they only act on the symptoms of the adenomyosis. The results of hormonal treatment are also immediate and not permanent. However, if a patient continues to take the medicine for longer duration then the results for the treatment may also last for that period of time.

Besides the treatment described above a patient may also opt for alternative treatments. A patient may use natural remedies like consuming foods rich in calcium and magnesium. A patient can use a herb by the name of Shepherd’s Purse for the treatment of adenomyosis. A glass of milk mixed with a pinch of turmeric has proven to be very helpful in the treatment of adenomyosis.