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Heavy periods followed with excruciating pain, debilitating cramps, and a bloated tummy – most women would often dismiss them as a bad case of menstrual symptoms without knowing that these red flags may be hints to something bigger: adenomyosis. Unfortunately, many so often do not find out about this condition until they have problems conceiving. This is a frustrating dead end, especially tho those who have realised it a tad too late.

If you find your quality of life severely affected by adenomyosis, all hope is not lost. There are a few ways to alleviate the painful experience, all while ensuring your future fertility.

Adenomyosis

Often described as the sister of endometriosis, adenomyosis is a lesser-known benign uterine disorder. It typically involves the endometrial glands and stroma (a special type of connective tissue) growing in the myometrium (middle layer of the uterine wall) instead of the endometrial tissue.

The condition is characterised by the new formation of small blood vessels as well as myometrial muscle hypertrophy (increase and growth of muscle cells) and hyperplasia (increase and growth of cells in an organ). This simply translates to an enlarged uterus with displaced tissues that continue to function as per normal – thickening, breaking down, and bleeding.

Adenomyosis: The Development

The exact cause of adenomyosis is unknown but researchers have put forward several theories. The most accepted hypothesis is that adenomyosis is resulted from a disrupted boundary between the endometrium basalis (the deepest layer of the endometrium) and the underlying myometrium. The risk tends to be higher if the individual has undergone an invasive surgery, such as caesarean delivery, and dilation and curettage procedure.

Another theory proposes that various hormones like estrogen, progesterone, prolactin, and follicle-stimulating hormones (FSH), may have triggered its development. This would explain how most cases of adenomyosis would decline once menopause settles in.

Symptoms and Risks

As far as symptoms go, it is either a hit or miss; some woemn display no symptoms whilst others exhibits multiple of them. One of the common symptoms include dysmenorrhea (severe menstrual cramps and pain), caused by the increased levels of prostaglandins, a type of active lipid compound with diverse hormone-like effects.

This uterine condition is also characterised by increased blood vessels in the uterus, abnormal uterine contractions, and growth in cell-signalling molecules like prostaglandins and estrogen – all of which may culminate into heavy menstrual bleeding. Excessive blood loss can reduce iron levels in the body, which impairs the body’s ability to produce sufficient red blood cells to transport oxygen to the body’s tissues. Beyond the increased risk of developing iron deficiency and anaemia, adenomyosis can also cause fatigue, dizziness, and moodiness, among other things.

Aside from these symptoms, studies have also shown that adenomyosis is associated with lifelong infertility. There are multiple mechanisms of infertility proposed by several prospective studies, including a drastic decrease in implantation and number of embryos transferred, development of abnormal uterotubal transport, as well as altered endometrial function and receptivity. Aside from a higher rate of miscarriage, individuals diagnosed with adenomyosis also have lower term pregnancy rates than their counterparts.

Adenomyosis vs Endometriosis

It is easy to mix adenomyosis and endometriosis as both are painful uterine disorders that involve the endometrial tissue. The main difference that sets the conditions apart is the area where the endometrial tissue grows.

Adenomyosis: Endometrial tissue grows into the myometrium.

Endometriosis: Proliferation of endometrial tissue occurs outside the uterus and may grow in areas like the ovaries, fallopian tubes, pelvic sidewalls, and even the bowel.

Do note that you can experience one or both of these conditions. A 2017 study has shown that 42.3 per cent of the 300 patients diagnosed with adenomyosis between 2008 and 2016 also had endometriosis.

Adenomyosis Management

Unfortunately, medical treatment for adenomyosis is heavily limited and often involves reducing any possibility of pregnancy. As such, it may not be an ideal solution for those who still dream of building a family of their own. Should you wish to conceive, there are a handful of remedies available that can help alleviate the pain and symptoms of the condition without having to compromise your future fertility.

The treatment options include:

Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are the primary medical therapies for adenomyosis. These medications work by targeting the cyclooxygenase enzyme that triggers the production of prostaglandins, effectively relieving severe cramps. However, do note that they come with adverse side effects, including high blood pressure, and liver and kidney problems.

Your doctor may advise you to take an anti-inflammatory medication a few days before the start of your period. However, if you are pregnant, you may want to several precautionary measures and consult your doctor as it may harm your pregnancy.

Hormonal Therapy

Symptoms can be controlled with various hormone therapies. This may include oral contraceptive pills, levonorgestrel-releasing intrauterine device (IUD), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) analogues. These hormonal treatments work by reducing the estrogenic effects that may lead to endometrial proliferation.

That said, hormonal therapies can produce several side effects, such as digestive problems, fatigue, mood swings and depression.

Endometrial Ablation

Endometrial ablation is an outpatient procedure that involves the removal of the endometrium. However, this treatment may not be for everybody as it invades the muscle more deeply. As such, it is only recommended for individuals who are not interested in getting pregnant or have completed childbearing. Possible side effects include fever, intense cramping, heavy bleeding, and urinal incontinence. However, patients typically take a few weeks to recover from these problems.

Hysterectomy

If conservative treatments are not improving the state of your condition, your doctor may suggest a total hysterectomy as a last resort. A hysterectomy involves a uterus removal, but it may also include the removal of the cervix, fallopian tubes, and other surrounding structures. Since patients will no longer possess the primary female organ responsible for pregnancy, conceivement after the surgery will be not be possible.

Since this is a life-changing treatment, getting a second opinion is crucial, especially if family building is something that you look forward to having.

Let Our Gynaecological Team Help You

Women health in and of itself is very delicate and complex. There are multiple health complications that are specific to only women, many of which can negatively affect one’s quality of life and lifestyle. Unfortunately, adenomyosis is one of the many ailments that cannot be prevented. The only option left is to employ treatments to alleviate the symptoms or remove the source of the pain altogether.

Your reproductive health deserves the care and attention it sorely needs, and The O&G Specialist Clinic can help you with that. With a team of experienced gynaecologists and specialists, we employ a holistic approach to gynecologic care to better assist you with your female reproductive health concerns. We will guide you through the available treatment options, finding one that aligns with your needs, and offer you advice such that you can take charge of your health today.

Book a virtual consultation and head down to our fertility clinic in Singapore today.

References:

Gunther, R., & Walker, C. (2020). Adenomyosis. StatPearls [Internet].

Harada, T., Khine, Y. M., Kaponis, A., Nikellis, T., Decavalas, G., & Taniguchi, F. (2016). The impact of adenomyosis on women’s fertility. Obstetrical & gynecological survey, 71(9), 557.

Vannuccini, S., & Petraglia, F. (2019). Recent advances in understanding and managing adenomyosis. F1000Research, 8.

Antero, M. F., O’Sullivan, D., Mandavilli, S., & Mullins, J. (2017). High prevalence of endometriosis in patients with histologically proven adenomyosis. Fertility and Sterility, 107(3), e46.

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