Hysterectomy Alternatives Program (HAlt)
Common Diseases of the Uterus
Adenomyosis (ad-en-oh-MY-oh-sis) is a condition where endometrial glands and supporting tissues are found in the muscular wall of the uterus where it would not occur normally. The wall of the uterus appears to have tiny cysts within it. These cysts are not cancerous. Adenomyosis is a disease that is closely related to endometriosis. Endometriosis is a disease where the cells that normally line the inside of the uterus and are shed during menstruation, become implanted and grow outside of the uterus. Adenomyosis may also be found in women who have already been diagnosed with endometriosis.
The exact cause of Adenomyosis is unknown. There is some evidence that women who have had Cesarean sections may be at a slightly higher risk for adenomyosis. The theoretical basis for this would be that when a surgical incision is made into the uterus, endometrial tissue is seeded down into the muscle of the uterus.
Another factor that has been suggested as a possible cause of adenomyosis is tubal ligation. Under this theory, normal retrograde flow of endometrial cells is blocked due to the ligation of the fallopian tubes. This would increase the intrauterine pressure and force some of those cells down into the muscle of the uterus and therefore cause the development of adenomyosis.
The most common symptoms of adenomyosis are: abnormal uterine bleeding, large uterus (uterus is often 2-3 times the normal size), and pelvic pain during menstruation. A normal uterus, being made of muscle, contracts to reduce menstrual flow. In women with adenomyosis, the tissue in the cysts bleeds. The cysts fill with blood and enlarge. The tissue also secretes hormones that dilate blood vessels and increase uterine muscle contraction leading to heavy, painful periods. This is why women report uterine tenderness or painful intercourse. That is why women may report heavy, painful menstruation. In some cases the uterus is so enlarged that it may interfere with other organs, such as the kidney or bowels.
Women may not have any symptoms. In many cases, women learn that the have adenomyosis after having an ultrasound of the pelvis.
Symptoms usually go away after menopause occurs. As estrogen levels decrease, the uterus gets smaller and monthly bleeding ceases alleviating the bulkiness and pain associated with adenomyosis.
Like fibroids, and endometriosis, there are many treatments for Adenomyosis:
NSAID’s (non-steroidal anti-inflammatory) such as Naprosyn ® is usually the first treatment for painful periods as well as heavy bleeding. This medication works best if taken at the onset of menstruation and throughout the bleeding period. It reduces pain by inhibiting prostaglandin production and decreases bleeding. Side effects are stomach upset, indigestion, and diarrhea.
GnRH analogues (e.g. Lupron ®) - this medication causes a menopause-like state, which can temporarily reduce or eliminate the symptoms of adenomyosis. The side effects of GnRh analogues are bone demineralization, hot flashes, mood swings and vaginal dryness. Usually these side effects are mild and short-lived.
Mirena ® - a progesterone intrauterine contraceptive device can be used to improve abnormal bleeding and pain while conserving fertility. (The devise is removed prior to conception.) It lasts for5 years and the side effects include weight gain, unpredictable bleeding and acne.
Continuous Hormonal Contraceptive - “the pill”, patch or ring is used to regulate and reduce bleeding. When used continuously (menstrual suppression) the pill can eliminate symptoms of adenomyosis. Once the pill is discontinued, symptoms may resume. Some women report headaches, breast discomfort or nausea when taking the pill. Women over the age of 35 who smoke should not use these medications.
Danazol - is a pituitary gonadotropin inhibitor. It can be used in the treatment of adenomyosis.
Depo-provera- this is an injectable medication normally used for birth control. It is a synthetic form of progesterone that inhibits estrogen and progesterone production which prevents hormone cycling, ovulation and endometrial growth. Side effects include irregular menstrual bleeding, weight gain, headaches, nausea, and acne but are generally mild. Bone mineral density (BMD) can be reduced with prolonged use of Depo-provera, however reversible and can be prevented by adding low dose estrogen. Women conceive on average 9 months after stopping Depo-provera.
Hysterectomy or the surgical removal of the uterus is the most common treatment for adenomyosis. It eliminates bleeding and most often, but not always, eliminates pain. Hysterectomy can be performed laparoscopically, vaginally or abdominally. There are some risks to either procedure but most women recover fully within 4-6 weeks.
Acupuncture-is widely used for menstrual pain. There are few contraindications but acupuncture must be administered by a qualified acupuncturist who follows correct guidelines and uses sterilized needles.
Endometrial ablation (burning the lining of the uterus) is unlikely to help women with symptomatic adenomyosis simply because the destruction of the endometrium does not eliminate the adenomyosis which is located much deeper in the uterine wall.