21 Sep Treatment Options for Adenomyosis Explained
Treatment options for adenomyosis range from pain-relief medicines and hormonal treatments through to surgery, including hysterectomy. The right choice depends on your symptoms, your stage of life and whether you wish to preserve your fertility. Many people start with non-surgical options before surgery is discussed.
Key Takeaways
- Adenomyosis treatment is chosen around your symptoms, your age and whether you plan to have children.
- Pain-relief medicines and hormonal treatments are usually discussed first.
- Surgery ranges from removing a localised adenomyoma to a hysterectomy, which ends the possibility of pregnancy.
How is adenomyosis treatment chosen?
Treatment is chosen to ease your main symptoms, usually heavy periods and pelvic pain, and it is tailored to your age, how severe your symptoms are and whether you wish to preserve your fertility. No single treatment suits everyone with adenomyosis.
Diagnosis comes first. A pelvic examination, ultrasound and sometimes an MRI scan help your doctor work out whether adenomyosis is the cause of your symptoms, because fibroids and endometriosis can cause similar ones.
What non-surgical treatments are used?
Non-surgical treatment usually means pain-relief medicines and hormonal treatments, which aim to manage symptoms rather than remove the adenomyosis. Common options include:
- A trial of anti-inflammatory medicines combined with paracetamol to ease period pain.
- A hormonal intrauterine device (IUD), such as Mirena, releases progesterone hormone inside the uterus.
- The combined contraceptive pill, a progesterone-only pill or a contraceptive implant can also be used as hormonal treatment.
- GnRH analogues are medicines that temporarily bring on a menopause-like state.
Healthdirect notes that hormonal IUDs, contraceptive pills and implants are forms of contraception, so you will not be able to get pregnant while using them properly, and it can take several months for fertility to return after stopping some of them.
What procedures and surgery are used?
Procedures and surgery are usually considered when medicines and hormonal treatments have not controlled symptoms well enough, and our guide to when adenomyosis needs surgery explains how that decision is made. The options are:
- Endometrial ablation treats the internal lining of the uterus. It is performed under general anaesthetic. While it can assist with heavy bleeding caused by adenomyosis, it may not improve pain and may worsen it depending on severity.
- Uterine artery embolisation interrupts the blood supply to the uterus so that it shrinks. As pe rEpworth HealthCare, it rarely has a role in managing adenomyosis.
- Adenomyomectomy removes just the affected part of the uterus when adenomyosis is contained in one lump, called an adenomyoma, although recurrence is possible.
- Hysterectomy removes the uterus, so adenomyosis cannot return. It is irreversible and ends the possibility of pregnancy.
Endometrial ablation is generally not suitable when adenomyosis is severe, and you cannot conceive afterwards, so it is only used if you do not plan a pregnancy. Hysterectomy may be an option if you have severe symptoms and have not responded to other treatments.
A hysterectomy can be performed using minimally invasive or robotic-assisted techniques where suitable, and the ovaries are usually preserved when they are normal.
How do pregnancy plans affect your options?
Plan for future pregnancy affects treatment options. Some treatment options prevent pregnancy while you use them, while others end it permanently. Hormonal treatments can be stopped or removed when you are ready to try, whereas endometrial ablation and hysterectomy are irreversible.
Fertility issues and a higher risk of pregnancy complications are among the possible complications of adenomyosis, so it is worth planning treatment around your pregnancy goals with your gynaecologist.
When should you see a doctor about adenomyosis symptoms?
See your doctor if you have painful or heavy periods, if your symptoms stop you from doing your usual activities, or if you have unusual vaginal bleeding or pain during sex. Your GP can then refer you to a gynaecologist to discuss which treatment options suit you.
Planning your adenomyosis treatment with Dr Kent
The options above are a starting point, and the right plan depends on your symptoms, your age and your plans for a family. A treatment plan can also be reviewed if your symptoms or goals change.
Dr Kent Kuswanto is a Melbourne specialist gynaecologist with high volume experience in robotic and minimally invasive complex gynaecological surgery. To discuss your treatment options or seek a second opinion, contact Dr Kent Kuswanto’s team with your GP referral.