Your adenomyosis treatment options depend on your symptoms and your past treatments. Sydney Fibroid Clinic offers medical therapies, Mirena IUD, uterine artery embolisation, and hysterectomy as a last resort.
Medical Therapy for Adenomyosis
Nonsteroidal anti-inflammatory drugs (NSAIDs), birth control pills, or progesterone agents may be used to control heavy periods, however these treatments may cause stomach ulcers and promote bleeding.
Gonadotropin-releasing hormone (GnRH) agonists can be used to control bleeding. Due to common side effects however – such as hot flashes, mood changes and osteoporosis – use is generally limited to six months.
Cyklokapron reduces heavy periods by enhancing the body’s clotting ability – but serious side effects include deep venous thrombosis (DVT) and pulmonary embolism (clots in the lung).
Mirena IUD for Adenomyosis
Mirena is an IUD that slowly releases sex the hormone Progestrone over 5 years.
A Turkish study showed Mirena could be as effective as a hysterectomy for controlling heavy menstrual bleeding.
A 3-year follow-up study from China showed Mirena could be effective for pain control. However satisfaction rate was only 56.3% at 12 month. The side effects were prolonged light bleeding (25%), irregular bleeding (14%), and weight gain, ovarian cyst, lower abdominal pain and acne.
Mirena is less effective in women with extensive adenomyosis when the uterus is larger than 150ml. Discontinuation rate of 70% is noted in women with uterine volume larger than 314ml.
Uterine Artery Embolisation for Adenomyosis
Uterine artery embolisation (UAE) is a safe, minimally invasive, non-surgical alternative to a hysterectomy. Reducing heavy periods and relieving pain, the procedure has been shown to be as effective in 90% of women suffering from adenomyosis. Having had UAE, 95% of women are able to avoid a hysterectomy.
UAE is suitable for women who have failed conservative medical therapy or Mirena IUD, yet trying to avoid a hysterectomy.
The procedure and its benefits can be summarised as follows:
- Local anaesthetic procedure
- Proven to be safe and effective
- 90% patient satisfaction rate
- No surgical cuts, no general anaesthesia
- 1 – 2 nights hospital stay
- 1-week recovery
- Keep your uterus and pelvic floor intact
Uterine artery embolisation (UAE) means means blocking of the arteries supplying the uterus. It is performed by an interventional radiologist. Only a tiny nick on the skin is needed to allow insertion of a small 1 – 2mm diameter tube called a catheter into the femoral artery in the groin. The catheter is navigated to the uterine artery under X-ray guidance. Tiny particles are then injected inside the uterine arteries to block the blood flow, thereby starving and killing the adenomyosis tissue. Normal uterine tissue has immense capacity to recruit dormant vessels and therefore remains unharmed.
The procedure is suitable for women who wish to avoid a hysterectomy, keep their uterus and recover quickly.
Endometrial Ablation for Adenomyosis
Endometrial ablation uses heat energy to destroy the inner lining of the uterus, so bleeding will be reduced.
However, glands in the muscle (adeno= glands; myosis in the muscle) will be trapped. Some have described this as sealing off the juice on the BBQ hot plate. Bloating and period pain can get worse. Even with modern technology, adenomyosis deeper than 2.5mm cannot be treated by ablation, according to a 2015 study.
If MRI is used for diagnosis, the depth is 12mm minimal. Therefore, adenomyosis diagnosed on MRI should not be treated with ablation.
In the past, when ablation failed to treat adenomyosis or if pain is worse after ablation, hysterectomy is to follow.
Today, there is an alternative to a hysterectomy.
If you had ablation and the pain has becomne worse, UAE might help to kill off adenomyosis tissue and alleviate pain.
Hysterectomy for Adenomyosis
A hysterectomy is a surgical operation in which all or part of the uterus is removed.
Hysterectomy is a major operation that requires general anaesthetic, several days in hospital and up to 4 to 6 weeks of recovery.
Surgical risks include anaesthetic complications, blood transfusion, infection, wound issues, and rarely injuries to the bowel, bladder and ureter (the tube connecting the kidney to the bladder). The overall risks of severe complications from hysterectomy is 3.5 to 11% and hysterectomy mortality rate can be as high as 0.15%.
Long term side effects of a hysterectomy are prolapse and urinary incontinence, early menopause and higher risk of cardiovascular disease (even with ovaries left behind), change of sexual feeling and constipation, and so called post hysterectomy syndrome with depression and lethargy.
If you have uterine cancer, your only choice may be to remove the uterus. However, an overwhelming number of hysterectomies in developed countries – like Australia and the United States – are performed for benign conditions such as fibroids and adenomyosis.
In the past, when conservative treatments failed or were deemed unsuitable, women were faced with the difficult decision to putting up with symptoms or having a hysterectomy.
Today, there are now many effective, non-surgical forms of adenomyosis treatment, hysterectomies for adenomyosis should be considered as a last resort, if all other less invasive methods have failed. Depending on your specific situation, medical therapy, Mirena IUD (56% patient satisfaction) or uterine artery embolisation (90% patient satisfaction) should be considered before embarking on hysterectomy.
Surgical Removal of Adenomyosis
Generally speaking, adenomyosis is not suitable for surgical removal. Adenomyosis is often a diffuse infiltrative process. Unlike fibroids, which can be easily separated from the normal uterine wall, adenomyotic tissue does not have a clear boundary with the normal myometrium.
Surgeons often find it difficult to determine where adenomyosis stops and where normal myometrium starts. The removal is either incomplete, leaving behind adenomyotic tissue which can continue to grow and cause problems, or a larger than necessary amount of normal myometrium around the adenomyosis might have to be removed.
Surgeons might have been misled by an incorrect ultrasound diagnosis and inadvertently went ahead with surgery, with the intention of removing a “fibroid”. Half way through the surgery, it is then realized that the “fibroid” cannot be separated out from uterus and in fact it was adenomyosis that they are dealing with, and that surgery might need to be abandoned.