Adenomyosis is a benign gynaecological condition of the uterus where the endometrial tissue i.e the lining of the uterus invades the muscular wall of the uterus.It is prevalent in 10 to 18 percent of the female population. A woman could complain of severe menstrual pain (dysmenorrhea) , (menorrhagia) heavy bleeding and or prolonged bleeding, pain during intercourse and chronic pelvic pain. Adenomyosis can commonly co-exist with an other benign condition of the uterus called uterine fibroids. It can sometimes be associated with endometriosis as well.
Risk factors for developing adenomyosis – advanced age, previous uterine surgery, smoking, previous pregnancy, tamoxifen drug use or it could be developmentally acquired.
Diagnosis – diagnosis of adenomyosis is usually made from clinical features, transvaginal ultrasound scan and MRI.
How does adenomyosis affect fertility?
Adenomyoma may distort the uterine cavity , may obstruct the tubal ostia ( opening of the tube) and interfere with sperm migration and embryo transport. Adenomyosis may also alter the architecture of the muscular wall of the uterus and thereby causing disturbed Uterine Peristalsis and Sperm Transport. It may also affect the endometrial (uterine lining) function and receptivity thereby lead to decreased endometrial receptivity.
The treatment totally depends on the severity of symptoms, the desire for childbearing, extent of the disease and desire to preserve the uterus . Hormone therapy with oral contraceptive pills, Gonadotropin‐releasing hormone (GnRH) agonists, Hormone‐containing intrauterine devices (IUDs) and Drugs like dienogest can be used for conservative treatment where the drug can be given for prolonged intervals which may show reasonable reversal of symptoms. Hysteroscopic endometrial ablation/ resection has been used to treat patients with menorrhagia, including patients with adenomyosis. Minimal access surgery ( hysteroscopic)with focal resection of the Adenomyoma is a promising procedure for patients desirous of fertility.
Myometrial/adenoymoma excision and myometrial reduction -Focal excision of adenomyosis can be performed if the location of foci can be determined. However, unlike myomectomy, it is difficult to expose the lesions, define margins and determine the extent of disease and thus, the efficacy of excision remains low.
In patients who are not interested conserving the uterus and have completed childbearing may opt for a laproscopic hystrectomy. It is important to understand that Adenomyosis is a progressive disease which keeps worsening until the patient attains the menopause.
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