Severe menstrual pain or heavy blood loss at your period: could be due to adenomyosis!
1. What is adenomyosis?
- Tissues from the lining of the uterus has migrated to grow within the uterine muscle wall
- Adenomyosis tissues are influenced by the female hormones and will have periodic bleeding within the muscle wall, causing menstrual pain. The growth of these adenomyosis tissues will also thicken the uterine wall
- The lesions can also migrate to different parts of the uterine wall, enlarging the entire uterus. With an enlarged uterus, the period will be heavy
- Sometimes the adenomyosis tissues can be confined to one part of the uterine wall, like a localized tumour. It is then called an “adenomyoma”
2. What are the symptoms of adenomyosis?
- Some do not have symptoms, especially if the lesions are small
- Painful period (dysmenorrhea), which may interfere with daily life
- Heavy menstrual bleeding, which can lead to anaemia
3. How is adenomyosis diagnosed?
- Ultrasound – more common and less expensive
- Magnetic Resonance Imaging (MRI) – more accurate in making diagnosis and localizing the adenomyosis lesions. Much clearer images compared with ultrasound, but a more expensive test
4. What medications are available for adenomyosis?
- Painkillers, like Paracetamol and Non-steroidal anti-inflammatory drugs (such as Ibuprofen)
- Medication to reducing menstrual loss
- Hormonal medicines, including oral contraceptive pills, oral progestogen pills, birth control injection, and progestogen-containing intrauterine contraceptive device (Mirena)
5. What are the surgical options for adenomyosis?
- Hysterectomy – Since the boundary between adenomyosis and the adjacent normal uterine muscle is generally not obvious, it is difficult to excise the adenomyosis selectively. Hence, the entire uterus is usually removed to eradicate the pathology
- HIFU (High Intensity Focused Ultrasound) – Special machine to emit focused high energy at the lesions to ablate the pathology