Horizon Prime Hospital - Thane

Adenomyosis -A Medical Condition That Affects 1 In 4 Women

“Uterine Artery Embolization, A Game-Changer In Managing Adenomyosis” says Dr Manali Shilotri, Leading Consultant Gynaecologist, Horizon Prime Hospital

One in Four women experience the intense pelvic pain and heavy periods caused by adenomyosis – yet little is known about it. Women suffer with this problem for years and undiagnosed. Women feel shy to talk about this painful periods with anyone and suffer alone silently thinking that its normal pain during menstruation cycle.

Dr Hrushikesh Vaidya, Medical Director and Chairman Horizon Group of Hospitals said “We need to take away the taboo and shame around periods and stop normalising heavy and painful periods. It’s common, but it’s not normal. It is unacceptable that too many women are not receiving the care they deserve, and our Horizon Prime Hospital Women’s Wing are determined to change that. Never again will women’s health be neglected. We need to prioritise women’s health – it’s costing us our lives”.

Adenomyosis is a gynaecological condition where the cells that is the inside of the uterus grow inward into the uterine muscle. During a person’s menstrual cycle, these “trapped” cells undergo stimulation by the hormones of the menstrual cycle, similar to the mucous membrane lining of the uterus. This can make menstrual cramps and bleeding more severe than usual. The symptoms of adenomyosis vary throughout the menstrual cycle because of rising and falling levels of estrogen, which affect the shedding of the uterus lining. Symptoms usually go away or improve after menopause when a person’s estrogen levels naturally decrease. It is now more commonly diagnosed in women over the age of 30. It can affect anyone who has periods.

Symptoms

Adenomyosis symptoms vary widely among people. Around one-third of the women, do not experience any symptoms at all, while for others, symptoms can disrupt their daily life.

• Heavy menstrual bleeding
• Very painful periods
• Pain during sex
• Bleeding between periods
• Worsening uterine cramps
• An enlarged and tender uterus
• General pain in the pelvic area
• A feeling that there is pressure on the bladder and rectum
• Pain while having a bowel movement

Adenomyosis and endometriosis are two common conditions that affect women’s reproductive health. People often get confused between adenomyosis and endometriosis as the symptoms of the two conditions can be very similar. Both conditions involve the growth of endometrial tissue outside of its usual location in the uterus, and both can cause heavy menstrual bleeding, severe menstrual cramps, chronic pelvic pain, and pain during sex. In addition, both conditions can be difficult to diagnose because the symptoms often mimic other gynaecological conditions.
Dr. Manali Shilotri, Leading Gynaecologist and Consultant Horizon Prime Hospitals says, “We have heard of endometriosis through various news articles and there is quite a lot of awareness spread about it. Both these conditions are equally widespread. Adenomyosis and endometriosis can sometimes occur together. Studies have shown that up to 50% of women with endometriosis may also have adenomyosis. When these two conditions occur together, the treatment can be challenging. However, there are a few differences between the two that can help people to distinguish the two conditions.”

The main difference between adenomyosis and endometriosis is the location of abnormal growth of tissue. Adenomyosis occurs when endometrial tissue grows inside the muscular wall of the uterus, while endometriosis occurs when endometrial tissue grows outside of the uterus, such as on the ovaries, fallopian tubes, or other organs in the pelvic area.

Adenomyosis and endometriosis also tend to affect women at different stages in their reproductive lives. Adenomyosis is more common in women over the age of 30 who have had children or multiple pregnancies, while endometriosis is more common in women in their 20s and 30s who have not had children.

Dr Manali Shilotri further said “Many women aren’t aware they have adenomyosis because the condition doesn’t always have symptoms. The exact prevalence of adenomyosis is unknown. Researchers don’t know why some people develop adenomyosis or what causes it. However, researchers know it’s more common in people who have had a procedure on their uterus and who are older than 40 yrs. But now-a-days, doctors are diagnosing adenomyosis more frequently in women who are in their 30s who have abnormal vaginal bleeding or painful periods. Approximately 2-5 percent of adolescents with severely painful cycles have adenomyosis. Some research suggests hormones, genetics or inflammation/ trauma may contribute to adenomyosis”.

Factors That Can Lead To Adenomyosis

1. Estrogen:Conditions that increase the time of exposure to estrogen may include menopause, a higher body mass index, or past use of hormonal contraceptives.
2. Age:This condition can affect individuals of any age. However, many people do not receive a diagnosis of adenomyosis until during or after menopause after having a hysterectomy.
3. Pregnancy:A high percentage of females with adenomyosis have had multiple pregnancies.
4. Uterine surgery:Having previous surgery on the uterus, including cesarean delivery may increase the risk of adenomyosis

The Diagnosis Process

Diagnosing adenomyosis begins with a consultation with a doctor. They will likely take a medical history and perform a physical and pelvic exam. A person will often feel tenderness in her uterus during the pelvic exam. If a doctor thinks that the uterus feels slightly enlarged and they suspect adenomyosis, they may consider other tests, including

• Ultrasound:This allows the doctor to examine pockets of the uterus lining tissue in the muscle of the uterus.
• MRI:An MRI scan is a common way for the doctor to see the inner uterus muscle.
• Endometrial biopsy:Sometimes, the doctor will want to take a small sample of the endometrial tissue in the uterus for testing. While it will not help diagnose adenomyosis, it will rule out other causes of a person’s symptoms.

Adenomyosis Treatment

Without treatment, adenomyosis may remain the same or worsen. Treatment is not necessary if a person has no symptoms, is not trying to get pregnant, or is nearing menopause, which is when most people find relief from their symptoms.

The treatment options for adenomyosis and endometriosis can also differ. Hormonal birth control may be effective for managing symptoms of both conditions, however, adenomyosis may require more aggressive treatments such as uterine artery embolization or even hysterectomy in severe cases. Surgery to remove endometrial tissue or scar tissue may be recommended for women with endometriosis and assisted reproductive technologies may be needed for those experiencing infertility.

Dr Manali Shilotri said “While adenomyosis and endometriosis share some similarities in terms of symptoms and causes, there are important differences between the two conditions that require proper diagnosis and treatment. If someone is experiencing symptoms of either condition, it’s important to consult a doctor to get an accurate diagnosis and discuss the most appropriate treatment options for the condition with their gynaecologists”.

Following are the treatment options for Adenomyosis

• Anti-inflammatory medications:Medications can reduce pain and discomfort.
• Medications:Oral contraceptive pills, progestin intrauterine devices, or injections  can help ease symptoms.
• Uterine artery embolization: Traditionally, the management of adenomyosis has involved hormonal therapies, pain medications, and, in severe cases, surgical interventions like hysterectomy. However, with advancements in medical technology, non-surgical alternatives have emerged as effective options for addressing adenomyosis, with Uterine Artery Embolization (UAE) standing out as a promising solution. Uterine Artery Embolization is a minimally invasive procedure that involves blocking the blood vessels supplying the uterus with tiny particles. This process restricts blood flow to the abnormal tissue, causing it to shrink and alleviating symptoms associated with adenomyosis.Unlike conventional surgical approaches, UAE preserves the uterus, offering women an option to retain their reproductive capabilities. One of the key advantages of Uterine Artery Embolization is its minimal invasiveness, reducing the need for major surgery and the associated risks. Patients typically experience a quicker recovery with shorter hospital stays compared to traditional surgical interventions. Moreover, UAE offers a fertility-preserving alternative, making it an attractive option for women who wish to conceive in the future.

Dr Manali Shilotri says “Uterine Artery Embolization emerges as a game-changer in managing adenomyosis, offering a non-surgical alternative with minimal invasiveness, shorter recovery times, and fertility preservation. As we continue to advance in the field of women’s health, it is imperative that both healthcare providers and patients are informed about innovative solutions like UAE that can significantly improve the lives of those affected by adenomyosis.”

It is crucial to highlight that Uterine Artery Embolization is not a one-size-fits-all solution. Patient selection is key, and a thorough evaluation by a qualified healthcare professional is essential to determine the suitability of UAE for an individual case. The procedure is generally well-tolerated, but like any medical intervention, it carries potential risks and complications that should be discussed with the treating physician.

• Hysterectomy: The only definitive treatment for adenomyosis is the complete removal of the uterus. It may be an unsuitable option for a person who still wants to become pregnant unless all therapies have failed and they wish to prioritize pain relief over pregnancy.

Speaking on the complications of adenomyosis, Dr Manali Shilotri further said “The symptoms of adenomyosis tend to get worse over time. Heavy menstrual bleeding from adenomyosis increases women’s risk of anaemia. Anaemia occurs when the body doesn’t have enough iron-rich red blood cells. Anaemia may cause women to feel fatigued or cold. Adenomyosis also increases risk of pregnancy and childbirth complications in women”.

Dr Hrushikesh Vaidya, Medical Director and Chairman Horizon Group of Hospitals says “Women should reach out to the gynaecologists when they experience problems. Adenomyosis is not a life threatening condition on its own. Although the condition will go away once a person reaches menopause, it can cause severe discomfort and lead to complications before then. An individual should consult their doctor if they suspect adenomyosis or endometriosis. Several treatments can help alleviate the symptoms”.

Dr Hrushikesh Vaidya concludes “We need more education and more empathy on women who has both conditions. Women’s health is not talked about; we only started talking about the menopause five or six years ago and it is only now in the news. Adenomyosis should be given the same importance. While awareness is growing around endometriosis, adenomyosis is a whole other beast – lagging behind in education and research. Sadly, most people haven’t even heart of it. The women might look perfectly fine from outside, but due to this medical condition, women end up losing their career, financial independence, body confidence too. It affects every aspect of women’s life”.