ADENOMYOSIS
Adenomyosis Treatment Options
Adenomyosis may be treated or managed in several ways depending on each patient’s case. Treatment options for adenomyosis include medication and hormone therapy with surgical management, the primary and best option for patients with moderate to severe symptoms. Alternative, and often less effective treatments like physical therapy and nutrition supplements can be attempted but typically have low success rates. A hysterectomy is generally recommended as a definitive treatment for adenomyosis. Physicians may recommend additional measures like medication as a complement to surgery or for patients who want to maintain fertility options.
Hysterectomy
The only cure for adenomyosis is a hysterectomy. Unlike fibroids, which are often surrounded by a capsule that separates each fibroid from normal tissue and allows it to be completely removed, there is no clear border between adenomyosis and normal uterine tissue. In effect, adenomyosis grows into the uterine muscle like a “spider” and cannot be removed without removing the muscle itself the way fibroids can. If removal is attempted, portions of the uterine muscle will be removed as well¹.
Hormonal Suppression
For women who are not yet finished with childbearing, the symptoms of adenomyosis can be temporarily managed through medication that suppresses estrogen, the hormone responsible for adenomyosis growth. Although not always very effective, hormonal suppression with continuous birth control pills, Depo-Provera or the Mirena IUD (intrauterine device) may help to keep symptoms manageable.² With all of these treatments, low levels of estrogen are continually introduced in the body, and the adenomyosis will continue to grow. For those patients with extensive disease that cannot undergo hysterectomy, sometimes GnRH agonists such as Orlissa, or antagonists such as Lupron, can be used. These agents will block estrogen production, and will help to treat the condition, alleviating symptoms of pain and bleeding. Unfortunately, the treatment is not long term since side effects such as osteoporosis – bone loss – can occur. Even in the short term, many patients have difficulty with the loss of estrogen, having menopausal symptoms such as hot flashes, night sweats, vaginal dryness, anxiety, depression, mood swings, and other issues.
Pain Medication
Some patients may be able to effectively alleviate symptoms like cramping and pelvic pain with NSAIDs like ibuprofen or naproxen. Pain relief using medication is temporary and may only be effective for mild cases of adenomyosis.
Natural Treatments for Adenomyosis
Adenomyosis symptoms may also be managed through nonsurgical treatments including pain management, acupuncture, pelvic floor physical therapy, nutritional counseling and more. These natural and at-home treatments should be advised by a GYN specialist and are not a replacement for essential surgical treatment.
At-Home Remedies
In mild cases, some patients may be able to temporarily ease pain and cramping using at-home remedies. These may include soaking in a warm bath, using a heating pad on the abdomen or doing some light stretching.
Adenomyosis and Menopause
Once a patient goes through menopause, estrogen production decreases. Because further growth of adenomyosis tissue is estrogen-dependent, it is possible that symptoms may subside after menopause. However, this is not the case for many women. If you continue to have severe symptoms after going through menopause, it’s important to be evaluated by an adenomyosis specialist to determine a more definitive treatment.
When to See a Doctor
If symptoms like heavy, prolonged bleeding or severe cramping are interfering with your everyday routine, it’s time to see a doctor. If you need to miss work or you are having trouble sleeping due to painful and disruptive symptoms, the adenomyosis specialists at CIGC can help you find relief and get back to your life.
References
- Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018 Mar;109(3):406-417
- Pontis A, D’Alterio M, Pirarba S, et al. Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol. 2016 Sep;32(9):696-700.
