Although it is not a malignant or pre-malignant condition, adenomyosis can cause debilitating pain and severe menstrual bleeding for some women. Detecting adenomyosis can only be done with an MRI, and it is confirmed after surgery through pathology. The only adenomyosis treatment that can cure it is a hysterectomy. Adenomyosis is an extremely common condition, but it is not always readily identified by many doctors, as initial imaging of the uterus is often conducted by an ultrasound, commonly used to detect fibroids.
The CIGC® surgical specialists are fellowship trained and highly experienced with treating adenomyosis. They have seen many women who have had failed treatments for adenomyosis, including birth control or ablation. Neither of these treatments control the disease. The CIGC specialists perform minimally invasive hysterectomies using DualPortGYN® with low risk of complications, fast recovery & less pain.
WHAT IS ADENOMYOSIS?
Adenomyosis is a condition in which the cells that line the inside of the uterus (endometrium) are abnormally located in cells that make up the uterine wall (myometrium). This can result in a somewhat enlarged uterus. Adenomyosis can cause very painful periods and heavy bleeding.
WHO DOES IT AFFECT?
Although it most commonly affects women in their forties and fifties, it can occur even among teenagers.
WHAT CAUSES IT?
It is unknown what causes adenomyosis. One theory is that the endometrial cells are somehow able to migrate and invade the normal uterine wall. Another theory is that cells in the uterine wall develop into endometrial cells.
ARE THERE ANY RISK FACTORS?
It seems that childbearing, previous uterine surgery, short menstrual cycles, and early age of menarche (age of first period) may be risk factors for adenomyosis.(1)
WHAT IS THE ASSOCIATION BETWEEN ADENOMYOSIS AND INFERTILITY?
At this time it is unclear, with some studies showing an association and others showing no effect.(2,3)
- Obstetrics and Gynecology Journal, 2004
- Current Opinion in Obstetrics and Gynecology Journal, 2005
- Journal of Obstetrics and Gynecology, 2012
Adenomyosis can vary greatly from woman to woman. It can be localized or diffuse, scattered or clustered. Although it is not a malignant or pre-malignant condition, adenomyosis can cause debilitating pain and severe menstrual bleeding for some women. Up to 30 percent of women with adenomyosis have no symptoms at all.
The only way to definitively diagnose adenomyosis is by having a pathologist examine the uterus after a hysterectomy has been completed. Imaging studies can be used to suggest adenomyosis but are not completely accurate.
An MRI is the best imaging study to diagnose adenomyosis. The characteristic feature on an MRI is a thickened junctional zone, which is the thin innermost layer of myometrium (uterine muscle wall). Sometimes adenomyosis can form a large cluster and is mistaken for fibroids on imaging studies. An ultrasound can also be used to look for adenomyosis but is less sensitive than an MRI. Sonographic features of adenomyosis include an enlarged “globular” uterus, thickened endometrial lining, and heterogeneous uterine wall.
The diagnosis of adenomyosis is often made by a clinician with a high index of suspicion based on the patient’s reported symptoms. Since adenomyosis can occur simultaneously with other conditions, the diagnosis of adenomyosis is sometimes missed by clinicians. For example, a woman having heavy periods may have both adenomyosis and fibroids. Since fibroids are a well-known cause of heavy periods, one might assume her heavy bleeding is from the fibroids. However, if only the fibroids are removed, the adenomyosis will still be there and she will continue to have heavy bleeding.
IS ADENOMYOSIS THE SAME AS ENDOMETRIOSIS?
No. Although they can occur together, endometriosis is when endometrial cells (the lining of the uterus) is in a location outside of the uterus. Adenomyosis is when these cells are within the uterus, in the uterine wall. Although both can cause pain, endometriosis does not typically cause heavy bleeding. To read more on endometriosis click here.
The only cure for adenomyosis is a hysterectomy. Unlike fibroids, which are often surrounded by a capsule, there is no clear border between adenomyotic tissue and normal uterine tissue. Because there is not a clear separation, adenomyosis cannot be effectively removed the way fibroids can.
PREVENTING MENOPAUSE AFTER HYSTERECTOMY FOR ADENOMYOSIS
It is important to choose an adenomyosis surgeon who is a minimally invasive GYN specialist, who can perform a hysterectomy while leaving the ovaries intact to prevent early menopause. Adenomyosis is a disease of the uterus and does not affect the ovaries.
FERTILITY AND ADENOMYOSIS
For women who are not yet finished with child-bearing, the symptoms of adenomyosis can be temporarily managed through medication. Although not always very effective, hormonal suppression with continuous birth control pills, Depo-Provera, or the Mirena IUD may help to keep symptoms manageable.
WHY CIGC FOR YOUR ADENOMYOSIS TREATMENT?
Adenomyosis can be an extremely painful condition, but CIGC has the expertise to provide relief.
The only surgery that cures adenomyosis is a hysterectomy. When choosing an adenomyosis specialist, it’s important to choose a minimally invasive GYN surgical specialist. The CIGC surgeons have the training and experience to perform this procedure with a low risk of complications, minimal scarring, and a quick recovery period.
Why not my OB/GYN?
Many patients have a strong relationship with their OB/GYNs and are wary of having a hysterectomy for adenomyosis performed elsewhere. We partner with OB/GYNs. It is important to understand that an OB/GYN is primarily focused on obstetrics, and many are only trained in open or robotic procedures. GYN surgical specialists consistently perform a high volume of surgeries, on average about 400 hysterectomies per year. The average OB/GYN only performs about 27.
At CIGC, minimally invasive GYN surgery is the only medicine we practice. We have made a commitment to surgery for adenomyosis and other gynecological conditions; we are board-certified, and fellowship-trained in Minimally Invasive Technology and Gynecological Oncology. Many OB/GYNs perform hysterectomy through open or robotic procedures, but CIGC has a unique and powerful approach to the procedure. Our laparoscopic hysterectomies provide full access to all of the anatomy, with the smallest number and size of incisions possible. Rather than having a long, expensive procedure and painful recovery, you will be back on your feet in no time and with minimal scarring.
Know your options. CIGC surgeons see cases of adenomyosis on a daily basis, and we are familiar with the condition in all of its severities. We are well-informed about your treatment options, and we’ll make sure that you are too. If you are still planning on having children, we will take your lifestyle into consideration and help you manage your adenomyosis until you are ready for other options. If not, we will explain the laparoscopic hysterectomy to you and why it is setting the standard for GYN procedures all around the world.
We know that our customers are fastidious when choosing their surgeons, and we think extensive research is important. When you are exploring your adenomyosis treatment options, get to know our surgical specialists and see why they are the best in the industry.
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