Adenomyosis is a condition where the lining of the womb extends abnormally deep into the uterus. This is more common than previously thought (affecting up to 70% of women). Symptoms are similar to those from uterine fibroids including:
- Heavy periods and prolonged bleeding
- Severe period pain
Adenomyosis causes heavy and prolonged bleeding. The heavy bleeding caused by fibroids can lead to tiredness, fatigue and low energy due to iron deficiency anaemia. Severe pain from adenomyosis also can severely affect quality of life and sexual function.
What causes adenomyosis?
We don’t know for sure. We know there is some link to endometriosis, a condition where cells from the lining of the womb are found outside the uterus. Adenomyosis often co-exists with fibroids, adenomyosis is routinely misdiagnosed as fibroids.
How is adenomyosis diagnosed?
Adenomyosis can be identified on transvaginal US but is often missed. MRI pelvis is far more sensitive for detection of adenomyosis as well as allowing identification of all fibroids and other potential causes of symptoms such as endometriosis. Accurate diagnosis is important as this affects treatment options.
Do I need treatment?
Only patients who are symptomatic need treatment. The majority of women with adenomyosis will not be symptomatic. When they occur however symptoms can be debilitating. If you are concerned by any of the following then you may wish to consider treatment:
- Heavy bleeding with frequent changes of pads
- Having to wear double pads
- Passing large clots
- Tiredness due to anaemia
- Concerns over periods limit your work, social life or normal activities
How is adenomyosis managed?
Adenomyosis can be managed in the following ways:
- Medically – for example using contraceptive medication to control bleeding symptoms. Anti-inflammatory medications can also be used for pain.
- Surgically – options include endometrial ablation or hysterectomy. For more focal collections of adenomyosis (known as adenomyoma) there may also be other surgical options. Hysterectomy, removal of the entire uterus is a definitive treatment for symptoms but comes with the risks of anaesthesia and surgery as well as of course preventing further pregnancy.
- Uterine Artery Embolisation – this minimally invasive approach is almost identical UFE performed for uterine fibroids. This allows significant symptom control in a majority of patients and can prevent the need for hysterectomy.
The first line treatment option is medical management. Undoubtedly symptoms are best managed by an individual patient-centred approach and some women would be best served by surgery and others by embolisation. When you are seen in rooms by the IR specialist you can trust that you will be offered treatment only if it is thought to be the best option for you as an individual.
Initial patient enquiries are welcome. Send us an email or call and we will email a patient information form for you to complete.
Ask your GP to refer you for a consult. Note that consultations without a referral cannot be claimed from medicare.
After listening to your symptoms and taking a medical history we will discuss further investigations or scans needed to establish whether you are a candidate.
This will be discussed at time of consult but may include:
MRI – we know that ultrasound is poor as identifying adenomyosis and distinguishing it from fibroids (although both can be treated by embolisation). MRI is superior in establishing the full picture and planning treatment to improve your symptoms.
Pap smear – an up to date is required
Pelvic examination – a pelvic examination by a gynecologist should have been performed recently to identify any concerns over other potential causes for your symptoms.
Uterine embolisation for adenomyosis typically takes about 90 mins.
Unlike some other treatment options, embolisation is performed under sedation and local anaesthetic. The procedure itself is not painful. Pain in the hours afterwards is managed by a strong painkillers (usually a pump known as a PCA).
The procedure is performed by a specialist interventional radiologist – an expert in this area. A small plastic tube (<3mm) is placed in an artery in the wrist or groin. X-ray guidance is used to approach the artery supplying the uterus. Tiny particles, like very fine sand, are injected into these blood vessels. This causes the abnormal cells in the uterus to die improving your symptoms. Any fibroids present will also be improved by this treatment. There is no abdominal incision or scar.
You will stay overnight, if pain is controlled and you can eat and drink you will go home the next morning.
You will have to avoid exercise, heavy lifting etc for 5-7 days. To reduce risk of infection you will have to avoid bathing, tampons and intercourse for one week. It is common to feel tired and have a low fever for the first few days. By the end of the first week you should be feeling almost normal. 99% of women return to work at this point.
UAE is an excellent option if your adenomyosis symptoms are poorly controlled on medication but you do not want surgery.
It preserves the uterus should you potentially wish to have children (see UAE and fertility) It avoids a scar. The recovery period is much shorter than for surgical treatments.
An excellent evidence base exists for embolisation in the context of fibroids. We know major complications are rare.
UFE is supported by the UK NICE who state that the UAE for adenomyosis is safe and effective. The success rate is lower than for fibroids but still is greater than 80%. Importantly embolisation can help women avoid hysterectomy. Those who do not have satisfactory symptom relief from embolisation can still proceed to hysterectomy.
No, it has been used for over 20 years and has been studies in many gold-standard research papers. It is approved by Medicare for the treatment of fibroids. NICE, the standards body in the UK approve it as a treatment option.
This can be established based upon your MRI. You might have an adenomyoma best treated surgically. If your family is complete you may wish definitive treatment (hysterectomy) and accept the associated surgical risks. You can discuss this at your consult.
Symptoms can recur, some women who initially respond well will see symptoms return after a few years.
It is normal to feel tired and weak for a few days afterwards.
There is a risk of infection which in the worst cases can result in a hysterectomy being required – this is very rare.
The effects of the embolisation technique for adenomyosis (which is slightly different to that for fibroids) is less well known.
Fertility problems can be because of adenomyosis and coexistent fibroids. Treatment of these conditions may therefore improve chances of becoming pregnant.
NICE in the UK recommend UAE for women with adenomyosis who wish to preserve fertility and avoid hysterectomy.
It is advised not to attempt to become pregnant for 6 months after UAE to allow the lining of the womb time to recover.
No. It is however best for those who wish to avoid surgery and try a minimally invasive option first.
UAE is a minimally invasive and effective treatment with a quicker recovery and fewer complications than surgical options.