Adenomyosis Treatment at Shree IVF Clinic

What is Adenomyosis?

Adenomyosis is a condition where cells from the uterus lining grow into the uterus muscle. This condition is often confused with endometriosis, but they are quite distinct.

While endometriosis involves endometrial tissue growing outside the uterus, adenomyosis involves this tissue growing within the uterus’s muscle layers.

Adenomyosis is a gynecological condition that affects numerous women worldwide. It occurs when the endometrial tissue – the tissue that lines the uterus – grows into the uterus’s muscular wall.

This condition can lead to discomfort and severe menstrual cramps, significantly affecting a woman’s quality of life. In this guide, we will delve deeper into understanding adenomyosis, its causes, symptoms, diagnosis, types, and treatment options.

The association of Focal Adenomyosis with Endometriosis is about 70%. The association between Diffuse Adenomyosis and Endometriosis is about 60% and the association of Focal Adenomyosis of Outer Myometrium (FAOM) with Deep Endometriosis is almost 99-100%.

It’s important to understand that the pathology between Adenomyosis and endometriosis is absolutely the same and the only difference is that Adenomyosis affects the Uterus Musculature whereas endometriosis affects the rest of the pelvis.

Both diseases can cause a severe amount of Dysmenorrhea and infertility and both of them require a huge amount of expertise to be operated on and treated. Unfortunately in India at the moment, the numbers of doctors who treat this disease are very limited.

The majority of the patients who are referred to our unit headed by Dr Jay Mehta have been operated on at least once before they are sent for surgery and as a result of this the outcomes can be compromised further.

Treatment of endometriosis as we have discussed throughout on our website as well as across social media requires a lot of detailing and expertise right from the diagnosis as well as providing the most accurate surgical options.

The primary symptoms of adenomyosis include painful periods, heavy or prolonged menstrual bleeding with clotting, and abdominal/pelvic pain.

Some women may also experience bloating, a feeling of pressure in the lower abdomen, and pain during intercourse. However, it’s important to note that some women with adenomyosis may not have any symptoms.

The exact cause of adenomyosis remains unknown. However, it is believed to be estrogen-dependent or hormone-sensitive.

Factors like childbirth and uterine surgeries may disrupt the boundary of cells in the uterus, allowing the invasion of endometrial cells into the myometrium (muscular wall of the uterus).

Early diagnosis can help manage the symptoms effectively and improve your quality of life.

Dr. Jay Mehta, a top gynecologist in Mumbai, provides expert Adenomyosis treatment consultations in Pune, Chennai, Hyderabad, Bangalore, Delhi, and beyond. To Book a consultation Call at +91-99209 14115

We help a couple with Endometriosis and Adenomyosis in their journey to parenthood.

Diagnosing adenomyosis can be tricky as its symptoms often mimic other conditions like uterine fibroids and endometriosis.

Healthcare professionals use a combination of medical history, physical examination, and imaging tests like ultrasound or magnetic resonance imaging (MRI) for diagnosis.

In some cases, the definitive diagnosis of adenomyosis can only be made after a hysterectomy with a subsequent pathological examination.

 – Diffuse Adenomyosis 

This is the most common type, where the endometrial tissue spreads out within the uterine muscle.

 – Focal Adenomyosis

Also known as adenomyoma, in this type, the endometrial tissue forms a mass or cluster within the uterine wall.

The choice of treatment for adenomyosis depends on several factors, including the severity of symptoms, the patient’s age, and whether the patient plans to have children in the future.

The treatments for adenomyosis include hormonal contraceptives, medications, and surgical procedures.

Non-surgical treatments include pain medication, hormonal therapy, and the use of a levonorgestrel-releasing intrauterine device (IUD). Surgical options include uterine artery embolization, endometrial ablation, and hysterectomy (removal of the uterus).

Adenomyosis is a very common and extremely distressing disorder that predominantly goes and affects the uterine muscular region. As a result of this, it gives rise to severe pain in the abdomen and the pelvis, and this is much more common during the menstrual cycle. This is what we call Dysmenorrhea.

Adenomyosis on its own has a large variety of treatment options but we predominantly break off the treatment options into fertility-enhancing options for getting pregnant with Adenomyosis and the radical options where family is complete and removal of the uterus is offered.

It has to be noted and understood clearly that in Adenomyosis the size of the uterus is a very important aspect to be considered while offering medical management. If the size of the uterus is less than 10 cm that is typically when the medical line of management is going to work the best. If the patient is complaining of only mild pain, then painkillers would remain the treatment of choice for early Adenomyosis.

One has to also categorically understand that that if the size of the uterus is more than 10 cm, then usually no form of medical management is going to be beneficial, even if the patient is planning fertility-enhancing option. Typically when a patient is planning for fertility, we like to give a unique combination of Letrozole plus Regesterone to these patients. This is a combination that is prescribed for 100 days and it achieves about 10-15% volume reduction in Adenomyosis.

Being a referral unit for Adenomyosis in India, Dr Jay Mehta has popularized this protocol across the country, and as a result of this, a lot of women who are suffering from endometriosis and Adenomyosis and are desirous of fertility have greatly benefited.

The other type of hormonal medical management which is available and which predominantly focuses only on volume reduction is temporary and the most commonly used is a GnRH agonist depot. Unfortunately, the GN RH agonist cannot be provided to the patient for more than 3 to 4 months, and as a result of this, the benefit that the patient experiences is extremely minimal in this situation.

One of the nicer minimally invasive approaches that are available for a patient, who is having diffuse Adenomyosis, is to consider microwave ablation of the entire disease using a highly specialized probe, which is available. This particular approach was initially popularized in China and when done correctly using ultrasound or laparoscopic guidance, this can greatly benefit women who are well chosen for this procedure.

One must also remember that when microwave ablation is done, the symptomatic benefit can take approximately 3 to 4 months for the patient to start experiencing. In many situations to get the maximum benefit out of microwave ablation, it has to be combined with a laparoscopic approach in order to ensure that the disease clearance and the additions are achieved completely so that any form of complication which can then occur, can be completely prevented.

Dr. Jay Mehta and the team have performed the maximum number of microwave ablation for Asees, especially for young women who are desirous of retaining their uterus in our country and it has been broadly noted that in well-selected cases, approximately 80% of these women experience a wonderful benefit of this procedure and can conceive Within 6 to 8 months of this procedure. This is provided the rest of the fertility assessment is absolutely normal.

Finally, one has to remember that even today the best morality of treatment, why it is called as the treatment of choice remains surgical management. Surgical management for adios is very complex and requires a great depth of understanding the tissue of someone to do it successfully and nicely. An incorrectly done surgery for Adenomyosis can cause permanent infertility and as a result of women, must choose their Adenomyosis specialist or their Endometriosis specialist very very wisely.

Unfortunately, this is still the case in our country, India. A lot of patients get heavily missed, and as a result, for somebody who is a recognized super specialist for endometriosis and Adenomyosis in India, like Dr. Jay Mehta, the majority of the cases that get referred are the cases that have been operated on at least once before. This involves repeat surgery for these patients.

There is one important thing, that every patient should know before getting their surgery done especially if they desire fertility. If the EM junction, which is also called as the endometrial myometrial junction. If well preserved before the surgery, then the outcomes of the surgery to the patient are going to be excellent and done by an expert. If the EM junction is distorted, then despite the best possible surgical efforts the outcome for fertility could be low and the patient may require multiple other methods to ensure fertility.

For a Focal Adenomyosis that is more than 3cm, for any lesion of Focal Adenomyosis of Outer Myometrium (FAOM), and for any diffuse Adenomyosis where the size of the uterus is more than 10cm, surgical management is the treatment of choice. Dr Jay Mehta has taken excellent master class sessions on these topics on YouTube for the training of his fellow gynecologists across India.

Typically, these surgeries are achieved with laparoscopic surgery, which is also called as minimally invasive surgery. Dr. Jay Mehta uses the technique of ICG dye marking with Near Infra red imaging while doing this surgery and this gives a definition of the microcapillary spread of the Adenomyosis. As a result of this, the disease clearance can be optimally achieved. However, at this point the patient should note that no matter what one does. One can never remove 100% of Adenomyosis from the uterus in a fertility-enhancing surgery as some microscopic diseases get left behind.

A recent addition to our surgical armamentarium has been using a two-stage surgery combination as well as laparoscopic surgery.

Adenomyosis is a disease that is bound by a natural disease process. Unfortunately, there is no therapy which is naturally available to reduce and limit the intensity of endometriosis and Adenomyosis.

It is important to understand that this is the disease process which occurs predominantly due to an abnormal stimulation signal, which is derived from a naturally secreted hormone of the body, which is estrogen and even if one consumes or modifies treatment to reduce the estrogen levels, the effects are at their best level, pretty temporary.

 As a patient, one may scroll and find a lot of information about the possible dietary changes which could be done for a patient who is suffering from Adenomyosis, it’s very important to note that there is no specific diet recommendation for this disease. Avoiding coffee, avoiding red meat, avoiding green tea or some of the possible things which are commonly mentioned across the internet, but none of them have been proven to have any role in the disease process.  

The pain which typically occurs in this disease is extremely significant, and the patient usually will have to sort down to medical management or painkillers in order to alleviate their symptoms. 

The cost of adenomyosis surgery varies widely in India, depending on the type of surgery, the hospital, and the city.

On average, a hysterectomy can cost anywhere from INR 90,000 to INR 3,50,000. It’s important to discuss the cost and potential financial implications with your healthcare provider before making a decision.

In conclusion, adenomyosis is a complex condition that requires comprehensive care and management.

If you suspect you may have adenomyosis, seek medical attention to start the journey towards relief and recovery.

Adenomyosis has a very very severe effect as far as fertility and pregnancy is concerned. The disease itself is such that it causes a severe compromise of the anatomy of the uterus, predominantly because it causes a thickening of the posterior wall of the uterus., in such a situation, the tendency do have abortions, Pre Term labour as well as recurrent miscarriages and recurrent IVF failures are very common.

Many of the patients who have Adenomyosis need to be treated with assisted reproductive techniques especially IVF because the disease can also cause a distortion of the EM Junction, Endo-Myometrial Junction. Once the EMJ is compromised the fertility outcomes of the patient is going to be very poor, irrespective of the disease being handled by a super specialist. Though an off label use, one can try to perform a microwave ablation under laparoscopic guidance for this disease in order to reduce the intensity of the Adenomyosis and well selected patients will benefit from this

Once the patient conceives post Adenomyosis surgery, it really comes down to how well has the surgery been done for Adenomyosis. A well done surgery where the approximation of the tissue is done adequately without leaving behind any dead space in the tissue will have the best obstetrics and pregnancy outcomes for the patient. Usually we recommend a delivery of these patients at 37 weeks and the mode of choice is to deliver these patients with a cesarean section.

One must note that there is no correlation of any sort between having a uterine polyp and Adenomyosis, though occasionally both go hand in hand.

Adenomyosis is a disease of the uterine musculature and polyp is an aberration of the endometrial lining. Both are different disease processes

A polyp and Adenomyosis both can be very effectively diagnosed using ultrasound. 

It’s also interesting to note that polyp and Adenomyosis can be treated simultaneously, for a patient in the same setting.