Adenomyosis is a condition affecting the uterus, characterized by the growth of tissue that normally lines the uterus into its muscular wall. This condition can result in extended menstrual bleeding, severe menstrual cramps, and pelvic pain during sexual activity. In a discussion with HT Lifestyle, Dr. Dhatchayani S, a consultant in obstetrics and gynecology at Manipal Hospital, Sarjapur Road, stated, “Adenomyosis is a chronic and painful condition that impacts approximately 20-65% of adult women. It occurs when the endometrial glands and stroma invade the myometrium, which is the muscular layer of the uterus.”

The gynecologist further noted that although adenomyosis is relatively common, it is frequently confused with endometriosis due to similar symptoms.

Early symptoms of adenomyosis:

“While pain is a hallmark symptom of adenomyosis, around one-third of women affected may not exhibit any symptoms and are diagnosed incidentally during gynecological or pelvic examinations for unrelated issues,” Dr. Dhatchayani S explained. The symptoms to be aware of are:

• Intense menstrual pain, particularly on the second day of the cycle
• Pain during intercourse (dyspareunia)
• Persistent pelvic pain
• Irregular vaginal bleeding
• Infertility, as adenomyosis can diminish the likelihood of implantation, thereby lowering pregnancy rates and increasing the risk of miscarriage. However, hormonal treatment prior to pregnancy may enhance outcomes.

Who is at risk of adenomyosis?

• Women aged over 35
• Those who have had multiple pregnancies (multiparous women)
• Individuals with a history of cesarean sections or uterine surgeries
• Co-occurrence with conditions such as endometriosis or fibroids

Complications caused by adenomyosis:

Adenomyosis extends beyond merely being a menstrual issue, as highlighted by Dr. Dhatchayani S. The physician elaborated on the potential complications arising from this condition:

• Infertility occurs in 22-25% of cases.
• Pregnancy-related risks include preterm labor, premature rupture of membranes, low birth weight, and miscarriage.
• The condition predominantly affects women under 40 and those aged 40-50.

Treatment options:

"The management of adenomyosis encompasses both medical and surgical strategies," the gynecologist stated.

Medical managament:

• First-line treatment involves GnRH agonists.
• Additional medications include oral contraceptives (OCPs), progesterone, and Dienogest (a progestin).
• The Levonorgestrel intrauterine system (LNG IUS) is an option for individuals who have completed their families but wish to preserve their uterus.

Surgical management:

• Conservative fertility-preserving options consist of endometrial microablation, hysteroscopic adenomyoma resection, and laparoscopic adenomyomectomy.
• Hysterectomy is advised for women over 40 who have completed their families and in instances where medical treatments have proven ineffective.

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