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Tuesday, 22 January 2013

Adenomyosis/ Endometriosis ( Heavy + Painful periods )

Adenomyosis is a very common condition and is very easily missed in a gynaecological examination. It is a condition in which the endometrium which lines the cavity of the womb somehow penetrates the muscle protruding into the myometrium. It can be focal ie isolated pockets in the womb or diffuse and extensive causing the whole womb to enlarge.
The most common symptoms are heavy and painful periods. This condition commonly coexists with other disorders such as fibroids, endometriosis and polyps. No one knows the cause, but it is thought to be due to an imbalance in the hormones. The pain during periods is due to the ectopic endometrial cells bleeding into the muscle of the womb and the heavy periods due to the whole surface area of the womb being enlarged.
It is typically diagnosed on ultrasound scan of the pelvis and on MRI.
I recently performed a removal of the adenomyosis on a 39 year old lady. She was single. This was unusual as adenomyosis most often affects those who have had pregnancies or previous surgery to the womb. She came with the problem of severe period pains and backache, pain radiating down to her thigh and leg. At the time of surgery, the back of the womb was filled with a large adenomyoma and the womb was stuck to her rectum and intestines at the back. She in addition had endometriotic cyst of her ovary and a polyp in the cavity of her womb. The surgery was performed through a conventional open method rather than through key-hole surgery as it would be impossible to remove the adenomyoma entirely otherwise and thereby risking a higher chance of recurrence.
Surgery would be the primary form of treatment in severe cases and very often if the patient has completed her family a hysterectomy would be recommended. In less severe cases, other forms of treatment can be tried such as Lucrin injections to induce a chemical menopause, inserting a mirena device.