The only surgical treatment for adenomyosis is hysterectomy, that is, uterus removal. However, it permanently ends the woman’s capability to give childbirth.

Therefore, it is only performed at later ages when the family is complete and there is no desire for further childbirth or the condition severs and the pain becomes extremely unbearable. It can be performed through either of the two methods-

• Open-cut Hysterectomy: This is a conventional method of uterus removal, done through an open-cut incision and stitches. Typically, it costs an average of Rs. 55,000 to 65,000 in India.
• Laparoscopic Hysterectomy: This is an advanced and minimally invasive method of uterus removal. The surgery is commonly called keyhole surgery and costs an average of Rs. 75,000 to 1,00,000 in India.

While adenomyosis does affect a woman’s fertility at times, it is not extremely common. Therefore, the exact cause must first be diagnosed through a detailed diagnostic hystro-laparoscopy. Here, both- the uterus and abdomen are examined to understand the gaps in fertility. Basis the specific reason, the corresponding fertility support method is suggested. Some of the commonly suggested and successful fertility treatments for adenomyosis include assisted reproductive technology. These are:

• Invitro-fertilization (IVF): For female factor fertility issues where the partner’s sperms are healthy and motile.
• Intracytoplasmic sperm injection (ICSI): For female factor fertility issues where the partner’s sperms are of lower health and motility.

•  Surrogacy: For female factor fertility issues where the uterus is unhealthy for conception. 

• Abdominal/ Open cut Hysterectomy: Here, your gynecologist makes an open cut incision in your lower abdomen and manually removes the uterus. The site is then closed with self-dissolving sutures and substantial recovery can be expected in 5-6 weeks.
  
• Vaginal Hysterectomy: This method is particularly performed only in cases of uterine prolapse. Here, your gynecologist removes the already prolapsing uterus from the vaginal route. Post excision, fine absorbable sutures are made close to the surgical site. The procedure is comparatively simpler to abdominal Hysterectomy and substantial recovery can be expected in 1-2 weeks.
• Total Laparoscopic Hysterectomy (TLH): Here, the uterus removal is performed using an advanced medical tool- laparoscope, that is, a tiny, specialized catheter with a camera and light on its end.First, your gynecologist makes 4-5 keyhole-sized ports in your lower abdomen and inserts a laparoscope. The laparoscope gives a magnified view of the otherwise smaller and narrower organs. It thus helps your surgeon achieve more precision with better clarity. The uterus and its supporting organs are then separated using ultrasonic energy to minimize blood loss. Once separated, the uterus is removed through the vaginal route. While most of the laparoscopic keyholes (lesser than half an inch) heal by themselves, the one keyhole larger than 1 cm, is closed with a suture. Few sutures are also made at the birth canal route. However, they are very few in comparison to abdominal Hysterectomy and recovery can be expected within 1-2 weeks.

Following are a list of ways through which you can prepare well for hysterectomy surgery:

• Confirm all your current medications, supplements, and herbal potions to your doctor. Certain medicines, such as ibuprofen, insulin, or blood thinners may be required to halt for a few days. This is because they can hamper the surgery and risk excessive bleeding during the procedure.
• No surgery can be performed with imbalanced BP or sugar levels. This is why they must first be brought under control to proceed with the surgical treatment.
• Do not eat or drink anything at least 4-6 hours before the surgery. Else, it may cause anesthesia-related complications.
• Limit smoking/ drinking and use of recreational drugs at least two weeks before the surgery.
  
• Do not shave the surgical site yourself. A simple cut may infect the site and cause complications.
• Carry a pair of loose cotton clothing to change into after your surgery.
• Carry a pack of soft sanitary pads to use for post-surgical bleeding.

• Hysterectomy surgery is always performed under the influence of general anesthesia. Hence, it is completely painless.
• The surgery may take anywhere between 60-90 minutes. 

• As you wake up from the effects of anesthesia, you’ll feel considerable relief in the abdominal area. However, you might feel slight discomfort, pull, and itching at the surgical site. For the same, you will be provided with mild painkillers and antibiotics.
• In the case of laparoscopic hysterectomy, you may be discharged after 1-day hospitalization.  In the case of conventional open cut surgery, 2-3 days of hospitalization may be required.

Before the final hysterectomy procedure, the patient with adenomyosis would experience extremely sharp and knife-like pain during each menstrual cycle. The uterus removal surgery would bring an end to this painful experience. 

However, note that hysterectomy permanently ends the woman’s capacity of child-birth. Hence, if you desire a child, we suggest you consult the doctor for alternative treatment options before hysterectomy.