Adenomyosis Treatment: Diagnosis, Medication & Surgery

Risk Factors for Adenomyosis

Certain factors increase the likelihood of developing adenomyosis, including:

• Women between 35 and 50 years of age
• Previous pregnancy or childbirth
• History of cesarean delivery
• Prior uterine surgery
• Endometriosis
• Uterine fibroids
• Prolonged exposure to estrogen
• Obesity
• Family history of uterine disorders

Having one or more risk factors does not necessarily mean that a woman will develop adenomyosis, but regular gynecological evaluations can help detect the condition early.

Diagnosis of Adenomyosis

Diagnosing adenomyosis can be challenging because its symptoms often resemble those of uterine fibroids, endometriosis, or pelvic inflammatory disease. A thorough clinical evaluation and imaging tests help confirm the diagnosis and rule out other conditions.

Medical History

Your gynaecologist will discuss your menstrual history, pain severity, bleeding pattern, previous pregnancies, and any prior uterine surgeries.

Pelvic Examination

A pelvic examination helps assess whether the uterus is enlarged, tender, or irregular in shape, which may suggest adenomyosis.

Transvaginal Ultrasound

This is the first-line imaging test for diagnosing adenomyosis. It provides detailed images of the uterus and may reveal thickening of the uterine muscle, cystic spaces, or an enlarged uterus.

MRI Scan

Magnetic Resonance Imaging (MRI) provides highly detailed images of the uterus and is especially useful when ultrasound findings are inconclusive or when differentiating adenomyosis from fibroids.

Blood Tests

Blood tests may be recommended to evaluate anemia caused by excessive menstrual bleeding and assess your overall health before planning treatment.

Treatment for Adenomyosis

The treatment for adenomyosis depends on the severity of symptoms, the woman’s age, reproductive goals, and the extent of the disease. Women with mild symptoms may benefit from conservative treatment, while severe or persistent cases often require surgical intervention for long-term relief.

Non-Surgical Treatment for Adenomyosis

The treatment approach for adenomyosis depends on the severity of symptoms, the patient’s age, and whether she wishes to have children in the future. Women with mild to moderate symptoms can often manage the condition with non-surgical treatments aimed at reducing pain, controlling heavy menstrual bleeding, and improving quality of life.

1.Pain Relievers (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are commonly prescribed to relieve menstrual cramps and pelvic pain associated with adenomyosis. These medications work best when started one or two days before menstruation and continued during the menstrual cycle.

2.Hormonal Therapy

Hormonal medications help regulate menstrual cycles and reduce excessive bleeding by controlling estrogen levels. Common options include:

• Birth control pills
• Progesterone-only pills
• Hormonal intrauterine device (LNG-IUD)
• Injectable contraceptives
• GnRH agonists in selected cases

Although hormonal therapy can effectively manage symptoms, it does not permanently cure adenomyosis, and symptoms may return after treatment is discontinued.

3.Lifestyle Modifications

Healthy lifestyle habits can help improve symptom management alongside medical treatment. Your doctor may recommend:

• Maintaining a healthy body weight
• Regular low-impact exercise
• Stress management through yoga or meditation
• Eating an iron-rich diet to prevent anemia
• Applying heat therapy to relieve pelvic pain

Women with persistent or severe symptoms despite conservative treatment may require surgical intervention.

Surgical Treatment for Adenomyosis

Surgery is usually recommended when medications fail to provide adequate relief or when adenomyosis significantly affects daily life. The choice of surgery depends on the patient’s age, severity of disease, and future fertility plans.

1.Adenomyomectomy

For women who wish to preserve fertility, an adenomyomectomy may be considered in carefully selected cases. This procedure removes localized adenomyotic tissue while preserving the uterus. However, it is not suitable for all patients, particularly those with diffuse adenomyosis.

2.Laparoscopic Hysterectomy

Laparoscopic hysterectomy is considered the gold-standard surgical treatment for women with severe adenomyosis who have completed their family. During this minimally invasive procedure, the uterus is removed through small keyhole incisions using a laparoscope and specialized surgical instruments.

Compared with conventional open surgery, laparoscopic hysterectomy offers:

• Smaller incisions
• Less postoperative pain
• Minimal blood loss
• Lower risk of infection
• Shorter hospital stay
• Faster recovery
• Better cosmetic results

3.Open Hysterectomy

In certain situations, such as a significantly enlarged uterus or complex pelvic anatomy, an open hysterectomy may be recommended. The surgeon removes the uterus through a larger abdominal incision. Although recovery takes longer than laparoscopic surgery, it remains a safe and effective treatment when minimally invasive surgery is not feasible.

How is Laparoscopic Hysterectomy Performed?

Laparoscopic hysterectomy is performed under general anesthesia and usually takes between 60 and 120 minutes.

The procedure generally involves the following steps:

Step 1: General anesthesia is administered to ensure a painless procedure.

Step 2: Three to four small incisions are made in the abdomen.

Step 3: A laparoscope equipped with a high-definition camera is inserted to provide a magnified view of the pelvic organs.

Step 4: Specialized instruments are used to carefully separate the uterus from the surrounding tissues while preserving nearby structures whenever possible.

Step 5: The uterus is removed through the vagina or via one of the small abdominal incisions.

Step 6: The incisions are closed using absorbable sutures, and the patient is shifted to the recovery room for monitoring.

Most patients are discharged within 24 to 48 hours after surgery.

What Happens During Surgery for Adenomyosis?

Step 1 · 30-60 mins

Hospital Admission

The patient arrives at the hospital on the scheduled day of surgery.

Registration and admission formalities are completed.

Vital signs such as blood pressure, pulse, temperature, and oxygen levels are checked.

Blood tests, imaging reports (ultrasound or MRI), and pre-operative investigations are reviewed to confirm fitness for surgery.

The gynecologist reviews the patient's symptoms, previous treatments, and surgical plan.

Step 2 · 30–45 mins

Pre-surgery Preparation

The gynecologist confirms the planned procedure, which may be laparoscopic adenomyomectomy (removal of adenomyosis while preserving the uterus) or hysterectomy (removal of the uterus) depending on the severity of the condition and the patient's fertility goals. ✔ The anesthetist performs a final pre-anesthesia evaluation.

The anesthetist performs a final pre-anesthesia evaluation.

The procedure, expected outcomes, benefits, recovery, and possible risks are explained, and informed consent is obtained.

An IV line is inserted for fluids, medications, and anesthesia.

Compression stockings or pneumatic compression devices may be applied to reduce the risk of blood clots.

The patient is shifted to the operation theatre.

Step 3 · 10–20 mins

Anesthesia Administration

General anesthesia is administered to ensure the patient remains asleep and pain-free throughout the procedure.

The surgical area is cleaned with an antiseptic solution and sterile drapes are placed.

A urinary catheter may be inserted to keep the bladder empty during surgery.

Step 4 · 1–3 hours

Adenomyosis Surgery

The surgeon performs the procedure using the most appropriate surgical approach, usually laparoscopic or robotic-assisted surgery, depending on the patient's condition.

For women who wish to preserve fertility, the adenomyotic tissue may be carefully removed while preserving the uterus (adenomyomectomy).

In severe cases or when childbearing is complete, a hysterectomy (removal of the uterus) may be recommended.

Bleeding is controlled, and the incisions are closed with sutures or surgical glue.

Step 5 · 1–2 hours

Post-surgery Care

The patient is shifted to the recovery room for observation.

Nurses monitor blood pressure, pulse, oxygen levels, pain, and overall recovery.

Once fully awake and stable, the patient can begin drinking fluids and gradually resume a light diet.

Pain medications and antibiotics are administered as needed.

Step 6 · Same Day to 2–3 Days

Discharge

Most patients undergoing laparoscopic surgery are discharged within 1–2 days, while those undergoing an open procedure or hysterectomy may require a longer hospital stay.

Medications for pain relief and infection prevention are prescribed.

The patient receives instructions on incision care, activity restrictions, and follow-up appointments.

They should contact their doctor immediately if they experience high fever, severe pain, heavy bleeding, wound discharge, or difficulty passing urine.

Risks of Delaying Adenomyosis Treatment

Ignoring persistent adenomyosis symptoms may lead to several complications, including:

• Chronic pelvic pain
• Severe menstrual cramps
• Heavy menstrual bleeding
• Iron-deficiency anemia
• Enlarged uterus
• Fatigue and weakness
• Reduced quality of life
• Emotional stress and anxiety
• Fertility challenges in some women

Early diagnosis and timely treatment can help prevent these complications and improve long-term health outcomes.

When Should You Consult a Gynaecologist for Adenomyosis?

Consult a gynaecologist if you experience:

• Heavy periods lasting longer than 7 days
• Severe menstrual pain that affects daily activities
• Pelvic pain between periods
• Pain during intercourse
• Large blood clots during menstruation
• Difficulty conceiving
• Symptoms of anemia such as fatigue and dizziness
• Heavy bleeding despite medication

Early diagnosis can prevent worsening symptoms and improve treatment outcomes.

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