What are the best treatments for adenomyosis

Do you know what adenomyosis is? Dr. Alicia Vázquez will explain it to you!

Today we would like to introduce you to Dr. Introducing Alicia Vázquez Sarandeses, the gnyecologist recently joined the Tambre team to help make the dreams of all patients who visit us come true. We're talking to Dr. Vázquez on a very interesting topic: adenomyosis, a common disease that is sometimes associated with other diseases such as Fibroids is confused. Would you like to hear what our new specialist has to say on this topic? Read on now!

 

To start with the topic, what is adenomyosis?

Adenomyosis is a disease that is characterized by the presence of uterine lining glands in the myometrium. In the uterus we find the so-called endometrium, consisting of an inner layer that lines the uterus (shed during menstruation and rebuilds during the cycle) and an outer muscle layer (also called the myometrium) that the walls of the uterus forms. Ultimately, adenomyosis describes the presence of endometrial tissue in the myometrium.

Why does adenomyosis occur?

The cause of adenomyosis is not yet known with certainty. The area that separates the endometrium from the myometrium is where the uterine contractions occur during the menstrual cycle. Changes in the pattern of these contractions in women with adenomyosis have been observed in various studies. Therefore, it is believed that the dysregulation of the contractile mechanism may be the cause of this pathology. Either through change (dysperistalsis) or through excessive contractions (hyperperistalsis).

This mechanism, based on the contractile changes in the uterus, is also seen in some women with endometriosis.

 

Is adenomyosis linked to endometriosis or other pathologies?

Adenomyosis can occur in women who also have other uterine fibroids or who have endometriosis. In these cases, the coexistence of fibroids or endometriosis with adenomyosis means that affected women are more likely to complain of pelvic pain and that this pain is also more severe.

It is important to note that in cases where endometriosis is present in addition to adenomyosis, the impairment of fertility and reproductive capacity may be greater.

 

How is it diagnosed?

The diagnosis is made through imaging tests such as:

  • Gynecological ultrasound
  • Magnetic resonance
  • Hysteroscopy, which enables a direct visualization of the uterine cavity and a comprehensive assessment of this and the possible impairment if this is due to adenomyosis.

In addition to imaging tests, we are guided by the symptoms women are complaining about and thus lead us to suspect that they might be affected by the condition.

 

What symptoms are characteristic of adenomyosis?

  • About 30% of women with adenomyosis are asymptomatic. A determination is usually made when performing a gynecological ultrasound during an examination or at the time of the start of treatment. However, most show the following symptoms:
  • Pelvic pain: Pelvic pain associated with adenomyosis can occur as a result of these or as the coexistence of other conditions. We can observe severe pain during menstruation (dysmenorrhea), pain during sexual intercourse (dyspareunia) or chronic pelvic pain.
  • Abnormal bleeding: Although this symptom is more common in nulliparous women, it can also occur in any woman with adenomyosis. It is believed that factors such as a larger uterus (common in adenomyosis), an increase in the number of blood vessels in this area, changes in uterine contractions, or increased hormone production can be causes of this bleeding.
  • Impairment of fertility: Many studies have found adenomyosis in a high percentage of women who have sought advice about fertility problems. It is known that adenomyosis can affect a woman's fertility and also the development of pregnancy.

Are there different classes, types or levels?

To date there is no classification for adenomyosis. Several groups of experts have proposed different classifications, but these have not been officially confirmed.

There was also no agreement on possible degrees of adenomyosis, as it can affect many areas: from a slight thickening of the interface area (contact area between the endometrium and myometrium) to extensive lesions that affect much of the myometrium. Depending on the extent of the adenomyotic lesions, there is a classification according to levels from I (slight infestation) to IV (higher infestation level). However, as mentioned above, none of these classifications have been adopted or validated by the various scientific reference societies.

When examining adenomyosis, we will find several factors: extent, infestation, location, appearance of the lesions ... all of them must be carefully assessed in order to obtain an accurate diagnosis and to know the possible consequences.

What possible treatments or surgeries can be done to relieve adenomyosis?

We need to be aware that while adenomyosis can cause a variety of symptoms that can affect our quality of life and fertility, it is nonetheless a benign condition.

There is still a great lack of knowledge about this condition, so there is no official treatment method yet. But there are several therapeutic options. Basically, we can differentiate between the following methods:

  • Medical treatment: Anti-inflammatory and hormonal treatments (hormone IUDs, progesterone tablets, combination contraceptives, analogs of gondotropin-releasing hormone (a-GNRH)).
  • Surgical treatment: (In very specific cases and to be assessed individually) Generally not recommended for women who want to have children. Surgical options can include a myometrial wedge resection or adenoidectomy.
  • In general, we recommend analogues with gondotropin-releasing hormone (a-GNRH) for women who want to have children, which have proven effectiveness in these cases. It can occur before the start of fertility treatment or after the egg cells have been removed and before the embryo transfer. Each case must be assessed individually.

 

How does an adenomyosis diagnosis affect fertility?

Some studies have shown that changes in the regulation of contractions can affect sperm transport through the fallopian tubes. Adenomyosis can also negatively affect embryo implantation and thus fertility. The diagnosis is associated with a lower chance of conceiving and a higher chance of miscarriage. Many studies have found adenomyosis in a high percentage of women who have sought advice about fertility problems.

If there is any suspicion, it is important to have yourself examined to determine whether it is indeed adenomyosis and, if so, whether you are in a preoperative condition.

Uterine normality is important for proper reproductive development. In the case of fertility problems, this uterine integrity is essential for the success of fertility treatments. Therefore, examining the uterus should not be limited to just the uterine cavity and a global assessment of the uterus: the endometrial cavity and wall myometrium and the relationship between the two should also be examined.

 

What would fertility treatment for a patient with adenomyosis at Clínica Tambre look like?

In our clinic, we will fully examine the affected patient in order to have a detailed diagnosis and to be able to choose the best reproductive technique so that we can achieve the best results.

There are various possibilities and therapeutic processes for the fertility patient. Therefore, an accurate, individual diagnosis is key to choosing the best treatment modality for your particular case.