Ovan.info

Hysterectomy is currently considered by most the only effective treatment for symptomatic adenomyosis. In recent years I have successfully treated many patients with adenomyosis by removing only the part of the uterus containing the bulk of the disease (as carefully defined by transvaginal ultrasound) followed by reconstruction of a close-to-normal size uterus.

Frequently the moderately enlarged uterus is asymptomatic and no treatment is necessary. In symptomatic cases, with heavy bleeding and pain, birth control pills and progestins are usually an ineffective treatment, or offer only temporary or partial relief. Temporary relief of very painful heavy periods can be achieved with GnRH agonists such as Lupron.

However, both MRI and ultrasound may yield a false positive diagnosis (diagnosing adenomyosis erroneously) especially in the presence of fibroids, even small ones. The fibroids alter the vascularity and appearance of the surrounding myometrium and this may lead to the wrong diagnosis of adenomyosis.

Adenomyosis is frequently an incidental, clinically unsuspected, finding in uteri removed for other reasons. Occasionally adenomyosis is diagnosed by an hysterosalpingogram (pelvic x-ray after filling the uterus with a contrast medium).

Adenomyosis may be present and cause no symptoms. When this condition presents with symptoms the typical triad is uterine enlargement, pelvic pain and heavy menstrual bleeding.