Sunday, 16 February 2014
Adenomyosis is a variant of endometriosis in which the endometriotic lesions occur within the muscle wall of the uterus. The lesions caused by adenomyosis may be limited to a small area or may involve a substantial part of the uterine wall leading to a moderate increase in the size of the uterus. It may be asymptomatic in as many as one-third of patients. It frequently co-exists with fibroids and endometriosis in the pelvis. Frequently associated symptoms include painful periods, deep pain during intercourse, painful evacuation of bowels and heavy, prolonged periods. There is some evidence that by impairing implantation, adenomyosis may lead to infertility and lower chances of pregnancy after infertility treatment.
Adenomyosis can be more easily diagnosed through MRI and 3D ultrasound scan. It can often be misdiagnosed on ultrasound. Hence a possibility of adenomyosis must be kept in mind so as to diagnose correctly and plan the management as appropriate.
Hysterectomy is the most effective surgical treatment for adenomyosis but is obviously not suitable for patients who have not completed their family. The conservative options in this case would include removal of the adenomyotic area through either keyhole surgery or an open surgery. Alternatively Mirena intrauterine system or three to six month course of GnRH agonist injections can be tried immediately prior to an IVF/ICSI cycle. There is little evidence to show that corrective surgery improves fertility. As surgery involves cutting into the uterine muscles, patients who conceive after surgical removal are at an increased risk of uterine rupture in pregnancy or during labour. The patients should therefore be monitored closely and advised a planned caesarean section for delivery.