Adenomyosis and Hysterectomy

Treatment of uterine abnormality considered a last resort

Woman with cramps
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A hysterectomy is the surgical removal of all or part of a woman’s uterus. It is a procedure that is sometimes used to treat cancer, chronic pain, heavy bleeding, or other serious disorders of the uterus.

One of the conditions treated by a hysterectomy is called adenomyosis, a condition where the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus.

Understanding Adenomyosis

Adenomyosis is not a life-threatening condition but one that can seriously impact a woman's quality of life.

Symptoms include cramping, heavy periods, clotting, lower abdominal pain, and bloating. The condition can develop throughout the entire uterus or be localized to just one spot.

Adenomyosis is most often diagnosed in middle-aged women who have had children. A prior uterine surgery may also increase the risk.

Adenomyosis is often mistaken for another condition called uterine fibroids. These are noncancerous growths in or on the uterine wall as opposed to adenomyosis which has a less defined structure. Diagnosis is typically made using either a transvaginal ultrasound or a magnetic resonance imaging (MRI) scan. An MRI is more commonly used if a woman is experiencing heavy bleeding.

Non-Surgical Treatment Options

Treatment for adenomyosis depends largely on the severity of symptoms. Mild symptoms can often be treated with over-the-counter pain medications and a heating pad to help relieve cramping.

Among the other options:

  • Hormone therapy can help ease heavy or painful periods.
  • Uterine artery embolism is a technique in which a catheter feeds tiny particles into a uterine artery to block blood flow to affected tissue,
  • Endometrial ablation is a minimally invasive procedure which destroys (ablates) parts of the uterine lining to relieve pain.
  • Laparoscopic surgery is the gold standard for minimally invasive removal of adenomyotic tissue. Using specialized equipment and a keyhole incision, the surgeon can precisely view and remove any abnormal tissue.

When Hysterectomy Is Indicated

A hysterectomy is only indicated if a woman's quality of life has been seriously affected and all other treatment options have been exhausted.

With that being said, the only complete cure for adenomyosis is a hysterectomy. Unlike fibroids, which are often surrounded by a capsule, there is no clear border between abnormal and normal uterine tissue. Because of this, the condition can commonly recur even after ablation or embolism.

Depending on the situation, there are several advantages to a hysterectomy:

  • The likelihood of further treatment is reduced.
  • If you are beyond your child-bearing years, it is much more definitive treatment.
  • If there are other co-existing conditions, such as endometriosis, it may be easier to treat them all at once.

How the Procedure Is Performed

There are several types of hysterectomy that can be used to treat adenomyosis. The surgical approach is based largely on the extent of endometrial penetration.

A total hysterectomy (involving the removal of the uterus and cervix) or a subtotal hysterectomy (in which only the upper portion of the uterus is removed) are only used in cases where adenomyosis is widespread.

Irrespective of the procedure used, a hysterectomy is performed under general anesthesia and involves the separation of the uterus from the tissues that hold it in place. Once the uterus is removed, the incision wound is closed with staples, sutures, absorbable sutures, or sterile tape.

Post-Surgical Recovery

Most women undergoing a hysterectomy can go home within 48 hours of the operation and return to their usual activities within two weeks. After undergoing a hysterectomy, it is not uncommon for a woman to experience a range of menopausal symptoms, including:

All hysterectomy procedures, irrespective of type, will end a woman's ability to conceive. The emotional aftermath can be devastating to a woman, particularly if planning a family. It is for this reason that a hysterectomy should always be considered a last resort when there is no other way to treat the disability or pain caused by adenomyosis.

Source:

American College of Obstetrics and Gynecology. "Hysterectomy: FAQs." Washington, D.C.; updated March 2015.

Tosti, C.; Troìa, L.; Vannuccini, S. et al. "Current and future medical treatment of adenomyosis." J Endometr Pelvic Pain Disord. 2016; 8(4):127-135. DOI: 10.5301/je.5000261.

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