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Adenomyosis
Adenomyosis is a pathological condition when the endometrium (uterine lining) is located in the wall of the uterus.
Adenomyosis is not the same as endometriosis and represents a special pathological condition.
It can be diffuse or localized (focal, adenomyoma) in a specific area of the uterine wall.
- Heavy menstrual bleeding;
- Menstrual pain;
- Chronic pelvic pain;
- Painful and uncomfortable urination;
- Pain during sexual intercourse;
- Infertility.
- It is not possible to say exactly how common adenomyosis is.
- It also occurs in younger women, but adenomyosis is more common in women in their forties and fifties.
- In women whose uterus was removed due to bleeding, adenomyosis was confirmed in 40-70%, while it occurs in 20-90% of women with endometriosis.
- early onset of menstrual bleeding;
- multiple births;
- menstrual cycle shorter than 24 days;
- obesity;
- surgeries and interventions on the uterus.
How is adenomyosis diagnosed?
- conversation with the patient (anamnesis);
- gynecological examination;
- vaginal ultrasound examination;
- magnetic resonance imaging;
- hysteroscopy
Treatment of adenomyosis in Gyn. Fertility Clinic Milenković
- symptomatic therapy against pain and heavy bleeding (non-steroidal pain relievers-NSAIDs and tranexamic acid);
- hormonal therapy
- progesterone-based hormonal coil;
- tablets and injections of synthetic progesterone;
- injections of gonadotropic-releasing hormone (GnRH analogue).
Surgical treatment of adenomyosis
- If the woman has completed her reproductive period, and has pronounced symptoms-the treatment is hysterectomy..
- Heavy bleedings are treated by hysteroscopy (by hysteroscopic resection of the endometrium).
- If the woman has not finished giving birth it is possible to remove focal adenomyosis. In the Gyn. Fertility Clinic Milenković, this operation is performed as an open surgery - laparotomy (an operation where a classic open incision is made on the abdomen).
Laparotomy
Diagnostics of adenomyosis is carried out in the Gyn. Fertility Clinic Milenković.
Open surgeries-laparotomies are performed in a partner hospital.
- The staff from the clinic contacts the hospital and arranges admission.
- The patient's blood count and blood type are taken, as well as any other blood tests
- Food and water are not allowed for 6-8 hours before the surgery.
- Upon admission to the hospital, the patient gets her own room, takes a shower with an antiseptic agent if she is in good general condition.
- The anesthesiologist conducts an interview and examination before going to the operating room, possibly in the operating room depending on the degree of urgency.
- A catheter is inserted into the patient's urinary bladder;
- After preparing the operative field and obtaining general anesthesia, a low transverse incision is made 2-3 cm above the pubic bone in the length of about 7-8 cm, but it can be extended if necessary;
- If the patient has an incision from a previous abdominal surgery, the cavity is opened according on the old incision;
- The preparation, that is, the tissue removed from the organism, is sent for histo-pathological examination;
- The anterior abdominal wall is sutured in layers;
- It is not necessary to remove the sutures from the skin;
- Skin incisions are sutured with thread that does not need to be removed;
- A protective patch is placed on the incision, which is removed after 5-6 days.
- The patient returns to the patient room and is given pain and nausea medications;
- 3-4 hours after the operation, the patient begins to drink liquids, and then she is given light food;
- The catheter is removed from the urinary bladder no later than 24 hours after the operation;
- It is desirable that the patient gets out of bed with the help of the staff 2-3 hours after the operation;
- Sometimes a blood transfusion is needed;
- The patient can take a shower on the same day or on the day after the operation with the help of the staff;
- The woman is most often discharged from the hospital two or three days after the operation, sometimes even on day the after the operation itself.
- It is advised to take the time off from work for 2-3 weeks, possibly longer if the patient is not feeling well.
- The protective patch is removed after 5 days, while the sutures do not need to be removed;
- Complications are very rare. If there is scanty bleeding or secretion from the wound, it is recommended to wash it exclusively with saline solution;
- In case of elevated temperature, pain or conditions that deviate from normal, the patient contacts the clinic or the hospital;
- The patient gets informed on the result of the histopathological analysis;
- Check-up is usually 3-4 weeks after the surgery.
- The patient can start physical training and sexual intercourses 3-4 weeks after the operation.
- Pregnancy can be planned 3-4 months after the operation.
- Cesarean delivery is advised because of the increased risk of uterine rupture during childbirth, which is higher than after myoma surgery or a previous cesarean section.
Expert advice: frequently asked questions
Answered by: Milan Milenković MD, PhD
Does adenomyosis increase the risk of cancer?
Adenomyosis is not a risk factor for the development of cancer.
Can adenomyosis go away without treatment?
Adenomyosis disappears in menopause.
Does adenomyosis cause infertility?
Adenomyosis reduces the chance of pregnancy by disrupting the implantation of the embryo and the formation of the placenta.
Can adenomyosis lead to complications in pregnancy?
Adenomyosis increases the risk of spontaneous abortion and of premature birth.
Is spontaneous pregnancy possible in women with adenomyosis?
Spontaneous pregnancy is possible in women with adenomyosis.
Does adenomyosis affect the result of IVF procedures?
Studies with donated eggs have shown that adenomyosis does not affect the percentage of pregnancies after IVF, but there is an increased risk of spontaneous abortions. Several studies where one's own egg cells were used showed a negative effect of adenomyosis on the outcome of the IVF procedure.
What are the complications of adenomyosis?
Adenomyosis disrupts the quality of life, especially in the case of severe pain and heavy bleeding. There are no serious complications.
If you have additional questions, please feel free to contact us.
You can expect an answer during office hours, from Monday to Friday, between 9 a.m. and 7 p.m.
