In this article
South Island Interventional Radiology in Christchurch assesses patients from across the South Island for image-guided treatments, including treatment for selected patients with adenomyosis. Contact the team to discuss your symptoms and available options.
What is adenomyosis?
Adenomyosis occurs when tissue similar to the womb lining is present within the muscular wall of the uterus. It can cause the uterus to enlarge and lead to heavy or painful periods, although some people have no symptoms. Its exact cause is unclear. Adenomyosis differs from endometriosis, in which similar tissue occurs outside the uterus, such as around the ovaries or elsewhere in the pelvis. The two conditions can occur together.
Common symptoms
Adenomyosis symptoms can vary from woman to woman, but heavy menstrual bleeding and increasingly painful period pain are two of the most frequent symptoms. Some other common symptoms are chronic pelvic pain, abdominal bloating, fatigue, painful sex and lower abdomen pressure.
Diagnosis
Assessment usually starts with a discussion of symptoms and, when appropriate, a pelvic examination. Pelvic ultrasound, often transvaginal ultrasound with your consent, is usually the first imaging test. MRI may help if the diagnosis is uncertain or when planning treatment. Blood tests may be needed to check for anaemia and iron deficiency when bleeding is heavy.
Non-surgical treatments
Medicines are usually tried first. Options may include treatment to reduce bleeding or pain and hormonal treatment, such as a levonorgestrel-releasing intrauterine device. Uterine artery embolisation (UAE) may be considered for selected patients with persistent symptoms. It is a minimally invasive procedure using a catheter and particles to reduce blood flow to affected uterine tissue. It can improve bleeding and pain, but symptoms may persist or recur and further treatment may be needed. Effects on future fertility and pregnancy remain uncertain.
UAE can cause significant cramping and other temporary symptoms during recovery. Risks include infection, bleeding or arterial injury at the access site, reduced ovarian function or early menopause, and rarely complications requiring surgery. Your specialist will explain these risks and the follow-up plan.
When is surgery needed?
Surgery may be considered when symptoms are severe or other treatments are unsuitable or have not provided enough relief, taking the patient’s preferences into account. Hysterectomy removes the uterus and is the definitive treatment for adenomyosis. It is generally considered for patients who do not wish to become pregnant in the future, as it permanently ends the ability to carry a pregnancy.
Choosing a treatment
Adenomyosis can have a detrimental impact on women’s health and wellbeing if left untreated. Treatment should reflect your symptoms, health, preferences and any plans for pregnancy. A clinician can discuss the likely benefits, limitations and risks of each option and arrange follow-up to assess your response.