Adenomyosis is a common estrogen-dependent gynecological disorder characterized by the ectopic growth of endometrial tissue into the myometrium, which often causes severe dysmenorrhea, heavy menstrual bleeding, pelvic distension, and even anemia. For women entering menopause, the decline of ovarian function leads to a natural decrease in estrogen levels, which can alleviate the stimulation of ectopic endometrial tissue, thereby relieving symptoms and slowing down the progression of lesions. The treatment of adenomyosis during menopause should be individualized, comprehensively considering factors such as the severity of symptoms, the size of lesions, the patient’s age, general health status, and whether there is a demand for fertility (usually not required for menopausal women). The main treatment methods include observation and follow-up, medication therapy, focused ultrasound ablation (a key added minimally invasive treatment), and surgical treatment.
1. Observation and Follow-up
This method is suitable for perimenopausal women who are close to menopause, with mild symptoms (such as mild dysmenorrhea, normal or slightly increased menstrual volume), no obvious anemia or pelvic compression symptoms, and small lesions. It is recommended to conduct regular follow-up every 3 to 6 months, including gynecological examination, pelvic ultrasound, and blood routine (to monitor hemoglobin levels). After menopause, as estrogen secretion continues to decrease, the ectopic endometrial tissue in the myometrium will gradually atrophy and degenerate, and most patients’ symptoms will be significantly relieved or even disappear. However, during the observation period, if symptoms worsen (such as severe dysmenorrhea that cannot be relieved, massive bleeding leading to anemia) or lesions grow rapidly, active treatment measures need to be taken in a timely manner.
2. Medication Therapy
Medication is mainly used to relieve symptoms such as pain and excessive bleeding, and is suitable for patients with moderate symptoms who are not suitable for surgery or refuse surgery. The commonly used drugs include the following categories: First, progestin drugs, which can inhibit the proliferation of ectopic endometrial tissue, reduce menstrual volume, and relieve dysmenorrhea, but long-term use may cause side effects such as weight gain and irregular vaginal bleeding. Second, gonadotropin-releasing hormone agonists (GnRH-a), which can significantly reduce estrogen levels in the body, make ectopic lesions shrink, and quickly relieve symptoms, but they may cause menopausal symptoms such as hot flashes and osteoporosis, so they are generally used for short-term transition before menopause. Third, non-steroidal anti-inflammatory drugs (NSAIDs) and hemostatic drugs, which are mainly used to relieve acute dysmenorrhea and reduce menstrual bleeding, and are used as auxiliary treatment. It should be noted that all medications need to be taken under the guidance of a doctor to avoid adverse reactions.
3. Focused Ultrasound Ablation (High-Intensity Focused Ultrasound, HIFU) – Key Minimally Invasive Treatment
Focused Ultrasound Ablation (HIFU) is a safe, effective, and non-invasive minimally invasive treatment, which is particularly suitable for menopausal and perimenopausal women with adenomyosis and has become one of the preferred treatment options in this population. It is a non-surgical, incision-free treatment method that uses high-intensity focused ultrasound energy to penetrate the skin and normal uterine tissue, accurately focus on the adenomyotic lesions, and generate high temperature (60-100℃) at the focal point to coagulate and necrose the lesion tissue. After the lesion tissue is necrosed, it will be gradually absorbed and eliminated by the body’s immune system, thereby achieving the purpose of reducing lesions, relieving symptoms, and controlling the progression of the disease.
Compared with traditional surgical methods, HIFU has obvious advantages: First, it is non-invasive, with no incision, no bleeding, and no risk of infection, which greatly reduces the physical damage to patients and avoids the pain caused by surgery. Second, it preserves the integrity of the uterus, which is in line with the psychological needs of some women who want to retain the uterus even after menopause. Third, the treatment process is relatively short, usually completed in 1-3 hours, and the recovery period is fast. Patients can be discharged from the hospital 1-2 days after the operation, and can resume normal life and work in a short time. Fourth, the treatment effect is accurate. Most patients can significantly relieve dysmenorrhea and reduce menstrual volume 1-3 months after treatment, and the lesion volume can be reduced by 30%-80% in varying degrees. Fifth, it has good safety, with few complications, and will not affect the normal function of surrounding organs (such as the bladder and rectum). For menopausal women who are unwilling to accept surgery, cannot tolerate long-term medication, or have contraindications to surgery, HIFU is an ideal treatment choice.
It should be noted that HIFU is not suitable for all adenomyosis patients. Patients with extremely large lesions, severe uterine deformation, or combined with other gynecological diseases (such as large uterine fibroids, severe pelvic adhesion) need to be evaluated by a doctor to determine whether they can receive HIFU treatment.
4. Surgical Treatment
Surgical treatment is mainly suitable for patients with severe symptoms that cannot be relieved by conservative treatment and HIFU, such as intractable dysmenorrhea that seriously affects life, massive menstrual bleeding leading to severe anemia, or lesions that compress the bladder, rectum, etc., causing frequent urination, dysuria, constipation and other symptoms. Since menopausal women have no fertility needs, total hysterectomy is the most common and effective surgical method, which can completely remove the lesions and avoid recurrence. In some cases, if the patient’s general health is poor and cannot tolerate total hysterectomy, or if there are special requirements, subtotal hysterectomy (retaining the cervix) can be considered, but regular cervical cancer screening is required after the operation. In addition, for patients with isolated, small adenomyotic nodules, myomectomy can be considered, but the recurrence rate is relatively high, so it is not the first choice for menopausal patients.
In summary, the treatment of adenomyosis during menopause should adhere to the principle of individualization. Mild cases can be observed and followed up; moderate cases can choose medication or HIFU; severe cases need surgical treatment. Focused ultrasound ablation, as a non-invasive, uterus-preserving minimally invasive treatment, provides a new and better choice for menopausal women with adenomyosis, effectively relieving symptoms and improving the quality of life without causing excessive physical damage. No matter which treatment method is chosen, it is necessary to conduct regular follow-up after treatment to monitor the recovery of the condition and prevent recurrence.