Adenomyosis is a common benign gynecological disease characterized by the ectopic growth of endometrial glands and stroma into the myometrium, leading to thickening of the uterine wall and various clinical symptoms. It mainly affects women of childbearing age, especially those who have given birth, and its incidence has been on the rise in recent years. The exact cause of adenomyosis is not yet fully clear, but it is closely related to factors such as damage to the uterine wall (caused by childbirth, abortion, or uterine surgery), abnormal levels of sex hormones, and genetic factors. Clinically, the main symptoms include dysmenorrhea (often progressive and severe), menorrhagia, prolonged menstrual periods, enlarged uterus, and even infertility, which seriously affect the physical and mental health and quality of life of patients.
The treatment of adenomyosis should be comprehensively formulated according to the patient's age, severity of symptoms, fertility needs, and the size of the uterus. There is no one-size-fits-all treatment plan, and the main treatment methods include expectant management, drug treatment, surgical treatment, and minimally invasive treatment. Each method has its own indications and precautions, which need to be selected under the guidance of professional doctors.
Expectant Management for Adenomyosis
Expectant management is suitable for patients with mild or no clinical symptoms, small uterine size, and no fertility needs, especially perimenopausal women. Since the symptoms of adenomyosis are closely related to estrogen levels, after menopause, with the decline of ovarian function and the decrease of estrogen levels, the ectopic endometrial tissue will gradually shrink and atrophy, and the symptoms will be significantly relieved or even disappear. For such patients, regular follow-up observation (once every 6-12 months) is required, including gynecological examination and pelvic ultrasound, to monitor the changes of the uterus and symptoms. If the symptoms worsen or the uterus increases significantly during the follow-up, timely adjustment of the treatment plan is necessary.
Dr. David Wilson, a gynecological expert specializing in adenomyosis, reminds that expectant management is not applicable to all patients. For those with severe dysmenorrhea or heavy menstrual bleeding that affects normal life, active treatment should be taken in time to avoid complications such as anemia and severe pelvic pain.
Drug Treatment for Adenomyosis
Drug treatment is mainly used to relieve symptoms, reduce the size of the uterus, and delay the progression of the disease. It is suitable for patients with mild to moderate symptoms, those who want to retain fertility, or those who cannot tolerate surgery. The commonly used drugs include non-steroidal anti-inflammatory drugs, progestogens, gonadotropin-releasing hormone agonists (GnRH-a), and levonorgestrel-releasing intrauterine system (LNG-IUS).
Non-steroidal anti-inflammatory drugs are mainly used to relieve dysmenorrhea and reduce menstrual bleeding, but they cannot shrink the uterus or treat the cause. Progestogens can inhibit the proliferation of ectopic endometrial tissue, relieve symptoms, and are suitable for long-term use, but some patients may have side effects such as irregular vaginal bleeding and weight gain. GnRH-a can significantly reduce estrogen levels in the body, make the ectopic endometrial tissue shrink, and achieve the effect of reducing the uterus and relieving symptoms. However, long-term use may cause menopausal symptoms such as hot flashes, night sweats, and osteoporosis, so it is generally used for a short period of 3-6 months. LNG-IUS is an intrauterine device that releases levonorgestrel locally, which can effectively relieve dysmenorrhea and reduce menstrual volume, and has the advantages of long-term effect and convenient use, which is suitable for patients who do not want to take oral drugs.
Surgical Treatment for Adenomyosis
Surgical treatment is the main method for the radical treatment of adenomyosis, which is suitable for patients with severe symptoms, large uterine size, no fertility needs, or ineffective drug treatment. The main surgical methods include hysterectomy and adenomyomectomy.
Hysterectomy is the most thorough treatment method for adenomyosis, which can completely remove the lesion and avoid recurrence. It is divided into total hysterectomy and subtotal hysterectomy. Total hysterectomy is generally recommended, especially for patients with combined cervical lesions. For patients under 50 years old with normal ovarian function, ovaries can be retained as appropriate to maintain the body's endocrine balance. Subtotal hysterectomy is suitable for patients with good general condition and no obvious cervical lesions, but there is a small possibility of residual lesions and recurrence.
Adenomyomectomy is suitable for young patients who want to retain fertility. It is an operation to remove the adenomyosis lesions while retaining the uterus. However, due to the diffuse distribution of adenomyosis lesions, it is difficult to completely remove them, so the recurrence rate is relatively high (about 30%-50%). After the operation, patients need to use drugs for adjuvant treatment to reduce the recurrence rate, and contraception is recommended for 1-2 years to allow the uterus to recover. Dr. Emily Carter, a minimally invasive gynecological surgeon, points out that adenomyomectomy has high technical requirements for surgeons, and patients should choose regular hospitals and experienced doctors for the operation.
Minimally Invasive Treatment for Adenomyosis
With the development of medical technology, minimally invasive treatment has gradually become a new choice for adenomyosis patients, especially those who want to retain fertility or cannot tolerate traditional open surgery. Common minimally invasive treatment methods include focused ultrasound ablation, uterine artery embolization, and laparoscopic adenomyomectomy.
Focused ultrasound ablation uses high-intensity focused ultrasound waves to ablate the ectopic endometrial tissue, which has the advantages of non-invasiveness, quick recovery, and no scars. It is suitable for patients with small to medium-sized lesions and mild to moderate symptoms. Uterine artery embolization blocks the blood supply of the adenomyosis lesions through interventional technology, making the lesions shrink and necrosis, which can effectively relieve dysmenorrhea and reduce menstrual volume, but it may have an impact on ovarian function and fertility, so it is not recommended for patients who want to have children. Laparoscopic adenomyomectomy has the advantages of small incision, less bleeding, and quick recovery compared with traditional open surgery, but it also has the problem of high recurrence rate.