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The highly skilled and well trained gynecological surgeons at Cedars-Sinai Marina del Rey Hospital evaluate your symptoms and provide a treatment plan suitable for you. They can choose from the various non-surgical and surgical treatment options available.
The treatment that is suitable for your symptoms and severity of adenomyosis will be considered.
Adenomyosis is a benign (not life-threatening) disease related to the uterine muscle. It happens when the inner lining of the uterine muscle - endometrium breaks from the uterine wall and relocates to the rear side of the uterine muscle. This results in thickening of the uterine walls and may also lead to heavy menstrual bleeding and pain during sexual intercourse.
Based on the severity of the symptoms of adenomyosis and the preference of the patient, the doctor will suggest the appropriate type of treatment.
When medical treatments do not yield a good response, doctors suggest surgical treatment. The most promising treatment to eradicate adenomyosis is hysterectomy as per the situation of the patient.
Uterine Artery Embolization: This procedure involves the placement of small particles in the blood vessels to block the flow of blood to adenomyosis tissues. With a help of a tube inserted through the vagina and cervix, these small particles are guided to block the blood vessels. Once blood flow stops, adenomyosis shrinks.
Endometrial Ablations: In this surgical procedure, the uterine endometrial lining is either removed or destroyed. This procedure is generally considered as an alternative to hysterectomy. This procedure is used when the adenomyosis has not penetrated deep into the uterine wall.
Hysteroscope / Resectoscope Ablation: Endometrial ablation is done using a hysteroscope or resectoscope. These devices deliver laser or high-frequency electric current to destroy the adenomyosis tissues. These could have a roller ball or a scoop at the end to destroy the uterine lining.
D & C Ablation: In this process, a lining of the uterus is scraped off like mowing a lawn. This procedure will not always show the best results in the long run.
Balloon Ablation: This is a difficult technique and provides good result when performed by an expert. With the help of a device, a balloon is placed in the uterine cavity through the cervix and hot water is circulated in the balloon. The balloon has electrodes on its surface, and the radio frequency current released from these electrodes destroys the uterine lining. A computer is used to control the temperature.
Magnetic Resonance – guided Focused Ultrasound (MRgFUS): While this procedure ultrasound waves are targeted on the adenomyoma, thus retaining the uterus and giving a possibility for the patient to conceive children in the future.
Hysterectomy: When all the above steps fail and if the patient is having no plans to conceive a baby in her life, the more certain way to stop adenomyosis is hysterectomy, which will involves the removal of the uterus.
Adenomyosis is commonly found in two different forms and is described below:
On many occasions, adenomyosis may not have any signs or symptoms. In some cases, there can be mild discomfort or severe issues and some of them are listed below:
Adenomyosis is difficult to diagnose and is often mistaken for fibroids. An accurate diagnosis is very important and is made on the basis of signs and symptoms the patient is experiencing. Your doctor will also perform some of the following diagnostic procedures:
Pelvic examination: Your doctor will examine the pelvic and abdominal region for bloating and tenderness.
Endometrial biopsy: A small portion of the tissue is removed from the uterus and sent to a laboratory for microscopic examination of the tissue.
Ultrasound: To find out the extent of the problem as well as to confirm the diagnosis, your doctor may suggest an ultrasound examination. In this test, high-frequency sound waves from transvaginal ultrasound devices are used to create an image of the internal body structures.
Magnetic resonance imaging (MRI): This imaging test will reveal adenomyosis in the uterine cavity very clearly and can distinguish it from fibroids.
Sonohysterography / saline infusion sonogram: Saline solution is injected through a tiny tube into the uterus to expand the uterine cavity before an ultrasound to enable better imaging of the uterine cavity and uterine wall.
Hysterosalpingography: A dye is used to highlight the uterine cavity and its surroundings with the help of an X-ray.
Prior uterine surgery: Past history of a uterine surgical procedure or removal of fibroids.
Childbirth: More than two childbirths can be a risk factor.
Middle age: Adenomyosis is more often seen in women who have crossed 40 years of age. There are very few cases of adenomyosis affecting adolescents.
Hormone: Excessive exposure to estrogen hormone used for birth control.
Decrease in estrogen level circulation in the body reduces the symptoms of adenomyosis.
Genetic history: Having a first-degree relative, for instance, your sister or mother with uterine adenomyosis, can increase your risk of developing adenomyosis.
The exact cause of adenomyosis is not clearly established yet. Some of the widely accepted causes are listed below:
Uncontrolled tissue growth: Surgical incisions during cesarean section can promote the uncontrolled invasive growth of endometrial cells lining the uterine wall into the uterine muscle.
Developmental origins: This is a theory, which says that when the uterus develops in the female embryo of a baby girl, the endometrial tissue could deposite in the uterine muscle.
Childbirth-related uterine inflammation: Another theory states that after childbirth, swelling of the uterine lining can break the boundaries between the endometrial cells and the uterine muscles in a similar way as happens during uterine surgical procedures.
Origin of Stem cells: Another recent theory says that the stem cells of the bone marrow can penetrate the uterine muscle resulting in adenomyosis.
Herbal Medications: Medicines such as Women’s Best Friend™ has a blend of herbs that balance estrogen and reduce the symptoms of adenomyosis and other uterine disorders. Bromelain, an extract of pineapple, shepherd’s purse, ginger, turmeric, vitex, aloe vera, calcium, and magnesium helps in solving the issues related to adenomyosis and uterine disorders. Carrots, papaya and parsley regulate menstrual periods and blood flow. Chamomile, basil, cinnamon, and fennel tea help in reducing swelling and relieve menstrual cramps.
Aromatherapy: Hot compresses made from clary sage and marjoram essential oils are very effective in relieving pain and discomfort of adenomyosis.
Anti-Adenomyosis Tincture: A tincture, which is a mixture of herbs such as licorice 1 oz, partridge berry leaf, blue cohosh, geranium, 40 drops of cotton bark (Gossypium) is used in the treatment of adenomyosis. The combination of all these herbs taken 2 times a day can relieve the symptoms of adenomyosis. Consulting a herbalist or naturopathic doctor is the best thing to do before going for these herbal remedies.
Hot and cold pads: Applying hot and cold pads on the pelvic region and abdomen can ease the cramps of adenomyosis.
Warm water bath: Taking a warm water bath or shower or soaking in warm water can provide temporary relief from pain and discomfort.
Yoga: Meditation, breathing exercises, and relaxation techniques in Yoga will help balance and regulate the estrogen levels, and also helps in relieving the symptoms of adenomyosis. Yogic postures such as Adho Mukhasana, Bhujangasana Supta Badhha Konasana, and Utthita Anguli Sukhasana are effective in alleviating severe menstrual cramps. Performing Yoga practice for about 20 minutes a day can bring a big difference and help in getting rid of the symptoms of adenomyosis.
Electric Nerve Simulation: Transcutaneous electronic nerve stimulation (TENS) is the technique followed. In this method, electric impulses are projected through sticky pads placed on the skin of the pelvic region or abdomen in order to stimulate the nerves in the pelvic area and ease the pain.
Castor Oil packs: A cloth soaked in castor oil is placed on the abdomen to increase blood circulation, detoxification and healing of tissues and organs under the skin. This is usually followed as part of Self Fertility Massage™.
Massage Therapy: Self Fertility Massage™ is considered effective in improving the conditions of adenomyosis and uterine health. This has a series of massage techniques that can be done at home at a time convenient to the patient. This massage therapy has various benefits such as:
Regular exercises: Studies have shown that regular exercise controls hormonal imbalance and reduces the chances for adenomyosis. Swimming, walking and cycling can also help in alleviating the symptoms.
Lifestyle changes: Maintain a proper body weight by exercising regularly. Avoid doing exercises immediately after eating. Wait for at least two to three hours before you exercise. Avoid smoking and drinking excess amounts of alcohol.
Food habits: Always maintain a healthy diet. Include a lot of vegetables, legumes, whole grains, and fruits in your daily diet.
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