What Happens If Adenomyosis Goes Untreated?

Women who have given birth to at least one child frequently develop adenomyosis. However, the condition can make it challenging to conceive a child or to have another one. Therapy for infertility may be beneficial.

Once pregnant, there is a high risk of:

• Miscarriage (loss of pregnancy before a baby fully develops).
• Premature birth (childbirth before the 37th week of pregnancy).

Adenomyosis is most prevalent among women in their 40s and 50s, or during the reproductive years, because it is strongly influenced by estrogen levels. This problem may go away on its own when estrogen levels drop, which often occurs after menopause.

Although there is currently no established cause for adenomyosis, some potential causes could include:

• Childbirth-related uterine inflammation
• Invasive tissue growth 
• Stem cell growths (bone marrow stem cells invade the uterine muscle)
• Developmental growths in the uterus muscle (endometrial growth in the uterine muscle layer while the fetus’s uterus is developing)

Although the specific cause of adenomyosis is unknown, risk factors may include:

• Age: Most people with adenomyosis are between the ages of 35 to 50 years when they are no longer actively reproducing. After menopause, the primary symptoms of adenomyosis may disappear.
• Childbirth: Multiple pregnancies are common in people with adenomyosis. When an embryo implants in the uterine wall, endometrial tissue could infiltrate the myometrium. More studies are necessary to establish this.
• Surgeries: According to studies, uterine procedures such as cesarean delivery or dilatation and curettage may increase the risk of adenomyosis. Ongoing research is being done on this risk factor.

Many people with adenomyosis don't exhibit any symptoms. Some individuals go through:

• Dysmenorrhea (painful menstrual cramps)
• Menorrhagia (heavy menstrual bleeding)
• Chronic pelvic pain
• Dyspareunia (painful intercourse)
• Bloating, fullness, or heaviness
• Abdominal pressure
• Infertility

Hormone treatment

Hormonal contraceptives are typically the first line of treatment for adenomyosis symptoms. Birth control tablets and progesterone-releasing intrauterine devices (IUDs) are examples of these. To determine whether contraceptives will effectively reduce excessive bleeding and period cramps, women must use birth control for three to six months or use an IUD for six to one year.

Anti-inflammatory drugs

To manage pain and discomfort, your doctor may prescribe anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, and other brands). During your period, you can reduce menstrual blood flow and pain by starting an anti-inflammatory medication one to two days before the start of your period and using it as needed or prescribed.

Hysterectomy

A hysterectomy (surgery to remove the uterus) is the only procedure that can completely stop adenomyosis. Unlike fibroids, we can't just go in and remove the abnormal tissue because adenomyosis causes diffuse, frequently finger-like extensions of tissue to penetrate the uterine wall. Depending on the person’s preferences and the surgeon's recommendation, a hysterectomy may remove either just the uterus or both the uterus and cervix. The fallopian tubes and ovaries can remain in place.

Various techniques for performing hysterectomies include:

• Abdominally: An open hysterectomy requires a significant incision (cut) in the abdomen.
• Laparoscopically: To remove the uterus, a surgeon makes a few tiny incisions in your abdomen. They use a laparoscope (a flexible tube with a built-in camera) to perform the process.
• Vaginally: Surgeons can occasionally remove the uterus through the vagina, but if your vagina is too small or the uterus is excessively big, this treatment is not possible.

Endometrial ablation

Endometrial ablation for adenomyosis is a treatment option for some women who do not wish to have a hysterectomy. The uterine lining is removed using heat in this operation. Although the treatment may reduce heavy monthly bleeding, it does not deal with the root cause. Ablation is not usually advised as a treatment because it won't burn out tissue in the myometrium.

Uterine artery embolization

During this minimally invasive technique, which is frequently used to help reduce fibroids, blood veins that supply blood to the adenomyosis areas are blocked with microscopic particles. A little tube that the radiologist inserts into the person’s femoral artery allow the particles to be guided. The adenomyosis resolves as the blood supply is cut off.

Tranexamic acid

The non-hormonal drug tranexamic acid aids in reducing heavy menstrual bleeding. It's a medication you take throughout your period. Women who are unable to get hormonal treatments or who opt not to may benefit from this therapy.