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In adenomyosis, the inner lining of uterus, which is called endometrium, breaks through the muscle wall of the uterus. During the mensturation, this tissue bleeds into the muscle layer like the normal endometrium does into the uterine cavity. As a result, the patient may have severe crampy pain and increased bleeding during the menses. Adenomyosis can be localized (focal) or extensive (diffuse). Since clinical symptoms are alike, adenomyosis is often mistaken for fibroids. Both conditions may also frequently coexist.
Adenomyosis is generally seen in women between 30-50 years of age. It is more common in women who have children and in those who previously underwent uterine surgery. It is believed that it has a link with estrogen. For this reason, it is frequently seen together with other estogen-linked conditions such as endometriosis and uterine fibroids. Although it is quite a common disease, it may be difficult to diagnose adenomyosis. The most important step is to suspect clinically of adenomyosis. The most typical complaints are heavy, prolonged menstural bleeding, severe menstural cramps, abdominal pressure and bloating. Pain during sexual intercourse and infertility may also be seen. Although quite suggestive of adenomyosis, these complaints are not specific and may also be seen in endometriosis and fibroids.
In adenomyosis, the most useful imaging methods are transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). However, MRI must be preferred whenever possible, because it can show various forms of adenomyosis and also demonstrate the mimicking or coexisting conditions like endometriosis and fibroids more accurately than TVUS.
In patients who has no symptoms, adenomyosis may not be treated. But frequently, patients have severe complaints and seek treatment. Medical treatment include hormon-releasing intrauterine devices and hormonal pills to control menstural bleedings and analgesics to control heavy menstural pain. In general however, medical treatment is not considered very successful and frequently a surgical operation is planned. But unlike fibroids, adenomyosis can not be clearly seperated from the normal uterine tissue and thus, it is usually not possible to remove it surgically. For this reason, surgery for adenomyosis generally means hysterectomy. If the adenomyosis is focal, it can be burnt using HIFU or percutaneous ablation with some success, but in diffuse adenomyosis these treatments are not helpful. In recent years, embolization was successfully used in the treatment of adenomyosis. In a number of studies, it has been proven that embolization provided long-term relief of symptoms in most patients with both focal and diffuse adenomyosis.
In embolization, a small catheter is angiographically placed into the uterine arteries through the groin under local anesthesia, and these arteries are occluded by injecting small particles. This technique has been successfully used in all over the world for the treatment of uterine fibroids for more than 20 years, and is described in detail in our web site (video). It has been coincidentaly understood that the same technique is also helpful in adenomyosis; in patients who have both uterine fibroids and adenomyosis, embolization was used to treat fibroids. But it was later seen that in these patients, besides the successful treatment of fibroids, adenomyosis tissues also became smaller and their symptoms either decreased or disappeared. Following these observations, embolization started to be used in patients with isolated adenomyosis and the same successful results have been obtained. Until today, thousands of adenomyosis patients have been successfully treated with embolization. In a review article published in 2011, the results of more than 500 adenomyosis patients who were treated with embolization were analysed, and it was seen that in more than 75% of these patients, adenomyosis complaints either disappeared completely or decreased substantially.
In our center, besides the fibroids patients, we have used embolization technique also in the treatment of patients with adenomyosis, and we have seen a substantial improvement of symptoms in most our patients.