Tuesday, May 1, 2012

Adenomyosis: How to treat it effectively?

Last week as I was getting ready to leave for the hospital,I heard Mamta talking in quite a hurried tone to some lady.Later she told me that this was a Lady in pain who had come without an appointment.I have given your mobile number and have directed her to the Max Emergency( She is getting smarter by the day.....Max Healthcare should felicitate her).Anyways that Lady called me later and told her painful story of a very painful dysmenorrhoea (painful periods).
I called her two days later.she was a primipara,planning her second child but was waiting for this pain to settle before she planned any further.Her Scan done in dec 2011 was a Normal scan.
After an internal checkup later I was little confused.....It was either an acutely anteflexed uterus or a fibroid.If it was anteflexion than I was in no position to explain her dysmenorrhoea and if fibroid.....well the irregularity didn't feel like a fibroid.Another scan later.....Adenomyosis was the diagnosis in this 29 yrs old Lady.
When the endometrial cells (cells of the inner lining of the womb) invade the muscular layer of uterus it leads to the adenomyosis.It caused heavy and painful periods.If has been associated with fibroids and endometrial hyperplasia as well.An USG finding can be confirmed by a MRI.
It can happen due to weak muscles of the uterus,increased intrauterine pressure or due to some unknown reason.
Medical treatment is bleak.OCpills don't give as good relief as in endometriosis.Mirena ( IUS) has been found to be effective up to certain extent.Zoladex and Danazol have been used as second line treatment but have not been very effective methods.
There have been reports where hysteroscopically or laparoscopically surgeons have tried removing the tissue having 'adenomyosis'I have in fact seen Dr Eric Butrant at Aix an Provance performing such surgeries and these surgeries are quite simple but again there is not enough evidence to talk about it's benefits.
Lastly Hysterectomy always comes like a yamraj and takes away the femninty of a female to provide that final cure and yes it is applicable for adenomyosis too.

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