Dr Yogesh Nikam

By Dr Yogesh A Nikam

“Communities and countries and ultimately, the world is only as strong as the health of their women.” – Michelle Obama.

As we battle the age-old women’s health issue ‘Adenomyosis’, our best weapon is education and awareness. 

Adenomyosis is a progressive condition that involves the growth of the endometrial tissue (stroma & glands) that lines the uterus into the muscle wall (myometrium) of the uterus. As a result, the uterus becomes swollen and enlarged (hypertrophy and hyperplasia of the surrounding myometrium), often referred to as a globular or diffusely enlarged uterus. Adenomyotic tissue grows under the influence of estrogen produced by the ovaries. Adenomyosis usually disappears after menopause when the oestrogen levels decline. 

Adenomyosis typically causes longer, painful and heavy periods. Other symptoms may include bloating, low back pain, frequent urination and painful intercourse. Adenomyosis is not harmful or life-threatening, but its symptoms can negatively affect life quality. Excessive menstrual bleeding can cause iron deficiency Anaemia, leading to fatigue, dizziness. Pelvic pain during periods may lead to loss of working days, painful sexual intercourse. Prolonged symptoms have been linked to mood irritability, anxiety and depression. 

Adenomyosis is different from endometriosis, and these two conditions can frequently co-exist. Endometriosis is a condition when the endometrial tissue grows outside of the uterus. 

A complete medical evaluation by a doctor can help to determine the best course of treatment. Following a medical review, the doctor may recommend a pelvic ultrasound. An additional MRI scan may also be advised if the diagnosis is unclear. MRI has a better predictive value over ultrasound in diagnosing Adenomyosis, but an MRI is a more expensive test then an ultrasound; hence doctors prefer an ultrasound. MRI can also be used when it is crucial to distinguish diffuse and focal Adenomyosis from fibroids (leiomyomas) 

Many treatments are available to help alleviate symptoms. Treatments include the following:

Anti-inflammatory medications can help relieve period cramps (dysmenorrhoea) and may reduce blood flow during menstruation.

Hormonal treatments help in controlling the heavy and prolonged menstrual bleeding. These include oral contraceptives (oral birth control pills), progestin-only contraceptives (oral, injection, or an Intrauterine device – IUCD), and GnRH-analogues such as Zoladex (Goserelin- reduces the production of hormones oestrogen and progesterone by the ovaries). Hormonal IUCD (such as a Mirena IUCD) is more effective than OCP when treating Adenomyosis and can last up to five years. 

Endometrial ablation involves techniques to remove or destroy the endometrium (lining of the uterine cavity) and decrease menstrual bleeding. This may work in milder forms of Adenomyosis but may not be helpful in moderate to severe forms. 

Uterine artery embolization is a day procedure that blocks the blood supply to the uterus. An interventional radiologist (not a gynaecologist) makes a small cut in the groin to access the femoral artery and advances a catheter under X-ray guidance. Particles are then injected inside the uterine arteries to block the blood flow. It can cause shrinkage of the adenomyosis volume and improves heavy menstrual bleeding. About 2-3% of women may, however, experience premature ovarian insufficiency (menopause) due to the procedure. 

Hysterectomy is the only treatment to cure this condition completely. However, the condition often resolves on its own after menopause. Adenomyosis does not affect the ovaries. Hysterectomy involves complete surgical removal of the uterus with the conservation of ovaries; hence, women do not experience menopausal symptoms. As it is a definitive form of treatment, it can only be used in severe cases and in women who do not plan to have any more children.

At AEVAFEM, our specialists will take the time required to make you feel comfortable, alleviate the uncertainty of having a gynaecological procedure or surgery and help you make an informed decision on the best treatment solution for you.

Dr Yogesh Nikam is a Specialist Gynaecological Surgeon, with a special interest in complex gynaecological issues and works as a member a multi-disciplinary team involving Colorectal surgeons, Urologist, Pain specialists and Allied health specialist.

Call 1300 724 380 to make an appointment.

Disclaimer: The information provided does not constitute medical, professional or expert advice. Every effort has been done to provide accurate information at the time of printing / publishing. Users should seek professional medical assistance if they are suffering from any medical problem.