Adenomyosis

Adenomyosis is a condition of the uterus wherein endometrial tissue that lines the inner wall of the uterus breaks through and invades the muscle layers of the organ. Most commonly, the disease affects the back wall (posterior side) of the uterus. It is a benign condition that primarily affects women aged between 35 to 50. Adenomyosis is only seen in women in their reproductive years because its growth requires estrogen. Adenomyosis can occur only till a woman produces estrogen. So this condition is unlikely in menopausal women. Adenomyosis results in enlargement of the uterus; sometimes to even two or three times its original size. The condition can lead to difficulties in getting pregnant or sustaining a pregnancy.

Adenomyosis Symptoms

The extra tissue in the uterine muscles leads to painful menstrual cycle and heavy bleeding. In endometriosis, the endometrial glands live outside the uterus while in adenomyosis, the glands remain within the uterus but deeply embedded into its walls. A woman can suffer both conditions. Some of the symptoms of Adenomyosis include:

• Pelvic pain
  
  
• Abdominal pressure and bloating sensation
  
  
• Prolonged periods, lasting up to 8-12 days
  
  
• Bladder pressure with frequent urination
  
  
• Dysmenorrhea
  
  
• Abnormal discharge of blood clots during menstruation
  
  
• Pain during sexual intercourse.
  

Causes and risk factors

The causes of Adenomyosis is not known. However medical experts have identified few factors that can cause Adenomyosis.

• Invasive growth of tissue due to history of uterine surgery or through incisions made near the uterus during C-section may lead Adenomyosis.
  
  
• Postpartum uterine inflammation after childbirth, may cause a break in the boundary of the uterine wall causing endometrial cells to invade the myometrium (muscle tissue of the uterus).
  
  
• Bone marrow stem cells invade the uterine musculature leading to adenomyosis.
  

Research is still going on to identify the exact causes of Adenomyosis. However certain risk factors have been identified. Women in their reproductive age, Women over 30 years of age and Women with previous history of cesarean section or other uterine surgery carry the risk of developing Adenomyosis.

Diagnosis and Treatment

The diagnosis of Adenomyosis is tricky, as its symptoms mimic the symptoms other uterine conditions like fibroids and endometriosis. Confirmed diagnosis of Adenomyosis is only made through trans-vaginal ultrasound scan and MRI.

Mild cases of Adenomyosis are treated with analgesics to manage symptoms like pain and heavy bleeding. Doctors may also recommend intrauterine devices and hormonal treatment to reduce the symptoms.

If the woman in question does not respond to the above treatments and is still in a child bearing age, surgical resection of the adenomyosis from the muscle of the uterus can be done with preservation of the uterus. However, this is possible only if the disease is localized with well-defined borders. Hysterectomy is the common surgical option performed on women who are unable to respond to medications and hormone treatments.

Hysterosalpingogram

A Hysterosalpingogram or hsg is a diagnostic x-ray of the uterus and fallopian tubes. This test allows the gynecologist to observe the inside of the uterus and fallopian tubes for any problems such as blockage of fallopian tubes, endometrial polyps, fibroids, genital tuberculosis or abnormalities in the uterine cavity. Hysterosalpingogram is also done to find problems in the uterus, such as abnormal shape and structure, an injury, adhesions or a foreign body in the uterus. HSG is often used in cases where a sterilization reversal is sought.

Hysterosalpingogram procedure

A woman must inform the radiologist if she is allergic to iodine dye, suffer pelvic or sexually transmitted disease. Women with bleeding problems such as hemophilia or those on blood thinning medicines such as aspirin must keep the doctor appraised. The gynecologist or radiologist uses a cannula to fill the uterus with iodine. The dye will flow into the fallopian tubes as the uterus is hooked with these tubes, and the pictures are taken using high steady beam fluoroscopy, as the dye passes through. In case of injury or an abnormal structure, the picture can throw up the problems. The pictures are shown on a TV monitor during the test. If another view is needs, the examination table is tilted or the patient may be asked to change positions. A blockage can prevent sperm from moving into the fallopian tube and joining an egg for fertilization to occur.

A HSG can catch if there is any problem inside her uterus that possibly prevents a fertilized egg from implanting to the uterine wall. This helps in outlining the fallopian tubes so that any abnormalities in the tubes or uterine cavity is observed. In cases of infertility due to tubal blockage, HSG is used to evaluate the location and extent of blockage. The Hysterosalpingogram procedure takes a few minutes and can be moderately uncomfortable for the woman, with possibility of cramps. Women who have tubal disease may develop pelvic infection. In rare cases, the woman develops iodine allergy. Some women notice spotting for a couple of days after the HSG.

Risks of Hysterosalpingogram

In less than 1 in 100, there may be a chance of a pelvic infection after the test. The chances are higher in those who have had pelvic infections before. Antibiotics A negligible chance of damaging or puncturing the uterus or fallopian tubes during the test does exist during the test. There could be some allergic reaction to the iodine x ray dye. If oil based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung. But most HSG tests are water based. A woman may feel some cramping similar to menstrual cramps during the procedure and the amount of pain may depend upon the problems that the doctor finds and treats during the test. There could be some vaginal bleeding for several days after the test.

The test result is considered normal if the injected dye spills freely out from the ends of the fallopian tube and the x ray shows normal uterine shape. However, if further tests do not reveal the cause of infertility or recurrent pregnancy loss, the doctor could order for a hysteroscopy. There are chances that while a HSG could show a normal uterine shape, a hysteroscopy show abnormalities.

Hysterectomy

Hysterectomy is the surgical removal of the uterus that can sometimes save the life of a woman. Hysterectomies are usually performed abdominally or vaginally. Laparoscopic hysterectomy is also performed in some cases.

Reasons for hysterectomy

Gynecological cancer: Cancer of the uterus or cervix usually necessitates removal of the uterus and cervix. Endometrial cancer, cancer of the uterus or cervix or fallopian tubes usually requires hysterectomy surgery.

Endometriosis: In some cases of severe bleeding following endometriosis, a hysterectomy surgery is advised. This is the second leading reason for hysterectomies.

Fibroids: While most fibroid tumors can be treated by non-surgical methods, hysterectomy surgery may be the only permanent solution.

Uterine prolapse: When the uterus moves from its usual place down into the vagina, it can affect other organs such as the bladder. This can happen due to childbirth, obesity, loss of estrogen after menopause and weak pelvic ligaments and tissues.

Other reasons for going for a hysterectomy surgery range from heavy or irregular menstrual periods to dysmenorrhea. Severe pelvic inflammatory disease can sometimes necessitate a hysterectomy.

Types of hysterectomy surgery

Total hysterectomy involves removal of the cervix and uterus. It is known as Oopherectomy. Partial hysterectomy is a surgical procedure to remove only the upper part of the uterus, leaving the cervix in place. This type of hysterectomy is referred to as supra cervical hysterectomy or subtotal hysterectomy. Radical hysterectomy involves removal of the uterus, cervix, upper part of the vagina and the supporting tissues.

Hysterectomy surgery performed prior to menopause can bring about severe and prolonged symptoms as compared to natural menopause. A woman can experience bone loss, loss of libido, depression and anxiety. Many women may need hormone replacement therapy (HRT) following total hysterectomy where the ovaries are removed before menopause.