Adenomyosis · Guest Writers

GUEST WRITER: The UK Management of Adenomyosis: A Specialists Perspective

The following information has been provided by Mr William Dartey, consultant Obstetrician and Gynaecology surgeon.  I am lucky enough to work with Mr Dartey, who not only plays a pivotal role in the diagnosis and management of Endometriosis with his patients, but has also helped me with my gynaecology care.

For more information about Mr Dartey, please see the bottom section.

Like a small proportion of patients with Endometriosis, I have been subsequently diagnosed with the different but similar condition Adenomyosis.  The management of both diseases can be quite a minefield, which is why I approached Mr William Dartey, a consultant I work with, to see if he would be interested in helping me write an article about the two conditions with the most up-to-date evidence and research.  And thankfully, he was more than willing.

Adenomyosis

Often referred to as the “sister” of Endometriosis, Adenomyosis is a similar condition that can be found in up to 3% of women who already have a diagnosis of Endometriosis.  Whereas with Endometriosis, cells that normally line the uterus are found outside of the womb and elsewhere in the body, with Adenomyosis, these cells penetrate into the muscle wall of the uterus (the myometrium).  Its occurrence rate in females of reproductive age without Endometriosis is approximately 1 in 10, although it is most common in females aged 40-50 who’ve had children.

As with Endometriosis, there is no known cause for Adenomyosis, however studies have indicated that previous uterus surgery is a risk factor.  Other studies have found that certain hormones or hormone levels may trigger the condition.

The signs and symptoms of Adenomyosis include;

  • Very heavy periods, often with associated “flooding” (large and sudden gush of menstrual blood)
  • Prolonged periods
  • Painful periods

But other signs and symptoms include bloating, very intense cramps and a heavy or dragging sensation between the legs. 

“Like Endometriosis, Adenomyosis is a benign condition, but the impact on a woman can be profound and debilitating.   If a woman is suffering with menstrual symptoms, this can be distressing and life-limiting – pain and bleeding can severely reduce their quality of life.”

One of the main differences between Endometriosis and Adenomyosis is that Adenomyosis does not necessarily need to be surgically diagnosed;

“High resolution ultrasound scans, MRI scans and physical examination can aid in its diagnosis.  Imaging will often reveal a globular, enlarged and tender uterus, which is typical of Adenomyosis.

The management of Adenomyosis centres around medical, hormonal and surgical options. 

“The medical management of Adenomyosis focuses on the use of pain relief to ease symptoms.  Non-steroidal anti-inflammatory drugs can be taken a day or two before a period starts to help reduce pain, however the use of hormones is much more key in providing patients with relief.  The use of the combined oral contraceptive pill, progestins, intrauterine devices and GnRH analogues can be effective as they either reduce the regularity of periods or make them absent, thus reducing bleeding and associated pain.  Again, the intrauterine device (such as the Mirena Coil) has been identified as one of the most effective hormonal methods for managing Adenomyosis, specifically as they can decrease the volume of the endometrium.”

When it comes to surgical intervention, there are two procedures that are commonly used to relief symptoms – a uterine artery embolism (UAE) or an endometrial ablation;

“A UAE involves injecting particles into the arteries that supply the womb, which compromised blood flow and causes tissues to shrink.  Whereas an endometrial ablation involves using heat to destroy the womb lining, aiming to make menstrual bleeding lighter and more manageable.  Both procedures can be effective in reduce blood loss during periods or even stop them altogether.”

However, a more definitive surgical route that patients with Adenomyosis can go down is a hysterectomy;

“A bit like with Endometriosis patients, a hysterectomy is not guaranteed to relieve patients of their symptoms.  Whilst menstrual bleeding is guaranteed to be abolished with this operation, it cannot promise relief from pain or other pre-menstrual symptoms.  Some patients may even find that the scarring from a hysterectomy can make symptoms worse.  Patients and their specialists must weigh up the risks and benefits, as well as providing patients with information to make decisions whether or not to keep their ovaries.”

Both Endometriosis and Adenomyosis are severely debilitating and life-changing diseases that must be managed effectively in order for affected women to get relief from symptoms, as well as maintain or restore their fertility (particularly for Endometriosis sufferers).  The lack of awareness amongst healthcare professionals, despite them being relatively common gynaecology conditions, can mean that women end up living with their symptoms unnecessarily for years or find management of the disease very tricky.  However, access to specialist centres and care can make a big positive impact on the lives of Endometriosis and Adenomyosis patients.  Plus, developments in the technology available to surgeons is allowing them to see more than ever before, such as cases of microscopic Endometriosis, robotic-assisted surgery or the future possibility of women being able to be diagnosed without the need for surgery.

Mr William Dartey currently works for Emersons Green NHS Treatment Centre in Bristol, England, and is well known within the region.  He is a UK trained specialist, but has also studied in Canada and the USA.  He has also completed various research work and had papers published.  Aside from Endometriosis, Mr Dartey’s other areas of interest include urogynaecology, pelvic floor reconstruction and laparoscopic abdominal surgery. 

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