Adenomyosis Care in India – Non-Surgical & Surgical Treatments

Adenomyosis is a gynecological condition that affects numerous women worldwide. It occurs when the endometrial tissue—the tissue that lines the uterus—grows into the uterus’s muscular wall.

This condition can lead to discomfort and severe menstrual cramps, significantly affecting a woman’s quality of life. In this guide, we will delve deeper into understanding adenomyosis, its causes, symptoms, diagnosis, types, and treatment options.

Adenomyosis and Endometriosis are the two diseases that normally and almost always go hand in hand.

The association of Focal Adenomyosis with Endometriosis is about 70%. The association between Diffuse Adenomyosis and Endometriosis is about 60% and the association of Focal Adenomyosis of Outer Myometrium (FAOM) with Deep Endometriosis is almost 99-100%.

It’s important to understand that the pathology between Adenomyosis and endometriosis is absolutely the same, and the only difference is that Adenomyosis affects the uterus musculature, whereas endometriosis affects the rest of the pelvis.

Both diseases can cause a severe amount of Dysmenorrhea and infertility, and both of them require a huge amount of expertise to be operated on and treated. Unfortunately, in India at the moment, the number of doctors who treat this disease is very limited.

The majority of the patients who are referred to our unit, headed by Dr. Jay Mehta, have been operated on at least once before they are sent for surgery, and as a result of this, the outcomes can be compromised further.

Treatment of endometriosis, as we have discussed throughout on our website as well as across social media, requires a lot of detailing and expertise right from the diagnosis, as well as providing the most accurate surgical options.

The primary symptoms of adenomyosis include painful periods, heavy or prolonged menstrual bleeding with clotting, and abdominal/pelvic pain.

Some women may also experience bloating, a feeling of pressure in the lower abdomen, and pain during intercourse. However, it’s important to note that some women with adenomyosis may not have any symptoms.

The exact cause of adenomyosis remains unknown. However, it is believed to be estrogen-dependent or hormone-sensitive.

Factors like childbirth and uterine surgeries may disrupt the boundary of cells in the uterus, allowing the invasion of endometrial cells into the myometrium (muscular wall of the uterus).

Suppose you’re experiencing symptoms such as heavy menstrual bleeding, severe menstrual cramps that don’t improve with over-the-counter medication, or pain during intercourse. In such cases, it’s essential to consult one of the top gynecologists for Adenomyosis treatment in Mumbai, India.

Early diagnosis can help manage the symptoms effectively and improve your quality of life.

Dr. Jay Mehta, a renowned gynecologist in Mumbai, offers expert consultations for adenomyosis treatment across India. To book a consultation, call 1800-268-4000

We help a couple with endometriosis and adenomyosis in their journey to parenthood.

Diagnosing adenomyosis can be tricky, as its symptoms often mimic other conditions like uterine fibroids and endometriosis.

Healthcare professionals use a combination of medical history, physical examination, and imaging tests like ultrasound or magnetic resonance imaging (MRI) for diagnosis.

In some cases, the definitive diagnosis of adenomyosis can only be made after a hysterectomy with a subsequent pathological examination.

Adenomyosis can be classified into two types based on its location:

 – Diffuse Adenomyosis 

This is the most common type, where the endometrial tissue spreads out within the uterine muscle.

 – Focal Adenomyosis

Also known as adenomyoma, in this type, the endometrial tissue forms a mass or cluster within the uterine wall.

The choice of treatment for adenomyosis depends on several factors, including the severity of symptoms, the patient’s age, and whether the patient plans to have children in the future.

The treatments for adenomyosis include hormonal contraceptives, medications, and surgical procedures.

Nonsurgical treatments include pain medication, hormonal therapy, and the use of a levonorgestrel-releasing intrauterine device (IUD). Surgical options include uterine artery embolization, endometrial ablation, and hysterectomy (removal of the uterus).

Adenomyosis is a very common and extremely distressing disorder that predominantly goes and affects the uterine muscular region. As a result of this, it gives rise to severe pain in the abdomen and the pelvis, and this is much more common during the menstrual cycle. This is what we call Dysmenorrhea.

Adenomyosis on its own has a large variety of treatment options, but we predominantly break off the treatment options into fertility-enhancing options for getting pregnant with Adenomyosis and the radical options where the family is complete and removal of the uterus is offered.

It has to be noted and understood clearly that in Adenomyosis, the size of the uterus is a very important aspect to be considered while offering medical management. If the size of the uterus is less than 10 cm, that is typically when the medical line of management is going to work the best. If the patient is complaining of only mild pain, then painkillers would remain the treatment of choice for early Adenomyosis.

One also has to categorically understand that if the size of the uterus is more than 10 cm, then usually no form of medical management is going to be beneficial, even if the patient is planning a fertility-enhancing option. Typically, when a patient is planning for fertility, we like to give a unique combination of Letrozole plus Regestrone to these patients. This is a combination that is prescribed for 100 days, and it achieves about a 10-15% volume reduction in Adenomyosis.

Being a referral unit for Adenomyosis in India, Dr Jay Mehta has popularized this protocol across the country, and as a result of this, a lot of women who are suffering from endometriosis and Adenomyosis and are desirous of fertility have greatly benefited.

The other type of hormonal medical management, which is available and which predominantly focuses only on volume reduction, is temporary, and the most commonly used is a GnRH agonist depot.

Unfortunately, the GnRH agonist cannot be provided to the patient for more than 3 to 4 months, and as a result of this, the benefit that the patient experiences is extremely minimal in this situation.

One of the nicer minimally invasive approaches that is available for a patient who is having diffuse Adenomyosis is to consider microwave ablation of the entire disease using a highly specialized probe, which is available. This particular approach was initially popularized in China, and when done correctly using ultrasound or laparoscopic guidance, this can greatly benefit women who are well chosen for this procedure.

One must also remember that when microwave ablation is done, the symptomatic benefit can take approximately 3 to 4 months for the patient to start experiencing. In many situations, to get the maximum benefit out of microwave ablation, it has to be combined with a laparoscopic approach in order to ensure that the disease clearance and the additions are achieved completely so that any form of complication that can then occur can be completely prevented.

Dr. Jay Mehta and the team have performed the maximum number of microwave ablation for Asees, especially for young women who are desirous of retaining their uterus in our country and it has been broadly noted that in well-selected cases, approximately 80% of these women experience a wonderful benefit of this procedure and can conceive Within 6 to 8 months of this procedure. This is provided the rest of the fertility assessment is absolutely normal.

Finally, one has to remember that even today, the best morality of treatment, which is called the treatment of choice, remains surgical management. Surgical management for ADIOS is very complex and requires a great depth of understanding of the tissue of someone to do it successfully and nicely. An incorrectly done surgery for Adenomyosis can cause permanent infertility, and as a result, women must choose their Adenomyosis specialist or their Endometriosis specialist very, very wisely.

Unfortunately, this is still the case in our country, India. A lot of patients get heavily misdiagnosed, and as a result, for somebody who is a recognized super specialist for endometriosis and Adenomyosis in India, like Dr. Jay Mehta, the majority of the cases that get referred are the cases that have been operated on at least once before. This involves repeat surgery for these patients.

There is one important thing that every patient should know before getting their surgery done, especially if they desire fertility. If the EM junction, which is also called the endometrial-myometrial junction. If well preserved before the surgery, then the outcomes of the surgery for the patient are going to be excellent and will be performed by an expert. If the EM junction is distorted, then despite the best possible surgical efforts, the outcome for fertility could be low, and the patient may require multiple other methods to ensure fertility.

For a focal adenomyosis that is more than 3 cm, for any lesion of focal adenomyosis of the outer myometrium (FAOM), and for any diffuse Adenomyosis where the size of the uterus is more than 10 cm, surgical management is the treatment of choice. Dr. Jay Mehta has taken excellent master class sessions on these topics on YouTube for the training of his fellow gynecologists across India.

Typically, these surgeries are achieved with laparoscopic surgery, which is also called minimally invasive surgery. Dr. Jay Mehta uses the technique of ICG dye marking with near-infrared imaging while doing this surgery, and this gives a definition of the microcapillary spread of the Adenomyosis. As a result of this, the disease clearance can be optimally achieved. However, at this point, the patient should note that no matter what one does. One can never remove 100% of Adenomyosis from the uterus in a fertility-enhancing surgery, as some microscopic diseases get left behind.

A recent addition to our surgical armamentarium has been the use of a two-stage surgery combination, as well as laparoscopic surgery.

Adenomyosis is a disease that is bound by a natural disease process. Unfortunately, there is no therapy that is naturally available to reduce and limit the intensity of endometriosis and adenomyosis.

It is important to understand that this is the disease process, which occurs predominantly due to an abnormal stimulation signal, which is derived from a naturally secreted hormone of the body, which is estrogen, and even if one consumes or modifies treatment to reduce the estrogen levels, the effects are, at their best level, pretty temporary.

As a patient, one may scroll and find a lot of information about the possible dietary changes that could be done for a patient who is suffering from adenomyosis. It’s very important to note that there is no specific diet recommendation for this disease. Avoiding coffee, red meat, and green tea are some of the possible things that are commonly mentioned across the internet, but none of them have been proven to have any role in the disease process.

The pain that typically occurs in this disease is extremely significant, and the patient usually will have to sort down to medical management or painkillers to alleviate their symptoms.

The cost of adenomyosis surgery in India can vary significantly based on several factors, including the type of surgery required (such as laparoscopic surgery, uterine artery embolization, or hysterectomy), the choice of hospital, the technology used, the expertise of the surgeon, and the city where the treatment is performed. Typically, surgery costs in metropolitan cities may be higher compared to smaller cities, owing to advanced infrastructure and facilities.

To receive a clear and accurate estimate tailored to your medical needs, it is best to consult with an expert. Dr. Jay Mehta, a leading gynecologist and adenomyosis surgeon in India, provides both in-person and online consultations. He offers comprehensive guidance on the most suitable surgical approach, expected outcomes, recovery, and associated costs, helping patients make informed decisions.

Adenomyosis has a very, very severe effect as far as fertility and pregnancy are concerned. The disease itself is such that it causes a severe compromise of the anatomy of the uterus, predominantly because it causes a thickening of the posterior wall of the uterus. In such a situation, the tendency to have abortions, preterm labor, recurrent miscarriages, and recurrent IVF failures is very common.

Many of the patients who have adenomyosis need to be treated with assisted reproductive techniques, especially IVF, because the disease can also distort the EM Junction, Endo-Myometrial Junction. Once the EMJ is compromised, the fertility outcomes of the patient are going to be very poor, irrespective of the disease being handled by a super specialist. Though an off-label use, one can try to perform a microwave ablation under laparoscopic guidance for this disease in order to reduce the intensity of the adenomyosis, and well-selected patients will benefit from this

Once the patient conceives post-adenomyosis surgery, it really comes down to how well the surgery has been done for adenomyosis. A well-done surgery where the approximation of the tissue is done adequately without leaving behind any dead space in the tissue will have the best obstetrics and pregnancy outcomes for the patient. Usually, we recommend a delivery of these patients at 37 weeks, and the mode of choice is to deliver these patients with a cesarean section.

One must note that there is no correlation of any sort between having a uterine polyp and adenomyosis, though occasionally both go hand in hand.

Adenomyosis is a disease of the uterine musculature, and a polyp is an aberration of the endometrial lining. Both are different disease processes

A polyp and adenomyosis can both be very effectively diagnosed using ultrasound.

It’s also interesting to note that polyps and Adenomyosis can be treated simultaneously for a patient in the same setting.