Endometriosis, also known as adenomyosis, is an incredibly common condition affecting over 200,000 women every year. It happens when the tissue which usually lines your uterus growing outside of your uterus. This results in many side effects, including chronic and acute pain and irregular menstrual cycles. The women’s health experts at the Center for Women’s Health in Oxford, NC want you to know that you don’t have to live in constant pain. Today, we review several treatment methods for this incredibly painful condition. Keep reading to learn more.
Causes of Adenomyosis
Often, the most effective treatment method is prevention. One of the most commonly asked questions we get about this condition is its cause. Unfortunately, there are several potential causes of uterine tissue developing outside of your uterus. These include retrograde menstruation, transformation of peritoneal cells, embryonic cell transformation, surgical scar implantation, endometrial cell transport and certain immune system disorders.
Retrograde menstruation occurs when menstrual blood containing endometrial cells flows backward through the fallopian tubes instead of outside the body. These endometrial cells implant themselves on the pelvic walls and organs of the pelvis. As you continue to menstruate “backward”, they bleed and thicken.
Transformation of Peritoneal Cells
Sometimes, immune factors or hormones can transform peritoneal cells, which line the interior of your abdomen, into endometrial-like cells. In this case, to treat adenomyosis you should treat the hormone or immune disorder causing the condition. This is the only way to prevent it from occurring in the future.
Embryonic Cell Transformation
If someone you love shows symptoms of adenomyosis during puberty, embryonic cell transformation is the most likely cause. Puberty often causes skewed levels of estrogen. This hormonal imbalance may transform embryonic cells, or cells in their earliest developmental stage, into endometrial-like cell implants. In this case, the best way to treat the condition is to wait for puberty to end. It is highly unlikely that the condition will return once hormonal levels balance.
How to Treat Endometriosis
The most effective endometriosis treatment depends on a number of factors. Your personalized treatment plan may include several treatments, including pain medication, hormone therapy and home remedies. Let’s take a look at some of the most common treatment methods.
To ease menstrual cramps, take over-the-counter NSAIDs like ibuprofen. Other analgesics, such as naproxen sodium (Aleve), may also be effective. If over-the-counter pain medications are ineffective, you may need to take 7.5 or 15 mg of meloxicam, a prescription NSAID. If you’re not trying to get pregnant, pain relievers combined with hormone therapy may be enough to alleviate your symptoms.
Hormone replacement therapy is an excellent method for reducing or alleviating the pain caused by endometrial implants. During menstruation, these implants thicken, disintegrate and bleed. Hormone therapy may slow the growth of endometrial tissue and prevent its implantation outside of the uterus. However, once hormone therapy stops, your symptoms may return. Here are some of the most effective hormone therapies:
Hormonal contraceptives may come in the form of birth control pills, vaginal rings or patches. These control the levels of hormones responsible for endometrial tissue growing out of control each month. When you are on a hormonal contraceptive, you may experience a shorter or lighter menstrual flow than usual. Particularly in the case of continuous-cycle regimens, you can expect a reduction or elimination in endometrial pain.
Gn-RH Agonists and Antagonists
Gonadotropin-releasing hormone agonists and antagonists block the production of hormones, stimulating your ovaries. With a reduced level of estrogen, you cannot menstruate anymore. This causes your endometrial tissue to shrink and eliminates endometrial pain. Essentially, these prescriptions create artificial menopause.
To avoid the symptoms of menopause, such as vaginal dryness, bone loss and hot flashes, take a low dose of progestin or estrogen. Ovulation and menses will resume, and you will once again be able to conceive, once you stop taking these medications.
Several progestin therapies can treat endometriosis. The most common is an intrauterine device with levonorgestrel, such as Skyla or Mirena. If you prefer a pill, Camila is an excellent option. If you want a quarterly contraceptive injection, Depo-Provera can stop menses for up to three months at a time. However, you can only receive Depo-Provera for eight quarters safely. Finally, Nexplanon is the most effective contraceptive implant.
Aromatase inhibitors fall under a class of medications that lower estrogen levels in your body. In combination with progestin or hormonal contraceptives, endometriosis can be treated effectively.
If you are trying to become pregnant, a medical procedure may be necessary to remove the implanted endometrial tissue while preserving your ovaries and uterus. While this does not prevent uterine tissue from growing outside of your uterus in the future, it preserves your sexual reproductive organs while removing the current problem.
This procedure may be performed abdominally in extensive cases. However, it is most commonly performed laparoscopically. In fact, laparoscopic removal of endometrial tissue can very often be effective. The benefits of a laparoscopic procedure include a very brief recovery time, more comfort during recovery and minuscule incisions.
If you’re trying to get pregnant, you may find that you need fertility treatment to help you conceive. This type of treatment can range from stimulating your ovaries to in vitro fertilization. During your initial consultation, we will discuss your family planning goals and assess your fertility to determine if fertility treatment is right for you.
Hysterectomy or Oophorectomy
A hysterectomy is the removal of the uterus. Oophorectomy is the removal of the ovaries. Both of these prevent endometriosis from occurring in the future. Unfortunately, these procedures make conception impossible. If you are opposed to having a surrogate deliver your children, the removal of endometrial tissue is a better solution for you.
Effects of Oophorectomy
Menopause is triggered when your ovaries are removed. While the lack of estrogen produced by the ovaries will prevent endometrial tissue from growing outside your uterus, you must be emotionally prepared to deal with menopause. Hormone replacement therapy may be necessary to prevent post-menopausal syndrome.
Effects of Hysterectomy
If you are done having children, hysterectomy may be the best solution for endometriosis. This method is often preferred to oophorectomy because the ovaries remain in place and early menopause is not triggered. If uterine cramping makes menses painful and you experience an unusually heavy flow every month, removing your uterus will most likely alleviate symptoms.
At-Home Treatment Methods
While you can’t get rid of adenomyosis at home by yourself, there are steps you can take to alleviate pain without taking prescription NSAIDs and muscle relaxants. In many cases, adenomyosis causes pain due to severe muscle cramping. Unfortunately, NSAIDs do not treat this type of pain effectively. The best treatment for muscle pain is a prescription muscle relaxant, such as 10 mg of cyclobenzaprine. However, you can’t drive or operate heavy machinery after taking cyclobenzaprine, so many women do not have the luxury of taking this safe, effective medication.
To relax your pelvic muscles and alleviate pain caused by cramping, take a warm bath and use a heating pad or electric blanket. Weighted blankets are also very comforting. Naproxen sodium (Aleve) may be effective at easing muscle cramps, as well. Finally, drinking a glass of warm milk before bed will help you sleep and relax your muscles. Milk is an excellent source of highly bioavailable magnesium and contains a healthy amount of sodium. Both of these essential minerals are important for proper muscle function.
Diagnosis of Adenomyosis
To receive the safest, most effective treatment for pelvic pain, you need an accurate diagnosis. There are several effective methods for the diagnosis of adenomyosis. After a thorough discussion of your symptoms, such as the location of your pain and when it flares up, we will conduct one or more physical examinations. Here are some testing methods you can expect:
An ultrasound is a diagnostic imaging test that creates images from inside your body via high-frequency sound waves. To capture these pictures, a transducer is inserted into your vagina (transvaginal ultrasound) or pressed against your abdomen like you would expect during an ultrasound to provide images of a fetus.
Keep in mind that an ultrasound is not a definitive diagnostic test for adenomyosis. However, it can identify cysts, called endometriomas, which indicate adenomyosis.
Magnetic Resonance Imagery
Magnetic resonance imagery, or MRI, is one of the most common diagnostic tests for endometrial implants. This imaging test uses radio waves and a magnetic field to create extremely detailed images of the tissues and organs within your body. This helps with planning laparoscopy to remove endometrial tissue and also gives a clear picture of the size and location of endometrial implants.
Laparoscopy is a medical procedure performed under general anesthesia which allows a direct view inside the abdomen. During this procedure, a tiny incision is made near your belly button and a laparoscope, or slender viewing instrument, is inserted into the incision.
If you have uterine tissue growing outside your uterus, this procedure will identify the size, location and extent of the endometrial implants. A biopsy (tissue sample) may be taken for further testing. In most cases, your adenomyosis can be treated during this procedure and will no longer cause you problems.
During a pelvic exam, your physician will manually palpate parts of your pelvis, trying to identify any abnormalities. Abnormalities that may be found through a pelvic exam include scars behind your uterus and cysts which have formed on your reproductive organs. If your adenomyosis is large enough, it can be felt during a pelvic exam as well.
Symptoms of Adenomyosis
How do you know if you need to seek a women’s health specialist to diagnose adenomyosis in the first place? The most universal symptom of adenomyosis is pelvic pain, most commonly during menstruation. You may suffer from adenomyosis if your menstrual pain becomes increasingly more severe over time. Besides dysmenorrhea (painful menstruation) causing severe lower abdominal and lower back pain, here are some other signs you need to seek medical attention:
- Pain during or after sex
- Pain during urination or bowel movements
- Excessive bleeding during and after menstruation
Keep in mind, the level of pain you experience is not indicative of how extensive your adenomyosis is. You can have large, thick implantations of endometrial tissue but experience little pain. Similarly, you could have thin layers of endometrial tissue with severe pain during restroom visits and sex.
Take Back Your Life Today
Endometriosis is painful and can cause frustrating menstrual irregularities. However, the symptoms do not need to be permanent. To schedule your initial consultation, contact the dedicated women’s health experts at the Center for Women’s Health in Oxford, NC today. We will diagnose the cause of your pelvic pain and create a customized treatment plan that works best for you.