The short answer: Adenomyosis is a non-cancerous condition in which the lining of the womb grows into the womb muscle, which can make the womb bulky and cause heavy, painful periods (many women search for adenomyosis ka ilaj, एडिनोमायोसिस का इलाज). Most women are treated first without surgery, with pain-relief tablets, hormonal tablets or a hormone coil (Mirena). Surgery is considered when medicines do not help enough. Removing the womb (hysterectomy) is the only permanent cure, so it is usually discussed only when a woman has completed her family. If you want to understand the condition itself first, read our page on understanding adenomyosis: its symptoms and how it is diagnosed.
Treating Adenomyosis: From Hormones to Surgery
The treatment of adenomyosis depends on the woman’s age, her symptoms, her desire for future fertility, and whether she wishes to preserve her uterus. Because adenomyosis depends on the hormone oestrogen, symptoms usually settle after menopause, when the ovaries stop making it. For women who are years away from menopause, a treatment plan is made around what bothers you most: bleeding, pain, or both.
Hormonal Medical Therapies
The goal of medical treatment is to suppress the menstrual cycle and reduce oestrogenic stimulation of the adenomyotic tissue:
- Pain relief and non-hormonal tablets: anti-inflammatory painkillers and tranexamic acid, taken during periods, can reduce pain and bleeding; often the first step
- Combined oral contraceptive pill (COCP) taken continuously can stop or lighten periods and ease pain for many women with mild to moderate adenomyosis
- Levonorgestrel IUS (Mirena) a small hormone coil placed in the womb that releases a progestogen hormone; often reduces heavy bleeding a great deal and can ease pain; it also works as contraception and lasts several years
- GnRH agonists injections that cause a temporary, reversible menopause; can shrink the womb and ease symptoms, but cause menopause-like side effects such as hot flushes and bone thinning, so they are usually limited to about 6 months unless add-back HRT is given; useful as a bridge to surgery or to natural menopause
- Dienogest (a progestogen tablet) is available in India and taken daily; it can reduce pain and bleeding, though irregular spotting is common in the first few months
Surgical Options
Endometrial ablation — a short procedure, usually done as a day case, that destroys the lining of the womb. It can reduce heavy bleeding when adenomyosis is mild and close to the lining, but it often works less well when adenomyosis lies deep in the womb muscle (myometrium). It is only for women who do not want a future pregnancy, and contraception is still needed afterwards.
Adenomyomectomy — surgical excision of the adenomyotic tissue while preserving the uterus; technically challenging due to the diffuse nature of the disease; performed laparoscopically or by open surgery in selected women who strongly wish to keep the womb. Adenomyosis can come back afterwards, and a pregnancy after this operation needs careful planning and monitoring.
Hysterectomy — the only definitive surgical cure; appropriate for women who have completed their family and whose quality of life is significantly impaired despite medical treatment. It can often be done as keyhole surgery (laparoscopic, or robotic at Sterling Hospitals and KD Hospital), which usually means a shorter hospital stay and quicker recovery than open surgery; a very large womb may need open surgery. Whether the ovaries are kept is a separate decision, discussed with you before surgery.
Choosing the right treatment for you
There is no single best treatment for adenomyosis. The choice depends on how heavy the bleeding and pain are, your age and how far you are from menopause, whether you want to become pregnant, and how you feel about each option. Many women with adenomyosis do become pregnant; if pregnancy is your goal, hormonal treatments that stop periods are usually paused when you start trying, and your plan may involve a fertility specialist. If you have tried medicines without enough relief, it is reasonable to ask about the surgical options above. A few centres also offer other procedures for selected women, such as uterine artery embolisation; ask whether any of these would suit you.
Heavy bleeding or pain is not always caused by adenomyosis: fibroids, endometriosis, polyps and, less often, changes in the womb lining can cause similar symptoms, so a proper check comes first. Before your visit, this guide on preparing for a specialist appointment lists the reports and questions worth bringing.
For adenomyosis treatment in Ahmedabad, contact Dr. Nishtha Tripathi Patel at +91 76988 00333.