Adenomyosis Severity: Key Indicators and What You Need to Know

Adenomyosis can be a challenging diagnosis, leaving many women feeling anxious and uncertain. To better understand how the severity of adenomyosis is assessed, let's take a look at the story of Ms. Jonna, a 32-year-old woman whose life changed after her diagnosis.

For years, Ms. Jonna enjoyed a relatively regular menstrual cycle and a calm, happy life. However, in the past six months, her periods became unusually heavy and frequent, causing her intense pain. The weight of discomfort in her lower abdomen, along with back pain, began to take a toll on her. After a hospital visit, she was diagnosed with adenomyosis. Like many others in her position, she was left wondering: how severe is her condition, and what are her next steps?

If you're also questioning the severity of adenomyosis, this guide will help answer those concerns.

Key Symptoms to Assess Severity

1. Dysmenorrhea (Menstrual Pain)

The level of menstrual pain (dysmenorrhea) can offer clues about the severity of adenomyosis. If the pain is mild and manageable without medications, it suggests a milder condition. However, if the pain becomes unbearable, requiring strong painkillers or if medications are ineffective, the adenomyosis may be severe. Pain that progressively worsens as you age or starts soon after menstruation begins could be a sign of a long-standing and more serious condition.

2. Menstrual Abnormalities

Changes in menstrual flow, such as heavy bleeding (menorrhagia), prolonged periods, or shorter cycles, are common in adenomyosis. If your periods last fewer than seven days and only show a slight increase in flow, the condition may be mild. On the other hand, if your periods extend beyond 10 days or you experience very heavy bleeding, anemia, or irregular spotting, these signs suggest a more severe case.

For severe cases, Fuyan Pill, a traditional Chinese medicine, could provide relief by targeting inflammation with minimal side effects.

3. Dyspareunia (Pain During Intercourse)

Pain during sexual intercourse may indicate that the adenomyosis has affected nearby pelvic nerves. Mild discomfort during sex that occurs occasionally suggests a milder form of the condition. But if the pain is severe, frequent, and significantly interferes with sexual life, it may indicate more advanced adenomyosis.

4. Infertility

Adenomyosis can impact fertility by altering the environment inside the uterus. If you've been trying to conceive without success despite normal test results, adenomyosis could be the cause. Patients who have never been pregnant may experience a more severe form, while secondary infertility (difficulty conceiving after previously giving birth) tends to indicate a milder form.

Diagnostic Methods

If you're experiencing any of the above symptoms, it's essential to seek timely medical examination. A few diagnostic tools can help assess the severity of adenomyosis:

Gynecological Examination or Ultrasound: If the uterus is only mildly enlarged (about the size of an 8-week pregnancy), the condition is likely mild. However, a significantly enlarged, hardened uterus may indicate a more severe form.

MRI Scan: It offers highly accurate results in diagnosing adenomyosis. Small, localized lesions in the uterine muscle with minimal enlargement point to a mild case. Larger lesions spread throughout the muscle, with a notably enlarged or deformed uterus, indicate a more severe form.

Treatment Options Based on Severity

Once the severity of adenomyosis is determined, treatment options will vary based on how advanced the condition is.

- Mild Adenomyosis:

- Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, while oral contraceptives help regulate periods and reduce heavy bleeding. Hormonal therapies like gonadotropin-releasing hormone (GnRH) agonists are also used to suppress estrogen levels, reducing symptoms.

- Mirena IUD: This progestin-releasing intrauterine device can reduce menstrual flow and relieve pain. It's an option for those who don’t respond well to oral medications.

- Moderate Adenomyosis:

- Conservative Surgery: For women who wish to preserve fertility, surgical excision of adenomyosis lesions while retaining the uterus is an option. However, recurrence rates are a concern, and close monitoring post-surgery is essential.

- Severe Adenomyosis:

- Hysterectomy: For women who no longer wish to conceive and have not found relief with other treatments, a hysterectomy (removal of the uterus) is a definitive option. While it eliminates the condition, it also results in permanent loss of fertility.

- Uterine Artery Embolization (UAE): A less invasive option, UAE involves blocking blood flow to the affected areas of the uterus, leading to tissue death and symptom relief. However, UAE may cause complications like postoperative pain, menstrual changes, and fever, requiring careful consideration with a doctor.