I have recently been diagnosed with adenomyosis, my options for treatment are birth control pill, depro provera, and hysterctomy.

I have recently been diagnosed with adenomyosis, my options for treatment are birth control pill, depro provera, and hysterctomy. I am very confused.
I have been anemic in the past year, my periods are very heavy. I was on the pill for the past 6 months and that didn’t do much. A hysterctomy seems so drastic. My quality of life is compromised only when I am having my period. Are there any other options?

Dear Debbie-
You are correct-hysterectomy is very drastic…and irreversible. At the Institute, we believe in organ preservation as the first step. Often times, adenomyosis has greatly invaded the uterine muscle, therefore it is not always possible to maintain fertility. However, with out laser debulking procedure we can remove as much of the diseased tissue as necessary, reconstruct the uterus and allow your body is still function normally hormonally and sexually. Most of our patients have a significantly reduced flow to their period after this procedure-therefore, quality of life is changed also. Please call us if we can help you.

I was diagnosed with adeomyosis last week. Before the diagnosis I was given an ultrasound as a general physical by my gynocologist. He noticed that my uterus was enlarged and that I had a cyst on my ovary. He,right away, wanted to schedule a hysterectomy and I was caught by surprise by this , along with finding out the results of my test. I asked him why my uterus was enlarged and he said , Well , lets take a biopsy and see whats happening. The results came back as Adenomyosis. He still mentioned a hysterectomy, since I am 44, had my children and almost to the age of menopause. I said that at least menopause was a gradual process and that I felt that a hysterectomy was too harsh for me to go through right now. Right now I need some type of birth control and he recommended the depro provera. The polyp in my uterus is about 6 cms. big. How difficult would surgery be if I had the polyp and cyst removed? I would also want my tubes tied. Since I am approaching menopause age, would it be better, on the run, to have a hysterectomy?

Dear Ari-
This is again a typical response by a gynecologist. Their immediate solution is hysterectomy!!
You do not need this drastic, irreversible procedure. FAS can successfully treat your problems. At 44 years old, you could be 10 years away from menopause and delaying treatment may only produce further symptoms.
Please call us if we an help you.
Dr. DJ

I have been diagnosed with adenomyosis. My periods are extremely heavy. about 7 weeks ago I had surgery because my Dr. thought it might be fibroids. Once he opened me up, he found a mass of tissue affected by adenomyosis and removed it. He felt that he had only left healthy uterine tissue behind. There were no fibroids. He says that other than the removed growth, my uterus is a very normal size (about like a pear). The problem is that I am having my first period since surgery and I am bleeding just as badly as I did before surgery – lots of clotting and the inability to be away from the bathroom for more than an hour. My Dr. is now talking hysterectomy. I am desperately trying to have one more child, so I’ve started on 150mg chlomid a day. (this is how I conceived my first child about 8 years ago). What do you think?

Dear Annette-
Your symptoms are not uncommon for adenomyosis surgery. If the disease has deeply invaded the uterine muscle sometimes removal of this diseased portion is not enough to alleviate symptoms. For women who wish to maintain fertility this is the best treatment. However, if the patient wants to have relief from the symptoms, we perform a “debulking” procedure that removes the excess tissue built up in the uterus around the adenomyotic disease. It reduces the size of the uterus but will often not allow for fertility. You have a very difficult decision to make.

Dear Dr.
I have had adenomyosis for several years and each year, during my exam, the gyn says it’s about the same. From time to time, I have a back ache in the right side, low to mid back. My GP has ruled out kidney infection. Is back pain a symptom of adeomyosis? Should I be concerned about O.C.? I had my only child at 32. I am now 46.
Candace

Dear Candace-
You did not indicate how your adenomyosis was actually diagnosed. Symptoms also sound like endometriosis.
Adenomyosis has as one of its primary symptoms pain. It can be very debilitating depending on the patient and the invasiveness of the disease. For patients that do not wish to maintain fertility, we perform a debulking procedure that removes the disease from the uterus, while preserving the organ for hormonal function. FAS can help you with your problem.

I am 27 years old and for about three years now I have been having severe pain on my right side and sometimes in my lower abdomen. The pain is so bad that it keeps me up at night on occasion. I have a one-year old daughter and the entire time I was pregnant with her I had no pain at all. I had laparoscopic surgery about two months ago to remove what my Dr. thought was a fibroidal apendicitis. He was wrong, it was normal, but they found what looked like adenomyosis [enlarged, “mushy” uterus, enflamed blood vessels behind my uterus, and what the OBGYN looking in (not my Dr.) on the surgery said was adenomyosis] without doing a biopsy of my uterine lining. My Dr. says that he can’t do anything for me since I plan to have more children. I am and have been on birth control pills. He has not and will not try any medication because he says it will not do any good. He says my only option is a hysterectomy so I should come see him after I have all the children I want to have. I am at the end of my rope with the pain. I want to feel normal for the first time in a long time. Is there anything I can do?

Dear CBM-
You are in a very difficult situation. Adenomyosis can be a very debilitating disease. Unfortunately, the best form of treatment is surgical removal of the disease. We do not advocate hysterectomy as a first line of attack. Your doctor was correct in stating that if you wish to try to have further children, not much can be done other than palliative treatment at this time. However, if you want to remove the adenomyosis, FAS can save the uterus by debulking the diseased tissue with laser assistance and reconstructing the uterus for normal hormone and sexual functioning. Depending on how much tissue to surgically removed, fertility is not always possible. You have a decision make. Please let us know if we can help you.

In May of ’99 I was diagnosed with adenomyosis and endometriosis by laporoscopic. In June & September I recieved lupron shots, which were to treat my endo. I’m suffering with menopause at the age of 28! My pain has slightly eased a bit, however, my sanity has vanished. I’m sinking into a deep bout of depression. We are anxious to have a second child. My doctor tells me there is a slim to none chance that I can conceive again; and if I do that I would probably miscarry. He says he can only try to make me comfortable (give me more drugs) until I’m “ready” for a hysterectomy. Is he correct?

Dear Anonymous-
Adenomyosis can be very debilitating and can cause infertility.
Your menopausal symptoms and depression are exactly why I do not use lupron in my practice.
Our laser FAS procedure can treat your adenomyosis and endometriosis, which would alleviate many of your symptoms, however I cannot guarantee fertility after the removal of the diseased tissue. You have a difficult decision to make, however, hysterectomy is not your only option when treating this disease.
Good Luck

Dear Dr.
I am 42 years old, I had my tubes cut and tied and a D & C 15 years ago. For 13 years I have had pain in my abdomin and 5 years ago I was diagnosed with PMS. I have been taking prozac and it seemed to help the pain and depression. Now I am in so much pain in my abdomin and back and legs that it will put me in bed for 3 – 5 days. I had an ultrasound and a lapriscope done just 4 days ago and was told I have Adenomyosis, but that until they actually could study the uterus in pathology it would not be determined as a fact. My doctor said the uterus is enlarged and hard. She will discuss options with me on May 3. I am tired of the pain I have 2 children one in college and one graduating high school. I do not want any more children and want to have a normal life. I am always fatigued and always have pain in my back and abdomin. Any suggestions? Why would a hystorectomy be bad for me?

Dear Dianne-I do not believe in performing hysterectomies for benign conditions. This is an irreversible procedure with side effects of its own.
Please read the website section on hysterectomy complications; many women call our office during the year asking for help with post hysterectomy problems, and there is very little that can be done. The conservative approach should always be considered before anything radical.
Our FAS procedure would laser treat your adenomyosis, and we can remove the diseased portion of the uterine muscle. However, with the reconstructive part of the surgery, we can allow you to keep the healthy part of the uterus for natural hormone regulation, and sexual function. I would not advise a hysterectomy as the first line of defense.

I was diagnosed with Adenomyosis Last August during a Laperoscapy looking for Endometriosis. There was no biopsy taken, but my uterus was enlarged, puffy and discolored.
It was good news to find out that I didn’t have Endometriosis, but that was before I really knew what Adenomyosis was all about.

A hysterectomy has never been an option for me. I’m only 21 and hope to have children someday. I’ve been forced to try drug therapy to “control” the Adenomyosis. But so far have had terrible luck.

Right after the Laperoscapy I was put on Depo. I stayed on that for three months, but the side effects were unbearable. I began Lactating, gained 40 pounds, had hot flashes, and severe mood swings. Eventually it became too much to handle.

It was then that I went in for a third opinion on my Adenomyosis and treatment. The doctor gave me few options. The depo. in a sense had worked, it took away my periods and the pain.. but the side effects were something I couldn’t handle. He suggested a drug by the name of Synarel, it ended up being EXTREAMLY expensive, and a big pain. It had to be inhaled through the nose every 12 hours. I declined that..

since then I’ve gone on Progesterone therapy in the form of a high progesterone birth controll pill.. but the pain is slowly returning.

I keep looking and hoping for other options. I want to live my life pain free. I don’t want to take drugs that only stop the Adenomyosis for a while.. I want something to treat it. But the only treatment and cure that I have been offered is a hysterectomy. and I’m just so young.. I want children someday…

do you have anything to offer me? I have no fibroids.. sometimes I get small cysts on my ovaries…. but they go away…. I’m not anemic because of Adeno, but the pain is hard to handle…..

is there actually hope??????

Dear Zoieangel-
You are very young to have been diagnosed with this aggressive disease. There are ways to reduce the negative symptoms, as you have discovered, but these treatments do not directly address the pathology and the spread of the Adenomyosis. This disease needs to be treated as soon as possible-the longer you wait for treatment the more advanced it will become. It is not a “curable” disease, only a treatable one. If you want children, the sooner you can attempt to get pregnant the better. The longer you wait the disease can render the uterine muscle unable to maintain a pregnancy.
Our FAS procedure can definitely help you. We use a laser to treat the spread, but must remove the actual diseased area to reduce the symptomology. Depending on how severe your condition is, the removal of the adenomyotic tissue may render you unable to have children. You have a very difficult decision to make.
Whatever you decide-do not wait much longer. Good Luck

I have been diagnosed with endometriosis and adenomyosis. I have been offered birth control pills or hysterectomy. I don’t want a hysterectomy and the obgyn’s here do not want to do conservative laser surgery because I’m 40. The pills aggrevate my interstitial cystitis. Could FAS help me? Would natural progesterone be beneficial after Fas for endometriosis to keep it away. They also say I have pelvic varicosities and pelvic congestive syndrome. Can you do anything surgically?

Dear Sharon-
FAS can help you. I am not quite sure why your physicians would not consider laser surgery because of your age-40 is very young to offer anyone a hysterectomy!!!
Laser would be utilized to treat the endo and remove and treat the adeno. Depending on the severity of the disease, your uterus may need to be “debulked” in order to reduce the symptomology: this will render you infertile. Your varicosities would most likely be ligated.
Before precribing progesterone post operatively, I would like to have your hormones evaluated. If everything is within normal limits, and balanced, progesterone therapy should not be necessary.
Please contact my office nurse Patricia, if you are interested in the program.
Dr. DJ

I was diagnosed with Endometriosis 4 years ago through a laparascopy. I was put on Danocrine for about a year and felt like a new person. But this last year I have been having constant lower back pain and irregular brown clotty periods. I made an appt to get checked and while researching Endometriosis I came across “Adenomyosis” which I’d never heard of and am thinking perhaps this is what I now have. Are these symptons commom?

Dear Carmen-
Danocrine is a very old treatment for endometriosis.
If you were diagnosed with endo, you may indeed have adenomyosis-this is a form of endometriosis of the uterine muscle. Symptoms are associated with pain, heavy crampy periods, clots, and an enlarged uterus.
This disease requires treatment asap. Most gyns will recommend a hysterectomy-we perform a laser assisted
removal of the disease which has been very effective. It does however render the woman infertile. I recommend that any women with this diagnosis have her children asap in order to prevent infertility issues at a later date. Good Luck
Dr. DJ

I am a 44yr. old woman. I have been diagnosed with adenoymosis 2yrs ago. This was found during a leep procedure for cervical dysplasia. 3 days after the procedure a artery burst on my cervix. This was sutured in the ER by my obgyn. I was ok after that. I got another opinion for the adenomyosis because I have such severe pain in my back and abdomen. My new obgyn did a ultrasound to detect any adhesions. None were found. My obgyn suggested I take ibuprofen for the pain. No hysterectomy was recommended. Thank heavens. It was discussed at a last resort tmt but not advocated. I am taking birth control pills and ibuprofen but the pain is not relieved. I have become extremely moody because of the consistent pain. Do you have any suggestions?

Dear Michele-
I am pleased to see that your gyn did not immediately recommend a hysterectomy for your adenomyosis-that can be very common. Most patients that we treat with this condition have a high degree of pain on a monthly basis. Medication will treat the symptoms but not the condition/disease. Adenomyosis is a very aggressive and debilitating disease-it needs to be surgically removed. Most gyns will not do this type of surgery.
Our FAS procedure treats adenomyosis with a laser and debulking procedure:this allows the patient to keep their uterus for hormone regulation without the pain. We have had very good success. Please call my office if you are interested.

I am 52 yrs old and have been in menopause for over a year now. I just started bleeding this morning, after 20 months since my last period. The last time this happened a full year had gone by between periods. My Dr. convinced me to have a DandC and hysteroscopy (after an ultra sound had been done) just to make sure everything was all right. It was. Now here I go again. Can you give me some insight as to why I have gotten another period after such a long time? I am not on hormone replacement therapy, and have very slight discomfort from menopause…minimum hot flashes and occasional sleep disturbance. I am in very good health and so far this period is no big deal as far as discomfort. Do you recommend I have another D and C and hysteroscopy? Thank you.

Dear Mary-
Chances are, you are not yet in full blown menopause.
I do not recommend another surgical procedure, especially if you last one was normal. Have your hormones checked, and consider going on a form of natural hormone replacement. Surgery at this point is not indicated. Good Luck

I keep reading about “debulking” the diseased portion of the uterus when diseased with Adenomyosis, and removing the diseased portion of the uterus. Is it possible for the Aedenomyosis to return in whatever part of the uterus that is left? What is the cause of this disease? It seems extremely aggresive? Is it Estrogen receptive?
Yes, I have been diagnosed with Adenomyosis, Endometriosis and Fibroids, largest is cantelope size. I am 40, and do not plan to become pregnant. From the research I have done, it seems that all of my “female” problems are Estrogen receptive, is this correct?
Thank you for your time.

Dear LouAnne-
You are correct….your conditions are estrogen responsive.
Adenomyosis is a form of endometriosis that strictly attacks the uterine muscle. The etiology is unknown, however we do understand the pathophysiology of the disease.It is very aggressive and if left untreated will produce infertility and usually ends up in hysterectomy.
There is no “cure” for this disease…except a radical hysterectomy. Our laser delbulking procedure is a one of kind treatment that can significantly reduce the progression of the disease and allow women to keep their uterus for natural hormone regulation and sexual functioning. The procedure will reduce the pain and bleeding associated with adenomyosis thereby giving women freedom from the debilitating symptoms, and allow them to conserve their organs.
You are the perfect candidate for FAS due to your multiple diagnoses….please give my office a call if you are interested in surgery.