 |
 |
 |
|
|
|||
|
|
||||
|
||||
Adenomyosis- treatment optionsFrom: J.Glenn Bradley MD (anonymous@obgyn.net)Fri, 17 Sep 1999 15:40:48 -0500 (CDT)
Adenomyosis is usually a Dx. made retrospectively, after hysterectomy and subsequent microscopic evaluation of the surgical specimen. It should be highly suspected when the patient experiences a progressive problem with heavier periods, increasing cramping, and uterine tenderness. Clinical examination may reveal the uterus to be soft and boggy to touch, possibly tender, and slightly enlarged. An MRI may demonstrate adenomyosis, but this is an expensive test and usually will not change managment. After ruling out endometrial pathology such as endometrial overgrowth ('hyperplasia, or cancer") by uterine biopsy, and ultrasound or hysteroscopy, the question remains... what to do?? A trial of hormone therapy ( birth control pills, provera etc) is simple and inexpensive. If the heavy bleeding/ cramps/ tenderness is under control, great!! If the symptoms continue, the patient may be offered: 1) a D&C.... worthless as it will do nothing for adenomyosis 2) endometrial ablation... if the adenomyosis is superficial and not deep in the uterine wall, it may be destroyed by the ablative procedure. IMHO, endometrial resection in which the uterine lining is peeled off the uterine wall, and then the remaining uterine wall is sealed by ablation should at least theoretically provide better bleeding control than say a simple balloon procedure. Unfortunately, ablation may result in the sealing of endometrial tissue in the uterine wall, thus not allowing blood to escape at the time of normal menses. If this happens a progressive increase in cramping and tenderness may result, although the heavy bleeding may have been reduced to little or none 3) hysterectomy... certainly definitive. One English study found that ablations performed in women under age 45 was associated with an approximate subsequent hysterectomy rate of 35%. There are several ways to remove the uterus. Most entail an abdominal incision, or perhaps the procedure can be done vaginally. If available, laparoscopic hysterectomy allows the fastest recovery. For most patients, same day discharge from hospital, minimal to no pain medication requirements, and the resumption of almost all normal activities in a week or so is the experience of over 85% of the patients. Dr.B
|
|
Return to ![[ Women's Health Forum ]](http://www.obgyn.net/images_women/wh-forum.gif)
Report TECHNICAL Problems ONLY to: webmaster@obgyn.net
Last Updated: Mon Nov 2 07:18:27 2009
Women's Insurance Checklist from Auto Insurance Quote
home | medical professionals | women | industry | forums | international