| acute pain management

Avoiding Hysterectomies

Painful Adenomyosis: Common and Treatable

In women undergoing a hysterectomy, adenomyosis is seen in anywhere from almost 9% to over 60%. Adenomyosis is defined as endometrial glands and stroma within the middle layer of the uterine wall (myometrium), and can cause heavy monthly bleeding, dysmenorrhea, dyspareunia, chronic pelvic pain, and lead to preterm birth, pre-eclampsia, or infertility. For many women, a confirmed diagnosis of adenomyosis is only made after a hysterectomy.

In the journal JAMA, researchers stress the importance of imaging, physical exams, pathology, and even hysteroscopy: “The histologic diagnosis of adenomyosis is based on the presence of irregularly shaped islands of endometrial glands and stroma in the myometrium… The adenomyotic lesions are surrounded by hypertrophic and hyperplastic endometrium, further enlarging the uterus…” The study concludes that, “Several medical therapies and uterine-sparing procedures can effectively improve symptoms without need for hysterectomy. Improved clinical awareness is needed to ensure appropriate patient care and to encourage studies to improve the understanding of pathophysiology and drive development of more sensitive noninvasive diagnostics and novel, US Food and Drug Administration–approved treatments.”

 

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