ADENOMYOSIS

Definition

Adenomyosis is the condition when endometrial tissue grows into the muscular wall of the uterus. For the duration of each menstrual cycle, the misplaced tissue thickens, breaks down, and bleeds as usual. The result could be painful, heavy menstrual bleeding, and an enlarged uterus (bulky uterus).

Prevalence

Adenomyosis causes 30-40% infertility and 50-60% dysmenorrhea (menstrual pain) in women in the reproductive age group. It takes place in reaction to the estrogen hormone. Premenopausal status was found in 70% of the women with an adenomyosis diagnosis. Hormonal drug abuse for infertility management (IVF /IUI ) has also led to an increased number of cases recently.

Cause

The exact cause of Adenomyosis is idiopathic to modern medicine. Childbirth (especially after C-section), post-surgery-mainly pertaining to uterus and hormone medications (especially infertility treatments like IUI and IVF), etc, may lead to the conditions. Adenomyosis typically affects women between the ages of 35 and 50 who are past childbearing. After menopause, the main signs and symptoms tend to disappear.

Signs and symptoms

•         Painful period
•         Heavy menstrual bleeding
•         Pain during sexual intercourse
•         Bleeding between cycles
•         Pelvic pain
•         Pain while passing the bowel.
•         Infertility

How is adenomyosis treated in modern medicine?

The following treatments are usually carried out for the management of Adenomyosis

•         NSAIDs
•         Oral hormonal therapies like IUDs
•         Uterine artery embolization
•         Surgical procedures like Myomectomy, Adeno-myomectomy, and endometrial ablation.
•         Hysterectomy- which is not always advisable considering the age factor and other fertility demands of the patient.

Ayurveda approaches towards Adenomyosis

Early diagnosed Adenomyosis with mild symptoms is completely curable with internal oral medications in Ayurveda. The treatment for Adenomyosis with severe signs and symptoms in Ayurveda is mainly by the administration of external therapies and internal oral medications. The external therapies comprise of below-mentioned treatment based on the body type and symptoms of the patient which should be done at the IP level.

• Oleation (Snehana)
• Sudation (Swedana)
• Purgation (Virechanam)
• Vasthi (Medicated decoction and oil enema)
• Uttara vasthi (intra-uterine administration of medicated oils)
• Parisheka (pouring of medicated decoction over the afflicted areas)
• Pichu (Vaginal pessary dipped in medicated oil)

All treatments should only be carried out under the guidance of an Ayurveda gynaecology specialised doctor.

Customised diet addressing the requirements of the  body is also given special attention .Practice of Yoga and Pranayama will help to alleviate the vata dosha and even help in balancing the deranged hormones in the body.

Duration of Treatment:

Duration of treatment strictly depends upon the symptoms and chronicity of the condition .Extra fertility demands with this condition may require more time to achieve results .The treatment plan  includes in-house external and internal therapies with oral medication which may be continued after discharge for almost a 3-month period for better outcome .

Case study

Presenting complaints

A 33-year-old P0A2, nulliparous lady who is working as staff nurse in New-Zealand with over  9 years of married life, planning for a baby, came to our hospital with a history of unstoppable severe menstrual bleeding with heavy clots since 2 years associated with severe menstrual cramps and pain, tiredness, and palpitations. She is also suffering from intense mood swings and disturbed sleep for the past few years. As this condition is so debilitating she has been unable to attend her job for the past 1 year .

History

She underwent multiple allopathic treatment procedures like myomectomy in November 2019 which was a total failure and ended up in painful and  unstoppable heavy menstrual bleeding. She conceived in March 2020 which resulted in a threatened abortion in 6th week. Again after 6 months, she got pregnant which remained till 6 months and a spontaneous miscarriage had happened. This again led to intense bleeding per vaginum with severe pain.

 In November 2022 she underwent Adeno-myomectomy and was on oral hormonal pills which didn’t help her in any aspect. Meanwhile, the same Doctor advised her to have a Uterine artery embolization. She was referred to one of the famous hospitals in Kerala and underwent an emergency Uterine artery embolization. During this time her Hb level went down to 8.6gm/dL. Since she was a registered nurse in New Zealand, the conditions started affecting both her personal and professional life and the bleeding wasn’t under control, so she was suggested for IUD (Mirena). She was administered with 2 Mirena(p/v) with oral hormone pills to arrest the bleeding ,but both got expelled within a week span .Her Hb level was lowered below 5 and she was advised blood transfusion . She also was on Hematopoietic therapy and Blood transfusion for a while and her Hb was elevated above 7 .Still the bleeding continued  and finally  the allopathic doctor suggested for Hysterectomy to support her life .Considering the fertility demands of the patient as well her age she was not ready to go for hysterectomy so came down to Ayurveda .After so many researches she got to identify a Ayurveda hospital with an Ayurveda Sthree roga specialized doctor to rectify this issue.

Her reports during initial Ayurveda consultation:

USG Abdomen taken on 23/02/2023 suggests uterine fibroids and adenomyosis  

Blood reports taken on 11/02 /2023 shows Hb levels at 8.6gm/dL, Estradiol – 48.80pg/mL 

O/e Abdominal girth – bigger than normal size

p/a- hard

p/v – uterus heavily bulku

cx – erosion noted

os – bleeding +++ with clots

For these complaints, the patient with the above-mentioned histories took a consultation on OP level and was advised to take oral medicines for one week in April 2023, right after the six months of continuous bleeding.

After taking the medicines her bleeding per vaginum stopped completely. She was admitted to the hospital on 19/06/2023 for IP-level treatments for better management. 

Blood test on 20.06.2023 shows, HB – 11.9 gm/dL, ESR- 20 mm/hr, MCV- 81.8 FL, HBA1C – 6.1%, Triglycerides 0 337.0 mg/dL, HDL – 35.9 mg/dL, LDL – 102 mg/dL, VLDL Cholesterol – 67 mg/dL, SGPT/ALT – 52.0 U/L, Urine examination – Bacteria present, Vitamin D – 12.86 ng/ml. MRI Pelvis on 20.06.2023 impressed, a bulky uterus with diffuse asymmetric adenomyosis (posterior>anterior wall) and a few small fibroids. Bilateral polycystic ovarian morphology.  

She had undergone 14 days of IP-level treatments which included intense panchakarma therapies, strict dietary changes, yoga, and physiotherapies. 

Outcome

Bleeding per vagina stopped completely. Quality of life improved.Regular monthly cycles with 3-4 days of normal bleeding and timely cessation .No heaviness of the lower abdomen . Significant changes in tiredness, palpitation, and mood swings were noted. Sleep patterns also improved. 

Why is Sanjeevanam Special?

At Sanjeevanam, we have successfully managed many adenomyosis cases with detailed history taking, physical examination, investigations, and all other screening methods for better prognosis and better treatment outcomes. Our Department of Women’s Health is completely managed by Dr. Hridhya R S – an Ayurveda Sthree Roga Specialist (Ayurveda Gynecologist) in town for a better understanding and effective prognosis of these complicated conditions. We have an exclusively female team including Ayurveda gynecologist, junior doctors, nurses, therapists, yoga instructors, and physiotherapists.

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