How is adenomyosis treated?

  Adenomyosis (AD), also known as intrinsic endometriosis, is caused by the invasion of endometrial tissue from the basal layer of the endometrium into the myometrium and occurs in women after pregnancy or with a history of endometrial injury. The prevalence is reported to be 5% to 70% abroad and 13.4% in China. In recent years, with the implementation of birth control measures such as abortion and other clinical operations of endometrial injury, there are two obvious trends in this disease: one is the increase in incidence, and the other is the decrease in the age of onset, which is becoming more youthful. To date, there is still no ideal treatment for this disease, which is called “chronic cancer” and seriously affects the physical and mental health of women of childbearing age.  For younger patients, especially those who have not yet had children, hysterectomy is obviously not a very good method, while for older patients, hysterectomy can cure AD, but the consequence is not only the loss of fertility, early perimenopausal symptoms and other currently known symptoms, but also the pelvic floor damage caused by surgery. The main reason is that it is difficult to completely remove the lesion, and the efficacy is unsatisfactory or easy to recur. Drug treatment is mainly the use of hormonal drugs to perform pseudo-menopause therapy, the recent effect is obvious, but only temporary, after stopping the drug symptoms and signs often quickly relapse; and the use of drug time is too long, drug treatment of side effects and complications is also unacceptable to many patients.  In recent years, with the continuous development of interventional techniques, many scholars have tried to treat AD by interfering with the blood supply of uterine arteries and achieved relatively satisfactory treatment results. Domestic data show that the medium and long-term clinical efficiency is more than 85%. The main principle of this treatment method is: to block the blood supply to the endometrial tissues located between the myometrial walls by embolizing the upper branches of the uterine arteries bilaterally with granular embolic agents of suitable size, so that they become ischemic, hypoxic and then liquefied and necrotic, thus losing the pathological biological effect and achieving the purpose of cure. The normal function of the uterus is preserved because the normal myometrial tissue still has normal lateral branch blood supply without necrosis, and its biological role can be preserved.  This method simply involves making a small incision in the skin at the root of one thigh (femoral artery) the size of a sesame grain (about 2 mm) and using a puncture needle to access the femoral artery, after which the operation is completed in about one hour. Since the procedure is very minimally invasive, the patient can eat after the procedure and can get out of bed and move freely after 20 hours.  Interventional treatment does not aggravate the patient’s condition and does not interfere with the implementation of other treatments; in other words, even if interventional treatment fails, the patient can still choose other treatments such as surgical resection.  Since this treatment method preserves the patient’s uterus and its functions, the surgery is less invasive, and the patient recovers quickly after the surgery. Compared with the current surgical treatment, which mainly involves the removal of the uterus, and the drug treatment, which mainly involves amenorrhea, this treatment method is undoubtedly an excellent treatment method for the benefit of patients of reproductive age.