45-year-old woman with adenomyosis gave birth to second child

Women who are 45 years old have passed the best childbearing age and are considered older mothers. If they suffer from adenomyosis, they should not have a second child, otherwise it may cause some danger. Even if they want to have a second child, they must do so after the disease is cured. This can also reduce the chance of risks. Before that, women should receive the right treatment as soon as possible to cure their adenomyosis.

There are many treatment options for this disease, and clinical decisions need to be individualized based on the patient's age, symptoms, and fertility requirements. Surgery and drug treatment options can be chosen at the same time.

1. Medication

(1) Symptomatic treatment: For patients with mild symptoms who only require relief of dysmenorrhea, non-steroidal anti-inflammatory drugs such as ibuprofen, indomethacin or naproxen can be used for symptomatic treatment during dysmenorrhea.

(2) For patients with mild symptoms, no desire to have children, or near menopause, oral contraceptives or progestins can cause the ectopic endometrium to decidualize and atrophy, thereby controlling the development of adenomyosis.

(3) For women with heavy menstrual flow, dysmenorrhea, and no desire to have children, an intrauterine device containing highly effective progestin can be chosen. It continuously releases progestin locally in the uterus to control the development of ectopic lesions and needs to be removed or replaced after five years.

(4) Pseudomenopause therapy ("medical oophorectomy" or "medical hypophysectomy") involves the use of drugs to shrink the lesion before surgery and to reduce recurrence after surgery. GnRHa injection makes the hormone level in the body reach the menopausal state, thereby causing the ectopic endometrium to gradually atrophy and play a therapeutic role. The application of GnRHa can significantly reduce the size of the uterus and can be used as a preoperative medication for some patients with larger lesions and difficult surgeries.

If you wait until the uterus becomes smaller before performing surgery, the risks and difficulty will be significantly reduced. Side effects may cause menopausal symptoms and even serious cardiovascular and cerebrovascular complications and osteoporosis. Therefore, it is recommended to add estrogen in reverse after 3 months of GnRHa application to alleviate complications. In addition, GnRHa is expensive, so it is not currently used as a long-term treatment option. Once the drug is stopped, the resumption of menstruation may lead to further progression of the disease.