How to treat heavy menstrual flow caused by adenomyosis?

The estrogen level of patients with adenomyosis is always at a relatively high level, which will cause the endometrium to grow rapidly and become ectopic. In this case, the uterus cannot contract normally. Therefore, every time the patient has her menstrual period, she will not only have severe dysmenorrhea, but also a lot of menstrual flow. So, how to treat heavy menstrual flow caused by adenomyosis? It is recommended to solve the problem from the root and treat adenomyosis.

1. Medication

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

(2) Pseudopregnancy therapy is used for patients with mild symptoms, no desire to have children, and those 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"): drugs that shrink the lesions before surgery and 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.

(5) Treatment with Traditional Chinese Medicine Traditional Chinese Medicine believes that adenomyosis is related to internal blood stasis, and the formation of blood stasis is related to pathogenic factors such as qi deficiency, cold stagnation, qi stagnation, phlegm and dampness. Therefore, in terms of treatment, we should not only take promoting blood circulation and removing blood stasis as the principle, but also take into account the causes of blood stasis and the differences between deficiency and excess. You can take Chinese patent medicines such as Huazheng Zhitong Granules, Sanjie Zhentong Capsules, Dan'e Fukang Decoction, Shaofu Zhuyu Pills, etc. or decoctions adjusted according to your personal situation. You can also use Chinese medicine for promoting blood circulation and removing blood stasis, such as retention enema, plaster application, and ion introduction of Danshen injection. You can also use acupuncture on Guanyuan, Hegu, Sanyinjiao and other acupoints before and during menstruation, or use ear acupuncture on uterus, endocrine, liver and other acupoints.

2. Surgery

Surgical treatment includes radical surgery and conservative surgery. Radical surgery is hysterectomy, and conservative surgery includes adenomyosis lesion (adenomyoma) resection, endometrial and myometrial resection, myometrial electrocoagulation, uterine artery occlusion, presacral neurectomy and sacral neurectomy.

(1) Hysterectomy

It is suitable for patients who have no fertility requirements, have extensive lesions, severe symptoms, and are ineffective with conservative treatment. Moreover, in order to avoid residual lesions, total hysterectomy is the first choice, and partial hysterectomy is generally not advocated.

(2) Resection of adenomyosis lesions

Suitable for patients who want to have children or young patients. Because adenomyosis often has diffuse lesions and unclear boundaries with the normal uterine muscle tissue, how to choose the method of resection to reduce bleeding, residual tissue and facilitate postoperative pregnancy is a rather difficult problem.

3. Interventional treatment

Selective uterine artery embolization can also be used as one of the treatment options for adenomyosis. Its mechanisms of action include: necrosis of the ectopic endometrium, reduced secretion of prostaglandins, relief of dysmenorrhea, reduction of menstrual volume, and lower recurrence rate; establishment of collateral circulation of the endometrium in place, which can gradually migrate and grow from the basal layer to restore function. However, uterine artery embolization will affect the blood supply to the uterus and ovaries, thus having an adverse effect on pregnancy. It may cause infertility, miscarriage, premature birth and increase the rate of cesarean section.