Currently, the only treatment for complete resolution of symptoms is hysterectomy. However, some progress is being made in the treatment of adenomyosis. Check out the possible treatments below for more information.
Note: Adenomyosis Fighters does not promote or recommend any of the following treatments. This information is given FYI so that you may be prepared when going through your treatment for adenomyosis. Please know that there can be side effects and/or complications from any of the treatments or medications below.
Dilation and Curettage (D&C) – Although a D&C does not directly treat adenomyosis, it may be one of the first procedures done to treat heavy menstrual bleeding when unsure of the cause. This is a relatively easy outpatient surgery. You may have some cramping after the surgery, but it generally resolves quickly.
Endometrial ablation – This procedure destroys the endometrial lining of the uterus. If future pregnancy is desired, this surgery is not advised. In some cases, this procedure may work; however, in women with severe, diffuse adenomyosis, this procedure has been known to fail. If you have severe, diffuse adenomyosis and do not desire children, it may be worth it to go directly to a hysterectomy.
Percutaneous Microwave Ablation (PMWA) – This surgery is similar to the endometrial ablation, but instead of burning the lining of the uterus, a needle delivers microwave energy directly to the periphery of the adenomyotic lesion. As with the endometrial ablation, this procedure should not be done if future pregnancy is desired.
Hysterectomy – This is the only known “cure” for adenomyosis at the current time. If pregnancy is not desired in the future, it may be worth it to consider this option if you are in severe discomfort from this disorder. There are many different types of hysterectomy, but, in general, only the uterus needs to be removed as adenomyosis only affects the uterine wall. However, if it is known that you also have endometriosis, other reproductive organs may be taken such as the ovaries or cervix. It all depends on your situation. The story of my hysterectomy can be found on my blog on this site.
Laparoscopy – This is an outpatient procedure used to remove endometriosis implants on the ovary, uterus, and other abdominal structures using a laser. Although not useful in the treatment of adenomyosis, it may help with some symptoms if the patient has both adenomyosis and endometriosis. These two disorders often occur together. However, this procedure is now known to not be as effective as excision and cauterization (see Excision and Cauterization below).
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) – Another promising radiological technique is magnetic resonance guided focused ultrasound (MRgFUS). Using magnetic resonance imaging, a beam of energy is sent directly to the adenomyotic lesion and destroys it without injuring the tissue around it. This non-invasive procedure is a major breakthrough and it has a lower risk of complications compared to other procedures. This is so exciting to see a test that can actually pick this disorder up; however, my concern is that women generally won’t be able to access this technology due to cost and insurance requirements. That is why it is so important for EVERYONE to be aware of this condition and to know that this technology is out there. MRgUS is now being used in the treatment of fibroid tumors, but it is also effective in the treatment of adenomyosis. Please educate everyone you know about MRgFUS!
The Osada procedure – Dr. Osada has developed a new procedure that help women with adenomyosis retain uterine function. This may be a viable alternative to hysterectomy; however, there is a risk of uterine rupture during pregnancy after having this procedure.
Uterine Artery Embolization – Although this procedure has been performed on women with endometriosis and adenomyosis, a study in 2010 by Wang et al. showed disappointing results. Only 15% of the women rated the procedure as satisfactory at 6 months. Also, a study by Guo et al. in 2012 showed the recurrence rate of adenomyosis after this procedure in high.
Excision and Cauterization – This procedure has been found to be superior to laparoscopic ablation of endometriotic lesions. A lady on the Adenomyosis Fighters Support Group site explained it beautifully: Ablation is like mowing your lawn. You trim the grass (endometriosis lesions), but eventually it will grow back. But instead of just mowing, let’s say you dig up the grass by the roots. The grass won’t grow back. This is what happens with excision surgery. Many doctors have used this procedure on women with endometriosis, such as the well-known Dr. David Redwine and Dr. Ken Sinervo, with tremendous success. It would be well worth it to search for doctors who specifically do excision surgery.
Presacral Neurectomy (PSN) – In this surgery, some of the nerves that supply the uterus are cut. This results in a significant reduction of pain. However, there are risks with this surgery including loss of sensation in the bladder and damage to the ureters and/or the sigmoid colon.
Laparoscopic Uterosacral Nerve Ablation (LUNA) – In this surgery, the uterosacral ligaments are cut near the posterior cervix. Again, this results in significant reduction in pain. However, this procedure is rarely done anymore as the PSN has been shown to be far more effective.
Pharmaceutical and Natural Treatments
NSAIDS – Medications such as ibuprofen (Advil, Motrin) and Aleve are examples of NSAIDS. These medications block prostaglandins such as COX-2 and have been shown to be effective with menstrual pain. However, if the adenomyosis is severe, these medications may not be sufficient. In my case, the adenomyosis was so diffuse and severe through the uterine muscle that these medications were ineffective. If that is your case, you may want to talk to your doctor about stronger pain relievers and/or some of the other options below.
Tramadol (Ultram) – I mention this medication because in my latest book, I asked what medications the ladies found to be the most effective, and this medication came in at #2 just behind ibuprofen which was #1. It is important to note, however, that this medication is a controlled substance with a high risk of dependence, so it should be used carefully.
Continuous birth control therapy – Using continuous birth control therapy can be very effective in treating symptoms of adenomyosis. This involves being on the hormone pills continuously (no placebo pills during the week of menstruation) except about 4 times per year. It is recommended that if this therapy is administered, a progesterone dominant birth control pill is recommended.
Progesterone (levonorgestrel)-releasing IUD – The levonorgestrel releasing IUD (the most popular is Mirena) may be helpful in that it has been shown to reduce VEGF expression. This device can be easily inserted and can last up to 5 years. A speculum is used and a small tube is threaded into the uterus. The IUD is placed into the uterus, and a small string remains in the vaginal canal so the doctor/patient will know that it remains in the correct position. The patient may feel some discomfort after insertion including cramping and back pain. Other side effects include possible pelvic inflammatory disease (PID) and pregnancy complications in case of IUD failure. Benefits include lighter periods and a decrease in menstrual cramps.
Please note: I regularly read comments on adenomyosis support sites and have heard from many women that they have had severe pain when using an IUD. I therefore feel compelled to pass this information on through this website. Although the scientific literature reports that this type of IUD is effective in reducing adenomyosis symptoms, there have also been actual patient reports of severe pain and removal of the IUD within the first week.
Progestins – Dienogest, also known as Visanne, is an oral progestin that has been helpful in the treatment of endometriosis. A 2014 study by Hirata et al. showed that dienogest was an effective treatment for adenomyosis as it reduced pelvic pain. However, this progestin also caused worsening anemia in a few patients.
Danazol – This drug inhibits steroid hormone production which reduces estrogen levels. It may also increase testosterone production. Side effects include weight gain, increased body hair, oily skin, reduced sex drive, hot flashes and an increase in blood sugar. This drug is not being used much since the development and use of GnRH analogs.
Aromatase inhibitors – Aromatase inhibitors are a newer class of drugs and are typically used for breast and ovarian cancer in post menopausal women. Aromatase synthesizes estrogen, and these drugs block receptor sites for aromatase which in turn decreases the production of estrogen. Examples of aromatase inhibitors include exemestone (Aromasin), anastozole (Arimidex) and letrozole (Femara). Side effects include hot flashes, vaginal dryness, infertility, foggy thinking, muscle and joint pain, osteoporosis, arthritis, adrenal insufficiency, liver disorders, kidney failure and possible heart problems.
Gonadotropin-releasing hormone (GnRH) analogs – These drugs basically modify the release of lutenizing hormone(LH) and follicle stimulating hormone (FSH). These hormones control ovulation and menstruation. And example of this type of medication is Lupron. It is given either by injection or intra nasally. They have been used in the treatment of endometriosis, leiomyomas (fibroids), infertility, dysfunctional uterine bleeding, premenstrual syndrome (PMS), and hormone dependent tumors. In one study, these drugs were linked with a decrease in the thickness of the myometrial JZ (see “Causes” in the blog). Examples of GnRH analogs include Lupron, Synarel, Zoladex, cetrorelix (Cetrotide), and ganirelix. Side effects include menopausal type symptoms such as hot flashes, vaginal dryness, headaches, mood swings, decreased sexual drive, reduced bone mineral density, and nausea.
Pentoxifylline – Also known as Trental or Pentoxil, this medication is typically prescribed for those suffering from intermittent claudication, vascular dementia or other circulation problems. It improves blood flow throughout the body. Some recent studies have shown that this drug may be promising in the treatment of endometriosis and/or adenomyosis.
Vaginal bromocriptine – High levels of prolactin (hyperprolactinemia) have been noted in adenomyosis. Bromocriptine is a dopamine agonist used in the treatment of menstrual irregularities and hyperprolactinemia.
Tranexamic acid – this medication prevents blood clots from breaking down too quickly. This can potentially help with heavy menstrual bleeding.
Mefenamic acid (Ponstan forte or Ponstel) – this medication is a type of NSAID (see above).
Crystal Star Women’s Best Friend Herbal Supplement – This supplement, available on Amazon, is packed with herbs that are known to help balance hormone levels. I first heard of this supplement when a lady in the Adenomyosis Fighters Support Group talked about how much it helped her in dealing with this disorder. When I looked at the ingredients, I was impressed. It would be worth it to give it a try!
Castor oil packs – Ninety percent of the fatty acids in castor oil is ricinoleic acid which is known to support the lymphatic system, increase circulation and help balance hormones.
Exercise – I know how hard it is to exercise when dealing with adenomyosis, so this is easier said than done. But if you can get some form of exercise at least three times per week, even if it is only walking, it can make it easier to deal with this disorder. Adenomyosis has been linked to estrogen dominance. Obesity has been linked to an increased production of aromatase which leads to an increased production of estrogen. So, as you can see, excess weight can exacerbate the symptoms of adenomyosis.
Pelvic floor therapy – Performed by physical therapists, pelvic floor therapy includes myofascial release, pelvic floor muscle EMG/TENS, stretching and relaxation exercises, biofeedback, deep tissue massage and craniosacral therapy.
Antioxidant therapy – High levels of free radicals have been shown to occur in women with adenomyosis. In order to combat this, patients could receive antioxidant therapy such as a vitamin E drip.
Acupuncture – This technique has been shown to reduce pain through the release of endorphins and enkephalins, the body’s natural painkillers.
Biofeedback – This is a relaxation technique. It involves learning how to consciously regulate your breathing, heart rate, and blood pressure. This technique has been shown to be effective in many disorders such as insomnia, migraines, back pain, and gastrointestinal disorders.
Progesterone cream – The use of natural progesterone cream has shown some promise in the treatment of adenomyosis. Dr. John Lee has coined the term estrogen dominance and has developed his own natural progesterone cream. For more information, please check out his website at http://www.johnleemd.com
**Note: More recent studies have suggested that progesterone may not be as effective in the treatment of adenomyosis as previously thought. It has been noted that the number of progesterone B receptors are lower in adenomyosis patients as compared to those without adenomyosis. This leads to a condition called progesterone resistance. Progesterone must lock into their receptors in order to exert their hormonal influence on the body. If the level of receptors are low, it doesn’t matter how much progesterone is in the body – it can’t exert it influence because it can’t lock into its receptor. More studies desperately need to be done.
Melatonin – this natural supplement helps to regulate our circadian rhythm which helps us to sleep better. Recent studies have suggested that melatonin supplementation may be beneficial in the treatment of adenomyosis. Qi et al. (2018) showed that this supplement may block 17B-estradiol induced migration and invasion in endometriotic implants. Use caution at this point when using this supplement. Follow the directions on the bottle, and try to use it sparingly. Issues may arise from overuse of melatonin, and these recent studies are only suggestive of its help. More studies need to be done.
Resveratrol – a recent study has suggested that this supplement may be useful in adenomyosis. Zhu et al. (2015) showed that in rats with adenomyosis, resveratrol reduced the infiltration of adenomyosis into the myometrium and uterine hyperactivity when treated with resveratrol.
Qi, S., Yan, L….Zhang, H. (2019). Melatonin inhibits 17B-estradiol-induced migration, invation and epithelial-mesenchymal transition in normal and endometriotic endometrial epithelial cells. Reproductive Biology and Endocrinology, 16, 62. doi: 10.1186/s12958-018-0375-5
Zhu, B., Chen, Y., Zhang, H., Liu, X., Guo, S.W. (2015). Resveratrol reduces myometrial infiltration, uterine hyperactivity, and stress levels and alleviates generalized hyperalgesia in mice with induced adenomyosis. Reprod Sci., 22(11): 1336-49. doi: 10.1177/1933719115572479