Adenomyosis Management Dilemma: Pregnancy Preparation or Treatment?

Every woman experiences dysmenorrhea differently, with varying levels of pain. However, when mild discomfort escalates into severe pain, it could be a sign of adenomyosis, a condition often associated with painful menstruation. For women with adenomyosis who aspire to become pregnant, deciding whether to prioritize pregnancy or treatment can be challenging. This article explores the causes of adenomyosis and guides in making this important choice.

Causes of Adenomyosis:

1. Progesterone Influence: Experts have noted a higher incidence of adenomyosis among menopausal women than non-pregnant women. This suggests a correlation between adenomyosis onset and progesterone levels.

2. Uterine Surgery and Mishandling: Procedures such as uterine surgery, cesarean sections, uterine fibroid removal, and corrections of uterine deformities can inadvertently introduce endometrial fragments into the myometrium, potentially increasing the risk of adenomyosis.

3. Reproductive Tract Obstruction: Congenital or acquired diseases may obstruct the reproductive tract, impeding the flow of menstrual blood and leading to adenomyosis.

4. Age-Related Factors: Adenomyosis typically affects women aged 40-50 when ovarian function declines or ceases, leading to hormonal changes. Elevated estrogen and decreased progesterone levels can encourage excessive endometrial growth, contributing to adenomyosis.

Pregnancy Preparation or Treatment for Adenomyosis

Preparing for pregnancy and receiving treatment is a complex decision for individuals with adenomyosis. Each option carries its considerations:

- Pregnancy First: Opting for pregnancy first may raise concerns about the likelihood of conception and the potential for complications during pregnancy. The uterine environment affected by adenomyosis may not be ideal for successful pregnancies.

- Treatment First: Prioritizing treatment, especially surgical interventions, may lead to concerns about uterine damage and the time required for recovery. There's also uncertainty about the possibility of conception following treatment.

The decision should be tailored to the patient's specific circumstances:

- If adenomyosis is mild and unlikely to hinder pregnancy, couples can consider preparing for pregnancy. A thorough examination can guide appropriate treatment in cases of unsuccessful natural conception. Pregnancy can be planned once adenomyosis has improved.

- For younger patients, symptomatic treatment is often the initial approach. Addressing symptoms such as dysmenorrhea or anemia is crucial. Traditional Chinese medicine, like the Fuyan Pill, can alleviate symptoms, enhance the uterine environment, and improve natural conception chances.

- Married individuals without children can try to conceive, keeping a relaxed mindset. Many adenomyosis patients have successfully given birth, even discovering the condition during pregnancy. However, individual outcomes vary.

- For those with complex circumstances, such as large uterine sizes, poor uterine conditions, and a history of failed pregnancies, in vitro fertilization (IVF) might be a viable option. Patients who experience repeated miscarriages may need to consider surgical intervention.

- Surgery should be considered when symptoms are severe, uterine size is significant, and attempts at natural conception have failed over several years. Surgical removal of adenomyosis can improve the chances of pregnancy.

Ultimately, whether to prepare for pregnancy or prioritize treatment depends on the individual's situation. It is essential to take timely action when dealing with adenomyosis, as procrastination can lead to missed opportunities for effective treatment.