Is It Necessary to Treat Adenomyosis as Menopause Approaches?

Adenomyosis is recognized as the growth of endometrial tissue into the muscular wall of the uterus, creating widespread or localized lesions. This condition is a prevalent yet complex issue in the field of gynecology.

Patients with adenomyosis often experience symptoms such as heavy menstrual bleeding, extended periods, infertility, and a pain that intensifies over time. Typically, pain is not evident until menstruation begins, where it presents as severe menstrual cramps.

There's a common assumption among patients nearing menopause that the discomfort associated with adenomyosis is tied solely to menstrual cycles, believing that the pain will cease once menstruation stops. They resign themselves to endure the discomfort until menopause provides relief, but is this approach advisable?

Upon reaching menopause, individuals with adenomyosis may encounter one of two outcomes. Some may find that their painful symptoms subside with the cessation of their menstrual cycles, as the absence of bleeding allows the adenomyosis lesions to shrink and eventually resolve, alleviating the pain. This is more typical for those with minor pain and smaller lesions, who can continue their daily activities uninterrupted post-menopause, though they should maintain regular medical check-ups and manage their estrogen intake through diet and healthcare products.

However, there are patients whose pain persists after menopause. This continued discomfort can be attributed to one of two factors:

First and foremost, a situation may arise where the uterus has grown significantly in size, exceeding the 8-centimeter mark, a measurement that is deemed considerable especially when juxtaposed with the typical uterus size of around 5 centimeters in a non-affected state. This enlargement of the uterus is noteworthy as it might not undergo the expected reduction in size following the cessation of the menstrual cycle that accompanies menopause. Such a lack of diminishment in uterine size could pave the way for additional health concerns that may emerge as a direct consequence of the sustained enlargement.

In the second instance, there is the potential for a considerable number of adenomyotic lesions to have established themselves within the uterine walls. The pervasive nature of these lesions means that they are capable of inducing persistent pain, a discomfort that one might reasonably anticipate to conclude with the ending of menstrual periods. However, contrary to such expectations, these lesions might not regress, maintaining their presence within the uterine structure. The result is a relentless experience of discomfort that continues unabated, independent of the menstrual cycle's conclusion, thus contributing to a chronic state of unease and distress for the individual.

For those nearing menopause with significant adenomyosis symptoms, proactive treatment is often recommended.

Potential treatment options include Traditional Chinese Medicine (TCM) and surgical interventions. TCM approaches adenomyosis as a hormonal imbalance affecting the flow of Qi and blood, and treatments aim to strengthen the liver and kidneys, regulate Qi and blood, enhance blood circulation, clear heat, detoxify, and balance the endocrine system. The Fuyan Pill, a TCM remedy, is known for its benefits in regulating Qi and blood, reducing lesions, regulating menstrual cycles, and alleviating pain.

Surgery is an option for those with severe symptoms, ineffective medication results, and no desire for future fertility. Surgical options range from conservative procedures targeting only the affected tissue to complete hysterectomy, with each having its own set of pros and cons.

Ultimately, whether to pursue treatment for adenomyosis as menopause nears depends on the severity of the individual's condition. It's crucial for affected individuals to seek a formal diagnosis and treatment to address the underlying causes and improve their overall well-being.