Age of menopause in adenomyosis

The occurrence of adenomyosis brings some trauma to female patients. Some people even think that they have reached menopause, and then adenomyosis will heal itself. This statement is incorrect. First of all, patients with adenomyosis will experience delayed menopause, and even have obvious symptoms after menopause. Therefore, the age of menopause for adenomyosis will mostly be delayed by two to three years. It is recommended to take necessary measures to treat the disease as early as possible and take preventive measures in daily life.

Age of menopause in adenomyosis

The normal age of menopause for women is generally around 52 years old, but for sisters with adenomyosis, the menopause time is generally delayed by 2-3 years. As far as we know, many sisters with adenomyosis are still having menstruation at the age of 54. The main cause of menopause is ovarian failure. Ovarian failure may be caused by physiological reasons, medication, disease, surgical trauma, genetic factors, etc. Adenomyosis is only caused by the occurrence of endometriosis and does not affect the function of the ovaries itself. There is no correlation between the two. Therefore, it will not affect the age of menopause. Some pathological factors may lead to premature ovarian failure and early menopause, and endometrial lesions may delay the age of menopause. Adenomyosis not only has no effect, but its condition is aggravated by the onset of menstruation.

Adenomyosis symptoms

1. Dysmenorrhea: Most of them are secondary dysmenorrhea with progressive aggravation. The degree is severe and analgesics are often required. As adenomyosis progresses, the pain may begin about 1 week before menstruation or may extend to 1 to 2 weeks after menstruation. A small number of patients with adenomyosis experience pain before and after menstruation, which is still cyclical.

2. Excessive menstruation: Among the 318 cases reported in my country, there were 132 cases of excessive menstruation, accounting for 41.5%. A small number of patients with adenomyosis experience heavy bleeding, which is misdiagnosed as functional uterine bleeding before surgery.

3. Infertility: There are many symptoms of adenomyosis, and infertility is seen in a small number of patients with adenomyosis.

4. Uterine enlargement: It is usually uniform and hard, usually not exceeding 12 weeks in size. Otherwise, it may be accompanied by uterine fibroids. If it is a uterine adenomyoma, it may also show asymmetric enlargement. If combined with endometriosis, corresponding signs may appear.

Treatment of adenomyosis

1. Drug treatment

(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) Pseudo-pregnancy therapy: 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) Intrauterine device: 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. It needs to be removed or replaced after five years.

(4) Pseudomenopause therapy: drugs that shrink 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, Zhongji, Hegu, Sanyinjiao and other acupoints before and during menstruation, or use ear acupuncture on uterus, endocrine, liver and other acupoints.

2. Surgical treatment

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, have severe symptoms, and have not responded to conservative treatment. Moreover, in order to avoid residual lesions, total hysterectomy is the first choice, and partial hysterectomy is generally not advocated.

(2) Adenomyosis lesion resection: suitable for patients who want to have children or are young. 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. The establishment of in situ endometrial collateral circulation 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.

Patients with adenomyosis may experience symptoms such as abnormal menstruation, pain during intercourse, pelvic pain, low-grade fever, increased vaginal discharge, and menstrual pain. For those with mild symptoms who only seek to relieve dysmenorrhea, non-steroidal anti-inflammatory drugs such as ibuprofen, indomethacin or naproxen can be used for symptomatic treatment during dysmenorrhea.