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Adenomyosis Resection Surgery

Adenomyosis is a medical condition that refers to enlargement of the uterus because of presence of endometrial glands within the muscular layer of the uterus. Normally, the endometrial cavity is lined by endometrial glands (endometrium) . The endometrial cavity and its endometrial glands are surrounded by the muscle of the uterus. When some of the endometrial glands migrate to the inside of the muscle and form islands of endometrium within , it is called adenomyosis. It is a form of endometriosis in which endometrial glands migrate and form islands inside or outside the pelvis but in locations other than their normal location which is the endometrial cavity lining.

The adenomyosis tissue responds to ovarian hormonal stimulation just like the normal endometrium but with out the ability to shed itself  as happens with a normal endometrium every menstrual cycle.This leads to severe menstrual cramps and pain, prolonged and heavy menstral periods, and pain during intercourse. The uterus is enlarged and could be palpable on abdominal examination. It usually affects women in their thirties and forties.

The management could be conservative with use of hormonal therapy such as birth control pills or with hormonal intrautreine device that reduce the activity of the adenomyosis and hence reduce the symptoms . If conservative management does not help or is inappropriate such as in women who can not use hormones then hysterectomy is a good option for women who have completed their families.

If the woman with adenomyosis has not completed her family or does not wish to have a hysterectomy then surgical resection of the adenomyosis  from the muscle of the uterus can be done with preservation of the uterus and alleviation or improvement in the symptoms. The size of the uterus will be closer to normal with a closer to normal menstrual flow and  menstrual cramps.

The goal of the procedure is to resect as much as possible of the adenomyosis tissue and then to reconstruct the uterus. Since it is difficult to guarantee removal of all adenomyosis tissue , the possibility of future recurrence of adenomyosis and its accompanying symptoms does exist, but not necessarily.This procedure gives the patient the opportunity to form a family or to live for many years without the distressing symptoms of adenomyosis