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Adenomyosis and heavy bleeding

Ask Dr Jean 7 Apr 2020
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When it comes to women's health, there is no such thing as a silly question. Do you have a question you want answered, but have been too afraid or embarrassed to bring it up with your GP? Or you forgot to ask while you were in the doctor's surgery? Now, you can 'Ask Dr Jean'.


Answering your questions for this edition of 'Ask Dr Jean' is gynaecologist and Jean Hailes Medical Director, Dr Elizabeth Farrell AM (pictured below).

Question

I am 47, have adenomyosis and was on to my second Mirena in seven years, to control heavy bleeding. Recently I had been having heavy spotting for most of the month and then an extremely heavy period. Examinations showed that I am clear of any major problems, but that I have expelled the Mirena. I am hesitant to get another Mirena because I believe there is a higher rate of expulsion if it has happened before. Just wondering if this is indeed true and, apart from hysterectomy, are there any other methods available to control heavy bleeding?

Elizabeth Farrell

Answer

Adenomyosis , being a condition of the myometrium (muscle of the uterus) is managed conservatively by using the Mirena IUD (levonorgestrel-releasing IUD) to reduce the thickness of the endometrium (the lining of the uterus) and also the endometrial cells which grow in the myometrium. Also, this process may help to reduce the volume of the uterus. In heavy menstrual bleeding, the size and volume of the uterus will be a factor in rates of expulsion. The larger the uterus, the greater the rate of expulsion will occur.

A reassessment of your uterine size and volume would be appropriate before deciding on the optimal treatment at this point in time.

Some research has used a combination of a GnRH hormone (which is used sometimes to shrink endometriosis and fibroids prior to other therapies, causing a chemical temporary menopause) with the Mirena IUD to reduce volume and maintain a smaller size.

An endometrial ablation (a surgical technique used to destroy the lining cells of the uterine lining) is sometimes performed that may give some relief from the heavy menstrual bleeding, but will not treat the adenomyosis.

Hysterectomy with removal of the uterus is the only permanent method of treating adenomyosis.

Read more about adenomyosis.