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Adenomyosis

Obstetrics and GynaecologyReproductive Medicine

Adenomyosis is a condition that affects the uterus in women. It occurs when the tissue from the inner lining of the uterus (endometrium) breaks through the uterine wall and develops into new endometrial tissue within the uterine muscle layer. This growth can cause the uterine tissue to enlarge and thicken, leading to various symptoms.

Category

Adenomyosis is a uterine disorder that causes menstrual pain and excessive bleeding in women. It primarily involves invading endometrial cells into the uterine muscle layer, leading to an enlargement of the uterus. Adenomyosis can be classified based on the extent and distribution of the lesions:

  • Diffuse Adenomyosis: Adenomyosis affects the entire uterus, causing swelling of the uterine muscle layer. Diffuse adenomyosis typically results in an overall uterus softening, with abnormal endometrial tissue scattered throughout the uterine muscle layer.
  • Focal Adenomyosis: Adenomyosis only affects specific regions of the uterus rather than the entire organ. In this case, abnormal endometrial tissue is confined to a particular part, forming nodular areas.

Factors

The exact causes and risk factors of adenomyosis are not fully understood, but there are some potential factors and associations:

  • Invasion of Endometrial Cells: This may be due to the invasion of endometrial cells into the uterine muscle layer, leading to abnormal growth and changes.
  • Uterine Surgery History: Previous uterine surgeries, such as caesarean sections or hysterectomies, may increase the risk of developing adenomyosis.
  • Reproductive History: Women who have had multiple pregnancies and childbirths may be less likely to develop adenomyosis, while those who have not experienced pregnancy may be more susceptible to this condition.
  • Hormonal Factors: Changes in hormones, especially variations in oestrogen levels, may be associated with adenomyosis.
  • Age: Adenomyosis is more common in older women, particularly those approaching menopausal age.

Diagnosis

The diagnosis of Adenomyosis typically involves a series of assessments and examinations. Here are some standard diagnostic methods:

  • Clinical Examination: Doctors may conduct a gynaecological examination, usually including palpation of the uterus, to assess its size and shape and detect any abnormalities.
  • Ultrasound Examination: Ultrasound is used to generate images of the uterus, helping doctors examine whether the uterine structure is abnormal and if there are tumours or other issues.
  • MRI: MRI provides more detailed images of the uterine structure, assisting in confirming the presence of adenomyosis.
  • Biopsy: In some cases, doctors may recommend a histological examination, often through procedures like endometrial biopsy or hysteroscopy, to confirm the diagnosis.
  • Abdominal or Pelvic Laparoscopic Examination: Doctors might use abdominal or pelvic laparoscopy to observe the uterus and adjacent tissues directly, performing necessary treatments.

Treatments

The treatment for adenomyosis depends on the severity of symptoms and the patient's medical history. Here are some possible treatment options:

  • Pain Relievers: Over-the-counter or prescription pain relievers alleviate menstrual pain and other related symptoms.
  • Anti-inflammatory Medications: These medications may help reduce inflammation and associated discomfort.
  • Hormone Therapy: Hormone therapy, especially with oestrogen and progestin, is sometimes used to regulate the menstrual cycle and alleviate symptoms.
  • Intrauterine Device (IUD): In some instances, the use of an IUD can help reduce menstrual pain and blood flow.
  • Surgical Treatment: Surgery may be necessary in some cases. Surgical options include hysterectomy (partial or complete), endometrial ablation, or uterine artery embolization, where blood vessels affecting the uterus are closed off to reduce symptoms.
  • Ablation Therapy: High-Intensity Focused Ultrasound (HIFU) is a technique that uses ultrasound to ablate abnormal tissue in the uterus. Ultrasound reaches the uterus through the skin, subcutaneous tissue, and peritoneum, destroying the abnormal tissue affecting the uterus. One advantage of HIFU is the preservation of the uterus, allowing for the retention of fertility. However, HIFU may only be suitable for some patients.

FAQ

Adenomyosis and Uterine Fibroids are two different gynaecological conditions. Adenomyosis is primarily caused by the invasion of endometrial tissue into the muscular layer of the uterus, leading to abnormal growth and changes that may result in symptoms such as menstrual pain, pelvic pain, and irregular periods. On the other hand, Uterine Fibroids are non-cancerous tumours that develop in the muscular layer of the uterus and do not involve the endometrial tissue. Symptoms may include pelvic pain, frequent urination, irregular periods, and abdominal bloating.
Adenomyosis may impact fertility, but the extent varies from person to person. Some women with Adenomyosis can still conceive successfully, while others may encounter difficulties. Adenomyosis might affect the normal state of the endometrium, influencing the implantation of embryos in the uterus. Research suggests that adenomyosis could be associated with an increased risk of miscarriage and a higher likelihood of preterm birth. Additionally, during pregnancy, adenomyosis may cause the uterus to enlarge, increasing the chances of a caesarean section.
Adenomyosis is generally considered a benign uterine condition, and its direct association with cancer is relatively low. The main characteristic of Adenomyosis is the invasion of endometrial tissue into the muscular layer of the uterus, forming abnormal areas, but these tissues are not cancerous cells. Although Adenomyosis itself is not typically viewed as a cancer-causing condition, if a patient has other uterine-related conditions, such as endometriosis, it may increase the risk of certain cancers. Moreover, Adenomyosis and some uterine cancers may share similar symptoms, such as menstrual pain and abnormal menstrual bleeding. Therefore, doctors may conduct further examinations when these symptoms occur to rule out other potential issues.

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Abnormal Menstrual Cycle & Uterine Bleeding

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Menstrual cycle and abnormal bleeding refer to variations in the length, flow, or duration of the menstrual cycle outside the normal range. Irregular menstrual cycles may include intervals between periods that are too long or too short, excessively heavy or light periods, and intermittent bleeding between periods. Abnormal uterine bleeding may involve bleeding outside of the menstrual period.

Breast Disorders

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Breast Disorders refer to a series of conditions that may affect breast health. When women notice unusual conditions in their breasts, they often assume they have breast cancer. In reality, most breast diseases are benign, and it is best to seek medical follow-up to determine whether the condition is benign or malignant.

Cervical Cancer

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Cervical cancer, also known as cancer that occurs in the cervix, is statistically caused by HPV (Human Papillomavirus) infection in over 90% of cases, leading to abnormal cell growth and eventual development of cancer. Cervical cancer is one of the common cancers among women, and women of all age groups are at risk of developing cervical cancer. In Hong Kong, cervical cancer ranks the 7th most common cancer among women and the 9th leading cause of fatal cancer among women. In 2020, there were a total of 556 new cases recorded, with 159 fatalities.

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