How is Adenomyosis diagnosed?

A doctor may suspect Adenomyosis based on symptoms, or because the uterus feels bulky during a physical examination. It may also be picked up on an ultrasound scan. An MRI scan may also be helpful, as it can provide higher resolution pictures of the uterus. Sometimes assessment by a gynaecologist may be necessary for further investigation and to confirm the diagnosis.

What is an Adenomyoma?

Sometimes Adenomyosis can occur in the form of a benign (non-cancerous) lump, in the muscle wall of the uterus.

Is Adenomyosis the same as Endometriosis?

Adenomyosis and Endometriosis are  generally considered to be separate conditions, but some experts believe they may be related or are variations of the same condition. In Endometriosis, the type of tissue that lines the uterus (endometrial tissue) forms in other places, such as the outside of the uterus, bowel or bladder. In Adenomyosis, endometrial tissue grows inside the muscle layer of the uterus. Some experts suggest that these processes are related, and that Adenomyosis is basically Endometriosis in the uterine muscle. However, others believe they are separate issues. Women can have Adenomyosis and Endometriosis at the same time, and the symptoms for the two conditions can be similar.

Does Adenomyosis affect fertility?

It is not yet clear if Adenomyosis significantly affects fertility. Some studies suggest that Adenomyosis may interfere with the movement of the fertilised egg from the fallopian tube to the uterus. It is also thought Adenomyosis may affect implantation (how the fertilised egg attaches to the lining of the uterus). However, more research is needed in this area.

What is the treatment for Adenomyosis?

Treatment may not be necessary if there are no symptoms. And if a woman is close to menopause, it should naturally get better as oestrogen levels drop.

If periods are long, heavy and/or painful, treatment for Adenomyosis may be considered:

• Anti-inflammatories can be taken just before a menstrual period and for the first day or two. This may reduce pain and make the bleeding a little lighter.
• Hormonal medications such as the pill (combined oral contraceptive pill) may also reduce heavy bleeding.
• Long acting contraceptives containing progesterone, such as an intrauterine device, “the rod” or contraceptive implant, may eliminate periods and thus symptoms of Adenomyosis.
• In severe cases, or where other treatments are not working or are unsuitable, surgery to remove the uterus (hysterectomy) may be considered.

Does Adenomyosis get better by itself?

As Adenomyosis is driven by oestrogen, it goes away once menopause occurs. Prior to menopause, hysterectomy (a procedure to remove the uterus) is the only way to get rid of Adenomyosis. Obviously, in women who wish to have future pregnancies, symptoms of Adenomyosis may be managed with medication.

When should you see a doctor?

If you have symptoms such as heavy painful periods, abnormal bleeding, pelvic pain or discomfort during sex, you should speak to your GP or gynaecologist.

Further patient resources

www.mayoclinic.org

www.jeanhailes.org.au

Article Resources

Bergholt et al Prevalence and risk factors of adenomyosis at hysterectomy. Human Reproduction. 2001;16(11):2418-21.

Di Donato N et al Prevalence of adenomyosis in women undergoing surgery for endometriosis. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 2014;181:289-93.

Harada T et al The Impact of Adenomyosis on Women’s Fertility. Obstetrical and Gynaecological Survey. 2016

How is Ectopic Pregnancy diagnosed?

• about 15% of cases are diagnosed when there is sudden rupture, often in the setting of an Emergency Department.
• Diagnosis of Ectopic Pregnancy is usually made by physical examination, blood tests, ultrasound scans and/or keyhole surgery.

What is the treatment for Ectopic Pregnancy?

• If an Ectopic Pregnancy is not treated it can lead to internal bleeding and can become life-threatening.  Treatment options depend on the individual case, but can involve medication or surgery.
• If a fallopian tube has already ruptured and/or there is internal bleeding, emergency surgery will be performed, as this is a life-threatening situation. A blood transfusion may be needed.
• If the doctors think the risk of rupture and internal bleeding is quite high, they may advise surgery.
• If the Ectopic Pregnancy has not caused rupture of a tube, and the risk of internal bleeding is thought to be low, medication may be used to stop the Ectopic Pregnancy from growing. This does not always work, in which case surgery is the next option.

What about future pregnancies? 

• If you have an Ectopic Pregnancy you have a higher risk of having another one in the future- this is because the factors that caused the first Ectopic Pregnancy are likely to still be there. In addition, the Ectopic Pregnancy may have damaged the fallopian tube or the tube may have been removed surgically.
• The Royal Women’s Hospital recommend waiting 2 months after Ectopic Pregnancy surgery (or 3-4 months if treated with medication) before getting pregnant again. It is also recommended that women with a history of Ectopic Pregnancy get an early ultrasound scan in all future pregnancies, at around 5 or 6 weeks, to make sure it has implanted correctly in the uterus.
• An Ectopic Pregnancy can be a traumatic experience, so it is important to see your doctor, gynaecologist or other trusted healthcare professional if you have any ongoing issues or concerns.

Article Resources

www.thewomens.org.au

www.acog.org

What is the test for Mycoplasma Genitalium?

Your doctor or sexual health clinic can test for it by taking a swab from the vagina, cervix, anus or urethra. Or a urine test may be performed. You’ll need to speak to a doctor to organise a pathology referral (you can request an online appointment to organise an STI test here).

How do you treat Mycoplasma Genitalium?

It’s treated with oral antibiotics- sometimes two antibiotics are taken at the same time to clear the infection.  Unfortunately it can be resistant to antibiotics, so it’s important to get retested afterwards.

When can I have sex again and should I be tested after treatment?

It’s advisable to either avoid sex or carefully use condoms until you and your sexual partner(s) have been successfully treated. It’s also recommended to have another test one month following treatment to make sure it’s gone.

Should I tell my sexual partner(s) I’ve got Mycoplasma Genitalium?

Yes, you should inform your recent sexual contacts- and if this is difficult for you, an online service such as www.letthemknow.org.au can help you do so anonymously.

If you are concerned about STIs, speak to your GP or sexual health clinic.

How do you know if you have Chlamydia?

• You may not be able to tell- you may have symptoms, you may not.
• You are at risk if you’ve had sex with somebody who has Chlamydia.
• Chlamydia is common, so if you’re sexually active, it is best to get tested regularly, particularly if you’ve had multiple sexual partners or a recent change of partner. Usually this just involves providing a urine sample at your doctor’s surgery or sexual health clinic. Depending on symptoms, occasionally a swab of  other areas may be recommended (swabs may be taken from the vagina, urethra, anus, throat or eyes).

What about treatment for Chlamydia?

• If a sexual partner has Chlamydia then it’s best to assume you have it too and get treated as soon as possible.
• You can get treatment from a doctor or sexual health clinic.
• It’s vital you tell any other sexual partners so that they can take appropriate action. If you’re not comfortable making direct contact,  it’s possible to do so anonymously at www.letthemknow.org.au

Article Resources

www.sti.guidelines.org.au

Further Patient Resources

www.health.nsw.gov.au