Painful and Heavy Periods After 40 ? Do You Really Need a Uterus Removal Surgery?

What is Adenomyosis?

Adenomyosis is a gynaecological condition where endometrial tissue grows into the muscular layer of the uterus, causing severe pelvic pain and heavy bleeding.

Hysterectomy (removal of the uterus) is the definitive treatment and is rarely the initial approach. Alternative treatment options are usually tried first, but hysterectomy provides symptom relief when other conservative treatment options do not work.

What does Adenomyosis cause?

Adenomyosis can cause the uterus to become bulky and lead to:

• Severe menstrual pain

• Chronic pelvic pain

• Increased menstrual bleeding with clots

Which Age Group is Commonly Affected?

Adenomyosis is commonly diagnosed in women between 40–50 years of age, although it can occur much before 40 years and irrespective of parity.

How is it diagnosed?

Diagnosis is based on:

• Clinical symptoms

• Physical examination findings

• Ultrasound

• MRI of the pelvis

Sometimes a definitive diagnosis can only be confirmed after examination of the uterus following hysterectomy.

When is Hysterectomy Advised?

Hysterectomy is considered when:

• Conservative measures do not work

• It becomes the definitive treatment needed to relieve severe period pain and heavy menstrual bleeding

When Do Gynaecologists Usually Advise Hysterectomy?

Gynaecologists usually advise hysterectomy in the following cases:

1. Severe menstrual pain (dysmenorrhoea)

2. Heavy menstrual bleeding leading to severe anaemia

3. Hormonal pills, patches ,pain medications, and intrauterine devices (e.g., Mirena coil) do not work

4. The patient does not desire future pregnancies

Pros and Cons of Hysterectomy:

Pros

• Permanent treatment for adenomyosis symptoms

• Menstrual cycles do not return after hysterectomy

Cons

• Irreversible loss of fertility

• Surgical risks

• Early menopause if the ovaries are also removed

Conservative Treatment Options for Adenomyosis

For women who wish to keep their uterus, conservative treatment options are available.

1. Hormonal Therapies

Birth control pills, patches ,hormone injections, and hormonal intrauterine devices (Mirena coil) can help reduce pain and menstrual bleeding.

2. Uterine Artery Embolisation (UAE)

A procedure that blocks the blood supply to the uterus, helping reduce pelvic pain and bleeding.

3. Endometrial Ablation

A procedure that destroys the inner lining of the uterus to reduce heavy bleeding.

4. Uterine-Sparing Surgery

For localized adenomyosis, the affected area can sometimes be removed while preserving the uterus.

Hysterectomy Options

The removal of the uterus is the only permanent treatment for adenomyosis when conservative treatments fail to relieve pain and heavy bleeding.

Hysterectomy can be performed by:

Open Method (TAH)

Total Abdominal Hysterectomy (TAH) with or without removal of the ovaries.

Minimally Invasive Methods

• Total Laparoscopic Hysterectomy (TLH)– performed through keyhole surgery.

• Robotic Hysterectomy – a minimally invasive robotic-assisted technique for removing the uterus.

What to Expect After Surgery

Recovery typically takes 4–6 weeks, depending on whether the hysterectomy was performed:

• Abdominally (open surgery)

• Laparoscopically

• Robotically

The recovery period varies according to the surgical approach used.

Choice of Conservative Treatment vs. Hysterectomy for Adenomyosis

The choice between conservative treatment and hysterectomy (permanent treatment) for adenomyosis depends on several factors, including:

• The woman’s family planning goals

• The severity of symptoms

• Overall health.

Important Note:-

It is always best to consult a gynaecologist to determine the correct treatment option for your symptoms and adenomyosis.

Featuring insights from Dr. Srikala Dodda Reddy,  Obstetrician and Gynaecologist, Apollo Women's Hospitals, Chennai

For Queries or Appointments: +044 40401066.