Adenomyosis

Are you suffering from severe heavy menstrual bleeding?
Are you suffering from severe period pain?

YOU might have ADENOMYOSIS 

Breaking News

San study offers fresh hope for women suffering debilitating menstrual condition

A groundbreaking new study undertaken by two doctors from Sydney Adventist Hospital is offering fresh hope for women whose lives are severely impacted by heavy menstrual bleeding and period pain.

The study, led by San interventional radiologist Dr Eisen Liang and gynaecologist Dr Bevan Brown, has shown that Uterine Artery Embolisation (UAE) treatment may be a potential alternative for those women who otherwise faced the prospect of a hysterectomy. UAE is a little-known, non-surgical procedure, often used to shrink fibroids, which are non-cancerous tumours of the womb.

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Mums at the table

Interview with Eisen Liang: Ask the Experts

Why am I suffering from chronic period pain? Why does my period seem to last longer than normal? Dr Eisen Liang is here to answer all the frequently asked questions about your menstrual cycle.


Elizabeth's Journey with Adenomyosis 

A new solution to women's severe pain that isn't a hysterectomy

What is Adenomyosis? Watch this video >

What is adenomyosis?

Adenomyosis is a benign (non-cancerous) disease of the uterus due to the migration of glandular endometrial tissue into the muscle layer. Normally, glandular endometrial tissue lines the cavity of the uterus. This layer, thickens during each menstrual cycle and is shed at the end of the cycle. The shedding of the endometrial layer, together with bleeding, produces the menses each month. The embedding of endometrial glandular tissue into the muscle layer can cause heavy periods and inflammation.

How is adenomyosis diagnosed? 

The symptoms of adenomyosis are heavy and painful menstrual periods. The uterus maybe enlarged and tender on internal examination. These clinical features however are rather non-specific and therefore diagnosis maybe difficult. Ultrasound findings are usually quite subtle and might be missed. Focal adenomyosis (adenomyoma) can be mistaken as fibroid. MRI is more definitive than ultrasound, especially when fibroids are also present. There is no specific blood test for adenomyosis. CA125 may be raised but this is neither sensitive nor specific.

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What are the medical treatment options?

Non-steriodal anti-inflammatory drugs (NSAIDs) are useful for pain control. Tranexamic acid can be used to treat heavy periods but should not be used in patients with increased risk of venous thrombosis. Oral progestrogen can be used to control menstrual bleeding. The side effects are headache, nausea, bloating sensation and mood changes. Low-dose, continuous combined oral contraceptives with withdrawal bleeds every 4–6 months may also be used for symptom control.

Progestrogen-releasing IUD has a satisfaction rate of 56% at 1 year. It may not be immediately effective and the side effects are irregular spotting or continuous bleeding in the first few months, acne, weight gain, bloating sensation and mood changes. Gonadotropin-releasing hormone (GnRH) agonist can be used only in the short term, due to its side effects of low oestrogen such as hot flushes, mood changes and osteoporosis.

What are the procedural options to treat adenomyosis?

Diffuse adenomyosis cannot be removed surgically without hysterectomy. Unlike fibroids, focal adenomyosis or adenomyoma are not easily separated out from the normal adjacent tissue and therefore surgical removal is not appropriate.

Endometrial ablation heats only a depth of few millimeters of tissue and is not useful except for the very superficial type of adenomyosis. It can seal off the embedding endometrial tissue potentially worsening period pain. In the setting of painful heavy periods and an apparently normal ultrasound, it is prudent to exclude adenomyosis by MRI before endometrial ablation. In the past, hysterectomy is the only definitive treatment for adenomyosis.

Adenomyosis Procedure

How Does UAE work for adenomyosis?

What is Uterine Artery Embolisation (UAE)?

Tiny particles are injected inside the arteries to restrict the blood flow to the uterus. The adenomyosis tissue will shrink, as it is less tolerant to the lack of blood supply than the normal uterine muscle. Under local anaesthetic, a tiny nick allows the insertion of a small catheter (a tube 1- 2 mm in diameter) to be advanced into the uterine artery under X-ray guidance.

How effective is UAE for adenomyosis?

For pure adenomyosis, relief was achieved in 83% short-term and 65% long term. For combined adenomyosis and fibroids, relief was achieved in 93% short-term and 82% long term. The hysterectomy rate is around 13%, suggesting that 87% of women can be spared of hysterectomy. Our own patient satisfaction rate is 90%.

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Case Study 1

Case  Study 1

Incapacitated Mother of 3 young children
28-year-old mother of 3 young children was suffering from severe heavy menstrual bleeding (HMB). She was always tired and exhausted. The severe period pain would make her incapacitated for a few days each month. She tried and failed NSAID (Non-steriodal anti-inflammatory drugs like Ponstan and Nurofen). She was still changing super pads every 2 hours whilst on tranexamic acid (Cykrokapron). Progestrogen IUD (Mirena) was not tolerated due to acne and continuous spotting. The uterus on her ultrasound was reported as normal. Because of her severe symptoms, an MRI was performed and showed thickening of the junctional zone (arrows) confirming adenomyosis. She was treated with Uterine Artery Embolisation (UAE). MRI 6-months post UAE showed normalisation of the junctional zone. She now has regular periods which is very light and her pain has almost completely gone. She is energetic and able to bike ride with her children. She is very happy with the marked improvement of her quality of life.

Case Study 2

Case  Study 2

A case of mistaken identity
52-year-old horse breeder with 3 adult children was suffering from severe heavy menstrual bleeding (HMB) requiring tampon and pad change 30-60 minutes. She might bleed for as long as 3 weeks each month. Her crampy period pain and her HMB made her house bound and not able to work during her periods. Her ultrasound reported a small fibroid in her uterine wall and that is not quite enough to explain her severe symptoms.

Her MRI discovered that an area of adenomyosis (arrows) as the real culprit for her symptoms. Post-embolisation MRI at 6-months showed dark area of scar tissue (arrows). All her symptoms resolved. She was a very active woman and did not want to have hysterectomy. She was glad that she has chosen Uterine Artery Embolisation (UAE) as a less invasive option.

What are the advantages of UAE over hysterectomy?

UAE is less invasive. The symptoms are effectively treated without surgically removing the uterus. The risk of blood transfusion, wound infection/ breakdown and other surgical risks are eliminated and there is no need for general anaesthetics. The hospital stay is much shorter (1-2 days vs. 5-7 days). Time to return to normal activities is much faster (1 week vs. 4-6 weeks).

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Will I lose my period after UAE?

You may, but this is probably age-related natural menopause rather than caused by UAE. If you were younger than 40, the chance of natural menopause is less than 3%; if you were older than 50, the chance is more than 40%. Some particles might find their way to the ovaries via shared blood supply. However, studies have shown that UAE does not affect ovarian function in treated women.

Is pregnancy possible after UAE for adenomyosis?

There is currently lack of research data in this area. Pregnancy with adenomyosis may be difficult. Pregnancy after UAE for adenomyosis can be complicated. Uterus with adenomyosis is not normal to start with. One cannot be sure if the problem with fertility and pregnancy is related to underlying adenomyosis or the UAE treatment. UAE is useful to treat symptoms of adenomyosis, but is not to be used as a fertility-enhancing procedure.

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Case Study 3

Case  Study 3

“I have tried everything!”
45-year-old insurance broker who has suffered from severe heavy menstrual bleeding HMB and period pain for many years. Tranexamic acid (Cykrokapron) and Progestrogen (Primolut N) were not effective. She expelled 2 Mirenas andfailed endometrial ablation. Her MRI showed a large area of adenomyosis (arrows) in the back wall of the uterus; 6 months post UAE MRI showed scaring of focal adenoyosis (arrows), and shrinkage from 272ml to 115ml. Note the normal viable uterine wall (M). Her periods are now lighter than normal and no longer painful.

Case Study 4

Case  Study 4

Glands in the wrong place
45-year-old optometrist suffers from severe HMB and period pain. Pre-UAE MRI confirmed adenomyosis and showed multiple bright foci in wall of the uterus representing migration of endometrial tissues from the lining of the cavity. Post-UAE MRI showed disappearance of the bright foci. Her periods are now lighter than normal and her pain has markedly reduced.

What are the recovery issues and complications after UAE?

Some patients experience significant pain in the first 8-12 hours. Pain control can be achieved with our pain management protocol including Patient Controlled Analgesia (PCA). Procedural related complications such as injury to artery are extremely rare (<1%). Delayed complications, such as infection of the uterus, occur in less than 1- 3%. If you developed pain, fever and smelly vaginal discharge, you will need to be assessed and treated in a hospital emergency department. Most fragments can pass by themselves; rarely do they need to be removed by a gynaecologist via the vagina. The need for hysterectomy is highly unlikely.

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Effectiveness of UAE for Adenomyosis

UAE offers a non-surgical treatment for adenomyosis symptoms.

Liang et al. "A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: results in 117 women." Australian and New Zealand Journal of Obstetrics and Gynaecology (2018). doi: 10.1111/ajo.12767

Our objectives

To raise the awareness of this underdiagnosed condition.

To raise the awareness of non-surgical treatment options for adenomyosis.

To improve the current status of diagnosis and treatment for adenomyosis.

About us

The website is developed by Dr Eisen Liang, an interventional radiologist who is passionate about applying minimally invasive non-surgical treatments for women with fibroids and adenomyosis.

Why we are so passionate to help

Dr Liang has been treating adenomyosis since 2007. He has helped hundreds of women suffering from debilitating heavy menstrual bleeding and period pain. Many women did not know that adenomyosis was the underlying cause of their heavy menstrual bleeding and period pain. Many were told they have fibroids or nothing was wrong with their uterus. Others were thought to have endometriosis, and yet when laparoscopy was done, it was normal. Few women were treated by endometrial ablation, which resulted in exacerbation of their period pain. Others have been through cycles and cycles of IVF without success, NOT knowing they have underlying adenomyosis as the cause of their subfertility.

Delaying or missing the diagnosis of adenomyosis, or giving the incorrect treatment to women with adenomyosis can have devastating long-term effects to the health and well-being of women in their prime age. 

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Dr's Resources

ANZJOG 2018

ANZJOG 2018 

A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women.

ANZJOG 2017

Adenomyosis Review 2017

Adenomyosis: A potentially missed, neglected and inappropriately managed condition

ANZJOG 2012

ANZJOG 2012

Efficacy of uterine artery embolisation for treatment of symptomatic fibroids and adenomyosis – An interim report on an Australian experience

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Management of HMB 2019

Management of heavy menstrual bleeding: The role of Uterine Artery Embolisation

NEWS

San study offers fresh hope for women suffering debilitating menstrual condition18-Jan-2019

Dr Brown (left) and Dr Liang A groundbreaking new study undertaken by two do..

Dr Eisen Liang Presented Embolisation for Fibroid and Adenomyosis19-Mar-2018

Dr Eisen Liang Presented Embolisation for Fibroid and Adenomyosis- Australian Experience at Asia..

UAE- a safe and effective non-surgical treatment for adenomyosis15-Jan-2018

UAE- a safe and effective non-surgical treatment for adenomyosis January 2018 Dr Liang and..

The information of this web site does not constitute or substitute for medical advice by a qualified medical practitioner. Medical decisions should be made in consultation with a suitably qualified medical practitioner. See full Disclaimer for more information.