Adenomyosis Treatment in Ahmedabad — Balaji Horizon Women’s Hospital

What Is Adenomyosis? Understanding the Condition

The uterus has two main layers: the endometrium (inner lining, shed each month during menstruation) and the myometrium (thick outer muscular wall). In adenomyosis, endometrial glands and stroma are found embedded within the myometrium — where they do not belong. These ectopic endometrial islands respond to the monthly hormonal cycle: they proliferate, thicken, and bleed — but the blood has nowhere to go. The result is uterine wall oedema, inflammation, smooth muscle hypertrophy, and eventual diffuse or focal uterine enlargement.

Adenomyosis is classified as:

• Diffuse adenomyosis — endometrial tissue spread throughout the entire myometrium, causing generalised uterine enlargement (“bulky uterus” on ultrasound)
• Focal adenomyosis (adenomyoma) — a localised collection of adenomyotic tissue forming a poorly defined mass within the myometrium, similar in appearance to a fibroid but without a capsule
• Superficial adenomyosis — limited to the inner one-third of the myometrium; associated with infertility and implantation failure
• Deep adenomyosis — penetrating into the outer two-thirds or full thickness of the myometrium; associated with more severe symptoms and greater impact on uterine contractility

Adenomyosis and endometriosis frequently coexist — estimated in 20–50% of patients with endometriosis. This combination significantly complicates both pain management and fertility planning. See: Endometriosis management at Balaji Horizon →

Symptoms of Adenomyosis

Heavy Menstrual Bleeding (Menorrhagia)

The enlarged, congested uterine wall leads to heavier and more prolonged menstrual bleeding. Many women with adenomyosis pass clots, require frequent pad or tampon changes, and develop iron-deficiency anaemia from chronic blood loss. Heavy periods are often the presenting complaint, particularly in women in their late 30s and 40s — and frequently normalised (“it runs in the family”), delaying diagnosis by years.

Severe Dysmenorrhoea (Period Pain)

Adenomyosis causes cramping pain that often begins before menstruation and worsens during it — typically diffuse, deep, and central. Many women describe it as a heavy, bearing-down pelvic pain radiating to the lower back and thighs. Standard NSAIDs provide partial relief at best. The pain is driven by prostaglandin release from the inflamed myometrium and impaired uterine contractility.

Chronic Pelvic Pain and Dyspareunia

Unlike pure endometriosis (which is often cyclical), adenomyosis can cause background chronic pelvic pain that worsens around menstruation. Deep dyspareunia (pain during intercourse) can also occur, particularly in women with posterior adenomyosis.

Bulky Uterus and Pelvic Pressure

Adenomyosis causes the uterus to enlarge — sometimes to the size of a 12–14-week pregnancy in severe diffuse disease — causing a sensation of fullness or pressure in the lower abdomen and urinary frequency from bladder compression.

Infertility and Recurrent Pregnancy Loss

Adenomyosis impairs fertility through altered uterine contractility, junctional zone hyperplasia, inflammatory cytokines within the uterine cavity, and impaired endometrial receptivity. Studies suggest adenomyosis is associated with a 2–4-fold increase in implantation failure after IVF — an underappreciated cause of recurrent IVF failure. See: IVF Centre Ahmedabad — integrated fertility care →

Diagnosing Adenomyosis

Transvaginal Ultrasound (TVUS)

First-line diagnostic tool. Ultrasound features include: uterine enlargement with globular configuration, asymmetric myometrial thickening, heterogeneous myometrial echotexture with echogenic islands or linear striations, myometrial cysts (anechoic lacunae), poorly defined endometrial-myometrial junction, and increased myometrial vascularity. Accuracy depends critically on operator experience. At Balaji Horizon, gynaecological ultrasound is performed by Dr. Priyadatt Patel — an advanced gynaecological ultrasonographer with specific training in endometriosis and adenomyosis ultrasound mapping.

MRI (Magnetic Resonance Imaging)

The gold standard when ultrasound findings are equivocal, when differentiating adenomyosis from fibroids, or when pre-operative surgical planning requires detailed mapping. Key MRI findings: junctional zone thickness above 12 mm (most reliable criterion), high-signal foci within low-signal myometrium on T2-weighted imaging, and uterine asymmetry. MRI is particularly useful for distinguishing adenomyoma from fibroid — a distinction with major surgical implications.

Histology (Definitive Confirmation)

The definitive diagnosis remains histological — identification of endometrial glands and stroma within the myometrium. Obtained after hysterectomy or, in fertility-preserving surgery, from excised adenomyoma tissue during adenomyomectomy. Endometrial biopsy alone cannot diagnose adenomyosis.

Adenomyosis Treatment Options — Medical and Surgical

Treatment options at a glance

Medical Management — Hormonal Suppression

Adenomyosis is oestrogen-dependent. Reducing oestrogen exposure suppresses ectopic endometrial activity, reducing bleeding, pain, and uterine volume. Options include:

• Levonorgestrel IUS (Mirena) — most effective for heavy bleeding and pain; local progestogen release reduces endometrial proliferation significantly. Most effective in mild-moderate adenomyosis.
• Dienogest (Visanne) — oral progestogen with specific anti-endometriotic properties; effective for pain reduction and some volume reduction. Can be used long-term. Preferred in younger women with pain as the primary complaint.
• Combined oral contraceptive pill (COCP) — cyclical or continuous use reduces dysmenorrhoea and lightens periods; generally less effective than LNG-IUS or dienogest but useful as first-line in younger patients.
• GnRH agonists (leuprolide, triptorelin) — medical menopause; very effective at suppressing adenomyosis and reducing uterine volume (up to 40%); used 3–6 months pre-operatively or pre-IVF. Not suitable long-term without add-back therapy.
• Progestogen-only pill or injectable (Depo-Provera) — second-line; variable response.

Medical management does not cure adenomyosis — it suppresses activity while the medication is used. Symptoms typically return after stopping. This is especially relevant for women who wish to conceive: hormonal suppression must be discontinued before attempting pregnancy.

Surgical Management — Fertility-Preserving Options

Adenomyomectomy — surgical excision of a focal adenomyoma — is feasible laparoscopically in selected cases. Unlike fibroid myomectomy, adenomyomectomy is technically more challenging because adenomyosis does not have a capsule and blends into the surrounding myometrium. The goal is excision of the bulk of adenomyotic tissue while preserving as much normal myometrium as possible. Appropriate for: women with focal adenomyoma causing significant symptoms, women who wish to preserve the uterus, or as part of an IVF preparation plan for recurrent implantation failure.

For diffuse adenomyosis, adenomyomectomy is more controversial — “cytoreduction” (reducing the adenomyotic burden) is sometimes performed, but evidence for fertility outcomes after surgical cytoreduction of diffuse adenomyosis remains limited. See: Advanced laparoscopic surgery at Balaji Horizon →

Laparoscopic Hysterectomy — Definitive Treatment

For women who have completed their family with significant adenomyosis-related symptoms unresponsive to medical management, laparoscopic hysterectomy is the definitive and permanent treatment. We always confirm explicitly that the patient has fully considered this before proceeding.

Adenomyosis and IVF — When Is IVF the Right Path?

For women with adenomyosis-related infertility, key considerations for IVF planning include:

• Pre-IVF GnRH agonist downregulation for 3–6 months is recommended in women with severe adenomyosis — this reduces uterine volume, normalises the junctional zone, and is associated with improved implantation rates in several observational studies and meta-analyses.
• Frozen embryo transfer (FET) is generally preferred over fresh transfer in adenomyosis — the artificially prepared endometrium in a freeze-all cycle may be more receptive than a stimulated endometrium in the existing adenomyotic uterine environment.
• Adenomyomectomy before IVF may be considered for focal disease distorting the cavity or causing recurrent implantation failure — but RCT evidence for benefit remains limited, and uterine scar risk must be weighed carefully.
• Recurrent IVF failure with a bulky adenomyotic uterus should prompt a structured review including ERA (endometrial receptivity array) biopsy and targeted downregulation before the next transfer.

The Adenomyosis–Endometriosis Overlap

A significant proportion of women with endometriosis also have adenomyosis. When both conditions coexist, symptom burden is typically higher, fertility outcomes more complex, and management requires coordinated planning. At Balaji Horizon, both conditions are assessed together — with ultrasound mapping for endometriosis and adenomyosis in the same sitting, and a unified management plan that addresses both. Full endometriosis management →

Frequently Asked Questions — Adenomyosis

Is adenomyosis the same as endometriosis?

They are related but distinct. In endometriosis, tissue grows outside the uterus. In adenomyosis, it grows into the uterine muscle wall. Both are oestrogen-dependent, both cause pain and fertility problems, and both frequently coexist. Key clinical difference: adenomyosis causes primarily heavy bleeding and a bulky uterus; endometriosis presents more with pelvic masses, adhesions, and anatomical distortion.

Can adenomyosis be cured without hysterectomy?

Not completely. However, excellent symptomatic control and fertility outcomes are achievable without hysterectomy using hormonal suppression, focal adenomyomectomy for discrete disease, and IVF planning with pre-IVF GnRH agonist downregulation. The goal is disease control sufficient to achieve acceptable quality of life and reproductive outcomes — not anatomical cure.

Can I get pregnant with adenomyosis?

Yes — many women with adenomyosis conceive naturally or with IVF. GnRH agonist downregulation for 3–6 months before IVF improves implantation and pregnancy rates in women with significant adenomyosis. Natural conception is possible in mild disease. Management depends on severity, symptom burden, age, ovarian reserve, and fertility timeline.

What does a “bulky uterus” mean on an ultrasound report?

“Bulky uterus” indicates the uterus is larger than normal. The most common cause in women with heavy periods and pain is adenomyosis. A bulky uterus on ultrasound requires dedicated assessment — including myometrial texture, junctional zone measurement, and myometrial vascularity. A normal-sized uterus does not exclude adenomyosis — superficial or early disease may be present without significant volume increase.

How is adenomyosis different from fibroids on ultrasound?

Fibroids are discrete, well-circumscribed masses with a pseudocapsule — clearly delineated on ultrasound, often with posterior acoustic shadowing. Adenomyosis is ill-defined, blends into the myometrium, and is characterised by heterogeneous, asymmetric myometrial texture, myometrial cysts, and poorly defined endometrial-myometrial junction. MRI is the most reliable way to distinguish focal adenomyoma from fibroid in cases of uncertainty.

Which doctor should I see for adenomyosis in Ahmedabad?

Adenomyosis is best managed by a gynaecologist with expertise in advanced gynaecological ultrasound, endometriosis, and reproductive medicine. Dr. Priyadatt Patel at Balaji Horizon Women’s Hospital, Science City Road, Ahmedabad — contact: +91 97234 31544.

Are there newer uterus-sparing techniques for adenomyosis?

Emerging options include radiofrequency or microwave ablation of focal adenomyosis and high-intensity focused ultrasound (HIFU). They may help selected women — particularly with focal disease — but the evidence base is still developing, the effect on future fertility is not fully established, and they are not suitable for everyone. We counsel on them honestly, case by case.

Related Services

• Endometriosis — diagnosis, surgery, and long-term management →
• IVF Centre Ahmedabad — integrated fertility care →
• Advanced laparoscopic surgery at Balaji Horizon →
• Second opinion before surgery →
• Ovarian cyst surgery Ahmedabad →

Dr Priyadatt Patel

Endometriosis & Advanced Laparoscopic Surgeon

Dr Patel leads endometriosis diagnosis and surgery at Balaji Horizon with an evidence-based, ovarian-sparing philosophy aligned to ESHRE and ESGE — integrating pain, fertility and long-term disease control into a single plan, rather than treating the disease in isolation.