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Q. Pelvic ultrasound suggest endometriosis and adenomyosis. Will they cause infertility in long run?

Answered by
Dr. Deepti Kurmi
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 10, 2020

Hello doctor,

I am a 32-year-old female. I had my second baby via c section. A couple of months after, I started getting pelvic pain. The pain is across my whole pelvic area and lower back and some times in my thighs too, very similar to menstrual cramps. Occasionally, I would get a sharp pain on either side of my pelvic area, especially on the right side. I also get pelvic cramps every time after sexual intercourse and occasional pain when I go to the toilet. The pain is bearable and when it gets a little worse I can manage it by taking pain killers. I get the pain almost every single day as well, not just when I am on my period. My periods have always been very heavy and painful from the beginning but have been able to keep it under control by taking the combined contraceptive pill Gedarel 30/150 mg and Mefenamic acid which I have been taking for many years. I have also been getting headaches and I am always very tired due to the lack of sleep I get from these pains during the night. Half the time I feel very stressed out because of the way I am feeling and it is not easy being a mom of two young children as well and having to manage with the pains, etc.

I eventually visited the GP and had some tests done such as smear tests, infection swabs, blood tests and an ultrasound scan. Everything was normal but the transvaginal ultrasound showed I have endometriosis and adenomyosis. I was referred to a specialist gynecologist and although he has given me a course of action to follow for the next six months I felt that the appointment was a bit rushed and I had a lot of questions to ask regarding the two conditions.

I would really like to ask a few questions regarding the conditions as soon as possible because my next appointment is not for another six months and there are a few things I would like to know about how these two conditions will affect me in the long run. I just need some answers for peace of mind. Nothing specific to me but more about the disease itself.

The doctor has advised to take the combined contraceptive pill for another six months without a break and to take pain killers as and when required. The consultant also mentioned progesterone based methods but we had to rule that out as it causes hair loss and I have been through years of a form of alopecia and have just managed to get my hair back.

I have tried asking doctors online and have been conned by them because they have taken money from me and just copied and pasted answers from other places online which made me quite upset and furious. Hopefully, someone from here can give me proper and professional answers.

These are the following questions I would like to ask:

What causes these two conditions? I am aware that these two conditions cannot be 100% diagnosed via imaging methods and laparoscopy is the only method that provides a definitive diagnosis, so how can a clinician be sure that they are treating me for the right condition and it is not something worse?

How will these conditions affect me in the long run if they begin the progress? Which out of the two, endometriosis or adenomyosis is more severe and serious? How will they affect my fertility and what would happen if I wanted to have another baby in the future? Will it be hard to get pregnant? Will it cause problems to either me or the baby? Is there an increased risk of miscarriages and preterm labor and if so how likely is this?

What if I were to come off the pill for whatever reason? How can I manage these conditions? Are there any other methods or a form of lifestyle I can follow to help such as certain dietary intakes, etc? How can I prevent getting pain when I go to the toilet (mainly passing stool) and help with sleep? Any other information will be greatly appreciated. Also, are there any online groups or support websites for these conditions?

Dr. Deepti Kurmi

Obstetrics And Gynaecology
#

Hello,

Welcome to iclniq.com.

I have read your query. Both problems, more or less will have the same effect. In the long run, it might affect you getting pregnant. But if you get pregnant then symptoms of endometriosis subsided. May be for ever. It does not have any effects on pregnancy and baby. No risk of preterm delivery or anything.

The permanent solution for this condition is the removal of uterus and ovary. But not recommended if you have plans for further pregnancy. OC (oral contraceptive) pills can help you in disease suppression. Some GnRH (gonadotropin-releasing hormone) injection are also available but they have side effects so not recommend for long-term. OC pills can be taken for years.

If you miss OC pills for two to three months or so then endometriosis should not return back immediately. So any time if you want to stop it for a few months definitely you can do that.

Talking about the sharp pelvic pain, it could be because of fibrosis after cesarean section. You can do some moderate exercise on a daily basis which can help you. There are no specific dietary things which can help.


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Thank you doctor,

So, you have said that the endometriosis may subside after pregnancy but what about the adenomyosis? I have heard that there are some risks associated with pregnancy and adenomyosis because the uterus is enlarged or deformed.

Would you be able to explain to me the findings of my ultrasound report ? Especially the parts that say heterogeneous myometrium and nodule on the lateral parametrium. Are there any other ways to confirm these diagnoses? If the pill suppresses the disease does that not mean that it will get worse if I do not take it?

What is fibrosis and how can this be confirmed and will this heal over time? I am most likely going to have a c section next time if I have more children would that be a problem? What is the best form of exercise you would recommend and would you suggest I take any vitamins, etc.?

Also, in the first message, I asked regarding what I can do, if anything, with regards to the pain when going to the toilet. What does this suggest?

Dr. Deepti Kurmi

Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

Adenomyosis is a form of endometriosis only. It may affect your future chance of pregnancy and may lead to miscarriage also. But already you are successful in pregnancy in the past, so chances of you getting affected by fertility problem are less. Your sonography itself is confirming changes in the uterus due to adenomyosis. Adenomyosis means endometriosis of the uterus. So this is pattern of adenomyosis inside your uterus.

Endometriosis precipitate due to monthly hormonal changes and bleeding inside the body (rather than completely outside). So if you take pills then there will be no hormonal changes, less bleeding and less endometriosis. If you take it for a while then it keeps everything suppressed. If you stop the medicine in between then disease will recur but with less severity and over a couple of months it becomes very severe. So there is no harm in stopping the medicine for a while.

Fibrosis is adhesions inside the body due to previous surgery. They are band-like structure and the internal organ gets stuck to each other in fibrosis. Any kind of exercise will help you like running, swimming, jogging, and cycling. The main reason is it will increase the blood flow in the body and help in healing the previous damage. Pain while going to the toilet will also be controlled with some painkiller or OC pills.


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