Disability is the lack of ability to do what one wishes to do. And we know of various disabilities which we come across on a daily basis in our lives. We see various people with difficulties in mobility, hearing, vision, speech etc. which we can identify with and we empathize with them.

But as a gynecologist, I see a disability which only women face, a disability, which strikes on a monthly basis! Some women experience so much pain during their menstrual periods that they dread its approach month after month! It’s a disability, due to which they cannot attend to their daily chores at home, nor can they go to work if they are career women, they only keep popping tablets and lay in bed for about 3-4 days every single month! Some of them also have associated nausea vomiting and even faint, they are truly miserable!

 

This is not normal, this needs attention. So when a woman sees her gynecologist and is told after being examined and investigated that she has “Adenomyosis”, that’s when she is in for a rude shock! This is more so in younger women who wish to start a family.

 

“Adenomyosis” is a condition in which the “endometrium” ie. the inner lining of the uterus invades into the muscle of the uterus as tiny islets, into the uterus. In normal situations, a woman’s hormones cycle every month and the endometrium is shed off as a menstrual period through the vagina. But the endometrial islets within the muscles of the uterus in an adnomyotic uterus also respond to these changing hormones similarly and start shedding and bleeding. Unfortunately, there is no outlet to this bleeding. The blood accumulates within the muscle of the uterus as tiny cysts, giving rise to extreme pain which lasts as long as the period lasts and gets worse as the years go by!

 

Unfortunately the reason why Adnomyosis occurs is not yet known, hence we cannot cure it, we can only suppress the disease. Adenomyosis is a variant of Endometriosis which we discussed in my last column, the only difference being that in Endometriosis, the endometrium invades the tissues outside the uterus, mainly the ovaries, whilst in Adenomyosis the endometrium invades the muscles of the uterus itself!

 

Pain killers can control this pain, but after sometime as the uterus gets larger and larger with accumulated blood, these pain killers also fail to give relief. The only way to get rid of this pain is to temporarily stop a period, so that if there is no bleeding, there is no pain. But if a woman wishes to get pregnant, she cannot do so whilst on such a medication. Hence the best way that she can naturally stop the period is to get pregnant! But a uterus diseased with Adenomyosis is not the best ground for an embryo to implant, hence even though she desperately wants to be pregnant, she is constantly disappointed with a negative pregnancy test!

 

Women with Adenomyosis need assistance to get pregnant and Assisted Reproduction such as IVF is the quickest and most effective way to do so. We first suppress the disease with medications for a few months prior to the IVF treatment, and then carry out the IVF treatment, which finally gives results. Besides getting pregnant, it relieves them of the monthly pain as there is no menstruation for the next 1 to 1 ½ years due to pregnancy, childbirth and breastfeeding. IVF truly gives a double benefit- no pain and a baby!

 

On the other hand, older women who have completed their families, could be assisted with various medications, but the only permanent stop to this disease is the onset of natural menopause because then there is no period! We do not expect a woman to live, through this pain, waiting for menopause to occur. As she matures, the pain may also be accompanied by excessive bleeding, due to the enlarged uterus. This increases her disability even further, because she gets anemic with the excessive loss of blood leading to weakness and tiredness, along with the pain.

 

That’s when she gets  a  hysterectomy done!