Hello XXXXXXX,

Thanks for writing to us. I have gone through your wife's history in details. As a practicing gynecologist, I take this opportunity to answer this query.

Uterine adenomyosis with bulky uterus is commonly seen in women with child bearing age group in about 30% cases. It is basically the presence of ectopic endometrial tissue within the myometrium (muscle layer of uterus).

There are several treatment modalities to treat adenomyosis with preference to preserve uterus. These are as follows:

1) Use of Non steroid anti inflammatory drugs (NSAID) or pain killer (that she used) to get relief from period pain.

2) Hormonal suppression is quite helpful. Gonadotropin-releasing hormone (GnRH) agonists, danazol and intrauterine levonorgestrel device (MIRENA) have been used in the treatment of adenomyosis.

I think that your doctor is trying progesterone injection on monthly basis. This should be continued for at least 3-6 cycles. It can cause the shrinking.

3) Now, a very effective & very patient-friendly non-surgical treatment is available. It is called Uterine Artery Embolization. It requires only 12-24 hrs hospitalization with several benefits. It has effectiveness around 93-95% in treating adenomyosis. It is mostly advisable before removing entire uterus or open surgery.

4) In case of failure of all above treatment protocol, hysterectomy (removal of entire uterus) is the ideal or safe procedure for permanent cure.

I understand you are concerned, but do not be worried. There are many treatment options available to help your wife. So please consult with your gynecologist and discuss about the options. You could try the best suited alternative if her latest treatments do not help.

Hope I have answered your query. If you have any further questions I will be happy to help.
Wish her good health.

Regards,
Dr Soumen

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Hello XXXXXXX,

Thanks for follow up query. I am trying to give answer.

depo-provera/0000" >Depo provera or depot shot contains medroxy progesterone acetate (MPA) and it is an injectable medication It is a synthetic form of progesterone that is used to inhibit ectopic endometrial growth in case of adenomyosis.

Approximately 80% to 90% of patients who complete 12 months of Depo-Provera therapy will be amenorrheic. If this treatment fails to control bleeding or shrinking, then you have the choice for method.

Also you should know about side effects of using depo provera. These includes irregular menstrual bleeding, weight gain, headaches, nausea etc. Bone density can be reduced with prolonged use of Depo-provera. However it can be reversed with low dose estrogen.

It is associated with prolonged infertility and pregnancy comes on average 9 months after stopping Depo-provera.

Therefore, I think you can consult with your treating doctor regarding this for better management of this condition.

If you do not have any clarifications, you can close the discussion and rate the answer.
Take care of her.

Regards,
Dr Soumen

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