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Cramping pain, heavy periods with ADENOMYOSIS. Treatment?

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36 year old female. Been diagnosed with suspected moderate/severe Adenomyosis. Symptoms range in severity over the course of a monthly cycle. My main symptoms include very severe cramping pretty much all month long, prolonged very heavy periods, and very enlarged and hard lower abdomen which again size wise depends where I am in monthly cycle. For the past 5/6 months or so however symptoms have changed to some extent. I've still been suffering with very painful cramping and lower abdomen has enlarged even more than usual and has become very rigid to touch; however I have not had a period in this time. I am used to all these symptoms now having had this condition for about 2/3 years old patientnow, however the lack of periods, increased cramping and lower abdo enlargement for the past few months is a new thing. Are these symptoms all part of the condition???!!

Category: OBGYN

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Category: Infertility Specialist
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Hello,
Thanks for posting your query at DoctorSpring.com
Yes, the symptoms that you mention are typical of adenomyosis.
Cramping is definitely a symptoms.
You might feel bloating, but there should not be enlargement of the abdomen actually.
Also, periods might be irregular and yes, you might miss a period, followed by heavy bleeding later on.
Please have a scan to rule out pregnancy or any other condition.
Are you taking treatment for adenomyosis ?
Looking forward to hearing from you.
Take care.


Patient replied :

Hi
Thabk you for your reply. Not receiving any treatment for Adenomyosis as of yet. But you just raised something that hasn't even crossed my mind. You mentioned having a scan done. With these symptoms do you think that pregnancy is actually a possibility then??? I haven't been pregnant before and just assumed all these recent severe symptoms were simply due to the Adenomyosis. Just checked and actually haven't had a period since December (couple of months longer than I first thought) Would pregnancy fully explain this set of symptoms as well then??


Yes, it could be.
Kindly take a test and revert back to me.
Regards.


Patient replied :

Wow......well I've just rushed out to find a supermarket, come back and have just done 3 home pregnancy tests, they're all positive!!!!!!!!! I'm actually away at the moment and am for a little while. What slightly concerns me is not having had a period since December??? How pregnant does that make me??? Surely I should have noticed other symptoms???


That makes you around 6 - 7 months pregnant !
It is possible that adenomyosis led to an absent period or two, and then you conceived !
Get an ultrasound scan at the earliest to know the dating and to find out exactly how many weeks pregnant you are.
You should have noticed symptoms, but then, many women who do not even think of it as a possibility ( like you, I suppose ) might go on until the advanced stages of pregnancy , without having any specific symptoms.
Take care.
Am glad if I could help you in this regard.
Feel free to post a question directly to me anytime in future.
Good luck !


Patient replied :

Hi
its been quite an eventful couple of days. After doing the tests 2 days ago became very anxious that I didn't really have any details about anything other than the fact that I am obviously pregnant and likely to be actually quite pregnant. Was due to still be away with family for the next 2 weeks (about 4hr drive from home) and that was playing on my mind, along with the fact that now I know I'm pregnant, some of the symptoms are worrying like the cramping which had got worse over this week. So took the decision to come but during the long drive home the cramping intensified to quite an extreme point, so stopped at the hospital back home, as didn't feel I could wait until next week to make appointments with doctors and for scans etc. Explained the situation to the hospital and they confirmed from pregnancy test that I am definitely pregnant, and they agreed to do scan for 2 reasons, firstly because I had no idea how pregnant I was and secondly to check everything is ok. Well first shock that happened was finding out not only am I pregnant, but I'm actually nearly 31 weeks. Second big shock happened when they decided to check me out because of the bad cramping that had been getting worse and worse over the past few days. They did an examination and actually told me that I was essentially in pre-term labour and they had to do everything now to stop it. So I was quickly hooked up to a drip containing something to stop the labour and also was given steroids to help develop the baby's lungs incase the baby does come early. They did say that although my cervix had not begun to dilate yet, it was very thin now and the baby is essentially engaged, so the likelihood of going to full term now is unlikely. As you can imagine am in great state of shock!!!!!!! I feel very stupid!!! Now I know of course it is very obvious I that I am 7 months pregnant. My only defence is that with the adenomysisis I do get severe cramping, I can miss periods for several months at a time and my lower abdomen does enlarge/bloat to probably what looks like 4 month pregnancy. And I guess this is the reason I contacted you, because the abdomen enlargement was much worse than normal, and the cramping and the missed periods for longer than normal. They have now sent me home on bedrest with further appointments booked at the hospital for another scan and examination and general checks later this week. Does this all sound like the correct course of action?? They said to come back if concerned about anything, but to be honest I feel so stupid about not realising that I was 7 months pregnant, I now don't know what is normal/what isn't normal. What symptoms would you suggest that I go back to the hospital for?????


Phew !
You have certainly been through a lot, shock is an understatement.
Well, is this your first pregnancy?
And do not feel apprehensive about visiting / talking to your doctor just because you were not aware about your pregnancy.
You are , now, and that makes it important.
That is all.
They are bound to offer you all due care, attention and patience.
Preterm labour is serious, at 31 weeks, the baby would face a lot of issues if born this early.
Please comply with all instructions, take all medications, and take COMPLETE rest as far as possible.
Report to the hospital in case of - cramping, pain, feeling of heaviness in the lower abdomen, spotting, bleeding, pain or pressure in the pelvis, etc.
And yes, the course of action seems to be correct so far, follow it precisely.
I wish you so much luck.
I know it will require lots of adjustments on your part, but motherhood is a beautiful experience, if you wanted it !
Take care, keep me posted.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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