Quick links:
- Click here to read more about adenomyosis
- Click here to see a case study about ExAblate treatment of adenomyosis
- Click here to see a talk by Dr. Jaron Rabinovici about ExAblate treating adenomyosis at the FUS symposium 2010
What is Adenomyosis?
Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus. Its cause is unknown. Sometimes adenomyosis may cause a mass or growth within the uterus, which is called an adenomyoma. The disease usually occurs in women older than 30 who have had children. The symptoms include long-term or heavy menstrual bleeding, painful menstruation, which gets increasing worse and pelvic pain during intercourse. The ‘benign invasion of endometrium into myometrium’ that occurs in adenomyosis can lead to enlargement of the uterus and reactive hyperplasia and hypertrophy of the neighbouring myometrium (Bird et al., 1972).
Adenomyosis is difficult to distinguish clinically from uterine leiomyoma, since many symptoms of these two conditions are similar. Further, adenomyosis and leiomyoma are not easily distinguishable on ultrasound, and magnetic resonance imaging (MRI) is currently regarded as the best imaging tool for the differential diagnosis (Byun et al., 1999; Reinhold et al., 1999).
Adenomyosis Case Reports
ExAblate with continuos MRI imaging has the potential to precisely and effectively treat adenomyosis. Several reports have been published:
Rabinovici et al. (2006) Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report Hum. Reprod. Advance Access published 2006
Upon admission to the study, the patient was 36 years old, married and had one child. She had no abnormal medical history and no history of miscarriage or any prior invasive uterine procedures. The course of her previous pregnancy and delivery was normal. Her primary symptoms were prolonged and irregular menstrual bleeding, menometrorrhagia, abdominal distention and chronic fatigue. Her gynecologist diagnosed a uterine leiomyoma based on an enlarged uterus and ultrasonographic imaging of a circumscribed uterine tumour. Owing to the patient’s menometrorrhagia, which limited her ability to have timely intercourse and to conceive, her physician recommended that she undergo conservative myomectomy. While looking into myomectomy, she learned of our MRgFUS programme. She wished to bear at least one more child and thus sought to avoid an invasive surgical procedure with attendant possible side effects and complications. The patient completed MRgFUS with no complications. She graded the level of pain during treatment as moderate and reported little or no discomfort after being discharged. During the weeks following treatment, she experienced a significant reduction in menometrorrhagia. Six weeks after MRgFUS, the adenomyotic tumour showed a marked decrease in size to 3.5 cm × 4.3 cm on vaginal ultrasound.
Three menstrual cycles after MRgFUS, the patient conceived spontaneously. The course of her pregnancy was uneventful. Repeated ultrasound scans demonstrated normal fetal development, normal placental insertion in the posterior uterine wall and normal uterine anatomy. She gave birth to a full-term, 3.050 kg, healthy baby girl after an uneventful labour and vaginal delivery.
Following is the abstract of an article on the subject:
Fukunishi et al (2008) Early Results of Magnetic Resonance–guided Focused Ultrasound Surgery of Adenomyosis: Analysis of 20 Cases Journal of Minimally Invasive Gynecology (2008) 15, 571–579 2008
Twenty premenopausal women at least 18 years of age with symptomatic adenomyosis were treated by ExAblate. Extensive adenomyosis (6 cases) was treated with 2 applications. Uterine volume was evaluated by MR imaging before and immediately after treatment. The early results indicate the safe and effective ablation of adenomyosis tissue by ExAblate and resulted in the improvement in clinical symptoms during the 6 months of follow-up. Click here to see pre and post MRI images from this paper.
Yoon et al. (2008) Successful use of magnetic resonance–guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis Fertil Steril. 2008 Nov;90(5):2018.e13-5. Epub 2008 Aug 9
Case study of a 47-year-old premenopausal woman with focal symptomatic adenomyosis.Her symptoms were menorrhagia and dysmenorrhea. The MRI scan showed multiple, small, high signal intensity spots, which likely resulted from islands of ectopic endometrial tissue and cystic dilatation of glands. Six months after the ExAblate treatment, the patient reported that her QOL score (Uterine Fibroids Symptoms Quality of Life (UFS-QOL) questionnaire) had decreased to 28 points (from 50), and her subjective menstrual pain score was reduced to 5 points (from10). These scores were maintained at her 12 month follow-up visit. The MRI of her abdomen at 12 months showed a uterus size of approximately 320 cc3 (about 35% shrinkage from her pretreatment images). The image on the right-hand side shows the pre and post MR images. Please click on the image enlarge it.
Polina et al. (2012) Noninvasive treatment of focal adenomyosis with MR-guided focused ultrasound in two patients Indian J Radiol Imaging. 2012 Apr-Jun; 22(2): 93–97.
Case study of 2 Indian patients, one was a 39-year-old nulliparous and the second one was a 43-year-old multiparous woman. Both presented to their gynecologist with symptoms of dysmenorrhea, heavy bleeding, passing clots during the menstrual cycle and fatigue for the past six months. After treatment with ExAblate, both patients showed a steady decrease in symptoms over the course of the follow-up period, as demonstrated by the decline in the SSS. Both patients had high menstrual pain score before treatment (10 and 8, respectively, in patients 1 and 2). This gradually decreased and they were free of menstrual pain by the end of 6 months. They reported a significant improvement in their quality of life. In both patients no adverse events or complications were recorded during the treatment or follow-up period. In case 2, there was a fibroid associated with the focal adenomyosis,which was treated in the same sitting.
