Are Heavy Menstrual Flows a Definite Symptom in Patients with Adenomyosis?

It's a common scenario in clinical settings: patients questioning whether their diagnosis of adenomyosis is accurate because they don't experience heavy menstrual flow. But is heavy bleeding a definitive symptom of adenomyosis? Let's delve deeper into this issue.

While adenomyosis presents with several typical clinical signs, not all patients exhibit the complete array of symptoms concurrently. Symptoms can vary, with some individuals experiencing only one or two initially.

Symptoms may include painful periods, heavy menstrual bleeding, uterine enlargement, infertility, anemia, anal heaviness, and dyspareunia. Painful periods, progressively worsening over time, are prevalent and often dominate the clinical picture, causing significant discomfort for a large portion of affected individuals.

However, not all patients experience severe menstrual pain; some may tolerate it well or even remain pain-free, which is fortunate.

Heavy menstrual bleeding, often accompanied by large blood clots, ranks as the second most common symptom. Many patients also endure prolonged periods with heavy flow. Nevertheless, exceptions exist, and not all women with adenomyosis experience heavy bleeding.

In fact, some individuals have normal or even light menstrual periods. Typically, normal monthly bleeding for women ranges from 20 to 60ml, with over 80ml considered excessive and less than 15ml considered scanty. Even among those with heavy flow, the severity can vary, with mild cases being less pronounced and severe cases potentially leading to anemia.

The uterus gradually enlarges with each menstrual cycle due to factors like uterine enlargement, decreased contractility, and endometrial thickening. Consequently, women may experience heavy bleeding and prolonged periods, with severe cases necessitating hemostatic medications, blood tonics, or blood transfusions to counteract anemia.

While heavy bleeding is a common symptom, it's crucial for patients to promptly address it with hemostatic medications or traditional Chinese medicine like Fuyan Pill to alleviate symptoms and regulate menstruation.

Dietary adjustments can also help mitigate the effects of increased menses by consuming blood-nourishing foods, but overly nourishing tonics should be avoided. Additionally, stimulants like coffee and tea should be minimized to prevent exacerbating painful menstruation.

Keeping the abdomen warm and avoiding cold stimuli can provide relief. For those whose menstrual volume remains unmanageable, timely surgical intervention to remove lesions and restore normal uterine size may be necessary to address heavy periods and anemia at their core and improve associated symptoms.

Although some individuals experience light menstrual periods or irregular menstruation, it's important to recognize the correlation between adenomyosis lesion types and clinical symptoms.

The severity of bleeding and menstrual pain does not dictate diagnosis; instead, ultrasound findings primarily determine adenomyosis diagnosis. Light flow due to adenomyosis is uncommon in clinical practice, as the condition typically leads to increased flow owing to endometrial growth into the myometrium, resulting in uniform uterine enlargement.

In conclusion, while heavy menstrual flow is a common symptom of adenomyosis, its absence does not rule out the condition.

Women with adenomyosis who are planning for pregnancy should begin by undergoing a transvaginal ultrasound to evaluate the size of the uterus. If the uterus appears particularly enlarged, medication may be prescribed as a pre-treatment to help restore it to its normal size. Additionally, hormone level tests should be conducted to assess ovarian function and ovulation. Prenatal screening, including tests for rubella virus, cytomegalovirus, toxoplasmosis, and herpes simplex virus, as well as routine blood tests and blood type testing, should also be performed. Furthermore, checks for vaginal inflammation, mycoplasma, chlamydia, and folate levels are recommended.

If all tests come back normal, the patient can proceed with attempting to conceive. However, for older women or those who have undergone a hysterectomy, if conception remains elusive after 3-6 months of trying, it is advisable to promptly explore assisted reproductive techniques to facilitate pregnancy.