Adenomyosis and Pregnancy
Adenomyosis is a life-altering condition that occurs when the endometrium of the uterus invades its muscular layer.1 It affects 20-35% of the women of reproductive age, most prominently those in the 35-50 years age group.1 Notably, this benign condition is more prevalent in women who have given birth before.2 Thus, adenomyosis shares an intimate connection with pregnancy. In this article, we discuss the impact that adenomyosis can have on patients before and during pregnancy.
Adenomyosis Can Cause Difficulty to Achieve Pregnancy
Several studies suggest that adenomyosis may result in infertility in patients.2,3 Assisted
reproductive technologies, such as in vitro fertilization (IVF) can help, but adenomyosis reduces
the rate of pregnancy through IVF.4 Medical researchers suggest that this could be because the
invasive endometrial tissue results in an increased intrauterine pressure during pregnancy.4
Adenomyosis May Cause Pregnancy Complications
If you have adenomyosis and wish to conceive, it is important to know that adenomyosis patients who get pregnant may face a host of difficulties during their pregnancy. Most notably, pregnant women with adenomyosis face higher risks of miscarriages and preterm deliveries.1,5 Adenomyosis also increases the risk of fetal growth restriction (FGR).5 This is a condition in which the unborn baby has an abnormally low weight.
Another complication that pregnant women with adenomyosis are likely to experience is preterm premature rupture of membranes (PPROM).5 This condition involves early breakage of the amniotic membrane surrounding the baby.6 In other words, the water breaks earlier than 37 weeks of pregnancy.6 This exposes the expecting mother to infection, and often forces a preterm delivery.6
Adenomyosis-affected women are also highly likely to have a Cesarean delivery.2,7 Postpartum hemorrhage (PPH) is yet another challenge that comes with adenomyosis.2 There is also an increased risk of preeclampsia – or increased blood pressure and urinary protein – among pregnant adenomyosis patients.1,2 Other hypertensive disorders of pregnancy may also occur.2
Adenomyosis Treatment – Uterine Arterial Embolization (UAE)
Uterine artery embolization, or UAE, is a non-surgical image-guided procedure that effectively treats adenomyosis (and fibroids) in one treatment. This is done by placing a tiny catheter into the uterine artery and blocking the blood flow to the abnormal lining using tiny beads.
Some of the UAE advantages include:
- No hospital stay
- No general anesthesia
- No stitches
- No blood loss
- No risk of hysterectomy
- No major scars
- No surgical risks
Pregnancy after Uterine Arterial Embolization (UAE)
On a positive note, studies have shown that adenomyosis treatment, whether non-surgical or through conservative surgery, can help overcome infertility and achieve pregnancy.3,4 The non-surgical UAE treatment is a promising strategy to treat and achieve adenomyosis and pregnancy.7,8
Several reports suggest that adenomyosis patients may be able to conceive as early as five months after successful UAE treatment.7 While such reports give hope to adenomyosis patients who wish to conceive, it is crucial to note that there is always a chance of the complications that we discussed above, such as miscarriage, FGR, PPROM or a Cesarean delivery.7
Adenomyosis Treatment Planning
Adenomyosis is a complicated condition that can significantly impact pregnancies in a variety of possible ways. There are, however, case-to-case differences that many studies have noted. Moreover, adenomyosis is a field of active biomedical research. As such, scientists and doctors continue to discover intricate details about the condition and its impact on pregnancy. Yet, given the current knowledge of the pregnancy-related complications arising from adenomyosis, it is advisable to consult a doctor if you are trying to conceive before or after your treatment.
Not all embolizations are the same. Uterine artery embolization may be offered by practitioners of varying levels of experience. An academic hospital will have doctors in training that will often place too many beads into the artery. Other practitioners may use products or suboptimal techniques that are outdated.
Our center specializes in embolizations and our staff is uniquely trained to care for these type of procedures, from the pre-op to the post-op period. Our specialist performs a high number of embolization for not only the uterus but also in other more high risk and complex organs, such as the kidney, liver, lung and others. Patients are often surprised how quick and simple the UAE procedure was for them, but this comes at the experience of our specialist who performs a variety of complex embolizations safely. This diversity of experience has resulted in our specialist to treat complex fibroid and adenomyosis cases safely and effectively.
Our specialist continually keeps up with the research to make sure that he brings the best and newest technology to our center. We are also always collecting feedback from patients and modifying how we provide care so that patients have the best level of experience.
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Request a consultation to meet with our specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each woman is an individual and should discuss the potential risks and benefits of fibroid embolization and other treatments with our doctor to decide which option is best for her.
Consultations are available via an online video telehealth platform or in person based on availability at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here.
- Jensen KK, Pyle C, Foster BR, Sohaey R, Oh KY. Adenomyosis in Pregnancy: Diagnostic Pearls and Pitfalls. 2021; 41(3):929-44.
- Hashimoto A, Iriyama T, Sayama S, Tsuruga T, Kumasawa K, Nagamatsu T, Osuga Y, Fujii T. Impact of endometriosis and adenomyosis on pregnancy outcomes. Hypertension Research in Pregnancy. 2019: HRP2019-015.
- Szubert M, Koziróg E, Olszak O, Krygier-Kurz K, Kazmierczak J, Wilczynski J. Adenomyosis and infertility—review of medical and surgical approaches. International Journal of Environmental Research and Public Health. 2021; 18(3):1235.
- Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The impact of adenomyosis on women’s fertility. Obstetrical & Gynecological Survey. 2016; 71(9):557.
- Tamura H, Kishi H, Kitade M, Asai‐Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Complications and outcomes of pregnant women with adenomyosis in Japan. Reproductive Medicine and Biology. 2017; 16(4):330-6.
- Abou El Senoun G, Dowswell T, Mousa HA. Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks’ gestation. Cochrane Database of Systematic Reviews. 2014(4).
- Bonduki CE, Feldner Jr PC, da Silva J, Castro RA, Sartori MG, Girão MJ. Pregnancy after uterine arterial embolization. Clinics. 2011; 66(5):807-10.
- Kulshrestha V, Yadav R, Malla S, Gamanagatti S, Bhatla N. Successful pregnancy outcome in refractory adenomyosis treated with two sessions of uterine artery embolization: A case report and brief review. Journal of Gynecology Obstetrics and Human Reproduction. 2021; 50(7):102132.