Adenomyosis is a benign infiltration of the endometrium into the myometrium and its diffuse growth therein, characterized by ectopic endometrium and glands in the myometrium, accompanied by hypertrophy and hyperplasia of the myoblasts around them. Adenomyosis arises when the endometrium is not shed and flows out with menstruation but invades the myometrium by pressure, resulting in blood and lesions in the walls of the uterine cavity.

As a result, patients experience intense pain, with episodes of two or three days per month, one more painful than the other, which seriously affects the patient's quality of life and even family life. To reduce the pain, these patients often choose to take painkillers.

So does taking pain medication in the treatment of adenomyosis create resistance?

To clarify this question, we first need to understand what drug resistance is.

Drug resistance, also known as drug tolerance, refers to the resistance of pathogenic bacteria to drugs. In treating bacterial infections or parasitic infections, the long-term application of certain drugs, and the pathogenic bacteria's contact with such drugs repeatedly, its reflectivity will be slowly weakened. Therefore, the pathogenic bacteria can resist the drug eventually without being suppressed or destroyed. After the pathogenic bacteria get resistant, it usually makes the medical treatment ineffective.

Some patients take painkillers before their periods to reduce the pain they feel during their periods. However, long-term painkillers can cause the body to develop drug resistance, making them lose its pain-relieving effect. In addition, long-term use of painkillers may also cause the person to become dependent on the medication. If you do not take them before your period, you may experience more pain during your period than before.

Moreover, long-term use of painkillers can cause adverse effects, such as endocrine disruption. Long-term use of analgesics in patients with adenomyosis can cause disturbances in the body's internal secretion system, which can significantly impact health.

Taking only painkillers will not cure adenomyosis. And it can create drug resistance and the side effects mentioned above. So, what other methods are available to treat adenomyosis?

Firstly, medication can be used.

(1) Pseudopregnancy therapy is useful for patients with mild symptoms without temporary fertility requirements and near menopause. Patients can take oral contraceptive pills or progestin to result in the decidualization and contraction of the ectopic endometrium, aiming to control the development of adenomyosis.

(2) IUD. Patients with large menstrual volumes, dysmenorrhea, and no reproductive requirements can choose to use a contraceptive device containing high-efficiency progesterone.

(3) GnRHa injection can be performed as a preoperative drug for some patients with extensive lesions and difficulty in surgery to bring the hormone level in the body to the state of menopause, thus causing the ectopic endometrium to shrink gradually for treatment.

(4) Traditional Chinese medicine believes that adenomyosis is related to internal obstruction of blood stasis. The formation of blood stasis is related to pathogenic factors such as qi deficiency, cold condensation, qi stagnation, phlegm, and dampness. Therefore, the treatment should be based on the principle of activating blood stasis and resolving blood stasis but should also take into account the causes of blood stasis formation and the differences between deficiency and reality.

Secondly, surgical treatment is also available.

Surgical treatment includes radical surgery and conservative surgery. Radical surgery is hysterectomy, while traditional surgery includes excision of adenomyosis lesions (adenomyoma), endometrial and myomectomy, myometrial electrocoagulation, uterine artery block, and presacral neurectomy and sacral neurectomy.

Finally, interventional treatment may also be performed.

Selective uterine artery embolization can also be used as one of the options for the treatment of adenomyosis. The mechanisms of action are necrosis of the ectopic endometrium, reduction of prostaglandin secretion, relief of dysmenorrhea, reduction of menstrual flow and reduction of recurrence; establishment of collateral circulation of the in situ endometrium, which can gradually migrate from the basal layer to grow back to function. 

However, uterine artery embolization can affect the blood flow to the uterus and ovaries, thus detrimental to pregnancy. It may lead to infertility, miscarriage, and preterm delivery and increase the rate of cesarean delivery.

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