Adenomyosis

I have had severe cramping associated with my menstrual cycle since my first period at age 13. In January of this year I woke up one morning to find my pajamas soaked with blood down to the knees. This extreme bleeding lasted for 2 weeks, causing anemia. I made an appointment with a doctor who attributed my bleeding to not having enough estrogen. I was prescribed with an iron supplement and a new birth control. After starting this new pill, I began to have a period every 2 weeks. I went back to the doctor after 3 months (and 6 "periods"). I was put on yet another birth control.Mild dysplasia and HPV was found when a pap smear was done. Next, they did a colposcopy and claimed there were no abnormalities. (I should add that I was prescribed Ponstel nearly a year ago to combat the cramping) The next month after the colpo, I had several symptoms I had never experienced before and found them bizarre (insomnia, extreme moodiness, depression, lack of appetite, fatigue, anxiety, and several other symptoms normally associated with PMDD). I made an appointment with a new doctor immediately. This appointment was 3 days ago. My doctor did a pelvic exam and believes that I have Adenomyosis. I am only 19 years old, and after reading all the information I could possibly find, I wonder what the effects of this will be on my fertility. Also is there a way to be completely sure of this? Will a hysterectomy be necessary? Will I be able to have a successful pregnancy? I guess overall I am wondering what to expect or where to go from here.

[Elaine Brown, MD]

Hi!
You have a fairly extensive history for a 19 year old!  Only fairly recently we have begun to realize that women your age can have fairly significant endometriosis.  If you were my patient, I would take you to laparoscopy at the next opportunity.  I would biopsy any suspicious areas to confirm the diagnosis.  Laser ablate anything that I could see.  (Endometriosis often looks different in younger women than in older women), and then I would start you on something like depot Lupron with hormone replacement.  That is provided my theory is correct about the endometriosis.  Adenomyosis is a form of endometriosis by the way, so I don't disagree with your doctor.
If you take proper care of your reproductive organs, and don't wait too long to have children, you should be able to have a nice family.  MOST women who start out their reproductive years the way that you have ultimately do require hysterectomy, but we can usually put that off until after the kids come along.

Good luck!
Dr B