Duphaston: Can my hormonal treatment promote my adenomyosis?

Mom’s question:

I have been amenorrhea for 9 months. Despite several attempts to take Duphaston (for 3 cycles), ovulation does not start. During a hysterosonography last February, the ultrasound revealed cavities under the endometrium, and suspected adenomyosis. I don’t understand how adenomyosis can be suspected in February 2022, when my pelvic ultrasound from September 2021 did not show any. Could my adenomyosis appear following my hormonal treatment?

The answer from the expert, Dr. Diane Winaver, gynecologist

What is adenomyosis?

First of all, a little reminder: adenomyosis, also called “internal endometriosis”, is characterized by the abnormal infiltration of cells from the uterine cavity (endometrium) inside the myometrium (muscle of the uterine wall), which which weighs it down, thickens it, making it very painful.

When to take Duphaston?

Duphaston is a drug similar to the natural progesterone secreted by the ovaries. It triggers menstruation provided that the ovaries still secrete enough estrogen. It cannot trigger ovulation, so it is normal that you do not observe it at home.

Duphaston is also prescribed to rebalance the menstrual cycle and certain hormonal pathologies. Absence of menstruation (or amenorrhea) after 12 to 14 days of progestogen therapy may suggest the onset of menopause.

Synthetic progestogen Duphaston is one of the treatments for endometriosis but also for menstrual disorders:

– In case of haemorrhagic periods caused by hyperestrogenism which increases the thickness of the uterine lining and therefore the abundance of periods.

– Either as a first-line test in the event of amenorrhea to find out if the ovaries are still active.

Side effects of Duphaston

Duphaston is a drug and as such must be prescribed by a professional knowing all the contraindications, in particular the risk with certain brain tumors (meningiomas). Its side effects are numerous, in various areas (migraines, nausea, decreased libido, etc.) but, for the most part, well tolerated.

Can adenomyosis develop in a few months?

Hysterosonography is a more efficient exploration than the classic pelvic ultrasound to see what is happening inside the uterine cavity. It consists of injecting physiological serum into the uterus and exploring the endometrium using a probe, no longer vaginal but endouterine. Pelvic MRI is another possible mode of exploration.

Five months to develop adenomyosis seems a bit fast to me. But it all depends on your ovarian function. I don’t know your age, the regularity of your cycles, or your symptoms.

It is useful to know that it is estrogen and not progesterone that aggravates endometriosis, therefore adenomyosis. This is why the pill that puts the ovaries to rest is prescribed in many cases with success. However, your medical treatment consists of suppressing ovarian function, therefore blocking estrogen secretions.

Can hormone treatment promote adenomyosis?

Estrogen treatments promote adenomyosis, but not Duphaston, since it is a progestogen treatment.

Can adenomyosis cause amenorrhea?

No, but the amenorrhea (stopped menstruation) of menopause is the natural cure for adenomyosis.