The manifestation in women of internal genital endometriosis is sometimes called adenomyosis. The disease belongs to the group of systemic hormone dependent benign pathologies. In fact, is one of the varieties of endometriosis.
It is a pathological process caused by the germination of the endometroid cells of the inner layer of the uterus into the tissue structures of organs of different localization.
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Uterine adenomyosis - what is it?
Structural disorders of uterine tissues with local inflammatory and gradual degenerative processes that destroy parts of her body are uterine adenomyosis, triggered by the introduction of endometrial glandular cells into her muscle layer. Here begins their sequential focal growth with the formation of large nodes with the subsequent disintegration, rejection and release of blood.
Moreover, the whole cycle of disintegration and rejection coincides with the cyclic menstrual process occurring in the normal endothelium in different periods of the “lunar cycle”.
Depending on the histological structure, internal endometriosis is characterized by three main forms of manifestation:
1) Diffuse adenomyosis - manifested by multiple small focal nodal neoplasms scattered across the muscle layer over a large area of uterine tissue. It features a uniform arrangement of pathological tissues over the entire area of the myometrium of the anterior and posterior wall of the uterus.
2) Focal adenomyosis - represented by single large foci (heterotopies) of the lesion, localized in a separate small area of uterine myometrium. Foci are restricted from muscle tissue, as they are surrounded by a capsule of their own. Encapsulation of foci does not cause a change in the shape and size of the uterus. This form of lesion prone posterior wall of the uterus.
3) Nodular adenomyosis - occurs when pathological growth of the focal form, turning into a large neoplasm. In more than 80% of cases, the combination of fibroids with adenomyosis of the nodular form occurs. From a medical point of view, this process is due to similar signs of development.
Classification of the disease according to the severity of the clinical course, although not approved by an international commission, has been found to be the most convenient in clinical practice.
Manifestations of pathological processes in the tissues of the uterus, more than 70% of cases have a diffuse character, therefore, such adenomyosis is classified according to the degree of penetration of endometrial cells into the underlying tissue layers of the uterus.
- Grade One displays the diffuse proliferation of endometriotic tissue in the submucous uterine layer (submucosm).
- In the second degree, changes occur in almost half of the muscle mass of the uterus.
- In the third degree, the lesion covers most of the muscle mass.
- The fourth degree of pathology is characterized by an extensive growth of the glandular endometrium that goes beyond the myometrium in the perimetry, moving into the peritoneal cavity and involving organs in the pelvic cavity in the process of proliferation of the pathological tissue.
Signs of adenomyosis, characteristic symptoms
The characteristic signs and symptoms of uterine adenomyosis are caused by pronounced menstrual menorrhagia, leading to the development of IDA (iron deficiency anemia). Due to the large blood loss and the development of anemia, symptoms manifest themselves:
- Signs of weakness and drowsiness,
- Frequent infectious pathologies,
- Pallor of the skin and mucous membranes in sight,
- Signs of vertigo (dizziness) and dyspnea (shortness of breath), which even the most insignificant loads cause,
- Chronic fatigue and internal stress.
Specific signs of internal endometriosis include a bloody brown discharge before menstruation and after it (for 3 days). In the middle of the cycle, heavy menstrual bleeding may occur.
Three days before the start of the cycle, severe pain symptoms appear, disappearing spontaneously three days after menstruation.
The intensity of the pain syndrome also has its own characteristics. It is most pronounced in pathology in the uterine isthmus zone and in the extensive process of adhesions formation.
For example, pain, resembling signs characteristic of an acute abdomen, may occur when a two-horned cavity of the uterus is affected, triggered by a surge of blood during menstruation into the pelvic cavity. It is able to manifest symptoms similar to peritonitis.
By irradiating pain syndrome, it is easy to identify the localization of the pathological focus. For example, irradiating pain in the groin speaks of a pathological focus in the zone of bending of the uterus, pain in the large intestine or vagina is evidence of the presence of a pathological focus in the isthmus.
- By the way, this is evidenced by pain during an intimate act, shortly before menstruation.
In adenomyosis with myoma, the symptoms do not differ from the main signs of the disease. The exception is fibroids, with localization in the submucous uterine layer. In this case, the symptoms are manifested by acyclic menorrhagias. For this type of adenomyosis, the methods of conservative treatment are untenable and the problem is solved by a conservative method - hysterectomy.
What does the ultrasound diagnosis?
The most characteristic feature of internal endometriosis is the transvaginal ultrasound method. The accuracy of diagnosis is provided by more than 90%.
Pathognomical signs of uterine adenomyosis on ultrasound are displayed:
- The increased size of the front and rear walls of the body of the uterus, because of what it becomes spherical.
- Increasing it to the size of a six-month pregnancy, possibly larger.
- Asymmetry of enlarged uterine walls.
- The appearance before menstruation in the muscular shell uterine layer of cystic formations (up to 5 mm. And more).
Treatment of adenomyosis - drugs and surgery
The choice of treatment for uterine adenomyosis is based on many factors, taking into account the specific characteristics of each patient, the nature of the course of the disease, its prevalence and localization. This factor is taken into account - the desire of a woman in the future to become a mother.
Standard treatments for adenomyosis are due to:
- Surgical treatment, including methods of radical treatment - hysterectomy and oophorectomy and organ-preserving techniques - laparoscopy and excision of affected lesions.
- Conservative, medical treatment - the use of anti-inflammatory, immunomodulatory, vitamin and physiotherapy, soothing, supporting and resolving drugs, treatment of adenomyosis with hormonal drugs.
- Combined techniques.
Medication for the treatment of adenomyosis are prescribed after a thorough examination of the patient and include:
- Preparations of combined oral contraceptives, normalizing the functional properties of the ovaries, providing a reduction in menstrual flow and pain symptoms. Contributing to the cessation of menorrhagia and delayed menstruation. These are Logest and Janine, Jess or Marvelon and Yarin.
- To reduce the provocative functional effect of the ovaries on the endometrium, preparations of the pituitary hormone (antigonadotropins) are prescribed in the form of “Danazol” or “Danol”.
- Preparations of progestogens are used to slow down and stop the growth of endometriotic tissues. The most effective are Duphaston and Norethisterone. The effectiveness of the treatment of adenomyosis "Duphaston" is due to its effect on the reduction of menstrual flow, stabilization of the cycle, reduction in pain symptoms during this period.
- The action of anti-estrogens is aimed at suppressing gonodotropic hormones, which deprives vital support of pathological cells and causes their death here - Gastrinone or Medroxyprogesterone.
- Extinction of pathological foci, due to the increase in progesterone and decrease in estrogen, contributes to the drug - "Vizanna."
Many of these drugs have side effects and contraindications, so they should be prescribed only by a doctor.
Adenomyosis during pregnancy - 5 facts
The manifestation of adenomyosis during pregnancy today is not uncommon, which made it possible to study the nature, “habits” and influence of pathology in this period. The findings of numerous observations and studies are set forth in the relevant medical regulations.
1. According to different sources, more than half of women with internal uterine endometriosis have an increased risk of infertility, but in most cases, the combined therapy performed on time can restore fertility.
2. Often, adenomyosis is a serious threat due to preterm labor. To stabilize the situation, in many cases only adequate treatment according to the standard scheme can.
3. Premature delivery or abortion causes a relapse or exacerbation of the disease. In such situations, the process of pathology development is significantly accelerated, therefore, no matter what, if possible, the pregnancy should be maintained.
4. More than half of pregnant women with the presence of adenomyosis, delivery is normal and prosperous, but after delivery there is a risk of developing complications such as uterine hemorrhages, so women should be prepared for this.
5. In the postpartum period, with the restoration of the menstrual cycle, the pathological process can be activated. But the risk in this case is much lower than after an abortion.
In any cases (after a premature or normal birth, after an abortion), after the menstrual cycle has been restored, women with a history of internal endometriosis need to receive (hormonal, immunomodulatory, axidant, etc.) anti-relapse therapy.
The relationship between adenomyosis and endometriosis
Adenomyosis is a type of endometriosis, a disease in which endometrial cells multiply outside the uterine mucosa (in the fallopian tubes, ovaries, digestive, respiratory or urinary system). The proliferation of cells occurs by contact, lymphogenous or hematogenous. Endometriosis is not a tumor disease, since heterotopically located cells retain their normal structure.
However, the disease can cause a number of complications. All cells of the uterine lining, regardless of their location under the influence of sex hormones undergo cyclical changes. They multiply rapidly and are rejected during menstruation. This entails the formation of cysts, inflammation of the surrounding tissues and the development of adhesive processes. The frequency of combination of internal and external endometriosis is unknown, but experts suggest that the majority of patients with uterine adenomyosis have heterotopic foci of endometrial cells in various organs.
Causes of adenomyosis
The reasons for the development of this pathology has not yet been precisely determined. It has been established that adenomyosis is a hormone-dependent disease. Disease immunity and damage to the thin layer of connective tissue that separates the endometrium and myometrium and interferes with the growth of the endometrium deep into the uterus wall contribute to the development of the disease. Damage to the dividing plate is possible with abortions, diagnostic curettage, the use of the intrauterine device, inflammatory diseases, childbirth (especially complicated), operations and dysfunctional uterine bleeding (especially after surgery or during treatment with hormonal drugs).
Other risk factors for the development of adenomyosis associated with the female reproductive system include too early or too late onset of menstruation, late onset of sexual activity, taking oral contraceptives, hormone therapy and obesity, resulting in an increase in the amount of estrogen in the body. The risk factors for adenomyosis associated with impaired immunity include poor environmental conditions, allergic diseases, and frequent infectious diseases.
Some chronic diseases (diseases of the digestive system, hypertension), excessive or insufficient exercise, also have a negative effect on the state of the immune system and the general reactivity of the body. Some significance in the development of adenomyosis is unfavorable heredity. The risk of occurrence of this pathology is increased in the presence of close relatives, suffering from adenomyosis, endometriosis and tumors of the female genital organs. Congenital adenomyosis is possible due to impaired fetal development.
Classification of uterine adenomyosis
Given the morphological picture, there are four forms of adenomyosis:
- Focal adenomyosis. Endometrial cells invade the underlying tissues, forming separate foci.
- Nodular adenomyosis. Endometrial cells are located in the myometrium in the form of nodes (adenomyomas), in the form resembling myoma. The nodes, as a rule, are multiple, contain cavities filled with blood, surrounded by dense connective tissue resulting from inflammation.
- Diffuse adenomyosis. Endometrial cells are introduced into the myometrium without the formation of clearly visible foci or nodes.
- Mixed diffuse nodular adenomyosis. It is a combination of nodular and diffuse adenomyosis.
Given the depth of penetration of endometrial cells, four degrees of adenomyosis are distinguished:
- 1 degree - only the submucous layer of the uterus suffers.
- 2 degree - affects no more than half the depth of the muscle layer of the uterus.
- 3 degree - more than half the depth of the muscular layer of the uterus suffers.
- 4 degree - the whole muscle layer is affected, it can spread to neighboring organs and tissues.
Symptoms of adenomyosis
The most characteristic sign of adenomyosis is long (more than 7 days), painful and very heavy menstruation. In the blood, clots are often detected. 2-3 days before menstruation and within 2-3 days after its completion, brownish spotting is possible. Sometimes there are intermenstrual uterine bleeding and brownish discharge in the middle of the cycle. Patients with adenomyosis often suffer from severe premenstrual syndrome.
Another typical symptom of adenomyosis is pain. Pain usually occurs a few days before the onset of menstruation and stops 2-3 days after its onset. The features of the pain syndrome are determined by the localization and prevalence of the pathological process. The strongest pains occur with lesions of the isthmus and widespread adenomyosis of the uterus, complicated by multiple adhesions. When localized in the area of the isthmus, the pain may radiate to the perineum, while located in the area of the uterus angle - in the left or right inguinal region. Many patients complain of pain during intercourse, aggravated on the eve of menstruation.
More than half of patients with adenomyosis suffer from infertility caused by adhesions in the fallopian tube area, which prevent the penetration of the egg into the uterus, endometrial structure disturbances that impede egg implantation, and concomitant inflammatory process, increased myometrium and other factors that increase the likelihood of spontaneous abortion . A history of patients may show a lack of pregnancy with regular sex life or multiple miscarriages.
Abundant menstruation with adenomyosis often entail the development of iron deficiency anemia, which can manifest weakness, drowsiness, fatigue, shortness of breath, pallor of the skin and mucous membranes, frequent colds, dizziness, fainting and pre-unconscious states. Severe PMS, prolonged menstruation, persistent pain during menstruation and worsening of the general condition due to anemia reduce the patient's resistance to psychological stress and can provoke the development of neurosis.
Clinical manifestations of the disease may not correspond to the severity and extent of the process. 1 degree of adenomyosis, as a rule, is asymptomatic. At 2 and 3 degrees, both asymptomatic or oligosymptomatic, as well as severe clinical symptoms can be observed. 4 degree of adenomyosis, as a rule, is accompanied by pain, caused by a common adhesive process, the severity of the remaining symptoms may vary.
During the gynecological examination revealed a change in the shape and size of the uterus. With diffuse adenomyosis, the uterus becomes spherical and increases in size on the eve of menstruation, with a common process the size of the organ can correspond to 8-10 weeks of pregnancy. When nodular adenomyosis, uterine tuberosity or tumor-like formations are found in the walls of the organ. With the combination of adenomyosis and fibroids, the size of the uterus corresponds to the size of fibroids, the organ does not decrease after menstruation, the remaining symptoms of adenomyosis usually remain unchanged.
Diagnosis of adenomyosis
The diagnosis of adenomyosis is made on the basis of history, patient complaints, examination data on the chair and the results of instrumental studies. Gynecological examination carried out on the eve of menstruation.The presence of an enlarged uterus or tuberosities or nodes in the uterus in combination with painful, prolonged, heavy menstruation, pain during intercourse and signs of anemia is the basis for making a preliminary diagnosis of "adenomyosis."
The main diagnostic method is ultrasound. The most accurate results (about 90%) are provided by transvaginal ultrasound scanning, which, like a gynecological examination, is performed on the eve of menstruation. Adenomyosis is evidenced by an increase in the spherical shape of the organ, different wall thickness and cystic formations of more than 3 mm in size, appearing in the wall of the uterus shortly before menstruation. In diffuse adenomyosis, the effectiveness of ultrasound is reduced. The most effective diagnostic method for this form of the disease is hysteroscopy.
Hysteroscopy is also used to exclude other diseases, including uterine fibroids and uterus polyposis, endometrial hyperplasia and malignant neoplasms. In addition, in the process of differential diagnosis of adenomyosis, MRI is used, during which it is possible to detect thickening of the uterine wall, abnormalities in the structure of the myometrium and foci of implantation of the endometrium into the myometrium, as well as to assess the density and structure of the nodes. Instrumental diagnostic methods for adenomyosis are supplemented with laboratory tests (blood and urine tests, hormone tests), allowing to diagnose anemia, inflammation and hormonal imbalance.
Treatment and prognosis for adenomyosis
Treatment of adenomyosis can be conservative, operative or combined. Tactics of treatment is determined based on the form of adenomyosis, the prevalence of the process, the age and state of health of the patient, her desire to preserve the fertility function. Initially, conduct conservative therapy. Patients are prescribed hormones, anti-inflammatory drugs, vitamins, immunomodulators and agents to maintain liver function. They treat anemia. In the presence of neurosis, patients with adenomyosis are referred to psychotherapy, tranquilizers and antidepressants are used.
With the ineffectiveness of conservative therapy, surgical interventions are performed. Operations for adenomyosis can be radical (panhysterectomy, hysterectomy, supravaginal amputation of the uterus) or organ preserving (endocoagulation of endometriosis foci). Indications for endocoagulation in adenomyosis are endometrial hyperplasia, suppuration, the presence of adhesions that prevent the egg from entering the uterus, no effect on hormone treatment for 3 months, and contraindications to hormone therapy. Progressing of adenomyosis in patients over 40 years old, ineffectiveness of conservative therapy and organ-preserving surgical interventions, diffuse adenomyosis of grade 3 or nodular adenomyosis in combination with uterine myoma, the threat of malignancy are considered as indications for removal of the uterus.
If adenomyosis is detected in a woman planning a pregnancy, she is recommended to attempt conception no earlier than six months after undergoing a course of conservative treatment or endocoagulation. During the first trimester, the patient is prescribed gestagens. The question of the need for hormone therapy in the second and third trimester of pregnancy is determined based on the result of a blood test for the content of progesterone. Pregnancy is a physiological menopause, is accompanied by profound changes in hormonal levels and has a positive effect on the course of the disease, reducing the growth rate of heterotopic endometrial cells.
Adenomyosis is a chronic disease with a high likelihood of recurrence. After conducting conservative therapy and organ-preserving surgical interventions during the first year, relapses of adenomyosis are detected in every fifth woman of reproductive age. Within five years, recurrence is observed in more than 70% of patients. In patients with preclimacteric age, the prognosis for adenomyosis is more favorable, which is due to the gradual extinction of ovarian function. Recurrence after panhysterectomy is not possible. In the climacteric period, an independent recovery occurs.
Uterus adenomyosis: what is it in simple language?
The inner surface of the uterus covers a layer of cellular tissue called the endometrium. At the beginning of the menstrual cycle, it does not take up much space and consists only of the germ shell. From here the endometrium begins development and growth. During the month, the cell tissue matures and prepares to accept a fertilized egg. If this does not happen, the overgrown endometrium is rejected and leaves the uterus. This phenomenon is called menstruation.
With the normal functioning of the female body, the process is repeated monthly during the reproductive age. When adenomyosis is observed a different picture. The endometrium and muscle tissue of the uterus are separated by a special layer. In the normal course of the cycle, endometrial cells grow only inside the uterine cavity. If this month the pregnancy has not come, the functional layer is removed, leaving behind a germ shell. In adenomyosis, the endometrium penetrates through the dividing tissue of the uterus and grows into the muscle. And it happens not evenly, but at several points.
In those places where cells of another layer invaded the muscle fibers, the uterus responds with thickening of the muscle tissue. This process causes deformation of the reproductive organ. The menstrual cycle is lost, which ultimately affects the ability to conceive a child.
Knowing what uterus adenomyosis is and how this disease is dangerous, let us consider the etiology of this dangerous disease. The reasons that lead to the development of adenomyosis are not fully understood. In modern medicine there are several theories that explain the etiology of this disease.
Thus, the pathological growth of the endothelium can be caused by:
- menstrual disorders,
- genetic predisposition
- metabolic disorders,
- hormonal imbalance, with a sharp change in the concentration of sex hormones (estrogen, prolactin, progesterone, FSH),
- prolonged exposure to the sun under the scorching rays of the sun, excessive enthusiasm for tanning beds, mud baths with their incorrect use,
- age-related changes, as this pathology is in most cases diagnosed in women over 30-45 years old,
- throwing of menstrual blood with endometrial particles into the fallopian tubes, abdominal organs,
Women are at risk after a cesarean section, surgical procedures in the uterus, peritoneum.
Forms, types and degrees of adenomyosis
Morphological forms of the disease are:
The severity of the disease is determined by the depth of penetration of the growing connective tissue (as a rule, this classification is used for the diffuse form of adenomyosis):
- lesion of submucosal organ layer.
- growth to 1 2 in the muscle layer of the uterus.
- penetration into the muscular layer of an organ by more than 1 2.
- lesion of the uterus serosa and involvement of the pelvic organs nearby (ovaries, fallopian tubes, vagina).
Uterus adenomyosis and pregnancy
The pathology of the spread of endometrial cells in reproductive age is common. The consequence of this disease is infertility, which is manifested by the impossibility of conceiving or carrying a child. Sometimes pregnancy does not occur with adenomyosis due to the fact that there is an obstruction of the fallopian tubes, and this does not allow the spermatozoon to connect with the egg cell.
To prevent maternity sickness, before planning a child, it is necessary to get rid of internal endometriosis. The choice of treatment depends on the cause of infertility. To get pregnant with this pathology is often possible after taking contraceptive drugs (Yarin, Janine). Oral contraceptives in the composition contain hormones, leveling the balance of substances in a woman's body. Contraceptives inhibit the work of the ovaries, which, after discontinuation, stimulates their activity.
Treatment of uterine adenomyosis
If uterine adenomyosis occurs, there are two methods of treatment: conservative and operative. Naturally, the method of therapy depends on the degree of adenomyosis. As a rule, the first and second degrees, less often the third, are amenable to conservative treatment, and the fourth is treated only promptly.
First of all, women are prescribed hormonal drugs that artificially create menopause (cessation of menstruation for a certain period). The duration of treatment is from two to four months. At the end of the treatment course, hormone therapy must be continued.
Quite often and widely used in gynecological practice used uterine artery embolization. This method of treatment significantly improves blood circulation in the tissues, which is important with stagnation of blood and energy in the pelvis.
Electrocoagulation is another common treatment for adenomyosis. With this method, the affected areas of the uterus are eliminated.
The radical treatment method includes two main ways:
- Laparoscopy is the most benign. The reproductive organ is not completely removed, but only the affected areas are excised.
- Complete removal of the uterus (hysterectomy), sometimes with appendages.
For the prevention of recurrence of adenomyosis, women can be given hormonal contraceptives, and at 1-2 degrees - as a method of treatment. Many gynecologists recommend special intrauterine devices that reduce pain and normalize menstrual bleeding.
In addition to specific therapy, a fortifying treatment is also necessary. Pain relievers are prescribed to relieve pain, for example, Ibuprofen or Nurofen. Very often, adenomyosis is accompanied by anemia, so it is advisable to undergo a course of treatment with iron. For the maintenance of the body, gynecologists recommend taking vitamins. Some women need sedative (sedative) medications.
At the same time with the treatment of the disease with medical preparations, there are also folk remedies for the elimination of a very unpleasant pathology, but such methods can only be used at the discretion of a specialist. This treatment is based on herbal, medicinal herbs, leech therapy, or compresses with blue clay, because its healing properties have been legendary since ancient times.
This treatment based on decoctions and herbal tinctures, as indicated by numerous reviews, countless of which can be found on women's forums, says that with this treatment hormonal balance and metabolism are improved. And also decreases the number of uterine bleeding, improves the overall condition of the body. However, the treatment of folk remedies is prohibited to use with drugs, especially hormonal.
To prepare medicinal tinctures that are used as a douching you need to take:
On the packaging of herbs should be instructions for the preparation of the decoction. In addition, you must take into account the period of the menstrual cycle, because some herbs can only be used at the beginning, and others at the end.
Adenomyosis is a chronic disease with a high likelihood of recurrence. After conducting conservative therapy and organ-preserving surgical interventions during the first year, relapses of adenomyosis are detected in every fifth woman of reproductive age. Within five years, recurrence is observed in more than 70% of patients.
In patients with preclimacteric age, the prognosis for adenomyosis is more favorable, which is due to the gradual extinction of ovarian function. Recurrence after panhysterectomy is not possible. In the climacteric period, an independent recovery occurs.
What is uterine adenomyosis
Uterine adenomyosis is a special case of endometriosis, a systemic benign disease in which endometrial cells begin to multiply outside the mucous membrane of the uterine cavity. The term "adenomyosis (adenomyosis)" literally means glandular degeneration of muscle tissue ("adeno" - gland, "myo" - muscle tissue, the suffix "oz" - degenerative changes).
Under normal conditions, endometrial cells, according to their name, are located exclusively in the inner layer of the uterus - the endometrium. When they spread beyond the uterus, a pathological condition arises - endometriosis.
Until now, there is no consensus on the causes and mechanisms of development of endometriosis. There are several hypotheses etiopathogenetic variants of the disease. However, none of them separately explains the whole essence of the pathological processes occurring in endometriosis of the uterus.
In fact, the main, leading cause of adenomyosis is the hormonal imbalance. This factor is primary and underlies the pathogenesis of this pathology.
- surgeries like cesarean section, curettage, removal of fibroids, etc.
- age changes. This pathology in most cases is diagnosed in women after 30-45 years,
- genetic predisposition
- excessively frequent visits to the solarium, constant exposure to the sun without protection,
Uterus adenomyosis can be diagnosed in young women who have never experienced such manipulations. In this group of patients, the disease develops due to congenital abnormalities or insufficient opening of the neck during menstruation.
In addition to the above points, you should pay attention to the fact that any uterine surgery or curettage significantly increase the risk of adenomyosis. First of all, these include abortions, mechanical injuries, medical intervention after a miscarriage, etc.
Symptoms and photo adenomyosis of the uterus
Now you know what this disease is, but the worst thing in uterine adenomyosis is mostly asymptomatic. The first symptoms may appear already at the third stage, at which conservative treatment is already difficult.
In the photo you can see uterine adenomyosis
The most typical symptoms of adenomyosis are symptoms and signs such as:
- pelvic pain before menstruation, during it, and a few days later,
- dark brown discharge from the genital tract for some time before and after menstruation,
- various violations of the menstrual cycle (as a rule, its reduction),
- change in the size and shape of the uterus (this symptom is established during a special examination),
- pain during intercourse.
- deterioration of the general condition, frequent headaches, migraines, decreased performance, apathy, depression, sharp changes in mood, decreased performance.
Adenomyosis of the uterus is largely characteristic of the asymptomatic course of the pathological process, which can last for many years and even decades.
Forms of the disease
The following forms of uterine adenomyosis are distinguished:
- ovarian dysfunction,
- stomach ulcer,
- cirrhosis of the liver,
- thyroid cancer
The main feature of the nodular form is a violation of the menstrual cycle. The cycle becomes shorter, and menstruation is more abundant and longer due to the appearance of spotting in 2-3 days before the beginning of menstruation and within several days after their end.
- pulling pain from the abdomen,
- intense painless menstrual cycle
- the presence of bleeding for several days before and after menstruation.
Adenomyosis: 1, 2, 3, 4 degrees
The power with which these or other symptoms of the disease appear is related to the severity of adenomyosis. The classification of adenomyosis by prevalence is not international, but it is quite convenient and carried out in practice. There are four stages that vary depending on the distribution of the endometrium:
- The proliferation of cells is limited to the inner space of the uterus and does not extend beyond its shell.
- In the second stage, uneven compaction and proliferation of the endometrium are diagnosed in the muscular layer of the organ.
- Third degree: involvement in the process of more than half or all of the muscular wall of the uterus.
- At stage 4, germinating through the serous layer, endometrial tissues migrate beyond the uterus
Before and after menstruation, mucous discharge with a sharp, unpleasant odor can be observed. This suggests that the development of internal endometriosis reaches 2nd or 3rd degree.
The severity of the anomalous process depends on the depth of the lesion. Mild cases of adenomyosis occur in many women. At the same time, the endometrium grows no further than the submucosal layer.
Possible consequences for a woman
Adenomyosis of the uterus has 2 paths of development - favorable and critical. Timely detection and timely treatment of the disease ends for the woman as a whole safely, with preservation of reproductive function and restoration of hormonal levels.
Разрастание эндометрия за пределами внутреннего пространства матки приводит к тому, что слизистая оболочка органа нарушается, становится более тонкой и непрочной. Она не способна принимать и удерживать оплодотворённую яйцеклетку. Если не заниматься лечением, со временем может развиться бесплодие. The disease is the result of hormonal disorders that make it difficult to conceive a child.
That is why it is very important to regularly visit a gynecologist, endometriosis of the uterus body detected at an early stage is successfully treated, after which the onset of pregnancy is quite realistic.
Pregnancy with adenomyosis
Infertility is one of the frequent consequences of having endometrial cells in the muscle layer of the uterus. In some, this is manifested by the impossibility of conception; others cannot bear the child. In some cases, women suffer from obstruction of the fallopian tubes, which prevents the ovum from connecting to the sperm cell.
In a healthy woman in the second phase of the cycle, an increase in the size of the endometrium occurs in anticipation of pregnancy. In the event that fertilization does not occur, then there is a rejection of endometrial cells and their exit to the outside, together with menstruation. In case of adenomyosis, such an exit from the muscle tissue of the uterus does not occur, which causes the appearance of hemorrhage and severe inflammation of the organ.
Can I get pregnant with uterine adenomyosis? Pregnancy with adenomyosis is possible if comprehensive treatment aimed at restoring reproductive function is performed. The effectiveness of therapeutic effects depends on the duration of the disease. If adenomyosis has bothered a woman for no more than 3 years, the result of the treatment is likely to be positive.
Surgical intervention (operation)
- with adenomyosis of 3 and 4 degrees,
- with the combination of adenomazoa with myoma and atypical endometrial hyperplasia,
- with a nodular form (in women with infertility, conservative abdominal surgery is performed),
- with persistent anemia,
- with the ineffectiveness of conservative treatment.
In recent years, in the treatment of adenomyosis, hardware methods have been applied by cauterizing inflammatory foci of the endometrium in the body of the uterus with the help of a laser.
If the patient is not recommended to use conventional hormonal therapy, the question of the medical treatment of adenomyosis is not discussed, surgery becomes the method of choice.
There is no special diet recommended by doctors in the treatment of uterine adenomyosis. Therefore, the best diet will be the exclusion from the diet of fatty and spicy foods, excessive amounts of sweets and pastries. It is better to replace these products with fresh vegetables and fruits, nuts.
Try to include in your diet omega-3 fatty acids, which are involved in many important metabolic processes occurring in the body. Useful fatty acids are found in foods such as:
- Fatty fish and fish oil.
- Walnuts and walnut oil.
- Pumpkin seeds.
- Vegetable oils.
With this disease it is very useful to eat a lot of dark green leafy vegetables.
Collecting herbs for douching №1
To cope with the problem, you can apply douching. For the preparation of a therapeutic composition it is necessary to mix such herbs in equal parts:
- Badana root,
- Oak bark,
Collecting herbs you need to pour boiling water and leave to infuse. Then the composition should be filtered through a double layer of gauze and used for douching.
Collecting herbs №2
It is good to use a collection of mistletoe, peony, lilac, oak bark, calendula, yarrow flowers, celandine and nettle. The crushed dry plants are mixed in the same quantities, filled with hot water, wrapped and left to stand for up to 5 hours. Next, the grass is filtered through gauze folded several times and in a warm form they douche several times a day.
Nettle decoction four times a day. To prepare the drink, pour two teaspoons of the collection with a glass of boiling water, let the medicine stand and cool, then strain and take a couple of tablespoons several times a day. This infusion relieves inflammation and stops severe menstrual bleeding.
- Prevention of uterine adenomyosis mainly comes down to regular visits to the gynecologist. The specialist can correctly interpret these symptoms in a timely manner and prescribe the appropriate treatment.
- Passing the pelvic ultrasound, 1-2 times a year.
- Gynecologists believe that stress and constant fatigue strongly affect women's health and, of course, can lead to the development of adenomyosis. To prevent the onset of the disease, a woman needs to rest more, take a relaxing bath, go to a massage, more often be in a calm and cozy atmosphere.
- Keeping the body clean. Girls who ignore the rules of personal hygiene from an early age are more inclined to the disease of this type. As well as those who in childhood and adolescence have sex.
Respect for one's health is the main way to prevent not only adenomyosis, but also other equally dangerous diseases.
Mechanism of disease development
For some reasons, including hormonal disruptions, endometrial cells of the uterus penetrate into other layers of the organ, and in some cases - spread beyond the anatomical borders of its cavity. Most often, "hit" fall:
- the fallopian tubes,
After leaving the “native” organ, endometrial cells of the uterus continue to live and act in accordance with the established menstrual cycle. The immune system perceives them as foreign, which leads to inflammation in the tissues. Further, on the site of inflammatory processes, degenerative changes begin with a subsequent loss of the functions of the affected organ.
The muscular layer of the uterus is most affected with the formation of glandular formations in it, which leads to deterioration of the structure and functions of the organ itself. That is why the disease is called "adenomyosis" ("adeno" - iron, "myo" - muscle, "oz" - a prefix used to denote destructive changes).
With the help of the classification, doctors can systematize data about diseases, their symptoms and methods of treatment. It helps in communicating information and choosing the proper treatment tactics. On the territory of Russia, it is customary to allocate 4 stages of development of uterine adenomyosis:
- Endometrial cells reach the muscle layer, but do not penetrate it and therefore the changes end under the mucous membrane.
- Degenerative processes begin in the middle of the muscular layer of an organ.
- Changes in the entire uterus, up to its outer shell.
- Endometrial cells spread outside the uterus.
To facilitate the classification, it is customary to divide the cases by the nature of the lesions. In gynecology, they are isolated, as are the stages, four. Consider every detail.
The penetration of the endometrium into the muscles of the uterus is local, focal in nature. Most often, such pathological changes are detected among women entering the period of menopause, as well as at the beginning of it. The age of patients is 40-50 years.
Focal form is characterized by severe treatment, a tendency to relapse, the formation of a fistula between the uterus and nearby organs. Therapy is long, and the prognosis is always cautious.
Endometrium penetrates into the muscle layer and forms multiple nodules filled with brown liquid. This is due to the growth of the glandular layer, producing fluid during menstruation.
In some cases, this form of the disease can be confused with uterine myoma. Therefore, a thorough diagnosis is important: in adenomyosis, the nodules consist of glandular tissue, and in myoma - of muscles. Nodular adenomyosis is most common in women under the age of 25-30.
This is a complex form of the disease in which the endometrium enters the muscular layer along all the walls of the uterus. The localization of the lesions is such that their total area is quite significant. The disease is called complex, because it can not be used for surgical excision of the modified area - because of the diffuse nature of the pathology, life-threatening bleeding can occur.
In most cases, the woman will have to prepare for the fact that the uterus is removed completely. Given that diffuse adenomyosis of the uterus most often develops in young girls, and the loss of the uterus leads to irreversible infertility - few can decide on such a step.
Most often occurs as a diffuse-nodular form. Detected in most clinical cases, characterized by a combination of several types of lesions of the layers of the uterus. Treatment and its effectiveness in this form of pathology depends on many factors, including the localization of degenerative changes.
The main provoking factors
As of 2018, there is no consensus on the causes of adenomyosis. The disease is detected with the same frequency in women of any age. It is known that damage to the uterine mucosa cannot be a provoking factor - the disease is diagnosed and those who have not had surgery on the organ. However, established reasons that can give impetus to this pathology.
There is a relationship between the state of health of a woman and her mother, as well as her grandmother. The risk of developing adenomyosis increases if someone in the family has the following health problems:
- cancer of one of the organs of the reproductive system
This information is important for women. If they are at risk - the only preventive measure will be an annual examination by a gynecologist and passing the necessary examination. Like other diseases, uterine adenomyosis is better treated in the first and second stages of development.
Another factor causing the disease. It has been established that adenomyosis largely depends on the amount of female hormones and their ratio to the number of male hormones. Therefore, the following situations can cause illness:
- early or late onset of menstruation,
- uncontrolled hormonal drugs
- regular intake of hormonal oral contraceptives.
Hence the second measure of prevention - in the event of a deviation in physiological development, you need to constantly monitor your condition at the doctor, and also not to self-medicate and not to get involved in COC protection against pregnancy.
Some diseases can trigger the described changes in the cells of the uterus. Severe health problems include:
- chronic bowel disease,
- excess weight,
Inflammatory processes in the ovaries or in the cervix lead to the formation of scars or adhesions, therefore, they can also cause adenomyosis. Another option is the disruption of the immune system, as a result of which the own cells are attacked and then regenerated.
Also some external influences can cause the disease:
- ultra-violet rays,
- moving from country to country or in different climatic zones,
- excessive physical exertion.
These factors negatively affect the entire female body, including the genitourinary system, so it is possible that they may be responsible for uterine adenomyosis.
If pains occur with adenomyosis - they are quite serious, this is due to the peculiarity of the pathological process. Endometrial cells seem to have a pre-program. Having got into muscles, they expand and make a start from fabrics. This causes inflammation, which in turn provokes tissue swelling. Further, according to the classical scheme - compression of nerve endings and paroxysmal, severe pain.
In adenomyosis, the nature of the painful sensations is diverse. The pain appears:
- during menstruation - 2-3 days before the beginning and after as much after the end, with old age the pain intensifies),
- during intercourse,
- at the act of defecation,
- when urinating,
- in the lower abdomen.
The intensity of the pain is so strong that in many cases painkillers do not help. Especially this problem is relevant for the 3rd and 4th stages of nodular and mixed adenomyosis.
When adenomyosis is characterized by a cycle of causes and consequences. The disease causes a hormonal failure, and it, in turn, prompts a new round of the disease. And where hormonal disorders, there are problems with menstruation. In the case of the described disease, they are characterized by:
- irregularity - it is impossible to make calculations of the beginning of menstruation,
- by pain
- body weakness
- increased gas formation in the intestines.
In some women, 2-3 days before the onset of menstruation, a thick, dirty-brown liquid is released from the vagina, and the menstruation lasts longer (from 7 days). Some women may have bleeding from the genitals between menstruation, or more abundant during it.
Signs of anemia
Since adenomyosis is accompanied by abundant bleeding during menstruation, a decrease in blood volume is not excluded. At the same time, the number of erythrocytes falls, iron deficiency begins, the nutrition of tissues is disturbed. Anemia develops, which is manifested by the following symptoms:
- cracks in the corner of the mouth,
- poor hair and nail condition,
- in severe cases of shortness of breath, tinnitus,
- pallor of skin and mucous membranes.
In the described pathology, anemia is insignificant, therefore such symptoms may be absent. In such a situation, anemia is detected only in laboratory blood tests, which is taken into account in the final diagnosis.
Problems with conception and pregnancy
Irregular menstruation leads to impaired ovulation. This, in turn, is reflected in the ability to conceive. With adenomyosis of the uterus, a woman cannot become pregnant for two years and then she is given a disappointing diagnosis of "infertility."
However, even if the conception by “miracle” happened - there is a risk of abortion. There are also big risks in childbirth - a woman can have serious complications, up to uterine rupture.
Signs of intoxication
Inflammatory processes always cause the presence of decay products in the blood. The situation is aggravated if a woman drinks antibiotics or painkillers on her own. In these cases, signs of intoxication are possible:
- temperature rise up to 38 0 С,
- nausea or vomiting
- faint state
The stronger the inflammatory process in the uterus, the more pronounced symptoms of intoxication it will manifest.
Briefly about the diagnosis
First, the doctor needs to establish what kind of violation in the body takes place. Therefore, diagnostic procedures begin with anamnesis. The doctor asks the woman in great detail about the way of life, previous operations, existing chronic diseases. The information obtained will help to get a clearer idea of the necessary therapy.
After the survey and visual inspection of the genitals, the woman is sent for examination. Depending on the capabilities of the medical institution and the need, the doctor may choose one or several of the following methods:
- Ultrasound of the pelvic organs,
- Hysterosalpingography (GHA),
- Magnetic resonance imaging (MRI),
- Hysteroscopy - examination of the cervix using a special video device,
- Laparoscopy - examination of the uterus with an endoscope
- Biopsy for suspected malignant neoplasms in the organ.
From analyzes it is necessary to donate blood for general analysis and hormonal. The obtained data will help to get a clearer picture of the nature of the inflammatory process, the level of hormones, the level of intoxication. Based on the results of tests and examinations, the doctor selects the optimal therapeutic technique.
Treatment methods for uterine adenomyosis
Doctors do not prescribe traumatic methods of therapy, if there is hope to cure the disease with fewer threats to the body. Therefore, the treatment of adenomyosis begins with the use of drugs, and only when the fourth stage of the disease is detected, surgical intervention may be required. However, in this case, the basis of preparation is the course of certain pharmaceutical agents.
Use of drugs
Various drugs are prescribed for adenomyosis in order to relieve pain, reduce the intensity of the inflammatory process, prevent the spread of pathology to nearby organs and tissues. Especially widely used various drugs when planning pregnancy and in cases of preparation for surgery.
The choice of drugs depends on the course of the disease, the available complications and the general health of the woman. In some cases, the doctor may prescribe it from the agents listed below.
- Capsules "Utrozhestan." Can be used for internal use or for insertion into the vagina. Treatment regimen: 100-150 mg 2 times a day, 10-12 days.
- Solution "Farlutal" in the form of intramuscular injections. The first injection put on the fifth day of menstruation, to prevent conception. Next, the injection is carried out by a course of 100 mg twice a day or 50 mg once a day for six months.
- Norkolut tablets. Use two treatment regimens. The first involves the use of the fifth to the 25th day of the cycle for half a year, 1 tablet per day. The second is 0.5 tablets every 2-3 weeks for half a year.
- "Danazol". Dosage 200-800 mg. The exact treatment regimen is set individually.
- Oral contraceptive "Jess". The exact dosage and duration of admission are determined by the doctor on the basis of data on the hormonal background.
- Tablets "Esmia". 1 pc. (5 mg) per day for no more than 3 months. Beginning of the course from the first week of the menstrual cycle.
- "Wobenzym" in the dosage of 3-10 tablets 3 times a day.
- Indomethacin. Inside 25 mg 2-3 times a day.
- "Longidase". Subcutaneous or intramuscular injections in a dosage of 3000 IU 5-10 injections in a course of up to two weeks. It helps to fight edema in the uterus and the effects of inflammatory processes.
Hormonal drugs are always prescribed under the supervision of a physician. In some cases, hospitalization will be required for timely and constant monitoring of the hormones and the general condition of the body. Self-treatment in this case is unacceptable and may do more harm than good.
This is a relatively gentle method of treatment of adenomyosis, during which the inner lining of the uterus with invading epithelial cells is removed. For these purposes, the current of certain parameters, as well as low temperatures. The technique helps to avoid internal bleeding, while it is possible to keep the uterus in integrity.
There are 4 methods of ablation:
- Electroabolation. A special electrode is introduced into the cervix of a sick woman, to which a current of certain technical parameters is applied, under the influence of which the degenerative parts of the organ mucosa are destroyed.
- Hydrothermal abolation. A hot solution is inserted into the uterus, which removes the mucous membrane.
- Microwave abolation. Into the cervix implant a probe, which is the source of microwave waves, which destroy the pathological focus.
- Cryoablation The endometrium is affected by liquid nitrogen.
Ablation of the endometrium is not without serious flaws. There is a risk of damage to nearby organs. Also, a woman who underwent a similar procedure will never be able to conceive a child. Of the complications can be noted bleeding, in which you need to immediately consult a doctor.
If for some reason minimally invasive methods of treatment of adenomyosis are contraindicated, and drug therapy did not give a positive result, surgical intervention will be required. It is usually carried out at the fourth stage or after a preliminary physiotherapeutic effect on the pathological areas of the uterus.
Indications for surgical treatment of the uterus with adenomyosis are:
- the lack of a positive effect from taking hormones for six months,
- the formation of adhesions - areas of connective tissue between the organs of the reproductive system,
- detection of uterine fibroids (benign neoplasm),
- heavy discharge of blood, the intensity of which drugs do not affect,
- contraindications for hormone therapy,
- potential threat of oncological tumor formation.
The operation can be organ preserving. In this case, only significantly damaged areas of the uterine wall are removed, while retaining most of the organ. The operation is performed using laparoscopic access (through minor punctures on the skin of the abdomen) Therefore, after surgical treatment, the scars are almost imperceptible. Organ-preserving laparoscopic surgery does not affect a woman’s ability to conceive and carry a child.
In severe cases, gastrectomy is performed, that is, complete removal of the uterus. At the same time, the ovaries are either preserved or removed with it. Such an intervention can lead to a loss of femininity, and the ability to bear children also disappears.
The consequence of the operation is post-hysterectomy syndrome. It is manifested by the following problems:
- heart palpitations
- development of edema,
- increased fatigue.
Given this factor, as well as possible psycho-emotional problems, gastrectomy is appointed only in cases where there is a significant threat to the life of a woman.
Is it possible to treat folk remedies
Uterus adenomyosis is often caused by hormonal imbalance, and irreversible degenerative processes occur in the walls of the organ. Therefore, to cure the disease with the help of folk methods will not work - no plant has the ability to repair such disorders in the tissues.
However, in an integrated approach to therapy, it is possible to use some agents that stimulate the immune system, have anti-inflammatory effects and are sources of vitamins. Such therapy will help a woman to more easily tolerate the effects of adenomyosis, reduce the intensity of symptoms, help her recover from surgery on the uterus.
Before starting therapy, it is better to get advice and approval from your doctor. It does not prevent the delivery of allergy tests - some herbal ingredients are strong allergens and can be the cause of serious complications, up to anaphylactic shock. It is also important not to deviate from the traditional treatment regimen, but to use the methods of traditional medicine in combination.
Uterine adenoma is well treated in the early stages. The earlier the therapy is started, the lower the risks of losing the ability to conceive a child, therefore, a woman should pay close attention to the symptoms and not delay in visiting a doctor. This disease does not give in to self-treatment, therefore it is necessary to trust the competent medical specialist.
The uterus is an unpaired hollow muscular organ that looks like an inverted pear. It is located in the middle part of the small pelvis between the bladder in front and the rectum from behind in the anteroposterior direction. Between the uterus and the bladder is the vesical-uterine cavity. Between the posterior surface of the uterus and the rectum, there is a rectal uterine cavity. In an adult woman, the length of the uterus is 7.5 to 8 centimeters, width is 4 to 5 centimeters, thickness is 4 to 6 centimeters, and weight is about 70 grams.
The main function of the uterus is the development of the embryo, the bearing of the fetus and its expulsion during childbirth. Due to its structure during pregnancy, the uterus can increase significantly in size. A powerful muscular layer of the uterus contributes to the expulsion of the fetus during childbirth.
In the uterus are distinguished:
- The bottom of the uterus. It is a convex upper part of the body protruding above the entry point of the fallopian (uterinea) tubes in the uterus. The bottom of the uterus passes into the body of the uterus.
- The body of the uterus. The body of the uterus has the shape of a cone, tapering to the cervix. The junction forms an isthmus - a channel about 1 centimeter long. The upper part of the isthmus is called the anatomical pharynx (internal uterine throat), the lower limit - a histological pharynx.
- The cervix. The cervix is a continuation of the body of the uterus, but is a narrower and more circular part. The cervical canal opens into the vaginal cavity through the uterine opening. In nonpartum women, it has a round or transverse-oval shape. In women who have given birth, in the form of a transverse narrow slit with healed tears.
- Endometrium (mucous membrane). Endometrium consists of two layers - the basal layer (deeper, located directly on the muscle layer of the uterus) and functional layer (located superficially). The average thickness of the basal layer ranges from 0.5 to 2 millimeters, and in some cases from 6 to 7 millimeters. It weakly and non-continuously reacts to the effects of hormones, that is, it is not hormone-dependent. During menstruation, he is not subject to change. The functional layer has a thickness of about 1 millimeter, and in the phase of secretion of the menstrual cycle - 8 millimeters. This layer is hormone-dependent and constantly changing (structure, functionsa) under the influence of sex hormones estrogen. The basal layer serves as a source of restoring the integrity of the surface layer after childbirth, abortion, rejection of the functional layer during menstruation, curettage of the uterus (procedures for curettage, gynecological cleaning with special tools) and others. Coupling base (stromaa) The uterine lining consists of fibrous and cellular structures. It contains blood and lymphatic vessels, as well as piercing tubular glandular structures (structures emitting specific substances of different chemical composition). The glands produce a watery secret (glandular fluid), contributing to the moistening of the inner surface of the uterus.
- Myometrium (muscle shell). Myometrium is the thickest layer of the uterus. The uterine muscularis consists of three layers of smooth muscle bundles. Muscle bundles are separated by layers of connective tissue and elastic fibers. Outer longitudinal layer (subserotica) muscles tightly adhered to the serous membrane (perimetrya) the uterus and contains longitudinally spaced and circular fibers. The middle circular layer is the thickest and most powerful. Muscle fibers are distributed in a circular and oblique direction. The middle layer contains a large number of blood vessels, mainly venous. Therefore, this layer is also called vascular. Internal longitudinal layer (submucous) is the thinnest layer and is located directly below the endometrium. Muscle fibers have a longitudinal arrangement.
- Perimetry (serous membrane). Perimetry is a thin serous membrane, which is a continuation of the serous cover of the bladder. In the area of the uterus, the serous membrane is tightly adherent with its muscle layer. In the area of the isthmus the connection of the serous membrane and myometrium has a loose structure.
Menstrual cycle and endometrial changes
The menstrual cycle is a periodic change in the body of a woman of reproductive age (childbearing age) aimed at the possibility of conception and pregnancy. Maturation and release of the egg from the ovary with subsequent changes in the uterus for future pregnancy. If the pregnancy does not occur, all changes regress and the cycle begins anew.
First menstrual cycle (menarche) appears between the ages of 9 to 15 years. The average age of menarche is 12-14 years. Nine years - early menarche, absence of menstruation after fifteen years - primary amenorrhea (lack of menstruation). At the age of 45 years, there is a decline in the reproductive function of a woman, and by the age of 55 - hormonal function. There comes a menopause - a period of complete cessation of menstruation.
The duration of the menstrual cycle is normally from 21 to 36 days. The most common cycle is 28 days. The duration of the menstrual cycle is considered from the first day of the previous menstrual bleeding to the first day of the next bleeding. The duration of menstrual bleeding varies from 3 to 7 days. The volume of blood loss is normal - about 100 milliliters.
The menstrual cycle is a complex periodic process of changes in the ovaries and uterus, regulated by hormones. The highest regulation is the brain. In the brain, complex processes of information transfer, control and hormone release occur. In the pituitary gland is the release of hormones - gonadotropins, which have a direct effect on the menstrual cycle. These include follitropin (follicle-stimulating hormone - FSH) and lutropin (luteinizing hormone - LH).
Under the influence of follicle-stimulating and luteinizing hormones, the following occurs:
- stimulation of growth and maturation of follicles (structural component of the ovary consisting of an egg surrounded by epithelial cells and connective tissue),
- androgen synthesis (male hormones - the precursors of the female estrogen hormones),
- ovulation (the release of an egg from the ovary into the fallopian tube at rupture of the follicle),
- stimulation of progesterone synthesis (female sex hormone).
In the ovaries are synthesized (stand out):
- Estrogen The main estrogens are estradiol, estrone and estriol. The effect of estrogen on the endometrium is manifested in hypertrophy and hyperplasia of the tissue. Hypertrophy - an increase in tissue mass, caused by an increase in the mass and size of individual cells without changing their number. Hyperplasia - the growth of tissue by increasing the number of cells.
- Progestin The main progestogen is progesterone. The action of gestagen begins after estrogen stimulation. The effect on the endometrium is to suppress proliferation (tissue proliferation by cell division) caused by estrogen.
- Androgens. The main androgens are androstenedione, testosterone in small quantities and others. In low doses, androgens cause an estrogenic effect — an overgrowth of the uterine lining (endometrium). In large doses - anti-estrogenic effect. Anti-estrogenic effect is manifested in the suppression of proliferation (sprawla) endometrium.
The ovarian cycle consists of:
- Follicular phase. The follicular phase begins simultaneously with menstruation and lasts about 14 days. Menstruation is a period (3 -7 daysa) bleeding from the uterus caused by the rejection of the endometrium, to which, in the case of fertilization, an egg cell should have attached. In the follicular phase, the formation of a new follicle begins, in which the egg cell matures. At the same time, the process of updating the endometrium. The follicular phase ends in ovulation, which lasts up to three days. Ovulation is the process of release of a ripe egg cell into the cavity of the fallopian tubes as a result of a ruptured mature follicle. This process is regulated by hormones.
- Luteal Phase. Luteal phase - the gap between ovulation and the onset of menstruation. Its duration is from 11 to 16 days. During this period, estrogen and progesterone are actively produced, which prepare the body for a possible pregnancy. In this phase, premenstrual syndrome often occurs (PMS). PMS is a combination of symptoms associated with changes in hormonal levels and manifested by frequent mood changes, lower abdominal pain, increased appetite, and others.
- The proliferation phase. Corresponds to the follicular phase of the ovarian cycle, occurs under the influence of estrogen. The duration of the proliferation phase is 12-14 days, starting from the 5th day of the menstrual cycle. During this period, formed a new surface (functionala layer of the endometrium.
- Phase secretion. Corresponds to the luteal phase of the ovarian cycle. It is controlled primarily by progesterone. Duration - about 14 days. The greatest activity is observed on days 20-21 of the menstrual cycle. The secretion phase is characterized by changes in the endometrium, aimed at creating favorable conditions for the attachment of a fertilized egg. By the end of the phase (24 - 27 day cycle) in the absence of pregnancy, preparation for the rejection of the functional layer of the endometrium takes place.
- Bleeding phase (menses). It starts from 28 - 2 days of the menstrual cycle. The duration of menstruation - from 3 to 7 days. During this period, the functional layer of the uterine mucosa is rejected, accompanied by bleeding. By the end of the first day, 2/3 of the functional layer is rejected, and complete rejection occurs by the end of 3 days.
- Regeneration Phase (recovery). Starts from 3 - 4 days of the menstrual cycle. During this phase, restoration of the endometrial functional layer from the basal layer cells occurs. On the 4th day of the menstrual cycle, the entire wound surface of the endometrium is epithelized (covered by new epithelial cells). Next comes the proliferation phase.
Age-related changes of the endometrium
Throughout a woman’s life, the reproductive system undergoes significant changes. In adolescence, puberty begins, the first menstruation appears (in the period from 9 to 15 years). Reproductive age (fertile, child-bearing) Is the period of a woman’s life during which she is able to conceive, bear and give birth to a child. The optimal period is considered to be from 20 to 35 years. After 35 years, the function of the reproductive system begins to fade away. Then hormonal function of the ovaries fades away. This is manifested by the cessation of menstruation. The processes of “aging” of the reproductive system are over by the age of 55 with the onset of menopause.
Menopause (climax) Is a transitional period of a woman’s life from the reproductive phase with regular ovulatory menstrual cycles to the complete extinction of hormonal and reproductive functions, manifested by the cessation of menstruation.
In menopause emit:
- Premenopause. Premenopause - the time period of transition from the reproductive period to menopause. In the uterine mucosa appear areas of non-functioning endometrium. Such sites do not respond to the action of hormones. Glandular hyperplasia may occur (increase in tissue or organ by increasing the number of cells).
- Menopause. Menopause - a period of complete cessation of menstruation. Her date is set retrospectively, after a year of complete absence of menstruation. The average age of menopause is 50 years.
- Perimenopause. Perimenopause - the period from the appearance of the first signs of menopause to two years after the last menstruation.
- Postmenopause. Postmenopause - the period from the onset of menopause to 65 - 70 years. As a result of the extinction of ovarian function and a decrease in estrogen secretion, the endometrium is atrophied (depleted, decreasing, losing vitality).
Forms and stages of adenomyosis
The classification helps to streamline and combine all forms, levels and types of myometrial lesions. This helps to describe in detail the pathology in brief, which will be clear to any specialist. Each stage and form in the absence of treatment can move to another stage. Treatment and prognosis can also vary with different stages.
Depending on the depth of destruction of myometrium, adenomyosis is divided into:
- Stage I - endometrial foci grow to the myometrium, limited to the submucosal layer of the uterus,
- Stage II - the pathological process penetrates to the middle of the muscular layer of the uterus,
- Stage III - damage to almost the entire wall of the uterus to the serous membrane (tissue lining the uterus from the side of the abdominal cavity),
- Stage IV - extreme irreversible degree of damage to the entire muscle layer of the uterus with the spread of endometriosis (pathology in which endometrial cells fall outside the limits of the corresponding layer) into the abdominal cavity.
- Nodular adenomyosis. In nodular adenomyosis, the endometrium grows into the muscle layer of the uterus with the formation of nodes. Multiple nodes, dense consistency, filled with menstrual blood or a brownish liquid, surrounded by connective tissue. The content of the nodes is due to the growth of glandular tissue into the myometrium, which normally secretes (highlightsa) fluid in the endometrium in accordance with the menstrual cycle. Nodular adenomyosis is similar in shape to uterine myoma (benign tumor myometrium), which is often the cause of misdiagnosis. The difference lies in the fact that the nodes of adenomyosis consist of glandular tissue, and the nodes of fibroids - from muscle tissue. Nodular adenomyosis is characteristic of young girls of childbearing age.
- Focal adenomyosis. Focal adenomyosis is a local germination of the endometrium in the muscle layer of the uterus. Most characteristic of premenopausal women (the period in which the first signs of menopause begin to appear - the extinction of the function of the female reproductive system) and at the beginning of menopause - 45 - 50 years. Focal adenomyosis is difficult to conservative treatment. Treatment takes a long time, often relapses (the return of the disease after treatment), fistulas may form (pathological channels between organs).
- Diffuse adenomyosis. Pathological growth of the endometrium into the myometrium occurs diffusely in the entire area of the uterus. Diffuse adenomyosis is the most complex form of the disease. This is due to the diffuse location of the lesions in the uterus and the larger area of the lesion. In the case of nodal and focal adenomyosis, surgical removal of the pathological area is possible. This method of treatment is not suitable for diffuse adenomyosis, since a large area of the uterus is subject to removal, which can cause massive bleeding. Often the only way out is complete removal of the uterus. The difficulty lies in the fact that the disease often affects women of young childbearing age and can cause infertility, and the total removal of the uterus completely deprives a woman of the opportunity to have children.
- Diffuse-node. Diffuse-nodular adenomyosis is a combination of two forms of adenomyosis. It is characterized by the appearance of nodes and diffuse adenomyotic lesions of the uterus at the same time. This type of adenomyosis is diagnosed more often than others.
- with asymptomatic disease,
- with classic manifestations of adenomyosis.
Organ-preserving surgical interventions
The principle of organ-preserving surgery consists in excision, cauterization of the lesions with preservation of the organ. The operation is performed by laparoscopic method, that is, using special tools through small incisions in the abdomen. This method does not completely get rid of the disease, but retains the fertility of the woman. Therefore, this type of surgery is indicated for women planning pregnancy.
Indications for organ-sparing surgery are:
- adenomyosis II - III stage with hyperplasia (increasing tissue volume by increasing the number of cellsa) endometrium,
- adhesions of the fallopian tubes,
- the ineffectiveness of conservative treatment,
- the presence of somatic diseases for which long-term hormonal treatment is impossible - diabetes mellitus, epilepsy, severe liver disease and others,
- cysts (pathological cavities with contents) ovaries,
- the desire of a woman to have children in the future
- severe symptoms of adenomyosis,
- young age of the patient,
- purulent processes of the female genital organs.
When surgery is used:
- electrocoagulation - using special electric tools, cauterization is carried out (coagulation) foci of adenomyosis due to exposure to direct electric current,
- laser coagulation - cauterization of foci of adenomyosis under the influence of a surgical laser,
- argon plasma coagulation - the destruction of the tissue when exposed to radio waves, enhanced by an inert gas - argon,
- laser drilling (holmium laser) - the creation of channels in the myometrium that prevent the spread of pathology, suitable for the treatment of diffuse adenomyosis.
In a radical operation, the internal female genital organs are completely removed (uterus and ovaries). This method of treatment allows you to completely eliminate the disease and its spread beyond the uterus. Radical surgery is an extreme method of treatment.
Indications for radical surgical treatment of adenomyosis are:
- disease progression after 40 years
- the ineffectiveness of conservative treatment and organ-sparing surgical treatment,
- adenomyosis of the III degree diffuse-nodular form in combination with uterine myoma (benign tumor of the uterine muscle layer),
- high risk of developing cancer,
- adenomyosis with pronounced symptoms,
- treatment of patients not planning a pregnancy.
Hysterectomy (uterus amputation, uterus extirpation) - This is a surgical removal of the uterus. Depending on the indications, the patient can only remove the uterus with preservation of the ovaries, in other cases, both the uterus and the ovaries are completely removed. The woman is very hard psychologically transfers hysterectomy. This is perceived as a loss of sexuality, femininity. There is a fear of disintegration of the family, a feeling of inferiority. Therefore, such a radical operation should be carried out only if the evidence is sufficiently substantiated.
Depending on the volume of the tissues removed, the following are distinguished:
- subtotal hysterectomy - removal of the uterus with preservation of the cervix, ovaries, fallopian tubes,
- total hysterectomy - removal of the uterus and cervix with preservation of the fallopian tubes and ovaries,
- hysterosalpingoovarectomy - removal of the uterus with ovaries and uterine (fallopian) tubes with preservation of the cervix,
- radical hysterectomy - removal of the uterus, ovaries, fallopian tubes, cervix, upper vagina, lymph nodes and the surrounding pelvic tissue.
- laparotomy hysterectomy (abdominal surgery),
- laparoscopic hysterectomy,
- vaginal hysterectomy (colpogysterectomy).
After removal of the uterus, post-hysterectomy syndrome may occur - a complex of symptoms that arise after uterus removal with preservation of one or two ovaries. The mechanism of development is the violation of the microcirculation of the ovaries and the occurrence of ischemic zones (areas with reduced blood supply). Manifests a syndrome of decreased performance, increased fatigue, lethargy, depression, heart attack, increased pressure, increased sweating, a tendency to edema.
The postoperative period is very important, since if the recommendations of the doctor are observed, the recovery period will be more effective and the risk of complications will decrease.
The main recommendations in the postoperative period are:
- consultation of the gynecologist once a month,
- ultrasound (Ultrasound) once every three months,
- hormonal drugs,
- physiotherapy (therapy using various physical factors - light, water, electric current and other).
Minimally invasive treatment of adenomyosis
Minimally invasive treatment method - treatment that does not imply damage to the integrity of the skin and mucous membranes.
The minimally invasive methods for the treatment of adenomyosis include:
- Ablation of the endometrium. Endometrial ablation is a minimally invasive procedure for removing the inner lining of the uterus (endometrium) under the influence of physical factors - current, high and low temperatures. The procedure is performed under general or regional anesthesia. Ablation of the endometrium can significantly reduce the intensity of uterine bleeding, as well as reduce endometrial hypertrophy and preserve the uterus with myoma. Electrosurgical ablation is used to destroy the endometrium - an electrode is inserted into the cervix through which a weak electric current is passed, destroying the mucous layer. During hydrothermal ablation, hot fluid is injected into the uterine cavity, which cauterizes the endometrium. Cryoablation - the destruction of the endometrium by freezing with liquid nitrogen. With microwave ablation, a thin probe is inserted into the uterine cavity, radiating microwave energy, destroying the inner layer of the uterus. The main serious complications are damage to neighboring organs, perforation of the uterus, inability to become pregnant. The recovery period takes several days. There may be some bleeding after the procedure. In case of increased bleeding and an unpleasant odor, you should immediately consult a doctor.
- FUS - ablation. FUZ - focused ultrasound, ablation - rejection of a part of the tissue under the action of radiation. Thus, FUZ - ablation - is the remote destruction of the foci of adenomyosis with the help of focused ultrasound. The procedure is carried out under the control of magnetic resonance imaging. Passing through the tissue, ultrasonic waves do not damage their integrity. But when they focus, local heating of the tissues to 65 ° C - 85 ° C occurs. This leads to thermal damage to the tissue and impaired blood supply. This effect is called thermal necrosis (death) fabric. The duration of one exposure to a focused ultrasound pulse from 10 to 40 seconds. The duration of the entire procedure is 3-4 hours. The advantages of FUZ - ablation are - carrying out without the use of anesthesia, atraumatic, a short recovery period, the absence of blood loss and postoperative scars, the preservation of reproductive function. This technique is shown when combining uterine fibroids with adenomyosis, nodular and focal forms of adenomyosis.
- EMA (uterine artery embolization). This is a painless, organ-preserving procedure that effectively treats adenomyosis and allows a woman to plan a pregnancy. This method is minimally invasive, safe and has practically no contraindications. The uterine arteries are embolized by the endovascular method, that is, by accessing through the vessel. The method consists in blocking the lumen of the uterus arteries with the help of a special substance (no more than 500 milligrams). As a result, blood flow to the affected uterus or myoma stops (benign tumor myometrium), which leads to the death of tissue or neoplasm due to lack of oxygen and nutrients. The severity of symptoms decreases almost immediately after the procedure. One year after the procedure, the size of myoma nodes decreases 4 times. The advantage of EMA is to be performed under local anesthesia, preservation of reproductive function, short duration of the procedure, quick recovery of the patient, immediate improvement of the condition.
In the treatment of adenomyosis, physiotherapeutic methods are used to eliminate the main symptoms and causes of the disease. Physiotherapy is a complex of medical procedures with the use of physical factors - electric current, heat, light and others. Procedures are performed by a qualified doctor in a specially equipped office. The specialist will select the necessary treatment methods individually for each patient, coordinating the treatment with the obstetrician-gynecologist.
The main physical factors used in the treatment of adenomyosis are:
- Low-frequency impulse currents. These include diadynamic, rectangular, transcutaneous electroneurostimulation. Impulses have anti-inflammatory, analgesic, regenerating effect. At the same time, they do not cause stimulation of estrogen production. Electrophoresis (the introduction of drugs through the skin and mucous membranes under the action of pulsed currents) allows you to enter drugs in small doses. In adenomyosis, iodine is used. It is deposited in the skin for up to 3 weeks and gradually enters the blood. In the area of inflammation, iodine helps to reduce edema, stimulate reparative and regenerative processes, and normalize the balance of hormones. Treatment is prescribed for 5-7 days of menstruation. The effect of therapeutic action lasts for 2-4 months after the procedure.
- Magnetotherapy. The essence of the method lies in the local impact on the body of the electromagnetic field. Used in the postoperative period. It has anti-inflammatory, analgesic, sedative, protective effect. Normalizes microcirculation, reduces tissue swelling and improves metabolism.
- Electromagnetic Optical Oscillation (light) range. The essence of the method lies in the local effects of short-wave ultraviolet radiation (KUF) or laser radiation. Usually used in the early postoperative period in the wound area. Shortwave ultraviolet radiation has a pronounced bactericidal (bacteria killing), wound healing action. Laser radiation has anti-inflammatory, analgesic effect. Helps reduce tissue edema and normalize microcirculation in the wound area. The combined use of ultraviolet and laser radiation contributes to the speedy healing of wounds, prevents the formation of scars, infection and inflammation in the postoperative wound.
- Hydrotherapy. Treatment of adenomyosis is carried out with the help of coniferous, bishofit baths. The action is based on chemical and mechanical irritation of the skin. Such baths eliminate cramps, pain, have a calming effect. The duration of the aftereffect is 3-4 months.
- Balneotherapy (complex of water procedures with mineral, fresh water). Adenomyosis is treated with the use of radon and bromine baths. Radon contributes to a decrease in the level of estrogen and an increase in the level of progesterones, and has an anti-adhesive, sedative effect. The duration of the aftereffect of the procedure is about 6 months. Iodine-bromine baths have anti-inflammatory, analgesic, sedative effect, reduce the level of estrogen. The duration of the aftereffect is 4 months.
- Climatotherapy. The essence of the method is to create certain climatic conditions and avoid certain physical factors. The patient should avoid prolonged exposure to sunlight, the use of therapeutic mud, paraffin, visits to the bath and sauna, massage the lumbosacral area.
- minimum number of contraindications
- physiology (exposure to natural factors),
- no toxicity, adverse reactions,
- painless procedures
- possibility of compatibility with other methods of treatment,
- the duration of the aftereffect
- low cost.
- Adenomyosis I, II, III degree (surgically confirmed). In this case, physiotherapy supplements hormone therapy or is used as the main treatment in the interval between courses of hormonal therapy.The treatment is aimed at eliminating pain, inflammation and adhesions, improving blood circulation in tissues. Apply therapy with pulsed low-frequency currents, iodine electrophoresis, therapeutic baths. The duration and frequency of therapy is determined by the specialist.
- The impossibility of hormone therapy, severe comorbidities. When contraindications for hormone therapy, the appearance of severe side effects, physiotherapy can be the main effective treatment. Apply radon therapy, therapeutic baths and others.
- The young age of the patient. Physical therapy has a positive effect on hormones, allowing you to minimize or completely replace hormone therapy, as well as to avoid or delay the timing of surgical treatment. Conduct electrotherapy, therapy, therapeutic baths. Iodine-bromine baths are indicated for patients with an established menstrual cycle.
- Chronic pelvic pain, menstrual disorders, uterine bleeding, treatment of adhesions and inflammation after surgery. Iodine electrophoresis, balneotherapy, hydrotherapy and others are used. Such procedures reduce spasms, have analgesic, anti-inflammatory effects.
- Prevention of the formation of adhesions, complications in the early postoperative period (in the surgical treatment of adenomyosis). Laser and ultraviolet radiation therapy and magnetic therapy are used. Starting therapy in the first day after surgery. This reduces wound healing time, minimizes medication, and prevents scarring, inflammation, and wound infection.
- all forms of adenomyosis requiring surgical treatment
- III - IV stage of adenomyosis,
- severe psycho-emotional disorders of the patient.
Is adenomyosis treated with folk remedies?
Adenomyosis is a serious disease caused by hormonal imbalances or various lesions of the uterus. A single medicinal herb can not cure adenomyosis, but herbal medicine (herbal therapy) can be very effective in the complex treatment of adenomyosis. It has a positive effect on the general condition of the woman, strengthens the body, helps reduce the inflammatory process. Therefore, folk remedies can be part of adenomyosis therapy or monotherapy (use of only one drug or method in the treatment) after surgery and medical treatment.
Also, the use of medicinal herbs is recommended for patients with adenomyosis who do not require medical or surgical treatment. Medicinal herbs have antiviral, antitumor, anti-inflammatory, antioxidant, hemostatic (stopping bleeding), immunostimulating action. And also have a beneficial effect on the hormones of a woman. Apply medicinal herbs in the form of decoctions, tinctures and locally in the form of tampons and douching. Before starting treatment, it is imperative that you consult with your doctor, undergo necessary examinations and be tested, as incorrect use of herbs can adversely affect your health.
Benefits of Herbal Medicine (herbal therapies) are:
- low cost,
- no side effects and contraindications (individual intolerance is possible),
- tonic and stimulating effect on the body,
- natural composition,
- use during pregnancy and lactation (consult with a physician before use.),
- long period of use.
Clay has unique properties. It contains a huge amount of microelements and macronutrients, nutrients, salts (calcium, potassium, magnesium and others), which beneficially affect the body of a woman. Red, black, green clay can be used for treatment, but blue clay is particularly effective in treating adenomyosis. You can buy clay in a pharmacy in the form of powder. To use the clay should be diluted with warm water to the consistency of thick cream. For the preparation of the mixture using only ceramic or glassware. Heat the mixture in a water bath and apply on the lower abdomen. Then cover the clay with a film and wrap up with a warm blanket. The duration of the procedure is 2 hours. After that, wash off the remains of clay with warm water. The duration of the course depends on the symptoms and degree of damage.
What is the difference between adenomyosis and endometriosis?
Adenomyosis and endometriosis is not the same disease, despite the fact that there is much in common between them. Adenomyosis is considered a form of endometriosis. Endometriosis is a gynecological disease in which cells of the inner layer of the uterus (endometrium) grow beyond it. This is due to the fact that under certain conditions, endometrial cells of the uterus fall into any area of the body (where normally they should not meet), attach there and start sharing. Endometriosis of the uterus, ovaries, fallopian (uterine) tubes, peritoneum, vagina, intestines, skin scar, and even the lungs. Endometriosis of the uterus is called adenomyosis or internal endometriosis. Currently, this pathology is an independent disease and is designated by the term "adenomyosis," and not endometriosis of the uterus.
The differences between adenomyosis and endometriosis are extremely insignificant. The main difference is that endometriosis can affect any organs and tissues outside the uterus. This is due to the proliferation of endometrial cells in the body with blood and lymph, as well as mechanical trauma to the uterus. Adenomyosis affects only the muscular layer of the uterus.
Endometriosis is classified into:
- genital form - female genitals are affected (vagina, fallopian tubes, ovaries, etc.),
- extragenital form - internal organs and tissues are affected (intestines, bladder, postoperative scars and other),
- combined form - simultaneous damage to the genital organs and other internal organs and tissues of the body.
At the stage of distribution are distinguished:
- Stage I endometriosis - the appearance of one or several small foci of endometriosis that do not have a significant effect on the body,
- Stage II endometriosis - the existence of several lesions with the spread of endometriosis deep into the tissues of organs,
- Stage III endometriosis - a combination of several superficial and deep foci of endometriosis, the appearance of cysts, tumors, inflammatory processes,
- Stage IV endometriosis - Numerous deep lesions of internal organs with the appearance of benign and malignant tumors.
The main symptoms of endometriosis are:
- heavy bleeding during menstruation,
- pain at the site of localization of endometriosis (bladder, intestines and others) during exercise and menstruation,
- bleeding of the affected organ or tissue during menstruation,
- painful defecation and urination, painful intercourse,
- inflammatory processes in the center of endometriosis, the appearance of tumors (tumors),
What is dangerous adenomyosis?
Adenomyosis without treatment leads to dangerous complications. Often adenomyosis is asymptomatic. The appearance of symptoms suggests that the disease is progressing. In this case, adenomyosis is more difficult to treat and increases the risk of complications.
Serious complications of adenomyosis include:
- The development of anemia. As a result of regular heavy blood loss during menstruation and intermenstrual bleeding, hemoglobin is lost (red blood cell protein), which includes iron. The main function of hemoglobin is to transport oxygen and saturate tissues with oxygen. If hemoglobin is deficient, the organs suffer from hypoxia (lack of oxygen). Particularly affected are the brain and heart, which have the greatest need for oxygen. The woman has shortness of breath, weakness, dizziness, loss of consciousness, impaired memory, reduced performance.
- Infertility. In severe cases, adenomyosis can lead to infertility. One of the reasons is a violation of the hormonal background of a woman. With an excess of estrogen, ovulation is impaired - the maturation and release of the egg into the fallopian tubes. The menstrual cycle becomes anovulatory. Also in the endometrium phase of secretion does not occur. As a result, the fertilized egg cannot penetrate into the mucous layer of the uterus, that is, there is no implantation. Often adenomyosis is associated with endometriosis of the fallopian tubes. This leads to obstruction of the tube for the egg. Sperm can pass through the fallopian tube. It is dangerous to develop ectopic pregnancy - the development of pregnancy outside the uterus, which requires surgical intervention. If the pregnancy has nevertheless occurred, it can be interrupted by miscarriage due to the lack of progesterone and dysfunction of the muscle layer of the uterus.
- Distribution to neighboring organs. Foci of adenomyosis can spread beyond the muscle layer of the uterus to neighboring organs (intestine, bladder), postoperative scars, nerve bundles. Also, endometrial cells are transported through the body with blood and lymph. This can lead to the defeat of any organ. Around the focus of endometriosis appears inflammation, swelling, hemorrhage, the appearance of scars and adhesions. As a result, the function of the affected organs is disturbed, severe pains occur during menstruation, neurological disorders (in case of nerve fiber damage).
Internal endometriosis - what is it in accessible language?
Internal endometriosis of the uterus is a pathology in which the process of tissue proliferation in the thickness of the muscle walls of the uterus occurs. In gynecology, pathology is called adenomyosis. Pathology can occur for a number of specific reasons. The disease manifests itself in women with unpleasant symptoms that should not be ignored, so as not to aggravate the situation.
Tell what it is, in an accessible language, can be qualified doctors. They argue that it is necessary to pay attention to their health in a timely manner in order to eliminate it in the initial stages of the disease, preventing the development of all possible complications.
Experts note that to date, the causes and mechanisms of the onset of pathology have not been fully determined. With confidence, they talk about one thing - the disease is hormone-dependent, its development is often triggered by impaired functioning of the immune system.
The cause of the disease can be mechanical damage to the uterus, the integrity of its inner layer. Scraping becomes the cause of the development of the inflammatory process, the “protective” layer between the endometrium and the muscles is disturbed. As a result, endometrial cells freely penetrate deep into, continuing the process of cyclic function.
Experts have identified risk factors that increase the possibility of developing pathology:
- genetic predisposition
- early or late onset of menstruation,
- overweight, obesity,
- late onset of sexual activity
- difficult childbirth
- abortion, diagnostic curettage,
- use as a contraceptive vaginal spiral, oral agents,
- diseases of the inflammatory process of the appendages, uterus, bleeding,
- transferred immune, allergic diseases that disrupt the immune system,
- low standard of living
- physically hard work
- constant stress, sedentary lifestyle,
- diseases of the gastrointestinal tract, hypertension,
- state of ecology.
Psychological causes - an important factor in the development of pathology, which can not be discounted. Psychologists conducted research in which they established that the disease often occurs in women who do not want to accept themselves as they are.
The presence of constant frustration in oneself, dissatisfaction with life, a sense of insecurity - adversely affect the state of a woman. One more thing - reproaches from the man, lack of confidence in the chosen one. The inability of a woman to realize herself in life, constant torment about this negatively affect the state of the body.
An important point that increases the chance of developing pathology is the unwillingness to accept one’s sexuality, an internal rejection of motherhood, dictated by fears and doubts. Internal fear of losing a career, not developing a maternal instinct in oneself, fears of hard labor can also be risk factors provoking the development of the disease.
A comprehensive examination should be appointed by a specialist after a woman has treated with pain in the pelvic region, a violation of the menstrual cycle. Diagnosis includes:
- MRI of the uterus,
After the initial examination by a specialist, a woman must undergo a transvaginal ultrasound, the results of which can show the presence of pathology, its stage. Adenomyosis is examined by MRI for more accurate, additional information. Only after a comprehensive examination, the specialist makes a diagnosis, prescribes the necessary therapy.
Forms and degrees of adenomyosis
Internal endometriosis of the first degree, as a rule, is asymptomatic and is detected by chance during routine operations on the ovaries, gastroscopy. The first stage can be characterized by pain during menstruation, but women, most often, consider this condition to be normal. The cycle is not broken. There is no change in the uterus. A woman can become pregnant, bear the child.
Endometriosis 2 degrees is accompanied by menstrual disorders. Pain during menstruation increases. Total blood loss increases slightly. There are bloody discharge a few days before and after menstruation. A woman with this pathology is already faced with the problem of conception.
Adenomyosis and forms of its manifestation have distinctive features. Specialist during the diagnosis takes into account the depth of penetration of endometrial cells into the muscle layers of the uterus. There are 4 stages of pathology.
- Adenomyosis of the uterus 1 degree is characterized by a slight deepening of the lesions of the pathology in the muscle tissue.
- Adenomyosis of the second degree is characterized by the fact that the foci of pathology grow into half of the muscular layer.
- During grade 3 pathology, most of the walls of the uterus or the entire uterus are already involved.
- In grade 4 pathology, foci of adenomyosis germinate through the serous layer and can affect other organs beyond the redistribution of the uterus.
Pathologists 2-4 degrees provokes myometrial hyperplasia, the uterus increases in size. In the process of how the elements of the endometrium penetrate into the muscular layer of the uterus, they begin to grow, but the process does not always occur equally, evenly. Experts identified three forms of pathology:
Focal adenomyosis of the uterus is characterized by uneven growth of endometrial cells. This is reminiscent of islands. Focal form is well diagnosed during hysteroscopy.
The diffuse form of adenomyosis is characterized by a uniform distribution of endometrial cells in the muscle layer. At the same time, no accumulations of cells are observed, they are located throughout the uterus. More often this form can be provoked by curettage, abortion, chronic inflammatory processes, difficult childbirth.
The nodal form of adenomyosis is characterized by the formation of numerous nodes filled with fluid inside, which may resemble chocolate, blood. Pathology can be diagnosed already during the gynecological examination.
Pathology can be mixed. In this case, the specialist discovers signs of two (or more) forms of uterine lesions that are present simultaneously.
You should also know about the presence of 3 stages of disease. The first stage can be completely asymptomatic. On the second, there are violations of the menstrual cycle, increased pain. At a late stage, practically all the organs of the small pelvis are already involved in the development of the disease. Lack of timely, competent therapy can cause organ accretion.
Late, advanced stage of the disease is not always amenable to even operable treatment, may cause a fatal outcome.
Internal endometriosis of the uterus is a pathology during which the body of the uterus, the inner part of its tubes, is affected. The disease is rarely diagnosed on a gynecological examination.To make a diagnosis, an ultrasound scan with a vaginal probe is required, as well as an additional blood test with an appropriate marker.
This pathology can be detected in the vagina, ovaries. Due to the ability of the endometrium to go beyond the uterus, in some cases the disease can affect the bladder, ureter. Endometrial foci can even be found in the intestines. The center of pathology can be detected simultaneously in several places. Adenomyosis that affects the uterus is considered by specialists to be one of the most serious female diseases. Localized in the organ, it often becomes the cause of infertility. Despite the possible latent form of the pathology, it needs competent treatment, which will prevent further negative consequences.
The disease can be treated in several ways. Sometimes there is enough conservative therapy. In some cases, you can not do without surgery. A combined method may also be used.
Signs of internal endometriosis may be hidden, so many women do not even realize that they have already faced a disease that requires timely treatment. In the initial stages, nothing bothers you, but a slight indisposition, heightened pain during menstruation, does not force guard. Experts have identified a number of signs that should be paid special attention:
- pain during menstruation increased, its duration increased,
- smears that appear before and after menstruation,
- recurrent lower abdominal pain, lumbar region,
- painful sensations during intimacy
- general weakness of the body, fatigue, irritability, drowsiness,
- in the late stages of the development of the disease - pain, accompanying the process of defecation, urination. This suggests that endometrial cells have already spread beyond the uterus.
Signs of uterine adenomyosis on ultrasound
Ultrasound can determine the signs of the disease:
- the uterus takes the form of a ball due to the fact that its walls have changed in size,
- the thickness of the walls of the uterus exceeds the norm,
- on ultrasound, you can see cystic inclusions before the onset of menstruation. Their size directly depends on the form, neglect of the disease,
- 2-3 stage of pathology, you can see the heterogeneity of the structure of the uterus,
- it can be seen on the monitor that the uterine body changes shape due to the fact that the mucous layer grows unevenly.
These signs will immediately indicate to an experienced specialist for this ailment. After the diagnosis, therapy will be prescribed.
With the help of magnetic resonance imaging, you can get information about the features of the structure of the myometrium. During the study, you can see that the endometrium of the uterus is heterogeneous - this is one of the signs of the presence of pathology. This will be confirmed by the tightening of the muscle layer, which is viewed on an MRI.
Bleeding with adenomyosis occur quite often, are one of the main signs of illness. As a rule, in 2-3 days before the onset of menstruation, bloody or brown smears begin to appear. The same discharge accompanies the end of menstruation, continuing for a couple of days.
If you ignore the problem of bleeding may appear more often, this is due to the uneven flow of the necessary hormones. Against the background of bleeding, iron deficiency anemia develops, causing general deterioration of the condition. At the initial stage it can be a weakness, in a neglected state regular fainting appears.
Is it necessary to treat adenomyosis
Adenomyosis is not a life-threatening disease, so experts often say that some can do without therapy. Treatment is optional for those who:
- learned about the illness during the examination on another occasion,
- does not feel any symptoms of the disease, or they are so minimal that they do no harm,
- if the symptomatology of the pathology does not appear clearly, and the woman has reached the age of 45-50 years, when menopause most often occurs.
In other cases, therapy is necessary, the specialist will tell about the disease, how to treat it, will give the necessary recommendations.
What is adenomyosis?
Internal endometriosis (adenomyosis) is a disease of the uterus, in which the endometrium, its inner mucosa, grows into other layers of the organ.
Adenomyosis - A special case of endometriosis - a systemic benign disease in which endometrial cells begin to multiply outside the mucous membrane of the uterine cavity.
At the same time, the internal or external genital organs - the uterus, fallopian tubes, ovaries, vagina (genital endometriosis), and other organs and tissues of the body - the gastrointestinal tract, urinary system, lungs, navel, postoperative wounds, etc. (extragenital endometriosis).
Genital endometriosis, in turn, is divided into external (endometriosis of the ovaries and vagina) and internal - endometriosis of the uterus (adenomyosis).
Once outside the uterine mucosa, the endometrial cells continue to function in accordance with the monthly cycle - this causes local inflammation and then degenerative changes, which seriously disrupt the activity of the organ they colonized.
Thus, the term "adenomyosis" literally means glandular degeneration of muscle tissue ("adeno" - gland, "myo" - muscle tissue, the suffix "oz" - degenerative changes). Under the influence of the activity of the endometrial glands that invaded the myometrium of the cells, the muscular layer of the uterus undergoes serious pathological changes, leading to organ degeneration.
The terms "endometriosis of the uterus" and "adenomyosis" are registered in the international histological classification. However, in fairness it should be noted that according to a literal translation, adenomyosis can only be called such a form or degree of endometriosis of the uterus, when serious pathological changes occur in its muscle layer (nodular form of endometriosis of the uterus or diffuse adenomyosis of 2-3 degrees).
What is the danger of adenomyosis (endometriosis)?
Endometriosis is considered benign hyperplasia (pathological proliferation of tissue), since endometrial cells transferred to other organs and tissues retain their genetic structure. However, signs such as the ability to germinate in other organs, the tendency to resettlement throughout the body and resistance to external influences - it is related to malignant tumors.
The word "benign" also refers to the prognosis of the disease - it goes on for years and decades, as a rule, without leading to a severe depletion of the body and death. However, as in the case of malignant hyperplasia (cancer, sarcoma, etc.), adenomyosis (endometriosis) is difficult to conservatively treat, and surgery for this pathology is much more voluminous than in the case of benign tumors, since it is difficult to determine border between diseased and healthy tissue.
The most frequent complication of adenomyosis is due to the fact that endometrial cells functioning in accordance with the monthly cycle lead to heavy bleeding, which is fraught with the development of acute and / or chronic anemia. In some cases, patients have to be hospitalized, and even operated urgently for life-threatening bleeding.
Adenomyosis is prone to spreading the process to other organs and tissues, which leads to systemic lesions. With extragenital arrangement of endometrial cells, a number of complications are possible, requiring emergency medical intervention (intestinal obstruction in the endometriosis of the gastrointestinal tract, hemothorax (filling the pleural cavity with blood) in endometriosis of the lung, etc.).
And finally, another danger of endometriosis in general, and adenomyosis in particular, is the threat of a malignant genetic transformation of the migrated cells. Such a transformation is very real, since any hyperplasia has a more or less pronounced tendency to malignancy, and at the new site endometrial cells are forced to exist in extremely unfavorable conditions.
How many women suffer from adenomyosis?
The prevalence of endometriosis is the third among gynecological diseases (after inflammatory lesions of the appendages and uterine fibroids).
The incidence of endometriosis is about 20-90% (according to various sources). Such a spread of digital data should not cause suspicion. The fact is that many researchers contribute to these numbers and subclinical (asymptomatic) forms of the disease. According to clinical data, asymptomatic endometriosis accounts for up to 45% of all cases of pathology, and is detected in a study of women seeking help due to infertility. Since endometriosis does not lead to infertility in all cases, the number of women with endometriosis can only be guessed at. Hence the inaccuracy of the figures on the prevalence of pathology.
Endometriosis is most common in women of reproductive age, but in some cases it is diagnosed in adolescents, as well as in menopausal women who take hormone replacement therapy. Previously it was thought that the peak of the incidence was in late reproductive age and premenopause, but there were works that disprove this statement.
In recent decades, there has been a marked increase in the incidence of endometriosis. This is explained, on the one hand, by the violation of the immunological status of the population under the influence of many factors (environmental problems, stresses, etc.), and on the other, by the introduction of the latest diagnostic methods that sharply increased the detection of little and asymptomatic forms (laparoscopy, NMR tomography transvaginal ultrasound scan).
What causes the development of adenomyosis?
Unfortunately, the causes and the main mechanisms of development of endometriosis (adenomyosis) are currently not fully understood.
With confidence we can only say that endometriosis is a hormone-dependent disease, the development of which is promoted by impaired activity of the immune system.
Risk factors for adenomyosis include:
- unfavorable heredity in endometriosis, as well as in benign and malignant tumors of the female genitalia,
- too early or late onset of menstruation,
- late onset of sexual activity
- late childbirth,
- complicated childbirth,
- various manipulations on the uterus (abortion, diagnostic curettage),
- use of intrauterine device,
- use of oral contraceptives
- inflammatory diseases of the uterus and appendages, dysfunctional bleeding, especially if there have been surgical interventions or / and long-term hormone therapy,
- the presence of systemic extragenital diseases (hypertension, diseases of the gastrointestinal tract),
- frequent infectious diseases, allergic reactions, indicating a violation of the functions of the immune system,
- low socioeconomic status
- hard physical labor
- stresses, sedentary lifestyle,
- living in an ecologically unfavorable region.
How does adenomyosis occur in conjunction with uterine myoma?
The probability of combining adenomyosis with uterine myoma is very high (up to 85%, according to some authors), which is explained by similar mechanisms of development of these pathologies.
An increase in the uterus in such cases usually corresponds to the size of the fibroids. The size of the organ does not return to normal after menstruation, as is the case with isolated diffuse adenomyosis.
However, the remaining symptoms of adenomyosis when combined with myoma do not undergo pronounced changes. The exception is uterine fibroids with a submucosal arrangement of nodes; in such cases, abundant acyclic uterine bleeding is observed.
The combination of adenomyosis with uterine myoma is poorly amenable to conservative treatment, therefore it is with this combination of pathologies that patients are most often advised to decide on a hysterectomy (removal of the uterus).
Signs of a combination of adenomyosis with ovarian endometriosis
Adenomyosis is often combined with ovarian endometriosis, which is explained by the proliferation of the process from the uterus. Many researchers suggest that the formation of endometrial growths on the ovaries is associated with the throwing of menstrual blood through the fallopian tubes, containing proliferative live endometrial cells.
The prevalence of the process there are four degrees of ovarian endometriosis:
I. Point foci of endometriosis on the surface of the ovary and on the peritoneum, in the recess between the uterus and rectum.
Ii. One-sided endometrial cyst of no more than 6 cm in size, adhesions in the uterine appendages without intestinal involvement.
Iii. Bilateral endometrial cysts up to 6 cm in size, pronounced adhesions with intestinal involvement.
Iv. Large bilateral cysts, the transition process on the bladder and colon, a common adhesive process.
With the spread of endometriosis from the uterus to the ovaries, a whole group of symptoms joins the signs of adenomyosis.
First of all, the pain syndrome is transformed. Unlike adenomyosis, pain has a constant, periodically increasing nature. The maximum increase in pain is characteristic of the onset of menstruation and the period of ovulation (the release of a mature egg from the follicle in the middle of the menstrual cycle). The pains in endometriosis of the ovary are localized in the lower abdomen, in the projection of the uterus, have a aching or pulling character, give to the lumbar region, the sacrum, into the rectum.
For adenomyosis, combined with endometriosis of the ovary, more characteristic pronounced premenstrual syndrome, often accompanied by nausea, vomiting, cold extremities, a sharp decrease in working capacity. In the first days of menstruation, subfebrile condition is possible, a change in laboratory parameters of the complete blood count (an increase in the number of leukocytes and ESR).
With the development of adhesions may cause disruption of the bowel and bladder (constipation, frequent and painful urination).
During clinical examination, palpation of the appendages reveals their increase and tenderness, sometimes it is possible to probe the ovarian endometriosis cysts. Cysts are palpated, as a rule, when the size is more than 6 cm from the side and / or posterior to the uterus, as tumor-like formations of a densely elastic consistency, immobile due to the development of adhesions, sharply painful, especially on the eve and during menstruation.
For accurate diagnosis, the same types of studies are needed as in isolated adenomyosis.
Based on what studies are diagnosed with adenomyosis?
Of paramount importance for the correct diagnosis is the collection of anamnesis with the determination of the existence of risk factors in this patient (unfavorable heredity, operative manipulations on the uterus, certain physical diseases, etc.) and analysis of complaints (abundant and / or prolonged menstruation accompanied by pronounced pain, pain during intercourse, symptoms of anemia).
Then the doctor performs a physical examination (examination on the gynecological chair), during which, in the case of adenomyosis, a spherical uterus enlargement corresponding to 8-10 weeks of pregnancy (rarely more) is usually detected. Inspection is best carried out on the eve of menstruation, because at this time an increase in the uterus is most noticeable. When the nodular form of adenomyosis is often possible to probe the nodes or tuberosity of the uterus.
As a rule, careful collection of anamnesis with analysis of the obtained data, supplemented by physical examination, makes it possible to correctly make a preliminary diagnosis of internal endometriosis of the uterus (adenomyosis).
To clarify the diagnosis, in particular to determine the localization and extent of the process, additional instrumental studies are carried out to resolve the issue of further tactics of treatment of the patient.
The gold standard of the study for suspected adenomyosis is an ultrasound scan. In addition, such methods as nuclear magnetic resonance, hysterosalpingography and hysteroscopy are often used.
What are the signs of adenomyosis?
Among all types of echography (ultrasound), transvaginal ultrasound scanning is most informative in adenomyosis. The accuracy of diagnosis with this method of examination exceeds 90%.
If adenomyosis is suspected, it is best to perform an echography on the eve of menstruation (on the 23-25th days of the cycle).
Over the long years of development of ultrasound diagnostics, the following pathognomical echo signs of internal endometriosis (adenomyosis) of the uterus have become generally recognized:
1. An increase in the anteroposterior size of the uterus, with the result that the organ acquires a spherical shape.
2. Enlarged uterus up to 6 weeks of pregnancy and more.
3. Asymmetry of wall thickness.
4. The appearance on the eve of menstruation in the muscular layer of the uterus of cystic cavities with dimensions of 3-5 mm and more.
What treatment is prescribed for uterine adenomyosis?
Аденомиоз представляет собой не страдание отдельного органа, а хронически протекающее системное заболевание организма. Therefore, the treatment of pathology requires a purely individual approach, taking into account all the mechanisms of the onset and development of the disease in a particular patient.
Thus, when choosing a method of therapy, many factors are taken into account, first of all:
- the patient's age, and her desire to have children in the future,
- localization and prevalence of the pathological process,
- the severity of the clinical picture and the risk of complications,
- the general condition of the body (the presence of concomitant diseases, the state of the immune system, etc.),
- duration of adenomyosis.
All medical measures to combat adenomyosis can be classified as follows:
- radical (removal of the uterus and ovaries),
- organ preserving (laparoscopy and excision of endometroid foci).
Ii. Conservative treatment:
- hormone therapy
- non-specific anti-inflammatory therapy,
- sedatives (sedatives),
- vitamin therapy,
- maintaining liver function,
- elimination of anemia
- absorbable therapy
Iii. Combined treatment.
The general algorithm for the treatment of patients with adenomyosis is the following: first of all, conservative treatment is prescribed, and if it is ineffective, or if there are contraindications to the use of hormonal drugs, they turn to surgical methods of treatment.
In recent years, organ-preserving endoscopic operations have been successfully used to treat patients of reproductive age. The main indications for their conduct are:
- adenomyosis in combination with endometrial hyperplasia,
- functioning endometrial ovarian cysts (more than 5 cm in diameter),
- suppuration of uterus appendages affected by endometriosis,
- adhesions in the ampulla of the fallopian tubes (the main cause of infertility in endometriosis),
- the ineffectiveness of hormone therapy (there is no positive dynamics in the treatment of hormonal drugs for more than 3 months),
- the presence of somatic diseases, which are contraindications to long-term hormonal therapy (varicose veins and thrombophlebitis, severe liver disease, migraine, depressive states, epilepsy, cerebral circulation disorders, obesity, diabetes, hypertension, etc.).
Organ-preserving operations are not a radical method of treatment, since it is impossible to isolate all the foci of endometriosis, however, they are the method of choice for women who want to restore and / or maintain fertility.
Radical surgery with removal of the uterus and / or ovaries is performed if the following indications are present:
- progressive course of the disease in women older than 40 years
- lack of effect from the combined treatment with carrying out organ-preserving operations,
- a combination of a nodular form of adenomyosis or diffuse adenomyosis of grade 3 with uterine myoma,
- the threat of malignant transformation.
Is it possible to cure adenomyosis?
Adenomyosis - a disease with a chronically relapsing course. Relapse statistics after successful non-radical treatment (conservative therapy, organ-preserving operations) is about 20% per year. After five years, the number of relapses reaches 74%.
The longest effect is observed with the combined use of surgical (organ-sparing operations) and conservative (hormonal therapy) methods of treatment of adenomyosis, but in most cases relapses are nevertheless unavoidable.
The prognosis of premenopausal women is somewhat better, because with the physiological extinction of ovarian function, the process activity subsides.
In patients undergoing radical surgery (removal of the uterus and ovaries), the process does not resume.
Uterine adenomyosis - symptoms and signs
Let us consider in more detail the symptoms of the disease that occur in the overwhelming majority of all clinical cases of adenomyosis. It should be noted that the complexity of the pathological process can vary widely in a particular patient, thereby causing various kinds of symptoms and signs, which can manifest themselves differently.
Adenomyosis of the first degree, with its mild form, may not give any symptoms at all. The clinical picture often begins to manifest itself from the second degree, when endometrial germination occurs more deeply and a diffuse or diffuse-nodular form of the disease develops.
With regard to age, with non-congenital ademiosis, the clinical picture develops more actively in women older than 30 years of age, up to menopause. In younger patients, the disease occurs, but much less.
The main signs of diffuse adenomyosis and its other forms:
- Chronic persistent pelvic pain. It is found in 77% of all clinical cases of the disease.
- Too much menstrual bleeding - menorrhagia (40-60%). It is more common in women with deeper adenomyosis - with diffuse and diffuse-nodular form. Blood loss can be so significant as to cause anemia, as well as indirect symptoms of fatigue and dizziness.
- Abnormal uterine bleeding (50%). Patients do not observe discharge in the menstrual period.
- Painful spasmodic menstruation - dysmenorrhea (15-30%).
- Soreness during vaginal intercourse (7%).
- The feeling of "feeling" of the uterus.
- Pressure on the bladder and, accordingly, frequent urination.
- Reflective pain in the groin and hips.
- Enlarged uterus (30%), which in turn can lead to symptoms of pelvic fullness.
- Hypersensitivity in the uterus.
- Infertility or subfertility (11-12%). In addition, adenomyosis is associated with an increase in the frequency of preterm labor and premature rupture of the placenta.
It is worth emphasizing that patients with adenomyosis often suffer from comorbidities that aggravate the above symptoms and signs of adenomyosis, including:
- Uterine fibroids (50%).
- Endometriosis (11%).
- Polyp endometrium (7%).
Bleeding in adenomyosis
Abnormal discharge is one of the main signs of adenomyosis, which are often the cause of the initial visit to a gynecological clinic. Patients pay attention to the following changes in their menstrual status:
- Increased cyclic blood volume.
- Too early onset of menses.
- The extension of the period of monthly - more than 7 days.
- The appearance of pain during menstruation.
- In the menstrual blood detect clots.
- A couple of days before the menstrual period and the same after — you can find dark brown, smearing stains, often an unpleasant odor, on a hygienic tool.
- The appearance of acyclic secretions.
- Patients often experience severe premenstrual syndrome.
Increased bleeding in adenomyosis due to the release into the lumen of the uterus blood accumulated in adenomyomes, mainly in the diffuse-nodular form of the disease. Before and during menstruation, when the physiological cleansing of the uterus begins, its walls contract more actively, which squeezes out the accumulated blood.
Pain in adenomyosis
Hypersensitivity and soreness is another characteristic sign of adenomyosis. As mentioned above, the pains in adenomyosis appear 2-3 days before the beginning of menstruation and 2-3 days later. The severity of pain depends on the shape and degree of adenomyosis, as well as the localization of pathological changes in the uterus wall. Very severe painful sensations arise in the case of the development of endometriotic tissue in the area of the isthmus when the diffuse and diffuse-nodular form of the disease is neglected. The situation becomes even harder tolerated by patients if adhesions have formed in the uterus, which violate the normal anatomical structure of the organ.
Often, pain is transmitted to the groin, thighs and perineum. As a rule, this phenomenon is observed in the third and fourth degrees of the disease. In addition, pain can significantly increase during intercourse, as well as immediately before the onset of menstruation.
Adenomyosis and pregnancy
Reduced or complete lack of fertility - the scourge of the last degrees and severe, non-treated forms of adenomyosis. Reducing the tone of the uterus, splicing its tubes, spilled inflammatory processes and other pathological conditions prevent the passage of the egg and the attachment of the embryo to the endometrial wall. In addition, with this disease is extremely high probability of miscarriage. Such a condition requires clarifying diagnosis using ultrasound or MRI.
Indirect signs of adenomyosis
Abundant blood loss can lead to iron deficiency anemia, which in turn will entail such indirect signs and symptoms of adenomyosis, such as general weakness, increased sleepiness, shortness of breath, pallor, cold sweat, as well as conditions caused by decreased immunity, such as frequent colds, dizziness and even fainting. Persistent pain in adenomyosis is often the cause of neurosis and reduced resistance to the effects of various kinds of stress.
We hope that we have covered the topic: signs of adenomyosis of the uterus and what this is all about. As noted at the very beginning of the article - if you have questions - you can ask them in the comments below. We will also be very happy if you share your experience in treating ademiosis - the information will certainly be interesting to other patients. Take care of your health!
What determines the choice of treatment method
The choice of pathology therapy depends on several factors:
- the age of the patient
- duration of illness,
- the presence of symptoms, complications,
- the desire of a woman to realize reproductive function,
- the presence or absence of other gynecological pathologies,
- results of previous therapy
- general state of health of all organs and systems.
After analyzing all the factors, the specialist selects the most appropriate treatment method.
Treating adenomyosis with hormonal drugs is a common, effective practice. The result of therapy will not be earlier than 3-6 months after its start. Preparations prescribed by the doctor, self-treatment is strictly prohibited. The goal of treatment is to balance hormones, stabilize the condition.
The most commonly used hormonal agents can be distinguished:
- Novaring vaginal ring is widely used for pathology therapy. Its advantage is that it locally delivers the missing hormones into the woman’s body. It is introduced once a month, it is convenient and practical, the woman will not be afraid that she forgot to take the drugs on time. It has virtually no side effects.
- Norkolut appointed to regulate hormonal activity. The active ingredients of the drug have anti-estrogenic effect. The course of therapy can be up to 6 months. The drug is taken according to the scheme prescribed by the doctor, change the dosage, cancel it yourself is strictly prohibited.
- Mastodion is part of the prescribed therapy for the treatment of disease. Its main function is the relief of premenstrual syndrome, the stabilization of menstruation in case of their violation. Dosage, duration of the course prescribed by a doctor.
- Detytsiklen refers to low-dose oral contraceptives, is assigned to even out the hormones, improve the overall condition of the body. It stabilizes the menstrual cycle, removes the pain during this period. The duration of therapy is prescribed individually.
Hormone therapy shows a good result, but only if the diagnosis is made correctly, the patient fulfills all the recommendations of the doctor. Self-treatment, refusal of therapy will not allow to achieve the desired stabilization of the state.
Treatment of uterine adenomyosis with folk remedies can act as an additional therapy to medications. It should be remembered that some methods of alternative medicine are potentially dangerous to health, they can provoke a deterioration of the condition.
Treat folk remedies pathology better after consulting a doctor. He will indicate which methods will be most effective, which herbs can be selected. Herbal medicine should be carried out very carefully. Some plants contain phytoestrogens, which can lead to increased estrogenic activity. It should be remembered that the disease excludes the conduct of thermal procedures.
When using traditional medicine methods, the ailment is not completely cured, but most of the symptoms are removed, the general condition of the body stabilizes.
Hirudotherapy is carried out after a doctor's prescription and only by a specialist in this field. Leeches help with adenomyosis to speed up the process of recovery, recovery of the body. Those substances that they secrete into the blood of women, improve the absorbability of drugs. They highlight a secret that strengthens the immune system, it is important for those women who have the disease and was provoked by a weakening of the immune system. After a course of hirudotherapy will be improved. Procedures are contraindicated for women with poor blood clotting. If there is heavy bleeding during menstruation, this method may also not work.
Massage as an additional method of therapy can give its result. It has a beneficial effect on the general condition, internal organs. Normalizes blood flow throughout the body, which saves a woman from blood stasis in the uterus.
Adenomyosis is treated by homeopathy. To date, none of the experts have not confirmed or denied its effectiveness. Homeopathy is considered a controversial therapeutic method. Some researchers believe that it can only have a placebo effect, it all depends on the woman's belief in the effectiveness of the procedures.
Reviews of folk treatment
Catherine 34 g, Donetsk
The doctor recommended conservative treatment of the disease to add compresses of clay. It helped to remove pain. I did compresses on the lower abdomen for 10 days. The relief was substantial.
Olga 30 l, Omsk
To speed up the healing process, additionally doused with herbal decoction by prescription. At first she didn’t notice any particular relief, but during the menstruation period the pain was not as strong as before. She was not disappointed in the folk treatment, but used only what the doctor recommended.
Many women do not think about the consequences of the disease, than it is dangerous. Doctors note that delayed treatment or lack of it can be the cause of:
- development of cancer,
- active growth of the endometrium beyond the uterus,
- enhance pain syndrome.
The disease is benign, but if left untreated, it can turn into a huge problem with serious consequences for the woman.
Is it possible to get pregnant
Planning for pregnancy should begin with a thorough medical examination. When a disease is detected, the necessary therapy is prescribed to stabilize the condition. Doctors say that conception is possible after the first relief of the course of the disease.
Another option is contraceptive drugs. After a woman undergoes a course of therapy, her hormone levels return to normal, and after they are canceled, the chances of becoming pregnant become significantly higher. In the process of taking pills, the activity of the ovaries is suppressed, but after cessation of treatment they work much more intensively.
After the treatment of adenomyosis, the chances of a woman to realize reproductive function increase. In order to preserve reproductive health, she should undergo regular check-ups and monitor her condition.
Odds on IVF
The chances of successful IVF in adenomyosis are directly dependent on the stage of the disease, the general condition of the woman. Doctors have clear indications for IVF:
- absence of pregnancy 2 years with active sexual life,
- adhesive process, which is located in the pelvic organs, provoking obstruction of the fallopian tubes,
- lack of ovulation due to illness
- disorders of the immune system that prevent the embryo from consolidating in the uterus.
Preparing for IVF takes place in 2 stages. First, the woman removes the adhesions, foci of nodular endometriosis, if any. At the second stage, the patient takes hormonal drugs, the duration of therapy is determined by the doctor. After that, the procedure itself is carried out. In 30-60% of women, the desired pregnancy occurs.
Alina 32 g, Perm
I was given infertility. IVF made a positive result in 2012 on the first attempt. The whole pregnancy proceeded normally, toxicosis was present only for the first time.
Anna 28 l, Moscow
I was given endometriosis of 3 degrees. After 3 months of active drug treatment, IVF was done. Has become pregnant from the first time. During the pregnancy there were no complications, it was constantly observed by the doctor.
Prediction and lifestyle
Treatment of adenomyosis should be comprehensive, only this will ensure the absence of relapses. Almost all women are faced with the return of the disease after 5-7 years, if all this time ignored the visits to the doctor, did not pay attention to the primary symptoms of the development of pathology.
Women who have menopause or are in the period of premenopause, most often, can forget about the disease. Relapse does not occur. This is due to the fact that the function of the ovaries gradually fades away.
Can it degenerate into cancer?
Rebirth of pathology into cancer is possible. Многие специалисты утверждают, что заболевание существенно повышает риск развития рака шейки матки. Это связано с неконтролируемым разрастанием эндометрия.
A site of adenomyosis located in the uterine muscle layer can develop into cancer. Oncological diseases do not have age, can be diagnosed in young and mature women. Timely examinations, the implementation of the recommendations of the doctor, the correct therapy will be able to protect the woman to some extent.
Can it disappear by itself?
It is not possible for the disease to go on its own - all the doctors are talking about it. A general improvement in condition may occur during menopause. Prior to this, the intensity of the symptoms may decrease, increase. The lack of timely testing and therapy can aggravate the situation. Pathology needs medical treatment and control.
Julia 33g, Sochi
Adenomyosis showed up after the baby was born. A year and a half later, severe pains in the lower abdomen began. The doctor made a diagnosis. I was treated with unconventional methods. After a course of herbal tincture, the pain is gone. A year later, she reappeared, thinking about hirudotherapy.
Antonina 35 l, Moscow
Endometriosis was diagnosed 10 years ago. The doctor warned that the disease is not completely cured. Saw contraceptive Janine. Three years ago, gave birth. The pregnancy was hard, now I'm drinking again Jeanine. Everything is normal, no pain.
Endometriosis is a serious disease, often occurring in a latent form. A woman’s desire to protect herself is only in regular gynecological examinations, tests. Pathology carries a threat to the reproductive function. The implementation of the recommendations of the doctor, careful attitude towards yourself is the only way to health.
It is known that in order to prescribe an effective treatment of any disease, it is necessary to establish the cause, location, intensity, extent, form of the disease or pathological process. To do this, patients are prescribed a comprehensive diagnosis, a number of clinical studies and tests. The complex of diagnostic measures includes:
- Sampling of smears for checking the degree of acidity, cytological analysis.
- Colposcopy is a study of the state of the cervix.
- Ultrasound diagnosis of the pelvic organs.
- Transvaginal echography. Echo indications of adenomyosis: basal layer serration, asymmetric induration of the uterine wall.
- Hysteroscopy. When conducting a visual inspection on the outer surface of the endometrium clearly marked endometrial moves, change the color of the uterus, the presence of dark brown areas.
- Conducting comprehensive clinical studies of internal organs and body systems (respiratory, cardiovascular, urogenital, endocrine).
- Bimanual gynecological examination, through which you can determine the size, position, shape of the uterus, the presence of pathological tumors, painful areas, the localization of inflammatory processes.
- Endometrial biopsy.
Treatment of uterine adenomyosis is prescribed only after undergoing a comprehensive diagnosis. It is based on the use of drugs (conservative treatment), surgical intervention, as well as using folk remedies.
📌 As a rule, if you go to the clinic in time and establish a diagnosis, the first and second degrees are amenable to conservative treatment, and the third and fourth require surgical intervention.
In the treatment of drugs, patients are prescribed hormone therapy, the action of which is aimed at the temporary cessation of the menstrual cycle (artificial menopause). The duration of treatment with hormonal drugs is three to four months.
Full normalization of the menstrual cycle occurs five to six months after discontinuation of drugs. To improve blood circulation in the tissues of the uterus, to eliminate congestion in the pelvic organs, use the method of embolization of the uterine arteries.
To eliminate the affected areas using the method of electrocoagulation and ablation. The ablation method is used only if the structures of the endometrium have not penetrated the muscle tissue of the uterus. Ablation causes destruction of the inner layer of the uterus.
Drug treatment methods are aimed at improving the immune systems, increasing the body's resistance. With strong, frequent pain, doctors prescribe nonsteroidal drugs that have anti-inflammatory effects. Immunomodulators and other symptomatic drugs are prescribed simultaneously with hormone therapy.
Can adenomyosis be completely cured and can it go on its own without treatment?
Adenomyosis is a chronic disease with relapses (the return of the disease after treatment and the disappearance of symptoms). In the treatment of adenomyosis, the conservative method is used (medicamentous), physiotherapy, herbal medicine, radical (complete removal of the internal genital organs) and non-radical (organ preservinga) surgery. The treatment is aimed at improving the general condition of the woman, eliminating the symptoms, the possibility of becoming pregnant, preventing the spread of foci of adenomyosis. With this therapy, it is impossible to completely cure adenomyosis. Some time after the symptoms disappear and the apparent cure the disease returns. During the first year - in 20% of cases, within five years - in 75% of cases.
The longest effect is observed with the combined treatment - organ-sparing surgery in combination with hormone therapy. Good results are achieved also by drug treatment, but only in cases of adenomyosis of I and II degree with mild symptoms.
The only method for the complete cure of adenomyosis is a radical operation in which the internal genitals of a woman are removed. This method of treatment is suitable for women who are not planning a pregnancy, menopausal women and concomitant myoma (benign tumor myometrium) uterus.
Adenomyosis can not go away without proper treatment. Improvement of the general condition of the woman is observed with the onset of menopause. During this period, there is a decline in ovarian function and a decrease in the level of estrogen responsible for endometrial hypertrophy. In case of accidentally detected adenomyosis without symptoms and complications, treatment is not carried out.