Important nuances: how diffuse adenomyosis manifests itself and whether it needs to be treated. Adenomyosis of the uterus - what is it? Symptoms, causes and treatment

Adenomyosis of the uterus, also known as internal endometriosis, is a disease of the internal mucosa, which is expressed in the penetration and spread of endometrial cells to other layers of the uterus.

The term "adenomyosis" is used to refer to the processes of glandular degeneration in the muscular tissue of the uterus. By their nature, such processes are benign.

With this disease, endometrial cells acquire a new localization in the external and internal genital organs, in the uterus, fallopian tubes, ovaries, or appear in other tissues and organs: in the urinary system, gastrointestinal tract, navel, etc.

Adenomyosis of the uterus begins to affect the cellular myometrium, which provokes the development of all sorts of pathologies in the muscle tissues of the uterus. This can become a trigger for the start of the degradation of the uterus.

Endometrial cells that have spread outside the uterine mucosa continue to function according to the usual monthly cycle, which causes local inflammation, and subsequently leads to significant disruption of the affected organ.

ICD-10 code

D26 Other benign neoplasms of uterus

N85.1 Adenomatous hyperplasia of endometrium

Causes of adenomyosis of the uterus

The causes of uterine adenomyosis are not fully understood to date. Just as it is impossible to say with absolute certainty what are the mechanisms of its occurrence and progress of the pathological process.

Specialists in the field of gynecology are unanimous only in the fact that this disease is dependent on hormones. Based on this, it is stated that its occurrence is caused by immunological reasons.

There are a number of factors that increase the likelihood of developing adenomyosis.

At risk are primarily women with a hereditary predisposition to adenomyosis.

If menstruation began at a very early age, or vice versa, too late, this can become a certain prerequisite for the appearance of this pathological process.

Adenomyosis can develop in a woman against the background of obesity. The more the body mass index exceeds the norm, the higher the likelihood of this disease.

Risk factors include too early or too late onset of sexual activity.

The causes of uterine adenomyosis also lie in late childbirth and postpartum complications.

Adenomyosis can be caused by the consequences of gynecological manipulations. Such as abortion, curettage for diagnostic purposes, or the use of contraceptives, both mechanical - placement of a spiral in the uterus, and oral contraceptives.

Symptoms of adenomyosis of the uterus

Symptoms of adenomyosis of the uterus are manifested primarily in the form of heavy and prolonged bleeding during the monthly cycle. This is the main symptom peculiar exclusively to this disease.

Large volumes of blood loss over a long period of time leads, in turn, to the fact that secondary anemia of the iron deficiency type begins to develop against their background.

Its presence is determined by a decrease in body tone and performance, excessive drowsiness, and frequent dizziness. There is a painful pallor of the skin and mucous membranes, the body's resistance to infectious diseases decreases.

Adenomyosis of the uterus is characterized by specific secretions that appear a few days earlier before menstruation and a few days after it ends. A frequent case is the form of the disease that provokes metrorrhagia, that is, the appearance in the middle of the menstrual cycle of bleeding from the uterus.

Symptoms of adenomyosis of the uterus, depending on the type and characteristics of the process of its course, have varying degrees of severity.

So diffuse adenomyosis of the uterus of the 1st degree is distinguished by the almost complete absence of obvious symptoms. The 2nd and 3rd degrees of it are determined based on the size of the nodes of the neoplasms, as well as on the degree of distribution.

Pain in adenomyosis of the uterus

Pain in uterine adenomyosis appears as a pain syndrome of algomenorrhea or dysmenorrhea that occurs before menstruation and lasts for several days, after which it disappears.

The degree of intensity and severity of pain symptoms is determined by the specific location in which the process of development of this pathology takes place. Pain is manifested with great force in cases where the cervix is ​​affected, and in addition, they are concomitant manifestations of the progress of the spread of adenomyosis, associated with the formation of adhesions.

When the pathological process of formation of an additional uterine horn becomes the cause of adenomyosis, its symptoms resemble the manifestations of severe pain in the lower abdominal cavity of women, the so-called acute abdomen. This is caused by the penetration of menstrual blood into the uterine cavity.

The pain phenomena at the same time have similarity of the symptomatology inherent in peritonitis.

Pain in uterine adenomyosis, depending on their location, may indicate in the diagnosis the presence of pathology development processes in one or another part of the body. So pain in the groin area indicates that the corresponding corner of the uterus is affected, and if pain symptoms appear in the vagina or in the rectum, this may mean that the cervix is ​​involved in the pathological processes.

Uterine adenomyosis and pregnancy

Many women are concerned about the question of how adenomyosis of the uterus and pregnancy are related, and to what extent the presence of this disease can affect the likelihood of bearing and giving birth to a healthy child.

This pathology is characterized by the activation of processes in the uterus, which lead to the formation of adhesions, which in turn is fraught with infertility.

It also adversely affects the patency of the fallopian tubes, which prevents the possibility of becoming pregnant. Another feature is that the processes of egg maturation can be stopped in the ovaries. Undergo negative changes in the properties of the endometrium of the uterus.

Such pathological phenomena ultimately lead to the impossibility of attaching a fertilized egg to the uterine mucosa.

It should be noted that due to the appearance of hormonal imbalance, the first weeks of pregnancy seem to be especially responsible.

"Adenomyosis of the uterus and pregnancy" - if such a disease is diagnosed, in this case therapy is indicated using progestogens, which can contribute to the onset of pregnancy.

The use of these drugs should be continued further, in order to maintain the necessary hormonal levels. But here you need to carefully monitor the level of progesterone in the blood, on the basis of the indicators of which it is concluded that it is advisable to stop such therapy or stop it.

Is it possible to get pregnant with adenomyosis of the uterus?

Endometrial pathology is a fairly common disease, so for a woman planning a child, it becomes relevant to determine the pros and cons of whether it is possible to become pregnant with uterine adenomyosis.

This diagnosis is not a categorical sentence that puts an end to the possibility of getting pregnant, bearing and giving birth to a healthy child. This does not mean at all that the course of pregnancy will necessarily be accompanied by the appearance of all kinds of complications and pathologies.

An important point that contributes to the elimination of the likelihood of the appearance of all sorts of negative factors is a comprehensive examination of the body and the appropriate treatment based on the results obtained.

Of great importance in the diagnosis is the identification of sexually transmitted infections. The state of pregnancy is characterized by a decrease in the immune-protective functions of the body, and the presence of adenomyosis further weakens the immune system. Based on this, it can be argued that an infection that occurs in a woman's body during pregnancy can cause complications. Therefore, it is necessary to conduct an appropriate therapeutic course before pregnancy occurs, since many drugs are contraindicated in this condition.

Thus, the answer to the question of whether it is possible to become pregnant with uterine adenomyosis is positive to the extent that the appropriate therapeutic measures and the correct course of action are correctly prescribed in connection with such an important period in the life of a woman planning to become a mother.

Adenomyosis of the body of the uterus

Adenomyosis of the body of the uterus, also called endometriosis of the body of the uterus, is a form of this disease, which is characterized by the appearance of heterotopic, abnormally located, pathological foci in the myometrium.

To understand the mechanism of action of this disease, it is necessary to understand the structure of the tissues that make up the uterus. The endometrium is made up of the union of its basal layer with the functional layer. In the basal layer, there are processes responsible for the onset of menstruation and the formation of a functional layer. the latter contains glandular cells that produce a special mucus, and is distinguished by the presence of a large number of terminal branches of small spiral arteries. The functional layer peels off after the end of each monthly cycle. Behind the endometrium, which is the inner lining of the uterus, is the muscular membrane, the myometrium. Thanks to him, due to significant stretching, an increase in the volume of the uterus occurs during pregnancy.

With adenomyosis, which takes place in the body of the uterus, there is a spread of tissues that are essentially identical to the endometrial layer, outside their usual localization in the uterine mucosa.

Adenomyosis of the body of the uterus is characterized by the growth of such neoplasms, primarily among the muscle fibers in the myometrial layer of the uterus.

Adenomyosis of the cervix

Adenomyosis of the cervix, as well as other forms of endometrid lesions, is characterized by the pathological proliferation of mucosal cells in the tissue separating the endometrium and myometrium. Subsequently, the penetration of the endometrium into the muscular membrane of the uterus also occurs.

In a healthy state, in the absence of any pathologies during the monthly cycle, the endometrium grows exclusively into the uterine cavity, in which only its thickening occurs.

You need to pay attention to the next point. The pathological spread of the endometrium in adenomyosis does not occur immediately over the entire inner surface of the mucous membrane, but there is a tendency to the appearance of separate foci of its germination in adjacent tissues. The appearance of endometrial cells in the muscular membrane of the uterus causes a certain response from the myometrium. As a defense mechanism against the subsequent progress of such an invasion, the bundles of muscle tissue around the foreign formation thicken.

Adenomyosis of the cervix occurs as a result of the direction of such a process towards the cervix and is accompanied by all the relevant symptoms and phenomena that arise in connection with the appearance of endometrial lesions in it.

Diffuse adenomyosis of the uterus

The fact that there is such a variety of endometriosis as diffuse adenomyosis of the uterus is evidenced by the fact that blind pockets appear in the endometrium in the uterine cavity, differing in different depths of penetration into its layers. The possibility of fistulas, the localization of which is the pelvic cavity, is also not excluded.

This form of the disease can be provoked by the consequences of various gynecological radical interventions. Diagnostic curettage, repeated abortions, as well as mechanical cleaning during pregnancy failure or after childbirth can lead to it. Risk factors also include the presence of inflammatory processes in the uterus, surgical treatment on the uterus, and postpartum complications.

The pathological process exhibits such features as uniform germination of endometrial cells in the muscular layer of the uterus, without the appearance of scattered lesions.

Due to the significant difficulties in conducting effective therapeutic measures, the probability of a complete cure seems extremely small. Diffuse adenomyosis of the uterus can come to the stage of regression after the onset of menopause in a woman.

The disease is characterized by a significant degree of severity and is fraught with serious complications during pregnancy.

Nodular adenomyosis of the uterus

Nodular adenomyosis of the uterus is a disease in which there is a pathological spread of endometrial tissues in the myometrium of the uterus. As a concomitant phenomenon in the development of this form of adenomyosis and representing its characteristic feature, there is the appearance of nodes in the affected areas.

Such neoplasms appear in large numbers surrounded by connective tissue, have a dense structure and are filled with blood or a brownish liquid.

The liquid content is determined by the mechanism of formation of nodular adenomyosis of the uterus. Modified glands continue to function in accordance with the monthly cycle, as a result of which they produce fluid.

Nodular adenomyosis of the uterus manifests itself in symptoms similar to uterine fibroids. Its difference from the latter is that in this case, the nodes are formed from their glandular tissue, and not from muscle.

Often these two diseases occur together. This is expressed in the fact that the uterus, after the completion of the monthly cycle, does not return to its usual size, but remains enlarged to the extent that the pathological neoplasm of the fibroid has a size.

Focal adenomyosis of the uterus

Focal adenomyosis of the uterus is characterized by the germination of endometrial tissues in the layer of the myometrium of the uterus in the form of scattered clusters - separate foci of the development of pathological processes. These phenomena do not extend to the entire inner surface of the internal cavity of the uterus.

A tendency to the occurrence of such a disease may occur due to a violation of the integrity of the internal mucosa, the endometrium of the uterus during curettage for diagnostic purposes, abortion, and mechanical cleaning in case of a missed pregnancy.

Focal adenomyosis of the uterus is a very serious disease. It is difficult to treat, and the absolute disposal of it and the full restoration of health seems almost impossible. There is a possibility of regression when, at the age when a woman begins to fade sexual functions, with menopause.

For a woman during the period of bearing a child, there is a risk of significant complications and the development of all kinds of pathologies.

Therefore, if painful and heavy menstrual bleeding is detected, and sexual intercourse is accompanied by pain, this is an alarming signal.

Adenomyosis of the uterus 1 degree

Adenomyosis of the uterus of the 1st degree is a stage of endometrial damage to the uterus, in which the initial penetration of the endometrium into the muscle tissue of the uterus occurs. at the 1st degree, it is characterized by germination by approximately one third of the thickness of the myometrium.

After the introduction of individual cells of the functional layer of the endometrium into the myometrium, due to cyclic changes in the level of estrogen, their growth begins.

The factors for the development of this disease are a genetically determined or congenital degree of permeability of the basal layer of the endometrium, as well as an increase in intrauterine pressure, which is caused by the presence of disturbances in the outflow of blood during menstruation.

Adenomyosis of the uterus begins with the appearance of changes in the hormonal background due to an increase in the level of the female sex hormone estrogen in the blood. Estrogen in the first half of the monthly cycle contributes to the active growth of the endometrium. In this case, based on the fact that its amount exceeds the norm, the duration of the period of menstruation increases. Also, with an excess of estrogen, menstrual blood comes out in a much larger amount.

In addition, uterine adenomyosis of the 1st degree and the appearance of endometrial neoplasms in the myometrium are accompanied by disturbances in the immune system.

Adenomyosis of the uterus 2 degrees

Adenomyosis of the uterus of the 2nd degree is characterized by a deeper degree of germination of the endometrium into the muscular layer of the walls of the uterus. In this case, it has a distribution up to half the thickness of the myometrium.

At this stage of the progress of such an endometriotic pathological process, there may be a complete absence of any pronounced symptomatic manifestations. The main signs that may indicate its presence in the body can be an increase in the duration of the menstrual cycle and the appearance of dark brown discharge between periods. It is also possible the appearance of pain symptoms in the lower abdomen, heaviness in the abdomen and discomfort. In some cases, there is an increase in the intensity of pain that occurs during menstruation. As a result of an excessive amount of estrogen, the disease can also be accompanied by autonomic disorders, headache, nausea, vomiting, tachycardia and fever.

Adenomyosis of the uterus of the 2nd degree causes changes in the structure of the inner surface of the uterine cavity. The formation of tubercles takes place, it acquires a greater density, there is a significant decrease in elasticity.

Uterine leiomyoma with adenomyosis

Uterine leiomyoma with adenomyosis is a combination of two diseases, each of which individually belongs to the most common uterine lesions.

They have considerable similarity among themselves in the causes that cause their appearance, and in many cases where leiomyoma occurs, it is accompanied by adenomyosis, and vice versa.

The reasons for the development of each of these gynecological pathologies lie in the hormonal imbalance of the body, disorders in the immune system, and the presence of infectious processes in the chronic stage. Gynecological diseases in advanced form, repeated abortions, and stress factors can also cause their occurrence and progress.

Until recently, uterine leiomyoma with adenomyosis did not provide for other forms of treatment other than surgery to remove the uterus with appendages. However, given that young women of early childbearing age are often at risk for this disease, the expediency of such a drastic measure is in many cases unjustified.

To date, the optimal treatment is the use of minimally invasive surgery methods, such as operations using laparoscopy and hysteroresectoscopy.

Why is adenomyosis of the uterus dangerous?

Based on the fact that, by definition, adenomyosis is characterized by the appearance of tumor formations of a benign nature, the question arises of the severity of this disease, what serious threats does it pose and why is adenomyosis of the uterus dangerous?

Adenomyosis is characterized by the fact that when the endometrium appears in other tissues and organs, the genetic structure of its cells does not undergo any changes. This feature plus the tendency to spread throughout the body, as well as resistance, that is, resistance to external influences - all this makes this disease close in nature to oncology.

The possibility of the onset of malignant cellular transformation at the genome level cannot be discounted.

Cells of the extragenital endometrium are capable of provoking a wide range of complications and pathologies that require immediate medical measures. Among such complications, which is dangerous for adenomyosis of the uterus, it should be noted in particular the likelihood of intestinal obstruction due to endometriosis of the gastrointestinal tract, hemothorax - filling the pleural cavity with blood as a result of lung damage, etc.

Consequences of adenomyosis of the uterus

The consequences of adenomyosis of the uterus can take place in the form of the following phenomena.

Due to the large amount of blood loss, both during the monthly cycle and in connection with pathological processes in adenomyosis, iron deficiency anemia develops. Lack of oxygen causes dizziness, fainting, frequent headaches, memory impairment occurs. There is a general decrease in the vitality of the body and a significant deterioration in performance.

Endometrial damage to the uterus also has as a consequence the germination of cells through the myometrium of the uterus into the serous membrane, and the involvement in the development of the pathological process of organs located in close proximity to the uterus. Such as organs located in the peritoneal cavity, bladder and rectum.

One of the most significant consequences of adenomyosis is the likelihood of infertility, which is caused both by a violation of ovulation and the inability to attach the embryo to the walls of the uterus.

The consequences of uterine adenomyosis are also manifested by such an unfavorable factor as the fact that, in terms of the difficulties associated with the conservative treatment of this disease, it approaches oncological lesions. Pathological endometrium, which grows in other tissues and organs, has a tendency to degenerate into malignant neoplasms.

Diagnosis of adenomyosis of the uterus

Diagnosis of uterine adenomyosis involves, first of all, a gynecological examination of the genital organs, which boils down to examination using mirrors and using a colposcope, an optical device that gives a 30-fold increase in the examination of the cervix. In addition to these visual methods, smears are taken for appropriate laboratory analysis, and the respiratory and circulatory organs, digestive organs and urinary system are examined.

If a woman has certain chronic diseases or body characteristics associated with individual intolerance to certain drugs, additional consultations with relevant specialists are prescribed.

After carrying out such given activities, as a rule, an ultrasound examination of the pelvic organs is also prescribed. Ultrasound is one of the most common diagnostic methods in gynecology. If there are appropriate indications, the diagnosis of uterine adenomyosis is carried out using laparoscopy and hysteroscopy.

It is also possible to analyze the microflora of the vagina to identify all kinds of unfavorable bacteria.

echocardiography of uterine adenomyosis

One of the widely used, as well as the most effective and efficient types of echography in gynecology is a method of transvaginal ultrasound. Diagnostic measures that are carried out using this method provide research results that are distinguished by the maximum degree of accuracy.

The following, agreed and confirmed by a significant number of medical specialists, are the echo signs of uterine adenomyosis.

Adenomyosis of the uterus is manifested in this study by the presence of different thicknesses of the walls of the uterus, with its obvious asymmetry.

The next echo sign, which indicates this endometrial pathology in the female organ, is the spherical shape of the uterus, which it acquires due to an increase in its posterior and anterior dimensions.

The presence of adenomyosis of the uterus is indicated by the echo sign that it differs in significant sizes up to the six-week gestation period, and sometimes more.

Echosigns of uterine adenomyosis also consist in the appearance of cystic formations ranging in size from 3 to 5 millimeters before the onset of menstruation.

Adenomyosis of the uterus on ultrasound

Currently, to detect gynecological diseases, methods of direct examination of tissue fragments from the walls of the uterus, vagina, etc. are used. For this, scrapings, smears are taken, colposcopy and biopsy are performed. Another type of diagnosis is ultrasound.

During ultrasound, it is possible to visually assess the condition of the uterus, as well as the likely detection of structural changes and signs of pathologies.

Thanks to the use of this diagnostic method, it becomes possible to timely detect uterine adenomyosis on ultrasound.

Since the penetration of ultrasonic waves into the uterus is obstructed by the skin-fat layer of the peritoneal cavity, the transvaginal method of such a study is used to achieve diagnostic efficiency. This assumes that the ultrasound probe is inserted directly into the vagina.

The therapeutic method involves using various means of drug treatment to achieve the restoration of the normal functioning of the immune system and lead to the optimum hormonal background of the body. The drugs used for the therapeutic treatment of uterine adenomyosis are prescribed in accordance with the individual characteristics of the woman's body in such proportions that, with their greatest effectiveness, to minimize the likelihood of side effects. Most drugs currently produced have the ability to provide the greatest possible positive therapeutic effect, while the possibility of negative consequences from their use is small. These are mainly gestagens, that is, those that are characterized by the content of hormonal substances. Among their main positive qualities, it should be noted that they contribute to the successful onset of pregnancy.

Treatment with gestagens is carried out using, for example, Duphaston, didrogemterone, which has the form of 10 mg tablets. The duration of the minimum course is 3 months, during which the drug is taken from 2 to 3 times a day, starting on the 5th day and ending on the 25th day of the cycle. The drug can cause a number of side effects, manifested in the form of: increased sensitivity of the mammary glands, breakthrough uterine bleeding, minor liver dysfunction, itching and skin rashes, urticaria, and in rare cases, Quincke's edema and hemolytic anemia.

The drug 17-OPK, which is 17-hydroxyprogesterone capronate, is produced in 12.5% ​​and 25% concentrations in an oil solution placed in 1 ml ampoules. is intended for injection twice a week at a concentration of 500 mg. for one injection. The course of treatment is prescribed lasting from 3 months to six months. At 12-14 weeks of treatment, a pronounced atrophy occurs with the endometrium, and the uterus decreases in size. The use of the drug may be accompanied by headache, drowsiness, apathy, nausea and vomiting; can lead to a deterioration in appetite, a decrease in sexual desire, a decrease in the duration of the menstrual cycle and intermediate bleeding.

Norkolut or NORETHISTERONE tablets 5 mg. should be taken one per day, starting on the 5th day and stopping after the 25th day of the menstrual cycle. the course of treatment is 3-6 months. When calculating the dose, individual drug tolerance and therapeutic efficacy are taken into account. Side effects are reduced to the appearance of headaches, a state of nausea and an urge to vomit, there may be bloody vaginal discharge of an acyclic nature; there is a tendency to increase body weight, skin rash and itching may occur. The use of the drug for a long time can be fraught with thrombosis and thromboembolism.

Treatment of uterine adenomyosis by a surgical operation is performed in order to eliminate as many areas of localization of this pathology in the body as possible. Such an operative intervention is all the more effective than it is performed at an early stage in the development of the pathological process. The likelihood of a hasty cure also depends on the severity of the endometrial lesion.

As medical science develops, various innovative methods are emerging to combat this disease. Today, electrocoagulation is increasingly being used. This method of removing tumor formations can be used under anesthesia, which completely eliminates pain.

Prevention of adenomyosis of the uterus

Prevention of uterine adenomyosis mainly comes down to regular visits to the gynecologist.

A big misconception is the widespread belief that such visits are justified only during pregnancy, or in cases where any alarming signs appear that may raise suspicion of the onset of the disease. It is recommended at least once every six months to come to the doctor for a primary gynecological examination, and the likely detection of pathological changes inherent in uterine adenomyosis.

A specialist can correctly interpret such symptoms in a timely manner and prescribe appropriate treatment.

In addition, the prevention of uterine adenomyosis involves the need for periods of rest, stress relief and the consequences of stressful situations, if a woman notes the appearance of mild pain symptoms in the pelvic area. To do this, after consulting a doctor on this matter, it may be advisable to use all kinds of appropriate sedative drugs, physiotherapy procedures and relaxation massages.

Meaningful and attentive care of a woman about her own health is the best prevention of a large number of gynecological diseases.

Prognosis of adenomyosis of the uterus

Uterine adenomyosis is largely characterized by an asymptomatic course of the pathological process, which can stretch for many years and even decades. This disease may not manifest itself for a long time as a clear cause of a detrimental effect on the body, leading to exhaustion or, in the worst cases, causing its death.

The prognosis of uterine adenomyosis, with regard to the likelihood of all sorts of complications, is determined by the fact that, first of all, due to the large amount of blood loss from uterine bleeding, there is a risk of anemia in acute or chronic form.

At the same time, the progress of the development of the disease has features inherent in oncological pathologies, and, like malignant hyperplasia, cancer, sarcoma, etc., is difficult to treat conservatively.

The prognosis of adenomyosis of the uterus seems to be favorable if, after ascertaining recovery, there are no relapses within a five-year time period. A positive point in this regard is also the fact that during this period there is no resumption of pain in the pelvic region and no other characteristic symptoms are observed.

Video version:

“You have adenomyosis in your uterus” - such a conclusion is often heard by women (especially after 27-30 years) during an ultrasound scan or after examination on a chair. Very rarely, patients are explained in detail what this disease is.

Let's figure it out.

Adenomyosin is sometimes referred to as "intrinsic endometriosis" equating this disease to a type of endometriosis. Most researchers believe that although these diseases are similar, they are still two different pathological conditions.

What is adenomyosis?

Let me remind you that the uterine cavity is lined with a mucous membrane called the endometrium. The endometrium grows during the menstrual cycle, preparing to receive a fertilized egg. If pregnancy does not occur, the surface layer (also called “functional”) is rejected, which is accompanied by bleeding (this process is called menstruation). In the uterine cavity, the growth layer of the endometrium remains, from which the endometrium begins to grow again in the next menstrual cycle.

The endometrium is separated from the muscular layer of the uterus by a special thin layer of tissue that separates these layers. Normally, the endometrium can only grow towards the uterine cavity, simply thickening during the menstrual cycle. With adenomyosis, the following happens: in different places, the endometrium sprouts a dividing tissue (between the endometrium and the muscle) and begins to penetrate into the muscular wall of the uterus.

Important! The endometrium grows into the wall of the uterus not all the way, but only in places. For clarity, I will give an example. You have planted seedlings in a cardboard box, and if you have not transplanted them into the ground for a long time, then individual roots will sprout through the box. This is how the endometrium germinates in the form of separate “roots” that penetrate into the muscular wall of the uterus.

In response to the appearance of endometrial tissue in the uterine muscle, it begins to respond to the invasion. This is manifested by reactive thickening of individual bundles of muscle tissue around the invading endometrium. The muscle, as it were, is trying to limit the further spread of this ingrowth process.
Since the muscle increases in size, then, accordingly, the uterus with adenomyosis begins to increase in size, acquires a spherical shape.

What are the forms of adenomyosis?

In some cases, the implanted endometrial tissue forms foci of its accumulation in the thickness of the muscle, then they say that this is "adenomyosis - a focal form." If there is simply an introduction of the endometrium into the wall of the uterus without the formation of foci, they speak of a "diffuse form" of adenomyosis. Sometimes there is a combination of diffuse and nodular forms of adenomyosis.

It happens that the endometrium, which has invaded the wall of the uterus, forms nodes very similar to the nodes of uterine fibroids. If uterine fibroids, as a rule, are represented by muscle and connective tissue components, then the glandular component and connective tissue predominate in the nodes of adenomyosis. This form of adenomyosis is called "nodular".

Adenomyosis and uterine fibroids

It can be very difficult with ultrasound to distinguish a uterine fibroid node from a nodular form of adenomyosis. In addition, it is believed that endometrial tissue can be introduced into already existing myomatous nodes. Quite often, you can see a combination of adenomyosis and uterine fibroids. For example, against the background of diffuse adenomyosis, there are nodes of uterine fibroids.

It is very important as a result of the diagnosis to make the correct diagnosis and clearly determine what exactly is present in the uterus - uterine fibroids or adenomyosis - a nodular form. The treatment of uterine fibroids and adenomyosis is virtually the same, but the effectiveness is different, and this will affect the prognosis of treatment.

What causes adenomyosis?

The exact cause of the formation of adenomyosis is still not known. It is assumed that all factors that violate the barrier between the endometrium and the muscular layer of the uterus can lead to the development of adenomyosis.

What exactly:

• Curettage and abortion
• C-section
• Removal of uterine fibroids (especially with opening of the uterine cavity)
• Inflammation of the uterus (endometritis)
• Other operations on the uterus

At the same time, but very rarely, adenomyosis is found in women who have never endured the interventions and diseases described above, as well as in young adolescent girls who have only recently begun menstruation.

In these rare cases, two reasons are suggested.

First reason associated with the occurrence of disorders during the fetal development of the girl, and the endometrium without any external factors is introduced into the wall of the uterus.

The second reason due to the fact that young girls may not open the cervical canal during menstruation. Muscular contractions of the uterus during menstruation in the presence of cervical spasm create very high pressure inside the uterus, which can have a traumatic effect on the endometrium, namely on the barrier separating the endometrium and the muscular layer of the uterus. As a result, the introduction of the endometrium into the wall of the uterus can occur.

In addition, it is precisely this mechanism that can play a role in the development of endometriosis, since if the outflow of menstrual secretions from the uterus is difficult under the influence of high pressure, these secretions enter the abdominal cavity in large quantities through the tubes, where endometrial fragments are implanted on the peritoneum.

How does adenomyosis present?

More than half of women with adenomyosis are asymptomatic. The most characteristic symptoms of adenomyosis include painful and heavy periods, often with clots, with a long period of brownish spotting, pain during sexual activity, and sometimes intermenstrual spotting. Pain in adenomyosis is often quite strong, spastic, cutting, sometimes it can be "dagger". Such pain is poorly relieved by taking conventional painkillers. The intensity of pain during menstruation may increase with age.

Diagnosis of adenomyosis

Most often, the diagnosis of "adenomyosis" is made at the consultation of a gynecologist during an ultrasound scan. The doctor sees “an enlarged uterus, a heterogeneous structure of the myometrium (they also write “heterogeneous echogenicity”), the absence of a clear boundary between the endometrium and myometrium, “serration” in the area of ​​\u200b\u200bthis border, the presence of foci in the myometrium.

The doctor may describe a sharp thickening of one of the walls of the uterus compared to the other. These are the most common ultrasound descriptions of adenomyosis that you can read in your report. During the examination on the chair, the doctor can say that the uterus is enlarged in size, a very important word is "the uterus is round."

Adenomyosis is often diagnosed during hysteroscopy. During this procedure, they see the so-called "moves" - these are red dots in the endometrium, which correspond exactly to the places where the endometrium was introduced into the uterine wall.

Rarely, MRI is used to confirm the diagnosis. This method is most indicated in cases where ultrasound cannot reliably distinguish between the nodular form of adenomyosis and uterine myoma. This is important when planning treatment tactics.

Important! Since adenomyosis in more than half of women is asymptomatic and most women live their lives without knowing that they had adenomyosis (adenomyosis, like uterine fibroids and endometriosis regress after menopause) - you should not immediately worry if during you are diagnosed with this.

This is a fairly common situation - you come for a routine examination or with complaints of vaginal discharge - at the same time you are given an ultrasound and diagnosed with adenomyosis, despite the fact that you do not have symptoms characteristic of this disease. The doctor is obliged to describe the changes that he saw, but this does not mean that you need to urgently start treatment.

Adenomyosis is a very common "condition" of the uterus, which may not manifest itself for life and regress on its own after menopause. You may never experience symptoms of this disease.

Adenomyosis in most cases is characterized by a stable asymptomatic course, without progression of the disease, unless additional factors are created for this in the form of abortions and curettage.

In most women, adenomyosis exists as a “background” and does not require serious treatment, only preventive measures, which I will describe below.

Adenomyosis as a serious problem is less common, as a rule, in this situation it immediately manifests itself as symptoms and has a progressive course. Such "adenomyosis" requires treatment.

Treatment of adenomyosis

Adenomyosis cannot be completely cured, unless, of course, removal of the uterus is taken into account. This disease spontaneously regresses after menopause. Up to this point, we can achieve a small regression of adenomyosis and prevent further development of the disease.

For the treatment of adenomyosis, virtually the same approaches are used as for the treatment of uterine fibroids.

Since adenomyosis regresses after menopause, GnRH agonist preparations (buserelin depot, zoladex, lucrin, etc.) are used. These drugs create a reversible state of menopause, which leads to the regression of adenomyosis and the elimination of the symptoms of the disease. It is important to remember that after the end of the course of treatment and the restoration of menstrual function, adenomyosis quickly recurs in the vast majority of cases, therefore, after the main course of therapy, you should definitely switch to either hormonal contraceptives or install the Mirena spiral.

This will stabilize the results achieved by the main course of treatment.

Uterine artery embolization has an ambiguous effect on adenomyosis. There are publications in which the presence of adenomyosis is even called the reason for the ineffectiveness of UAE performed to treat uterine fibroids. But there are also publications describing the high efficiency of UAE in relation to adenomyosis. We did UAE in the presence of adenomyosis and had good results. I noted that if the tissue of adenomyosis was well supplied with blood, then UAE was effective, and if the blood flow in the area of ​​adenomyosis was poor, there was no effect.

Surgical methods include the removal of adenomyosis tissue while preserving the uterus and a radical solution to the problem - amputation of the uterus. Surgical methods of treatment should be resorted to only in extreme cases, when nothing else helps.

Well levels the symptoms of adenomyosis intrauterine device "Mirena". It is set for 5 years. Against the background of this spiral, menstruation becomes scarce or disappears completely, pain may disappear.

Hormonal contraceptives can provide prevention of adenomyosis, as well as stop its progression in the early stages of the disease. To achieve the greatest effect, contraceptives are best taken according to a prolonged scheme - 63 + 7 - that is, three packs in a row without a break, and only after that a 7-day break, then again 63 days of taking the drug.

Adenomyosis and infertility

According to Western authors, there is no proven relationship between adenomyosis and infertility, that is, it is assumed that adenomyosis in isolation does not affect the ability to become pregnant. However, adenomyosis is quite often combined with other pathological conditions, such as endometriosis or uterine fibroids, which can affect a woman's fertility.

To summarize:

• Adenomyosis is a fairly common disease, the frequency of which reaches 60-70%
• In adenomyosis, the endometrium invades the muscular wall of the uterus, leading to reactive thickening of the muscle fibers around the implanted tissue. This results in an increase in the size of the uterus.
• Adenomyosis is most often diagnosed in women over 30 years of age.
• It is assumed that various medical manipulations with the uterus lead to the development of adenomyosis - curettage, abortion, caesarean section, childbirth, operations on the uterus, inflammation.
• More than half of women with adenomyosis are asymptomatic
• The most common symptoms of adenomyosis are heavy, painful, and prolonged periods with clots and pain during sexual activity.
• Adenomyosis is most often diagnosed by ultrasound and hysteroscopy.
• Adenomyosis is often combined with uterine fibroids; in the nodular form of adenomyosis, it is difficult to distinguish it from a myomatous node
• The treatment of adenomyosis is reduced to the creation of a reversible menopause, followed by a stabilization stage in the form of taking hormonal contraceptives or installing the Mirena intrauterine hormonal system.
• Uterine artery embolization is an effective treatment for adenomyosis in some cases.
• Adenomyosis most likely does not lead to infertility on its own.

Many women, when visiting a doctor - a gynecologist or after an ultrasound - research, have to hear the phrase - "adenomyosis in the uterus." This term comes from two words - adeno - this part shows that the process is associated with glandular tissues and miosis - an indication of some kind of inflammatory process. This pathology is also called genital internal endometriosis.

What is adenomyosis

The inside of the uterus is lined with a layer of cells called the endometrium. This layer is constantly updated, during the entire cycle it develops rapidly, prepares for the onset of pregnancy, and if conception does not occur, it begins to be rejected. There is monthly bleeding - menstruation. Thus, in the normal state, the endometrium can only grow in the direction of the uterine cavity, during the normal cycle, its layer simply becomes thicker.

If a woman has adenomyosis, then the endometrium begins to grow inside the wall of the uterus, into its muscle fibers. But it does not germinate over the entire surface, but only in some areas.

The uterus responds to such an invasion in the following way - the muscle fibers thicken around the areas of the ingrown endometrium, the muscles seem to be trying to stop the pathological growth of the endometrium. Thus, the entire uterus becomes larger than normal, changes its configuration.

Causes of manifestation

With absolute accuracy, the causes of this painful manifestation are not named. It is clear that there are factors that lead to disruption of the barrier layer between endometrial cells and uterine muscles.

Suggested reasons:

• abortions, as well as curettage of the uterus;
• childbirth by caesarean section;
• excision of nodes in uterine myoma, especially if the body of the uterus was opened;
• complicated childbirth;
• inflammatory processes in the uterus;
• various surgical interventions affecting the uterus.

Occasionally, adenomyosis occurs in nulliparous girls or in women who have not undergone either abortion or surgery. In such cases, there are two reasons for the appearance of adenomyosis:

• pathology of the formation of a girl during her intrauterine development. With this option, endometrial cells are in the muscular layer of the uterus without external influence;

• very slightly open cervical canal of the uterus during monthly bleeding. In this case, the organ contracts and strong pressure arises inside, under the influence of which the uterus is injured, violating the integrity of its layers. As a result, endometrial cells enter the wall of the organ.

Symptoms of adenomyosis of the uterus

Asymptomatic flow is a hallmark of the disease. For a very long time, the patient is unaware of the problem.

The first signs may be:

• too heavy periods;
• prolongation of the period of menstruation;
• there are large clots in the menstrual blood.

As a result of severe blood loss, a woman gradually develops iron deficiency anemia due to a significant drop in hemoglobin.

In the future, there are direct signs of anemia - pallor, general weakness, sleep disturbances, severe shortness of breath even with light exertion, severe dizziness.

Almost always, patients talk about the appearance of soreness during intimate contacts, while the pain is felt in the cervical region.

Another feature is that a few days before the onset of menstruation, the patient has spotting dark discharge. They persist for up to several days after the cessation of menstruation and may be accompanied by aching pain in the abdomen.

Experts note that with adenomyosis, the pain is clearly localized and one can definitely say which area of ​​the uterus is affected by the process. If the lesion is in the cervical region, then the pain will be felt in the vagina, spread to the rectum. If the endometrium grows in any corner of the uterus, the pain spreads to the groin on the same side of the body.

Most often, adenomyosis in the initial stage is always determined by chance, especially with regard to the pathology of the diffuse type. Nodular adenomyosis is defined a little better.

Forms of adenomyosis

The form of the pathology depends on how extensively and to what extent the introduction of endometrial cells into the thickness of the uterus occurs.

There are such forms of adenomyosis:

• focal ademiosis. With this form, endometrial cells germinate in separate areas - islands in the muscle wall. This form rarely makes itself felt by any symptoms;

• nodular adenomyosis. In these cases, endometrial cells will form nodules in the muscular walls of the uterus. This form of adenomyosis is called uterine adenomyoma;

• diffuse adenomyosis. The foci of germination of the endometrium are very extensive, covering a large area of ​​the surface of the uterus.

Often, patients may have several forms of adenomyosis at once (for example, a diffuse nodular form).

Degrees of Adenmiosis

The process of adenomyosis develops for a long time. There are different stages of the disease in succession:

• first- endometrial cells grow through the layer - the gap that separates them from the muscular layer of the uterus;
• second- endometrial cells have already penetrated the muscles of the uterus, but no more than half the thickness of the muscle layer;
• third- the muscles of the uterus are already more than half affected by sprouted endometrium in the lesions;
• fourth- the endometrium completely penetrates the layer of muscles of the uterus and enters the peritoneum.

Danger and possible complications

Adenomyosis is, rather, a condition of the uterus that may not appear and progress for a long time, and after reaching menopause, undergo regression. In many patients, it is present in the background and does not require any measures, unless its further development is provoked by abortions and other influences.

But with the development of this pathology, there is a danger of progression of anemia due to heavy blood loss.. Hemoglobin (iron) is lost in the blood. Organs and tissues suffer due to lack of nutrition, they receive less oxygen. The patient feels lethargy, severe fatigue, lethargy. This problem especially affects the brain.

Infertility could be next. If adenomyosis is asymptomatic, then it usually does not affect the ability to conceive. If the hormonal status is disturbed, then the onset of ovulation is difficult. Cycles become anovulatory. In addition, endometris does not grow properly on the walls of the uterus, there is no secretory phase, and even if the egg is fertilized, it cannot attach to the wall of the uterus.

With the onset of pregnancy, there may be a risk of miscarriage due to a lack of progesterone, its task is to suppress uterine contractions.

There is still a risk of developing endometriosis in the fallopian tubes. This will lead to their narrowing and obstruction for the egg. If the sperm fertilizes the egg, an ectopic pregnancy will progress.

Adenomyosis can increase the chance of cancer in the uterus by increasing the number of abnormal (atypical) cells.

The process of adenomyosis in the fourth stage is characterized by complete germination of the walls of the uterus by the endometrium. Thus, its cells will fall on the surrounding organs and tissues. The bladder, rectum, and so on can be affected. The process can cause severe painful manifestations and disturbances in the normal functioning of organs.

In addition, the endometrial cells that have come out with the flow of blood and lymph will move around the body, remaining and fixing themselves in different places. In these areas, inflammation, swelling, and other disorders appear. If the endometrium enters the nervous tissue, neurology develops and intense pain appears during menstruation.

Diagnostics and examinations

If the process of adenomyosis is at an early stage, then it is not easy to diagnose it. In this case, the patient needs to be fully examined, carefully going through all the stages.

Main diagnostic points:

• without fail, the gynecologist takes smears to determine the degree of purity of the vagina and cytology;

• the cervix is ​​examined with a colposcope. Under multiple magnification, you can see individual cells of the endometrium in the cervix, with the fourth degree of adenomyosis, the endometrium also enters the cervix;

• Ultrasound - examination of the pelvic area. The examination is carried out through the vagina. In the case of adenomyosis, the specialist will see changes in the endometrial layer, thickening of the uterine walls, a spherical shape of the uterus;

• hysteroscopy procedure. It is carried out under general anesthesia. Inspection of the surface of the uterus will show changes in the endometrium. The color of the inner surface of the uterus changes, in the places of germination of the endometrium it becomes brown, bloody discharge is visible;

• consultations of various specialists are appointed to determine the state of all other body systems.

The thoroughness and depth of the examination is the key to a correct and timely diagnosis and the appointment of the correct treatment regimen.

How to treat adenomyosis of the uterus

Methods of therapy for this pathology are conservative and operative (surgical method). It all depends on the extent to which the process is developed in the patient's body. The first, second and even third degree respond well to conservative therapy. And the fourth degree can only be eliminated surgically.

When determining the treatment regimen, hormonal treatment is first used. With the help of these drugs, the patient provokes an artificial menopause for a period of 2 to 4 months. After this, menstruation resumes, but hormone treatment continues.

Uterine artery embolization is a commonly used treatment. It gives an effect if the pathological growths of the endometrium had a good blood supply. If these tissues had a weak blood flow, the response to treatment will be weak.

Electrocoagulation procedure. It is used to remove pathological tissue foci.

Means of treatment

Since the main manifestation of this pathology can be pain of varying intensity, painkillers are widely used, most often NSAIDs (for example, ibuprofen). They should be taken a few days before the expected menstruation.

In order to correct the cycle and normalize menstruation, contraceptives are actively used. These pills do not cure the pathology, but help to eliminate the symptoms and improve the patient's quality of life.

There are intrauterine devices with therapeutic effects (Mirena). With its use, it is possible to eliminate pain manifestations, reduce the degree of bleeding.

Drugs such as Utrozhestan and Duphaston are accepted for use in the treatment of adenomyosis. Their effect is to reduce bleeding, reduce the area of ​​affected tissues. The course is quite long, from six months or more.

The next group of drugs used are Sinarel, Zoladex and the like. Their effect is to stop menstruation, the ovaries do not work, the amount of sex hormones decreases. As a result, the lesions are reduced, the symptoms are smoothed out. The course of these drugs can not exceed six months. After stopping this therapy, the disease may recur.

Dienogest. This drug gradually leads to dystrophy of pathological foci. But at the same time, it can increase the degree of bleeding, so the condition of the patient taking this drug should be strictly controlled.

Folk remedies

In parallel with medical preparations, it is possible to use traditional medicine methods in the treatment of adenomyosis. There are a large number of herbs and fees, as well as other non-drug treatment options that can significantly help not only in the treatment of the pathology itself, but improve the general condition of the patient. But all applied options must be approved by the attending specialist.

A tool such as blue clay is widespread and many people use it.. But not everyone knows its properties for the treatment of adenomyosis. The method of treatment is simple. Clay is mixed with water in a standard way, obtaining a smooth, uniform mass. It is heated for a couple of no more than 5 minutes. Warm clay is laid out on a plastic film with a layer of 1-2 cm. This compress is applied to the stomach and kept for about two hours. The number of such procedures is five to seven.

There is another treatment option - with the help of leeches.. Leeches choose the most active points on the body. After exposure to leeches in the pelvic area, blood and lymph flow normalizes. And the biologically active substances that enter the blood when bitten by a leech have antiseptic properties and relieve inflammation in the uterus.

For the treatment of adenomyosis, the range of herbal remedies used is very extensive.. They are able to correct the cycle, reduce bleeding, normalize metabolism. But you can not use herbal treatment during hormone treatment.

The following decoctions and infusions are used:

• plantain (leaves)- cut and pour boiling water. Insist at least 120 minutes. The infusion is drunk four times a day, the first time in the morning strictly on an empty stomach, the rest evenly throughout the day, regardless of food;

• nettle, its ability to stop bleeding is widely known. It also eliminates inflammation, normalizes metabolism. Pour two large spoons of chopped herbs with boiling water (200 ml). Leave for about an hour. Drink this amount of infusion per day;

• helps in normalizing bleeding fresh beet juice. In the morning on an empty stomach you need to drink 100 ml of juice;

• to strengthen the muscular layer of the uterus, a course of decoction of herbs is good shepherd's purse. Pour a large spoonful of chopped herbs with boiling water (200 ml). After an hour of infusion, you can start taking in the amount of 1 large spoon in 30 minutes. before meals, four times a day;

• viburnum, more precisely, its bark, has a healing effect in adenomyosis. The method is the same as above - 1 tablespoon per 200 ml of boiling water, infused for an hour or more. Take three times a day, 2 large spoons. It has nothing to do with food intake.

Herbal remedies can be used not only for oral administration. Douches are very effective. For them, you need to make a collection consisting of the following types of raw materials - oak bark, eucalyptus leaves, mistletoe, yarrow grass, peony, calendula flowers. All in equal parts. Pour boiling water, insist at least an hour. Need daily douching.

An important nuance in the treatment of herbal remedies is at what time of the cycle to use them. Many fees are for specific phases of the cycle.

An example of a medicinal collection before menstruation:

• poplar, buds;
• birch, buds;
• plantain, leaves;
• tansy, inflorescences;
• calamus, rhizomes;
• juniper berries.

Mix all the raw materials and take a small spoonful, pouring boiling water over it (200 ml). Leave for at least 60 minutes. Drink this infusion in a quarter of a glass, after meals, several times a day. Accompany this treatment with peony tincture at a dosage of 35 - 40 drops in the morning and evening. Continue treatment for 3 to 5 cycles.

Collection option to use during menstruation:

• licorice, root;
• clover, inflorescences;
• fireweed, grass;
• anise, seeds;
• eucalyptus, leaves;
• currant, berries.

The raw materials are mixed. Take 1 small spoon, pour a glass of boiling water, insist until cool. Drink ¼ cup three times a day. In parallel with taking this drug, you need to use Eleutherococcus in tincture, 35 drops every day.

Disease prevention

Regular visits to a specialist - a gynecologist - is the main law of the prevention of adenomyosis. Any pathology, the earlier it is detected, the easier it will be to treat.

Experts note that women's health is highly dependent on stressful situations and exorbitant loads. Therefore, it is important for a woman to take care of maintaining peace of mind and strive to avoid severe stress. If these occur, it is advisable to take measures to relax, to devote sufficient time to rest.

After reaching the age of 30, it is desirable to limit the time spent in direct sunlight, not to abuse thermal procedures.

Very useful procedures aimed at relaxation, yoga, good massage, which help to balance the general condition of the body.

Adenomyosis and pregnancy

It would be wrong to say that pregnancy is impossible with adenomyosis. To a greater extent, it all depends on the degree of pathology. It happens that even correct and long-term therapy cannot help in the onset of pregnancy.

Many women with this pathology successfully bear a child. Pregnancy passes without any features and babies are born absolutely healthy. Even in cases where the operation is indicated for the patient, she still has a chance for a successful cure. In about half of the cases, pregnancy occurs. It is important that a pregnant woman with such a diagnosis be under the constant supervision of a doctor so that, at the slightest suspicion of trouble, timely assistance is provided to her.

The state of pregnancy has a positive effect on women's health. After all, the time of gestation is a state of physiological menopause, which in non-pregnant patients is induced with the help of drugs. There are cases when, after pregnancy, the state of adenomyosis passed completely.

Forecast

Adenomyosis never degenerates into a malignant neoplasm. But he has a tendency to relapse. Within a short period of time after treatment, about a fifth of patients report a return of symptoms, and after a five-year period, three-quarters of women report a relapse.

If you use mixed therapy, relapses are somewhat less, but they still exist. The chance of a complete cure in patients who have reached menopause, as the functioning of the ovaries stops.

Women aged 27-30 often have to hear such a diagnosis as adenomyosis of the uterus. The disease is sometimes called internal and is characterized by a specific growth of the endometrium in the uterus.

Adenomyosis is very common, occurring in 60-70% of women. The disease is associated with the introduction of the endometrium of the uterus into its muscular layer. Often the disease is diagnosed in women older than 30 years. In most patients, the disease does not manifest itself, so it can be argued that the percentage of its carriers is even higher.

Adenomyosis develops as a result of instrumental intervention in the uterus and the development of infectious diseases. Adenomyosis can be suspected by severe pain during menstruation and heavy discharge.

The inside of the uterus is lined with a mucous membrane called the endometrium. It plays an important role in the process of preparing the body for pregnancy. During the menstrual cycle, the endometrium grows, and if for some reason it does not reach the desired size, fertilization may not occur or complications may occur during pregnancy.

When pregnancy does not occur during ovulation, the upper layer of the endometrium (functional) is shed and comes out with menstrual flow. During this period, the uterus is covered with a germ layer, which will be the basis for the functional layer in the next menstrual cycle.

The endometrium and the muscular layer of the uterus are separated by a thin layer. In a healthy woman, the endometrium grows towards the inside of the uterus. With adenomyosis, the endometrium in some places grows through the separating layer and is introduced into the muscle walls of the organ.

The endometrium grows only in certain places. The muscular layer reacts to foreign objects. Thus, the muscles try to limit the further spread of the endometrium in the layer. Muscle growth leads to an increase in the wall, respectively, the uterus increases. With adenomyosis, it acquires a spherical shape.

Forms of adenomyosis

With a focal form of adenomyosis, the endometrium forms foci in the muscle layer. If foci are not formed, the form is considered diffuse. There is a combination of focal and diffuse forms of adenomyosis.

Sometimes the invading endometrium accumulates in nodes that look like foci of uterine fibroids. The difference in content: glandular and connective tissue predominates in the nodes with adenomyosis, while fibroids accumulate muscle and connective tissue. This form is called nodular adenomyosis.

Symptoms of adenomyosis depend on its degree, which is determined by the depth of penetration of the endometrium into the lower layers of the uterus. You can talk about degrees only with a diffuse form of adenomyosis.

Degrees of adenomyosis

1. Growth of the endometrium in the region of the submucosa of the uterus.
2. Penetration of cells into the muscle layer. Captures no more than half of its thickness.
3. The endometrium penetrates the muscle layer more than half.
4. The endometrium extends beyond the muscle layer, growing in the serous membrane of the uterus.

After the fourth stage, endometrial cells spread outside the uterus. It goes to the peritoneum, involves the pelvic organs.

The nature of adenomyosis

All factors that contribute to the violation of the barrier between the endometrium and the muscular wall of the uterus can lead to the development of adenomyosis.

Only recently adenomyosis was recognized as an independent disease. Since very often it is combined with other diseases of the uterus. Therefore, the nature of adenomyosis is poorly understood.

The disease develops in patients who are often exposed to stress. Often, adenomyosis is diagnosed in women who regularly overexert themselves at work and at home. Too active lifestyle, raising children, physical labor, doing business are risk factors for adenomyosis.

Some data confirm the relationship of the disease and heredity. It is believed that a large percentage of affected women had a genetic predisposition. If a woman has close relatives who suffer from adenomyosis, it is worth undergoing an examination and checking the condition of the uterus.

Medicine also notes the connection between adenomyosis and sun exposure. With excessive passion for solarium and sunbathing, ultraviolet rays have a weak negative effect on the female body. are also dangerous: if the procedure is carried out incorrectly, it will only harm the body.

Risk factors

• hereditary predisposition to endometriosis or adenomyosis, malignant and benign tumors in the genital organs;
• curettage, history of abortion;
• childbirth;
• obesity;
• C-section;
• endometriosis (inflammation of the endometrium);
• early or late menarche;
• removal of fibroids (especially when opening the cavity);
• early onset of sexual activity;
• late or difficult childbirth;
• surgical intervention in the uterus;
• use of uterine spirals, oral contraceptives;
• dysfunctional bleeding;
• allergic reactions that indicate functional disorders;
• immobility;
• permanent overvoltages and loads;
• extragenital diseases.

Less often, adenomyosis is diagnosed in patients who have never undergone surgical and instrumental intervention in the uterus. Sometimes the condition develops even with a clean history and in adolescents who have recently had their first menstruation.

In these cases, there may be two reasons. It is believed that adenomyosis can develop against the background of disorders that have arisen in the process of intrauterine development of the child. The endometrium begins to invade the muscle wall for no reason.

Another reason may be in the cervical canal. If during menstruation the channel does not open well, contractions of the muscular layer of the uterus are accompanied by increased pressure. High pressure in the uterus leads to the fact that the endometrium is injured (especially the layer between it and the muscles). The phenomenon leads to the fact that the endometrium begins to grow in the opposite direction.

The same mechanism is the cause of the development of endometriosis. With spasm of the cervical canal, menstrual flow flows with difficulty, high pressure is created. Secretions under pressure are ejected into the abdominal cavity, where the elements of the endometrium adhere to the peritoneum.

Clinical picture

Sometimes women complain of pain and copious discharge with clots during menstruation. The period of smearing brown discharge increases. Less commonly, spotting appears between cycles, pain occurs during sex.

Pain in adenomyosis is strong and cutting, reminiscent of dagger blows and spasms. The pain is difficult to treat with painkillers. Unpleasant sensations during menstruation increase with age.

Diagnosis of adenomyosis

To prescribe a safe treatment, it is worth discussing the plan with a general practitioner, hematologist, endocrinologist and gastroenterologist. Before surgery, special preparation is required. First, the current state of health is assessed using various blood and urine tests. The blood type and Rh factor are also determined (a transfusion is required during the operation). The smears from the vagina are re-examined to determine the state of the microflora. They also check the condition of the heart and lungs.

These precautions are not always necessary, but they help to avoid complications and negative consequences.

Methods for diagnosing adenomyosis:

• examination on a gynecological chair;
• colposcopy;
• study of smears;
• laparoscopy, .

Signs of adenomyosis on ultrasound:

• increased body size;
• heterogeneous structure of the muscle layer or heterogeneous echogenicity;
• fuzzy border between myometrium and endometrium;
• the presence of foreign foci in the muscle layer;
• a sharp thickening of one wall of the uterus.

When examined on a gynecological chair, the doctor diagnoses an increase in the uterus and its rounded shape. Hysteroscopy allows to confirm the diagnosis. It shows dots on the endometrium that correspond to areas where the tissue has grown into the muscle layer.

Sometimes magnetic resonance imaging is used to make a diagnosis. MRI is indicated when ultrasound does not find reliable signs of adenomyosis. Most often this occurs with a nodular form, combined with uterine myoma. The method allows for differential diagnosis, that is, to distinguish the nodes of adenomyosis from fibroids.

How to respond to a diagnosis

If this diagnosis is made after the diagnosis, you should not panic. The asymptomatic condition often leads to the fact that women live their whole lives without even knowing that they had adenomyosis.

Adenomyosis of the uterus is most often detected during a routine examination and diagnosis of the causes of vaginal discharge.

Often it does not manifest itself during life and begins to regress after menopause. Therefore, many women never experience its symptoms. Before menopause, adenomyosis is a stable and asymptomatic condition that can begin to develop when exposed to certain factors (abortion, curettage, surgery).

However, this should not be a reason to ignore the problem. Adenomyosis can be acute, but in this case it almost immediately manifests itself and progresses.

Differentiation of adenomyosis and fibroids

Even during an ultrasound examination, it is very difficult to distinguish uterine fibroids from nodular adenomyosis. Endometrial nodes are able to intrude into myomatous nodes, so a combination of adenomyosis and fibroids is possible.

The treatment of uterine fibroids and adenomyosis are similar, but the rate of treatment and prognosis are strikingly different. A correct diagnosis will help to avoid prescribing additional drugs.

How to cure adenomyosis of the uterus

Adenomyosis cannot be completely cured. The only way is a hysterectomy or removal of the uterus.

The treatment of adenomyosis is based on the same principles as the treatment of uterine fibroids. GnRH agonists (gonadotropin-releasing hormone) are used: lucrin, buserelin depot, and others. They allow you to achieve the effect of reversible menopause, which leads to an independent regression of adenomyosis.

After a course of GnRH agonists and the restoration of menstruation, the disease almost always returns, so patients are advised to fix the result with hormonal contraceptives or.

In adenomyosis, uterine artery embolization is sometimes used, although it has mixed results. In some cases, UAE has a good effect in the treatment of adenomyosis, in others the method is completely ineffective. According to research results, UAE will be most effective with good blood supply to adenomyosis foci. With poor blood supply, the result will be weaker or completely absent.

It is possible to radically remove the uterus or remove disease tissue while maintaining the functionality of the organ. Surgery is a last resort after the failure of conservative treatment.

"Mirena" allows you to level the symptoms of adenomyosis. The duration of the spiral is 5 years. During this period, menstruation disappears (or is significantly reduced), the pain disappears.

Hormonal contraceptives are more effective in preventing adenomyosis. They can also slow down its growth at an early stage. The “-63 + 7-” scheme turned out to be the most effective: three packs of drugs are drunk for 63 days, then a week-long break and again 63 days.

Electrocoagulation

For the treatment of adenomyosis, the method of electrocoagulation is used. It consists in removing knots with the help of an electric current. Removal is carried out by special electrocoagulators, which operate in three modes. The device allows you to take a sample for histological analysis, reduce the rehabilitation period and the amount of blood lost.

Procedure steps:

1. The operation is carried out on an outpatient basis in a clinic and hospital. The patient will be in the gynecological chair. With the help of a dilator, the doctor opens the vagina, cleans and moisturizes the cavity.
2. The procedure uses a colposcope. It makes it possible to see the cavity and distinguish the affected areas. A special solution is used to isolate the nodes. Under its influence, the nodes become lighter. Before removal, the doctor applies anesthesia. If deep tissues need to be cauterized, general anesthesia is used.
3. The doctor uses a ball electrode, which is applied to the affected area and treats the endometrium. For demarcation, a circular incision (5-7 mm deep) is first made using a needle electrode.

Complications are possible after electrocoagulation. Sometimes women start bleeding and the menstrual cycle is disturbed, acute inflammation of the uterine appendages develops, pulling and mild pains in the lower abdomen develop. Scars can form in the uterus, which will further interfere with conception, provoke miscarriage and premature birth. It happens that electrocoagulation leads to the development of endometriosis.

Embolization

The procedure consists in blocking the blood vessels to stop the blood supply to the nodes in adenomyosis. A thin tube is passed into the vagina, through which a substance that blocks the vessels is injected. Without a supply of nutrients, the nodes shrink.

Ablation

The procedure is minimally invasive. It consists in the destruction or removal of the entire lining of the uterus. The operation is performed under epidural anesthesia or intravenous anesthesia.

Preparation for ablation includes the following measures:

• smears from the vagina;
• Ultrasound of the pelvic organs;
• skull x-ray;
• colposcopy;
• definition of a hormonal background.

Ablation is carried out on a gynecological chair. First, the external genital organs are treated, then mirrors are inserted into the vagina, the cervix is ​​fixed with bullet forceps. A probe is used to measure the length of the uterus. The cervical canal is expanded with Hegar's dilators. This allows you to enter a special tool - a hysteroscope. It makes it possible to study the walls of the body.

Ablation itself can be carried out in different ways. You can destroy the mucosa using laser radiation, balloon thermal ablation, radiofrequency, diathermocoagulation, microwave.

Alternative methods of treatment of adenomyosis of the uterus

Adenomyosis is often treated with, that is, with the use of medical leeches. The method allows you to influence biological points with biologically active substances that are in the saliva of leeches. Saliva enters the lymph, which affects the lymph nodes. They begin to stimulate natural defense cells that enhance immune properties. Hirudotherapy improves blood supply to the uterus and ovaries, stabilizes hormonal status, and removes congestion in the pelvic area.

Another remedy for the treatment of adenomyosis is an infusion of birch buds, juniper, tansy, poplar buds, celandine, plantain and calamus root. All ingredients must be taken in equal portions. A glass of boiling water requires a teaspoon of the collection. You should insist at least an hour. After insisting, strain and take 70 ml three times a day after meals.

The danger of adenomyosis and infertility

Chronic adenomyosis of the uterus does not affect the reproductive function and the process of bearing a child, however, the condition is often combined with other diseases: endometriosis and uterine fibroids. They can deprive a woman of the opportunity to conceive a baby.

Among the frequent complications of the disease, iron deficiency anemia can be distinguished. It develops due to heavy menstrual flow. The condition is characterized by lethargy, pallor, inhibition of reactions, which significantly affects performance. With iron deficiency anemia, oxygen starvation occurs: dizziness, fainting occurs.

Foci of adenomyosis grow through the muscular layer of the uterus into the serous membrane, from where they spread to neighboring organs. The endometrium is able to reach the rectum, bladder, and other organs of the peritoneum.

Infertility in this pathology may be a consequence of concomitant diseases of the uterus or the result of a malfunction in the menstrual cycle in acute form. Since secretion in the endometrium does not occur in adenomyosis, the embryo does not have the opportunity to attach to the uterus. This leads to the absence of pregnancy or the attachment of the embryo to another organ.

The main complication of adenomyosis is the ability of the endometrium to cause bleeding. Chronic or acute anemia develops, which can cause urgent hospitalization in case of a threat to life.

Adenomyosis of the uterus is fraught with systemic disorders. The location of endometrial cells is dangerous with many complications: intestinal obstruction with endometriosis of the gastrointestinal tract, hemothorax with endometriosis of the lung (filling the pleural cavity with blood).

With adenomyosis, there is always a danger of the formation of a malignant formation from the migrated cells. Such changes occur at the genetic level.

Can adenomyosis become cancerous?

Adenomyosis nodes are benign formations. This is due to the preservation of the genetic structure of cells even during the transition to other tissues and the long course of the disease (up to decades without depletion and death of the body). However, doctors often equate adenomyosis with a malignant process, since with it the endometrium is able to germinate with other organs and spread throughout the body.

Similar to malignant neoplasms, nodes in adenomyosis do not respond well to conservative treatment. Surgical treatment of adenomyosis is complicated by the fact that it is difficult to determine the boundary between the affected and healthy tissue.

Adenomyosis of the uterus (internal endometriosis) is a disease of the uterus of a benign nature, in which a pathological growth of the inner layer of the mucous membrane of the organ (endometrium) in the muscular structures of the organ is diagnosed. The endometrium consists of a functional layer, which exfoliates spontaneously after the end of the menstrual cycle, and a basal layer, which takes part in the formation of new cellular structures of the inner lining of the uterus, a new functional layer.

signs

The main signs of adenomyosis of the uterus:

• The appearance of spotting in the middle of the menstrual cycle;
• strong, prolonged, unpleasant pain in the lower part of the abdominal region.

Pathological proliferation of cellular structures of the endometrium can affect other internal organs, leading to disruption of their functioning and disruption of homeostasis in the body. The proliferation of endometrial particles leads to the development of chronic inflammatory processes, swelling of the myometrium, a strong compaction of its individual sections, which in turn will lead to a noticeable increase in the volume of the uterus, followed by a violation of the function of the organ.

At the same time, adenomyosis quite often causes the development of concomitant, secondary diseases and pathologies, leads to a decrease in the protective functions of the immune system, hormonal imbalance, and a slowdown in metabolic processes in the body.

Painful swelling occurs at the sites of penetration of endometrial particles due to the body's reaction to the presence of a foreign body. If the structures of the endometrium penetrate the vaginal cavity, are fixed in the cervical canal, cervical adenomyosis is diagnosed.

If an effective, effective treatment is not prescribed in time, this pathology can cause infertility.

The reasons

The reasons that lead to the development of adenomyosis of the uterus are not fully understood. In modern medicine, there are several theories that explain the etiology of this disease. So, the pathological growth of the endometrium can be caused by:

• hormonal imbalance, with a sharp change in the concentration of sex hormones (estrogen, prolactin, progesterone, FSH);
• menstrual irregularities;
• age-related changes. This pathology in most cases is diagnosed in women after 30-45 years;
• reflux of menstrual blood with particles of the endometrium into the fallopian tubes, abdominal organs;
• genetic predisposition;
• prolonged exposure to the sun under the scorching rays of the sun, excessive passion for solariums, mud baths if they are used incorrectly;
• violation of metabolic processes.

The risk group includes women after a caesarean section, surgical procedures in the uterine cavity, peritoneal organs. The development of adenomyosis is facilitated by frequent stressful situations, infections of the genitourinary tract, including diseases that are transmitted through sexual contact, non-compliance with personal hygiene, birth injuries, complications of a different nature, a sedentary lifestyle, lack of physical activity, diseases of the endocrine, immune system Sedentary lifestyle, minimal activity contributes to the formation of congestion in the pelvic organs.

Classification

Adenomyosis of the uterus, depending on the nature and localization of the pathological process, is classified into:

• diffuse. The growth and invasion of the endometrium occurs evenly over the entire myometrium, without the formation of foci of penetration.
• Focal. The characteristic foci of penetration of the endometrium into other internal structures of the uterus are clearly visible.
• nodal. Diagnose the presence of nodular formations in the places of penetration of the cellular structures of the endometrium. The nodes are dominated by the glandular component and the connective tissue that covers them from above. Multiple nodular lesions have a different shape, diameter, filled with blood or dark brown exudate.
• Mixed or combined. This is a combination of nodular and diffuse forms of adenomyosis.

Depending on the depth of penetration of endometrial cells, this disease can have four degrees:

• 1 degree. Particles of the endometrium penetrate into the intermediate layer.
• 2 degree. Uneven compaction and growth of the endometrium is diagnosed in the muscle layer of the organ.
• 3 degree. It is characterized by damage to the muscular layer of the organ to the serous layer.
• 4 degree (last). The endometrium penetrates the abdominal cavity, affects the ovaries, fallopian tubes.

Symptoms 🤒

Symptoms depend on the degree and form of adenomyosis, as well as the localization of pathological growths of endometrial structures, age, and the general physiological state of the body. At the same time, clinical signs may be similar in nature to the symptoms of other pathologies and ailments. It is possible to establish an accurate diagnosis only when carrying out complex diagnostic measures.

The most characteristic clinical manifestations and signs include:

1. Menstrual disorders. Long periods are possible, which are accompanied by severe bleeding, the release of large blood clots.
2. Strong, aching frequent pain in the lower part of the abdominal cavity. Strengthening of the pain syndrome most often occurs a few days before the onset of menstruation, during the menstrual cycle, especially in the first two days, or a few days after it ends. Pain is localized in the isthmus of the uterus.
3. The appearance of bleeding maroon, brown in the middle of the menstrual cycle.
4. An increase in the volume of the uterus, the appearance of compacted thickenings on the walls of the organ.
5. Pain during intercourse (dyspareunia).
6. Deterioration of the general condition, frequent headaches, migraine, decreased performance, apathy, depression, sudden mood changes, decreased performance.

As a result of severe blood loss in the body of a woman, a decrease in the concentration of hemoglobin occurs, which can provoke the development of anemia. With anemia, the mucous membranes become pale, fatigue, drowsiness, and weakness appear throughout the body. Even with minor physical exertion, shortness of breath, a strong heartbeat, and a violation of blood pressure are noted. Patients often complain of frequent dizziness, a short-term loss of consciousness (fainting) is possible.

Quite often, older women are also diagnosed with fibroids in combination with uterine adenomyosis. This type of pathology occurs with hormonal disorders in the body, leads to disruption of the functioning of the uterus and is characterized by the appearance of a benign formation in the muscle structures of the organ.

Diagnostics 👩‍⚕️

As you know, in order to prescribe an effective treatment for any disease, it is necessary to establish the cause, localization, intensity, degree, form of the disease or pathological process. To do this, patients are prescribed the passage of complex diagnostics, a number of clinical studies and analyzes. The complex of diagnostic measures includes:

1. Taking smears to check the degree of acidity, cytological analysis.
2. Colposcopy - a study of the condition of the cervix.
3. Ultrasound diagnosis of the pelvic organs.
4. transvaginal echography. Echo signs of adenomyosis: serrated basal layer, asymmetric thickening of the walls of the uterus.
5. Hysteroscopy. When conducting a visual examination on the outer surface of the endometrium, endometrioid passages, a change in the color of the uterus, and the presence of dark brown areas are clearly marked.
6. Carrying out complex clinical studies of internal organs and body systems (respiratory, cardiovascular, genitourinary, endocrine).
7. Bimanual gynecological examination, thanks to which it is possible to establish the size, position, shape of the uterus, the presence of pathological neoplasms, painful areas, and the localization of inflammatory processes.
8. Biopsy of the endometrium.

Treatment 🏥

Treatment of uterine adenomyosis is prescribed only after undergoing a comprehensive diagnosis. It is based on the use of medications (conservative treatment), surgical intervention, and folk remedies.

📌 As a rule, if you go to the clinic in time and establish a diagnosis, the first, second degrees are amenable to conservative treatment, the third, fourth require surgical intervention.

Medical

In the treatment of drugs, patients are prescribed hormone therapy, the action of which is aimed at a 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 the withdrawal of drugs. To improve blood circulation in the tissues of the uterus, to eliminate congestion in the pelvic organs, the method of embolization of the uterine arteries is used.

To eliminate the affected areas, the method of electrocoagulation and ablation is used. The ablation method is used only if the endometrial structures have not penetrated into the muscle tissue of the uterus. Ablation destroys the lining of the uterus.

Drug treatment methods are aimed at increasing the immune systems, increasing the body's resistance. With severe, frequent pain, doctors prescribe nonsteroidal drugs that have an anti-inflammatory effect. Immunomodulators and other symptomatic drugs are prescribed simultaneously with hormone therapy.

Surgical

The radical, surgical methods that are most often used to treat the third or fourth degree of adenomyosis include laparoscopy and complete removal of the uterus with appendages (hysterectomy).

To prevent recurrence of the disease, after passing the tests, women are prescribed hormonal contraceptives, restorative therapy.

Folk remedies

Along with traditional methods of treatment, but only under the supervision of your attending physician, folk remedies can be used to eliminate this pathology.

Treatment is based on the use of herbal preparations based on:

• medicinal herbs (for example, Borovoy uterus);
• hirudotherapy - treatment with leeches;
• the use of compresses with blue clay - the healing properties of which have been known since ancient times.

Treatment based on tinctures and decoctions of medicinal herbs, as shown by numerous reviews that can be read on various women's sites and forums, helps to normalize hormonal balance, metabolism in the body, reduce the intensity of uterine bleeding, and improve the overall physiological state of the body.

📌 It is worth noting that alternative treatment of uterine adenomyosis with medicinal decoctions of herbs is not used simultaneously with treatment with hormonal medications.

For the preparation of medicinal tinctures that are used for douching, they use: tansy, calamus, plantain leaves, nettle, eucalyptus, viburnum bark, oak, shepherd's purse, St. John's wort, licorice root.

Broths are prepared according to the instructions indicated on the package. It is also necessary to take into account the phase of the menstrual cycle when taking herbs, since some herbs can only be used at the beginning of the menstrual cycle, others a few days after it ends.

Adenomyosis and pregnancy

According to some experts, adenomyosis, especially in the presence of concomitant diseases, leads to infertility. Other experts claim that this pathology helps to cure the disease. On the one hand, this theory is understandable, since during pregnancy there is no menstrual cycle, preventing and slowing down the pathological process of endometrial growth.

The causes of adenomyosis during pregnancy are chronic diseases of the genitourinary system, stress, overwork, taking hormonal drugs, poor quality, malnutrition. Pregnancy with adenomyosis can be complicated, so a woman should constantly be under the attention of her obstetrician-gynecologist.

Prevention

The main and most important preventive method is a visit to the gynecologist twice a year. The earlier an ailment is diagnosed, the more effective and quick the elimination of this ailment will be.

It is very important to monitor your health, avoid frequent stress, hypothermia, prolonged physical exertion. Also, do not sunbathe for hours under the scorching rays of the sun, often visit the solarium, minimizing the harmful effects of ultraviolet radiation.

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