Adenomyosis is an inflammatory gynecological disease associated with the level of hormones and the work of glands. This is a manifestation of endometriosis. The place of localization is the uterine cavity.
The content of the article:
Forms and degrees of adenomyosis
Causes of adenomyosis
Symptoms of adenomyosis
Diagnosis of adenomyosis
Therapeutic treatment
Surgical treatment
Preparation for surgery
Postoperative period
Adenomyosis and pregnancy
Adenomyosis
Forms and degrees of adenomyosis
Such a pathological condition of the uterus can have three forms: diffuse, nodular and mixed.
Diffuse adenomyosis provokes the formation of blind pockets in the endometrium, penetrating into the layers of uterine tissues to different depths. Sometimes this form causes the formation of fistulas in the pelvic cavity.
Nodular adenomyosis is accompanied by the ingress of glandular epithelium into the muscular layer of the uterus. At the same time, nodes of various sizes appear. Usually there are several of them, they are hollow, with blood or brown liquid inside. The fluid is formed from the endometrial glands responsible for timely menstrual bleeding, according to the cycle.
Mixed adenomyosis is a form of the disease in which signs of both described forms are observed at the same time.
The degrees of this pathology of the uterus are described in the international classification. Each degree is assigned based on the depth of the lesion of the underlying layers of the endometrium. The classification of degrees is relevant only for the diffuse form of uterine adenomyosis.
At the first, endometrial cells grow and penetrate into the submucosal layer. With the second – in the muscle, capturing no more than half of it. The third is characterized by the involvement of the same tissues in the disease, but in an amount exceeding half. The fourth degree is the proliferation of endometrial cells behind the muscle layer with concentration in the serous membrane. In the absence of adequate treatment or its complete absence, adenomyosis passes to the peritoneum and the involvement of organs in the pelvic area.
Causes of adenomyosis
The disease occurs and develops with hormonal failures and disorders of the immune system. Doctors identify several main factors that provoke adenomyosis. These are the following features:
Genetic predisposition;
Early or late onset of menstruation;
Late childbirth;
Severe childbirth with complications;
Surgical abortions and diagnostic curettage;
The use of spirals inside the uterus;
Taking oral contraceptives;
The onset of sexual activity is too late;
Inflammatory diseases of both the uterus and appendages;
Bleeding caused by surgery or hormone therapy.
Among the factors that cause uterine adenomyosis, there are also features that are not related to gynecology. These are frequent stresses, gastrointestinal diseases, poor ecology, hard physical work, sedentary lifestyle; obesity, infectious diseases, allergic reactions and other factors that weaken the immune system.
Symptoms of adenomyosis
The key sign is abundant and prolonged menstrual bleeding. Their danger is that they cause a sharp decrease in hemoglobin due to blood loss. In turn, this worsens the general state of health and undermines the work of the body. Therefore, it is possible to suspect the development of the disease by the following symptoms, observed simultaneously with increased blood secretion. These are such manifestations:
Pale shade of mucous membranes and skin;
Weakness and drowsiness;
Susceptibility to infectious infections;
Shortness of breath and dizziness.
On the part of the reproductive system, with different degrees of pathology, discharge is observed a few days before the start of menstruation and a few days after them. In advanced cases, metrorrhagia develops – bleeding in the middle of the cycle. At the same time, a woman is worried about pain, the severity and nature of which depends on the localization of pathology. The greatest perceptibility of symptoms is observed when the isthmus of the uterus is affected and with complex spread with the formation of adhesions.
Sometimes adenomyosis manifests itself as an additional horn of the uterus, which is similar in symptoms to an acute abdomen due to the ingress of monthly blood into the pelvic cavity. Localization of pathology in this case is determined by the irradiation of pain. So the pain giving into the rectum indicates a lesion of the isthmus, and in the inguinal region – localization in the corner of the uterus. Another obvious symptom is soreness during sexual intercourse, indicating a lesion of the isthmus.
The severity of the signs depends on the degree and prevalence of the lesion. So with a diffuse form at the initial stages, the symptoms are not noticeable, and the detection of pathology is more often accidental. With II and III degrees of diffuse and nodular adenomyosis, the symptoms depend on the prevalence of the lesion and the size of the nodes.
Diagnosis of adenomyosis
To make a diagnosis and choose a course of treatment, the doctor must conduct a comprehensive examination consisting of the following stages:
Examination of the patient’s genitals in mirrors;
Smear tests;
Cervical colposcopy;
Examination of the gastrointestinal tract, respiratory organs and circulatory organs.
The last stage is necessary for the correct choice of drugs in accordance with possible contraindications. In addition to a gynecologist, a hematologist, a gastroenterologist and a therapist are involved in the examination of a woman.
Without fail, the patient is referred for ultrasound of the pelvic organs. Additional tests for adenomyosis include laparoscopy or hysteroscopy, analysis of the vaginal microflora. The latter is done to identify and eliminate unwanted bacteria that accompany adenomyosis.
Therapeutic treatment
The therapy of this disease is similar to the treatment of endometriosis. With timely diagnosis, the use of medications is sufficient to restore the lost hormonal balance and immunity.
The choice of drugs for the disease is made according to the results of a general examination. A complex of immunomodulators and hormonal drugs is prescribed. The course of medical treatment is 2-3 months, during which the woman’s condition stabilizes.
Depending on the severity of the symptoms, additional medications are prescribed to relieve discomfort. If there are no severe pains, over-the-counter medications are sufficient. In case of spasmodic pain, it is recommended to apply a heating pad. Patients with severe pain are shown nonsteroidal anti-inflammatory drugs. The reception lasts for several days two to three days before menstruation.
With copious painful menstruation, female sex hormones are prescribed. They are especially shown to women who want to have children in the future. The course of hormones evens out the natural hormonal balance and normalizes the menstrual cycle one to one and a half months after the start of administration.
Surgical treatment
In advanced cases, therapeutic treatment of adenomyosis is ineffective. Such patients are shown surgical intervention. Its purpose is the removal of lesions and the return of the normal structure of the uterus.
Recovery time after surgical treatment is several days. After the end of rehabilitation, additional monitoring and regular examinations are required.
Methods of surgical treatment of adenomyosis:
Electrocoagulation is the removal of pockets and nodes by electric current under the influence of anesthesia.
Embolization is the overlap of blood vessels that supply blood to neoplasms in the uterus. Particles that contribute to vascular blockage are introduced through a narrow tube through the vagina. The lack of blood supply leads to the fact that the nodes of adenomyosis decrease.
Ablation is a procedure during which the inner lining of the uterus is destroyed. Endometrial ablation is effective with deep penetration of neoplasms into the muscle layer.
The method by which surgical treatment is carried out, as well as medications, are selected individually for each woman. The effectiveness of surgery in each case has its own level and depends on the development of the disease. As a rule, surgical intervention is prescribed in advanced cases.
Preparation for surgery
Preparation is required for all patients, regardless of the method of surgical treatment of adenomyosis. It consists of several stages:
Blood donation for a general analysis necessary to determine the group and Rh factor, as well as the biochemical composition and other features of the composition;
Repeated examination of smears taken from the vagina;
Passing urine for a general analysis;
Examination of internal thoracic organs using X-rays.
These manipulations are not included in the list of mandatory procedures, but they are necessary to exclude negative consequences. Responsible specialists strongly recommend that you go through all the stages of preparation before treatment.
Postoperative period
After the operation is performed by any of these methods, the patient requires inpatient observation. Recovery in the hospital lasts several days. After discharge, you should undergo a gynecological examination once every 7-10 days. This is necessary for the timely detection of complications that can provoke adenomyosis and surgery. At the end of therapy, regular visits to the gynecologist are required at least once every six months.
Complete elimination of lesions is characterized by a constant menstrual cycle and the absence of pain, discomfort in the pelvic area, as well as pathological secretions. Successful therapy excludes relapses for at least five years after surgery and rehabilitation.
Adenomyosis and pregnancy
Uterine adenomyosis is not considered a factor causing absolute infertility, the chances of getting pregnant remain, especially with recently developed adenomyosis. There are cases in which pregnancy occurred and was carried out after the treatment was completed. Conception can occur within 2 years after surgery in case of satisfactory results of subsequent examinations, during this period the uterus returns to normal. Pregnancy is also possible with untreated adenomyosis, if its spread is not extensive, and the symptoms are insignificant. Often, conception does not require any additional methods other than the natural way. If, with this diagnosis, constant attempts to conceive do not give the desired result for a year, you should additionally consult with a gynecologist, check the uterus and hormonal background again.
As in the case of healthy women, a new examination and tests will be required. At the same time, the partner also needs to pass them. Men are necessarily sent for a spermogram – an analysis of the viability of spermatozoa.
Women with adenomyosis perform the following studies:
Ultrasound of the pelvis;
Blood test for hormones;
HSG (hysterosalpingography), which allows to assess the patency of the fallopian tubes.
Basal temperature monitoring is often prescribed. It is carried out three months in a row every day to find out if a woman is ovulating.
Depending on the results of the examination, the gynecologist prescribes therapy. With obstruction of the uterine tubes, laparoscopy is indicated. If there is no ovulation, therapy of ovarian diseases is required to resume their work. Ovarian stimulation is performed with the help of hormonal drugs.
Adenomyosis can be accompanied by other diseases: polyps, uterine fibroids and other pathologies that cause difficulty in conception. If they are detected, appropriate medication or a new operation is prescribed.
