Adenomyosis of the uterus - what is it? Symptoms, causes and treatment. How many degrees does adenomyosis have and how each of them is dangerous? Basic treatment methods

Adenomyosis occupies a special place among other pathologies of the female genital organs. The fact is that this disease is very difficult to treat and control, and women of childbearing age are susceptible to it.

The highest percentage of the disease is recorded among women 25-45 years old, and their number reaches up to 50%. However, it is worth noting that in the last decade this disease has become significantly younger, since the beginnings of adenomyosis are also found in adolescents.

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What is adenomyosis

Adenomyosis is a chronic recurrent disease that not only disrupts menstrual function, but also, if unfavorably developed, can lead to infertility or even organ removal. Where does adenomyosis come from and how does it develop in the female body?

Let's start by looking at the structure and function of the uterus. So, it consists of the myometrium - the muscular layer or body of the uterus and the mucous membrane - the endometrium. The endometrium, in turn, has two layers - basal and functional. The basal layer is a kind of “root system” from which new endometrium grows every cycle. The functional layer is mucous, its purpose is strictly defined - to receive a fertilized egg and nourish it. When fertilization does not occur, the functional layer is rejected and comes out along with menstrual bleeding. There is also a dividing membrane between the mimometry and the endometrium. Each layer of the uterus has its own functions - the muscular layer allows the uterus to expand significantly during fetal development, the endometrium provides the fetus with necessary substances and participates in gas exchange.

And if the muscular body of the uterus has a purely mechanical function, then the endometrium reacts very sensitively functionally to hormonal changes in a woman’s body throughout the entire cycle. The functional layer consists of cytogenic stroma and glands located in them, they are responsible for the production of mucus during the secretory phase. The vessels of the functional layer are also highly sensitive to hormones, and depending on the phase, they undergo changes - twisting and lengthening during the luteal phase, thereby forming tangles of spiral arteries.

So, adenomyosis is a condition when the functional layer begins to grow, the basal layer begins to grow the functional layer in the wrong direction. That is, in the myometrium (muscular layer of the uterus) lesions appear functionally and morphologically similar to the endometrium. This in turn causes changes in the structure of the myometrium. As a result, since the endometrium has receptors that respond to hormonal changes, these same receptors enter the muscles of the uterus along with endometrial particles, and it begins to respond to hormonal cyclic changes. That is, in the uterus - in its muscular layer, the division of endometrial cells also occurs and their subsequent rejection towards the end of the cycle. All these processes manifest themselves in the form of chronic inflammation, pain and other disorders.

It should be noted that these changes in the muscles of the uterus occur simultaneously with changes in the endometrium, according to the cycle, however, the number of lesions with sprouted endometrium may continue to increase. This can explain the fact that adenomyosis, without proper treatment, begins to progress rapidly, and is also subsequently combined with other pathological conditions of the uterus.

Degrees of uterine adenomyosis

The degrees of uterine adenomyosis are divided according to the depth of damage to the muscle tissue of the uterus. There are four stages of adenomyosis:

• Adenomyosis of the uterus, grade 1, is diagnosed if no more than 1/3 of the myometrium is affected.
• Adenomyosis of the uterus, degree 2, is characterized by deeper penetration into the muscle tissue - up to half of the muscle layer. Adenomyosis of the uterus, grade 3, is characterized by complete damage to the entire layer of the uterus up to the serous membrane.
• Adenomyosis of the uterus 4 degrees - the process affects not only the uterus, but also the pelvic organs. The endometrium, breaking through the serous membrane, begins to affect the organs and tissue of the pelvis.

As we see, without timely and appropriate treatment, adenomyosis can lead to serious pathologies that can lead not only to surgery, but also to organ loss.

Forms of adenomyosis

Based on where and how the foci of endometrial penetration are localized, adenomyosis is usually divided into the following forms:

• The diffuse form of adenomyosis is characterized by an even distribution of the endometrium in the muscles of the uterus.
• Focal form - the sprouted endometrium is not distributed evenly, but forms foci of penetration.
• The nodular form is distinguished by the fact that in the myometrium, at the site of endometrial penetration, nodules of different sizes are formed; they can only be distinguished from myomatous nodes on MRI - their distinctive feature is that they do not have capsules.

In addition, there is a mixed form of adenomyosis - diffuse nodular.

Symptoms of uterine adenomyosis

The main symptoms of adenomyosis are due to its hormonal dependence. That is, all the main manifestations of the disease depend on the hormonal state and are manifested mainly by changes in the duration and intensity of menstrual bleeding:

• Pain during menstruation or algodysmenorrhea is an invariable companion to adenomyosis of stages 3 and 4, sometimes even the second. Pain can be of varying intensity and localization - lower abdomen, lower back, perineum, etc.
• Bloody or brown discharge before menstruation and for several days after it ends. In some cases, breakthrough heavy bleeding is hyperpolymenorrhea.
• Menstrual irregularities.
• In severe cases, miscarriages and infertility are also possible, which may be due to hormonal imbalance, adhesions, and the inability of the fetus to implant into the uterus.

Causes of development of uterine adenomyosis

Today there is no single coherent theory that would fully explain the causes of this pathology. Scientists have identified risk factors, but the mechanism of adenomyosis is still unknown. Just as its hereditary component is subject to study.

Risk factors contributing to pathology include:

• Mechanical damage to the uterus that occurs during interventions - abortions, curettage, removal of polyps, operations to remove myomatous nodes, cesarean sections, etc.
• Hormonal disorders.
• Heredity.

Stages of adenomyosis and pregnancy

Although in some cases doctors consider adenomyosis to be the cause of infertility, in most cases it is only one of many factors. Adenomyosis itself in the initial stages cannot become an obstacle to pregnancy and the birth of a healthy child. I would like to emphasize that this applies only to the first and second stages of adenomyosis, when the myometrial tissue is not completely affected. In addition, pregnancy with adenomyosis stages 1 and 2 can improve a woman’s condition, since during gestation the production of estrogen decreases; in some cases, after childbirth, adenomyosis may disappear completely.

For women planning a pregnancy, timely visits to the gynecologist are extremely important. Since adenomyosis is a disease with an unpredictable course - for some it can be in the first stage for decades and not bring any inconvenience, for others the disease can progress quickly. Therefore, periodic examinations and proper pregnancy planning will help to avoid unpleasant and unexpected moments.

Consequences of adenomyosis

If adenomyosis does not bother a woman and is stably in the initial stage, this does not mean that you should neglect visiting a doctor. The fact is, since this disease has not been sufficiently studied, what could become the impetus for rapid progress is unknown. And if at the first and second stages adenomyosis is not dangerous, then the third and fourth can lead to serious consequences, including:

• Infertility - most often accompanies adenomyosis of the third and fourth stages, but it is also possible with an earlier stage of a diffuse or mixed form. With proper and timely treatment, in most cases, the birth of a child in the early stages is possible.
• Although degeneration into a malignant tumor is a rare complication of adenomyosis, it should not be discounted.
• Risk of miscarriage.
• In the third and fourth stages of adenomyosis, neighboring organs are involved in the process and, as a result, adhesions and inflammatory processes in the pelvis and chronic pain.
• Large blood losses due to breakthrough bleeding followed by anemia.

Treatment of adenomyosis. Hormone therapy

Despite the fact that it is impossible to completely get rid of this pathology, with timely treatment it is quite possible to control the process of further development. It is worth considering that only progressive adenomyosis requires treatment, so many women live with this adenomyosis all their lives, without even knowing about its existence. In turn, if you suspect the progression of the disease, you must undergo appropriate treatment. In the first two stages and partially in the third, adenomyosis is treated conservatively. The early stages of adenomyosis are perfectly stabilized by taking oral contraceptives according to a special regimen. Sometimes a more radical approach is required, for example, in case of diffuse adenomyosis, when surgical intervention is impossible, GnRH agonist drugs are used, which introduce the body into a state of artificial menopause. This helps not only to stabilize the patient’s condition, but also to reduce adenomyoma. So, after the onset of natural menopause, women completely and forever get rid of this pathology. Artificial introduction to menopause is a reversible process that does not in any way affect the ability to bear children. Some specialists supplement hormonal treatment with restorative and immunomodulatory agents; in some cases, the patient also needs anti-inflammatory therapy. It should be borne in mind that hormonal treatment of adenomyosis has side effects such as weight gain. Therefore, a woman is required to follow the dosage and doctor’s recommendations, as well as a balanced diet and feasible physical activity.

Surgical treatment of adenomyosis

However, conservative treatment may not always lead to the desired result. In such cases, surgical intervention may be used:

The most common method of surgical treatment of focal and nodular adenomyosis is endoscopy. This operation allows not only to save the organ, but also to give birth to a child in the future. It is prescribed only for the above forms of adenomyosis.

Removal of the uterus is a radical method that has been used less and less in recent years. Previously, it was believed that removal of the uterus could not cause harm to women after 45 years of age, and they tried to solve all women’s problems in such a radical way. Today, the approach has changed somewhat, and complete removal of the organ is prescribed only in the most difficult cases.

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UAE for adenomyosis

In some cases, uterine artery embolization can be an effective treatment for adenomyosis. However, the success of this method depends on many factors - on the degree and form of adenomyosis, on the location of the blood supply vessels, etc. However, according to leading specialists of the European clinic, in cases of UAE in women with fibroids complicated by adenomyosis, in 60% of cases the effect was positive.

As we see, the course of the disease largely depends not only on the professionalism of doctors, but also on the consciousness of women. Only with regular visits to a gynecologist or ultrasound specialist can you ensure the health of your reproductive system. If a woman consults a doctor at stages 3-4 of adenomyosis, even a high-class specialist can do little to help her.

Bibliography

• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In the book: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Androutopoulos G., Dekavalas G. Recent advances in the treatment of uterine fibroids. Translation from English N. D. Firsova (2018).
• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of tumor nodes in uterine fibroids // Obstetrics and Gynecology. – 1983. – T. 4. – P. 13-16.

- form . In the vast majority of cases, it is found in women after 40 years of age due to multiple instrumental abortions and other surgical intrauterine interventions.

This chronic disease induces the development, significantly reduces the quality of life of a woman and remains an unresolved problem in modern gynecology.

Focal adenomyosis of the uterus - what is it?

Adenomyosis or - benign ingrowth of the basal layer of the endometrium into the myometrium with the formation of the uterine wall endometrioid tricks.

Focal adenomyosis - a local form of adenomyosis - appears to be a single or multiple focus of ectopic glands and endometrial stroma, surrounded by altered smooth muscle fibers.

In other words, with focal adenomyosis, endometrioid tissue does not affect the entire uterus, but a limited area of ​​the uterine wall.

• Diffuse
• Focal

Diffuse-focal form of adenomyosis

Isolated focal adenomyosis is quite rare (no more than 7% of all cases of the disease). Much more often, a mixed diffuse-focal form of grade 2-3 adenomyosis is observed, when a large local endometriotic focus is combined with small lesions scattered throughout the myometrium.

What is the danger of endometrial growth in the myometrium?

Increasing their viability, ectopic endometrial cells develop aggressive properties towards surrounding tissues:

• To weaken local immunity, they produce large quantities of prostaglandins - bioactive substances that induce inflammation, swelling and pain.
• To maintain its active growth, the tissues of the adenomyotic lesion autonomously synthesize estrogens and create a local hormonal imbalance (local estrogenia).
• Avoiding total hormonal control, adenomyotic tissue becomes insensitive to progesterone, a hormone that suppresses proliferative growth of glands at the site of the disease.

At the same time, endometrioid tissue remains an analogue of the uterine mucosa, therefore, during menstruation, it “menstruates.” Part of the bloody product is excreted through the endometrioid ducts into the uterine cavity, inducing spotting “chocolate” discharge, heavy, prolonged menstruation, leading to secondary anemia. The other part accumulates in the lumen of the ectopic glands, forming a large cyst (cystic form of focal adenomyosis).

Endometriotic tissue is prone to infiltrative growth. Even minimal adenomyotic lesions of the uterus in 40-50% of cases are combined with retrocervical or extragenital endometriosis of the intestine and other pelvic structures.

Invasion of the ectopic endometrium disorganizes the myometrium. The associated chronic inflammation and estrogen induce compaction, enlargement and transformation of muscle fibers, the formation of leiomyomatous nodules and smooth muscle cords.

An intrauterine pathological process disrupts the general immune and hormonal status of a woman. In patients with adenomyosis, structural and functional disorders of the ovaries, dysfunction of neuroendocrine regulation centers, autoimmune, neurotic and metabolic disorders are detected.

Focal adenomyosis is a benign tumor-like estrogen-dependent inflammatory disease with a chronic relapsing course

Causes of focal adenomyosis

Among the many hypotheses for the appearance of endometriosis in the development of adenomyosis, the leading role is occupied by:

• Genetic predisposition– an innate tendency for endometrial particles to penetrate the myometrium at certain stages of the menstrual cycle.
• Displacement of the endometrium through the injured myometrium in case of mechanical or inflammatory damage to the intermediate or transitional zone of the myometrium (Junctional Zone, JZ) adjacent to the endometrium - the natural tissue barrier between the mucous and muscular layers of the uterine wall.

95% of patients with adenomyosis have had medical abortions in the past. 75% underwent separate diagnostic curettage of the uterine mucosa. 3% - long-term use of intrauterine contraceptive devices, the wearing of which was complicated by chronic endo- and/or myometritis.

• Surgical gynecological interventions: instrumental abortions, cesarean section, hysteroresectoscopy, “blind” diagnostic curettage, manual revision of the uterine cavity, etc.
• Inadequate installation and/or prolonged wearing of intrauterine contraceptive systems.
• Inflammatory processes in the genital area.
• “Family” adenomyosis is a congenital predisposition to the disease, inherited by close relatives.
• Immunity impairment.
• Chronic stress.
• Metabolic disorders, obesity.
• Hypertension.
• Endocrine diseases, including diabetes.
• Gastrointestinal pathology.
• Chronic tonsillitis.
• Poor ecology, unsatisfactory medical and social situation.
• Alcohol.
• Physical inactivity.

Symptoms of focal adenomyosis

• Pelvic pain syndrome: constant, not associated with menstruation, nagging pain in the lower abdomen, radiating to the lower back and/or rectum.
• Painful menstruation.
• Painful intercourse.
• Spotting, bloody (brown or “chocolate”) discharge from the genitals: acyclic contact, before and/or after menstruation.
• Heavy menstruation (hypermenorrhea).
• Sometimes: dysfunctional uterine bleeding.
• Sometimes: posthemorrhagic (secondary) anemia.
• Spontaneous miscarriages, premature birth, abnormal postpartum bleeding.
• Infertility.

Can focal adenomyosis be asymptomatic?
YES!
In 12% of patients, the disease is detected by chance, on ultrasound, during a routine examination.

Diagnosis of focal adenomyosis

Up to 80% of cases of focal adenomyosis are diagnosed in late reproductive age or premenopause. But the true duration of the disease from the beginning of its development to the moment of detection is almost impossible to determine.

Diagnosis of adenomyosis begins with a thorough collection of complaints and an objective gynecological examination of the patient.

The primary instrumental method for identifying any intrauterine pathology remains echography - ultrasound scanning of the pelvic organs using a vaginal sensor (transvaginal ultrasound).

Despite the high information content of ultrasound, a number of difficulties often arise with the interpretation of research results - it is difficult to distinguish focal adenomyosis from diffuse focal or nodular adenomyosis, from fibroids or uterine malformations.

Echography of the uterus with adenomyosis should be carried out dynamically: several days before and after menstruation.

Echo signs of focal adenomyosis

• The uterus is enlarged.
• Asymmetry of the thickness of the uterine walls.
• Deformation of the basal layer of the endometrium.
• A cystic structure is visualized in the myometrium, without clear boundaries with a rim of increased echogenicity.
• Deformation of the outer contour of the myometrium.
• Vascularization in the pathological focus is enhanced.

• An increase in the size of the uterine body due to a pathological focus.
• Uneven increase in thickness and change in the echo structure of the transition zone.
• In the myometrium, a single or multiple cystic structure is visible with hypoechoic fine contents, with a hyperechoic rim, without clear boundaries.
• Unilateral increase in the thickness of the outer myometrium.

Based on the results of the ultrasound, the disease can only be assumed. As part of further examination and clarification of the diagnosis, an MRI is performed.

The “gold standard” for diagnosing focal forms of adenomyosis is MRI - magnetic resonance imaging of the pelvic organs.

A promising direction for verifying focal adenomyosis is MR spectroscopy, which evaluates the metabolic features at the locus of the disease.

Hysteroscopy with separate diagnostic curettage and histological examination of removed tissues
in case of focal adenomyosis, it is primarily carried out to exclude/confirm benign (hyperplasia, polyp) or malignant (adenocarcinoma) endometrial pathology combined with adenomyosis.

If hysteroscopy does not visualize signs of adenomyosis, this does not exclude the possibility of a focal endometrioid process in the thickness of the myometrium.

Focal adenomyosis of the uterus - treatment

The choice of treatment method for focal adenomyosis is often a big problem and largely depends on the age of the patient, the degree of prevalence of adenomyosis, the severity of clinical manifestations, and the presence of concomitant genital and somatic diseases.

Treatment tactics for adenomyosis are always agreed upon with the patient and are primarily based not on ultrasound results, but on the complaints presented and the objective clinical picture.

Focal adenomyosis 1 and 1-2 degrees - treatment

A number of experts believe that if the patient has no health complaints, no clinical manifestations of the suspected (not confirmed by histology) disease, then hormonal treatment is not prescribed. An examination by a gynecologist and ultrasound control is recommended once every 6 months.

At the same time, many researchers insist on the advisability of long-term restraining treatment of mild forms of adenomyosis with low-dose monophasic oral contraceptives or pure gestagens (oral, intrauterine) with a minimal load (dienogest, levonorgestrel) until the moment of planned pregnancy or the onset of natural menopause.

Focal adenomyosis 2 and 2-3 degrees - treatment

Management of mild and moderate focal adenomyosis depends on the form and severity of the clinical manifestations of the disease.

Analgesics and NSAIDs are used to treat minor pain.

In cases of more significant symptoms, conservative hormonal therapy is performed.

Drugs for the treatment of focal adenomyosis

First stage therapy does not require histological confirmation of the diagnosis. Applicable:

• Monophasic COCs in continuous mode:
  the drug of choice is (dienogest + ethinyl estradiol).
  Generics: “Siluet”, “Bonade”, “Diecyclen”
• Progestins in continuous mode:
  The drug of choice is (dienogest).

Clinical case:

Patient's complaints: pelvic pain, prolonged heavy menstruation.

Ultrasound results: in the left corner of the uterus, closer to the outer (serous) covering, a heteroechoic formation 3.5 x 5.3 x 4.2 cm with finely dispersed contents inside, with a hyperechoic peripheral rim up to 2 cm was found. Deformation of the outer myometrium. Signs of focal adenomyosis.

MRI results: focal adenomyosis was confirmed.

Surgical treatment was proposed, but the patient refused.

Assigned to: the drug "Visanne" in continuous mode.

Clinical effect: positive.

Second stage therapy prescribed if first-stage therapy is ineffective or intolerant:

• LNG-IUS "Mirena" (levonorgestrel)
• A-GnRH course for no more than 24 weeks:
  Experts' choice - Diferelin (triptorelin)
  Generics: “Decapeptyl-depot”, “Triptorelin-long”
  Popular A-GnRH: Zoladex (gozorelin), Buserelin.

Focal, diffuse-focal
adenomyosis 3, 3-4 degrees - treatment

Isolated moderate-to-severe and severe adenomyosis is extremely rare. More often it is combined with uterine fibroids, ovarian pathology, endometrial and/or myometrial hyperplasia, and is accompanied by severe symptoms and treated promptly.

Clinical case:

Patient's complaints: severe pelvic pain.

Ultrasound results: A heteroechoic formation measuring 4.3 x 5.1 x 3.5 cm with an outer zone of increased echogenicity was found along the left rib of the uterus in the lower third of the myometrium. Deformation of the external myometrium with bulging into the abdominal cavity. Signs of focal adenomyosis.

MRI results: presumably focal adenomyosis.

Conservative surgical treatment: A successful organ-preserving therapeutic laparoscopy was performed with excision of the pathological focus and subsequent restoration of the uterine wall.

Histological diagnosis: focal adenomyosis.

Is surgery necessary?

Indications for surgical treatment focal adenomyosis:

• Ineffectiveness of conservative therapy.
• Menstrual or acyclic uterine bleeding associated with adenomyosis, leading to anemia, resistant to drug treatment.
• Chronic pelvic pain, dyspareunia, significantly reducing the standard of living, resistant to drug treatment.
• Adenomyosis in combination with other gynecological pathology requiring surgical treatment.
• Diffuse nodular adenomyosis grade 3-4.
• Adenomyosis-associated dysfunction of organs adjacent to the uterus.

In young women who are interested in preserving their fertility are, if possible, carried out organ-preserving reconstructive plastic surgery. Optimal surgical approach – laparoscopic.

In pre- and postmenopausal women Supravaginal or total (complete) amputation of the uterus is performed - hysterectomy.

Total removal of the uterus is a necessary measure, a sad result of a woman’s late visit to the doctor, the wrong choice of conservative therapy, or the patient’s refusal for personal reasons from recommended hormonal treatment.

Every woman who does not comply with the drug treatment prescribed by her doctor for adenomyosis should be aware of the possible negative consequences of such a decision.

Uterine adenomyosis is a disease characterized by the spread of tissue similar in structure to the endometrium (uterine mucosa) into the thickness of the uterine muscle. Adenomyosis causes considerable damage to the uterus, as a result, the endometrium grows and affects the nearby layers of the organ. This problem does not apply to malignant tumors, but only in case of timely detection and treatment. How to treat this disease, how serious is it and what consequences can it have for a woman?

What is uterine adenomyosis

Adenomyosis of the uterus is a special case of endometriosis, a systemic benign disease in which endometrial cells begin to multiply outside the mucous membrane of the uterine cavity. The term “adenomyosis” literally means glandular degeneration of muscle tissue (“adeno” - gland, “myo” - muscle tissue, suffix “oz” - degenerative changes).

Under normal conditions, endometrial cells, in accordance with their name, are located exclusively in the inner layer of the uterus - the endometrium. When they spread beyond the uterine cavity, a pathological condition occurs -.

Causes

There is still no consensus on the causes and mechanisms of the development of endometriosis. There are several hypotheses for etiopathogenetic variants of the disease. However, none of them separately explains the entire essence of the pathological processes occurring during endometriosis of the uterus.

In fact, the main, leading cause of the development of adenomyosis is still hormonal imbalance. It is this factor that is primary and underlies the pathogenesis of this pathology.

Other reasons:

• operations such as cesarean section, curettage, fibroid removal, and so on;
• abortions;
• age-related changes. This pathology is in most cases diagnosed in women after 30-45 years of age;
• genetic predisposition;
• excessively frequent visits to the solarium, constant exposure to the sun without protection;
• excess body weight.

Uterine adenomyosis can be diagnosed in young women who have never experienced such manipulations. In this group of patients, the disease develops due to congenital pathologies or insufficient dilatation of the cervix during menstruation.

In addition to the above points, it is worth paying attention to the fact that any uterine surgical interventions or curettage significantly increase the risk of adenomyosis. First of all, these include abortions, mechanical injuries, medical intervention after a miscarriage, etc.

Symptoms and photos of uterine adenomyosis

Now you know what kind of disease this is, but the worst thing about uterine adenomyosis is its predominantly asymptomatic course. The first symptoms of uterine adenomyosis may appear already at the third stage, at which conservative treatment is already difficult.

In the photo you can see adenomyosis of the uterus

The most typical symptoms and signs of adenomyosis are:

• pain in the pelvic area before menstruation, during it, and also a few days later;
• dark brown discharge from the genital tract some time before and after menstruation;
• various disorders of the menstrual cycle (as a rule, its reduction);
• change in the size and shape of the uterus (this symptom is established during a special examination);
• painful sensations during sexual intercourse.
• deterioration of general condition, frequent headaches, migraines, decreased performance, apathy, depression, sudden mood changes, decreased performance.

Adenomyosis of the uterus is largely characterized by an asymptomatic course of the pathological process, which can last for many years and even decades.

Forms of the disease

The following forms of uterine adenomyosis are distinguished:

Adenomyosis: 1, 2, 3, 4 degrees

The intensity with which certain symptoms of the disease appear is associated with the severity of adenomyosis. The classification of adenomyosis by degree of prevalence is not international, but it is quite convenient and is carried out in practice. There are four stages in total, which vary depending on the spread of the endometrium:

1. Cell proliferation is limited to the internal space of the uterus and does not extend beyond its lining.
2. At the second stage, uneven compaction and growth of the endometrium is diagnosed in the muscle layer of the organ.
3. Third degree: involvement of more than half or all of the muscular wall of the uterus.
4. At stage 4, growing through the serous layer, endometrial tissue migrates outside the uterus

Before and after menstruation, mucous discharge with a sharp, unpleasant odor may be observed. This suggests that the development of internal endometriosis reaches the 2nd or 3rd degree.

The severity of the abnormal process depends on the depth of the lesion. Mild cases of adenomyosis occur in many women. In this case, the endometrium grows no further than the submucosal layer.

Possible consequences for women

Adenomyosis of the uterus has 2 development paths - favorable and critical. Timely detection and timely treatment of the disease ends generally well for the woman, with preservation of reproductive function and restoration of hormonal levels.

The growth of the endometrium outside the internal space of the uterus leads to the fact that the mucous membrane of the organ is disrupted, becoming thinner and more fragile. She is unable to receive and hold a fertilized egg. If left untreated, infertility may develop over time. The disease is the result of hormonal imbalances that make it difficult to conceive a child.

This is why it is very important to visit a gynecologist regularly; endometriosis of the uterine body detected at an early stage is successfully treated, after which pregnancy is quite possible.

Pregnancy with adenomyosis

Infertility is one of the common consequences of the presence of endometrial cells in the muscular layer of the uterus. For some, this manifests itself as the inability to conceive, while others cannot bear a child. In some cases, women suffer from blocked fallopian tubes, which prevents the egg from connecting with the sperm.

In a healthy woman, in the second phase of the cycle, the size of the endometrium increases in anticipation of pregnancy. If fertilization does not occur, then endometrial cells are rejected and come out along with menstruation. With adenomyosis, such release from the muscle tissue of the uterus does not occur, which causes hemorrhage and severe inflammation of the organ.

Is it possible to get pregnant with uterine adenomyosis? Pregnancy with adenomyosis is possible if complex treatment is carried out aimed at restoring reproductive function. The effectiveness of therapeutic intervention depends on the duration of the disease. If adenomyosis has bothered a woman for no more than 3 years, most likely the treatment result will be positive.

Diagnostics

It is possible to presumably diagnose uterine adenomyosis on the basis of characteristic complaints and as a result of a gynecological examination. Additional examination methods can be used to clarify the diagnosis and determine the stage of the disease.

1. Ultrasound of the pelvic organs, where changes in the shape and size of the uterus are clearly visible. Is it possible to see signs of uterine adenomyosis in women on an ultrasound? During an ultrasound, you can see on the screen the growth of the layers of the uterus, both uniform and uneven, and sharp protrusions or irregularities similar to myometrium may also be visible.
2. The most accurate results (about 90%) are provided by transvaginal ultrasound scanning, which, like a gynecological examination, is performed on the eve of menstruation.
3. For a detailed examination of the endometrium, hysteroscopy is prescribed. With its help, the doctor studies the nature and extent of damage to the uterine cavity, which makes it possible to determine the further course of treatment.
4. Laboratory tests of smears for flora are also required.
5. conducting the necessary comprehensive studies of other internal organs and systems - endocrine, genitourinary, respiratory, nutritional, cardiovascular;
6. endometrial biopsy;
7. bimanual gynecological examination.

Treatment of uterine adenomyosis

Treatment is based on the use of medications (conservative treatment), surgical intervention, and alternative medicine techniques.

When choosing a method and volume of therapy, the following must be taken into account:

• the patient’s age, her desire to have children, neuropsychiatric status;
• all characteristics of the pathological process;
• the combination of adenomyosis with the process of inflammation, whether there are cicatricial and adhesive changes, as well as the presence of hyperplasia and destruction in the uterus.

Drugs

When treated with medications, patients are prescribed hormone therapy, this should stop the menstrual cycle, so to speak, creating menopause. Treatment with hormones takes a very long time, from 3 to 5 months. The cycle can be completely normalized only after six months, after completing the medication.

Hormonal drugs for pathology:

• gestagens - drugs to restore reproductive function;
• oral contraceptives;
• antiestrogens;
• drugs analogues of gonadoliberin;
• antigonadotropins.

Removing the inflammatory process. To do this, use various gels, suppositories, and douching solutions. Medicines can be produced on the basis of medicinal herbs. Also, to relieve the inflammatory process, antibiotic-based drugs are often used, which makes it possible to get rid of fungal formations, infections, etc.

Surgical intervention (operation)

The operation is shown:

• with adenomyosis grades 3 and 4;
• with a combination of adenomysoasis and atypical endometrial hyperplasia;
• in case of nodular form (in women with infertility, conservative organ-preserving operations are performed);
• when standing ;
• if conservative treatment is ineffective.

In recent years, hardware methods have been used in the treatment of adenomyosis by cauterizing inflammatory foci of the endometrium in the body of the uterus using a laser.

If the patient is contraindicated from conventional hormonal therapy, the issue of drug treatment of adenomyosis is not discussed; surgery becomes the method of choice.

There is no special diet recommended by doctors for the treatment of uterine adenomyosis. Therefore, the best diet would be to exclude fatty and spicy foods, excessive amounts of sweets and baked goods. It is better to replace these products with fresh vegetables and fruits, nuts.

Try to include omega-3 fatty acids in your diet, which are involved in many important metabolic processes that occur in the body. Healthy fatty acids are found in foods such as:

• Fatty fish and fish oil.
• Walnuts and walnut oil.
• Pumpkin seeds.
• Vegetable oils.

For this disease, it is very beneficial to eat a lot of dark green leafy vegetables.

How to treat adenomyosis with folk remedies

Experts say that most medicinal herbs can improve the patient’s condition. Decoctions have anti-inflammatory, immunomodulatory, regenerating and hemostatic effects.

Collection of herbs for douching No. 1

To cope with the problem, you can use douching. To prepare a medicinal composition, you need to mix the following herbs in equal parts:

• eucalyptus;
• bergenia root;
• mistletoe;
• bedstraw;
• cottonweed;
• celandine;
• peony;
• calendula;
• Oak bark;
• yarrow.

The collection of herbs should be poured with boiling water and left to infuse. Then the composition should be filtered through a double layer of gauze and used for douching.

Herbal collection No. 2

It is good to use a collection of mistletoe, peony, cudweed, oak bark, calendula, yarrow flowers, celandine and nettle. Crushed dry plants are mixed in the same quantities, poured with hot water, wrapped and left to stand for up to 5 hours. Next, the herb is filtered through gauze folded several times and syringed while warm several times a day.

Nettle decoction

Nettle decoction four times a day. To prepare the drink, you need to pour two teaspoons of the collection with a glass of boiling water, let the medicine brew and cool, then strain and take a couple of tablespoons several times a day. This infusion relieves inflammation and stops heavy menstrual bleeding.

Prevention

1. Prevention of uterine adenomyosis mainly comes down to regular visits to a gynecologist. A specialist can correctly interpret such symptoms in a timely manner and prescribe appropriate treatment.
2. Undergoing pelvic ultrasound 1-2 times a year.
3. Gynecologists believe that stress and constant overwork have a strong impact on women's health and can undoubtedly lead to the development of adenomyosis. To prevent the onset of the disease, a woman needs to: rest more, take relaxing baths, attend a massage, and be in a calm and comfortable environment more often.
4. Keeping the body clean. Girls who ignore the rules of personal hygiene from an early age are more prone to this type of disease. And also those who engage in sexual relations in childhood and adolescence.

Taking care of your health is the main way to prevent not only adenomyosis, but also other equally dangerous diseases.

This is all about uterine adenomyosis: what kind of disease it is, what are its symptoms and signs, how to treat it. Do not be ill!

The third place among gynecological problems is occupied by grade 1 adenomyosis of the uterus. Why does it occur? To some extent, due to our negligent attitude towards our health. Few women recognize the initial stage of the disease; it passes without pronounced symptoms. Only a few pay attention to the slightest changes in the menstrual cycle and go to the doctor.

What is adenomyosis

Adenomyosis is one of the types of endometriosis, which, in turn, is a systemic disease with the penetration of endometrial cells into the deep muscles of the uterus. Moving from the membrane to the myometrium, they continue to perform their functions. Each menstrual cycle, the lining of the uterus undergoes renewal. Old cells are replaced with new “copies” and excreted in menstrual fluid.

Each cycle, cells that have grown into the myometrium are renewed. During replacement, the excreted substance does not have the opportunity to go beyond the focus. The accumulated contents gradually begin to irritate the surrounding tissues, which leads to an inflammatory process. As the disease progresses, the cells penetrate into the underlying layers of the myometrium. If this process is not treated, the disease progresses and the number of lesions increases.

In advanced stages, adenomyosis covers the entire organ. Hormonal drugs are unable to control the rate of transition of the endothelium into the muscles of the uterus. At the last stage of the disease, the cells penetrate the serosa and grow into other pelvic organs. The only “cure” will be removal of the affected organ. As a rule, the uterus most often suffers from adenomyosis, which reduces the chance of having a child in the future.

Causes of the disease

To date, doctors have not determined the exact cause of the disease. All scientists agreed that the nature of the disease is mainly hormonal. When estrogen levels are high, cells grow rapidly, and in the wrong direction. A patient with the first degree of adenomyosis observes a malfunction throughout the body. The disease affects the overall well-being of a woman.

The causes of the disease can be interventions in the uterine cavity - abortions, curettage, operations. Doctors often trace the connection between the occurrence of adenomyosis and psychological factors and heavy physical labor. During times of stress, menstruation often stops and, as a result, ovulation. It is necessary to list other important causes of the disease:

1. Complication after difficult and late childbirth.
2. Inflammatory processes in the pelvic area.
3. Impaired immune system, as evidenced by frequent infectious diseases.
4. The influence of heredity cannot be ruled out.

Many causes of adenomyosis depend on our lifestyle. Improper nutrition disrupts the amount of vitamins, which leads to weakened immunity and the development of infectious diseases. Severe shocks disrupt the menstrual cycle, which entails a number of problems in the reproductive system. Businesswomen, like no one else, are at risk of illness; their frantic pace of life wears out the body. It must be remembered that grade 1 uterine adenomyosis is best recognized at the first symptoms.

Symptoms

Patients often notice symptoms of adenomyosis only in the second stage of the disease. At the beginning of its development, the disease is discovered by chance during a routine examination by a gynecologist. As a rule, the patient does not perceive the first calls and thereby misses the chance of quick and effective treatment. Let us describe the signs of the onset of the disease:

1. Pain begins to be present a few days before the onset of menstruation. They are intense and extend to the lower abdomen and vagina.
2. Weakness, peeling of the skin and rapid fatigue indicate the onset of anemia (anemia) in the patient.
3. The duration of menstrual flow is a week.
4. During the breaks of menstruation, before and after it, a dark brown, spotting discharge occurs.
5. Painful sexual intercourse occurs.

Signs of the disease are associated with the localization of the pathological process. During illness, the doctor can also observe the presence of neoplasms that could cause adenomyosis. To avoid complications, you need to undergo treatment on time. To do this, it is recommended to visit a gynecologist once every six months.

Diagnostics

First, the doctor collects a history of complaints. He finds out how menstruation proceeds, how long the bleeding lasts, whether it is heavy or not, whether there is dark brown discharge before and after. The survey includes previous manipulations in the uterine area, heredity and somatic diseases. After this, the doctor performs an examination on a gynecological chair, during which he detects an enlargement of the uterus, characteristic of 8-10 weeks of pregnancy. In the nodular form of adenomyosis, the surface of the uterus has a tuberosity when palpated.

Among all echography, transvaginal ultrasound scanning is in first place in terms of effectiveness in detecting adenomyosis. Its accuracy exceeds 90%. An echography is performed three days before the onset of menstruation. The diagnosis of uterine endometriosis is made by a doctor with the following echo signs:

1. The uterus has a spherical shape, this is due to the enlargement of the anterior and posterior walls.
2. The organ is similar in size to 6 months of pregnancy.
3. Asymmetry of the walls.
4. Presence of cystic cavities before menstruation.

Magnetic resonance imaging is a more expensive method for determining adenomosis, but it is used to determine the structure of the myometrium. They talk about the presence of the disease based on such signs as heterogeneity of the muscular layer of the uterus and thickening of the walls. When foci of the endometrium are found, an accurate diagnosis is made - adenomyosis. MRI excludes possible other causes.

The doctor orders a blood test for estrogen. Its increased content leads to an increase in the growth rate of endometrial cells in the myometrium. The vaginal microflora is checked and smears are taken for microscopy. Consultation with specialized specialists such as a therapist, endocrinologist and gastroenterologist is not excluded.

Categories

First stage

Adenomyosis grade 1 is characterized by a small number of endometrial cells growing into the muscular layer of the uterus. The symptoms of the first stage are subtle. There is a slight change in menstruation. The discharge becomes abundant and prolonged.

The disease is discovered accidentally at an early stage during an examination by a gynecologist. The treatment that the doctor will prescribe will be a course of hormone therapy. The duration of taking the funds ranges from two months to six months. This course ensures the restoration of hormonal levels, which leads to the retreat of the disease. Upon completion of therapy, it is necessary to constantly visit the gynecologist in order to prevent the development of relapse.

Second stage

Adenomyosis of the 2nd degree is caused by the penetration of endometrial cells to a depth of up to 1/2 of the thickness of the uterine wall. At this stage, the myometrium thickens and the vagina loses its usual elasticity. The patient experiences brownish discharge before and after menstruation. The pain in the lower abdomen intensifies, then it radiates to the intestines.

Adenomyosis - should it be treated?

Nodular form of adenomyosis. Excision of nodes. Adenomyosis. Adenomyoma resection.

Endometriosis - answers to questions

Nodular endometriosis of the uterus. Adenomyosis uterus

Bilateral nodular mastopathy Application of Mladomaston

The doctor, depending on the prevalence of the pathological process in the organ, prescribes a course of hormonal therapy. In parallel with this, the patient is prescribed anti-inflammatory drugs and vitamins. The course lasts from six months to a year. If pregnancy occurs during the course of the disease, additional treatment is prescribed; pregnancy becomes difficult.

The doctor eliminates grade 2 Adenomyosis with progressive growth rates of the pathological process surgically. Laparoscopic intervention is possible only at the second stage of the disease, when the lesion has not reached catastrophic proportions. If completed successfully, the problem disappears. There is a possibility of relapse, but the doctor prescribes appropriate treatment.

Final stage

Adenomyosis grade 3 is characterized by complete germination of endometrial cells in the muscles of the uterus. In the final stage of the disease, the pathological process penetrates the serous membrane and spreads to other organs. Symptoms are severe pain in the lower abdomen, heavy menstrual bleeding. In grade 3, anemia develops, and general health deteriorates sharply.

Treatment for the final stage is complete removal of the uterus, followed by a long course of recovery. The patient is forced to take medications to prevent relapses and complications of the operation. An advanced disease leads to the loss of the chance to have a child.

Nodular form of adenomyosis

Nodular adenomyosis is caused by foci of endometrial growth into the myometrium with the formation of a cystic cavity in it. The number and size of neoplasms depends on the degree of progression of the disease. The contents of the node are a brownish liquid, the secretion of the glands during the menstrual cycle. The outside of the lesions is lined with dense connective tissue; during examination, the doctor palpates them.

Laparoscopic intervention is performed to treat the nodular form of the disease. The doctor makes a 5-10 mm long incision with a special instrument and removes the lesion. This intervention is used in the initial stages of the disease. In the fourth degree, when the nodes extend beyond the serous membrane, the uterus is completely removed.

Diffuse form of the disease

When the location of endometrial cells occurs at the same level, they speak of a diffuse form of the disease. This type of disease is not subject to complete treatment. For a long time, the patient will take hormonal medications that will balance hormone levels and slow down the development of adenomyosis. The course of therapy is prescribed exclusively by the doctor, based on the results of the examination.

Often the cause of a diffuse appearance is surgical intervention in the uterine cavity. During manipulation, the integrity of the lining epithelium is disrupted, and its cells have the opportunity to freely enter the myometrium. There are cases of adenomyosis in women who have not undergone surgery on the uterine cavity. The cause of the disease is then considered to be incomplete dilatation of the cervix during menstrual bleeding.

Focal form

Foci of adenomyosis occupy a chaotic location in the thickness of the uterine myometrium. The doctor diagnoses this form during hysteroscopy. During the examination, the affected areas of tissue are visible. The number of islands of pathology depends on the degree of the disease.

For this type, hormonal therapy is prescribed. Having applied at the initial stage of the disease, the patient has the right to count on a positive result. Upon completion of the course of hormonal therapy, she must constantly visit a specialist to prevent the development of a relapse. Treatment at the last stage will only be removal of the uterus.

Prevention

The best way to treat a disease is to prevent it. Some people believe that a visit to a gynecologist is a waste of time, and is only justified if you are pregnant or have an obvious illness. This is not true; the doctor recognizes the disease in the early stages. The earlier it is detected, the more effective the treatment.

Remember, you need to relieve stress and physical fatigue. If a woman notices mild pain in the pelvic area, she should go to the gynecologist and have her health checked. The doctor may prescribe you anti-anxiety medications. By being attentive to her health, a woman ensures the health of her future children. It is better to spend a couple of hours consulting a gynecologist than spending months on treatment.

Only if there are no diseases of the genital organs and congenital anomalies can you easily conceive and bear a child.

Some diseases may be asymptomatic, and the woman wonders why she cannot get pregnant for a long time.

And sometimes the cause of infertility lies in pathologies, the symptoms of which do not bring noticeable discomfort and therefore remain unattended.

Adenomyosis of the uterus - what is it?

One of the common diseases of the female reproductive organs is uterine adenomyosis. In order to understand the essence of the disease, you need to remember the structure of this reproductive organ.

The uterus is a hollow organ, the inside is covered with endometrium, the outer layer consists of smooth muscle cells. Between them there is an intermediate submucosal layer of tissue.

During the menstrual cycle, the thickness of the endometrium changes due to the growth of its functional part facing the uterine cavity. In this way, the woman’s reproductive system prepares for the possible occurrence of pregnancy.

After the death of the egg, if conception does not occur, the endometrial mucosa is torn off and comes out along with bloody discharge during menstruation.

After menstruation, restoration and re-growth of the functional layer occurs due to endometrial growth cells.

But disorders occur in which endometrial cells can be thrown into a woman’s abdominal cavity, and even carried by blood to other organs, such as the lungs.

This disease is called. Uterine adenomyosis is internal endometriosis, in which endometrial elements grow into the body of the uterus, its muscular layer. It is most often diagnosed in women over 30 years of age.

This disease is quite common, and a woman may not be aware of its presence. Adenomyosis is often asymptomatic, or manifests itself as painful periods or menstrual irregularities.

Meanwhile, a woman may unsuccessfully try to get pregnant, not understanding the reasons for her pregnancy.

And, although the direct connection of this disease and problems with pregnancy has not yet been proven, approximately half of women with infertility who turn to a gynecologist learn about the diagnosis of “adenomyosis of the uterine body.”

Types of uterine adenomyosis

Adenomyosis can develop in several forms, which differ in the nature of endometrial growth:

1 Diffuse adenomyosis of the uterus– proliferation of the inner layer is observed over large areas of the organ; individual lesions and nodules are not detected during examination of the woman.

2 Nodular form of uterine adenomyosis characterized by the appearance of nodules at the site where the endometrium grows into the muscle layer. For this reason, adenomyosis and uterine fibroids are often confused.

3 Focal adenomyosis of the uterus characterized by penetration of the inner layer into the muscle layer in limited areas of the organ, which are called foci.

The main problem is a decrease in the chances of pregnancy with uterine adenomyosis.

Interesting! Is it possible to get pregnant before, after and during menstruation?

Adenomyosis of the uterus - treatment

Women diagnosed with uterine adenomyosis should be aware of two main points. Firstly, this disease cannot be completely cured unless extreme measures are taken - removal of the uterus. But there is good news: when menopause occurs, adenomyosis disappears on its own.

Despite the impossibility of completely eliminating the disease during the childbearing period, its manifestations can be reduced. The answer to the question of how to treat uterine adenomyosis depends on the type and severity of the disease and the woman’s desire to have a child.

The medical treatment of adenomyosis involves the use of hormonal drugs, for example, oral contraceptives. A woman should be prepared to take medications for a long time, because the course of treatment can last for several months.

If the last stages of the disease are diagnosed, or the area of ​​damage to the muscle layer is large, only surgical intervention will be effective.

When a woman no longer plans a pregnancy, the uterus can be removed for adenomyosis.

This is a radical solution, but it can eliminate unpleasant symptoms if they greatly affect the woman’s health.

In the case when a woman wants to give birth to a child in the future, the doctor turns to other methods of surgical intervention. At the moment, laparoscopy is a very effective technique.

It involves a minimal degree of intervention in the woman’s body, and only 3 small, unnoticeable seams remain on the body.

The patient's rehabilitation is faster and easier than with other types of surgery.

There are other, more complex methods of treating adenomyosis, for example, by changing the blood circulation of the uterus.