“You have adenomyosis in your uterus” – this conclusion is quite often heard by women (especially after 27-30 years) during ultrasound or after an examination on the armchair. Very rarely patients explain in detail what the disease is.
Adenomyosis is sometimes called “internal endometriosis”, equating this disease with a kind of endometriosis. Most researchers believe that even though these diseases are similar, they are still two different pathological conditions.
What is adenomyosis.
Let me remind you that the uterus cavity is lined with a mucous membrane called the endometrium. Endometrium grows during the menstrual cycle, preparing to receive a fertilized egg. If pregnancy does not occur – the surface layer (it is also called “functional”) is rejected, which is accompanied by bleeding (this process is called menstruation). In the uterine cavity there is a growth layer of the endometrium, from which the endometrium begins to grow 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 grow only towards the uterine cavity, simply thickening during the menstrual cycle. In adenomyosis, the following occurs: in different places of the endometrium, the dividing tissue germinates (between the endometrium and the muscle) and begins to penetrate into the muscular wall of the uterus.
Important! Endometrium grows into the wall of the uterus not all over, but only in places. For clarity, I will give an example. You planted seedlings in a cardboard box, and if you have not transplanted it into the ground for a long time, then individual roots grow through the box. This is how the endometrium grows in the form of separate “roots” that enter the muscular wall of the uterus.
In response to the appearance of endometrial tissue in the uterine muscle, she begins to respond to the invasion. This is manifested by the reactive thickening of individual bundles of muscle tissue around the invaded endometrium. The muscle as it tries to limit the further spread of this process of ingrowth. As the muscle increases in size, accordingly, the uterus with adenomyosis begins to increase in size, acquires a spherical shape.
What are the forms of adenomyosis?
In a number of cases, the endometrial tissue that has entered forms the foci of its cluster in the muscle mass, then it is said that this is adenomyosis – a focal form. If there is simply the introduction of the endometrium into the wall of the uterus without the formation of foci – talk about the “diffuse form” of adenomyosis. Sometimes there is a combination of diffuse and nodal forms of adenomyosis.
It happens that the endometrium, which has penetrated into the wall of the uterus, forms nodes very similar to the nodes of the uterine myoma. If the uterine myoma is usually represented by muscle and connective tissue components, then the glandular component and the connective tissue predominate in the nodes of adenomyosis. This form of adenomyosis is called “nodular.
Adenomyosis and uterine myoma.
It can be very difficult for ultrasound to distinguish the node of the uterine myoma from the 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 myoma.
It is very important as a result of diagnosis to put the correct diagnosis and clearly determine what is present in the uterus – myoma of the uterus or adenomyosis – the nodular form. Treatment of uterine fibroids and adenomyosis is virtually the same, but the effectiveness is different, and this will affect the prognosis of treatment.
Because of what adenomyosis is formed.
The exact cause of adenomyosis is still unknown. 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.
Scraping and abortion.
Removal of nodes of uterine fibroids (especially with the 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 tolerated the above-described interventions and diseases, as well as in young adolescent girls who have only recently started menstruation.
In these rare cases, two reasons are assumed.
The first reason is associated with the occurrence of disorders during the intrauterine development of the girl, and the endometrium without any external factors is introduced into the wall of the uterus.
The second reason is related to the fact that young girls may have poor opening of 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 the barrier separating the endometrium and the muscular layer of the uterus. As a result, endometrial insertion into the uterine wall can occur.
In addition, this mechanism can play a role in the development of endometriosis, since with difficulty in the outflow of menstrual discharge from the uterus under the influence of high pressure, these discharges through the tubes in large quantities enter the abdominal cavity where the endometrial fragments are implanted on the peritoneum.
How is adenomyosis manifested.
More than half of women adenomyosis is asymptomatic. The most characteristic symptoms of adenomyosis are painful and profuse menstruation, often with clots, with a long period of brownish spotting, pain during sexual intercourse and sometimes intermenstrual bleeding. Pain in adenomyosis is often strong enough, spastic, cutting, sometimes can be “dagger”. Such pains are poorly treated with the usual pain medication. The intensity of pain during menstruation can increase with age.
Diagnosis of adenomyosis.
Most often the diagnosis of “adenomyosis” is put on a gynecologist’s advice during ultrasound. The doctor sees an “enlarged uterus, an inhomogeneous structure of the myometrium (still written” heterogeneous echogenicity “), the absence of a clear boundary between the endometrium and myometrium, the” serration “in the region of this boundary, and the presence of foci in myometrium.
A doctor can describe the sharp thickening of one of the walls of the uterus compared to the other. These are the most frequent ultrasound examinations of adenomyosis, which you can read in your conclusion. During the examination on the armchair the doctor can say that the uterus is enlarged in size, the very important word “uterus round.
The diagnosis of “adenomyosis” is often made during hysteroscopy. During this procedure, the so-called “strokes” are seen – these are red dots in the endometrium, which correspond exactly to those places where the endometrium was inserted into the uterine wall.
MRI is used less often to confirm the diagnosis. This method is most indicated in cases when using ultrasound can not reliably distinguish the nodal 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 myoma and endometriosis regress after menopause) – do not immediately worry if, during examination you put this diagnosis.
This is quite a frequent situation – you come to a routine examination or with complaints about discharge from the vagina – you are also doing ultrasound and diagnosed with adenomyosis, even though you do not have the symptoms characteristic of this disease. The doctor is obliged to describe those changes that he saw, but this does not mean that you need to urgently begin to be treated.
Adenomyosis is a very common “condition” of the uterus, which can not manifest itself all life and regress itself after menopause. You can never run into the symptoms of this disease.
Adenomyosis in most cases is characterized by a stable asymptomatic course, without progression of the disease, if additional factors such as abortion and curettage are not created for this.
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. This “adenomyosis” requires treatment.
Treatment of adenomyosis.
Adenomyosis can not be cured completely, unless of course taking into account the removal of the uterus. This disease regresses itself after the onset of menopause. Until now, 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 – use drugs agonists GnRH (Buserelin Depo, zoladex, lucrin, etc.). These drugs create a reversible state of menopause, which leads to regression of adenomyosis and elimination of symptoms of the disease. It is important to remember that after the end of the course of treatment and recovery of menstrual function, adenomyosis quickly recurs in the overwhelming majority of cases, so after the main course of therapy it should necessarily go either to hormonal contraceptives or to install the Mirena spiral.
This will stabilize the results achieved by the main course of treatment.
Embolization of uterine arteries has an ambiguous effect on adenomyosis. There are publications in which the presence of adenomyosis is even called the cause of inefficiency of EMA, conducted with the aim of treating uterine fibroids. But there are also publications describing the high efficiency of EMA in relation to adenomyosis. We did EMA in the presence of adenomyosis and had good results. I noted that if the adenomyosis tissue is well-blooded, then the EMA was effective, and in the event that the blood flow in the adenomyosis area was meager – there was no effect.
Surgical methods include the removal of adenomyosis tissue with preservation of the uterus and a radical solution to the problem – amputation of the uterus. To surgical methods of treatment should be resorted only in extreme cases, when nothing does not help.
Well mitigates the symptoms of adenomyosis intrauterine spirat “Mirena”. It is set for 5 years. Against the backdrop of this spiral, menstruation becomes scarce or disappears completely, pain can 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 of contraceptives it is best to take a prolonged schedule – 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 link between adenomyosis and infertility, that is, it is assumed that isolated adenomyosis does not affect the possibility of becoming pregnant. However, adenomyosis is often combined with other pathological conditions, for example with endometriosis or uterine myoma, which can affect a woman’s fertility.
Adenomyosis is a fairly common disease, the frequency of which reaches 60-70.
In adenomyosis, the endometrium is inserted into the muscular wall of the uterus, leading to a reactive thickening of the muscle fibers around the embedded tissue. This increases the size of the uterus.
Most often, adenomyosis is diagnosed in women after 30 years.
It is assumed that the development of adenomyosis lead to various medical manipulations with the uterus – scraping, abortion, cesarean section, labor, surgery on the uterus, inflammatory process.
More than half of women adenomyosis is asymptomatic.
The most frequent symptoms of adenomyosis are profuse, painful and prolonged menstruation with clots and pain during sexual activity.
Adenomyosis is most often diagnosed with ultrasound and hysteroscopy.
Adenomyosis is often combined with uterine myoma, with the nodular form of adenomyosis it is difficult to distinguish it from the myomatous node.
Treatment of adenomyosis is reduced to the creation of reversible menopause followed by a stabilization stage in the form of hormonal contraceptives or the installation of the intrauterine hormonal system Mirena.
Embolization of uterine arteries in a number of cases is an effective method of treatment of adenomyosis.
Adenomyosis most likely does not lead to infertility on its own.