Adenomyosis is a disease characterized by the germination of the endometrium in the muscle layer of the uterus, while the mucous membrane cells that fall into the myometrium retain their genetically inherent function.
Accordingly, undergoing cyclical changes, they grow in a certain period and require an exit that is absent in muscle tissues. As a result, the uterus increases in size, the functionality of the organ is disturbed.
Often uterine adenomyosis is confused with endometriosis. However, this is only a variation thereof, the so-called internal endometriosis of the uterus, when the endometrium multiplies outside the uterus itself. This is a systemic benign non-cancer disease of the uterus. Endometrium is located on different organs, such as the uterus, vagina, kidneys, gastrointestinal tract and others.
Why does uterine adenomyosis occur, and what is it? Adenomyosis - a type of endometriosis, which is the proliferation of the tissue of the mucous membrane of the uterus. As a result of the pathological process, endometrioid cysts are formed, filled with liquid contents. Endometriotic foci in adenomyosis are located in the body of the uterus.
Adenomyosis can develop for these reasons:
- Congenital formation of foci of endometriosis, resulting from disorders of embryonic development.
- The introduction of endometrial cells into the surrounding tissue when performing surgical interventions or traumatic delivery.
There are factors that provoke the development of adenomyosis:
- sex life started too late;
- late or difficult childbirth;
- early or late onset of menstruation;
- frequent inflammatory processes in the uterus and appendages;
- gynecological manipulations on the uterus (abortion, diagnostic curettage);
- genetic predisposition to benign or malignant neoplasms;
- too much weight of the woman, obesity;
- use of oral contraceptives and intrauterine devices;
- the presence of diseases that are caused by functional disorders of the immune system;
- large physical and psychological stress for a long time.
The long existence of severe adenomyosis leads to anemia, marked pain syndrome, damage to neighboring organs and a sharp decline in the quality of life of a woman, up to the impossibility of having sex and any physical activity.
There are several degrees of prevalence and severity of penetration into the layers of the uterus. This classification is used only in relation to adenomyosis of the uterine body.
- degree - penetration of diffuse cells into the submucous layer of the organ.
- degree - pathological course of the disease with penetration into the muscle layers of the uterus, with the capture of less than half of this layer.
- degree - pathological diffuse process took more than half.
- degree - the growth of the endometrium beyond the uterus, with the transition of pathology to other organs. Endometrium penetrates all layers of the uterus structure.
By the nature of the tumor process, the following forms of adenomyosis are distinguished:
- diffuse form (heterotopies are evenly located in the thickness of the myometrium) - with a frequency of 50-70%
- nodular form (heterotopies are located in the myometrium in the form of endometriotic "nodes" of various sizes and localization); a characteristic feature of these nodes is the absence of a capsule; This form occurs in 3-8% of patients.
- mixed form.
The first degree and the second do not require surgical intervention, which cannot be said about the third and fourth. The last two - are difficult to conservative treatment, often adopted two methods in the complex.
Symptoms of adenomyosis
Sometimes adenomyosis can occur without noticeable symptoms, and can only be detected by chance during the examination for another reason. However, in most cases the following signs are observed in uterine adenomyosis:
- Pain in the lower abdomen, extending to the groin, rectum, vagina.
- Pain is most intense in the first days of menstruation (monthly uterine bleeding associated with physiological rejection of the endometrium - the inner layer of the mucous membrane of the uterus), with the end of bleeding pain subsides.
- Manifestations of anemia (anemia): weakness, pallor and peeling of the skin, drowsiness, fatigue.
- Abundant and prolonged (more than 5 days) menstrual bleeding.
- The appearance of spotting dark brown discharge from the genital tract 2-5 days before and within 2-5 days after menstruation.
- Uterine hemorrhage (discharge of blood from the genitals) in the period between periods.
- Painful intercourse (dyspareunia).
At first, the symptoms of adenomyosis are smoothed out and are perceived as a common premenstrual change in the body. Then, as it progresses, the intensity of the pain increases, and the time increases. Patients feel pain not only before menstruation, but also constantly.
In order to accurately establish the diagnosis of "adenomyosis" and prescribe treatment, as a rule, first a comprehensive examination is used, including:
- examination of the genitals with mirrors;
- colposcopy (examination of the cervix by means of a special device, giving an increase of about 30 times);
- laboratory tests (taking smears);
- general examination of the respiratory, circulatory, digestive, urinary system;
- magnetic resonance imaging (MRI);
- laparoscopy (the most modern method of diagnosis and treatment).
The main diagnostic method is ultrasound. The most accurate results (about 90%) are provided by transvaginal ultrasound scanning, which, like a gynecological examination, is performed on the eve of menstruation.
How to treat adenomyosis
There are two ways to treat uterine adenomyosis: conservative and operative. Naturally, the method of treatment depends on the degree of adenomyosis. As a rule, the first and second degrees, less often the third, are amenable to conservative therapy, and the fourth is treated only promptly.
In order to conservative effects apply:
- Oral contraceptives with the formation of amenorrhea (absence of menstruation), which lead to the blockage of menstruation and the removal of foci of endometriosis. Prescribe medications with ethinyl estradiol at a concentration of 0.03 and higher for 6-12 months of a continuous course,
- Progestins (didrogestenone, medroxyprogesterone, gestrinone), they lead to atrophy of endometriotic foci,
- Androgens (danazol) with the formation of amenorrhea and removal of foci of endometriosis. But the drugs have a number of serious side effects,
- Synthetic analogues of gonadoliberins (nafarelin, gistrelin) in drops or sprays, intramuscularly to reduce estrogen levels.
In the absence of a result from a therapeutic treatment, a surgical method of treatment is used, the purpose of which is to remove localization foci and restore the normal anatomical structure of the uterus.
Removal of the uterus in adenomyosis is not always required. Surgery may be recommended if adenomyosis:
- causes severe uterine bleeding, which is not amenable to treatment and leads to a large loss of blood;
- the woman already has children and she does not plan a future pregnancy;
- the woman is in premenopausal age (over 45-50 years old) and is not against the removal of the uterus;
- combined with uterine myoma large size;
- combined with undesirable changes in the endometrium or cervix.
There are two main ways to perform surgical operations for adenomyosis - open and laparoscopic (or endoscopic). An open way is abdominal surgery to remove the uterus. Laparoscopic surgery allows you to remove foci of adenomyosis and save the uterus.
Together with traditional therapeutic and surgical methods for the treatment of adenomyosis, new methods are now used. The most common non-classical method is electrocoagulation, by which, when anesthesia is used, the lesion is removed without serious consequences.
Adenomyosis is a chronic disease with a high likelihood of recurrence. After conducting conservative therapy and organ-preserving surgical interventions during the first year, relapses of adenomyosis are detected in every fifth woman of reproductive age. Within five years, recurrence is observed in more than 70% of patients.
In patients with preclimacteric age, the prognosis for adenomyosis is more favorable, which is due to the gradual extinction of ovarian function. Recurrence after panhysterectomy is not possible. In the climacteric period, an independent recovery occurs.