home Audience 3 Adenomyosis of the uterus, what is it in simple language with photos. Adenomyosis - what is it? Signs, degrees and treatment, pregnancy

Adenomyosis of the uterus, what is it in simple language with photos. Adenomyosis - what is it? Signs, degrees and treatment, pregnancy

Rice. 1. Localization of foci of endometriosis in the abdominal cavity and the thickness of the uterus (adenomyosis)

Adenomyosis (internal endometriosis) of the uterine body is a pathological process in which tissue similar to the endometrium (the inner layer of the uterus) grows in the muscular layer of the uterus. In this case, processes similar to cyclic changes in the endometrium occur: cell proliferation, glandular transformation and rejection of these cells. And since all these changes occur in a confined space (in the myometrium), and the rejected tissue cannot come out during menstruation, the monthly cyclic processes are accompanied by an increase and swelling of the tissue of the muscular layer of the uterus, compression of nerve endings, hemorrhage in the affected areas, which leads to the development of chronic inflammatory process, prolonged edema and disruption of tissue innervation. The second name for adenomyosis is internal genital endometriosis.

Symptoms, signs and clinical manifestations of adenomyosis

The most typical signs and symptoms of adenomyosis of the uterine body are manifestations such as:

various disorders of the menstrual cycle, for example, shortening of the cycle in combination with heavy and painful menstruation;
pain in lower sections abdomen and lower back before menstruation, during it and a few days later;
characteristic dark brown vaginal discharge a few days before and some time after menstruation; intermenstrual discharge of a “spotting” nature;
dyspareunia - pain during sexual intercourse;
infertility and miscarriage (approximately 40–50% of women of reproductive age who have been diagnosed with adenomyosis of the uterine body experience infertility).

Diagnosis of adenomyosis

The long-term existence of a severe degree of adenomyosis leads to anemia, severe pain, damage to neighboring organs and a sharp decrease in the woman’s quality of life, up to the inability to walk. sex life and any physical activity.

To accurately establish the diagnosis of adenomyosis, a comprehensive gynecological examination is performed, including:

classical gynecological examination(examination of the cervix in the speculum);
colposcopy (examination of the cervix through special device, giving an increase of 5–30 times);
taking smears followed by microscopy;
ultrasonography pelvic organs;
analysis of vaginal microflora (according to indications);
general examination of the respiratory, circulatory, digestive, and urinary systems;
consultation of narrow specialists - endocrinologist, therapist, gastroenterologist (conducted if there are indications determined by me during the initial consultation);
diagnostic hysteroscopy.

Based on the nature of the tumor process, the following forms of adenomyosis are distinguished:

diffuse form (heterotopias are evenly distributed throughout the myometrium) - with an incidence of 50–70%
nodular form (heterotopias are located in the myometrium in the form of endometrioid “nodes” of various sizes and locations); a characteristic feature of these nodes is the absence of a capsule; this form occurs in 3–8% of patients
mixed form.

According to the depth of spread of the process into the thickness of the myometrial tissue, adenomyosis is divided into the following degrees:

Vesti-Kuzbass: video report about the master class: “Endoscopic operations in surgery, urology and gynecology”

1st degree - germination of heterotopias 1/3 of the thickness of the myometrium.
2nd degree - germination by heterotopias of 1/2 the thickness of the myometrium.
3rd degree - germination of heterotopias throughout the thickness of the myometrium (up to the serous membrane).
4th degree - germination by heterotopias of the entire thickness of the myometrium, including the serous layer with possible further spread (pelvic peritoneum, adjacent organs).

Sonographic symptoms of diffuse adenomyosis:

enlargement of the uterus, “spherical” shape
many echo-positive inclusions (endometrioid heterotopias and areas of local fibrosis)
unevenness and jaggedness of the endo-myometrial border
round anechoic inclusions up to 5 mm in diameter

Sonographic symptoms of nodular adenomyosis:

Echo-positive inclusions in the myometrium are irregularly oval or round in shape without an acoustic shadow behind these formations; the echo density of these formations is high.
There may be liquid cavities up to 3 cm in diameter.

MRI studies play a major role in the diagnosis of adenomyosis. This diagnostic method is especially important when it is necessary to differentiate uterine fibroids and nodular adenomyosis.

Rice. 2. MRI images show a nodular form of adenomyosis with a submucosal location of the node

Very important role in the diagnosis of adenomyosis belongs to hysteroscopy, in which it is possible to identify endometriotic ducts, rough relief of the walls in the form of ridges and crypts, rigidity of the uterine walls, and poor extensibility of the cavity is also determined; - all this allows you to make a diagnosis of adenomyosis and determine the degree of its prevalence.

Hysteroscopic classification of the prevalence of endometriosis (V. G. Breusenko et al., 1997)

Stage 1 - the relief of the walls is not changed, endometriotic ducts are identified in the form of “eyes” of a dark blue color or open bleeding ones. The wall of the uterus during curettage is of normal density.
Stage 2 - the relief of the walls of the uterus is uneven, has the appearance of longitudinal or transverse ridges or disintegrated muscle tissue, endometriotic ducts are visible. During the examination, the walls of the uterus remain rigid and the uterine cavity is poorly distensible. When curettage occurs, the uterine wall is denser than usual.
Stage 3 - on the inner surface of the uterus, tissue bulges of various sizes without clear contours are detected. On the surface of these formations, open or closed endometriotic ducts are sometimes visible. When scraping, an uneven surface of the walls and ribbing are felt. The walls of the uterus are dense, a characteristic creaking is heard.

Treatment of adenomyosis (endometriosis of the uterus)

Indications for surgical intervention for adenomyosis are the presence of a diffuse form of adenomyosis of 3–4 degrees, nodular or mixed forms of adenomyosis in the absence of the effect of hormone therapy (prolonged bleeding accompanied by anemia, severe pain), combination with other pathological processes in the uterus (uterine fibroids, endometrial pathology , pathology of the cervix), combination with ovarian tumors.

To determine the indications for surgical treatment in your case, you need to send it to my personal email address [email protected] [email protected] copy Full description Ultrasound of the pelvic organs, indicate age and main complaints. Then I will be able to give a more accurate answer to your situation.

In general, for adenomyosis of the uterine body, as a special case of endometriosis, there are two ways to treat the disease - conservative (therapeutic) with the help of various medications or surgical (surgical) intervention.

Conservative treatment of adenomyosis of the uterine body is carried out with a complex of modern medications containing hormonal substances (for example, oral contraceptives or gestagens). Conservative therapy is indicated for small sizes single outbreak adenomyosis or initial forms of diffuse adenomyosis in women of reproductive age. The duration of treatment is from 2 to 6 months.

Tactics surgical treatment depends on the extent and form of adenomyosis, as well as on the patient’s reproductive plans and her desire to preserve the uterus.

Surgical treatment of adenomyosis of the uterine body is the method of choice for extensive and multiple foci of adenomyosis, especially in nulliparous women, since surgical treatment makes it possible to restore the normal anatomical structure of a woman’s internal genital organs, while removing the maximum possible number of foci of adenomyosis. The effectiveness of surgical treatment of adenomyosis of the uterine body is determined by the degree of development of adenomyosis, the number of affected areas, and a number of other factors.

In the presence of a nodular form of adenomyosis, it is necessary to perform laparoscopic excision of endometriosis nodes with subsequent restoration of the uterine wall. This operation has the following nuances:

the operation is technically complex, which is associated with difficulties in isolating the adenomyotic node from the surrounding myometrium due to the lack of clear boundaries and “capsule”;
it is difficult to compare the wound surface (suturing the uterine wall) due to the rigidity of the walls, since endometriosis is always accompanied by a persistent inflammatory process.

For these operations it is necessary to use a certain complex techniques, allowing you to level out all the difficulties and perform the operation on high level and without complications. This complex includes: the use of temporary occlusion of the arteries supplying the uterus, as well as the use of through “U-shaped” sutures when suturing the wound, which allows you to fully “tighten” the wound surface. The surgical protocol must necessarily include the use of anti-adhesion barriers. All this allows the surgeon to successfully perform organ-preserving operations on the uterus for nodular forms of adenomyosis.

Recovery period after surgery most often lasts several days, spent by the patient in the hospital under the supervision of a specialist. From the first day, patients begin to get out of bed and take liquid food. Discharge from the hospital is carried out on days 1–3. After the operation, only 3 small punctures about 5 - 10 mm in size remain on the skin of the abdomen.

The advantages of laparoscopic surgery for uterine adenomyosis lie in the possibility of clarifying the localization and extent of spread of adenomyosis to other organs and tissues of the abdominal cavity (due to image magnification), and carrying out therapeutic manipulations in an expanded volume. Laparoscopic treatment of adenomyosis is often accompanied by separation of adhesions around the uterus, removal of foci of endometriosis on the peritoneum, including retrocervical endometriosis, removal of endometriotic ovarian cysts and foci of bladder, ureter and intestine.

Rice. 3. Excision of foci of endometriosis of the uterosacral ligaments during laparoscopy

Laparoscopic surgery for adenomyosis of the uterine body in combination with endometriosis shows all the qualifications of the surgeon; he has to deal with damage to various organs and tissues of the abdominal cavity and pelvis, so my skills in general surgery, urology and proctology allow such operations to be performed as radically and safely as possible for the patient.

From the first day, patients begin to get out of bed and take liquid food. Discharge from the hospital is carried out on days 1–3. After the operation, only 3 small punctures about 5 - 10 mm in size remain on the skin of the abdomen.

The recovery period after surgery most often lasts several days, spent by the patient in the hospital under the supervision of a specialist. For the next 2 months, we recommend being re-examined by a doctor on the 7th, 14th and 30th days after surgery, then once every six months.

The criteria for the effectiveness of treatment of adenomyosis of the uterine body are the absence of clinical symptoms of adenomyosis (pelvic pain, discharge), the absence of ultrasound signs of the disease, and the absence of relapse of the disease for 3–5 years after surgery.

Prevention of adenomyosis

One of the best ways to prevent adenomyosis of the uterine body and its complications is the earliest diagnosis during regular preventive examinations, which are recommended to be performed at least once every six months.

As a preventive measure for adenomyosis, it can be recommended to lead a healthy lifestyle, get proper rest, and give preference to rest during the “velvet season”, when the level of solar activity is lower and does not have a detrimental effect on the body. At constant stressful situations at work and in your personal life, you should consult a therapist about the use of drugs that normalize nervous system, relaxation massage and all kinds of physiotherapy.

With a sensitive and attentive attitude to your health, you can reduce the risk of developing adenomyosis and other gynecological disorders to a minimum.

Every day I spend several hours answering your letters.

By sending me a letter with a question, you can be sure that I will carefully study your situation and, if necessary, request additional medical documents.

Huge clinical experience and tens of thousands of successful operations will help me understand your problem even from a distance. Many patients require no surgical care, but properly selected conservative treatment, while others need urgent surgery. In both cases, I outline a course of action and, if necessary, recommend additional examinations or emergency hospitalization. It is important to remember that some patients require prior treatment for successful surgery. concomitant diseases and proper preoperative preparation.

In the letter, be sure (!) to indicate age, main complaints, place of residence, contact phone number and email address for direct communication.

So that I can answer all your questions in detail, please send along with your request scanned reports of ultrasound, CT, MRI and consultations of other specialists. After reviewing your case, I will send you either a detailed response or a letter with additional questions. In any case, I will try to help you and justify your trust, which is the highest value for me.

Yours sincerely,

surgeon Konstantin Puchkov"

The incidence of adenomyosis has a wide range - 5-70%. The reason for this “scatter” of statistical data is the lack of uniform diagnostic standards and the nonspecificity of the clinical manifestations of the pathology. There are also different opinions regarding the interpretation of the concepts of adenomyosis and endometriosis - what is the difference? Some experts use the first term to designate one of the forms, others - its initial stage, others consider these two diseases to be different in origin, development, histological structure and clinical course.

Pathology tends to constantly increase, especially among young women. In addition, in the structure of diseases of the female genital organs, it is in third place (after fibroids and inflammatory processes), and the degeneration of endometriosis into malignant tumors is registered in 0.1-24%.

Definition and types of disease

The uterus consists of three layers: serous (from the abdominal cavity), muscular (myometrium) and mucous, or endometrium (from the uterine cavity). The essence of the disease is the growth of tissue similar to the endometrium beyond the mucous membrane. In appearance it may be similar to the inflammatory infiltrate, cystic formations and nodes, in structure and function it is identical to the endometrium, but is less susceptible to specific changes depending on the menstrual cycle.

The characteristic properties of endometriosis, which make it similar to a malignant tumor process, are:

absence of connective tissue capsule;
infiltrating (penetrating) growth into neighboring tissues with disruption of the structure of the latter;
the ability to metastasize (transfer) to neighboring tissues and distant organs through lymphatic and blood vessels.

Endometriosis is a hormone-dependent benign tumor process that occurs against the background of an imbalance in the body's hormonal and immune systems. It involves tissue that is identical in structure and function to the endometrium, but sometimes develops like a malignant tumor, that is, outside the normal boundaries of the endometrium, and has a tendency to infiltrative growth, sometimes to metastasis.

Classification of endometriosis depending on its location and severity

Adenomyosis, a type of endometriosis

Thus, in accordance with the classification, adenomyosis of the uterine body with the isthmus is only a particular, local, most common type of endometriosis with all its main characteristics. However, symptoms and complications are characteristic of this particular localization, taking into account which diagnosis and treatment are carried out.

Many works use the phrase “cervical adenomyosis.” Taking into account the existing classification, it is incorrect, since the localization of the pathological process in the vaginal part of the cervix and along its posterior surface refers not to internal, but to external extraperitoneal endometriosis. It often occurs as a result of injury to the mucous membrane and the introduction of pathological tissue cells into it during instrumental abortions and other therapeutic and diagnostic procedures. Endometriosis of the cervix is determined by examining it in the speculum, as well as through colposcopy or endoscopic cervicoscopy (examination of the cervical canal) in the form of reddish or purple spots.

Forms and stages of adenomyosis

The following forms of the disease are distinguished:

Focal
Diffuse
Knotty

Focal adenomyosis of the uterus

It represents individual isolated foci of endometriosis in the myometrium, that is, not all the walls of the uterus are affected, but certain parts of it. This form is more common in the premenopausal period (45-50 years old).

Diffuse adenomyosis

It is characterized not by isolated foci, unlike focal ones, but by a uniform distribution of pathological tissue throughout the myometrium. In this case, “blind pockets” of varying depths are formed in the mucous membrane. They penetrate into the following uterine layers, up to the formation of fistulas that open into the pelvic cavity.

A combination of focal and diffuse forms is possible, then we are talking about diffuse focal adenomyosis.

Nodular or nodular form

It is characterized by the germination of pathological elements into the muscle layer with the formation of dense nodes without a capsule. Due to the presence of glandular tissue that functions in accordance with the menstrual cycle, these nodes usually contain transparent or “chocolate” colored liquid or blood.

Nodes are formed due to the fact that in muscle tissue, surrounding foci of endometriosis, bloody discharge of a menstrual-like nature penetrates. They contain particles of destroyed tissue, as well as proteolytic and lipolytic enzymes secreted by endometriotic tissue and breaking down proteins and fats. This explains the absence of a capsule in endometriotic nodes. Nodal form the disease is very similar to.

Quite often, uterine fibroids occur in combination with adenomyosis against the background of hyperplastic (proliferation) processes in the endometrium. Many operating authors note this combination in 49-85% of myomatosis and consider it non-random, which is explained by identical reasons, risk factors, clinical manifestations and features of the development mechanism. This combination is most common in pre- and postmenopausal women. It significantly increases the risk of degeneration of myomatous formations with endometriosis into a malignant tumor.

Depending on the depth of penetration of pathological tissue into the muscular layer of the uterus, the following stages of adenomyosis are distinguished:

I Art. - ingrowth to a slight depth, into the submucosal layer
II Art. - lesions reach ½ thickness of the muscle layer
III Art. - endometriotic tissue penetrates the entire thickness of the myometrium
IV Art. - pathological tissue extends beyond the myometrium, affecting the serous membrane, that is, the parietal ( inner part) pelvic peritoneum, and neighboring organs.

Risk factors

The generally accepted most likely risk factors for adenomyosis are:

dysfunctional conditions of the endocrine and immune systems;
age;
hereditary predisposition;
socio-economic situation.

Less likely factors:

late onset of menstruation and sexual activity;
late and/or complicated labor;
frequent abortions and therapeutic and diagnostic manipulations on the genitals;
frequent or long-term stress loads, obesity;
excessive solar radiation and thermal procedures in the pelvic area.

Clinical signs of adenomyosis and its diagnosis

Manifestations of the disease are not specific to adenomyosis. However, most typical symptoms- This:

Pelvic pain and pain in the lower abdomen associated with menstruation (algomenorrhea), the day before, during and for several days after its end. The pain syndrome is most pronounced in the nodular form of the disease, and depending on the stage - in stages I, III and IV, that is, with superficial or very deep lesions. Particularly severe pain accompanies damage to the isthmus of the uterus. When localized in the posterior sections of the isthmus, the pain radiates (gives) to the area of the rectum and coccyx, in one of the uterine angles - to the corresponding groin area.
Heavy and prolonged menstrual bleeding (hyperpolymenorrhea) or bleeding from the genital tract in the period between menstruation (metrorrhagia) like bleeding, which is less common. Hyperpolymenorrhea most often accompanies the diffuse form of adenomyosis. Particularly heavy and prolonged bleeding, severe pain and posthemorrhagic anemia characteristic of a combination of fibroids and adenomyosis.
Appearance dark brown discharge before the onset of menstruation and for several days after its end.
Moderate or severe form of premenstrual syndrome (40%) - vegetative-vascular and neuropsychic disorders.
Unpleasant sensations and/or pain during sexual intercourse (dyspareunia), especially if the isthmus is affected.
Infertility or miscarriage.

Diagnosis of adenomyosis

Based on symptoms and comprehensive examination women. It includes a routine gynecological examination with a bimanual examination and taking smears from the vagina and cervical canal, colposcopy with targeted biopsy (if necessary), separate diagnostic curettage of the uterine cavity under hysteroscopy control, computed tomography(CT) and magnetic resonance imaging (MRI).

In the latter case, the characteristic criteria of the disease are an enlarged uterine cavity, altered shape and relief of its mucous membrane (the “wave formation” phenomenon). In the endometrium, formations (nodes) with unclear boundaries, yellow or pale yellow in color, and with characteristic “eyes” are identified.

The most valuable and available method, who received wide use in diagnostics various forms endometriosis and largely focuses on how to treat adenomyosis - transvaginal and abdominal. It is carried out during the second phase of the menstrual cycle - a few days before the start of menstruation. In this case, special attention is paid to the condition of the basal layer of the endometrium.

The main signs of adenomyosis on ultrasound:

Pelvic ultrasound is a valuable method, but when used, over- or under-diagnosis is possible, which depends on the severity of the process, the doctor’s experience and the quality of the equipment. With an increase in the stage of the pathological process and its prevalence, as well as the severity of clinical symptoms, the degree of detection of the disease also increases. MRI has a high diagnostic ability exceeding 90%.

Treatment of adenomyosis

If the disease occurs without pain and bleeding, that is, without obvious symptoms, and is detected during random examinations, there is no need for specific treatment, especially if the woman is not planning a pregnancy.

Unfortunately, therapeutic, conservative surgical or combined methods Treatments rarely lead to complete recovery. Late stages of adenomyosis are the most common cause of infertility. At the same time, timely treatment in certain cases can lead to a more or less long-term remission of the disease, allowing one to become pregnant and give birth to a child, but there is often a risk of spontaneous abortion or, in best case scenario, premature birth.

After pregnancy and childbirth, many women remain at risk of uterine bleeding and the spread of endometriosis in the body. But sometimes after childbirth there is a remission due to the fact that pregnancy is a kind of menopause, and the activity of the pathological tissue decreases.

In the absence of pregnancy, IVF can be performed. However, adenomyosis and eco can be compatible concepts only if surgery and a course of therapeutic treatment are first carried out. The effectiveness of IVF for this disease ranges from 30 to 60%.

The tactics of therapeutic methods consist in the use of drugs of a predominantly hormonal nature, aimed at suppressing excess activity hormonal system, and the impact on immune system body. The goal of treatment is to suppress the activity of endometriotic lesions and atrophy of pathological tissue.

Such means include:

The latest generation of oral contraceptive drugs are Yarina, Marvelon, Regulon, Silest, Janine, etc. The duration of their continuous use should be from six months to 1 year. At mild degree disease, necrosis of pathological foci often occurs with a decrease or disappearance of pain in 60-95% of patients, and in 50% pregnancy may occur.
Preparations of the progestogen group - Gestrinone, Medroxyprogesterone, etc., also cause atrophy of endometrioid foci.
Androgenic drugs (Danazol), which prevent the growth of existing old lesions, and if they arise, prevent the appearance of new ones.
GnRH analogues (gonadotropin-releasing hormone), the duration of treatment of which is (depending on the drug and the severity of the disease) from 3 months to 1 year or more. The mechanism of their action is a decrease in estrogen secretion. The most used drugs are Triptorelin and Buserelin.
Immunomodulatory agents.
Painkillers and hemostatic drugs (symptomatic therapy).

The choice of drugs should be made only by a specialist and under his strict supervision, since some of them, especially GnRH analogues, have side effects such as osteoporosis, diffuse alopecia, autonomic and psychogenic reactions such as menopausal syndrome.

Surgical treatment is used in cases of:

a woman's desire to have children;
adenomyosis stages III and IV;
the presence of a nodal form;
combinations of adenomyosis with fibroids;
ineffectiveness of conservative therapy.

It can be conservative or radical. The first consists of eliminating visible lesions using radio waves, laser or electrocoagulation, as well as using laser ablation, embolization of the uterine arteries (especially when combined with fibroids). However, often conservative surgical methods facilitate the transplantation of pathological tissues into neighboring areas and organs.

The only effective treatment for heavy bleeding, the development of anemia and the ineffectiveness of conservative therapy is surgical removal of the uterus. During menopause, due to a decrease in the activity of female sex hormones, most women experience a decrease in endometriosis foci and their atrophy.

Adenomyosis is the appearance of endometrium in the uterus, which is accompanied by pathological changes in its structure. Patients complain of discomfort in the abdomen, irregular menstruation, pathology reproductive function. The disease is characterized by constant progression, causing complications. If an appropriate diagnosis is made, therapeutic measures are selected, part of which are medications. It is necessary to choose medications depending on the patient’s age and the characteristics of the disease.

With uterine adenomyosis, women often encounter a number of unpleasant signs:

Bleeding between periods.
A loss large quantity blood, pain during menstruation.
Irregular menstruation.
If the disease worsens, bloating appears.
Unreasonable deterioration in health.
Increased fatigue, weakness.
Paleness of the mucous membranes.
Frequent infectious diseases.

Causes

The development of the disease can be assumed if the following risk factors are present:

Hereditary predisposition.
Increase in body weight.
Abortion, other operations on the uterus.
Use of hormonal contraceptives.
Inflammatory diseases of the genital organs.
Immune system disorders.
Physical overload.

What does the treatment regimen depend on?

Before choosing the optimal treatment method, you need to pay attention to important factors:

Age. It is this parameter that determines whether a woman plans to continue sex life, give a birth to a baby. Sometimes patients are offered to remove the affected organ, especially if menopause has already passed. The surgical method of correcting the disease allows you to get rid of possible relapses of the pathology, guarantee complete cure 100%
Availability various pathologies mental health, which may influence the course of treatment.
Other abnormalities in the structure of the organ, in addition to uterine adenomyosis. There may be scars, increases in size, adhesions and other disorders that require immediate correction.

Treatment methods

Measures to get rid of the disease can be used either independently or in combination:

Name	Description
Surgical	Organ resection
Conservative	Prescribed steroid medications
Symptomatic	It is believed that uterine adenomyosis is incurable disease. By doing therapeutic measures acceptance can be reduced negative manifestations, for example, remove pain, anemia
ethnoscience	To achieve stable remission, completely stop the symptoms of the disease, use only folk remedies it is forbidden. Typically, such methods are used in conjunction with drug therapy. As a result, the general condition of the patient improves
Immunity correction	Are used as medical supplies, as well as competent selection of diet, thanks to which the body independently fights tumors and other formations, leading to a decrease in their number and a decrease in foci of the disease

Oral contraceptives

These drugs are used not only to protect against unwanted pregnancy, but also as therapeutic measures. They can be used cautiously, only on the advice of a doctor. Contraceptives contain estradiol, progesterone derivatives, which help maintain hormonal balance, common violations are eliminated.

With regular use of oral contraceptives, the patient's condition improves due to the stabilization of ovarian functions and the acceleration of the emergence of new germ cells. Hormonal levels and the process of endometrial development are normalized.

Signs indicating improvement in the patient's condition:

Reduced pain, especially during menstruation.
Elimination of bleeding from the uterus on days when they are pathological.
Reducing the likelihood of delayed menstruation, treating hormonal imbalance.

To get what you want positive effect, it is necessary to continue treatment for 3 months to six months. Most common in medical practice drugs are Janine, Jess, Logest, Marvelon. During the course of treatment, you should not worry about the absence of menstruation. This is a normal phenomenon; the pills affect the production of estrogen, as a result of which the functioning of the ovaries slows down.

Antigonadotropins

Antigonadotropins are prescribed if a decrease in the amount of pituitary hormones is required. Hormonal drugs affect the activity of the ovaries and reduce a person’s ability to work. They also have a suppressive effect on the endometrium.

The following drugs are popular:

Danazol;
Danol.

In accordance with the doctor’s recommendations, the drugs should be taken in an amount of 400-800 mg per day. During the entire period of use, menstrual bleeding practically does not appear, and amenorrhea (temporary absence of menstruation) may occur. Usually drugs have to be used in courses. Remember that during this time you need to closely monitor your health.

Progestogens

To reduce the amount of estrogen, it is enough to take progesterone regularly. As a result, you can quickly and effectively cope with the symptoms of the disease and the causes of its occurrence. This substance reduces the intensity of endometrial growth, reducing the number or completely eliminating foci of the disease. Among the drugs in this series, the following options are popular:

Duphaston;
Norkolut.

When exposed to the body, they do not have a negative effect on the functioning of the ovaries. The components of the composition reduce the number of menstruation, which reduces the likelihood of excessive enlargement of the endometrium. The drug has a complex effect, penetrating the tissue structure.

When taking it, you need to pay attention to the following factors:

Reducing the volume of secretions.
Normalization of the frequency of menstruation, elimination of other characteristic disorders.
Reduced pain.

If you use these drugs alone or in combination, menstruation will disappear, which is important for many patients. The drugs are supplied in tablet configuration. The medication must be taken from days 5 or 16 to 25 of the cycle. To adjust the dose and clarify the time of administration, it is advisable to seek advice from a doctor.

Antiestrogens

These elements consist of synthetic components. When taken regularly, it turns out that not only the standard medicinal effect, but the production of certain substances produced by the pituitary gland also slows down. There is a decrease in the amount of a number of hormones, which has a positive effect on the prognosis of the disease.

Popular drugs often prescribed by doctors:

Gestrinone. The composition contains the main substance classified as a steroid. Thanks to this element, the amount of sex and gonadotropic hormones is reduced. As a result, the uterine cells do not receive proper nutrition and atrophy occurs. During active medication use, periods do not appear. In addition there is no other unpleasant symptoms, such as pain, bleeding occurring for unknown reasons. If you use this remedy from the first day of the cycle, the next dose occurs on the fourth day. One capsule per day is enough. If used standard scheme treatment, the drug is used 2 times every 7 days, and the total course of therapy is six months.
Depo-Prover. Affects reproductive system, suppressing the possibility of the appearance, development and decay of the egg. Sex hormones are produced in such a way that they do not affect the activity of the uterus. Overgrown tissues do not receive proper nutrition, which is why they gradually atrophy. As a result, pain does not appear, menstruation stops, and blood does not come out of the vagina. The drug is sold in the configuration of a solution for injection. Intramuscular administration is practiced once every 7 days. The course of treatment varies from 3 to 6 months.

Don't forget that these drugs have a lot of important side effects. They provoke an early onset of menopause, which is why they appear various complications: mental instability, hot flashes, dry mucous membranes.

Substances that provoke an increase in the amount of FSH and LH. Initially, this effect has a stimulating effect on the functioning of the gonads, but later their functioning gradually decreases and activity drops to a minimum.

To achieve this effect, use the following medications:

Buserelin. Intramuscular administration is practiced on the 5th day of the cycle. As a result, the drug is taken almost monthly at 4.2 mg.
Goserelin. It is administered not intramuscularly, but subcutaneously once every 28 days, 3.6 mg.
Decapeptyl depot. 3.75 mg is used monthly.

When using these drugs, weakness and deterioration may occur. general well-being, other disorders that prevent a person from practicing normal activities. Hot flashes, increased nervousness, increased heart rate, and hypertrichosis are also possible.

With the use of drugs, menstruation does not appear.

Antiandrogens

To completely get rid of adenomyosis, they often use Vizanne. Active ingredient is dienogest, which has a significant effect on the general condition of the body and reproductive system. When taking this drug, the level of progesterone constantly increases, due to which the amount of estrogen gradually decreases. The main areas of spread of the disease are gradually being stopped, their number is decreasing. To carry out the full course of treatment, you must take Visanne for 6 months, 1 tablet per day. Menstruation may pass, however this phenomenon doesn't always happen.

When is hormone therapy not needed?

Treatment measures are selected specifically for each patient. Initially, a series of tests and diagnostic measures are carried out in order to prescribe the optimal medications, taking into account the general condition of the person. Even if uterine adenomyosis is detected, hormones are not used under the following circumstances:

The woman does not notice changes in the frequency of the cycle, the amount of discharge, and no other negative symptoms requiring immediate correction.
There are no unpleasant sensations in the genital area.
The course of the disease is almost imperceptible, and due to her age, the patient should soon begin menopause.

In some cases, after a detailed examination and appropriate tests, hormonal contraceptives are prescribed. When selected correctly, these drugs are safe, at the same time they allow you to protect against infection and protect against unplanned pregnancy.

With adenomyosis of the uterus and miscarriages, and medical abortions are contraindicated for patients, which is why it is necessary to carefully monitor your general condition.

Contraindications to taking hormonal drugs:

Diabetes mellitus, which a woman has been suffering from for several years.
Failure vital important organs, to which various pathological processes in their structure led.
The presence of allergies, congenital tolerance to at least one of the components of the selected medications.
Increased blood clotting, risk of blood clots.
Body weight exceeding normal.

Conservative methods

To normalize the communication condition with uterine adenomyosis, it is not necessary to use drugs containing hormones. It is possible to use homeopathic remedies, folk recipes, as well as more gentle medications.

Conservative medications can be used either independently or in combination with more radical methods:

Video - Adenomyosis

Surgical intervention: when is it used?

The operation is performed only if the use of a complex of various drugs and procedures cannot have the desired effect. The following factors influence the specialists’ decision to prescribe surgery:

The use of medications does not have a powerful effect, for a long time no improvement is seen.
During treatment, anemia develops, characterized by a gradual increase in negative symptoms.
The patient has already passed menopause. In this case, surgery is prescribed in order to completely cure uterine adenomyosis.
The presence of other diseases that have a significant impact on the activity of the uterus. Enlarged nodes and stage 3-4 tumors are especially dangerous.

Abdominal. The skin is cut directly above the pathological area, and the overgrown endometrium of the uterus is removed. As a result of the operation, the functionality of the genital organs is restored, the symptoms of the disease do not return. After some time, there is a risk of relapse of the disease.
Hysteroscopic. Surgeons use a hysteroscope in combination with a standard set of instruments. The operation is carried out under video surveillance. Corrections of uterine tissue occur through the vagina, and benign nodes are completely removed.
Laparoscopic. Several incisions are made in the abdominal area. A laparoscope is installed into the formed holes. This surgical intervention does not require sutures and is characterized by a minimum number of possible complications.

In most cases, general anesthesia is used during surgery. After the operation, a minimum set of drugs is prescribed to support the functions of the uterus.

To cure uterine adenomyosis, it is necessary to conduct an examination. This way you can choose the optimal hormonal drugs. Many drugs from this group include a number of contraindications. They cannot be used during pregnancy and lactation, so radical treatment measures in some cases have to be postponed. If you use the prescribed therapy correctly, you can quickly get rid of the manifestations of adenomyosis and gradually defeat the disease.

Video - Treatment of adenomyosis with folk remedies

Adenomyosis of the uterus is relatively uncommon among representatives of the fairer sex and is accompanied by diverse and unpleasant symptoms. Women of reproductive age are predominantly affected, in whom the pathology is manifested by disruptions in the menstrual cycle and pain. It is believed that the most effective method Treatment is surgical, but there are cases where conservative therapy gave good results.

Let's look at the reasons why uterine adenomyosis develops, how it manifests itself in the body and how it is treated. We will also give brief information about the principles of development of the pathological process and whether alternative treatment will help.

For some reasons, including hormonal imbalances, endometrial cells of the uterus penetrate other layers of the organ, and in some cases, spread beyond the anatomical boundaries of its cavity. Most often the ones that come under attack are:

Having left the “native” organ, the endometrial cells of the uterus continue to live and act in accordance with the established menstrual cycle. The immune system perceives them as foreign, which leads to inflammation in the tissues. Further, at the site of inflammatory processes, degenerative changes begin, followed by loss of functions of the affected organ.

The muscular layer of the uterus is most affected, with the formation of glandular formations in it, which leads to a deterioration in the structure and functions of the organ itself. That is why the disease is called “adenomyosis” (“adeno” - gland, “myo” - muscle, “oz” - a prefix used to denote destructive changes).

Modern classification

Using classification, doctors can systematize data about diseases, their symptoms and treatment methods. This helps in conveying information and choosing appropriate treatment strategies. In Russia, it is customary to distinguish 4 stages of development of uterine adenomyosis:

Endometrial cells reach the muscle layer, but do not penetrate it, and therefore the changes end under the mucous membrane.
Degenerative processes begin in the middle of the muscle layer of the organ.
Changes throughout the uterus, down to its outer lining.
Endometrial cells spread outside the uterus.

To facilitate classification, it is customary to divide cases of the disease according to the nature of the lesions. In gynecology, they are distinguished, like stages, into four. Let's look at each in more detail.

Focal form

The penetration of the endometrium into the muscles of the uterus is local, focal in nature. Most often these pathological changes are detected among women entering menopause, as well as at the beginning of it. The age of the patients is 40-50 years.

The focal form is characterized heavy treatment, a tendency to relapse, the formation of fistulas between the uterus and nearby organs. Therapy is long, and the prognosis is always cautious.

Nodal form

The endometrium, penetrating into the muscle layer, forms multiple nodules filled with brown liquid. This is explained by the growth of the glandular layer, which produces fluid during menstruation.

In some cases, this form of the disease can be confused with uterine fibroids. Therefore, careful diagnosis is important: with adenomyosis, the nodules consist of glandular tissue, and with fibroids, they consist of muscles. Nodular adenomyosis most often occurs in women under the age of 25-30 years.

Diffuse form

This is a complex form of the disease in which the endometrium penetrates the muscle layer along all the walls of the uterus. The localization of the lesions is such that their total area is quite significant. The disease is called complex because it cannot be treated with surgical excision of the changed area - due to the diffuse nature of the pathology, life-threatening bleeding can occur.

In most cases, a woman will have to prepare for the fact that the uterus will be completely removed. Considering that diffuse adenomyosis of the uterus most often develops in young girls, and the loss of the uterus leads to irreversible infertility, few can decide to take such a step.

Mixed form

Most often it occurs as a diffuse nodular form. Revealed in most clinical cases, is characterized by a combination of several types of damage to the layers of the uterus. Treatment and its effectiveness for this form of pathology depend on many factors, including the localization of degenerative changes.

Main provoking factors

As of 2018, there is no consensus on the causes of adenomyosis. The disease is detected with equal frequency in women of any age. It is known that damage to the uterine mucosa cannot be a provoking factor - the disease is also diagnosed in those who have not undergone surgery on the organ. However, the reasons that can give rise to this pathology have been established.

Genetic factors

There is a relationship between the health of a woman and her mother, as well as grandmother. The risk of developing adenomyosis increases if someone in your family has had following problems with health:

cancer of one of the organs of the reproductive system;
adenomyosis;
endometriosis.

This information is important for women. If they are at risk, the only preventive measure will be an annual examination by a gynecologist and undergoing necessary examination. Like other diseases, uterine adenomyosis is best treated in the first and second stages of development.

Hormonal disorders

Another factor provoking the disease. It has been established that adenomyosis largely depends on the amount of female hormones and their ratio to the number of male hormones. Therefore, the following situations can cause the disease:

early or late onset of menstruation;
uncontrolled use of hormonal drugs;
constant use of hormonal oral contraceptives.

Hence the second preventive measure - in case of deviation in physiological development, you need to constantly monitor your condition with a doctor, and also not self-medicate and not get carried away with COCs to protect against pregnancy.

Some diseases

Some diseases can provoke the described changes in the cells of the uterus. These health problems include:

chronic intestinal diseases;
excess weight;
allergy.

Inflammatory processes in the ovaries or cervix lead to the formation of scars or adhesions, and therefore can also cause adenomyosis. Another option is a disruption of the immune system, as a result of which one’s own cells are attacked, followed by their degeneration.

The disease can also be caused by some external influences:

ultra-violet rays;
moving from country to country or to different climate zones;
excessive physical activity.

These factors negatively affect the entire female body, including genitourinary system, therefore it is possible that they may be the culprits of uterine adenomyosis.

Symptoms of adenomyosis

Adenomyosis is characterized by frequent asymptomatic and it is discovered by chance during an examination related to another problem. However, the symptoms can be so severe that they prevent a woman from living a full life. Women aged 35-50 years, whose body is gradually weakening, complain most about such problems.

Adenomyosis is characterized by a disorder in different organs and systems, so signs of the disease can be combined into groups.

Painful sensations

If pain occurs with adenomyosis, it is quite serious, this is due to the peculiarity of the pathological process. Endometrial cells seem to have a preset program. Having penetrated the muscles, they grow and are pushed away from the tissues. This causes inflammation, which in turn causes tissue swelling. Next, according to the classical scheme, there is compression of the nerve endings and paroxysmal, severe pain.

With adenomyosis, the character painful sensations diverse. Pain appears:

during menstruation - 2-3 days before the start and the same amount after the end, pain intensifies with old age);
during sexual intercourse;
during the act of defecation;
when urinating;
in the lower abdomen.

The intensity of the pain is so severe that in many cases painkillers do not help. This problem is especially relevant for stages 3 and 4 of nodular and mixed adenomyosis.

Menstruation disorders

Adenomyosis is characterized by a cycle of causes and consequences. The disease causes hormonal imbalance, and this, in turn, prompts a new round of illness. And where hormonal disorders, there are problems with menstruation. In the case of the disease described, they are characterized by:

irregularity - it is impossible to calculate the onset of menstruation;
pain;
nausea;
weakness of the body;
increased gas formation in the intestines.

In some women, 2-3 days before the start of menstruation, a thick, dirty-brown liquid is released from the vagina, and the menstruation itself lasts longer (from 7 days). Some women may experience bleeding from the genitals between menstruation, or more heavy discharge during it.

Signs of anemia

Since adenomyosis is accompanied by heavy bleeding during menstruation, a decrease in blood volume is possible. At the same time, the number of red blood cells decreases, iron deficiency begins, and tissue nutrition is disrupted. Anemia develops, which is manifested by the following symptoms:

malaise;
cracks in the corner of the mouth;
poor condition of hair and nails;
in severe cases, shortness of breath, tinnitus;
pallor of the skin and mucous membranes.

With the described pathology, anemia is insignificant, so such symptoms may be absent. In such a situation, anemia is detected only when laboratory research blood, which is taken into account in the final diagnosis.

Problems with conception and pregnancy

Irregular menstruation leads to ovulation disorders. This, in turn, affects the ability to conceive. With adenomyosis of the uterus, a woman cannot become pregnant for two years and then she is given a disappointing diagnosis of infertility.

However, even if conception occurs “by miracle,” there is a risk of miscarriage. There are also great risks during childbirth - a woman can have serious complications, including uterine rupture.

Signs of intoxication

Inflammatory processes always cause the presence of breakdown products in the blood. The situation is aggravated if a woman voluntarily takes antibiotics or painkillers. In these cases, signs of intoxication are possible:

chills;
temperature rise to 38 0 C;
nausea or vomiting;
dizziness;
pre-fainting state.

The stronger the inflammatory process in the uterus, the more pronounced symptoms of intoxication it will manifest.

Briefly about diagnostics

First, the doctor needs to establish what kind of disorder is occurring in the body. Therefore, diagnostic procedures begin with collecting anamnesis. The doctor will ask the woman in great detail about her lifestyle, previous operations, and existing chronic diseases. The information obtained will help you get a clearer idea of the necessary therapy.

After a survey and visual examination of the genitals, the woman is sent for examination. Depending on capabilities medical institution and necessity, the doctor may choose one or more of the following methods:

Ultrasound of the pelvic organs;
Hysterosalpingography (HSG);
Magnetic resonance imaging (MRI);
Hysteroscopy – examination of the cervix using a special video device;
Laparoscopy – examination of the uterine cavity with an endoscope;
Biopsy if a malignant neoplasm in the organ is suspected.

From the tests it is necessary to donate blood for general analysis and hormonal. The data obtained will help to obtain a clearer picture of the nature of the inflammatory process, the level of hormones, and the level of intoxication. Based on the results of tests and examination, the doctor selects the optimal therapeutic method.

Treatment methods for uterine adenomyosis

Doctors do not prescribe traumatic methods of therapy if there is hope of curing the disease with fewer threats to the body. Therefore, treatment of adenomyosis begins with the use of medications, and only when the fourth stage of the disease is detected, surgical intervention may be required. However, in this case, the basis of training is a course of certain pharmaceuticals.

Use of drugs

Various drugs are prescribed for adenomyosis to relieve pain symptom, reducing the intensity of the inflammatory process, preventing the spread of pathology to nearby organs and tissues. Various drugs are especially widely used when planning pregnancy and in cases of preparation for surgery.

The choice of drugs depends on the course of the disease, existing complications and the general health of the woman. In some cases, the doctor may prescribe it from the remedies listed below.

Capsules "Utrozhestan". Can be used internally or for insertion into the vagina. Treatment regimen: 100–150 mg 2 times a day, 10–12 days.
Farlutal solution in the form of intramuscular injections. The first injection is given on the fifth day of menstruation to prevent conception. Next, injections are carried out in a course of 100 mg twice a day or 50 mg once a day for six months.
Norkolut tablets. Two treatment regimens are used. The first involves the use of 1 tablet per day from the fifth to the 25th day of the cycle for six months. The second is 0.5 tablets every 2-3 weeks for six months.
"Danazol". Dosage 200-800 mg. The exact treatment regimen is determined individually.
Oral contraceptive "Jess". The exact dosage and duration of use are determined by the doctor based on hormonal data.
Esmiya tablets. 1 piece each (5 mg) per day for no more than 3 months. The course starts from the first week of the menstrual cycle.
"Wobenzym" in a dosage of 3-10 tablets 3 times a day.
"Indomethacin". Orally 25 mg 2-3 times a day.
"Longidaza". Subcutaneous or intramuscular injections at a dosage of 3000 IU, 5-10 injections over a course of up to two weeks. Helps fight edema in the uterus and the consequences of inflammatory processes.

Hormonal drugs are always prescribed under the supervision of a doctor. In some cases, hospitalization will be required for timely and constant monitoring of hormonal levels and the general condition of the body. Self-medication in this case is unacceptable and can do more harm than good.

Gentle treatment methods

Often, minimally invasive methods are used to treat uterine adenomyosis. They allow you to reduce the degree of impact on the body, but in some cases exceed the effectiveness of conservative treatment.

Endometrial ablation

This is a relatively gentle method of treating adenomyosis, during which the inner shell uterus with invading epithelial cells. For these purposes, a current of certain parameters is used, as well as low temperatures. The technique helps to avoid internal bleeding, while managing to keep the uterus intact.

There are 4 ablation methods:

Electroablation. A special electrode is inserted into the cervix of a sick woman, to which a current of certain technical parameters is supplied, under the influence of which the degenerative areas of the mucous membrane of the organ are destroyed.
Hydrothermal abolation. Injected into the uterus hot solution, which destroys the mucous membrane.
Microwave ablation. A probe is inserted into the cervix, which is a source of microwave waves, which destroy the pathological focus.
Cryoablation. The endometrium is exposed to liquid nitrogen.

Endometrial abolization is not without serious drawbacks. There is a risk of damage to nearby organs. Also, a woman who has undergone a similar procedure will never be able to conceive a child. Complications include bleeding, which requires immediate medical attention.

FUS – ablation

Unlike previous techniques, FUS (focused ultrasound) does not cause such serious consequences. During a session lasting 3-4 hours, a focused ultrasound beam is directed at the pathological lesions. It does not affect healthy tissue, and at the site of pathology formation it increases the temperature to 85 0C. As a result, the irradiated area of the mucosa evaporates and the blood supply stops.

The advantages of the technique are:

no bleeding;
no need for anesthesia;
absence of scars on the body;
short rehabilitation period;
maintaining the ability to conceive.

The session is carried out under MRI control, so the likelihood of injury to healthy uterine tissue is minimized. FUS abolation of the uterus is prescribed for nodular and focal forms of adenomyosis, including young women for whom it is important to preserve reproductive function.

Uterine artery embolization

Another low-traumatic method of treating uterine adenomyosis, which has very few contraindications. Its essence is to block the lumen of the arteries by introducing a special component into them. After such an effect, the blood flow in the place chosen by the doctor stops, the destructured tissue of the uterus experiences a deficiency of oxygen, as a result of which it dies.

Uterine artery embolization has many advantages:

the intensity of symptoms decreases immediately after manipulation;
there is no need for general anesthesia;
the ability to conceive and bear a child is preserved.

After exposure, the sick woman recovers very quickly, and a year after UAE, the number and size of nodes in the muscle layer decreases fourfold. Such tactics for treating uterine adenomyosis allow women to plan a pregnancy in the future and are not a source of threat to life and health.

Surgery

If for some reason minimally invasive methods of treating adenomyosis are contraindicated, and drug therapy does not produce a positive result, surgical intervention will be required. It is usually carried out at the fourth stage or after preliminary physiotherapeutic treatment of pathological areas of the uterus.

Indications for surgical treatment of the uterus for adenomyosis are:

lack of positive effect from taking hormones for six months;
formation of adhesions - areas connective tissue between the organs of the reproductive system;
detection of uterine fibroids (benign neoplasm);
copious discharge of blood, the intensity of which is not affected by drugs;
contraindications to hormonal therapy;
potential threat of cancer formation.

The operation can be organ-preserving. In this case, only significantly damaged areas of the uterine walls are removed, preserving most of the organ. The operation is performed using laparoscopic access (through minor punctures in the skin of the abdomen). Therefore, after surgical treatment, the scars are almost invisible. Organ-sparing laparoscopic surgery does not affect a woman’s ability to conceive and bear a child.

In especially severe cases, a gastrectomy is performed, that is, complete removal of the uterus. The ovaries are either preserved or removed along with it. Such interference can lead to loss of femininity, and the ability to bear children also disappears.

The consequence of the operation is posthysterectomy syndrome. It manifests itself in the following problems:

lethargy;
rapid heartbeat;
hyperhidrosis;
development of edema;
increased fatigue.

Taking into account this factor, as well as possible psycho-emotional problems, gastrectomy is prescribed only in cases where there is a significant threat to the woman’s life.

Is it possible to treat with folk remedies?

Adenomyosis of the uterus is often caused by a disorder hormonal levels, and irreversible degenerative processes occur in the walls of the organ. Therefore, it will not be possible to cure the disease using traditional methods - not a single plant has the ability to restore such disorders in tissues.

However, in an integrated approach to therapy, you can use some drugs that stimulate the immune system, have an anti-inflammatory effect and are sources of vitamins. Such therapy will help a woman more easily endure the consequences of adenomyosis, reduce the intensity of symptoms, and help her recover after surgery on the uterus.

Before starting therapy, it is better to obtain the advice and approval of your doctor. It wouldn't hurt to take an allergy test - some plant components are strong allergens and can cause serious complications, including anaphylactic shock. It is also important not to deviate from the traditional treatment regimen, but to use traditional medicine methods in combination.

Conclusion

Uterine adenoma is well treated in the early stages. The earlier therapy is started, the lower the risk of losing the ability to conceive a child, so a woman should pay close attention to the symptoms and do not hesitate to visit a doctor. This disease cannot be self-medicated, so you need to trust a competent medical specialist.

What is adenomyosis? A pathology in which the internal mucous membrane, the endometrium, penetrates deep into the muscular layer of the organ, it is also called adenomyosis of the uterine body.

Also considered a special case of endometriosis - internal endometriosis, because they develop according to the same pattern: the endometrium grows where it is not supposed to. In the case of endometriosis, the lesions can affect the fallopian tubes, cervix, ovaries, urinary system, etc. Often these two diseases can occur simultaneously.

This is a hormone-dependent disease, most often occurs in patients of childbearing age after 26-36 years, and disappears after the onset of menopause. Accompanied by heavy, prolonged menstruation with severe pain, brownish discharge during the intermenstrual period.

Causes of adenomyosis

Nowadays, there is no unambiguous evidence of the formation of this pathology, but there are assumptions on which modern medicine relies:

hormones (prolactin, progesterone, estrogen, FSH) – their imbalance;
immune system disorder;
endocrine system disorder;
abortions;
use of gynecological coils;
genetics;
operations on the uterus;
C-section;
obesity;
stress;
genitourinary system infections;
low activity lifestyle;
high physical activity;
excessive use of sunbathing and solariums.

When you consult a doctor, you will be able to find out a clearer picture of the causes in each specific case.

Symptoms of uterine adenomyosis

Often it exists without special features, that's why you need to attend routine checkups with your doctor regularly. The following indicators are considered the main symptoms:

heavy periods, accompanied by severe pain and clots;
irregular menstruation;
brownish discharge during the intermenstrual period, or a couple of days before the start of menstruation and at the end;
increase in size, especially in the first days of menstruation;
spasms in the pelvic area;
pain that occurs during intimacy;
infertility;
anemia, which appears due to severe bleeding, manifests itself as drowsiness, increased fatigue, pale skin, frequent colds;
manifestation of increased nervousness.

The choice of treatment regimen for adenomyosis largely depends on the symptoms, so it is important to consider each.

There are several forms of the disease:

focal - with it, separate areas (foci) appear that penetrate the myometrium;
nodular - here nodes are formed in the muscle layer;
diffuse – penetration occurs evenly throughout the myometrium;
mixed - a combination of nodular and diffuse.

Depending on the depth of endometrial penetration, 4 stages are distinguished:

1st degree – the submucosal layer of the organ is affected.

2nd degree – no more than half of the myometrium is captured.

Grade 3 – more than half of the myometrium is affected.

Grade 4 – the entire muscle layer is affected.

Uterine fibroids in combination with adenomyosis

Myoma is a benign tumor. It is formed due to the division of muscle cells under the influence of a number of factors, which leads to the appearance of new cells that form a node (myoma).

These are two female gynecological ailments that have much in common, they have the same nature of origin, and are often combined together.

Causes:

hormonal imbalance;
chronic infectious diseases;
immune disorder;
abortions;
heredity;
gynecological painful conditions in advanced form.

Why is this combination dangerous?

As a rule, this occurs in patients of reproductive age, which entails disorders:

infertility;
miscarriages;
abortion.

If you consult a doctor in time, you can stop the proliferation of cells without serious complications. In its advanced form, this pathology entails removal of the organ.

Adenomyosis and pregnancy

Often this painful condition is the cause of infertility, despite this, complex therapy often gives a positive outcome. Pregnant patients are at risk because the threat of abortion with such a diagnosis remains. Careful observations and timely correction of violations are important here, which will avoid bad consequences.

Often pregnancy offers a chance to cure this pathology. The fact is that the body accepts this condition as menopause, endometrial cells stop growing. However, the disease will not disappear completely.

Each case of pregnancy is unique and depends on many factors: form, degree, presence of fibroids and other complications, so therapy is individual for everyone.

This disease does not affect the intrauterine development of the fetus; correction of well-being is aimed at eliminating the threat of miscarriage and termination of pregnancy.

Diagnostics

One of the main factors in choosing treatment for adenomyosis is its diagnosis. Due to the fact that this disease is of the same nature as others, a thorough examination is necessary.

The first thing to do is to visit a doctor, based on the patient’s complaints and examination using mirrors, he can make a preliminary diagnosis. This procedure should be done on the eve of menstruation. If the doctor sees that the organ is enlarged 2-3 times, has a bumpy surface or nodes, and the presence of heavy and painful periods, then to identify a more accurate picture (determine the type and stage) he prescribes a number of other examinations. These include: taking a smear, blood test for hormones (prolactin, testosterone, progesterone, estradiol), ultrasound (ultrasound), transvaginal examination, hysteroscopy (a type of examination of diffuse adenomyosis of the uterus), colposcopy (examination of the cervix), MRI (magnetic resonance tomography).

Ultrasound allows you to examine the internal genital organs, see their changes and pathologies. The most effective is transvaginal examination for this disease.

What echographic signs of adenomyosis can be seen on ultrasound?

increase in the size of the uterus (corresponding to six weeks of pregnancy);
uneven wall thickness;
spherical shape, as a result of an increase in its walls;
cystic formations.

Echosigns of adenomyosis enable a specialist to accurately diagnose this disease.

Hysteroscopy is a more thorough examination for diffuse adenomyosis; it serves to exclude other pathologies (fibroids, malignant neoplasms, etc.).

MRI is the most thorough method of examination, because with it, the structure of the myometrium can be determined. Using it, you can determine the presence of foci, nodes, and the thickness of the myometrium.

Can adenomyosis be cured?

The diagnosis of adenomyosis is not fatal, in most cases it does not cause serious complications. Therefore, not all patients are prescribed therapy. It is not necessary if:

diagnosed accidentally during a routine examination;
the signs are mild and do not affect the quality of life;
premenopausal patients, if symptoms do not bother you.

It is impossible to completely get rid of this disease with the help of drug therapy, she only fights the symptoms. Only through surgical intervention - removal of an organ - can you get rid of the disease.

How to treat uterine adenomyosis

There are several types: conservative, surgical and combined. The choice of method depends on the degree, form, neglect of the condition, complications of other diseases, and whether the woman wants to have children in the future. Taking all these circumstances into account, only a doctor can offer the most effective therapy, you should not self-medicate.

The conservative type includes hormone therapy, immunotherapy, the use of anti-inflammatory drugs, and vitamins.

The use of anti-inflammatory drugs is aimed at reducing pain in the lower abdomen (prescribing Ibuprofen, Ketoprofen).

Hormone therapy is based on the use of hormonal agents.

Goserelin, Buserelin, Sinarel, the action of these hormones is aimed at temporarily stopping menstruation (artificial menopause), which leads to a reduction in endometrial foci, and symptoms weaken. The duration of the course is no more than 6 months

Treatment with duphaston has a positive effect, because it turns out to be a synthetic analogue female hormone progesterone, which aims to improve the regularity of the menstrual cycle, can completely eliminate the signs of the disease. Application period is 6-9 months.

Contraceptive drugs (Yarina, Zhanine, etc.) - ensure the constancy of the cycle, reduce uterine bleeding, relieve pain during menstruation, and spotting between cycles disappears.

In a timely manner, established diagnosis in grades 1 and 2, in most cases, it can be treated with conservative therapy. All drugs for the treatment of adenomyosis and their dosage are prescribed strictly by a doctor.

Surgical treatment of uterine adenomyosis includes hysterectomy (complete removal of the organ) and laparoscopy (removal of lesions while preserving the uterus). The type of surgical intervention is determined by a specialist.

When is surgery used?

If conservative look does not give results;
contraindications to hormone therapy;
adenomyosis grade 3-4;
adenomyosis in combination with other pathologies (fibroids, cervical diseases);
ovarian tumor;
nodular form of the disease;
severe anemia.

Treatment with folk remedies

Alternative medicine methods also have a therapeutic effect ( herbal infusions, douching, blue clay compresses, leeches). About efficiency this method They say positive reviews on the forums.

Herbs can really normalize hormonal balance, have an anti-inflammatory effect, and can reduce uterine bleeding, regulate metabolism, have a calming effect. It is worth knowing that you cannot combine hormone therapy with traditional methods.

The main herbs are: hogweed, cinquefoil, shepherd's purse, cinquefoil root, calamus and serpentine root, knotweed grass, nettle leaves, white willow bark, Abraham tree, angelica, black cohosh, wild yam, tansy, plantain leaves, viburnum and oak bark, St. John's wort, licorice root. Decoctions are prepared according to the instructions indicated on the package. It is important to take into account the phase of the menstrual cycle, because... Some herbs are taken at the beginning, and others a few days after the end of menstruation.

Blue clay is an effective means of combating this disease. Warm compresses are made from it and applied to the lower abdomen. This procedure is carried out over three weeks, you need to choose the time between menstruation. Clay helps reduce signs of illness.

Treatment of adenomyosis with leeches

Hirudotherapy is a method of healing with leeches. Every year this method becomes more popular, because... gives a positive effect. When using this technique, the process of restoration of the body begins, good absorption of medications is ensured, and has a strengthening effect on the immune system. Only medical leeches can be used; others will not give a positive result. The leech is used once and then disposed of. Hirudotherapy is prescribed by the attending physician, because This method has a number of contraindications; a specialist will be able to weigh the pros and cons and make a decision when prescribing the method.

What is adenomyosis - video

Prevention

In most cases, women visit a gynecologist if something worries them, or during pregnancy. This attitude leads to irreversible consequences, because often the disease occurs without any symptoms. Detection of pathology in the early stages can be treated conservatively without further consequences. Therefore, women need to visit a gynecologist 2 times a year.

If you have a hard job physically or emotionally, you experience constant stress, and as a result, pain in the lower abdomen, then experts recommend resting more often, getting out of stress conditions using relaxation procedures. This will reduce the risk of developing this disease.

It is worth limiting the use of sunbathing or visiting a solarium.

If you are attentive and listen well to your body, promptly pay attention and respond to changes that arise, you can significantly reduce the likelihood of developing gynecological abnormalities.