What does a spherical uterus mean? Adenomyosis. Causes, symptoms, diagnosis and treatment of pathology

Most often it occurs in women over 35 years of age, but congenitality of the disease cannot be ruled out.

What is adenomyosis?

Adenomyosis and endometriosis are often compared with each other. And if endometriosis is the attachment of endometrial cells to the most different organs, then adenomyosis is their penetration into the muscular, next layer of the uterus.

Cell penetration provokes defensive reaction immune system. She perceives them as strangers, and the walls of the uterus begin to gradually thicken in order to prevent foreign invasion. This protection explains the description of the shape of the uterus in the form of a ball in adenomyosis. Thickening of the walls increases the size of the organ and leads to the transformation of the organ into a ball.

This fight of the immune system with “foreign” cells depletes it, causing infertility. Although pregnancy is still possible in some cases.

During menstruation, ingrown endometrial cells cannot come out. Remaining inside, they only swell and provoke hemorrhage into the muscle layer of the uterus.

Causes of adenomyosis

Doctors identify several main causes of the disease:

• Abortions, curettages.
• C-section. Surgery increases the risk of endometrial cells spreading to other organs of the reproductive system.
• Chronic stress.
• Abuse of solarium, sunbathing, mud therapy (baths).

Symptoms of adenomyosis

Adenomyosis sometimes it is asymptomatic. But it is usually accompanied by the following symptoms:

• pain during sexual intercourse (dyspareunia);
• prolonged, heavy discharge during menstruation (in 40% of patients);
• brownish, dark discharge before and after menstruation;
• violation menstrual cycle(usually its abbreviation);
• pain in the pelvic area before, during and after menstruation;
• enlargement of the uterus to a size comparable to the 5th or 6th week of pregnancy.

If any of these symptoms occur, contact your doctor immediately.

Diagnosis of adenomyosis

To identify adenomyosis, the following is carried out:

• gynecological examination genitals using mirrors;
• hysteroscopy (examination using an optical device);
• examination by a gastroenterologist, endocrinologist and cardiologist (on the recommendation of a gynecologist).

Treatment of adenomyosis

Stage of adenomyosis disease, woman’s age, general state her health, the degree of damage muscle tissue uterus allows you to choose one or another treatment for adenomyosis. But in general, there are only two types of treatment:

• medication - successful in the early stages, without complications; medications normalize hormonal balance ( hormonal drugs) and restores the immune system (immunomodulatory drugs);
• surgical - recommended from the 3rd stage of the disease; the scope of surgical intervention depends on each specific case; the operation restores the anatomical structure of the organ and removes as many areas of inflammation as possible; after discharge, a doctor’s examination is required every 7-10 days; pregnancy must occur within 2 years; multiple lesions portend infertility even after surgery;
• electrocoagulation is a new method of eliminating lesions with anesthesia.

An absolute cure from adenomyosis is stated only in the case of a regular menstrual cycle, absence of discharge, pain during intercourse and relapses for 5 years.

To prevent adenomyosis, it is extremely important to undergo regular examinations with a gynecologist, learn to relieve stress and not overuse tanning.

Adenomyosis is one of the most common gynecological diseases. It is also called differently internal endometriosis.

It is with the development of adenomyosis that most cases of constant pain in the lower abdomen in women are associated reproductive age.

With this pathology, the cells lining the inner layer of the uterus begin to grow, going beyond their usual location.

In internal endometriosis, or adenomyosis of the uterus, the endometrium (the layer of cells lining the uterine cavity) grows into the myometrium (the muscular layer of the uterus).

In this case, the uterus takes on a round or spherical shape and increases significantly in size, often reaching the size of the uterus at 5-6 weeks of pregnancy.

Endometrial cells that end up in the muscle layer disrupt its normal functioning. This is the main danger of this disease.

This is a hormone-dependent disease, i.e. it is caused by an imbalance and relationship between certain hormones in a woman’s body.

The epithelium lining the inner surface of the uterus can penetrate the muscle layer to different depths. Depending on this, a certain stage of adenomyosis is distinguished.

The first stage is characterized by the germination of endometrial cells within the boundaries of the submucosal layer, i.e. without reaching the myometrium itself.

The second stage is characterized by germination of the endometrium to half of the myometrium (the muscular lining of the uterus).

The onset of the third stage, or degree, of adenomyosis is diagnosed when endometrial cells have grown into the muscle layer to more than half its thickness.

At the fourth stage, the endometrium grows through the wall of the uterus, reaching its serous membrane, and then, in the absence of treatment, the pathological process also affects the peritoneum. This is the most advanced stage.

Forms of adenomyosis

There are not only different stages (degrees), but also different forms of adenomyosis.

Diffuse form of adenomyosis– characterized by the fact that endometrial tissue grows into the myometrium evenly, without forming separate isolated areas.

Focal form- characterized by the fact that germination does not occur over the entire surface of the border between the inner and middle membranes of the uterus, but focally - only in some areas.

In this case, the stages of the disease are determined depending on the number of these areas and the depth of germination of the endometrium into the muscular layer.

Mixed form is a cross between the two options described above.

The form of adenomyosis is determined based on ultrasound or CT data.

Causes of adenomyosis development

If we talk about the reasons for the development of adenomatosis, then they all boil down to the fact that they lead either to a violation of the integrity, traumatization of the endometrium, or to a hormonal imbalance. In fact, the main, leading cause of the development of adenomyosis is still hormonal imbalance. It is this factor that is primary and underlies the pathogenesis of this pathology.

Another important factor is hereditary predisposition. It creates a certain background that contributes to the development of this type of pathology. That is why, when patients are exposed to provoking factors, adenomyosis develops only in some of them.

Too late or too early start menstruation– another important factor. However, as mentioned above, it is rather a consequence, a manifestation of hormonal imbalance or a tendency to develop it, which is already present in the patient.

Obesity. Obesity contributes to metabolic disorders in the body. The human body is integral, so isolated pathology is hardly possible.

If a pathology occurs in one organ or system, then, as a rule, this will somehow affect the functioning of the entire organism. This is especially true for obesity, when several systems are involved in the pathological process: endocrine, digestive, cardiovascular and reproductive.

The whole point is that fat cells produce estrogen-like substances that disrupt the hormonal balance throughout the body.

In addition, obesity leads to metabolic disorders throughout the body, with almost all organs and tissues affected.

Too much late start sexual life. Oddly enough, this factor also plays a role in the development of uterine adenomyosis. The onset of sexual activity triggers a number of changes in a woman’s hormonal background.

And if in Soviet times, the beginning of sexual activity at the age of 16 was considered almost shameless, now this state of affairs is a classic, the norm. And you will hardly surprise anyone with a girl who lost her virginity at 14 or even 13 years old.

But when is it too late for “this” thing? Here the views of doctors differ. It is generally accepted that the onset of sexual activity after 25 years can already be considered late and hormonal imbalance in such cases cannot be avoided.

Late pregnancy and late or complicated childbirth are also a factor in the development of adenomyosis, since they play a significant role in hormonal changes in a woman’s body.

Abortions, curettages or other manipulations inside the uterine cavity. Often, these procedures cause mechanical trauma to the endometrium, the epithelium lining the uterine cavity. It is precisely such micro-traumas that can become trigger mechanism, triggering a chain of pathological changes leading to the growth of the endometrium into the myometrium.

. It is not only the installation that is dangerous intrauterine device, which (as described above) can lead to mitrotraumatization of the endometrium, oddly enough, the factor that provokes adenomyosis is one of the most common methods of contraception - taking contraceptives.

This is due to the fact that contraception of this kind is provided by taking low doses of sex hormones, which, although to a small extent and in low doses, still change hormonal background women influence him.

Chronic inflammatory diseases of the genitourinary system. It is widely known that a chronic inflammatory process does not lead to good, and yet, millions of women continue to initiate treatment for various types of adnexitis, cystitis, etc., explaining this by lack of time, funds and other reasons.

A chronic inflammation meanwhile, it progresses like an echo, echoing in the work of other organs, disrupting the structure of the inflamed organ and invariably leading to disruption of its function.

Serious physical activity also serve as a serious risk factor for the development of adenomyosis. The female body is not adapted for heavy physical labor, carrying heavy loads, therefore, if a woman is engaged in this kind of work, the risk of developing adenomyosis increases many times over.

Constant stress. It’s not for nothing that there is an old saying: “all diseases come from nerves.” Psychological condition a person undoubtedly plays a huge role in the development of one or another pathology. And if so we're talking about about the female body, namely the reproductive system, then everything here is even more subtle and sensitive to external influences.

The constant negative impact of stress is quite enough for a woman to develop adenomyosis, and more than once. That is why it is so important for the doctor to ask the patient in detail about the psychological climate in her family, her living conditions, and negative social factors that could potentially affect her health.

Extragenital pathology. The development of adenomyosis is also greatly influenced by the presence of extragenital pathology in the patient, i.e. others, concomitant diseases, which influence the course of adenomyosis or contribute to its development.

Symptoms

The symptoms of this disease are very varied. From a sluggish form of chronic adenomyosis, which practically does not manifest itself at all, to serious complications leading to hospitalization of the patient.

• Heavy menstrual bleeding is quite characteristic symptom adenomyosis. The danger of this condition, in addition to the significant discomfort of the woman herself, is the threat of developing anemia, which aggravates the patient’s condition. Especially in the case of advanced, untreated adenomyosis.
• Brownish discharge between periods. Some women mistake this discharge for an early onset of menstruation. Such mini-bleedings also contribute to the development of anemia and cause significant discomfort to the woman.
• Dyspareunia - this “terrible” medical term is called sharp pains during sexual intercourse. This often becomes a serious problem for both partners. This Very common reason a woman seeks help from a doctor, since such symptoms of adenomyosis become a cause of concern for a married couple and require immediate resolution. It is this, and not other symptoms, that often cause a patient to see a doctor.
• Intense pain in the lower abdomen immediately before, during and immediately after menstruation . Troubles such as pain during menstruation are more than common. In this regard, many women believe that these types of symptoms are not a sufficient reason to see a doctor and silently heroically endure the torment, washing down the pain that torments them with handfuls of painkillers. This approach is fundamentally wrong, since it can lead to more serious complications of adenomyosis in a woman.
• Disruptions in the well-functioning menstrual cycle. Most often, it becomes shorter, thereby bringing additional inconvenience to the woman;
• An instrumental examination reveals a significant increase in the size of the uterus. This can also be determined by palpation, when examining a woman by a gynecologist;

The most common symptoms of adenomyosis are quite easily confused with signs of other diseases.

Treatment

Treatment of this disease is often lengthy and requires a lot of patience, both on the part of the patient and on the part of the doctor treating her.

Therapy for adenomyosis can be divided into two main areas:

• conservative treatment
• surgery

Conservative treatment primarily means drug treatment. In this case, the woman is prescribed various types of hormonal drugs. These are both progestogens and androgens; including very effective in this case can be oral agents for contraception.

With the help of these drugs, it is possible to correct the hormonal imbalance present in a woman’s body. Well, when normal hormonal levels are restored, the doctor should pay attention to the main reason that led to this imbalance.

Methods surgical treatment adenomyosis can be extremely radical, including removal of the uterus. For this reason, most doctors still try to avoid this type of surgical intervention and place all their hopes on conservative treatment.

However, recently, more and more opponents of such radical methods of surgical intervention for adenomyosis have appeared among surgeons. In this regard, a number of organ-saving surgical techniques for this disease have been developed. Such organ-saving operations are performed by hysteroscopy and laparoscopically.

Internal endometriosis (adenomyosis) is a disease of the uterus in which the endometrium, its inner mucous membrane, grows into other layers of the organ.

Most often, endometriosis nodes have a dense consistency, since growth occurs around them connective tissue. Such nodes are similar to benign encapsulated formations, however, endometrial cells may also be located outside the capsule-like connective tissue growths.

The mixed nodular-diffuse form is morphologically represented by both types of elements.

What signs are used to determine the degree of adenomyosis of the uterine body?
What is uterine adenomyosis grades 1, 2, 3 and 4?

The classification of adenomyosis by degree of prevalence is not international, but it is quite convenient, and therefore is often found in the domestic literature and is carried out in practice.

The degree of severity in this classification is determined by the depth of penetration of endometrial cells into the underlying layers of the uterus (used exclusively in relation to the diffuse form of adenomyosis of the uterine body).
I. Diffuse proliferation of endometrial cells in the submucosal layer of the uterus.
II. The pathological process penetrated into the muscular layer of the uterus, but captured no more than half of this layer.
III. The muscle layer is involved in the pathological process by more than half.
IV. Proliferation of endometrial cells outside the muscular layer, in the serosa of the uterus, with further transition to the peritoneum and involvement of the pelvic organs in the process.

What is the danger of adenomyosis (endometriosis)?

Endometriosis is considered benign hyperplasia (pathological growth of tissue), since endometrial cells that have migrated to other organs and tissues retain their genetic structure. However, such characteristics as the ability to germinate into other organs, the tendency to spread throughout the body and resistance to external influence– they are related to malignant tumors.

The word “benign” also speaks about the prognosis of the disease - it lasts for years and decades, as a rule, without leading to severe depletion of the body and death. However, as in the case of malignant hyperplasia (cancer, sarcoma, etc.), adenomyosis (endometriosis) is difficult to treat conservatively, and operations for this pathology are much more extensive than in the case of benign tumors, since it is difficult to determine the boundary between diseased and healthy tissue.

The most common complication of adenomyosis is due to the fact that endometrial cells functioning in accordance with the monthly cycle lead to heavy bleeding, which is fraught with the development of acute and/or chronic anemia. In some cases, patients have to be hospitalized and even undergo emergency surgery for life-threatening bleeding.

Adenomyosis is prone to spreading the process to other organs and tissues, leading to systemic lesions. With the extragenital location of endometrial cells, a number of complications are possible that require emergency medical intervention (intestinal obstruction in endometriosis gastrointestinal tract, hemothorax (filling of the pleural cavity with blood) with endometriosis of the lung, etc.).

And finally, another danger of endometriosis in general, and adenomyosis in particular, is the threat of malignant genetic transformation of the migrated cells. Such a transformation is very real, since any hyperplasia has a more or less pronounced tendency to malignancy, and in a new place, endometrial cells are forced to exist in extremely unfavorable conditions.

How many women suffer from adenomyosis?

In terms of prevalence, endometriosis ranks third among gynecological diseases (after inflammatory lesions of the appendages and uterine fibroids).

The incidence of endometriosis is about 20-90% (according to various sources). Such a scatter of digital data should not raise suspicions. The fact is that many researchers include subclinical (asymptomatic) forms of the disease in these figures. According to clinical data, asymptomatic endometriosis accounts for up to 45% of all cases of pathology, and is detected during the study of women who seek help due to infertility. Since endometriosis does not lead to infertility in all cases, one can only guess about the number of women with endometriosis. Hence the inaccuracy of figures on the prevalence of pathology.

Endometriosis most often occurs in women of reproductive age, but in some cases it is diagnosed in adolescents, as well as in menopausal women taking hormone replacement therapy. Previously, it was believed that the peak incidence occurs in late reproductive age and premenopause, but studies have appeared that refute this statement.

IN last decades There has been a marked increase in the incidence of endometriosis. This is explained, on the one hand, by a violation of the immunological status of the population under the influence of many reasons ( ecological problems, stress, etc.), and on the other hand, the introduction of the latest diagnostic methods, which have sharply increased the detection of mild and asymptomatic forms (laparoscopy, nuclear magnetic resonance imaging, transvaginal ultrasound scanning).

What causes the development of adenomyosis?

Unfortunately, the causes and underlying mechanisms of development of endometriosis (adenomyosis) have not been fully studied to date.

All we can say with certainty is that endometriosis is a hormonally dependent disease, the development of which is facilitated by disturbances in the functioning of the immune system.
Risk factors for developing adenomyosis include:

• unfavorable heredity for endometriosis, as well as benign and malignant tumors of the female genital area;
• too early or late onset of menstruation;
• late onset of sexual activity;
• late birth;
• complicated childbirth;
• various manipulations on the uterus (abortion, diagnostic curettage);
• use of an intrauterine device;
• use of oral contraceptives;
• inflammatory diseases of the uterus and appendages, dysfunctional bleeding, especially if there have been surgical interventions and/or long-term hormonal therapy;
• the presence of systemic extragenital diseases (hypertension, diseases of the gastrointestinal tract);
• frequent infectious diseases, allergic reactions indicating a dysfunction of the immune system;
• low socioeconomic status;
• hard physical labor;
• stress, sedentary lifestyle life;
• living in an environmentally unfavorable region.

Symptoms of uterine adenomyosis

The main and pathognomic (characteristic only for this disease) sign of adenomyosis is heavy and/or prolonged menstrual bleeding, leading to secondary iron deficiency anemia.

Anemia, in turn, is manifested by the following symptoms:

• weakness;
• tendency to various infectious diseases;
• pallor skin and visible mucous membranes;
• V severe cases- shortness of breath with little physical exertion;
• a sharp decrease in performance and the ability to adequately assess one’s own condition.

Symptoms pathognomic for adenomyosis also include the appearance of brown spotting 2-3 days before the onset of menstruation, and 2-3 days after it.

With common forms of adenomyosis, metrorrhagia can develop - uterine bleeding that occurs in the middle of the menstrual cycle.

Another characteristic sign of adenomyosis is pain syndrome, which occurs a few days before the onset of menstruation and, as a rule, disappears 2-3 days after its onset (dysmenorrhea or algomenorrhea).

The nature and severity of pain depends on the location of the process. Particularly severe pain syndrome is observed with damage to the uterine isthmus, as well as in the case of widespread adenomyosis with the development adhesive process.

Adenomyosis often occurs with a pathology such as the accessory horn of the uterus, when affected by endometriosis, the clinic may resemble an acute abdomen (menstrual blood is thrown into the pelvic cavity and causes symptoms of peritonitis).

Based on the irradiation of pain, it is often possible to determine the localization of the pathological process. So, when the angle of the uterus is affected, the pain is referred to the corresponding groin area, and if the isthmus is affected - into the vagina or rectum.

Another characteristic symptom of adenomyosis is pain during sexual intercourse, especially on the eve of menstruation (most often found when the isthmus of the uterus is affected).

Clinical examination of patients with adenomyosis reveals an enlarged uterus, especially pronounced before menstruation and in the first days of the menstrual cycle. The diffuse form is characterized by a “spherical” uterus. With nodular adenomyosis, it is sometimes possible to palpate the nodes.

It should be noted that the severity of the symptoms of adenomyosis to a certain extent depends on the extent of the process. Thus, grade 1 diffuse adenomyosis is an accidental finding during certain examinations and is asymptomatic. However, with diffuse adenomyosis of degrees 2 and 3, as well as with the nodular form of adenomyosis, the severity of clinical symptoms does not always coincide with the extent of the process and the size of the nodes.

How does adenomyosis occur in combination with uterine fibroids?

The probability of a combination of adenomyosis with uterine fibroids is very high (up to 85%, according to some authors), which is explained by similar mechanisms of development of these pathologies.

The enlargement of the uterus in such cases, as a rule, corresponds to the size of the fibroid. The size of the organ does not return to normal after menstruation, as happens with isolated diffuse adenomyosis.

However, other symptoms of adenomyosis when combined with fibroids do not undergo significant changes. The exception is uterine fibroids with submucosal nodes; in such cases, heavy acyclic uterine bleeding is observed.

The combination of adenomyosis with uterine fibroids is difficult to treat conservatively, therefore, it is with this combination of pathologies that patients are most often advised to decide on a hysterectomy (removal of the uterus).

Signs of a combination of adenomyosis and ovarian endometriosis

Adenomyosis is often combined with ovarian endometriosis, which is explained by the spread of the process to them from the uterine cavity. Many researchers suggest that the formation of endometrial growths on the ovaries is associated with reflux through the fallopian tubes menstrual blood containing living endometrial cells capable of proliferation.

Based on the prevalence of the process, there are four degrees of ovarian endometriosis:
I. Point foci of endometriosis on the surface of the ovary and on the peritoneum, in the recess between the uterus and rectum.
II. One-sided endometroid cyst no larger than 6 cm in size, adhesions in the area of ​​the uterine appendages without involving the intestines.
III. Bilateral endometroid cysts up to 6 cm in size, pronounced adhesions involving the intestines.
IV. Large bilateral cysts, transition of the process to the bladder and colon, a common adhesive process.

When endometriosis spreads from the uterine cavity to the ovaries, a whole group of symptoms joins the signs of adenomyosis.

First of all, the pain syndrome is transformed. Unlike adenomyosis, the pain is constant and periodically intensifying. The maximum increase in pain is typical for the beginning of menstruation and the period of ovulation (the release of a mature egg from the follicle in the middle of the menstrual cycle). Pain in ovarian endometriosis is localized in the lower abdomen, in the projection of the uterine appendages, has an aching or pulling character, and radiates to the lumbar region, sacrum, and rectum.

For adenomyosis combined with ovarian endometriosis, severe premenstrual syndrome is more typical, often accompanied by nausea, vomiting, coldness of the extremities, and a sharp decrease in ability to work. In the first days of menstruation, low-grade fever and changes in laboratory parameters of the general blood test (increased number of leukocytes and ESR) are possible.

With the development of the adhesive process, disturbances in the functioning of the intestines and bladder may occur (constipation, frequent and painful urination).

During a clinical examination, palpation of the appendages reveals their enlargement and pain; sometimes it is possible to palpate endometriotic ovarian cysts. Cysts are palpated, as a rule, with a size of more than 6 cm on the side and/or posterior to the uterus, as tumor-like formations of a dense elastic consistency, immobile due to the development of the adhesive process, sharply painful, especially on the eve of and during menstruation.

For an accurate diagnosis, the same types of studies are necessary as for isolated adenomyosis.

What tests are used to diagnose adenomyosis?

Of primary importance for correct diagnosis is the collection of anamnesis to determine the existence of risk factors in a given patient (unfavorable heredity, surgical manipulations on the uterus, certain somatic diseases, etc.) and analysis of complaints (abundant and/or long periods accompanied by severe pain, pain during sexual intercourse, symptoms of anemia).

Then the doctor conducts a physical examination (examination on a gynecological chair), during which, in the case of adenomyosis, a spherical enlargement of the uterus is usually detected, corresponding to 8-10 weeks of pregnancy (rarely more). The examination is best done on the eve of menstruation, since this is when the enlargement of the uterus is most noticeable. With the nodular form of adenomyosis, it is often possible to palpate the nodes or tuberosity of the surface of the uterus.

As a rule, a thorough history taking with analysis of the data obtained, supplemented by a physical examination, makes it possible to correctly make a preliminary diagnosis of internal endometriosis of the uterus (adenomyosis).

To clarify the diagnosis, in particular to determine the localization and extent of the process, additional instrumental studies, allowing us to decide on further treatment tactics for the patient.

The gold standard for testing for suspected adenomyosis is an ultrasound scan. In addition, examination methods such as nuclear magnetic resonance, hysterosalpingography and hysteroscopy are often used.

What are the echo signs of adenomyosis?

Among all types of echography (ultrasound), transvaginal ultrasound scanning is the most informative for adenomyosis. The diagnostic accuracy of this examination method exceeds 90%.

If adenomyosis is suspected, it is best to carry out echography on the eve of menstruation (on the 23-25th days of the cycle).

Over the many years of development of ultrasound diagnostics, the following pathognomic echo signs of internal endometriosis (adenomyosis) of the uterus have become generally accepted:
1. An increase in the anterior-posterior size of the uterus, as a result of which the organ acquires a spherical shape.
2. Enlargement of the uterus up to 6 weeks of pregnancy or more.
3. Asymmetry of wall thickness.
4. The appearance of cystic cavities measuring 3-5 mm or more in the muscular lining of the uterus on the eve of menstruation.

What treatment is prescribed for uterine adenomyosis?

Adenomyosis is not a disease of a single organ, but a chronic disease systemic disease body. Therefore, when treating pathology, a purely individual approach is needed, taking into account all the mechanisms of the occurrence and development of the disease in a particular patient.

Thus, when choosing a therapy method, many factors are taken into account, primarily:

• the patient’s age and her desire to have children in the future;
• localization and prevalence of the pathological process;
• the severity of the clinical picture and the risk of complications;
• general condition of the body (presence of concomitant diseases, state of the immune system, etc.);
• duration of adenomyosis.

All medical measures to combat adenomyosis can be classified as follows:
I. Surgery:

• radical (removal of the uterus and ovaries);
• organ-preserving (laparoscopy and excision of endometroid lesions).

II. Conservative treatment:

• nonspecific anti-inflammatory therapy;
• sedatives (calming) drugs;
• vitamin therapy;
• maintaining liver function;
• elimination of anemia;
• immunomodulators;
• resorption therapy;

III. Combined treatment.

The general algorithm for treating patients with adenomyosis is as follows: first of all, conservative treatment is prescribed, and if it is ineffective, or if there are contraindications to the use of hormonal drugs, surgical treatment methods are turned to.

In recent years, organ-sparing endoscopic operations have been successfully used to treat patients of reproductive age. The main indications for their implementation are:

• adenomyosis in combination with endometrial hyperplasia;
• functioning endometroid ovarian cysts (more than 5 cm in diameter);
• suppuration of the uterine appendages affected by endometriosis;
• adhesions in the ampullary section of the fallopian tubes (the main cause of infertility in endometriosis);
• ineffectiveness of hormonal therapy (no positive dynamics when treated with hormonal drugs for more than 3 months);
• Availability somatic diseases, which are contraindications to long-term hormonal therapy (varicose veins and thrombophlebitis, severe liver diseases, migraines, depressive states, epilepsy, disorders cerebral circulation, obesity, diabetes, hypertension, etc.).

Organ-preserving operations are not radical method treatment, since it is impossible to isolate all foci of endometriosis, however, they are the method of choice for women who want to restore and/or maintain reproductive function.

Radical surgery with removal of the uterus and/or ovaries is performed if the following indications exist:

• progressive course of the disease in women over 40 years of age;
• lack of effect from combined treatment with organ-preserving operations;
• combination of nodular adenomyosis or diffuse adenomyosis of the 3rd degree with uterine fibroids;
• threat of malignant transformation.

Can adenomyosis be cured?

Adenomyosis is a disease with a chronically relapsing course. The statistics of relapses after successful non-radical treatment (conservative therapy, organ-saving surgery) is about 20% per year. After five years, the relapse rate reaches 74%.

The longest lasting effect is observed with combined use surgical (organ-preserving operations) and conservative (hormonal therapy) methods of treating adenomyosis, however, in most cases, relapses are still inevitable.

The prognosis for premenopausal women is somewhat better, since the activity of the process subsides with the physiological decline of ovarian function.

In patients who have undergone radical operations(removal of the uterus and ovaries), the process does not resume.

Is it possible to get pregnant with uterine adenomyosis?

Adenomyosis is the second leading cause female infertility after inflammatory diseases of the female genital area. And if we also take into account that some of the chronically worsening adnexitis (inflammatory processes in the ovaries) is caused not by an infectious process, but by internal endometriosis, then the connection between adenomyosis and infertility becomes obvious.

According to statistical studies different authors, infertility with adenomyosis is diagnosed in every third or second case, or even more often (according to some data, among patients with adenomyosis the level of infertility reaches 60-80%).

The mechanisms of infertility with adenomyosis are different in different patients, and, therefore, the prognosis and treatment tactics will be different.

We list the most common causes of infertility in patients with internal endometriosis of the uterus (in descending order of frequency of observations):
1. Disruption of the transport function of the fallopian tubes due to the adhesive process, or a decrease in their motor activity, so that the egg cannot get from the ovary to the uterine cavity.
2. Pathological changes in the hormonal sphere, preventing ovulation (the maturation of the egg and its release from the follicle). Some authors consider this reason to be the main reason for the occurrence of infertility with adenomyosis.
3. Autoimmune reactions, leading to the deactivation of sperm in the uterine cavity, as well as preventing the implantation of a fertilized egg and the further development of the embryo.
4. Termination of pregnancy at early stages due to increased myometrial contractility caused by inflammatory phenomena in the muscular layer of the uterus.
5. Pain during intercourse, making regular sexual activity difficult.

Often, infertility with adenomyosis can be caused by several reasons at once, so to restore reproductive function long-term complex treatment is required. The success of therapy strongly depends on the duration of the period of infertility. Thus, the best results are obtained if its duration does not exceed 3 years.

Thus, adenomyosis very often leads to infertility, but timely comprehensive treatment gives a chance to restore the ability to conceive.

Adenomyosis and pregnancy. Is there a chance of carrying and giving birth healthy?
child?

To date, a large amount of material has been collected on the course of pregnancy, childbirth and the postpartum period in women suffering from internal endometriosis of the uterus (adenomyosis). General conclusions from numerous studies can be summarized as follows:
1. In women with adenomyosis, the incidence of infertility is increased (from 40 to 80% according to various sources), however, timely comprehensive treatment of endometriosis in most cases leads to the restoration of the ability to bear children.
2. A frequent complication in women with adenomyosis is the threat of premature termination of pregnancy. Nevertheless, adequate therapy in most cases it allows to stabilize the condition. Treatment is carried out according to general standard scheme, as well as in women who do not suffer from adenomyosis.
3. Artificial or spontaneous termination of pregnancy leads to relapse or exacerbation of adenomyosis with subsequent accelerated development of the pathological process, therefore, if possible, one should strive to maintain pregnancy.
4. In most women with adenomyosis, childbirth proceeds safely, but in the afterbirth and early postpartum period there is an increased tendency to uterine bleeding, so the possibility of developing these complications should be taken into account.
5. After childbirth with restoration of menstrual function, an activation of the process is possible, but it is always lower than in the case of an artificial or spontaneous abortion.
6. After induced and spontaneous abortions, as well as after childbirth with restoration of menstrual function, patients with a history of adenomyosis must undergo anti-relapse treatment (hormonal therapy, immunomodulators, antioxidants, etc.).

What are the traditional methods of treating internal endometriosis?
(adenomyosis) of the uterus? Is it possible to cure adenomyosis with folk remedies?
means?

There are so many different ways traditional treatment adenomyosis, some of them are recognized official medicine, and can be included in complex treatment of pathology.

However, the Internet and real quasi-medical literature contain many useless and even extremely bad advice, so before using any of folk recipes treatment of adenomyosis, you should consult your doctor. Under no circumstances should you replace treatment prescribed by a doctor with traditional methods.

Adenomyosis is a disease prone to relapse, so it is very problematic to completely cure it, both with the help of official and traditional medicine.

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Accelerated rhythm modern life draws a woman into a whirlpool of events, affairs, interests. In this bustle, representatives of the fair sex do not always pay due attention to the state of their women's health. Without noticing the signs of many diseases, for a woman the diagnosis of a globular uterus may sound like a bolt from the blue. And although similar phenomenon is by no means uncommon - it occurs in 70% of women who have crossed the thirty-year mark; not everyone imagines the features and scale of such a pathology.

What is a globular uterus?

Ball-shaped uterus - what is it? Alternative names for the pathology are adenomyosis, internal genital endometriosis. It is a pathology of the female reproductive organ, in which endometriosis grows into other uterine zones. In particular, this process can form in the area of ​​the uterus itself (ovaries, vagina, fallopian membranes) and outside it (lungs, intestines, urinary tract, sometimes - in postoperative wounds).

Ball-shaped uterus - pathology of the female reproductive organ

The norm is that the endometrium grows exclusively into the uterine cavity. With adenomyosis, the endometrium gradually penetrates the muscular wall of the organ.

By the way. The endometrium "populates" in uterine wall not everywhere, but locally, i.e. in some places. For comparison purposes, you can imagine seedlings planted in a cardboard box. When the seedlings have not been planted in the ground for a long time, the root system of the plants will gradually begin to grow through the cracks of the box. By the same principle, the endometrium penetrates the wall of the uterus.

The uterus itself does not remain inactive - it reacts to an uninvited invasion. As a result, individual areas of muscle tissue around the enlarged endometrium thicken. In this way, the uterus tries to stop further pathological growth. Gradually, following the muscle, the uterus itself enlarges, eventually becoming round in shape.

Causes

Atypical growth of endometrial cells can be caused by the following reasons:

• Various surgical interventions (caesarean section, abortion, curettage) contribute to the destruction of the internal septum of the uterus. As a result, the endometrium is able to freely droop into the organ cavity.
• Disorders in intrauterine development reproductive system female embryo.
• Malfunctions of the endocrine system.
• Weak opening of the cervix during menstruation. At this moment, endometrial cells are under pressure, which causes its penetration into the wall of the uterus, and then into the peritoneal cavity.
• Adenomyosis often becomes a companion for women who love excessive sunbathing and visiting a solarium;
• Allergic reactions, infectious diseases, liver pathologies - all signs indicating low immunity can cause adenomyosis.
• Stress, nervous shock, as well as a sedentary lifestyle can provoke stagnant processes in the pelvis. For this reason, compactions form in the uterus, and adenomyosis begins.

The mechanism of pathology development

As a rule, during menstruation, excess endometrium begins to be rejected by the body. And if the uterus has the ability to remove “unusable” tissues, then other organs susceptible to adenomyosis do not have this opportunity. As a result, they swell and put pressure on the nerve endings, causing acute pain.

Heavy monthly bleeding is explained by the fact that the amount of excess uterine lining increases with adenomyosis. Subsequently, this “ballast” is thrown directly into the uterine cavity and provokes an increase in the volume of discharge.

Pain during menstruation becomes especially acute in the first day - this means that the rounded uterus is trying to get rid of excess endometrium. Depending on the location of the uterine lesion, the pain may be radiated to different areas bodies. So, if the endometrium has spread in one of the uterine angles, discomfort will be localized in the groin area. The affected cervix will make itself felt by pain in the area of ​​the rectum or vagina.

Symptoms of the anomaly

A spherical uterus does not always make its presence known in the female body. Sometimes the pathology is asymptomatic, and a woman may not even be aware of the presence of problems with the shape of the reproductive organ. However, in advanced cases The following warning symptoms may appear:

• Heavy bleeding during menstruation. A very characteristic sign of adenomyosis. In addition to the completely natural feeling of discomfort about this, a woman runs the risk of developing anemia, which is fraught with subsequent complications. Women with advanced stages of adenomyosis are especially at risk.
• Spotting bloody issues brownish color between periods. Some women mistake them for the beginning of menstruation. But such a discharge can cause anemia.
• Painful sensations at the moment intimacy. Otherwise, this not the most pleasant phenomenon is called dyspareunia. This circumstance often becomes the cause of physiological and psychological problems intimate life sexual partners. Pain during sex is one of the most common reasons that brings a woman to see a gynecologist.
• Pain immediately before, during and after the end of menstruation. Many women consider pain before and during menstruation to be an absolutely normal, typical phenomenon. This position is fundamentally wrong. Pain, especially sharp and prolonged - serious reason to contact a specialist.
• Disruptions in the menstrual cycle. Usually with adenomyosis it becomes shorter than usual.
• During a gynecological examination, the doctor diagnoses an enlarged uterus. This can easily be detected by palpation of the uterus by a gynecologist.

Important! Very often, the symptoms of adenomyosis are confused with manifestations of other gynecological diseases. To exclude all possible unfavorable options and diagnose pathology, you must immediately contact a gynecologist if you discover one or more alarming signs.

Diagnosis of a globular uterus

Ultrasound is considered the main method for diagnosing adenomyosis. By using this study determine the size of the reproductive organ, its structure, the boundaries of the endometrium and myometrium. Also, a similar method allows you to determine the degree of germination of the mucous membrane into the uterus. The accuracy of the results is about 90%.

An examination by a gynecologist can also confirm that the patient has a round uterus. The size of the organ varies from normal to atypical (corresponding to 6-8 weeks of gestation). The surface of the organ is uneven, touching certain places can cause pain.

For a more accurate diagnosis, a hysteroscopy procedure can be used. Its essence is the introduction of a specialized device into the uterine cavity. In this case, the walls of the organ are visualized from the inside and the doctor has the opportunity to assess the extent of the pathology, take a tissue sample for a biopsy, or perform therapeutic measures(cauterization of inflammation, removal of polyps, etc.).

Colposcopy is one of the methods for diagnosing and treating adenomyosis

In some cases, the doctor hesitates in making a diagnosis, since adenomyosis is similar in symptoms to uterine fibroids. To finally verify the correctness of the diagnosis, the patient may be sent for a magnetic resonance imaging (MRI) procedure.

Treatment methods for adenomyosis

According to medical research, the shape of the uterus and the ability to get pregnant are not directly related. In other words, adenomyosis itself is not considered a cause of infertility. But often the germination of the endometrium is accompanied by additional complications (fibroids or endometriosis), which can become an obstacle to the desired pregnancy. Cured adenomyosis increases the possibility of conception by 30-60%. If there are no complications throughout the pregnancy, a woman with a spherical uterus can safely give birth naturally. The only complication may be the risk of uterine bleeding.

Treatment of a uterus that has taken on an atypical shape is carried out in the following ways:

• Taking hormonal drugs. With their help, an artificial menopause is created. Upon completion of the treatment course, there is a risk of re-growth of the endometrium. Therefore, the doctor selects hormonal medications for the patient with the optimal dosage for continuous use. Modern medicinal products this type practically does not cause damage to the female body.
• Embolization of the uterine arteries. Helps improve blood circulation in organ tissues.
• Surgical intervention. It is recommended to eliminate the affected tissue areas, nodes, or the entire organ as a whole.

Possible consequences, complications

Adenomyosis that is not detected and treated in time can lead to unpleasant consequences and provoke complications in the functioning of the reproductive organs. In particular, the consequences may be as follows:

• Iron-deficiency anemia;
• development of endometriosis into a malignant tumor;
• infertility.

Adenomyosis can cause infertility

Adenomyosis is a serious pathology of the female reproductive system. To prevent uterine deformation and further problems, a woman needs to carefully monitor her reproductive health. Regular visits to a gynecologist are mandatory. proper nutrition and maintaining a healthy lifestyle.

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Rice. 1. Localization of endometriosis foci in abdominal cavity and thicker than 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 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 parts 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 - painful sensations 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:

• classic 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 system;
• consultation narrow specialists- endocrinologist, therapist, gastroenterologist (carried out 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); characteristic feature these nodes are 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:

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• 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

A 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 degree of 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 sound 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, cervical pathology), 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 a complete description of the pelvic ultrasound, 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 carried out by a complex of modern medications containing hormonal substances (for example, oral contraceptives or gestagens). Conservative therapy shown 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.

Surgical treatment tactics depend 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 allows you to restore the normal anatomical structure of the 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, which allows you to level out all the difficulties and perform the operation at a 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 with nodal forms 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 performing 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. In case of constant stressful situations at work and in personal life, it is necessary to 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 do not require surgical treatment, but rather properly selected conservative treatment, while others require urgent surgery. In both cases, I outline tactics of action and, if necessary, recommend a passage additional examinations or emergency hospitalization. It is important to remember that some patients require preliminary treatment of concomitant diseases and proper preoperative preparation for successful surgery.

In the letter, be sure (!) to indicate age, main complaints, place of residence, contact phone number and address Email 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"