Adenomyosis and pregnancy

Endometriosis of the uterus, the proliferation of the endometrium (inner layer) of the uterus, is also called adenomyosis. The function of the endometrium is to periodically, cyclically increase the thickness of the tissue layer so that a fertilized cell can be retained in it (this is how pregnancy occurs).

If fertilization does not occur during this period of the cycle, the endometrium peels off, giving rise to bleeding (menstruation begins). At the same time, the "embryos" of the endometrium remain on the inner surface of the uterus, which begin their growth again, going through the same circle. Now it becomes clear why adenomyosis and pregnancy are close and future mothers are interested in whether they can exist together.

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Causes of adenomyosis during pregnancy

Many doctors believe that the causes of adenomyosis during pregnancy have two different genesis:

• The first is the genetic predisposition of this patient to the occurrence and development of this disease. The body experiences a failure of the hormonal program, which entails the progression of adenomyosis.
• The second is forced implantation, when particles of rejected endometrium do not leave the woman's body completely or partially, but are retained in the genitals (in the tubes, on the ovaries, peritoneum). This creates favorable conditions for the emergence and development of the disease.

Also, the causes of adenomyosis during pregnancy can be:

• Stresses that can contribute to negative changes in the neuroendocrine system.
• Various diseases, complications of which may include hormonal imbalances, metabolic and endocrine processes in a woman’s body.
• Malnutrition.
• Taking hormonal drugs, which are usually prescribed after gynecological surgeries, can lead to temporary infertility, since an excess of one or another hormone suppresses a woman's reproductive abilities. Upon completion of the treatment course, hormones are discontinued, and the ability to fertilize an egg is restored.
• The risk group for the development of adenomyosis also includes injuries inflicted on a woman, both at home and during childbirth or surgery (abortions, miscarriages, other operations).
• Overly active lifestyle.
• Physically hard work.
• Excessive use of solariums or tanning in the open intense sun (sunburn).

It is worth clarifying that none of the above reasons is absolutely proven. At the same time, strangely enough, this pathology most often affects young women who are in their childbearing period. Therefore, at first glance it may seem that adenomyosis and pregnancy are mutually exclusive processes.

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Symptoms of adenomyosis during pregnancy

The presence of symptoms does not clearly indicate the presence of this disease in a woman's body. However, their absence also does not guarantee a woman that she does not have this disease. Some representatives of the fair sex only find out about their problem at a gynecologist's appointment, since they do not feel any discomfort, while others get it "to the fullest."

The most common symptoms of adenomyosis during pregnancy are:

• During menstruation, a woman feels severe spasmodic pain. There are cases when blood discharge is observed during pregnancy. In this case, the woman is hospitalized for preservation.
• Menstruation occurs with the loss of a large amount of blood, which often leads to a decrease in hemoglobin levels.
• The size and configuration of the uterus changes. This can only be determined by a gynecologist during an examination.
• During the periods preceding or following the onset of menstruation, small discharges (smearing) appear. They are usually dark brown in color.
• Increased uterine tone.
• A woman may experience pain during sexual intercourse.

If a woman has complex or selectively specified symptoms, it would not hurt her to seek advice from a specialist. Only an obstetrician-gynecologist can confirm or refute the suspected diagnosis of adenomyosis.

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Diffuse adenomyosis and pregnancy

Before we figure out how diffuse adenomyosis and pregnancy are combined and whether they are combined at all, let's first figure out what diffuse adenomyosis is. This pathology refers to the morphological forms that can form the uterine endometrium. The diffuse form of this pathology is small capsules of the endometrium that begin to penetrate into the deep layers of the uterus, up to the formation of fistulas that can go into the pelvic cavity. Diffuse adenomyosis itself cannot provoke infertility. It is not an obstacle to bearing and giving birth to a baby. Most likely, the cause of infertility in the presence of diffuse adenomyosis lies in hormonal imbalances associated with this disease, as well as in the case when the disease affects not only the area of the uterine endometrium, but also the ovaries, fallopian tubes.

Diffuse adenomyosis and pregnancy - this relationship has not yet been fully studied, however, it should not be dramatized. Timely diagnosis and effective treatment will allow the patient to subsequently conceive, carry and give birth to a child normally.

Adenomyosis and pregnancy

In modern medical literature, you can find a lot of material covering the issue of adenomyosis and pregnancy. The main thing that needs to be taken out of these articles can be outlined in several conclusions.

• Various sources show different percentages of women who have a history of adenomyosis and suffer from infertility. This figure varies from 40 to 80%. But timely diagnosis and effective treatment in the vast majority of cases can restore a woman's ability to bear children.
• With this diagnosis, in case of pregnancy, there is a real threat of miscarriage or premature birth. Therefore, in such a situation, the patient should be under special attention of the obstetrician-gynecologist who observes her during pregnancy. Connected, if necessary, medications will make it possible to stop the undesirable scenario of the development of pathology.
• Abortions and surgical interventions can trigger a progressive pathological process with repeated relapses. Therefore, if possible, it is necessary to preserve the pregnancy, since after an unsuccessful abortion a woman may remain infertile forever.
• With adenomyosis, most pregnant women do not have problems with childbirth. The postpartum period is considered more dangerous, when this pathology can provoke uterine bleeding.
• After childbirth, when the woman's body returns to normal, the menstrual cycle begins to improve, the growth of the endometrium may become more active, but it will still be lower than after a spontaneous or artificial abortion.

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Is adenomyosis dangerous during pregnancy?

The endometrium is the inner layer of the uterus, but under unfavorable circumstances it may happen that it grows and goes beyond its normal localization, capturing, for example, the surface of the peritoneum or ovary, or the endometrium penetrates into the deep layers of the uterus. The latter case of pathology is called adenomyosis. Let's try to figure out whether adenomyosis is dangerous during pregnancy?

The answer to this question is ambiguous. For some, it is a sentence to childlessness, adenomyosis and pregnancy show their complete incompatibility. The disease in this case is an insurmountable barrier that cannot be destroyed by any treatment. But there are other examples when a woman manages to conceive, carry and give birth to a healthy child without any problems.

If a woman has any problems with her female genital organs, she should consult a gynecologist and undergo an adequate course of treatment.

Many representatives of Western medicine believe that there is no direct relationship between adenomyosis and pregnancy (or infertility). This pathology can become an obstacle to motherhood only if other diseases of the pelvic organs are observed. It has been established that after surgical intervention, 35%-60% of women get the opportunity to become a mother. If pregnancy, with this pathology, has successfully occurred on its own, then the expectant mother falls under the close attention of the attending obstetrician-gynecologist, since there is a high probability of miscarriage.

But pregnancy can also become a healing force, which can, in some cases, completely cure adenomyosis. During pregnancy, menstrual cycles are absent. It turns out to be a kind of physiological menopause - this slows down the process of endometrial growth.

Adenomyosis and pregnancy - each individual case is individual, and the approach to it is necessary the same. All information that can be found on the Internet is of an introductory nature, and in no way can replace the consultation and examination of a specialist. If a woman wants to become a mother, she needs adequate diagnostics and effective treatment, which can only be obtained in a specialized clinic under the supervision of experienced highly qualified specialists.

Diagnosis of adenomyosis during pregnancy

Diagnosis of adenomyosis during pregnancy includes several key points:

• The doctor collects the patient's medical history: irregular cycle, painful cycle, etc.
• Gynecologist's examination. Depending on the severity of the pathology, the size of the uterus can be the parameters of the fifth to eighth week of pregnancy. The structure of the uterus is dense, smooth. But if there are nodes, it can be uneven, with tubercles. The isthmus is widened. The female organ gives pain when touched.
• Conducting an ultrasound examination using an optical tube. Vaginal examination provides high diagnostic accuracy. Signs of adenomyosis during pregnancy:
• the size of the uterus does not correspond to the norm for the period of pregnancy under study (larger than expected).
  • Increased echogenicity of the myometrium is noted. On ultrasound it shows a lighter shade with dark inclusions.
  • Small cysts may be visible.
  • Uneven structure of the lesion contour.
• Magnetic resonance imaging (MRI). Thanks to this study, it is possible to view the state of the tissue structure, the presence of foci of pathology. This study has a high level of information content, but due to the high cost of the services provided in our country, it is not widespread.
• X-ray examinations during pregnancy are done quite rarely, only when absolutely necessary.
• Hysteroscopy. This diagnostic method for diagnosing adenomyosis is very difficult to overestimate. Thanks to it, the following is assessed:
  • Structure of the endometrium.
  • Condition of the uterine cavity.

But the disadvantage of this method is the need to conduct the study under anesthesia, which is not good for the expectant mother and the unborn child. Therefore, this study is used for pregnant women extremely rarely.

• Laparoscopy. This method of examination is rarely, but still used to diagnose adenomyosis.

Treatment of adenomyosis during pregnancy

It has already been proven that one of the causes of endometriosis is a failure in the hormonal background of a woman (a change in the level of estrogen in her blood). This situation can be improved by pregnancy itself, since it involves hormonal changes in the body (the pregnant woman's body undergoes physiological menopause with a low level of the hormone - estrogen). In this case, the tissues affected by adenomyosis react to the change. In some cases, the disease goes away completely. But this happens, nevertheless, rarely. Therefore, the doctor is forced to conduct a course of drug therapy. Methyltestosterone and diethylsilbestrol, today, are no longer used by doctors in the treatment of endometriosis, since with low efficiency, they have multiple side effects, especially in case of pregnancy. They are unfavorable for both the woman and her unborn child.

Drug treatment of adenomyosis during pregnancy comes down to taking certain medications that are designed to atrophy the foci of pathological endometrium.

For example, androgens:

Danazol. It is administered orally. In most cases, the daily dosage is 200-800 mg (depending on the clinical picture of the pathology and the threat of miscarriage), divided into two to four doses. The starting dose for endometriosis can be prescribed in the amount of 400 mg, subsequently increasing it to 800 mg. The duration of administration is up to six months.

This drug has unpleasant side effects such as: rash, swelling, headaches, increased secretory functions of the sebaceous glands and others.

Danazol should not be given to patients who suffer from liver and heart failure, diabetes. It should be taken very carefully during pregnancy (the dosage should be selected individually and under close supervision of the attending physician).

Or progestogens:

Gestrinone. This medication is used twice a week at 2.5 mg for six months. If the patient misses any of the doses, the medicine must be taken as soon as possible and continue to take it according to the scheme. If, due to forgetfulness or other circumstances, two or more doses were missed, the treatment is interrupted and the scheme of taking the medicine is started from the beginning.

The proposed medicinal product is contraindicated for use in case of hypersensitivity to the components of the drug, severe heart failure, metabolic disorders and other diseases. Gestrinone should be taken very carefully during pregnancy (only as prescribed and under the supervision of a doctor).

The side effects of this medicine are also not very pleasant: headache, nausea, seborrhea, irritability, bleeding from the uterus and some others.

Dydrogesterone. The dosage of this drug is prescribed individually to each patient, depending on the severity and clinical picture of the disease. Mostly a single dose of one intake is 10 mg. One to three doses are used during the day. During the intake of this drug, the gynecologist should repeatedly prescribe mammography (monitoring the condition of the mammary glands).

This drug is contraindicated for women who have individual intolerance to the components of the drug, in case of severe liver pathology. It should be taken with caution in case of severe kidney pathology, cardiovascular insufficiency, migraine, diabetes mellitus and epilepsy. Dydrogesterone can be used during pregnancy, but only on doctor's prescription.

Gonadotropin-releasing hormone analogues are also used, such as: buserelin, leuprolelin, histrelin, nafarelin, goserelin:

Buserilin. This is an antitumor agent, in its action consonant with the chemistry of the receptor cells of the anterior pituitary gland. Allows a short-term increase in the amount of sex hormones in the blood.

This medicine is administered intramuscularly, once every four weeks, at a dosage of 4.2 mg. The duration of injections is from four to six months.

Another way to administer the drug is intranasally. After clearing the nasal passages, drip 900 mcg throughout the day. Single dose - 150 mcg.

The drug is contraindicated for use by people who suffer from hypersensitivity to the components of this drug, during pregnancy and other manifestations.

Leuprolelin. The solution for intramuscular injection is prepared immediately before use. The injection is given once every four weeks at a dosage of 3.5 mg. The duration of the treatment course should not exceed six months.

Doctors do not recommend this for use by patients with a history of individual intolerance to gonadotropin-releasing hormone, uterine bleeding of unclear origin, renal failure and some other diseases.

Which drug is necessary for a particular patient can only be decided by her attending physician based on the severity of adenomyosis. Self-medication in this case is unacceptable. As a rule, it is advisable for a pregnant woman to take hormonal drugs until the 14th week. Studies have not revealed any negative effects of hormones on fetal development (for example, dydrogesterone). This drug allows you to normalize a woman's hormonal background so that pregnancy proceeds without unpleasant surprises.

Dydrogesterone. The dosage is individual and depends on the nature and severity of the disease. This drug is used one to three times a day, 10 mg each. The drug is not prescribed for acute liver pathology and individual intolerance to the components of the drug.

In the case of this disease, if necessary, surgical treatment is also practiced, up to and including removal of the uterus, but this method is not acceptable in the case of treating adenomyosis during pregnancy.

The most unpleasant complication of pregnancy against the background of adenomyosis is the threat of miscarriage or spontaneous abortion. In this case, the gynecologist prescribes a complex course of treatment for the patient, which includes antispasmodic, sedative drugs and drugs that can improve metabolic processes.

Spazmolgin (antispasmodic). The drug is used after meals. The daily dosage should not exceed six tablets. Therefore, for children over 15 years old and adults, two to three doses of one to two tablets per day are prescribed. The course duration is five days, no more. The dose can be increased only under the supervision of a doctor.

It is not recommended to prescribe Spazmolgin to patients with a history of increased individual intolerance to the components of the drug, circulatory disorders, liver and kidney failure, gastrointestinal obstruction and some other contraindications.

Calm (sedative). The tablet is kept in the mouth until completely dissolved. Take one tablet in the morning for one to two months. In case of increased nervousness and stress, you can take one tablet two to three times a day. If necessary, after a two to three week break, the treatment course can be repeated.

The only contraindication to the use of the drug is hypersensitivity to the components of the drug.

Glycine (a drug that improves metabolic processes). The medicine is used under the tongue at 0.1 g. No contraindications for use have been identified.

The most common complication of adenomyosis during pregnancy is the threat of miscarriage. Therefore, if there is the slightest possibility of miscarriage, the pregnant woman is hospitalized for a comprehensive examination and treatment.

In connection with adenomyosis and pregnancy, folk medicine is also widely used in the treatment of this disease. With the help of all kinds of collections and infusions, it is possible to normalize the menstrual cycle, metabolic processes, and reduce stress manifestations. But all these decoctions should be used only with the permission of your attending physician, and under his supervision, since many drugs are incompatible with the intake of herbal infusions and instead of effective treatment, the patient may get the opposite result.

• Shepherd's purse works great in this case. Pour a tablespoon of the medicinal herb with one glass of hot water. Leave for one hour. Drink one tablespoon four times a day 30 minutes before meals.
• Nettle also has an excellent blood-stopping and anti-inflammatory effect. It also works great to normalize metabolism. Pour 200 ml of boiling water over two tablespoons of the plant. Infuse, cool and strain. Drink small portions throughout the day.
• Pour hot boiled water over a tablespoon of crushed plantain leaves and let it brew for two hours. Divide the resulting amount of decoction into four doses. It is not recommended to combine it with food, but the first dose of the infusion should be taken on an empty stomach.
• Beetroot juice is another excellent remedy for adenomyosis. Drink one hundred grams of freshly squeezed juice every morning.

After the approval of the attending physician, you can also douche. One of the most effective collections for adenomyosis can be called an infusion of equal proportions of such plant components as oak bark, calendula, yarrow, peony, eucalyptus and mistletoe. Infuse for about an hour and you can douche.

But do not forget that when using folk remedies, a complete cure for this disease is possible only at mild stages of its manifestation. At more severe stages, it is impossible to do without drug treatment.

Prevention of adenomyosis during pregnancy

Prevention of adenomyosis during pregnancy is quite simple:

• Regular visits to the gynecologist, at least once every six months. This will allow you to recognize the disease at an early stage.
• Once a diagnosis is made, you should not delay treatment; the problem will not “go away” on its own.
• If there is any deviation from the norm, you must immediately consult a doctor.
• It is necessary to minimize stressful situations.
• The body must receive adequate rest.
• Relaxing baths and massages.
• You should not overuse solariums and sunbathing (you should minimize your body's exposure to ultraviolet radiation).

You just need to treat yourself more carefully and attentively.

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Prognosis of adenomyosis during pregnancy

It should be noted that with the right approach to the disease, regular examinations by a gynecologist and, if necessary, effective treatment, the prognosis for adenomyosis during pregnancy is quite favorable. It is also encouraging that this disease is not prone to degeneration into malignant neoplasms.

After completing a course of treatment, approximately 20% of women experience relapses within the first five years; after five years, the percentage increases to 75%.

But when pregnancy occurs, if adenomyosis is diagnosed at a mild stage, the disease can go away completely, since during pregnancy menstruation stops, an artificial menopause occurs, therefore, the progression of endometrial growth decreases, which allows the disease to be completely cured or the existing situation to be significantly improved.

Unfortunately, adenomyosis and pregnancy are somewhat mutually exclusive events. Therefore, if a woman has this disease in her medical history, she should consult her gynecologist when planning a pregnancy. If pregnancy has already occurred, there is a certain risk of losing the child, which makes the doctor pay more attention to such a patient. But adenomyosis is not an obstacle to normal conception, bearing and birth of a baby, but this process should not be left to chance.

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