Adenomyosis and pregnancy

Endometriosis of the uterus, the proliferation of the endometrium (inner layer) of the uterus, also called adenomyosis. The function of the endometrium includes a periodic, cyclical, increase in the thickness of the tissue layer so that a fertilized cell can linger in it (this is how pregnancy begins).

If fertilization did not occur during this period of the cycle, the endometrium peels off, giving rise to bleeding (menstruation begins). At the same time, “embryos” of the endometrium remain on the inner surface of the uterus, which begin to grow again, passing through the same circle. Now it becomes clear why adenomyosis and pregnancy stand side by side and future mothers are interested in whether they can exist together.

[1], [2], [3], [4]

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. In the body, hormone program failure occurs, which entails the progression of adenomyosis.
• The second is imposed implantation, when particles of the rejected endometrium do not fully or partially leave the woman’s body, but are retained on the genitals (in the tubes, on the ovaries, on the peritoneum). This creates favorable conditions for the emergence and development of the disease.

The same causes of adenomyosis during pregnancy can be:

• Stress that may contribute to negative changes in the neuroendocrine system.
• Various diseases, complications of which may be hormonal disorders, metabolic and endocrine processes in a woman’s body.
• Malnutrition.
• Acceptance of hormonal drugs, which are usually attributed after gynecological operations, can lead to temporary infertility, since with an excess of a hormone, the reproductive abilities of a woman are inhibited. At the end of the treatment course, the hormones are canceled, and the possibility of fertilizing the egg is restored.
• The risk of adenomyosis can include injuries to a woman, both at home and during childbirth or surgery (abortion, miscarriage, other surgery).
• Overly active lifestyle.
• Physically hard work.
• Excessive passion for tanning or tanning in the open intense sun (sunburn).

It should be clarified that none of the above reasons is not absolutely proven. In this case, it is not strange, this pathology is more often affected by young women who are just in the childbearing period. Therefore, from the first time it may seem that adenomyosis and pregnancy are mutually exclusive processes.

[5]

Symptoms of adenomyosis during pregnancy

The presence of symptoms does not indicate unequivocally about the presence in the woman's body of this disease. However, their absence also does not guarantee a woman that she is not the owner of this disease. Some of the fair sex, only at the reception at the gynecologist will learn about their problem, because they do not feel any discomfort, while others get "the whole coil."

The most common symptoms of adenomyosis during pregnancy:

• During menstruation, the woman feels severe spasmodic pains. There are cases when the discharge of blood is observed during pregnancy. In this case, the woman is placed in a hospital for preservation.
• Menstruation passes with the loss of a large amount of blood, which often leads to a decrease in hemoglobin level.
• There is a change in the size and configuration of the uterus. This can only be determined by the gynecologist during the examination.
• In the periods preceding the onset of menstruation, or after it, small discharges (daub) appear. They usually have a dark brown shade.
• Increased uterine tone.
• A woman may feel pain during intercourse.

If a woman has complex or selectively specified symptoms, it does not hurt to consult a specialist. Only an obstetrician-gynecologist can confirm or refute the alleged diagnosis of adenomyosis.

[6], [7]

Diffuse adenomyosis and pregnancy

Before we figure out how to combine and whether diffuse adenomyosis and pregnancy are combined at all, let us first understand what diffuse adenomyosis is. This pathology refers to the morphological forms that the endometrium of the uterus can form. The diffuse form of this pathology is a small capsule of the endometrium, which begin to penetrate into the deeper layers of the uterus, up to the formation of fistulas that can go into the pelvic cavity. By itself, adenomyosis diffuse forms provoke infertility can not. It is not a barrier to the carrying and birth of the baby. The fastest cause of infertility in the presence of diffuse adenomyosis lies in the hormonal disruptions associated with the disease, as well as in the case when the disease affects not only the endometrial area of the uterus, but also the ovaries and fallopian tubes.

Diffuse adenomyosis and pregnancy - this relationship is not yet fully understood, however, it is not worth dramatizing. Timely diagnosis and effective treatment will allow the patient, subsequently, to conceive, bear and give birth to a child.

Adenomyosis and pregnancy

In modern medical literature, you can find a lot of material covering the issue - adenomyosis and gestation. The main thing that needs to be learned from these articles can be identified by several conclusions.

• Different sources show a different percentage of women who, with a history of adenomyosis, suffer from infertility. This figure varies from 40 to 80%. But timely diagnostics and effective treatment in the overwhelming majority of cases can restore a woman's ability to bear children.
• With this diagnosis, in the case of pregnancy, there is a real threat of miscarriage or premature birth. Therefore, in such a situation, the patient should be under the special attention of an obstetrician-gynecologist, who observes her during pregnancy. The medications connected, if necessary, will make it possible to arrest an undesirable pathology development scenario.
• Abortions, surgical interventions can provoke the launch of a progressive pathological process with repeated relapses. Therefore, if possible, it is necessary to maintain a pregnancy, because after an unsuccessful abortion a woman can remain infertile forever.
• With adenomyosis, most pregnant problems with childbirth do not occur. More dangerous is the postpartum period, 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 can be activated, but it will still be lower than after spontaneous or induced abortion.

[8], [9]

Is adenomyosis dangerous during pregnancy?

Endometrium is the inner layer of the uterus, but under unfavorable circumstances it may happen that it expands, goes beyond its normal localization, capturing, for example, the surface of the peritoneum or ovary, or the endometrium penetrates into the deeper layers of the uterus. Just the last 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, this is a sentence on childlessness, adenomyosis and pregnancy show their full incompatibility. The disease in this case is an insurmountable barrier that cannot be destroyed by any treatment. But there are other examples where a woman, without any problems, manages to conceive, bear and give birth to a healthy child.

If a woman has any problems with regard to the female genital organs, it is necessary to consult a gynecologist and undergo an adequate course of treatment.

Many representatives of Western medicine believe that there is no direct correlation between adenomyosis and pregnancy (or infertility). This pathology can become an obstacle to maternity only when other diseases of the pelvic organs are observed. It was found that after surgery, 35% -60% of women get the opportunity to become a mother. If the pregnancy, with this pathology, has safely arrived itself, then the future mom gets under the close attention of the attending obstetrician-gynecologist, since there is a high probability of miscarriage.

But pregnancy can also become a healing power that can, in some cases, completely cure adenomyosis. During pregnancy, menstrual cycles are absent. It turns out a kind of physiological menopause - it slows the growth of the endometrium.

Adenomyosis and pregnancy - each individual case is individual, and the approach to it requires the same. All information that can be found in the Internet space 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 main points:

• Patient's medical history: irregular cycle, painfulness, and others.
• Examination by a gynecologist. Depending on the severity of the pathology, the size of the uterus may be the parameters of the fifth to eighth weeks of pregnancy. The structure of the uterus is dense, smooth. But in the presence of nodes, it can be uneven, with tubercles. Isthmus expanded. Female body gives pain when touched.
• Conducting ultrasound 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 studied period of pregnancy (more than it should)
  • There is an increased echogenicity of the myometrium. The ultrasound shows a lighter shade with darker inclusions.
  • Small cysts may be visible.
  • The uneven structure of the contour of the lesion.
• Magnetic resonance imaging (MRI). Thanks to this research, 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 is not very massive.
• X-ray examination during pregnancy is done quite rarely, only for great need.
• Hysteroscopy. This method of diagnosis for the diagnosis of adenomyosis is very difficult to overestimate. Thanks to him, it is estimated:
  • The structure of the endometrium.
  • The condition of the uterus.

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

• Laparoscopy. This research method is rare, but is 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 her blood level of estrogen). Pregnancy itself can improve this situation, since it is accompanied by hormonal changes in the body (the pregnant woman's body receives a physiological menopause with a low hormone level - estrogen). At the same time, tissues affected by adenomyosis respond to the change. In some cases, the disease goes away completely. But it happens, nevertheless, rarely. Therefore, the doctor is forced to conduct a course of drug therapy. Methyltestosterone and diethylsilbestrol, to date, doctors no longer use in the treatment of endometriosis, since with low efficiency, they have multiple adverse events, especially in the case of pregnancy. They are unfavorable for both a woman and her unborn child.

Drug treatment of adenomyosis during pregnancy is reduced to the adoption of certain drugs that are designed to atrophy the nidi of pathological endometrium.

For example, androgens:

Danazol. Application is oral. In most cases, the daily dosage is 200-800 mg (depending on the clinical picture of the pathology and the threat of miscarriage), is spread by two to four doses. The starting dose for endometriosis can be prescribed in the amount of 400 mg, subsequently bringing it to 800 mg. The duration of admission - up to six months.

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

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

Or progestogens:

Gestrinon. This medicine is used twice a week, 2.5 mg for six months. If the patient missed one of the methods, the medicine should be drunk as soon as possible and continue to be taken as prescribed. If, due to forgetfulness or due to other circumstances, two or more times were missed, the treatment is interrupted and the schematic administration of the drug is started anew.

The proposed drug is contraindicated for use with hypersensitivity to the components of the drug, with 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 physician).

Side effects of this medication are not entirely pleasant: headache, nausea, seborrhea, irritability, bleeding from the uterus and some others.

Didrogesterone. The dosage of this drug is prescribed individually for each patient, depending on the severity and clinic of the disease. Predominantly a single dose of one dose - 10 mg. Practice one to three doses per day. In the process of taking this drug, the gynecologist must repeatedly appoint a mammogram (monitoring the state of the mammary glands).

This drug is contraindicated in women who have an individual intolerance to the components of the composition of the drug, in the case of severe liver disease. Care should be taken with severe pathology of the kidneys, with cardiovascular insufficiency, migraine, diabetes and epilepsy. Didrogesteron can be used during pregnancy, but only as prescribed by a doctor.

Gnadoliberin analogues are also used, such as: buserillin, leuprolelin, gistrelin, nafarelin, goserelin:

Buceriline. It is an antitumor agent, in its action consonant with the chemistry of the receptor cells of the anterior pituitary gland. Allows you to quickly increase the amount of sex hormones in the blood.

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

Another route of administration is intranasal. After cleaning the nasal passages, drip 900 mcg throughout the day. Single dose - 150 mcg.

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

Leuprolelin. The solution for intramuscular injection is prepared immediately before use. An 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.

This doctors do not recommend for use by patients who have an individual intolerance to gonadotropin-releasing hormone in their history, with uterine bleeding of not clear nature, renal failure and some other diseases.

What drug is needed for a particular patient can only be addressed by her doctor based on the severity of adenomyosis. Self-treatment in this case is unacceptable. As a rule, it is advisable to take hormonal preparations for pregnant women up to 14 weeks. Studies have not revealed the negative effects of hormones on the development of the fetus (for example, didrogesterone). This drug allows you to normalize the hormones of a woman so that the pregnancy proceeds without unpleasant surprises.

Didrogesterone. The dosage is individual and depends on the nature and severity of the disease. Apply this drug one to three times a day 10 mg. The drug is not prescribed for acute pathology of the liver and individual intolerance to the component components of the drug.

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

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

Spazmolgin (antispasmodic). The drug is used after meals. The daily dosage should not exceed six tablets. Therefore, for children who are over 15 years old and adults there are two or three doses, one or two tablets per day. The course duration is five days, not more. Increase the dose can only be under the supervision of a doctor.

It is not recommended for prescription of spasmolgin in patients with a history of increased individual intolerance to the components of the drug, circulatory disorders, hepatic and renal insufficiency, obstruction of the gastrointestinal tract and some other contraindications.

Calm (sedative). The tablet is kept in the mouth until completely dissolved. Apply one tablet in the morning for one to two months. With 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 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 drug is used under the tongue to 0.1 g. Contraindications for use have been identified.

The most common complication of adenomyosis during pregnancy is the threat of its termination. Therefore, in the event of the slightest possible miscarriage, the pregnant woman is placed in a hospital for a comprehensive study and treatment.

In connection with adenomyosis and pregnancy, the treatment of this disease is widely used and means of alternative medicine. With the help of various fees and infusions, you can normalize the menstrual cycle, the metabolic process, reduce stress manifestations. But all these decoctions should be used only with the permission of your doctor, and under his control, since many medicines are not compatible with taking herbal infusions and instead of effective treatment, the patient can get the opposite result.

• Perfectly in this case the shepherd's bag works. One glass of hot water pour a tablespoon of medicinal herbs. Leave for one hour. Drink one tablespoon four times a day 30 minutes before meals.
• Nettle also has excellent blood-stopping and anti-inflammatory effects. Excellent it works on the normalization of metabolism. Two tablespoons of the plant pour 200 ml of boiling water. Insist, cool and strain. Drink during the day in small portions.
• A tablespoon of crushed leaves of the plantain pour hot boiled water, Infuse for two hours. Divide the amount of decoction into four doses. Associated with food is not worth it, but the first method of infusion is necessary to take on an empty stomach.
• Beetroot juice is another excellent remedy for adenomyosis. Drink every day in the morning a hundred grams of fresh juice.

After approval by the attending physician, douching can also be performed. One of the most effective charges for adenomyosis can be called an infusion of the same proportions of plant components such as oak bark, calendula, yarrow, peony, eucalyptus and mistletoe. Insist about an hour and you can carry out the procedure douching.

But do not forget that with the use of alternative means possible complete cure of this disease only in the light stages of its manifestation. With 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 recognize the disease even in its early stages.
• When making a diagnosis, it is not worthwhile to treat with the treatment, the problem itself will not “resolve”.
• In case of any deviation from the norm, it is necessary to immediately consult a doctor.
• It is necessary to minimize stressful situations.
• The body should receive proper rest.
• Relaxing baths and massages.
• Do not abuse the solarium and sunbathing (it is necessary to minimize the body exposure to ultraviolet radiation).

You just need to treat yourself more carefully and carefully.

[10], [11], [12]

Prognosis of adenomyosis during pregnancy

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

After completing the course of treatment, approximately 20% of women get relapses during the first five years, with a period of more than five years, the percentage component increases to 75%.

But when pregnancy occurs, if adenomyosis is diagnosed in the lung stage, the disease can go away completely, as menstruation stops during pregnancy, artificial menopause occurs, therefore, the progression of endometrial growth is reduced, which allows to completely cure the disease, or significantly improve existing situation.

Unfortunately, adenomyosis and pregnancy are still somewhat mutually exclusive events. Therefore, if the disease is present in a woman’s history, when planning a pregnancy, you should consult your gynecologist for advice. In the case, if the pregnancy has already come, there is a certain risk of losing the child, which makes the doctor more attentive to such a patient. But adenomyosis is not an obstacle to the normal conception, childbirth and the birth of a baby, just let this process take its course.

[13], [14]