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Adenomyosis of the uterus
Last reviewed: 23.04.2024
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Uterine adenomyosis also known as internal endometriosis is a disease of the internal mucosa, which is expressed in the penetration and spread of endometrial cells to other layers of the uterus.
The term "adenomyosis" is used to refer to the processes of glandular degeneration in the muscular tissue of the uterus. By their nature, such processes are benign.
With this disease, endometrial cells acquire new localization in the external and internal genital organs, in the uterus, fallopian tubes, ovaries, or appear in other tissues and organs: in the urinary system, in the gastrointestinal tract, in the navel, etc.
Adenomyosis of the uterus begins to affect the cellular myometrium, which provokes the development of all pathologies in the muscular tissues of the uterus. This can become a trigger mechanism for initiating processes of uterine degradation.
Endometrial cells that have spread beyond the uterine mucosa continue to function according to the usual monthly cycle, which causes local inflammation, and subsequently leads to significant disturbances in the activity of the affected organ.
Causes of adenomyosis of the uterus
The causes of adenomyosis of the uterus to date have not been fully studied. Just as it is impossible to say with absolute certainty what are the mechanisms of its origin and the progress of the pathological process.
Specialists in the field of gynecology are unanimous only in the fact that this disease is dependent on hormones. Proceeding from this, it is stated that its occurrence is caused by immunological reasons.
There are a number of factors that increase the likelihood of adenomyosis.
In the risk group are primarily women with a genetic predisposition to adenomyosis.
If menstruation began at a very early age, or vice versa, too late, it can be a certain prerequisite for the emergence of this pathological process.
Adenomyosis can develop in women against obesity. The more the body mass index exceeds the norm, the higher the probability of the appearance of this disease.
To risk factors is too early or too late the onset of sexual activity.
The causes of adenomyosis of the uterus are also found in late delivery and postpartum complications.
Adenomyosis can have as its cause the consequences of gynecological manipulation. Such as abortion, scraping for diagnostic purposes, or the use of contraceptives as a mechanical - placement of the spiral in the uterus, and oral contraceptives.
[4]
Symptoms of adenomyosis of the uterus
Symptoms of adenomyosis of the uterus are manifested primarily in the form of profuse and prolonged bleeding during the monthly cycle. This is the main characteristic peculiar to this disease.
Large amounts of blood loss for a long period of time leads, in turn, to the fact that secondary anemia of iron-deficiency type begins to develop on their background.
Its presence is determined by reducing the tone of the body and working capacity, excessive drowsiness, frequent dizziness. There is a painful pallor of the skin and mucous membranes, the resistance of the organism to infectious diseases decreases.
Adenomyosis of the uterus is characterized by specific secretions that appear several days earlier before menstruation and several days after its termination. A common case is the form of the disease that triggers metrorrhagia, that is, the appearance of a bleeding from the uterus in the middle of the menstrual cycle.
Symptoms of adenomyosis of the uterus, depending on the type and characteristics of the process of its flow, have a different degree of severity.
So diffuse adenomyosis of the uterus of the 1st degree differs almost complete absence of obvious symptoms. The 2 nd and 3 rd degrees are determined on the basis of the size of the nodes of the neoplasms, as well as the degree of spread.
Pain in adenomyosis of the uterus
Pain in uterine adenomyosis appears as a pain syndrome of algomenorrhea or dysmenorrhea that occurs before menstruation and lasts for several days, after which it passes.
The degree of intensity and severity of pain symptoms is determined by the specific location in which the process of development of this pathology occurs. Painful sensations with great force are manifested in cases when the cervix is affected, but in addition are concomitant manifestations of the progress of adenomyosis, associated with the formation of adhesions.
When the cause of adenomyosis is the pathological process of the formation of the additional horn of the uterus, its symptomatology resembles the manifestations of severe pain in the lower abdominal cavity of women, the so-called acute abdomen. This is caused by the penetration of menstrual blood into the uterine cavity.
Pain phenomena in this case have the similarity of symptoms inherent in peritonitis.
Pain in adenomyosis of the uterus, depending on their location, may indicate in the diagnosis of the presence of pathological development processes in this or that part of the body. So the pain in the groin area indicates that the corresponding angle of the uterus is affected, and if the pain symptoms appear in the vagina or rectum, this may mean that the cervix is involved in the pathological processes.
Adenomyosis of the uterus and pregnancy
Many women are worried about how the adenomyosis of the uterus and pregnancy are related, and to what extent the presence of this disease can affect the likelihood of bearing and the birth of a healthy child.
This pathology is characterized by activation of processes in the uterus, which lead to the formation of adhesions, which in turn is fraught with infertility.
It also has a detrimental effect on the patency of the fallopian tubes, which prevents the possibility of becoming pregnant. Another feature is that in the ovaries the maturation of the egg can be stopped. Undergone negative changes in the properties of the endometrium of the uterus.
Such pathological phenomena lead ultimately to the impossibility of attaching a fertilized egg to the mucous membrane of the uterus.
It should be noted that due to the appearance of hormonal imbalance, the first weeks of pregnancy are particularly responsible.
"Adenomyosis of the uterus and pregnancy" - if such a disease is diagnosed, in this case, therapy with the use of progestogens, which may contribute to the onset of pregnancy, is indicated.
The use of these drugs should be continued further, in order to maintain the necessary hormonal background. But here you need to closely monitor the level of progesterone in the blood, based on the indices of which it is concluded that it is advisable to stop such therapy or stop it.
Can I get pregnant with adenomyosis of the uterus?
Endometriosis pathology is a fairly common disease, so for a woman planning a child it becomes urgent to determine the pros and cons of whether one can become pregnant with adenomyosis of the uterus.
This diagnosis is not a categorical sentence, putting an end to the possibility of getting pregnant, taking out and giving birth to a healthy child. This does not mean that the course of pregnancy will necessarily be accompanied by the appearance of all sorts of complications and pathologies.
An important point, contributing to the exclusion of the likelihood of all kinds of negative factors, is a comprehensive examination of the body and the conduct of appropriate treatment on the basis of the results obtained.
Great value in diagnostics is given to revealing of infections transferred sexual by. The state of pregnancy is characterized by a decrease in the immune-protective functions of the body, and the presence of adenomyosis further weakens the immune system. Based on this, it can be argued that the infection that occurs in the body of a woman during pregnancy can cause complications. Therefore, it is necessary to conduct an appropriate therapeutic course before the pregnancy occurs, since many drugs are contraindicated in this condition.
Thus, the answer to the question of whether to become pregnant with adenomyosis of the uterus is positive to the extent that the appropriate treatment measures and the right line of behavior are correctly assigned in connection with such an important period in the life of a woman planning to become a mother.
Where does it hurt?
Adenomyosis of the body of the uterus
Adenomyosis of the uterus body, also called endometriosis of the uterus, is a form of this disease that is characterized by the appearance of heterotopic, abnormally located, pathological foci in myometrium.
To understand the mechanism of action of this disease, it is necessary to understand the structure of the tissues of the constituent uterus. Endometrium is made up by combining its basal layer with the functional one. In the basal layer, processes occur that are responsible for the onset of menstruation and the formation of a functional layer. The latter contains glandular cells that produce a particular mucus, and is characterized by the presence of a large number of terminal branches of small spiral arteries. The functional layer exfoliates after the end of each monthly cycle. Behind the endometrium, which is the internal mucosa of the uterus, is the muscle membrane, myometrium. Due to it, due to significant stretching, there is an increase in uterine volumes during pregnancy.
In adenomyosis, which takes place in the body of the uterus, tissues, which are essentially identical to the endometriotic layer, spread out beyond their usual localization in the uterine mucosa.
The adenomyosis of the uterus body is distinguished by the growth of such neoplasms primarily among muscle fibers in the uterine myometrium layer.
Cervical adenomyosis
Cervical adenomyosis as well as other forms of endometrial damage is characterized by pathological proliferation of mucosal cells in the tissue that separates the endometrium and myometrium. Subsequently, the penetration of the endometrium into the muscular membrane of the uterus also occurs.
In a healthy state, in the absence of any pathologies during the monthly cycle, the endometrium germination takes place exclusively inside the uterine cavity, in which only its thickening occurs.
It is necessary to pay attention to the next moment. The pathological spread of the endometrium with adenomyosis does not occur immediately over the entire internal surface of the mucous membrane, but there is a tendency for individual foci of its germination to enter adjacent tissues. The appearance of endometrial cells in the muscular membrane of the uterus causes a certain response from the side of the myometrium. As a protective mechanism from the subsequent progress of such an invasion, the bundles of muscle tissue around the foreign formation thicken.
Adenomyosis of the cervix arises as a result of the direction of this process towards the cervix and is accompanied by all the relevant symptoms and phenomena that arise in connection with the appearance of foci of endometrial damage in it.
[12]
Diffuse adenomyosis of the uterus
The fact that there is such a variety of endometriosis as diffuse adenomyosis of the uterus is evidenced by the fact that blind pockets appear in the endometrium in the uterine cavity, differing in the depth of penetration into its layers. The possibility of the appearance of fistulas, the localization of which is the cavity of the small pelvis, is also not excluded.
This form of the disease provoked can be the consequences of various gynecological radical interventions. To lead to it can be diagnostic curettage, repeated abortions, as well as carrying out a mechanical cleansing during a pregnancy breakdown or after childbirth. Risk factors also include the presence of inflammatory processes in the uterus, surgical treatment on the uterus, postpartum complications.
The pathological process manifests such features as uniform germination of endometriotic cells in the muscular layer of the uterus, without the appearance of separate foci of lesion.
Due to significant difficulties in conducting effective treatment activities, the probability of complete cure is extremely low. Diffuse adenomyosis of the uterus can come to a stage of regression after the onset of a woman's menopause.
The disease is very serious and fraught with serious complications during pregnancy.
[13]
Nodal adenomyosis of the uterus
Nodal adenomyosis of the uterus is a disease in which pathological proliferation of endometriotic tissues takes place in the uterine myometrium. As a concomitant phenomenon in the process of development of this form of adenomyosis and its characteristic feature, there is the appearance of nodes in the affected areas.
Such neoplasms appear in large numbers surrounded by connective tissue, have a dense structure and are filled with blood or a liquid of a brownish color.
The liquid content is determined by the mechanism of formation of nodular adenomyosis of the uterus. Modified glands continue to function in accordance with the monthly cycle, as a result of which they produce a liquid.
Nodal adenomyosis of the uterus is manifested in a symptom similar to the myoma of the uterus. Its difference from the latter is that in this case the nodes are formed by their glandular tissue, and not from the muscular.
Often these two diseases occur together. This is expressed in the fact that the uterus does not return to its usual size after the completion of the monthly cycle, but remains enlarged to the extent that the pathological neoplasm of the myoma has a value.
Focal adenomyosis of the uterus
Focal adenomyosis of the uterus differs by the germination of endometriotic tissues in the layer of the uterine myometrium in the form of disparate clusters - separate foci of development of pathological processes. On the entire internal surface of the internal cavity of the uterus, these phenomena do not spread.
The tendency to occurrence of such a disease can take place due to disruption of the integrity of the internal mucous membrane, endometrium of the uterus when scraping for diagnostic purposes, abortion, and mechanical cleaning in the case of a dead pregnancy.
Focal adenomyosis of the uterus is a very serious disease. It is difficult to treat, and getting rid of it completely and completely restoring health is almost impossible. There is a possibility of recurrence, when at the age when the woman begins to fade in sexual functions, with menopause.
For a woman in the period of bearing a child there is a risk of significant complications and the development of all pathologies.
Therefore, in the event that a painful and profuse menstrual bleeding is found, and sexual intercourse is accompanied by pain, this is a warning signal.
[14]
Adenomyosis of the uterus of 1 degree
Adenomyosis of the uterus of the 1st degree is a stage of endometriotic uterine lesion, at which the initial penetration of the endometrium into the muscular tissue of the uterus occurs. At the 1 st degree is characterized by germination by approximately one third of the thickness of the myometrium.
After the introduction into the myometrium of individual cells of the functional layer of the endometrium, due to cyclic changes in the level of estrogens, their proliferation begins.
Factors of development of this disease are genetically determined or congenital degree of permeability of the basal layer of the endometrium, as well as an increase in intrauterine pressure, which is caused by the presence of violations in the outflow of blood during menstruation.
The adenomyosis of the uterus begins with the appearance of changes in the hormonal background due to the increase in the level of the female sex hormone estrogen in the blood. Estrogen in the first half of the monthly cycle promotes active growth of the endometrium. In this case, based on the fact that its number exceeds the norm, the duration of the period of menstruation increases. Also, with an excess of estrogen, menstrual blood is released in a much larger amount.
In addition, adenomyosis of the uterus of 1 degree and the appearance of endometriotic neoplasms in myometrium is accompanied by disturbances in the work of the immune system.
[15], [16], [17], [18], [19], [20], [21]
Adenomyosis of the uterus 2 degrees
Adenomyosis of the uterus of the 2nd degree is characterized by a deeper degree of germination of the endometrium into the muscular layer of the walls of the uterus. In this case it spreads to half the thickness of the myometrium.
At this stage in the progress of such an endometriotic pathological process, there may be a complete absence of any significant symptomatic manifestations. The main signs that can indicate its presence in the body can serve as an increase in the duration of the menstrual cycle and the appearance of dark brown discharge in the periods between menstruations. Also, there may be pain symptoms in the lower abdomen, heaviness in the abdomen and a sense of discomfort. In some cases there is an increase in the intensity of pain arising from menstruation. As a consequence of excessive amounts of estrogens, the disease can also be accompanied by vegetative disorders, headache, nausea, vomiting, tachycardia, and fever.
Adenomyosis of the uterus of the 2nd degree causes changes in the structure of the inner surface of the uterine cavity. The formation of the hillocks takes place, it acquires a high density, there is a marked decrease in elasticity.
Leiomyoma of the uterus with adenomyosis
Leiomyoma of the uterus with adenomyosis is a combination of two diseases, each of which individually belongs to the most common lesions of the uterus.
They have significant similarities among themselves in the causes that cause their appearance, and in many cases, when there is a leiomyoma, adenomyosis accompanies it, and vice versa.
The reasons for the development of each of these gynecological pathologies lie in the hormonal imbalance of the body, disorders in the immune system, the presence of infectious processes in the chronic stage. Gynecological diseases in neglected form, repeated abortions, stress factors can also cause their occurrence and progress.
Leiomyoma of the uterus with adenomyosis, until recently, did not provide for other forms of treatment except surgery for the removal of the uterus with appendages. However, considering that young women of early childbearing age are often at risk of this disease, the expediency of such a radical measure is in many cases unjustified.
To date, the optimal treatment is the use of methods of minimally invasive surgery, such as operations using laparoscopy and hysteroresectoscopy.
What is dangerous for adenomyosis of the uterus?
Proceeding from the fact that, by definition, adenomyosis is characterized by the appearance of tumoral formations of benign nature, the question arises of the severity of this disease, what serious threats does it represent and how dangerous is the adenomyosis of the uterus?
Adenomyosis is characterized by the fact that when the endometrium appears in other tissues and organs, the genetic structure of its cells does not undergo any changes. This feature plus the tendency to spread throughout the body, as well as resistance, that is, resistance to external influences - all this makes this disease close in nature to oncology.
It is impossible to discount the possibility of the onset of malignant cell transformation on the genome level.
Cells of extragenital endometrium are capable of provoking a wide range of complications and pathologies requiring immediate medical measures. Among such complications, what is dangerous is adenomyosis of the uterus, it should be noted in particular the probability of intestinal obstruction due to endometriosis of the gastrointestinal tract, hemothorax - the filling of the pleural cavity by blood as a result of lung injury, etc.
Consequences of adenomyosis of the uterus
The consequences of adenomyosis of the uterus can take place in the form of the following phenomena.
Due to the large amount of blood loss, both during the monthly cycle, and in connection with pathological processes in adenomyosis, anemia of iron deficiency develops. Lack of oxygen causes dizziness, fainting, frequent headaches, memory loss occurs. There is a general decrease in the vitality of the body and a significant deterioration in performance.
Endometriosis damage to the uterus also results in the germination of cells through the uterine myometrium into the serous membrane, and the involvement of the organs in the immediate vicinity of the uterus in the development of the pathological process. Such as organs located in the cavity of the peritoneum, bladder and rectum.
One of the most significant consequences of adenomyosis is the probability of infertility, which is caused both by a violation of ovulation, and by the impossibility of attaching the embryo to the walls of the uterus.
The consequences of adenomyosis of the uterus are also manifested by such an unfavorable factor as that, on the difficulties associated with the conservative treatment of this disease, it is approaching oncological lesions. The pathological endometrium, which grows in other tissues and organs, is characterized by a tendency to degeneration into malignant neoplasms.
Diagnosis of uterine adenomyosis
Diagnosis of uterine adenomyosis involves, first of all, gynecological examination of the genitals, which is reduced to examination using mirrors and with the help of a colposcope - an optical device giving a 30-fold increase in the study of the cervix. In addition to these visual methods, swabs are taken for appropriate laboratory analysis, and respiratory and circulatory organs, digestive organs and the urinary system are examined.
If a woman has certain chronic diseases or features of the body associated with the individual intolerance of certain medications, additional consultations are appointed with the appropriate specialists.
After carrying out of such resulted actions, as a rule, ultrasound examination of organs of a small basin is appointed still. Ultrasound is one of the most common diagnostic methods in gynecology. In case there are appropriate indications, the diagnosis of uterine adenomyosis is performed using laparoscopy and hysteroscopy.
It is also possible to carry out an analysis of the microflora of the vagina for the detection of all kinds of unfavorable bacteria.
[30],
Echoes of adenomyosis of the uterus
One of the most widely used and most effective and effective types of echography in gynecology is the method of transvaginal ultrasound. Diagnostic measures, which are carried out using this method, provide the results of the study, which are characterized by the maximum degree of accuracy.
The following, coordinated and confirmed by a significant number of medical specialists, the echocardiogram of the adenomyosis of the uterus are distinguished.
Adenomyosis of the uterus has its manifestation in this study the presence of different thickness of the walls of the uterus, with its apparent asymmetry.
The next echo, which testifies to this endometriotic pathology in the female organ, is the spherical shape of the uterus, which it acquires due to an increase in its posterior and anterior dimensions.
For the presence of adenomyosis of the uterus indicates that echoprimax that it is significant in size before the six-week gestation period, and sometimes more.
Echo signs of adenomyosis of the uterus are also in the appearance of cystic formations ranging in size from 3 to 5 millimeters before the onset of menstruation.
Uterine adenomyosis on ultrasound
At present, methods for the direct study of fragments of tissues from the walls of the uterus, the vagina, etc. Are used to detect gynecological diseases, scrapings, strokes, colposcopy and biopsy are performed for this purpose. Another type of diagnosis is ultrasound.
During ultrasound, it is possible to visually assess the status of the uterus, as well as the likely detection of structural changes and signs of pathologies.
Thanks to the use of this method of diagnosis, it becomes possible to detect uterine adenomyosis on the uzi in time.
Since penetration of ultrasonic waves into the uterus creates an obstacle to the skin-fat layer of the peritoneal cavity, in order to achieve diagnostic efficiency, a transvaginal method of such a study is used. This suggests that the ultrasound sensor is inserted directly into the vagina.
Adenomyosis of the uterus on the uzi manifests itself in the form of a set of certain echoes that can be used to ascertain the presence of this disease.
Of great importance is a clear and unambiguous interpretation of the results of the study. So the detection of fairly common diffuse changes in myometrium can often be mistaken for adenomyosis.
On this basis, the analysis and diagnosis based on the findings are exclusively in the competence of the relevant specialist in the field of gynecology.
What do need to examine?
Treatment of uterine adenomyosis
Treatment of uterine adenomyosis is possible with the use of one of two ways to get rid of this disease.
The therapeutic method involves, through the use of all possible medications, to restore the normal functioning of the immune system and lead to an optimum hormonal background of the organism. Drugs used for the therapeutic treatment of uterine adenomyosis are prescribed in accordance with the individual characteristics of the woman's organism in such proportions that at the greatest effectiveness they minimize the likelihood of side effects. Most drugs currently produced have the properties to provide the greatest possible positive therapeutic effect, while the possibility of negative consequences from their use is small. Mostly these are gestagens, that is, they are characterized by the content of hormonal substances. Among their main positive qualities, it should be noted that they contribute to the successful onset of pregnancy.
Treatment with gestagens is carried out using, for example, Dufaston, dydrohemteron, which has the form of 10 mg tablets. The duration of the minimum course is 3 months, during which the drug is taken 2 to 3 times a day starting on the 5th day and ending with the 25th day of the cycle. The drug can cause a number of side effects, manifested in the form of: increased sensitivity of the mammary glands, breakthrough uterine bleeding, minor liver dysfunctions, itching and rash on the skin, urticaria, and in rare cases - Quincke edema and hemolytic anemia.
The 17-OPC preparation is a 17.5-hydroxyprogesterone capro- nate which is produced in 12.5% and 25% in an oily solution in 1ml ampoules. Is administered for injection twice a week at a concentration of 500 mg. For one injection. The course of treatment is prescribed for a duration of 3 months to 6 months. At the 12-14 week of treatment with the endometrium, severe atrophy occurs, and the uterus decreases in size. The use of the drug may be accompanied by headache, drowsiness, apathy, nausea and vomiting; can lead to a deterioration of appetite, a decrease in sexual desire, a decrease in the duration of the cycle of menstruation and intermediate bleeding.
Tablets Norkolut or NORETHISTERONE 5 mg. Should be taken one at a time, starting on the 5th day and stopping after the 25th day of the menstruation cycle. The course of treatment is 3-6 months. When calculating the dose, the individual drug tolerance and therapeutic effectiveness are taken into account. Side effects are reduced to the appearance of headaches, the state of nausea and the urge to vomit, there may be bloody vaginal discharge of acyclic nature; there is a tendency to increase the body weight, there may be a skin rash and itching. The use of the drug for a long time can be fraught with thrombosis and thromboembolism.
Treatment of adenomyosis of the uterus by surgery is performed in order to eliminate as many of the zones of localization of this pathology as possible in the body. Such surgical intervention is all the more effective than at the earliest stage of the development of the pathological process it occurs. The likelihood of a rapid cure also depends on the severity of the endometriotic lesion.
As the development of medical science develops and various innovative ways to combat this disease. To date, more and more beginning to find the use of electrocoagulation. This method of removing tumor formations can be used under anesthesia, which completely excludes pain.
More information of the treatment
Prevention of uterine adenomyosis
Prevention of adenomyosis of the uterus is mainly reduced to regular visits to the doctor of a gynecologist.
It is a common misconception that such visits are justified only during pregnancy, or in cases when there are any alarming signs that may cause suspicion of the onset of the disease. It is recommended to visit the doctor at least once every six months for a primary gynecological examination, and probable detection of pathological changes in the uterine adenomyosis.
The specialist can correctly interpret such symptoms in a timely manner and prescribe the appropriate treatment.
In addition, prevention of adenomyosis of the uterus requires the need for periods of rest, stress relief and the consequences of stressful situations if the woman observes the appearance of mildly painful symptoms in the pelvic region. To do this, after consulting a doctor about this, it may be advisable to use all appropriate sedative medications, physiotherapeutic procedures and relaxation massages.
Meaningful and attentive care of a woman about her own health is the best prevention of a large number of gynecological diseases.
Prognosis of uterine adenomyosis
Adenomyosis of the uterus is largely characteristic of the asymptomatic course of the pathological process, which can be stretched for many years and even decades. This disease can for a long time not manifest itself as a clear cause of the harmful effects on the body, leading to depletion or in the worst cases causing its death.
The prognosis of uterine adenomyosis, as to the probability of occurrence of all complications, is conditioned by the fact that first of all, due to the large amount of blood loss from uterine bleeding, there is a risk of anemia in acute or chronic form.
At the same time, the progress of the development of the disease has the features inherent in oncology pathologies, and also like malignant hyperplasia, cancer, sarcoma, etc., and poorly yields to conservative treatment.
The prognosis of uterine adenomyosis appears to be favorable in the event that after the recognition of recovery in a five-year time interval there are no relapses. A positive aspect in this connection is also the fact that during this period there is no resumption of pain in the pelvic region and no other characteristic symptoms are observed.