Uterine adenomyosis

Adenomyosis of the uterus, also known as internal endometriosis, is a disease of the internal mucous membrane, which is expressed in the penetration and spread of endometrial cells into other layers of the uterus.

The term "adenomyosis" is used to describe processes of glandular degeneration in the muscular tissue of the uterus. Such processes are benign in nature.

With this disease, endometrial cells acquire a 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, gastrointestinal tract, in the navel, etc.

Adenomyosis of the uterus begins to affect the cellular myometrium, which provokes the development of all sorts of pathologies in the muscular tissues of the uterus. This can become a trigger for the onset of uterine degradation processes.

Endometrial cells that have spread beyond the uterine mucosa continue to function according to the normal monthly cycle, which causes local inflammation and subsequently leads to significant disruptions in the functioning of the organ affected by them.

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Causes of adenomyosis of the uterus

The causes of uterine adenomyosis have not been fully studied to date. Just as it is impossible to say with absolute certainty what are the mechanisms of its occurrence and progression of the pathological process.

Gynecology specialists are unanimous only in the fact that this disease is dependent on hormones. Based on this, it is stated that its occurrence is caused by immunological reasons.

There are a number of factors that increase the likelihood of developing adenomyosis.

The risk group primarily includes women with a hereditary predisposition to adenomyosis.

If menstruation began at a very early age, or, conversely, too late, this may become a certain prerequisite for the appearance of this pathological process.

Adenomyosis can develop in a woman against the background of obesity. The more the body mass index exceeds the norm, the higher the probability of this disease.

Risk factors include starting sexual activity too early or too late.

The causes of adenomyosis of the uterus also lie in late childbirth and postpartum complications.

Adenomyosis can be caused by the consequences of gynecological manipulations, such as abortions, curettage for diagnostic purposes, or the use of contraceptives, both mechanical - the placement of an IUD in the uterus, and oral contraceptives.

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Symptoms of adenomyosis of the uterus

Symptoms of uterine adenomyosis manifest themselves primarily in the form of heavy and prolonged bleeding during the monthly cycle. This is the main symptom that is unique to this disease.

Large volumes of blood loss over a long period of time lead in turn to the development of secondary iron deficiency anemia.

Its presence is determined by a decrease in the body's tone and performance, excessive drowsiness, and frequent dizziness. A painful pallor of the skin and mucous membranes occurs, and the body's resistance to infectious diseases decreases.

Adenomyosis of the uterus is characterized by specific discharges that appear several days before menstruation and several days after its completion. A common case is the form of the disease that provokes metrorrhagia, that is, the appearance of bleeding from the uterus in the middle of the menstrual cycle.

Symptoms of uterine adenomyosis, depending on the type and characteristics of the process, have varying degrees of severity.

Thus, diffuse adenomyosis of the uterus of the 1st degree is characterized by a virtually complete absence of obvious symptoms. The 2nd and 3rd degrees are determined based on the size of the neoplasm nodes, as well as the degree of spread.

Pain in adenomyosis of the uterus

Pain associated with adenomyosis of the uterus appears in the form of pain syndrome of algomenorrhea or dysmenorrhea, which 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 development of this pathology occurs. Painful sensations manifest themselves with great force in cases where the cervix is affected, and in addition, they are concomitant manifestations of the progression of the spread of adenomyosis, associated with the formation of adhesions.

When the cause of adenomyosis is the pathological process of formation of an additional horn of the uterus, its symptoms are similar to manifestations of severe pain in the lower parts of the abdominal cavity of women, the so-called acute abdomen. This is caused by the penetration of menstrual blood into the uterine cavity.

The pain symptoms are similar to those associated with peritonitis.

Pain in adenomyosis of the uterus, depending on its localization, can indicate during diagnostics the presence of pathology development processes in one or another part of the body. Thus, pain in the groin area indicates that the corresponding corner of the uterus is affected, and if pain symptoms appear in the vagina or rectum, this may mean that the cervix is involved in pathological processes.

Adenomyosis of the uterus and pregnancy

Many women are concerned about the relationship between uterine adenomyosis and pregnancy, and to what extent the presence of this disease can affect the likelihood of bearing and giving birth to a healthy child.

This pathology is characterized by the 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 the processes of egg maturation in the ovaries can be stopped. The properties of the uterine endometrium undergo negative changes.

Such pathological phenomena ultimately lead to the impossibility of attachment of the fertilized egg to the uterine mucosa.

It should be noted that due to the occurrence of hormonal imbalance, the first weeks of pregnancy seem to be especially critical.

"Adenomyosis of the uterus and pregnancy" - if such a disease is diagnosed, in this case, therapy with the use of gestagens is indicated, which can facilitate the onset of pregnancy.

The use of these drugs should be continued further, in order to maintain the necessary hormonal background. But here it is necessary to carefully monitor the level of progesterone in the blood, based on the indicators of which a conclusion is made about the advisability of stopping such therapy or its termination.

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Is it possible to get pregnant with adenomyosis of the uterus?

Endometriotic pathology is a fairly common disease, so for a woman planning a child it becomes important to determine all the pros and cons of whether it is possible to become pregnant with adenomyosis of the uterus.

This diagnosis is not a categorical sentence that puts an end to the possibility of getting pregnant, carrying 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 that helps to eliminate the likelihood of the appearance of any negative factors is a comprehensive examination of the body and the implementation of appropriate treatment based on the results obtained.

Great importance in diagnostics is given to the detection of sexually transmitted infections. 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 an infection that occurs in a woman's body during pregnancy can cause complications. Therefore, it is necessary to conduct an appropriate therapeutic course before pregnancy occurs, since many drugs are contraindicated in this condition.

Thus, the answer to the question of whether it is possible to become pregnant with adenomyosis of the uterus is positive to the extent that the appropriate treatment measures and the correct line of behavior in connection with such an important period in the life of a woman planning to become a mother are correctly prescribed.

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Adenomyosis of the uterine body

Adenomyosis of the uterine body, also called endometriosis of the uterine body, is a form of this disease that is characterized by the appearance of heterotopic, abnormally located, pathological foci in the myometrium.

To understand the mechanism of action of this disease, it is necessary to understand the structure of the tissues that make up the uterus. The endometrium is composed of a combination of its basal layer with the functional layer. In the basal layer, processes occur that are responsible for the onset of menstruation and the formation of the functional layer. The latter contains glandular cells that produce a special mucus, and is distinguished by the presence of a large number of terminal branches of small spiral arteries. The functional layer peels off after the end of each monthly cycle. Behind the endometrium, which is the internal mucous membrane of the uterus, is the muscular membrane, the myometrium. Due to it, due to significant stretching, an increase in the volume of the uterus occurs during pregnancy.

In adenomyosis, which occurs in the body of the uterus, there is a spread of tissues, essentially identical to the endometrioid layer, beyond their usual localization in the uterine mucosa.

Adenomyosis of the uterine body is characterized by the growth of such neoplasms primarily among the muscle fibers in the myometrium layer of the uterus.

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Adenomyosis of the cervix

Adenomyosis of the cervix, like other forms of endometrial lesions, is characterized by the pathological spread of mucosal cells into the tissue separating the endometrium and myometrium. Subsequently, the endometrium also penetrates into the muscular membrane of the uterus.

In a healthy state, in the absence of any pathologies during the monthly cycle, the endometrium grows exclusively into the uterine cavity, during which only its thickening occurs.

It is necessary to pay attention to the following point. Pathological spread of the endometrium in adenomyosis does not occur immediately across the entire inner surface of the mucous membrane, but there is a tendency for the emergence of individual foci of its germination into adjacent tissues. The appearance of endometrial cells in the muscular membrane of the uterus causes a certain response from the myometrium. As a protective mechanism against the subsequent progress of such an invasion, the bundles of muscle tissue around the foreign formation thicken.

Adenomyosis of the cervix occurs as a result of the direction of such a process towards the cervix and is accompanied by all the corresponding symptoms and phenomena that arise in connection with the appearance of foci of endometriotic lesions in it.

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Diffuse adenomyosis of the uterus

The fact that there is such a type of endometriosis as diffuse adenomyosis of the uterus is evidenced by the fact that blind pockets appear in the endometrium in the uterine cavity, which differ in the depth of penetration into its layers. The possibility of fistulas, localized in the pelvic cavity, is also possible.

This form of the disease can be provoked by the consequences of various gynecological radical interventions. It can be caused by diagnostic curettage, multiple abortions, as well as mechanical cleaning during pregnancy failure or after childbirth. Risk factors also include the presence of inflammatory processes in the uterus, surgical treatment of the uterus, and postpartum complications.

The pathological process exhibits such features as uniform germination of endometriotic cells in the muscular layer of the uterus, without the occurrence of isolated lesions.

Due to the significant difficulties in carrying out effective treatment measures, the probability of complete recovery seems extremely small. Diffuse adenomyosis of the uterus may reach the stage of regression after the onset of menopause in a woman.

The disease is characterized by a significant degree of severity and is fraught with serious complications during pregnancy.

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Nodular adenomyosis of the uterus

Nodular adenomyosis of the uterus is a disease in which pathological spread of endometriotic tissues in the myometrium of the uterus occurs. As a concomitant phenomenon in the process of development of this form of adenomyosis and representing its characteristic feature, the occurrence of nodes in the affected areas occurs.

Such neoplasms appear in large numbers surrounded by connective tissue, have a dense structure and are filled with blood or brownish liquid.

The fluid content is determined by the mechanism of formation of nodular adenomyosis of the uterus. The modified glands continue to function in accordance with the monthly cycle, as a result of which they produce fluid.

Nodular adenomyosis of the uterus manifests itself in symptoms similar to uterine myoma. Its difference from the latter is that in this case the nodes are formed from glandular tissue, not from muscle.

Often these two diseases occur together. This is expressed in the fact that the uterus after the end of the monthly cycle does not return to its normal size, but remains enlarged to the extent that the pathological neoplasm of the myoma has a size.

Focal adenomyosis of the uterus

Focal adenomyosis of the uterus is characterized by the growth of endometriotic tissues in the myometrium layer of the uterus in the form of scattered clusters - individual foci of development of pathological processes. These phenomena do not extend to the entire internal surface of the internal cavity of the uterus.

The tendency for such a disease to develop may occur as a result of a violation of the integrity of the internal mucous membrane, the endometrium of the uterus during curettage for diagnostic purposes, abortions, or mechanical cleaning in the case of a frozen pregnancy.

Focal adenomyosis of the uterus is a very serious disease. It is difficult to treat, and complete recovery from it and complete restoration of health seems almost impossible. There is a possibility of regression when at the age when a woman's sexual functions begin to fade, during menopause.

For a woman during pregnancy there is a risk of significant complications and the development of all sorts of pathologies.

Therefore, if painful and heavy menstrual bleeding is detected, and sexual intercourse is accompanied by pain, this is an alarming signal.

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Adenomyosis of the uterus grade 1

Adenomyosis of the uterus grade 1 is a stage of endometriotic uterine lesion, in which the initial penetration of the endometrium into the muscular tissue of the uterus occurs. Grade 1 is characterized by growth of approximately one third of the thickness of the myometrium.

After the introduction of individual cells of the functional layer of the endometrium into the myometrium, their proliferation begins as a result of cyclic changes in estrogen levels.

The factors in the development of this disease are a 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 disturbances in the outflow of blood during menstruation.

Adenomyosis of the uterus begins with changes in the hormonal background due to an 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 amount exceeds the norm, the duration of the menstrual period increases. Also, with an excess of estrogen, menstrual blood comes out in significantly larger quantities.

In addition, stage 1 adenomyosis of the uterus and the appearance of endometriotic neoplasms in the myometrium are accompanied by disturbances in the functioning of the immune system.

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Adenomyosis of the uterus grade 2

Adenomyosis of the uterus of the 2nd degree is characterized by a deeper degree of endometrial growth into the muscular layer of the uterine walls. In this case, it extends up to half the thickness of the myometrium.

At this stage of the progress of such an endometriotic pathological process, there may be a complete absence of any pronounced symptomatic manifestations. The main signs that may indicate its presence in the body may be an increase in the duration of the menstrual cycle and the appearance of dark brown discharge between periods. Also possible are the appearance of pain symptoms in the lower abdomen, heaviness in the abdomen and a feeling of discomfort. In some cases, an increase in the intensity of pain occurring during menstruation is noted. As a consequence of an excessive amount of estrogens, the disease may be accompanied by vegetative disorders, headache, nausea, vomiting, tachycardia and an increase in body temperature.

Adenomyosis of the uterus of the 2nd degree causes changes in the structure of the inner surface of the uterine cavity. There is the formation of tubercles, it acquires greater density, a significant decrease in elasticity is noted.

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Uterine leiomyoma with adenomyosis

Uterine leiomyoma with adenomyosis is a combination of two diseases, each of which individually is one of the most common uterine lesions.

They have significant similarities in the causes that cause them to appear, and in many cases where leiomyoma occurs, it is accompanied by adenomyosis, and vice versa.

The causes of each of these gynecological pathologies are rooted in the hormonal imbalance of the body, disorders in the immune system, and the presence of infectious processes in the chronic stage. Their occurrence and progression can also be caused by gynecological diseases in an advanced form, repeated abortions, and stress factors.

Until recently, uterine leiomyoma with adenomyosis did not provide for any other forms of treatment except surgical intervention to remove the uterus with appendages. However, given that young women of early childbearing age are often at risk for this disease, the advisability of such a radical measure is unjustified in many cases.

Today, the optimal treatment is the use of minimally invasive surgical methods, such as operations using laparoscopy and hysteroresectoscopy.

What is the danger of uterine adenomyosis?

Based on the fact that by definition adenomyosis is characterized by the appearance of benign tumor formations, the question arises about the severity of this disease, what serious threats does it pose and what is the danger of adenomyosis of the uterus?

A characteristic feature of adenomyosis is 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.

The possibility of the onset of malignant cellular transformation at the genomic level cannot be discounted.

Extragenital endometrial cells can provoke a wide range of complications and pathologies that require immediate medical interventions. Among such complications, what is dangerous about adenomyosis of the uterus, it is necessary to note in particular the probability of intestinal obstruction due to endometriosis of the gastrointestinal tract, hemothorax - filling the pleural cavity with blood as a result of lung damage, etc.

Consequences of adenomyosis of the uterus

The consequences of adenomyosis of the uterus may take 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, iron deficiency anemia develops. Lack of oxygen causes dizziness, fainting, frequent headaches, and memory impairment. A general decrease in the body's vitality and a significant deterioration in performance are noted.

Endometriotic uterine lesions also result in the growth of cells through the myometrium of the uterus into the serous membrane, and the involvement of organs in the development of the pathological process that are in close proximity to the uterus. Such as organs located in the peritoneal cavity, the urinary bladder and the rectum.

One of the most significant consequences of adenomyosis is the possibility of infertility, which is caused by both ovulation disorders and the inability of the embryo to attach to the walls of the uterus.

The consequences of adenomyosis of the uterus are also manifested by such an unfavorable factor as the fact that in terms of the difficulties associated with conservative treatment of this disease, it approaches oncological lesions. Pathological endometrium, which grows in other tissues and organs, is characterized by a tendency to degenerate into malignant neoplasms.

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Diagnosis of adenomyosis of the uterus

Diagnosis of adenomyosis of the uterus involves, first of all, a gynecological examination of the genitals, which comes down to an examination using mirrors and a colposcope - an optical device that provides 30-fold magnification when examining the cervix. In addition to such visual methods, smears are taken for appropriate laboratory analysis, and the respiratory and circulatory organs, digestive organs and urinary system are also examined.

If a woman has certain chronic diseases or body characteristics associated with individual intolerance to certain medications, additional consultations with relevant specialists are prescribed.

After carrying out such above mentioned measures, as a rule, an ultrasound examination of the pelvic organs is also prescribed. Ultrasound is one of the most common diagnostic methods in gynecology. If there are appropriate indications, diagnostics of uterine adenomyosis is carried out using laparoscopy and hysteroscopy.

It is also possible to conduct an analysis of the vaginal microflora to identify all kinds of unfavorable bacteria.

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Echo signs of uterine adenomyosis

One of the most widely used, as well as the most effective and efficient types of ultrasound in gynecology is the transvaginal ultrasound examination method. Diagnostic measures that are carried out using this method provide research results that are distinguished by the highest degree of accuracy.

The following echo signs of uterine adenomyosis are identified, agreed upon and confirmed by a significant number of medical specialists.

Adenomyosis of the uterus is manifested in this study by the presence of different thicknesses of the uterine walls, with obvious asymmetry.

The next echo sign that indicates 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.

The presence of adenomyosis of the uterus is indicated by the echo sign that it is distinguished by its significant size up to six weeks of pregnancy, and sometimes more.

Echo signs of adenomyosis of the uterus also include the appearance of cystic formations measuring 3 to 5 millimeters before the onset of menstruation.

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Adenomyosis of the uterus on ultrasound

Currently, to detect gynecological diseases, methods of direct examination of tissue fragments from the walls of the uterus, vagina, etc. are used. For this, scrapings, smears are taken, colposcopy and biopsy are performed. Another type of diagnostics is ultrasound examination.

During an ultrasound, it is possible to visually assess the condition of the uterus, as well as the possible detection of structural changes and signs of pathologies.

Thanks to the use of this diagnostic method, it becomes possible to promptly detect adenomyosis of the uterus using ultrasound.

Since the penetration of ultrasound waves into the uterus is impeded by the skin-fat layer of the peritoneal cavity, a transvaginal method of such examination is used to achieve diagnostic efficiency. This assumes that the ultrasound sensor is inserted directly into the vagina.

Adenomyosis of the uterus on ultrasound is manifested as a set of certain echo signs, by which the presence of this disease can be confirmed.

Clear and unambiguous interpretation of the obtained research results is of great importance. Thus, detection of fairly common diffuse changes in the myometrium can often be mistaken for adenomyosis.

Based on this, analysis and diagnosis based on the data obtained is exclusively within the competence of the relevant specialist in the field of gynecology.

Treatment of uterine adenomyosis

Treatment of adenomyosis of the uterus seems possible using one of two ways to get rid of this disease.

The therapeutic method involves using all possible means of drug treatment to restore normal functioning of the immune system and bring the body's hormonal background to an optimum. The drugs used for the therapeutic treatment of uterine adenomyosis are prescribed in accordance with the individual characteristics of the woman's body in such proportions that, with their greatest effectiveness, the likelihood of side effects is minimized. Most drugs produced at present have the properties of providing the maximum possible positive therapeutic effect, while the possibility of negative consequences from their use is small. These are mainly gestagens, that is, those that are characterized by the content of hormonal substances. Among their main positive qualities, it is necessary to note that they contribute to the successful onset of pregnancy.

Treatment with gestagens is carried out using, for example, Duphaston, dydrohemterone, which is in 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 on 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 dysfunction, itching and rashes on the skin, urticaria, and in rare cases - Quincke's edema and hemolytic anemia.

The drug 17-OPK, which is 17-hydroxyprogesterone capronate, is produced in 12.5% and 25% concentrations in an oil solution placed in 1 ml ampoules. It is intended for injection twice a week at a concentration of 500 mg per injection. The course of treatment is prescribed for a duration of 3 months to six months. At 12-14 weeks of treatment, the endometrium undergoes pronounced atrophy, and the uterus decreases in size. The use of the drug may be accompanied by headache, drowsiness, apathy, nausea and vomiting; it can lead to a deterioration in appetite, decreased sexual desire, a decrease in the duration of the menstrual cycle and intermediate bleeding.

Tablets Norkolut or NORETHISTERONE 5 mg. should be taken one per day, starting on the 5th day and stopping after the 25th day of the menstrual cycle. The course of treatment is 3-6 months. When calculating the dose, individual tolerance of the drug and therapeutic efficacy are taken into account. Side effects are reduced to the appearance of headaches, nausea and vomiting, there may be bloody vaginal discharge of an acyclic nature; there is a tendency to increase body weight, skin rash and itching may appear. Use of the drug for a long time can be fraught with thrombosis and thromboembolism.

Treatment of uterine adenomyosis by means of surgical operation is performed in order to eliminate in the body as many zones of localization of this pathology as possible. Such surgical intervention is more effective, the earlier the stage of development of the pathological process it is performed. The probability of urgent recovery also depends on the severity of endometriotic lesion.

As medical science develops, various innovative methods appear aimed at combating this disease. Today, electrocoagulation is increasingly being used. This method of removing tumor formations can be used under anesthesia, which completely eliminates pain.

Prevention of adenomyosis of the uterus

Prevention of adenomyosis of the uterus mainly comes down to regular visits to the gynecologist.

A big misconception is the widespread belief that such visits are justified only during pregnancy, or in cases when any alarming signs appear that may raise suspicion about the onset of the disease. It is recommended to visit a doctor at least once every six months for an initial gynecological examination and the possible detection of pathological changes inherent in adenomyosis of the uterus.

A specialist can promptly and correctly interpret such symptoms and prescribe appropriate treatment.

In addition, prevention of adenomyosis of the uterus requires periods of rest, stress relief and the effects of stressful situations if a woman notes the appearance of mild pain symptoms in the pelvic area. For this purpose, after consulting a doctor on this matter, it may be advisable to use all sorts of appropriate sedatives, physiotherapy procedures and relaxation massages.

A woman’s meaningful and attentive care for her own health is the best prevention of a large number of gynecological diseases.

Prognosis of uterine adenomyosis

Adenomyosis of the uterus is largely characterized by an asymptomatic course of the pathological process, which can stretch out for many years and even decades. This disease may not manifest itself for a long time as an obvious cause of harmful effects on the body, leading to exhaustion or, in the worst cases, causing its death.

The prognosis of adenomyosis of the uterus, as regards the likelihood of the occurrence of all sorts of complications, is determined by the fact that, first of all, due to the large amount of blood loss from uterine bleeding, there is a risk of developing anemia in acute or chronic form.

At the same time, the progression of the disease has features inherent to oncological pathologies, and just like malignant hyperplasia, cancer, sarcoma, etc., it is poorly amenable to conservative treatment.

The prognosis for uterine adenomyosis appears favorable if, after the recovery has been confirmed, there are no relapses within a five-year period. Another positive aspect in this regard is the fact that there is no recurrence of pelvic pain during this period and no other characteristic symptoms are observed.