Causes, symptoms and treatment of adenomyosis. Adenomyosis and infertility

Symptoms, treatment of causes of adenomyosis

Very often, patients at an appointment with a gynecologist ask the question: "Diffuse adenomyosis of the uterus - what is it?" Are the consequences severe? Can the nodular form be cured without surgery?" Women with this disease often suffer from infertility.

Adenomyosis - what it is in accessible language

Adenomyosis is the growth of the endometrium (inner lining of the uterus) into its deeper layers. The pathology is diagnosed in women of reproductive age, most often - from 27 to 30 years old. Regardless of the degree of adenomyosis and even in the absence of treatment, it is capable of self-elimination after the onset of menopause.

This is a fairly "popular" disease - it is the third most common after adnexitis (inflammation of the appendages) and uterine myoma (a benign tumor of its muscle layer). Gynecologists often diagnose the combined development of adenomyosis and uterine fibroids.

Adenomyosis and pregnancy are an urgent problem also because the incidence of this pathology has been increasing in the last 10 years. This is associated with the following factors:

• growth of immune disorders;
• disease detection is more frequent due to the fact that diagnostic methods are becoming more perfect, and women are more aware (they visit doctors more often not only when pathological symptoms appear, but also for a preventive examination).

Types and degrees of adenomyosis

There are four types of adenomyosis:

• cellular - endometrial cells grow into the layers of the uterus in the form of small groups. The diagnosis of "focal adenomyosis" can be initial, then the pathology can develop in the form of a nodular form;
• nodular - endometrial cells are grouped in the form of nodes. Cavities with blood surrounded by a connective tissue capsule are found in the nodes;
• diffuse - endometrial cells are scattered in the tissues of the uterus without the formation of cells or nodes;
• mixed diffuse-nodular – a combination of nodular and diffuse forms of adenomyosis.

This classification is important in terms of diagnosis: the signs of the nodular form of adenomyosis on ultrasound will differ from the signs of the focal form.

There is another classification - taking into account the depth of penetration of endometrial cells into other layers of the uterus. It is important for understanding how to treat adenomyosis. According to this classification, the following are identified:

• 1st degree – only the submucosal layer is affected;
• 2nd degree – there is an impression up to half the depth of the myometrium (muscle layer of the uterus);
• 3rd degree – endometrial cells affect more than half of the depth of the myometrium;
• 4th degree – the endometrium grows over the entire myometrium, its spread to neighboring organs and tissues is possible.

Causes of adenomyosis

You should understand the difference between adenomyosis and endometriosis. With adenomyosis, the endometrium grows through the layers of the uterus, with endometriosis, it develops in other organs after the transfer of endometrial cells with the flow of blood or lymph.

The exact causes of the development of this pathology have not been clarified. But there are established factors against which adenomyosis occurs more often:

• early or late onset of menarche (first menstruation);
• late onset of sexual intercourse;
• use of oral contraceptives;
• treatment with hormonal drugs;
• disruption of the hormonal background;
• destruction of the thin connective tissue plate, which serves as a kind of separator between the endometrium and myometrium (in this case, the treatment of adenomyosis is complicated).

Damage of the mentioned plate is possible under the following circumstances:

• diagnostic scraping of the uterine cavity;
• operational intervention;
• use of intrauterine spirals;
• inflammatory impression of the endometrium;
• complicated childbirth;
• abortions (in this light, the problem of adenomyosis and pregnancy becomes especially relevant).

Unfavorable heredity deserves special attention. It should be remembered that the development of congenital adenomyosis is also possible.

Symptoms of the disease

First of all, the development of adenomyosis is signaled by changes in menstruation - they become:

• prolonged (lasting more than 7 days);
• painful;
• bulky, with clots.

The severity of such disorders may not depend on the degree of adenomyosis.

A few days before and after menstruation, there are brown discharges that stain the underwear. Sometimes in the period between periods, uterine bleeding occurs, which can be considered as premature menstruation.

Pains in the lower abdomen are also a characteristic signal of adenomyosis. They appear literally a couple of days before menstruation, and last for several days after it. The more endometrium grows through the layers of the uterus, the more intense the pain.

Infertility was found in more than 50% of patients with the described pathology. Adenomyosis is considered a cause of infertility, because it disrupts the normal structure of the endometrium, which impairs the implantation of a fertilized egg, and the tone of the muscle layer increases.

Due to pronounced menstrual bleeding, anemia develops, which requires special attention in the treatment of adenomyosis. Anemia is manifested by paleness, weakness, fatigue and other general disorders. The development of neurosis is possible due to prolonged menstruation, severe pain and anemia.

Diagnostics

Adenomyosis can be suspected already when examining a woman on a gynecological chair: before menstruation, the uterus has the shape of a ball, is enlarged and can even simulate a pregnant uterus. If nodular adenomyosis develops, peculiar bumps can be felt in the uterus.

An accurate diagnosis is made with the help of additional research methods:

• ultrasound examination. With its help, differential diagnosis of the disease with other pathologies is carried out (the signs of adenomyosis and ovarian cysts will be different);
• hysteroscopy - examination of the uterine cavity using a hysteroscope (a type of endoscopic equipment);
• magnetic resonance imaging;
• general blood test - it reveals signs of anemia, which develops against the background of uterine bleeding;
• determining the level of hormones.

How to treat adenomyosis

Treatment of adenomyosis begins with conservative methods. At the same time, the following are appointed:

• hormonal drugs;
• anti-inflammatory means;
• immunomodulators;
• pharmacy vitamin complexes and injectable vitamins;
• sedative drugs.

If the results of conservative treatment of adenomyosis are unsatisfactory, surgical treatment is possible. The following operations are practiced:

• endocoagulation ("burning") of pathological cells of the endometrium;
• supravaginal amputation of the uterus;
• hysterectomy.

The choice of surgical treatment should be approached very responsibly - for the health of a woman who plans to become pregnant, one should fight to the last with the help of conservative treatment methods. An absolute indication for removing the uterus can only be profuse (pronounced) bleeding and total germination of all layers of the uterus by the endometrium.

On the website https://dobrobut.com/ you can make an appointment with our specialists. From them you will learn about adenomyosis - what it is in an accessible language.

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