Is it possible to get rid of adenomyosis? How to treat uterine adenomyosis? Symptoms, signs and reviews

The diagnosis of adenomyosis is most often made in women of reproductive age. This pathology is a type of endometriosis and is characterized by the germination of the epithelium into the muscular uterine layer. It is not difficult to suspect adenomyosis - atypical menstruation begins in women, pulls the lower abdomen, and if you want to get pregnant, it does not occur. When such symptoms appear, women visit a doctor who will make a diagnosis and draw up a diagram of how to treat adenomyosis conservatively. If a positive result does not occur, the pathology is treated surgically.

Drug treatment

Adenomyosis is a hormone-dependent disease.

During menopause and pregnancy, the pathology regresses. Hormonal drugs are actively used to treat the disease. They create a state of pseudomenopause or lead to chronic anovulation. This effect is necessary in order to restore the normal growth of the endometrium. Pseudomenopause and anovulation are temporary – as soon as medicinal preparations are cancelled, the woman can become pregnant without problems.

Among the hormonal drugs that are used to treat adenomyosis, the following groups of drugs are used:

• combined monophasic drugs - Femoden, Ovidon, Rigevidon, Janine, Marvelon, Diane-35, Microgynon;
• progestin drugs - Norkolut and Duphaston, Gestrenol, Depo-Provera;
• antiestrogenic agents – Tamoxifen;
• antigonadotropins – Danoval, Danazol;
• gonadotropin releasing hormone agonists – Triptorelin, Zoladex;
• gonadotropin hormone antagonists – Nerobol, Retabolil.

Hormonal drugs are the basis of conservative treatment of adenomyosis

Hormone therapy must be completed for a sufficiently long period - the course of treatment for such patients can take from 6 to 9 months. In order to reduce the effect of hormonal drugs on the gastrointestinal tract, supportive drugs are prescribed that protect the liver, pancreas and gastric mucosa from negative impact active substances. To maintain the functioning of the gastrointestinal tract and activate metabolism, patients are prescribed Festal, Panzinorm, Karsil, Methyluracil. Sea buckthorn oil, olive oil, protector preparations Almagel and Phosphalugel are useful.

It has been established that most often adenomyosis appears against the background of decreased immunity, so it is very important to prescribe medications to patients to normalize immune status. For this purpose, it is recommended to take Levomizol one tablet per day for 3 days. Then a four-day break is taken and the course begins again. So you need to take 4 courses, that is, 12 tablets.

To increase immunity, Levomizol should be taken 3-4 times a year, interrupting for an average of two months. If necessary, doctors can prescribe Splenil injections. They are done daily intramuscularly.

The following drugs are prescribed as additional immunomodulators:

• Timalin,
• Cycloferon,
• Pentaglobin,
• Thymogen.

Along the way, the treatment regimen includes fortified preparations – ascorbic acid, tocopherol acetate, Unithiol. It is very important to use absorbable agents for the complex treatment of adenomyosis. Patients are given microenemas with sodium thiosulfate or electrophoresis with potassium iodide and zinc sulfate.

In order to suppress the production of prostaglandins, non-steroidal anti-inflammatory drugs are prescribed. For example, indomethacin is administered orally in the form rectal suppositories. This therapy is carried out presumably a week before menstruation and the administration of suppositories is stopped just before the onset of menstruation. critical days. To treat pain, you can prescribe No-shpu, Analgin or Baralgin. The neurological component can be eliminated with sedatives or tranquilizers.

Baralgin – effective remedy to remove painful sensations with adenomyosis

Is it possible to cure adenomyosis with tablets? This issue is currently controversial among doctors. Enormous advances in the treatment of pathology, the use of an ever-increasing range of hormonal drugs and a decrease in the level of side effects gives great hope for the successful treatment of adenomyosis. However, at the moment it is impossible to completely get rid of the pathology. Adenomyosis is chronic illness, with such a pathology we can only talk about achieving a stable period of remission.

The examination that women undergo with adenomyosis twice a year confirms that remission in three to five years can be considered a good result, when during this time new foci of adenomyosis do not appear, and old ones become less active and do not negative symptoms. Such results can be achieved with focal adenomyosis, when the pathological endometrium is limited in its distribution.

The diffuse form of pathology presents great difficulties for treatment, since foci of activation of pathology fade away in one place and reappear in another. The uterus is an organ with a completely damaged muscle layer; it is extremely difficult to treat.

Surgical treatment of adenomyosis

If extensive foci of pathology are diagnosed, then surgery is performed in women over 35 years of age who do not plan to have any more children. There are clear indications for the operation that doctors follow:

• ineffectiveness of drug therapy;
• deterioration of the patient's health;
• development nodal shape adenomyosis;
• combination of the disease with other pathologies of the uterus, for example, fibroids;
• the patient has an ovarian tumor.

The choice of surgical intervention tactics depends on the prevalence of the pathology (the entire organ is affected or only in some places), as well as on the woman’s desire to have children in the future. For a woman, it is best to deal with focal forms of pathology. The nodes can be removed laparoscopically, and the uterine wall is restored, and the woman can have children in the future.

Surgery is necessary if adenomyosis has completely affected the uterus

For doctors, such an operation poses certain difficulties - it is necessary to have enough practical experience to correctly identify the boundaries of the lesions and perform high-quality suturing wound surface on the wall of the uterus. During the post-surgery period, doctors preventive actions against venous thrombosis and pulmonary embolism.

A diffuse form of pathology with complications involves radical surgery on the female genital organs. If a woman does not want to have children in the future, then doctors remove the uterus. These recommendations are given by the European and American Association obstetricians and gynecologists, since the risk of developing tumor formations with signs of malignancy is high. Removal of the uterus does not in any way affect the quality of a woman’s sex life.

Surgical interventions by the laparoscopic method are sparing procedures. Women do not have large scars as with abdominal interventions, and the recovery period for treatment is much shorter. Today, most of these operations are performed using the laparoscopic method. The condition of the patients after the operation is satisfactory - they can get up and eat, and spend an average of three days in the clinic, if there are no complications.

Full work ability is allowed after three weeks of sick leave, sex life resolved after a month. In the future, women need to have an ultrasound of the genital organs 1-2 times a year.

Folk remedies

Folk remedies for the treatment of adenomyosis will be effective if they are used correctly and all recommendations are fully followed without interrupting the therapeutic course. There are several ways to combat adenomyosis. Populists recommend using various herbs, clay and even leeches. Let's consider ways to treat the disease using these methods.

In Asian countries, angelica has been used to treat diseases since ancient times. This plant helps not only with adenomyosis. They can cure menstrual pain, vaginal dryness, endometriosis, Negative consequences menopause, prolonged menstrual bleeding.

Angelica increases the body's defenses, and the substance coumarin contained in it allows you to expand blood vessels, improve work nervous system, activate blood circulation in the body. Angelica is also able to relax the uterine muscles and fight hormonal imbalances in the body.

Dried angelica root is an effective remedy for the treatment of adenomyosis

To treat adenomyosis, populists recommend using angelica root. It normalizes hormonal levels, as a result of which endometrial cells undergo a process of autolysis and disappear. Angelica root can be taken in tea form. To do this, pour one tablespoon of angelica root, dried and crushed, into a glass of boiling water and leave for five minutes.

You need to take the medicinal liquid three times a day. Crushed angelica root can also be swallowed in dry form with water. Approximately half a centimeter of root is crushed at one time, and you need to eat three servings per day.

A herb with the specific name black cohosh will help cope with women's problems. It is used to ease menopause, painful menstruation, irregular periods, and impaired fertility. The herb can have a calming effect on the body and eliminate muscle pain. Black cohosh contains phytoestrogens. They have antitumor activity. The medicinal plant increases blood flow to the genitals and reduces intense pain.

All women can take medicine based on black cohosh, but heart problems are a contraindication. Also, the herb is not recommended during pregnancy or suspicion of it. Prepare medicine Black cohosh is very easy. One tablespoon of the herb should be poured into a thermos and poured with a liter of boiling water. Infuse the product for 10 hours and then drink it instead of tea. It is recommended to take no more than one liter of healing liquid per day. If the product seems bitter, you can add a little honey to it.

The disease can be treated with blue clay. This is an effective remedy in the treatment of pathology. You can prepare the remedy in the following way: blue clay It is necessary to put it in a deep basin and crumble it into small pieces. There is no need to moisten the clay with plenty of water. It is enough just to sprinkle the clay with water so that it becomes softer and can knead.

Treatment with blue clay helps to reduce foci of adenomyosis

After the clay and water have a uniform consistency, similar to porridge, it is transferred to a container (no more than 700 g) and placed on water bath. The clay is kept there for about five minutes, then laid out in plastic bag and make a cake of clay about 2 cm thick. Warm (but not hot!) Clay is applied to the lower abdomen, covered with a blanket, and the application is maintained for two hours. In total, you need to do six procedures, each time using new clay.

Since the pathology is largely associated with circulatory disorders, populists recommend that leeches be included in the treatment regimen for the disease. Leeches can not only thin the blood, but they also help relieve the inflammatory process. When treating adenomyosis, it is recommended to place leeches on bottom part belly. The procedure time is not limited. You need to wait until the leeches fall off on their own. The interval between procedures should be two to three days, after which the treatment is repeated. On average, it will take 5-6 hirudotherapy sessions to get results.

Treatment of adenomyosis presents significant difficulties due to the fact that the disease has chronic course. Having tried conservative treatment methods and folk remedies, patients should not refuse the operation proposed by doctors. For many it becomes the only way get rid of pathology and eliminate the risk of developing cancer.

The manifestation of internal genital endometriosis in women is sometimes called adenomyosis. The disease belongs to the group of systemic hormone-dependent benign pathologies. In fact, it is one of the types of endometriosis.

It is a pathological process caused by the germination of endometroid cells of the inner layer of the uterus into the tissue structures of organs of various localizations.

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Adenomyosis of the uterus - what is it?

Structural disorders of the uterine tissue with local inflammatory and gradual degenerative processes that destroy parts of its body are adenomyosis of the uterus, provoked by the introduction of endometrial glandular cells into its muscle layer. This is where their succession begins focal growth with the formation of large nodes followed by disintegration, rejection and bleeding.

Moreover, the entire cycle of decay and rejection coincides with the cyclic menstrual process occurring in normal endothelium in different periods"lunar cycle".

Depending on the histological structure, internal endometriosis is characterized by three main forms of manifestation:

1) Diffuse adenomyosis - manifests itself as multiple small focal nodular neoplasms scattered throughout the muscle layer over a large area of ​​uterine tissue. It is distinguished by the uniform distribution of pathological tissues over the entire area of ​​the myometrium of the anterior and back wall uterus.

2) Focal adenomyosis- represented by single large foci (heterotopias) of lesions localized in a separate small area of ​​the uterine myometrium. The lesions are limited to muscle tissue, as they are surrounded by their own capsule. Encapsulation of lesions does not cause changes in the shape and size of the uterus. The posterior wall of the uterus is susceptible to this form of damage.

3) Nodular adenomyosis- occurs with pathological growth focal form, turning into large neoplasms. In more than 80% of cases, the development of fibroids is combined with nodular adenomyosis. WITH medical point In terms of vision, this process is due to similar signs of development.

Classification of the disease by severity level clinical course, although not approved by the international commission, is recognized as the most convenient in clinical practice.

Manifestations of pathological processes in the tissues of the uterus, in more than 70% of cases, are diffuse in nature, therefore such adenomyosis is classified according to the degree of penetration of endometrial cells into the underlying tissue layers of the uterine body.

1. The first degree reflects diffuse proliferation of endometriotic tissue in the submucosal uterine layer (submucosal).
2. In the second degree, changes occur in almost half muscle mass body of the uterus.
3. In the third degree, the lesion covers most of the muscle mass.
4. The fourth degree of pathology is characterized by extensive growth glandular endometrium, extending beyond the myometrium into the perimetrium, passing into the peritoneal cavity and involving in the process of growth pathological tissue organs located in the pelvic cavity.

Signs of adenomyosis, characteristic symptoms

The characteristic signs and symptoms of uterine adenomyosis are due to pronounced menstrual menorrhagia, leading to the development of IDA ( Iron-deficiency anemia). Due to the large blood loss and the development of anemia, the symptoms manifest themselves:

• Signs of weakness and drowsiness;
• Frequent infectious pathologies;
• Pallor of the skin and mucous membranes in the visible area;
• Signs of vertigo (dizziness) and dyspnea (shortness of breath), which is caused by even the most insignificant exertion;
• Chronic fatigue and internal tension.

Specific signs of internal endometriosis include spotting Brown before and after menstruation (within 3 days). In the middle of the cycle, heavy menstrual bleeding may occur.

Three days before the start of the cycle, severe pain symptoms appear, which disappear spontaneously three days after menstruation.

Intensity pain syndrome also has its own characteristics. It is most strongly expressed in pathology in the area of ​​the uterine isthmus and in the extensive process of formation of adhesions.

For example, pain reminiscent of the symptoms characteristic of an acute abdomen can occur when the bicornuate uterine cavity is damaged, provoked by the reflux of blood during menstruation into the pelvic cavity. It can manifest itself with symptoms similar to peritonitis.

Based on the irradiation of the pain syndrome, it is easy to identify the localization of the pathological focus. For example, radiating pain in the groin indicates a pathological focus in the flexure zone of the uterus; pain in the large intestine or vagina is evidence of the presence of a pathological focus in the isthmus.

• By the way, this is also evidenced by pain during intimate intercourse, shortly before menstruation.

With adenomyosis with fibroids, the symptoms do not differ from the main signs of the disease. The exception is fibroids, localized in the submucous uterine layer. In this case, the symptoms manifest themselves as menorrhagia of an acyclic nature. For this type of adenomyosis, conservative treatment methods are untenable and the problem is solved conservative method– hysterectomy.

What does ultrasound diagnostics provide?

The best characterization of internal endometriosis is provided by the transvaginal ultrasound method. Diagnostic accuracy is ensured by more than 90%.

Pathognomic signs of uterine adenomyosis on ultrasound are displayed:

• Increased sizes of the anterior and posterior walls of the uterine body, due to which it becomes spherical in shape.
• Increasing it to the size of a six-month pregnancy, possibly larger sizes.
• Asymmetry of enlarged uterine walls.
• The appearance before menstruation of cystic formations (up to 5 mm or more) in the muscular lining of the uterine layer.

Treatment of adenomyosis - drugs and surgery

The choice of treatment tactics for uterine adenomyosis is based on many factors, taking into account specific features each patient, the nature of the disease, its prevalence and localization. Another factor taken into account is the woman’s desire to become a mother in the future.

Standard treatments for adenomyosis are based on:

1. Surgical treatment, including methods radical treatment– hysterectomy and oophorectomy and organ-preserving techniques – laparoscopy and excision of affected lesions.
2. Conservative, drug treatment - the use of anti-inflammatory, immunomodulatory, vitamin and physiotherapy, sedatives, supportive and absorbable drugs, treatment of adenomyosis with hormonal drugs.
3. Combined methods.

Medications for the treatment of adenomyosis are prescribed after a thorough examination of the patient and include:

• Preparations of combined oral contraceptives that normalize the functional properties of the ovaries, ensuring a decrease in menstrual flow and pain symptoms. Helping to stop menorrhagia and delayed menstruation. These are “Logest” and “Janine”, “Jess” or “Marvelon” and “Yarin”.
• To reduce the provocative functional effect of the ovaries on the endometrium, pituitary hormone preparations (antigonadotropins) in the form of “Danazol” or “Danol” are prescribed.
• To slow down and stop the proliferation of endometrioid tissues, progestogen preparations are used. The most effective are Duphaston and Norethisterone. The effectiveness of treatment of adenomyosis with Duphaston is due to its effect on reducing menstrual flow, stabilizing the cycle, and reducing pain symptoms during this period.
• The action of antiestrogens is aimed at inhibiting gonodotropic hormones, which deprives the life support of pathological cells and causes their death; this can be classified as “Gastrinon” or “Medroxyprogesterone”.
• The extinction of pathological foci, due to an increase in progesterone and a decrease in estrogen, is facilitated by the drug “Visanne”.

Many of these drugs have side effects and contraindications, so should only be prescribed by a doctor.

Adenomyosis during pregnancy - 5 facts

The manifestation of adenomyosis during pregnancy is not uncommon today, which made it possible to study the nature, “habits” and influence of pathology in this period. The conclusions of numerous observations and studies are presented in the relevant medical regulations.

1. According to various sources, more than half of women with internal uterine endometriosis have an increased risk of infertility, but in most cases, timely complex therapy can restore reproductive function.

2. Adenomyosis is often a serious threat caused by premature birth. In many cases, only adequate treatment according to the generally accepted regimen can stabilize the situation.

3. Premature birth or abortion causes relapse or exacerbation of the disease. In such situations, the process of development of pathology is significantly accelerated, therefore, no matter what, the pregnancy should be maintained if possible.

4. More than half of pregnant women with adenomyosis have a normal and safe birth, but after childbirth there is a risk of developing complications in the form of uterine hemorrhages, so women should be prepared for this.

5. IN postpartum period, with the restoration of the menstrual cycle, the pathological process can be activated. But the risk in this case is much lower than after an abortion.

In any cases (after premature or normal delivery, after an abortion), after restoration of the menstrual cycle, women with a history of internal endometriosis need to undergo (hormonal, immunomodulatory, oxidant, etc.) anti-relapse therapy.

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Adenomyosis is a form of endometriosis. The main difference between this form is that the endometrium, breaking through the protective layer of the uterus, grows into its muscle layers. At the same time, the uterus, as defensive reaction, forms muscle seals around the embedded endometrium to prevent further growth.

Let's take a closer look at the structure of the uterus to understand what adenomyosis is. The uterus itself consists of several layers - the myometrium, that is, the muscular layer of the uterus and the endometrium, the mucous layer covering the inside of the uterus. It is the rejection of the endometrium, at the end of each cycle, that is accompanied by bleeding. The endometrium itself is two-layered, i.e. it consists of a main layer - a basal layer, which serves as the basis for the growth of new endometrium, and a functional layer, this layer exfoliates monthly. The functional layer consists of one layer of cells resembling the shape of a cylinder; between them are cells that produce mucus - glandular cells. It is the functional layer that grows into the pathology muscular body the uterus “breaking through” the basal layer.

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Causes of adenomyosis development

Today there is no one theory that fully answers the question of why adenomyosis appears. Each of the theories put forward can partially explain its appearance, but does not completely answer all the questions. Here are the most common theories about the causes of adenomyosis:

1. Implantation - this theory explains the appearance of endometriosis due to a sharp reflux of blood into the pelvic organs and peritoneum, but if this can explain endometriosis, then the appearance of adenomyosis is difficult to explain.
2. Metaplasia of the coelomic epithelium - this theory explains the appearance of adenomyosis by the fact that not all embryonic tissue undergoes regression before menstruation; it is this tissue that is introduced into the myometrium.
3. Induction - this theory largely coincides with the previous one and assumes the possibility of the appearance of adenomyotic foci under the influence of unfavorable external factors.

The second or third theory may partially explain the appearance of adenomyosis in young patients, but evidence for these theories has not yet been provided. In addition to the theories described above, there are others - hormonal (lack of prostaglandins), genetic and others, but they still remain theories.

In addition, there are a number of factors that can increase the risk of adenomyosis. These include:

• Infections of the genitourinary system.
• Abortions and scrapings.
• Intrauterine interventions.
• Injuries, including birth injuries.
• Disturbed hormonal levels.
• Genetic predisposition.

Types of adenomyosis

Adenomyosis of the uterine body is divided into nodular, focal and diffuse. There are four stages of development of this pathology:

I - the endometrium grows to the myometrium;

II - the endometrium penetrates to the middle of the muscular layer of the uterus;

III - the endometrium reaches the serous layer;

IV - the endometrium penetrates the peritoneum.

Main symptoms of adenomyosis

1. Pain during menstruation or algodismenorrhea is the most common symptom. It is especially worth paying attention if it appears in teenagers. Pain appears due to the accumulation of fluid in the tissues and the local inflammatory process, as well as due to the accumulation of blood.
2. Violation of the cycle is another sign of adenomyosis. Most often manifested in the form of bleeding. Possible brown discharge before and after menstruation, but menstruation itself may last longer and with more heavy bleeding than usual.
3. Infertility is usually not so much a consequence of adenomyosis as a combination of several factors. When the process spreads to the entire uterine cavity, active adhesions, and if adenomyosis is accompanied by other diseases, such as endometriosis, fibroids and others, then the chance of getting pregnant is sharply reduced. Adenomyosis itself cannot become an obstacle to pregnancy with proper treatment and prevention.
4. A miscarriage, or spontaneous abortion, is also a consequence of a combination of several pathological conditions.

Course of adenomyosis

Without proper monitoring and treatment, adenomyosis progresses in most patients. Thus, in the absence of treatment for six months, the disease progresses in 45% of patients, and improvement is observed in 30%. If the disease is neglected for a longer period of time, for example for a year, deterioration is already noticed in 65% of patients, and improvement in only 25%. The condition of adenomyosis can stabilize and even improve during pregnancy.

Diagnosis of adenomyosis

When making a diagnosis of adenomyosis, anamnesis is of no small importance. The patient's complaints about irregular cycles, painful periods, brown discharge before and after menstruation, pain during intercourse - all of these are indirect indicators of the presence of adenomyosis. In addition, you can determine adenomyosis:

1. In terms of the size and structure of the uterus - the size of the uterus, depending on the stage and development of adenomyosis, can be either enlarged up to 5-8 weeks of pregnancy, or normal. The body of the uterus is often compacted, and in some cases tuberous. On palpation before menstruation or the patient may feel pain. Pain and tightness of the cervix are also possible. The uterus itself may lose normal mobility.
2. With an ultrasound examination, it is much easier to diagnose adenomyosis, especially if a vaginal examination is performed. With this type of diagnosis, the accuracy of the diagnosis will be 90%. It is better to perform an ultrasound on days 22-25 of the cycle.

An ultrasound examination may show the following signs of adenomyosis:

• increased echogenicity of the myometrium;
• increased size of the uterus;
• the presence of small inclusions with a diameter of 0.2 to 0.6 mm. In this case, an experienced doctor will be able to distinguish an adenomyotic node from a myomatous one by the absence of a capsule in it and by its clear shape.

1. MRI is not used so often, but with this method it is possible to assess the condition of the myometrium and the presence of adenomyotic foci in them.
2. Hysteroscopy. The most effective and informative diagnostic method. Allows you to accurately determine the condition of the myometrium and more accurately determine the stage of the disease and prescribe adequate treatment. The disadvantage of this method is that the patient must be put under anesthesia. The hysteroscopic classification of adenomyosis looks like this:

• At the first stage, small lesions are visible, but the walls of the uterus are not changed.
• In the second stage, adenomyotic “movements” are observed, the uterus does not stretch well and has uneven walls.
• At the third stage, “bulges” of varying sizes appear in the uterine cavity, without clear contours. The presence of adenomyotic “passages” on the protrusions is possible, but not necessary.

1. Sampling of uterine material for histological examination - diagnostic curettage. This method can accurately confirm or refute the presence of adenomyosis in the uterine cavity. Most often, I prescribe this method to women over 40 years of age who complain of brown discharge between periods. The method allows not only to make an accurate diagnosis, but also to exclude the oncological component.

Uterine adenomyosis treatment and medications

Since the development of adenomyosis directly depends on the level of estrogen in a woman’s body, treatment is primarily aimed at suppressing estrogen. Confirmation of the effectiveness of this method is the improvement of the clinical picture during pregnancy and immediately after it - when the woman’s body produces a minimum amount of estrogens. Foci of adenomyosis immediately respond to altered hormone levels in a similar way to normal endometrium.

Drugs prescribed for uterine adenomyosis:

1. Oral contraceptives - can simulate pregnancy and cause amenorrhea and Per oral contraceptives– they simulate pregnancy, cause amenorrhea and loss of the myometrial membrane and adenomyotic lesions. Often, when treated with contraceptives, the foci of adenomyosis completely disappear. Any contraceptives that contain ethinyl estradiol in doses of at least 0.03 mg can be used to treat adenomyosis. Contraceptives are taken either continuously or 63+7, where you drink for 63 days hormonal contraceptive, and there is a break for seven days. Treatment should last at least six months, usually the treatment period is 6-12 months, depending on the stage of the disease. Studies show that after a course of treatment with contraceptives, pregnancy occurred immediately after the course of treatment in 50% of women, pain and bleeding stopped in 70-85% of women. The relapse rate was about 18%.
2. Progestogens are quite effective in the treatment of adenomyosis, and also have a low cost. Thanks to their action, foci of adenomyosis atrophy. The following drugs are used in treatment:

• Medroxyprogesterone is most often used in the treatment of adenomyosis, since this drug is the most studied. Approximate daily dose is 30 mg; in case of discharge, the dose can be increased.
• Dydrogesterone - used 2-3 times a day, 10 mg.

These drugs have a number of side effects, the main ones being weight gain and nausea. In some cases, bleeding is possible, in which a short course of estrogen is recommended.

1. Androgens. The most commonly used is danazol. It causes amenorrhea and prevents the growth of foci of adenomyosis and the appearance of new ones. Can cause long-term remission in adenomyosis. Used in doses of 600 to 800 mg per day. Start taking 200 mg. 2 times a day, gradually increasing the dose to 800 mg. The drug is taken until the clinical manifestations of adenomyosis begin to disappear. However, it should be noted that this drug has a number of side effects: acne, decreased sex drive, weight gain. Contraindicated for liver diseases as it can destroy liver cells.
2. Analogues of GnRH such as: goserelin, histrelin, leuprolelin, buserilin, nafarelin and others. When prescribing this drug, mandatory monitoring of its level in the blood is carried out, due to the fact that it can cause osteoporosis. Other side effects include decreased libido and atrophic vaginitis. To prevent the occurrence of osteoporosis, it is necessary to prescribe the drug in combination with progestogens and estrogens.
3. The Mirena spiral is installed for a period of 5 years. Thanks to it, adenomyosis stabilizes and stops regressing, and the symptoms gradually disappear.

Please note that all information in this article is for reference only and in no way encourages self-medication. Install accurate diagnosis and only a doctor can prescribe adequate treatment.

Other treatments for adenomyosis

Embolization of the uterine arteries - in some cases it is sufficient effective method, especially when adenomyosis nodes are well supplied with blood. In other cases, this method is ineffective.

Removal of the uterus is indicated only in particularly severe cases and is a last resort, often unjustified.

Surgical removal of adenomyosis nodes is possible only with a small number and minimal size.

Prevention of adenomyosis

Timely and annual visits to the doctor are the best prevention of such a disease. Women should also try to avoid abortions and use modern methods of contraception to avoid unwanted pregnancies.

Adenomyosis causes considerable damage to the uterus, as a result, the endometrium grows and affects the nearby layers of the organ. This problem does not apply to malignant tumors, but only in case of timely detection and treatment. How to treat this disease, how serious is it and what consequences can it have for a woman?

What is uterine adenomyosis

Adenomyosis of the uterus is special case endometriosis - a systemic benign disease in which endometrial cells begin to multiply outside the mucous membrane of the uterine cavity. The term "adenomyosis" literally means glandular degeneration of muscle tissue ("adeno" - iron, "myo" - muscle tissue, the suffix "oz" - degenerative changes).

IN normal conditions Endometrial cells, as their name suggests, reside exclusively in the innermost layer of the uterus, the endometrium. When they spread outside the uterine cavity, pathological condition– endometriosis.

Causes

There is still no consensus on the causes and mechanisms of endometriosis development. There are several hypotheses of etiopathogenetic variants of the onset of the disease. However, none of them separately explains the whole essence of the pathological processes that occur in uterine endometriosis.

In fact, the main, leading cause of the development of adenomyosis is still hormonal imbalance. It is this factor that is primary and underlies the pathogenesis of this pathology.

• operations like caesarean section, curettage, removal of fibroids, and so on;
• abortions;
• age-related changes. This pathology in most cases is diagnosed in women after years;
• genetic predisposition;
• excessively frequent visit solarium, constant exposure to the sun without protection;
• excess body weight.

Uterine adenomyosis can be diagnosed in young women who have never experienced such manipulations. In this group of patients, the disease develops due to congenital pathologies or insufficient dilation of the cervix during menstruation.

In addition to the above points, it is worth paying attention to the fact that any uterine surgical interventions or curettage significantly increase the risk of adenomyosis. First of all, these include abortions, mechanical injuries, medical intervention after a miscarriage, etc.

Symptoms and photos of adenomyosis of the uterus

Now you know what kind of disease it is, but the worst thing about uterine adenomyosis is that it is mostly asymptomatic. The first symptoms may appear already in the third stage, in which conservative treatment is already difficult.

In the photo you can see adenomyosis of the uterus

The most typical symptoms and signs of adenomyosis are:

• pain in pelvic area before menstruation, during it, and also a few days later;
• dark brown discharge from the genital tract some time before and after menstruation;
• various disorders of the menstrual cycle (as a rule, its reduction);
• change in the size and shape of the uterus (this symptom is established during a special examination);
• painful sensations during sexual intercourse.
• deterioration of the general condition, frequent headaches, migraine, decreased performance, apathy, depressive state, sudden changes in mood, decreased performance.

Adenomyosis of the uterus in to a large extent typically asymptomatic pathological process, which can last for many years and even decades.

Forms of the disease

The following forms of uterine adenomyosis are distinguished:

• ovarian dysfunction,
• metaplasia,
• stomach ulcer,
• cirrhosis of the liver,
• thyroid cancer

The main symptom of the nodular form is menstrual irregularity. The cycle becomes shorter, and menstruation becomes more abundant and longer due to the appearance of spotting 2-3 days before the start of menstruation and for several days after its end.

• pulling painful sensations lower abdomen,
• intense painless menstrual cycle,
• the presence of bloody discharge several days before and after menstruation.

Adenomyosis: 1, 2, 3, 4 degrees

The intensity with which certain symptoms of the disease appear is associated with the severity of adenomyosis. The classification of adenomyosis by degree of prevalence is not international, but it is quite convenient and is carried out in practice. There are four stages in total, which vary depending on the spread of the endometrium:

1. Cell proliferation is limited to the internal space of the uterus and does not extend beyond its lining.
2. At the second stage, uneven compaction and growth of the endometrium is diagnosed in the muscle layer of the organ.
3. Third degree: involvement of more than half or all of the muscular wall of the uterus.
4. At stage 4, growing through the serous layer, endometrial tissue migrates outside the uterus

Before and after menstruation, mucous discharge with a sharp, unpleasant odor may be observed. This suggests that the development of internal endometriosis reaches the 2nd or 3rd degree.

The severity of the abnormal process depends on the depth of the lesion. Mild cases of adenomyosis occur in many women. In this case, the endometrium grows no further than the submucosal layer.

Possible consequences for a woman

Adenomyosis of the uterus has 2 ways of development - favorable and critical. Timely detection and timely treatment of the disease results in a generally successful outcome for the woman, with preservation of reproductive function and hormonal restoration.

The growth of the endometrium outside the internal space of the uterus leads to the fact that the mucous membrane of the organ is disrupted, becoming thinner and more fragile. She is unable to receive and hold a fertilized egg. If left untreated, infertility can develop over time. The disease is the result of hormonal imbalances that make it difficult to conceive a child.

That is why it is very important to visit a gynecologist regularly; endometriosis of the uterine body detected at an early stage is successfully treated, after which the onset of pregnancy is quite realistic.

Pregnancy with adenomyosis

Infertility is one of the frequent consequences of the presence of endometrial cells in the muscular layer of the uterus. For some, this is manifested by the impossibility of conception, others cannot bear a child. In some cases, women suffer from obstruction fallopian tubes which prevents the egg from joining the sperm.

In a healthy woman, in the second phase of the cycle, the size of the endometrium increases in anticipation of pregnancy. If fertilization does not occur, then endometrial cells are rejected and come out along with menstruation. With adenomyosis, such release from the muscle tissue of the uterus does not occur, which causes hemorrhage and severe inflammation organ.

Is it possible to get pregnant with uterine adenomyosis? Pregnancy with adenomyosis is possible if complex treatment aimed at restoring reproductive function. The effectiveness of therapeutic intervention depends on the duration of the disease. If adenomyosis has bothered a woman for no more than 3 years, most likely the treatment result will be positive.

Diagnostics

It is possible to presumably diagnose uterine adenomyosis on the basis of characteristic complaints and as a result of a gynecological examination. To clarify the diagnosis and determine the stage of the disease, it is possible to carry out additional methods examinations.

1. Ultrasound of the pelvic organs, where changes in the shape and size of the uterus are clearly visible. Is it possible to see signs of uterine adenomyosis in women on an ultrasound? During an ultrasound, you can see on the screen the growth of the layers of the uterus, both uniform and uneven, and sharp protrusions or irregularities similar to myometrium may also be visible.
2. The most accurate results (about 90%) are provided by transvaginal ultrasound scanning, which, like gynecological examination, performed on the eve of menstruation.
3. For detailed research endometrial hysteroscopy is prescribed. With its help, the doctor studies the nature and extent of damage to the uterine cavity, which makes it possible to determine the further course of treatment.
4. Laboratory tests of smears for flora are also required.
5. carrying out the necessary comprehensive studies of other internal organs and systems – endocrine, genitourinary, respiratory, nutritional, cardiovascular;
6. endometrial biopsy;
7. bimanual gynecological examination.

Treatment of uterine adenomyosis

Treatment is based on the use medications(conservative treatment), carrying out surgical intervention, methods of alternative medicine.

When choosing a method and volume of therapy, the following must be taken into account:

• the patient’s age, her desire to have children, neuropsychiatric status;
• all characteristics of the pathological process;
• the combination of adenomyosis with the process of inflammation, whether there are cicatricial and adhesive changes, as well as the presence of hyperplasia and destruction in the uterus.

Drugs

When treated with medications, patients are prescribed hormone therapy, this should stop the menstrual cycle, so to speak, creating menopause. Treatment with hormones takes a very long time, from 3 to 5 months. The cycle can be completely normalized only six months after the completion of the medication.

Hormonal drugs for pathology:

• gestagens - drugs to restore reproductive function;
• oral contraceptives;
• antiestrogens;
• drugs analogues of gonadoliberin;
• antigonadotropins.

Removing the inflammatory process. To do this, use various gels, suppositories, and douching solutions. Medications can be produced based on medicinal herbs. Also, to relieve the inflammatory process, antibiotic-based drugs are often used, which makes it possible to get rid of fungal formations, other infections.

Surgical intervention (operation)

• with adenomyosis grades 3 and 4;
• when adenomysoa is combined with fibroids and atypical endometrial hyperplasia;
• with a nodular form (in women with infertility, conservative organ-preserving operations are performed);
• with persistent anemia;
• if conservative treatment is ineffective.

In recent years, in the treatment of adenomyosis, hardware methods have been used by cauterizing inflammatory foci of the endometrium in the body of the uterus using a laser.

If the patient prescribes the generally accepted hormone therapy contraindicated, question about drug treatment adenomyosis is not discussed; surgery becomes the method of choice.

There is no special diet recommended by doctors for the treatment of uterine adenomyosis. That's why the best diet there will be an exclusion from the diet of fatty and spicy foods, excessive amounts of sweets and pastries. It is better to replace these products with fresh vegetables and fruits, nuts.

Try to include omega-3 in your diet fatty acid, which take part in many important metabolic processes occurring in the body. Healthy fatty acids are found in foods such as:

• Fatty fish and fish oil.
• Walnuts and walnut oil.
• Pumpkin seeds.
• Vegetable oils.

In this disease, it is very useful to eat a lot of dark green leafy vegetables.

How to treat adenomyosis with folk remedies

Experts say that most medicinal herbs can improve the patient’s condition. Decoctions have anti-inflammatory, immunomodulatory, regenerating and hemostatic effects.

Collection of herbs for douching No. 1

To cope with the problem, you can use douching. For cooking medicinal composition You need to mix the following herbs in equal parts:

The collection of herbs should be poured with boiling water and left to infuse. Then the composition should be filtered through a double layer of gauze and used for douching.

Herbal collection No. 2

It is good to use a collection of mistletoe, peony, cudweed, oak bark, calendula, yarrow flowers, celandine and nettle. Chopped dry plants are mixed in the same quantities and poured hot water, wrap and leave to stand for up to 5 hours. Next, the herb is filtered through gauze folded several times and syringed while warm several times a day.

Nettle decoction

Nettle decoction four times a day. To prepare the drink, you need to pour two teaspoons of the collection with a glass of boiling water, let the medicine brew and cool, then strain and take a couple of tablespoons several times a day. This infusion relieves inflammation and stops heavy menstrual bleeding.

Prevention

1. Prevention of uterine adenomyosis mainly comes down to regular visits to the gynecologist. A specialist can correctly interpret such symptoms in a timely manner and prescribe appropriate treatment.
2. Undergoing pelvic ultrasound 1-2 times a year.
3. Gynecologists believe that stress and constant overwork strongly affect women's health and, undoubtedly, can lead to the development of adenomyosis. To prevent the onset of the disease, a woman needs: more rest, take relaxing baths, attend a massage, more often be in a calm and comfortable environment.
4. Keeping the body clean. Girls who ignore the rules of personal hygiene from an early age are more prone to this type of disease. And also those who are in children's and adolescence enters into sexual relations.

Careful attitude to one's health is the main way to prevent not only adenomyosis, but also other no less dangerous diseases.

© All information on the “Symptoms and Treatment” website is provided for informational purposes. Do not self-medicate, but contact an experienced doctor. | User Agreement |

Adenomyosis of the uterus - what is it? Symptoms, causes and treatment

Adenomyosis is a disease characterized by the germination of the endometrium into the muscular layer of the uterus, while the cells of the mucous membrane that have fallen into the myometrium retain their genetically inherent function.

Accordingly, undergoing cyclical changes, they grow in a certain period and require an exit, which is absent in muscle tissue. As a result, the uterus increases in size and the functionality of the organ is impaired.

Uterine adenomyosis is often confused with endometriosis. However, this is only a type of it, the so-called internal endometriosis of the uterus, when the endometrium multiplies outside the uterus itself. This is a systemic benign non-oncological disease of the uterus. The endometrium is located on different organs, such as the uterus, vagina, kidneys, gastrointestinal tract and others.

Causes

Why does uterine adenomyosis occur, and what is it? Adenomyosis is a type of endometriosis that is an overgrowth of tissue in the lining of the uterus. As a result of the pathological process, endometrioid cysts are formed, filled with liquid contents. Endometriotic foci with adenomyosis are located in the body of the uterus.

Adenomyosis can develop due to the following reasons:

1. Congenital formation of foci of endometriosis, resulting from disorders of embryonic development.
2. The introduction of endometrial cells into surrounding tissues during surgical interventions or during traumatic childbirth.

There are factors that provoke the development of adenomyosis:

• sexual activity started too late;
• late or difficult labor;
• early or late onset of menstruation;
• frequent inflammatory processes in the uterus and appendages;
• gynecological manipulations on the uterus (abortion, diagnostic curettage);
• hereditary predisposition to benign or malignant neoplasms;
• the woman is too overweight, obese;
• use of oral contraceptives and intrauterine devices;
• the presence of diseases that are caused by functional disorders of the immune system;
• great physical and psychological stress for a long time.

The prolonged existence of a severe degree of adenomyosis leads to anemia, severe pain, damage to neighboring organs and a sharp decrease in a woman’s quality of life, up to the inability to have a sexual life and any physical activity.

Classification

There are several degrees of prevalence and severity of penetration into the layers of the uterus. This classification is used only for adenomyosis of the uterine body.

1. degree - penetration of diffuse cells into the submucosal layer of the organ.
2. degree - pathological course diseases with penetration into the muscular layers of the uterus, involving less than half of this layer.
3. degree - the pathological diffuse process occupied more than half.
4. degree - growth of the endometrium beyond the uterus, with the transition of pathology to other organs. The endometrium penetrates into all layers of the uterine structure.

The nature tumor process The following forms of adenomyosis are distinguished:

• diffuse form (heterotopias are evenly distributed throughout the myometrium) - with an incidence of 50–70%
• nodular form (heterotopias are located in the myometrium in the form of endometrioid “nodes” of various sizes and locations); a characteristic feature of these nodes is the absence of a capsule; this form occurs in 3–8% of patients
• mixed form.

The first and second degrees do not require surgical intervention, which cannot be said about the third and fourth. The last two are difficult to treat conservatively; more often, two methods are used in combination.

Symptoms of adenomyosis

Sometimes adenomyosis can occur without noticeable symptoms, and is discovered only incidentally during an examination for another reason. However, in most cases with uterine adenomyosis, the following symptoms are observed:

1. Pain in the lower abdomen, spreading to groin area, rectum, vagina.
2. The pain is most intense in the first days of menstruation (monthly uterine bleeding associated with the physiological rejection of the endometrium - the inner layer of the mucous membrane of the uterus), with the end of bleeding, the pain subsides.
3. Manifestations of anemia (anemia): weakness, pallor and flaking of the skin, drowsiness, fatigue.
4. Abundant and prolonged (more than 5 days) menstrual bleeding.
5. The appearance of spotting dark brown discharge from the genital tract 2-5 days before and within 2-5 days after menstruation.
6. Uterine bleeding (bleeding from the genitals) between menstruation.
7. Painful intercourse (dyspareunia).

At first, the symptoms of adenomyosis are smoothed out and are perceived as a normal premenstrual change in the body. Then, as it progresses, the intensity of the pain increases and the time increases. Patients feel pain not only before menstruation, but constantly.

Diagnostics

In order to accurately establish the diagnosis of adenomyosis and prescribe treatment, as a rule, a comprehensive examination is first used, including:

• examination of the genital organs with the help of mirrors;
• colposcopy (examination of the cervix using a special device that magnifies approximately 30 times);
• laboratory samples (taking smears);
• general examination of the respiratory, circulatory, digestive, and urinary systems;
• magnetic resonance imaging (MRI);
• laparoscopy (most modern method diagnosis and treatment).

The main diagnostic method is ultrasound. The most accurate results (about 90%) are provided by transvaginal ultrasound scanning, which, like a gynecological examination, is performed on the eve of menstruation.

How to treat adenomyosis

There are two ways to treat uterine adenomyosis: conservative and surgical. Naturally, the treatment method directly depends on the degree of adenomyosis. As a rule, the first and second degrees, less often the third, can be treated with conservative therapy, and the fourth can only be treated surgically.

For the purpose of conservative action the following is used:

• Oral cotraceptives with the formation of amenorrhea (absence of menstruation), which leads to blocking of menstruation and removal of foci of endometriosis. Prescribe drugs with ethinyl estradiol in a concentration of 0.03 or higher for 6-12 months of continuous course,
• Gestagens (dydrogestenone, medroxyprogesterone, gestrinone), they lead to atrophy of endometriotic foci,
• Androgens (danazol) with the formation of amenorrhea and removal of foci of endometriosis. But the drugs have a number of serious side effects,
• Synthetic analogues of GnRH (nafarelin, histrelin) in drops or sprays, intramuscularly to reduce estrogen levels.

If there is no result from therapeutic treatment A surgical treatment method is used, the purpose of which is to remove localized foci and restore the normal anatomical structure of the uterus.

Operation

Removal of the uterus for adenomyosis is not always required. Surgery may be recommended if adenomyosis:

• causes severe uterine bleeding that cannot be treated and leads to large blood loss;
• the woman already has children and does not plan to become pregnant in the future;
• the woman is premenopausal (older) and is not against removal of the uterus;
• combined with large uterine fibroids;
• combined with undesirable changes in the endometrium or cervix.

There are two main ways to perform surgery for adenomyosis - open and laparoscopic (or endoscopic). Open way there is abdominal surgery to remove the uterus. Laparoscopic operations can remove foci of adenomyosis and preserve the uterus.

Together with traditional therapeutic and surgical methods of treating adenomyosis, new methods are now being used. The most common other than classical method is electrocoagulation, with the help of which, when using anesthesia, lesions are removed painlessly.

Treatment prognosis

Adenomyosis is a chronic disease with high probability development of relapses. After conservative therapy and organ-preserving surgical interventions during the first year, relapses of adenomyosis are detected in every fifth woman of reproductive age. Within five years, recurrence is observed in more than 70% of patients.

In premenopausal patients, the prognosis for adenomyosis is more favorable, which is due to the gradual decline of ovarian function. After panhysterectomy, relapses are impossible. IN menopause spontaneous recovery occurs.

Polycystic ovary syndrome - symptoms, causes and treatment

Uterine fibroids - what is it? Symptoms and treatment

One comment

I was also diagnosed with adenomyosis, only through ultrasound and PCa for hormones. She said nothing would work without laparoscopy. I really didn’t want to be cut and interfered with there. I tracked O through Ovuplan tests and began to believe and pray.

I also started taking Duphaston when I was 16 and was prescribed 25, but I was afraid that if I got pregnant I would immediately have a miscarriage and decided to take it before my period started. After 4 days of delay, I took a test and it showed // Girls, believe, pray and act!

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Only a qualified doctor can treat diseases.

What drugs are used to treat uterine adenomyosis?

Adenomyosis is a disease in which the inner surface layer of the uterine cavity grows beyond its limits into the depths of the organ. Such a disorder can cause various symptoms of the disease: pain, bleeding, reproductive dysfunction, reducing the quality of life. The asymptomatic course of the disease is even more dangerous, since the absence of problems does not allow women to consult a doctor for help in time and leads to major changes structure of the uterus.

What is adenomyosis

The body of the uterus consists of three layers of tissue: inner, middle and outer.

The inner functional layer (endometrium) is the mucous membrane of the organ. It tends to be completely renewed once a month, being rejected during menstrual bleeding and growing again towards the middle of the cycle. The endometrium can be considered one of the most important tissues for a favorable pregnancy. The possibility of attachment depends on its condition ovum to the walls of the uterus, and subsequently the harmonious development of the placenta.

The middle layer (myometrium) is the tissue of the uterus, consisting of smooth muscle fibers. Its main function is the contraction of the uterus during childbirth (contractions).

The outer layer (perimetry) is the serous membrane that covers the organ.

IN healthy condition the tissues of the uterus do not intersect and are located "parallel" to each other. But there are diseases that disrupt the natural arrangement of cells inside an organ, one of which is adenomyosis.

Adenomyosis is an unnatural proliferation of endometrial cells deep into the myometrial tissue. At the same time, mucosal cells grow and are rejected according to monthly cycle women, which causes disturbances in the functioning of the organ, inflammatory processes and unpleasant symptoms of the disease.

There are several forms of adenomyosis:

• diffuse adenomyosis - large areas of the endometrium grow evenly deep into the uterus;
• nodular (focal) adenomyosis - the formation in the myometrium of areas (nodes) consisting of endometrial glandular tissue and filled with blood or brown intercellular fluid;
• mixed adenomyosis consists of the simultaneous presence of diffuse and nodular forms of the disease in the uterus in one patient;

Determining the degree of adenomyosis directly affects how the disease should be treated:

• first degree – growth in the upper layer of the endometrium;
• second degree - endometrial cells penetrated approximately half into the myometrial tissue;
• third degree - the myometrium is damaged by more than half;
• fourth degree - endometrial cells have penetrated the myometrium and affect the serous membrane (if adenomyosis is not treated at the fourth stage of the disease, you can wait until the endometrium spreads beyond the uterus and the development of extensive endometriosis).

Symptoms of the disease

Symptoms of uterine adenomyosis initial stages may not be noticed. In this case, it will most likely not be possible to treat the disease with hormones.

• pain in the lower abdomen, in the groin, in the vagina in the lower back;
• any irregularities in the menstrual cycle (increased pain before or during menstrual periods, delays, decreased number of days in the cycle, acyclic bleeding and spotting, absence of menstruation);
• symptoms of anemia - drowsiness, pale skin, dizziness, weakness, increased fatigue;
• pain during sexual intercourse;
• brown vaginal discharge.

All these symptoms may indicate the development of a number of diseases of the reproductive system.

How to treat

Before prescribing treatment, the doctor sends the patient for a comprehensive examination, which includes:

• Inspection for gynecological chair(two-handed examination to determine the shape and size of the uterus, examination of the vagina and cervix using speculum). The doctor can make a preliminary diagnosis, if he is familiar with the medical history, after an examination. The uterus with adenomyosis has a characteristic round shape and is slightly enlarged.
• Colposcopy is an examination of the cervix using a microscope to exclude the mucous from leaving the uterus.
• Vaginal smears and cervical canal on microflora and sexually transmitted infections.
• Magnetic resonance imaging.
• Hysteroscopy is an examination of the uterine cavity using a video camera.

Treatment is prescribed according to the results. For grades 1-3, drug therapy can be performed. Drugs most often prescribed by a gynecologist.

• Combined oral contraceptives for a period of 4-6 months (preparations “Yarina”, “Zhanin”, “Belara” and others). COCs ensure the normalization of the balance of female sex hormones, which leads to a gradual reduction in the areas of affected tissue. For adenomyosis, Janine is taken for 3-6 months, then the drug is completely discontinued and cure is monitored.
• Antigonadotropins (drugs "Danazol", "Danol"). Antigonadotropins reduce the production of hormones, reduce the efficiency of the ovaries, which leads to a decrease in the effect of hormones on endometrial tissue. Such drugs can only be taken under the supervision of a specialist.
• Progestogens (drugs Duphaston, Utrozhestan, Norkolut). High concentration progesterone reduces the concentration of estrogen, which does not allow the tissues of the uterine mucosa to multiply excessively.
• Antiestrogens (drugs Gestrinone, Medroxyprogesterone). These drugs stimulate the artificial onset of menopause, so they try to prescribe this treatment to women after 40 years of age. The result of therapy, lasting 5-6 months, is the complete cessation of menstruation, the elimination of all symptoms of the disease and a complete stop in the growth of the endometrium.
• Antiandrogens (drug "Visanne"). While taking the drug, endometriosis lesions are reduced by reducing the amount of estrogen and increasing the level of progesterone.
• An analogue of gonadoliberin (drugs "Buserelin", "Zoladex", "Decapeptil"). While taking the drug, the functions of the gonads first increase greatly and then sharply decrease, which leads to a decrease in pathological areas of tissue.

Duphaston

There is a lot of debate about whether adenomyosis can be treated with Duphaston. As you know, Duphaston is an artificial analogue of progesterone. That is why some experts argue that it makes no sense to treat progesterone-dependent tissue proliferation by increasing the level of this hormone.

However, experience shows that long-term use of the drug Duphaston in continuous courses does not allow the progression of adenomyosis, leads to a reduction in foci of mucosal proliferation and a significant reduction in the symptoms of the disease. Treatment allows:

• reduce the amount of estrogen, normalizing the work of the ovaries;
• reduce the spread of endometrial cells outside the tissue;
• stabilize the body’s production of its own progesterone in the required quantity.

"Duphaston", prescribed by a specialist, successfully treats grade 1 and 2 adenomyosis. The choice of treatment regimen and duration depends on the test results.

Treatment of adenomyosis with Duphaston during preparation for pregnancy allows you to improve the functioning of the reproductive system, successfully conceive, carry and give birth healthy child without resorting to surgical intervention.

Contraindications for taking Duphaston:

• serious kidney and liver diseases;
• pedunculated fibroids;
• risks of thrombosis;
• endometriosis outside the uterus;
• intolerance to the drug.

If the doctor prescribes Duphaston, remember possible emergence side effects (for example, enlargement, hardening and pain in the breast, swelling of the face and body, migraines, weight gain) and be sure to tell us about them at the appointment.

Surgery

The main surgical treatment for adenomyosis is removal of the uterus. But such an outcome can be avoided if the disease does not develop to stage 4, which is life-threatening.

Indications for the operation:

• ineffectiveness of other treatment methods;
• combination of endometriosis with large uterine fibroids;
• at frequent relapses diseases;
• the appearance of atypical cells;
• severe bleeding that cannot be corrected.

Hysterectomy is performed open (cavitary) or laparoscopic way(through three small incisions).

Patients very often hope for a miracle and try to cure adenomyosis using traditional methods (using herbs, leeches, douching, acupuncture, etc.). But such methods are unable to eliminate the cause of the disease, and, therefore, only lead to further spread of the disease and the appearance of complications. Traditional methods can only be beneficial in combination with traditional therapy under the supervision of a physician.

Adenomyosis is a disease of the uterus that can cause prolonged uterine bleeding, spotting in the middle of the cycle and severe pain in the lower abdomen.

Adenomyosis is said to occur when the endometrium, which normally should only be found in the uterine cavity, penetrates deep into the muscular layer of the uterus. Due to the fact that the endometrium begins to grow where it is not supposed to grow, it develops inflammatory response, and the uterus increases in size.

Adenomyosis and endometriosis

Adenomyosis is sometimes referred to as uterine endometriosis or internal endometriosis. Indeed, both adenomyosis and endometriosis develop for the same reason: if the endometrium begins to grow where it is not supposed to grow.

With endometriosis, endometrial foci can be found outside the uterus (on the ovaries, in fallopian tubes oh, in the cervix, etc.) There is a .

It is not uncommon for the same woman to have both endometriosis and adenomyosis at the same time.

Why does adenomyosis appear?

The causes of adenomyosis are not known. There are several theories to explain possible reasons of this disease, but so far none of them is generally accepted.

It is known that sex hormones (estrogen, progesterone, prolactin, FSH) play an important role in the development of adenomyosis. When the level of sex hormones in the blood decreases (this happens in women during menopause), the symptoms of adenomyosis usually go away.

Who is at increased risk for adenomyosis?

Adenomyosis is a fairly common disease among middle-aged women who have given birth (over 35-40 years old). Increased risk adenomyosis is observed:

• in women who have given birth (either spontaneously or by caesarean section)
• in women who have had uterine surgery (for example,)
• in women over 35-40 years old

Forms of adenomyosis

Depending on how large the endometrial areas are in the muscular layer of the uterus, several forms of adenomyosis are distinguished:

• Focal adenomyosis: the endometrium forms separate islands, or foci of adenomyosis, in the muscular layer of the uterus. Focal adenomyosis is often asymptomatic or with mild symptoms.
• Nodular adenomyosis: The endometrium forms separate nodes in the muscular layer of the uterus. Endometrial nodes in the nodular form of adenomyosis are also called adenomyomas, since they are very similar to uterine fibroids.
• Diffuse adenomyosis: large areas of the endometrium almost uniformly grow throughout the entire muscular layer of the uterus.

Some women may have several forms of adenomyosis at once: for example, a combination of diffuse and nodular forms (diffuse nodular adenomyosis).

Degrees of adenomyosis

Depending on how deep the endometrium penetrates into the muscular layer of the uterus, there are 4 degrees of adenomyosis:

• 1st degree of adenomyosis: shallow penetration of the endometrium deep into the uterus. The endometrium is found only in the submucosal layer of the uterus.
• 2nd degree adenomyosis: deeper penetration of the endometrium deep into the uterus: foci of adenomyosis are found in the muscular layer of the uterus, but affect no more than half of the muscular layer.
• 3rd degree adenomyosis: foci of endometriosis are found in the muscular layer of the uterus and affect more than 50% of its thickness
• 4th degree of adenomyosis: deep defeat. The endometrium grows into all layers of the uterus.

Symptoms and signs of adenomyosis

Sometimes adenomyosis can be asymptomatic and discovered only incidentally during an examination for another reason. But often with adenomyosis the following symptoms are observed:

• Long and heavy periods that last more than 7 days in a row. Often with adenomyosis, uterine bleeding may occur.
• Smearing in the middle of the cycle.
• During menstruation, blood is released in clots (lumps).
• Expressed or in the middle of the cycle. Pain with adenomyosis can be cramping or cutting.

With adenomyosis, the uterus can increase in size by 2-3 times. Because of this, some women manage to feel the lower abdomen (behind pubic bone) round dense formation. This is an enlarged uterus.

Consequences of adenomyosis

Adenomyosis is not life-threatening and usually does not cause any serious complications. Nevertheless, heavy bleeding with adenomyosis, they can provoke anemia, and severe abdominal pain worsens the quality of life and can lead to depressed mood, anxiety and depression.

Adenomyosis and pregnancy

Despite the fact that adenomyosis is often found in women suffering from infertility, a direct connection between this disease and the inability to conceive a child has not yet been established.

If you have adenomyosis and are unable to get pregnant, you may need careful evaluation and then treatment. Read below about how to get pregnant with adenomyosis.

Diagnosis of adenomyosis

Contact your gynecologist if you have at least one of the symptoms of adenomyosis listed above. The gynecologist will perform and clarify whether there is a need for a more thorough examination.

The difficulty of diagnosing adenomyosis lies in the fact that there are no examination methods that would allow one to confidently make such a diagnosis. The only reliable method for diagnosing adenomyosis is removal of the uterus and subsequent examination of uterine tissue under a microscope (histological examination).

Of course, removal of the uterus is an unacceptable diagnostic method for many women, so to clarify the diagnosis they began to use alternative methods examinations: MRI, sonohysterography, uterine biopsy.

These examinations can look for signs of adenomyosis and exclude other diseases with similar symptoms:, uterine polyps, endometriosis, endometrial hyperplasia. Only if other possible diseases are excluded is a diagnosis of adenomyosis made.

Gynecological examination in a chair

Despite the fact that during a routine examination the gynecologist cannot notice foci of adenomyosis in the uterus, a gynecological examination is very important. First of all, the gynecologist will be able to determine the size of the uterus: with adenomyosis, the uterus increases in size by 2-3 times and takes on a spherical shape. Secondly, during the examination, the gynecologist will rule out other possible causes of bleeding or abdominal pain.

Ultrasound of the pelvic organs

Ultrasound is also not final method diagnosis of adenomyosis, but this examination is very important, as it will exclude other possible diseases of the uterus or uterine appendages. The main signs (echo signs, echo picture) of adenomyosis on ultrasound are:

• an increase in the size of the uterus and a change in its shape
• the presence of hypoechoic inclusions in the muscular layer of the uterus (myometrium)
• heterogeneous structure of the myometrium
• the presence of small cysts (up to 5 mm in diameter) in the muscle layer of the uterus
• thickening of the walls of the uterus (thickening of the posterior wall of the uterus is especially common)

It is important to understand that only on the basis and general examination no doctor can diagnose adenomyosis. Ultrasound allows only suspect the presence of adenomyosis.

MRI (magnetic resonance imaging)

MRI is a more expensive examination method that allows you to clarify the structure of the muscular layer of the uterus. The main signs of adenomyosis on MRI are thickening of the muscular layer of the uterus, heterogeneity of the myometrium and the presence of foci in it, which may be foci of the endometrium. MRI can also help rule out other possible uterine diseases.

Hysteroscopy

Hysteroscopy can be used to exclude other possible causes of uterine bleeding (uterine polyps, endometrial hyperplasia, malignant diseases of the uterus, etc.). During hysteroscopy, the doctor may take a piece of tissue for further examination under a microscope. The procedure for collecting material for research is called a biopsy, and studying the obtained material under a microscope is a histological study.

Hysterosalpingography (HSG) and sonohysterography

Hysterosalpingography and sonohysterography are also used to exclude other possible diseases of the uterus. In addition, if a woman has adenomyosis, then hysterosalpingography or sonohysterography can detect indirect signs of this disease. It is available on our website.

How is adenomyosis diagnosed?

Although adenomyosis cannot be called rare disease, doctors very often “miss” it or confuse it with other diseases that cause similar symptoms.

For example, uterine bleeding can occur both with adenomyosis and with submucosal uterine fibroids, uterine polyps, hormonal disorders, endometrial hyperplasia, malignant diseases uterus, etc. Abdominal pain during menstruation can occur not only with adenomyosis, but also with primary dysmenorrhea and endometriosis.

In this regard, many experts are of the opinion that to make a diagnosis of adenomyosis, it is necessary to exclude all other possible diseases with similar symptoms. If all examinations performed did not reveal other disorders, but did reveal indirect signs of adenomyosis, then the diagnosis of adenomyosis is considered confirmed. The final diagnosis can only be made by histological examination of the uterus after its removal.

Does adenomyosis need to be treated?

As mentioned above, adenomyosis does not threaten a woman’s life and, as a rule, does not cause any serious complications. In this regard, not all women require treatment for adenomyosis. You do not need treatment if:

• signs of adenomyosis were discovered by chance during an examination for another reason
• you have no symptoms of adenomyosis, or the symptoms are not pronounced and are tolerable
• the symptoms of adenomyosis do not cause significant inconvenience, you are over 45-50 years old and you are about to experience menopause

Is it possible to completely cure adenomyosis?

Unfortunately, there are no medications that can help get rid of adenomyosis. All used in treatment medications help only to cope with the symptoms of adenomyosis, but do not eliminate the disease itself. The only guaranteed way to get rid of adenomyosis is to remove the uterus.

Treatment of adenomyosis

Treatment of adenomyosis depends on the symptoms that bother the woman.

• Painkillers in the treatment of adenomyosis

If, with adenomyosis, a woman often has severe pain in the lower abdomen, then non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed: Ibuprofen, Ketoprofen, etc.

In order for them to really work, you need to start drinking tablets even before your period appears (1-2 days before the expected date of menstruation and take one tablet every 6 hours).

• Birth control pills in the treatment of adenomyosis

With adenomyosis, women often experience severe uterine bleeding, spotting in the middle of the cycle, and menstrual irregularities.

In order to regulate the menstrual cycle, the doctor may prescribe birth control pills (Janine, et al.). Contraceptive pills do not cure adenomyosis, but sometimes help eliminate or reduce symptoms of adenomyosis, such as severe uterine bleeding and.

• Intrauterine device Mirena for adenomyosis

How to get pregnant with adenomyosis?

It is believed that adenomyosis cannot cause infertility, so you have every chance of getting pregnant with adenomyosis on your own, without treatment.

If you are unable to conceive for 12 months or more, then you and your husband need to be tested. What examinations should a woman undergo:

• Ultrasound of the pelvic organs
• blood test for hormones
• to assess tubal patency
• for at least 3 consecutive months to determine whether ovulation occurs

What examinations should a man undergo:

• semen analysis (spermogram)

Depending on the examination results, the doctor prescribes treatment. So, for example, if obstruction of the fallopian tubes was detected, then a laparoscopic operation is prescribed to restore their patency. If a woman does not ovulate, treatment is prescribed to restore the normal functioning of the ovaries, or ovulation stimulation courses. If concomitant diseases (uterine polyps, fibroids, etc.) were found during the examinations, then appropriate treatment is prescribed.