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

Adenomyosis is most commonly diagnosed 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.

Medical treatment

Adenomyosis is a hormone-dependent disease.

During menopause and during pregnancy, the pathology regresses. For the treatment of the disease, hormonal drugs are actively used. They create a pseudomenopausal state or lead to chronic anovulation. This effect is necessary in order to restore the normal growth of the endometrium. Pseudo-menopause and anovulation are temporary—as soon as medical preparations canceled, a 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;
• gestagenic preparations - Norkolut and Dufaston, Gestrenol, Depo-Provera;
• antiestrogenic drugs - Tamoxifen;
• antigonadotropins - Danoval, Danazol;
• gonadotropin releasing hormone agonists - Triptorelin, Zoladex;
• gonadotropin hormone antagonists - Nerobol, Retabolil.

Hormonal drugs - 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, protective preparations Almagel and Phosphalugel are useful.

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

To increase immunity, Levomizol should be drunk 3-4 times a year, interrupted by an average of two months. If necessary, doctors may prescribe injections of Splenil medication. They are done daily intramuscularly.

As additional immunomodulators, drugs are prescribed:

• Timalin,
• Cycloferon,
• pentaglobin,
• Thymogen.

Along the way, the treatment regimen is introduced vitaminized preparations – vitamin C, Tocopherol acetate, Unithiol. It is very important for the complex treatment of adenomyosis to use absorbable agents. Patients are given microclysters 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 as rectal suppositories. Such therapy is carried out presumably a week before menstruation and the administration of suppositories is stopped just before the start critical days. For the treatment of soreness, No-shpu, Analgin or Baralgin can be prescribed. The neurological component can be eliminated with sedatives or tranquilizers.

Baralgin - effective remedy for removal pain with adenomyosis

Can adenomyosis be cured with pills? This question is currently debatable among physicians. Huge advances in the treatment of pathology, the use of an increasing range of hormonal drugs and a decrease in the level side effects holds great promise 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 survey, which women undergo with adenomyosis twice a year, confirms that a good result can be considered a remission of three to five years, when during this time new foci of adenomyosis do not appear, and the old ones become less active and do not give negative symptoms. Such results can be achieved with focal adenomyosis, when the pathological endometrium is limited in its distribution.

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

Surgical treatment of adenomyosis

If extensive foci of pathology are diagnosed, then in women over 35 years old who do not plan to have more children, an operation is performed. There are clear indications for the operation, which are guided by doctors:

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

The choice of tactics of surgical intervention depends on the prevalence of the pathology (the entire organ is affected or only in some places), as well as on the desire of the woman 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 presents certain difficulties - it is necessary to have enough practical experience in order to correctly identify the boundaries of the lesions and sutured them with high quality 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 a radical operation 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 obstetrician-gynecologists, since the risk of developing tumor formations with signs of malignancy is high. Removal of the uterus in no way affects the quality of a woman's sexual life.

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

Full working capacity is allowed after three weeks of sick leave, sex life resolved within a month. In the future, women need to do ultrasound of the genital organs 1-2 times a year.

Folk remedies

Folk remedies in the treatment of adenomyosis will be effective if they are used correctly and fully follow all the recommendations without interrupting the therapeutic course. There are several ways to fight adenomyosis. Populists recommend using various herbs, clay and even leeches. Consider the methods of treating the disease with 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 painful menstruation, 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 performance nervous system, activate blood circulation in the body. Angelica is also able to relax the uterine muscles, fight hormonal disorders in the body.

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

For the treatment of adenomyosis, populists recommend using angelica root. It normalizes the hormonal background, as a result of which the endometrial cells experience the process of autolysis and disappear. Angelica root can be taken in the form of a tea. To do this, one tablespoon of angelica root, dried and crushed, pour a glass of boiling water and insist for five minutes.

It is necessary to take the medicinal liquid three times a day. The crushed angelica root can also be swallowed dry, washed down with water. At one time, about half a centimeter of the root is crushed, and three servings should be eaten per day.

The herb with the specific name black cohosh will help to cope with women's problems. It is used to relieve menopause, with painful menstruation, irregular periods, impaired fertility. The herb is able to 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. cook medicine with black cohosh is very easy. One tablespoon of grass should be poured into a thermos and pour a liter of boiling water. Infuse the remedy for 10 hours, and then drink instead of tea. It is recommended to take no more than one liter of healing liquid per day. If the remedy seemed bitter, you can add a little honey to it.

You can treat the disease 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 in a deep basin and crumble into small pieces. It is not necessary to wet the clay with water. It is enough just to sprinkle the clay with water so that it becomes softer and can be kneaded.

Treatment with blue clay helps to reduce adenomyosis foci

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

Since the pathology is largely associated with circulatory disorders, the populists recommend that leeches be included in the treatment regimen. Leeches are able not only to thin the blood, but they also contribute to the removal of the inflammatory process. In the treatment of adenomyosis, it is recommended to put leeches on lower 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, 5-6 sessions of hirudotherapy will be needed to get the result.

Treatment of adenomyosis presents significant difficulties due to the fact that the disease has chronic course. Having tried conservative methods of treatment 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 varieties of endometriosis.

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

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Adenomyosis of the uterus - what is it?

Structural disorders of the tissues of the uterus with local inflammatory and gradual degenerative processes that destroy parts of her body - this is adenomyosis of the uterus, provoked by the introduction of endometrial glandular cells into its muscle layer. Here begins their successive focal growth with the formation of large nodes with subsequent disintegration, rejection and release of blood.

Moreover, the entire cycle of decay and rejection coincides with the cyclic menstrual process that occurs 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 - manifested by multiple small focal nodular neoplasms scattered over the muscle layer in a large area of ​​​​uterine tissue. Differs in a uniform arrangement of pathological tissues over the entire area of ​​the myometrium of the anterior and rear wall uterus.

2) Focal adenomyosis- represented by single large foci (heterotopia) lesions, localized in a separate small area of ​​the uterine myometrium. The foci are limited from muscle tissue, as they are surrounded by their own capsule. The encapsulation of the foci does not cause a change in the shape and size of the uterus. This form of damage affects the posterior wall of the uterus.

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

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

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 depth of penetration of endometrial cells into the underlying tissue layers of the uterine body.

1. The first degree reflects the diffuse growth of endometrioid tissues 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;
• Paleness of the skin and mucous membranes in the zone of visibility;
• Signs of vertigo (dizziness) and dyspnea (shortness of breath), which is caused by even the most insignificant exertion;
• Chronic fatigue and internal stress.

Specific signs of internal endometriosis include spotting Brown color before menstruation and after it (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, disappearing spontaneously three days after menstruation.

Intensity pain syndrome also has its own characteristics. Most strongly, it is expressed in pathology in the area of ​​the uterine isthmus and with an extensive process of formation of adhesions.

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

According to 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 area of ​​the uterine bend, 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 an intimate act, shortly before menstruation.

In adenomyosis with fibroids, the symptoms do not differ from the main signs of the disease. An exception is myoma, with localization in the submucosal uterine layer. In this case, the symptoms are manifested by acyclic menorrhagia. For this type of adenomyosis, conservative treatment methods are untenable and the problem is solved. conservative method- hysterectomy.

What does ultrasound diagnostics give?

The transvaginal ultrasound method gives the greatest characteristic of internal endometriosis. The diagnostic accuracy is more than 90%.

Pathognomic signs of uterine adenomyosis on ultrasound are displayed:

• The increased size 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.
• Asymmetry of enlarged uterine walls.
• The appearance before menstruation in the muscular membrane of the uterine layer of cystic formations (up to 5 mm or more).

Treatment of adenomyosis - drugs and surgery

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

Standard treatments for adenomyosis are due to:

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, soothing, supporting and resolving 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, normalizing the functional properties of the ovaries, providing a decrease menstrual flow and pain symptoms. Contributing to the cessation of 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) are prescribed in the form of Danazol or Danol.
• To slow down and stop the growth of endometrioid tissues, progestogen preparations are used. The most effective are Duphaston and Norethisterone. The effectiveness of the treatment of adenomyosis "Duphaston" is due to its effect on the reduction of menstrual flow, stabilization of the cycle, reduction of pain symptoms during this period.
• The action of antiestrogens is aimed at inhibiting gonodotropic hormones, which deprives the vital support of pathological cells and causes their death, this can be attributed to Gastrinone or Medroxyprogesterone.
• The extinction of pathological foci, due to an increase in progesterone and a decrease in estrogen, is facilitated by the drug - "Visanna".

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 the impact of pathology in this period. The conclusions of numerous observations and studies are set out in the relevant medical provisions.

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 childbearing function.

2. Often, adenomyosis is a serious threat due to premature birth. In many cases, only adequate treatment according to the generally accepted scheme can stabilize the situation.

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

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

5. AT 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 case (after premature or normal delivery, after an abortion), after the restoration of the menstrual cycle, women with a history of internal endometriosis should undergo (hormonal, immunomodulatory, acidic, etc.) anti-relapse therapy.

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Adenomyosis is a form of endometriosis. The main difference of 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 implanted 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, i.e. 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-layer, i.e. it consists of the main layer - the basal one, which serves as the basis for the growth of a new endometrium, and the functional one, this layer exfoliates every month. The functional layer consists of a single layer of cells that resemble the shape of a cylinder, between them are cells that produce mucus - glandular cells. It is the functional layer in pathology that grows into muscular body uterus "breaking through" the basal layer.

Please note that this text was prepared without the support of our.

Reasons for the development of adenomyosis

Today, there is no single theory that fully answers the question of why adenomyosis appears. Each of the theories put forward can partially explain its appearance, but not completely answer all 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 organs of the small pelvis and peritoneum, however, 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 she who is introduced into the myometrium.
3. Induction - this theory largely coincides with the previous one and suggests the possibility of the appearance of adenomyosis foci under the influence of adverse 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 given. 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.
• Disturbed hormonal background.
• genetic predisposition.

Types of adenomyosis

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

I - endometrium grows to myometrium;

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

III - the endometrium reaches the serous cover;

IV - the endometrium penetrates the peritoneum.

The main symptoms of adenomyosis

1. Pain during menstruation or algomenorrhea is the most common symptom. It is especially worth paying attention if it appears in adolescents. The 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, the menstruation itself can proceed for a longer period and with more abundant bleeding than usual.
3. Infertility - as a rule, is not so much a consequence of adenomyosis, as a combination of several factors. When the process spreads to the entire uterine cavity, active adhesive processes, 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. Miscarriage, or spontaneous abortion, is also the result of a combination of several pathological conditions.

The course of adenomyosis

Without proper monitoring and treatment, in most patients, adenomyosis progresses. So, in the absence of treatment for six months, the disease progresses in 45% of patients, and improvement is observed in 30%. With a longer neglect of the disease, for example, within a year, deterioration was already noticed in 65% of patients, and improvement in only 25%. The condition of adenomyosis may stabilize and even improve during pregnancy.

Diagnosis of adenomyosis

Of no small importance in the diagnosis of "adenomyosis" is the collection of anamnesis. The patient's complaints about an irregular cycle, painful periods, brown discharge before and after menstruation, pain during intercourse - all this is an indirect indicator of the presence of adenomyosis. In addition, you can determine adenomyosis:

1. According to the size and structure of the uterus - the size of the uterus, depending on the stage and development of adenomyosis, can be both increased up to 5-8 weeks of pregnancy, and 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 conduct ultrasound on the 22-25th day of the cycle.

Ultrasound examination can show the following signs of adenomyosis:

• increased echogenicity of the myometrium;
• enlarged uterus;
• the presence of small inclusions, with a diameter of 0.2 to 0.6 mm. At the same time, an experienced doctor will be able to distinguish an adenomyosis node from a myomatous node by the absence of a capsule in it and by clear forms.

1. MRI - is not used so often, however, using this method, you can assess the condition of the myometrium and the presence of adenomyosis foci in them.
2. Hysteroscopy. The most effective and informative diagnostic method. It allows you to accurately determine the state 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. Hysteroscopic classification of adenomyosis looks like this:

• At the first stage, small foci are visible, but the walls of the uterus are not changed.
• In the second stage, adenomyosis “moves” are observed, the uterus is poorly stretched and has uneven walls.
• In the third stage - there are different sizes of "bulging" in the uterine cavity, which do not have clear contours. It is possible to have adenomyosis "moves" on the bulges, but not necessarily.

1. Collection of material from the uterus for histological examination - diagnostic curettage. This method can accurately confirm or disprove the presence of adenomyosis in the uterine cavity. Most often, this method is prescribed to women after 40 years of age who complain of brown discharge between periods. The method allows not only to accurately diagnose, but also to exclude the oncological component.

Adenomyosis of the uterus treatment and drugs

Since the development of adenomyosis is directly dependent 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 estrogen. Foci of adenomyosis immediately react to the changed level of hormones in a similar way to normal endometrium.

Drugs prescribed for adenomyosis of the uterus:

1. Oral contraceptives - able to mimic pregnancy and cause amenorrhea and Per oral contraceptives- they mimic pregnancy, cause amenorrhea and fall off of the myometrial membrane and adenomyosis foci. Often, in the treatment of contraceptives, the foci of adenomyosis completely disappear. Any contraceptives that contain ethinylestradiol in doses of at least 0.03 mg can be used to treat adenomyosis. Contraceptives are taken either continuously or 63 + 7, where 63 days of drinking hormonal contraceptive, and a break is made for seven days. Treatment should take 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, soreness and bleeding stopped in 70-85% of women. The recurrence rate was about 18%.
2. Progestogens - are quite effective in the treatment of adenomyosis, moreover, they already have a low cost. Thanks to their action, adenomyosis foci atrophy. In the treatment, the following drugs are used:

• Medroxyprogesterone - most often used in the treatment of adenomyosis, as this drug is the most studied. Approximate daily dose is 30 mg, with secretions, the dose may be increased.
• Dydrogesterone - applied 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 estrogens is recommended.

1. Androgens. The most commonly used is danazol. It causes amenorrhea and prevents the growth of adenomyosis foci and the appearance of new ones. Able to cause long-term remission in adenomyosis. It is 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 in liver diseases as it can destroy its cells.
2. Analogues of gonadoliberin such as: goserelin, gistrelin, leuprolelin, buserilin, nafarelin and others. When prescribing this drug, it is mandatory to monitor its level in the blood, due to the fact that it can cause osteoporosis. Also, side effects are a decrease in sexual desire and atrophic vaginitis. To prevent the occurrence of osteoporosis, it is necessary to prescribe the drug in combination with progestogens and estrogens.
3. Mirena spiral - is established for a period of 5 years. Thanks to her, adenomyosis stabilizes and stops regressing, and the symptoms gradually disappear.

Please note that all information in this article is for reference only and does not in any way encourage self-treatment. 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 enough effective method especially when adenomyosis nodes are well supplied with blood. Otherwise, this method is ineffective.

Removal of the uterus - is indicated only in especially severe cases and is an extreme measure, often unjustified.

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

Prevention of adenomyosis

A timely and annual visit to the doctor is the best prevention of such a disease. Also, women should try to avoid abortions and use modern methods of contraception to avoid unwanted pregnancies.

Adenomyosis causes considerable harm 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 adenomyosis of the uterus

Uterine adenomyosis 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).

AT 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.

The reasons

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, scraping, 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;
• overweight.

Adenomyosis of the uterus 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 surgery or curettage significantly increases 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 for adenomyosis are such symptoms and signs as:

• 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 violations 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);
• pain during intercourse.
• deterioration of the general condition, frequent headaches, migraine, decreased performance, apathy, depression, abrupt mood changes, decreased performance.

Uterine adenomyosis in to a large extent typically asymptomatic pathological process, which can stretch over many years and even decades.

Forms of the disease

There are the following forms of adenomyosis of the uterus:

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

The main symptom of the nodular form is a violation of the menstrual cycle. The cycle becomes shorter, and menstruation is more abundant and longer due to the appearance of spotting 2-3 days before the onset of menstruation and within a few days after they end.

• pulling pain lower abdomen,
• intense painless menstrual cycle,
• the presence of spotting a few days before and after menstruation.

Adenomyosis: 1, 2, 3, 4 degrees

The intensity with which certain symptoms of the disease appear is related to the severity of adenomyosis. The classification of adenomyosis according to the degree of prevalence is not international, but it is quite convenient and is carried out in practice. In total, four stages are distinguished, which vary depending on the distribution of the endometrium:

1. Cell growth is limited to the inner space of the uterus and does not go beyond its shell.
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 in the process of more than half or the entire muscular wall of the uterus.
4. At stage 4, germinating through the serous layer, endometrial tissues migrate outside the uterus

Before and after menstruation, mucous discharge with a sharp, unpleasant odor can 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 ends for the woman as a whole safely, with preservation reproductive function and hormonal restoration.

The growth of the endometrium outside the inner space of the uterus leads to the fact that the mucous membrane of the organ is broken, becomes 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 disorders 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, an increase in the size of the endometrium occurs in anticipation of the onset of pregnancy. In the event that fertilization does not occur, then there is a rejection of endometrial cells and their release to the outside along with menstruation. With adenomyosis, such an exit from the muscular tissue of the uterus does not occur, which causes the appearance of hemorrhage and severe inflammation organ.

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

Diagnostics

Presumably, it is possible to diagnose adenomyosis of the uterus already on the basis of characteristic complaints and as a result of a gynecological examination. Clarify the diagnosis and determine the stage of the disease allows additional methods examinations.

1. Ultrasound of the pelvic organs, where a change in the shape and size of the uterus is clearly visible. Is it possible to see signs of uterine adenomyosis in women on ultrasound? During an ultrasound on the screen, you can see the growth of the layers of the uterus, both uniform and uneven, sharp protrusions or irregularities similar to myometrium can also be seen.
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 study endometrial hysteroscopy. With its help, the doctor studies the nature and degree of damage to the uterine cavity, which makes it possible to determine the further course of treatment.
4. Laboratory analyzes of smears for flora are also required.
5. conducting the necessary comprehensive studies of other internal organs and systems - endocrine, genitourinary, respiratory, food, vascular-cardiac;
6. endometrial biopsy;
7. bimanual gynecological examination.

Treatment of adenomyosis of the uterus

Treatment is based on 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 age of the patient, her desire to have children, neuropsychiatric status;
• all characteristics of the pathological process;
• a 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.

Preparations

In drug treatment, patients are prescribed hormone therapy, this is to stop the menstrual cycle, so to speak, creates a menopause. Hormone treatment 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.

Preparations of the hormonal group in pathology:

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

Removal of the inflammatory process. To do this, use various gels, suppositories, douching solutions. Medications can be made on the basis 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 3 and 4 degrees;
• with a combination of adenomysoa with myoma and atypical endometrial hyperplasia;
• with a nodular form (in women with infertility, conservative organ-preserving operations are performed);
• with persistent anemia;
• with the ineffectiveness of conservative treatment.

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's appointment is 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 and nuts.

Try to include omega-3s 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 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, douching can be used. For cooking medical composition you need to mix the following herbs in equal parts:

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.

Collection of herbs №2

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

Nettle decoction

Nettle decoction four times a day. To prepare a 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. Passage of ultrasound of the small pelvis, 1-2 times a year.
3. Gynecologists believe that stress and constant overwork strongly affect women's health and, of course, 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 childhood 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 only. Do not self-medicate, but contact 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, the functionality of the organ is disturbed.

Adenomyosis of the uterus is often confused with endometriosis. However, this is only a variation thereof, the so-called internal endometriosis of the uterus, when the endometrium multiplies outside the uterus itself. It is a systemic benign non-cancer disease of the uterus. The endometrium is located on different bodies such as the uterus, vagina, kidneys, gastrointestinal tract and others.

The reasons

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

Adenomyosis can develop due to such reasons:

1. Congenital formation of foci of endometriosis, resulting from violations of embryonic development.
2. The introduction of endometrial cells into the 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 childbirth;
• early or late onset of menstruation;
• frequent inflammatory processes in the uterus and appendages;
• gynecological manipulations on the uterus (abortions, diagnostic curettage);
• hereditary predisposition to benign or malignant neoplasms;
• too much weight of a woman, obesity;
• 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 syndrome, damage to neighboring organs and a sharp decrease in the quality of life of a woman, 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 in relation to adenomyosis of the body of the uterus.

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, with the capture of less than half of this layer.
3. degree - pathological diffuse process took 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 located in the thickness of the myometrium) - with a frequency of occurrence of 50–70%
• nodular form (heterotopias are located in the myometrium in the form of endometrioid "nodes", of various sizes and localizations); a characteristic feature of these nodes is the absence of a capsule; this form occurs in 3-8% of patients
• mixed form.

The first degree and the second do not require surgical intervention, which cannot be said about the third and fourth. The last two are difficult to conservative treatment, more often two methods are taken in combination.

Symptoms of adenomyosis

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

1. Pain in the lower abdomen radiating to groin, rectum, vagina.
2. 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 uterine mucosa), with the end of bleeding, the pain subsides.
3. Manifestations of anemia (anemia): weakness, pallor and peeling of the skin, drowsiness, fatigue.
4. Abundant and prolonged (more than 5 days) menstrual bleeding.
5. The appearance of the smearers 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 periods.
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 used first, including:

• examination of the genital organs with the help of mirrors;
• colposcopy (examination of the cervix using a special device that gives an increase of about 30 times);
• laboratory samples (taking smears);
• general examination of the respiratory, circulatory, digestive, urinary system;
• 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 adenomyosis of the uterus: conservative and surgical. Naturally, the method of treatment directly depends on the degree of adenomyosis. As a rule, the first and second degrees, less often the third, are amenable to conservative therapy, and the fourth is treated only surgically.

For the purpose of conservative influence apply:

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

In the absence of a result from therapeutic treatment a surgical method of treatment is used, the purpose of which is to remove foci of localization 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 is not treatable and leads to a large loss of blood;
• the woman already has children and she does not plan pregnancy in the future;
• the woman is in premenopausal age (senior) and is not opposed to the removal of the uterus;
• combined with large uterine fibroids;
• combined with unwanted 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 an abdominal operation to remove the uterus. Laparoscopic surgery allows you to remove foci of adenomyosis and save the uterus.

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

Treatment prognosis

Adenomyosis is a chronic disease 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 patients of premenopausal age, the prognosis for adenomyosis is more favorable, due to the gradual extinction of ovarian function. After panhysterectomy, recurrence is impossible. AT menopause self-recovery occurs.

Polycystic ovaries - symptoms, causes and treatment

Uterine fibroids - what is it? Symptoms and treatment

One comment

I was also diagnosed with adenomyosis, only by ultrasound and PCA by an hormone test. She said that without laparoscopy nothing will work. I did not want to be cut and intervened there. I tracked O according to Ovuplan's tests and began to believe and pray.

I also started taking Duphaston at 16 and were prescribed 25 each, but I was afraid if I got pregnant there would be a miscarriage right away and decided to drink before the onset of menstruation. After 4 days of delay, I did a test and showed // Girls, believe, pray and act!

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What drugs are used to treat adenomyosis of the uterus

Adenomyosis is a disease in which the inner surface layer of the uterine cavity grows beyond its limits deep into the organ. Such a violation 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 seek medical 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 by 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 state. gestational sac 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.

AT 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 within an organ, one of which is adenomyosis.

Adenomyosis is an unnatural growth of endometrial cells deep into the tissues of the myometrium. 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 evenly grow deep into the uterus;
• nodular (focal) adenomyosis - the formation of areas (nodes) in the myometrium, consisting of endometrial glandular tissue and filled with blood or brown intercellular fluid;
• mixed adenomyosis consists in 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;
• the second degree - the endometrial cells penetrated about half into the myometrial tissues;
• third degree - the myometrium is damaged by more than half;
• fourth degree - endometrial cells have penetrated the myometrium, affect the serous membrane (if you do not treat adenomyosis at the fourth stage of the disease, you can wait for the spread of the endometrium outside the uterus and the development of extensive endometriosis).

Symptoms of the disease

Symptoms of adenomyosis of the uterus initial stages may not be noticed. In this case, it is most likely that it will no longer be possible to treat the disease with hormones.

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

All these symptoms can 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 on gynecological chair(two-hand examination to determine the shape and size of the uterus, examination of the vagina and cervix using mirrors). The doctor can make a preliminary diagnosis, if he knows the medical history, after the examination. The uterus with adenomyosis has a characteristic rounded shape and is slightly enlarged.
• Colposcopy - examination of the cervix using a microscope to exclude the exit of the mucosa outside the uterus.
• swabs from the vagina and cervical canal on microflora and sexual infections.
• Magnetic resonance imaging.
• Hysteroscopy - examination of the uterine cavity using a video camera.

According to the results, treatment is prescribed. At 1-3 degrees, drug therapy can be carried out. Drugs that are 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 decrease in the areas of affected tissue. Jeanine with adenomyosis is taken for 3-6 months, then the drug is completely canceled and the cure is monitored.
• Antigonadotropins (preparations "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 (preparations "Gestrinone", "Medroxyprogesterone"). These drugs stimulate the artificial onset of menopause, so they try to prescribe such treatment to women after 40 years. The result of therapy, 5-6 months long, is the complete cessation of menstruation, the elimination of all symptoms of the disease and the complete stop of the growth of the endometrium.
• Antiandrogens (drug "Visanne"). While taking the drug, endometriosis foci 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 tissue areas.

Duphaston

There is a lot of controversy about whether it is possible to treat adenomyosis 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 growth by increasing the level of this hormone.

However, experience shows that long-term use of the drug "Dufaston" in continuous courses does not allow the progression of adenomyosis, leads to a decrease in foci of mucosal growth and a significant decrease 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 production of the body's own progesterone in the right amount.

"Dufaston", appointed by a specialist, successfully treats adenomyosis 1 and 2 degrees. The choice of scheme and duration of treatment depends on the results of the tests.

Treatment of adenomyosis with the drug "Dufaston" in the period of preparation for pregnancy allows you to establish the functioning of the reproductive system, successfully conceive, endure and give birth healthy child without resorting to surgical intervention.

Contraindications for taking the drug "Dufaston":

• serious diseases of the kidneys and liver;
• myoma on the leg;
• thrombosis risks;
• endometriosis outside the uterus;
• drug intolerance.

If the doctor prescribes "Dufaston", remember about possible appearance side effects (for example, enlargement, tightness and pain in the chest, swelling of the face and body, migraines, weight gain) and be sure to tell 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 development of the disease is not allowed to the 4th degree, which is life-threatening.

Indications for the operation:

• failure of other treatments;
• 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 with folk methods (using herbs, leeches, douching, acupuncture, etc.). But such methods are unable to eliminate the cause of the disease, and, therefore, lead only to the further spread of the disease and the appearance of complications. Alternative methods can only be beneficial in combination with traditional therapy under the supervision of the attending 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.

They say about adenomyosis if the endometrium, which should normally be only 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 .

Often, both endometriosis and adenomyosis are found in the same woman 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 occurs in women during menopause), the symptoms of adenomyosis usually disappear.

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 older than 35-40 years

Forms of adenomyosis

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

• 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 discrete 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 myoma.
• Diffuse adenomyosis: extensive areas of the endometrium grow almost evenly 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 penetrated into the muscular layer of the uterus, there are 4 degrees of adenomyosis:

• 1 degree adenomyosis: shallow penetration of the endometrium deep into the uterus. The endometrium is found only in the submucosal layer of the uterus.
• 2 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.
• 3 degree adenomyosis: foci of endometriosis are found in the muscular layer of the uterus and affect more than 50% of its thickness
• 4 degree adenomyosis: deep defeat. The endometrium grows into all layers of the uterus.

Symptoms and signs of adenomyosis

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

• Prolonged and profuse periods that last more than 7 days in a row. Often with adenomyosis, uterine bleeding can be observed.
• Smearing in the middle of the cycle.
• During menstruation, blood is released in clots (lumps).
• Expressed or in the middle of a cycle. Pain in 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 grope in the lower abdomen (for pubic bone) rounded dense formation. This is the enlarged uterus.

Consequences of adenomyosis

Adenomyosis is not life-threatening and usually does not cause any serious complications. Nonetheless, heavy bleeding in 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 link between this disease and the inability to conceive a child has not yet been established.

If you have adenomyosis and are unable to conceive, then you may need a thorough examination and then treatment. How to get pregnant with adenomyosis, read below.

Diagnosis of adenomyosis

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

The complexity of diagnosing adenomyosis lies in the fact that there are no such methods of examination that would allow such a diagnosis to be made with confidence. The only reliable method for diagnosing adenomyosis is the removal of the uterus and the subsequent examination of the tissues of the uterus under a microscope (histological examination).

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

These examinations allow you to find signs of adenomyosis and exclude other diseases with similar symptoms: , uterine polyps, endometriosis, endometrial hyperplasia. Only if other possible diseases are excluded is the diagnosis of adenomyosis made.

Gynecological examination in the chair

Despite the fact that during a routine examination, the gynecologist cannot notice the foci of adenomyosis in the uterus, the 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 acquires 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 in the muscular layer of the uterus (myometrium) of hypoechoic inclusions
• heterogeneous structure of the myometrium
• the presence of small cysts in the muscular layer of the uterus (up to 5 mm in diameter)
• thickening of the walls of the uterus (especially common thickening of the back wall of the uterus)

It is important to understand that only on the basis and general inspection no doctor can diagnose adenomyosis. Ultrasound only allows 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 also allows you to exclude other possible diseases of the uterus.

Hysteroscopy

Hysteroscopy can be used to rule out 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 taking material for research is called a biopsy, and the study of the material obtained under a microscope is a histological examination.

Hysterosalpingography (HSG) and sonohysterography

Hysterosalpingography and sonohysterography are also used to exclude other possible uterine diseases. In addition, if a woman has adenomyosis, then hysterosalpingography or sonohysterography can detect indirect signs of this disease. Our website has .

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 in adenomyosis and in submucosal uterine myoma, uterine polyps, hormonal disorders, endometrial hyperplasia, malignant diseases uterus, etc. Pain in the abdomen 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 in order 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 revealed indirect signs of adenomyosis, then the diagnosis of adenomyosis is considered confirmed. The final diagnosis can only be given by a histological examination of the uterus after its removal.

Should adenomyosis 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, the treatment of adenomyosis is not required for all women. You do not need treatment if:

• signs of adenomyosis were discovered by chance, during examination for another reason
• you have no symptoms of adenomyosis, or the symptoms are mild and tolerable
• the symptoms of adenomyosis do not cause severe inconvenience, you are over 45-50 years old and you should soon have menopause

Can adenomyosis be completely cured?

Unfortunately, there are no drugs 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 for adenomyosis depends on the symptoms that bother the woman.

• Pain medications 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 the tablets even before your period appears (1-2 days before the expected date of menstruation and take one tablet every 6 hours).

• Contraceptive 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 the patency of the fallopian tubes
• for at least 3 consecutive months to determine if you are ovulating

What examinations should a man undergo:

• semen analysis (spermogram)

Depending on the results of the examination, 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.