Why is the uterus spherical in shape? Why is the uterus round?

Adenomyosis “You have adenomyosis in your uterus”– this conclusion is often heard by women (especially after 27-30 years) during an ultrasound or after an examination in a chair. Very rarely, patients are explained in detail what this disease is.

Let's figure it out.

Adenomyosis sometimes called “internal endometriosis,” equating this disease to a type of endometriosis. Most researchers believe that although these diseases are similar, they are still two different pathological conditions.

What is adenomyosis?

Let me remind you that the uterine cavity is lined with a mucous membrane called the endometrium. The endometrium grows during the menstrual cycle, preparing to receive a fertilized egg, and if pregnancy does not occur, the surface layer (also called “functional”) is shed, which is accompanied by bleeding (this process is called menstruation). A growth layer of the endometrium remains in the uterine cavity, from which the endometrium begins to grow again in the next menstrual cycle.

The endometrium is separated from the muscular layer of the uterus by a special thin layer of tissue that separates these layers. Normally, the endometrium can only grow towards the uterine cavity, simply thickening during the menstrual cycle. With adenomyosis, the following happens - in different places the endometrium grows into the separation tissue (between the endometrium and the muscle) and begins to penetrate into the muscular wall of the uterus.

Important! The endometrium does not grow into the wall of the uterus along its entire length, but only in places. For clarity, I will give an example. You planted seedlings in a cardboard box and if you haven’t transplanted them into the ground for a long time, individual roots will grow through the box. This is how the endometrium grows in the form of separate “roots” that penetrate the muscular wall of the uterus.

In response to the appearance of endometrial tissue in the muscle of the uterus, it begins to react to the invasion. This is manifested by reactive thickening of individual bundles of muscle tissue around the invading endometrium. The muscle seems to be trying to limit the further spread of this ingrowth process.
As the muscle increases in size, the uterus accordingly begins to increase in size and acquires a spherical shape.

What forms of adenomyosis are there?

In some cases, the implanted endometrial tissue forms foci of its accumulation in the thickness of the muscle, then they say that this is “adenomyosis – focal form.” If there is simply implantation of the endometrium into the uterine wall without the formation of foci, they speak of “diffuse form” of adenomyosis. Sometimes there is a combination of diffuse and nodular forms of adenomyosis.

It also happens that the endometrium, embedded in the wall of the uterus, forms nodes very similar to the nodes of uterine fibroids. If uterine fibroids, as a rule, are represented by muscle and connective tissue components, then in adenomyosis nodes the glandular component and connective tissue predominate. This form of adenomyosis is called "nodal"

It can be very difficult to distinguish a uterine fibroid node from a nodular form of adenomyosis using ultrasound. In addition, it is believed that endometrial tissue can invade existing myomatous nodes. Quite often you can see a combination of adenomyosis and uterine fibroids. For example, against the background of diffuse adenomyosis, there are nodes of uterine fibroids.

It is very important as a result of the diagnosis to make the correct diagnosis and clearly determine what exactly is present in the uterus - uterine fibroids or adenomyosis nodular form. Treatment for uterine fibroids and adenomyosis is virtually the same, but the effectiveness is different, and this will affect the prognosis of treatment.

What causes adenomyosis?

The exact cause of adenomyosis is still not known. It is assumed that all factors that disrupt the barrier between the endometrium and the muscular layer of the uterus can lead to the development of adenomyosis.

What exactly:

Curettage and abortions

evil of uterine fibroids (especially with opening of the uterine cavity)

ChildbirthInflammation of the uterus (endometritis)Other operations on the uterus

In the same time, but very rarely, adenomyosis is found in women who have never had the interventions and diseases described above, as well as in young teenage girls who have only recently started menstruating.
In these rare cases it is assumed two reasons.

First reason is associated with the occurrence of disturbances during the intrauterine development of a girl, which leads to the endometrium being implanted into the wall of the uterus without any external factors.

The second reason due to the fact that young girls may have difficulty opening the cervical canal during menstruation. Muscular contractions of the uterus during menstruation in the presence of cervical spasm create very high pressure inside the uterus, which can have a traumatic effect on the endometrium, namely the barrier separating the endometrium and the muscular layer of the uterus. As a result, the endometrium may invade the uterine wall.

In addition, it is this mechanism that can play a role in the development of endometriosis, since when the outflow of menstrual discharge from the uterus is difficult, under the influence of high pressure, these discharges through the pipes in large quantities enter the abdominal cavity, where implantation of endometrial fragments on the peritoneum occurs.

How does adenomyosis manifest?

More than half of women have adenomyosis is asymptomatic. The most characteristic symptoms of adenomyosis include painful and heavy, as well as prolonged menstruation, often with clots, with a long period of brownish spotting, pain during sexual activity, and sometimes intermenstrual bleeding. Pain with adenomyosis is often quite strong, spastic, cutting, and can sometimes be “dagger-like.” Such pain is poorly relieved by taking conventional painkillers. The intensity of pain during menstruation may increase with age.

Diagnosis of adenomyosis

Most often, the diagnosis of adenomyosis is made during Ultrasound. In this case, the doctor sees “an enlarged uterus, a heterogeneous structure of the myometrium (they also write “heterogeneous echogenicity”), the absence of a clear boundary between the endometrium and myometrium, “jaggedness” in the area of ​​this border, the presence of foci in the myometrium.

The doctor can describe sharp thickening of one of the walls of the uterus compared to the other. These are the most common ultrasound descriptions of adenomyosis that you can read in your report. During an examination on the chair, the doctor can say that the uterus is enlarged in size, the very important word is “round uterus”.

The diagnosis of adenomyosis is also often made during hysteroscopy. During this procedure, the so-called “passages” are seen - these are red dots in the endometrium, which correspond exactly to the places where the endometrium has penetrated into the wall of the uterus.

Less commonly used to confirm the diagnosis MRI. This method is most indicated in cases where ultrasound cannot reliably distinguish between the nodular form of adenomyosis and uterine fibroids. This is important when planning treatment tactics.

Important! Since adenomyosis in more than half of women is asymptomatic and most women live their lives without knowing that they had adenomyosis (adenomyosis, like uterine fibroids and endometriosis, regress after menopause) - you should not immediately worry if during examination, you are given this diagnosis.
This is a fairly common situation– you come for a routine examination or with complaints of vaginal discharge – at the same time they do an ultrasound and diagnose you with “adenomyosis”, although that you do not have symptoms characteristic of this disease. The doctor is obliged to describe the changes that he saw, but this does not mean that you urgently need to start treatment.

Adenomyosis is very common“condition” of the uterus, which may not manifest itself in any way throughout life and may regress on its own after menopause. You may never experience symptoms of this disease.

Adenomyosis in most cases is characterized stable asymptomatic course, without progression of the disease, unless additional factors are created for this in the form of abortions and curettage.

In most women, adenomyosis exists as a “background” and does not require serious treatment, only preventive measures, which I will describe below.

Adenomyosis as a serious problem is less common; as a rule, in this situation it immediately manifests itself with symptoms and has a progressive course. This “adenomyosis” requires treatment.

Treatment of adenomyosis

Adenomyosis cannot be cured completely, unless of course you take into account the removal of the uterus. This disease regresses on its own after menopause. Until this point, we can achieve a slight regression of adenomyosis and prevent further development of the disease.

For the treatment of adenomyosis, virtually the same approaches are used as for the treatment of uterine fibroids.

Since adenomyosis regresses after menopause, GnRH agonist drugs are used (

– a disease in which the inner lining (endometrium) grows into the muscle tissue of the uterus. It is a type of endometriosis. It manifests itself as long, heavy menstruation, bleeding and brownish discharge during the intermenstrual period, severe PMS, pain during menstruation and during sex. Adenomyosis usually develops in patients of childbearing age and subsides after the onset of menopause. Diagnosed on the basis of a gynecological examination, the results of instrumental and laboratory tests. Treatment is conservative, surgical or combined.

General information

Adenomyosis is the growth of the endometrium into the underlying layers of the uterus. Usually affects women of reproductive age, most often occurring after 27-30 years. Sometimes it is congenital. It fades away on its own after menopause. It is the third most common gynecological disease after adnexitis and uterine fibroids and is often combined with the latter. Currently, gynecologists note an increase in the incidence of adenomyosis, which may be due to both an increase in the number of immune disorders and improved diagnostic methods.

Patients with adenomyosis often suffer from infertility, however, the direct connection between the disease and the inability to conceive and bear a child has not yet been precisely established; many experts believe that the cause of infertility is not adenomyosis, but concomitant endometriosis. Regular heavy bleeding can cause anemia. Severe PMS and intense pain during menstruation negatively affect the psychological state of the patient and can cause the development of neurosis. Treatment of adenomyosis is carried out by specialists in the field of gynecology.

Relationship between adenomyosis and endometriosis

Adenomyosis is a type of endometriosis, a disease in which endometrial cells multiply outside the lining of the uterus (in the fallopian tubes, ovaries, digestive, respiratory or urinary systems). Cell spread occurs by contact, lymphogenous or hematogenous route. Endometriosis is not a tumor disease, since heterotopically located cells retain their normal structure.

However, the disease can cause a number of complications. All cells of the inner lining of the uterus, regardless of their location, undergo cyclic changes under the influence of sex hormones. They multiply intensively and then are rejected during menstruation. This entails the formation of cysts, inflammation of surrounding tissues and the development of adhesions. The frequency of the combination of internal and external endometriosis is unknown, but experts suggest that most patients with uterine adenomyosis have heterotopic foci of endometrial cells in various organs.

Causes of adenomyosis

The reasons for the development of this pathology have not yet been precisely clarified. It has been established that adenomyosis is a hormone-dependent disease. The development of the disease is facilitated by impaired immunity and damage to the thin layer of connective tissue that separates the endometrium and myometrium and prevents the growth of the endometrium deep into the uterine wall. Damage to the separation plate is possible during abortion, diagnostic curettage, use of an intrauterine device, inflammatory diseases, childbirth (especially complicated ones), operations and dysfunctional uterine bleeding (especially after operations or during treatment with hormonal drugs).

Other risk factors for the development of adenomyosis associated with the activity of the female reproductive system include too early or too late the onset of menstruation, late onset of sexual activity, taking oral contraceptives, hormonal therapy and obesity, which leads to an increase in the amount of estrogen in the body. Risk factors for adenomyosis associated with immune disorders include poor environmental conditions, allergic diseases and frequent infectious diseases.

Some chronic diseases (diseases of the digestive system, hypertension), excessive or insufficient physical activity also have a negative impact on the state of the immune system and the general reactivity of the body. Unfavorable heredity plays a certain role in the development of adenomyosis. The risk of this pathology increases if you have close relatives suffering from adenomyosis, endometriosis and tumors of the female genital organs. Congenital adenomyosis is possible due to disturbances in intrauterine development of the fetus.

Classification of uterine adenomyosis

Taking into account the morphological picture, four forms of adenomyosis are distinguished:

• Focal adenomyosis. Endometrial cells invade the underlying tissues, forming separate foci.
• Nodular adenomyosis. Endometrial cells are located in the myometrium in the form of nodes (adenomyomas), shaped like fibroids. The nodes, as a rule, are multiple, contain cavities filled with blood, and are surrounded by dense connective tissue formed as a result of inflammation.
• Diffuse adenomyosis. Endometrial cells invade the myometrium without forming clearly visible foci or nodes.
• Mixed diffuse nodular adenomyosis. It is a combination of nodular and diffuse adenomyosis.

Taking into account the depth of penetration of endometrial cells, four degrees of adenomyosis are distinguished:

• 1st degree– only the submucosal layer of the uterus suffers.
• 2nd degree– no more than half the depth of the muscular layer of the uterus is affected.
• 3rd degree– more than half the depth of the muscular layer of the uterus is affected.
• 4th degree– the entire muscle layer is affected, with possible spread to neighboring organs and tissues.

Symptoms of adenomyosis

The most characteristic sign of adenomyosis is long (over 7 days), painful and very heavy menstruation. Clots are often detected in the blood. Brownish spotting is possible 2-3 days before menstruation and 2-3 days after it ends. Intermenstrual uterine bleeding and brownish discharge in the middle of the cycle are sometimes observed. Patients with adenomyosis often suffer from severe premenstrual syndrome.

Another typical symptom of adenomyosis is pain. Pain usually occurs several days before the start of menstruation and stops 2-3 days after it begins. Features of the pain syndrome are determined by the localization and prevalence of the pathological process. The most severe pain occurs with damage to the isthmus and widespread adenomyosis of the uterus, complicated by multiple adhesions. When localized in the area of ​​the isthmus, the pain can radiate to the perineum; when located in the area of ​​the angle of the uterus, it can radiate to the left or right groin area. Many patients complain of pain during sexual intercourse, which intensifies on the eve of menstruation.

More than half of patients with adenomyosis suffer from infertility, which is caused by adhesions in the fallopian tubes, preventing the penetration of the egg into the uterine cavity, disturbances in the structure of the endometrium, complicating the implantation of the egg, as well as the accompanying inflammatory process, increased myometrial tone and other factors that increase the likelihood of spontaneous abortion . Patients may have a history of no pregnancy with regular sexual activity or multiple miscarriages.

Heavy menstruation with adenomyosis often entails the development of iron deficiency anemia, which can manifest itself as weakness, drowsiness, fatigue, shortness of breath, pale skin and mucous membranes, frequent colds, dizziness, fainting and presyncope. Severe PMS, long menstruation, constant pain during menstruation and deterioration of general condition due to anemia reduce the patient's resistance to psychological stress and can provoke the development of neuroses.

Clinical manifestations of the disease may not correspond to the severity and extent of the process. Grade 1 adenomyosis is usually asymptomatic. In grades 2 and 3, both an asymptomatic or low-symptomatic course and severe clinical symptoms can be observed. Grade 4 adenomyosis is usually accompanied by pain caused by widespread adhesions; the severity of other symptoms may vary.

During a gynecological examination, changes in the shape and size of the uterus are revealed. With diffuse adenomyosis, the uterus becomes spherical and increases in size on the eve of menstruation; with a widespread process, the size of the organ can correspond to 8-10 weeks of pregnancy. With nodular adenomyosis, tuberosity of the uterus or tumor-like formations in the walls of the organ are detected. When adenomyosis and fibroids are combined, the size of the uterus corresponds to the size of the fibroids, the organ does not shrink after menstruation, and other symptoms of adenomyosis usually remain unchanged.

Diagnosis of adenomyosis

The diagnosis of adenomyosis is established on the basis of anamnesis, the patient’s complaints, examination data on a chair and the results of instrumental studies. A gynecological examination is carried out on the eve of menstruation. The presence of an enlarged spherical uterus or tubercles or nodes in the uterine area in combination with painful, prolonged, heavy menstruation, pain during sexual intercourse and signs of anemia is the basis for a preliminary diagnosis of adenomyosis.

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. Adenomyosis is evidenced by the enlargement and spherical shape of the organ, varying wall thickness and cystic formations larger than 3 mm that appear in the uterine wall shortly before menstruation. With diffuse adenomyosis, the effectiveness of ultrasound is reduced. The most effective diagnostic method for this form of the disease is hysteroscopy.

Hysteroscopy is also used to exclude other diseases, including fibroids and uterine polyposis, endometrial hyperplasia and malignant neoplasms. In addition, in the process of differential diagnosis of adenomyosis, MRI is used, during which it is possible to detect thickening of the uterine wall, disturbances in the structure of the myometrium and foci of endometrial penetration into the myometrium, as well as assess the density and structure of the nodes. Instrumental diagnostic methods for adenomyosis are complemented by laboratory tests (blood and urine tests, hormone tests), which make it possible to diagnose anemia, inflammatory processes and hormonal imbalances.

Treatment and prognosis for adenomyosis

Treatment of adenomyosis can be conservative, surgical or combined. Treatment tactics are determined taking into account the form of adenomyosis, the prevalence of the process, the age and health status of the patient, and her desire to preserve reproductive function. Initially, conservative therapy is carried out. Patients are prescribed hormonal drugs, anti-inflammatory drugs, vitamins, immunomodulators and agents to maintain liver function. Anemia is treated. In the presence of neurosis, patients with adenomyosis are referred to psychotherapy, tranquilizers and antidepressants are used.

If conservative therapy is ineffective, surgical interventions are performed. Surgeries for adenomyosis can be radical (panhysterectomy, hysterectomy, supravaginal amputation of the uterus) or organ-preserving (endocoagulation of endometriosis foci). Indications for endocoagulation in adenomyosis are endometrial hyperplasia, suppuration, the presence of adhesions that prevent the egg from entering the uterine cavity, lack of effect when treated with hormonal drugs for 3 months and contraindications to hormonal therapy. Indications for hysterectomy include progression of adenomyosis in patients over 40 years of age, ineffectiveness of conservative therapy and organ-preserving surgical interventions, diffuse adenomyosis of grade 3 or nodular adenomyosis in combination with uterine fibroids, and the threat of malignancy.

If adenomyosis is detected in a woman planning a pregnancy, she is recommended to attempt conception no earlier than six months after undergoing a course of conservative treatment or endocoagulation. During the first trimester, the patient is prescribed gestagens. The need for hormonal therapy in the second and third trimester of pregnancy is determined taking into account the result of a blood test for progesterone levels. Pregnancy is a physiological menopause, accompanied by profound changes in hormonal levels and has a positive effect on the course of the disease, reducing the rate of proliferation of heterotopic endometrial cells.

Adenomyosis is a chronic disease with a high probability of relapse. 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. During menopause, spontaneous recovery occurs.

Endometriosis is a systemic disease that occurs in women of fertile age. Adenomyosis is one of its forms. Adenomyosis of the uterus, what is it? How will the disease affect the possibility of conception?

Adenomyosis is classified as a type of endometriosis, more precisely, its internal form. Normally, the uterine cavity is lined with a mucous layer, which grows during the monthly cycle and secretes in preparation for receiving a blastomere. If a fertilized egg is missing, it is rejected and menstruation begins. After which the cycle repeats.

When a malfunction occurs in the body, glandular cells penetrate the barrier between the endometrium and the uterus, penetrate its muscle layer, and continue to grow and function. This leads to serious pathological changes in the organ. Literally, adenomyosis of the uterus can be translated as glandular degeneration of the muscle layer.

Spreading beyond its habitat, the endometrium works in accordance with its purpose. This causes inflammatory processes in the altered tissues, leading to their degeneration. Since the epithelium is supplied with blood vessels, bleeding may occur. The uterus, in turn, reacts to such interference and tries to reject cells that are not specific to the muscle layer. At the site of the “struggle,” compactions form. Gradually there are many of them, and the uterus takes on a spherical shape.

There are diffuse, nodular and mixed adenomyosis. In the first case, pockets are formed through which glandular tissue penetrates into the muscles to different depths. In some cases, fistulas may form. The nodular form is formed when connective tissue grows around endometrial cells.

What is the difference between endometriosis and adenomyosis?

Endometrial cells leave their boundaries in endometriosis. Then why are both adenomyosis and endometriosis classified, what is the difference?

Endometriosis is a broad concept. Leaving the lining of the uterus, the cells can spread throughout the body, affecting almost all organs. They are found in the tissues of the genital organs, lungs, gastrointestinal tract, navel, and urinary system.

Internally, genital endometriosis (adenomyosis) affects only the uterus. It spreads into its muscle layer, can perforate the walls, but does not go beyond its limits. Otherwise, the disease is classified as external endometriosis.
Read also
We recommend watching a video about endometriosis and whether it is possible to get pregnant with this disease.

Etiology of the disease

It is very difficult to determine the exact cause of the disease, since signs of adenomyosis may be absent for a long time. We can definitely say that since the endometrium is a hormonally dependent tissue, its pathological spread can be affected by a malfunction of the endocrine system. Factors that can trigger the disease include:

• abortions, trauma during childbirth, medical curettage;
• late birth;
• taking contraceptives;
• history of adenomyosis;
• frequent infectious diseases;
• inflammation of the pelvic organs;
• long-term hormonal therapy;
• endocrine disorders;
• difficult working or living conditions;
• sedentary lifestyle.

How to recognize adenomyosis

Characteristic signs that make one suspect adenomyosis include prolonged menstrual bleeding, which is accompanied by pain. Light bleeding may occur during the ovulation period. Spotting brown discharge before menstruation.

Due to large blood loss, drowsiness, dizziness, low blood pressure, and anemia often occur. Pain for adenomyosis is characteristic only during menstruation. If the pain is constant, then by its type and location it is possible to determine which organs other than the uterus are involved in the process.

Adenomyosis, the symptoms of which are very vague, can be confirmed by laboratory and instrumental studies. Low-grade fever in the first days of menstruation, an increase in ESR and leukocytes are a sign of inflammation. Ultrasound diagnostics is able to recognize the uneven structure of the muscular layer of the uterus, heterogeneous echogenicity and enlargement of the organ as a whole are observed. If ultrasound findings are doubtful, MRI can be used. Based on these studies, a final diagnosis is not made.

Types of treatment for adenomyosis

If uterine adenomyosis is diagnosed, treatment should begin immediately. The choice of tactics will depend on a number of factors:

• patient's age;
• presence of children;
• general condition;
• localization of foci;
• severity of the disease.

Whatever treatment plan the doctor outlines, the final decision is made by the patient, since in some cases, the intervention leads to significant changes in the patient’s life.

Symptomatic treatment

Uterine bleeding in the middle of the cycle is controlled with hemostatic drugs. In mild cases, a decoction of nettle is sufficient. It is necessary to systematically take vitamin complexes to support a weakened immune system.

When pain occurs, conventional analgesics are effective. Nonsteroidal anti-inflammatory drugs have little effect. Despite the lack of evidence, contraceptives containing estrogens and progestins are still prescribed and considered effective.

Conservative therapy

The basis of traditional treatment is the use of hormones, drugs that promote the resorption of nodes, and physical therapy. Hormones come in the form of contraceptives: estrogen-progestin, antiprogestins, antiestrogens, progestins. Immunomodulators, anti-inflammatory drugs, and anti-anemia drugs are used as concomitant therapy.

If there are somatic diseases, their compensation or remission is required. If there are diseases that are incompatible with taking hormones (diabetes mellitus, migraine, epilepsy), combined or radical treatment methods should be used.

Radical treatment method

>Surgical intervention is used in complex therapy or when other methods have exhausted themselves. Laparoscopy or complete removal of the reproductive organs may be performed. During the operation, only endometroid lesions are excised through small holes. Such intervention is possible with further traditional treatment.

Hysterectomy and removal of the ovaries ensures that endometriosis or malignancy does not occur in these systems. The following difficulties may arise:

• psychological barrier when a woman feels inferior;
• impossibility of conception;
• all the “delights” of menopause;
• the need for lifelong replacement therapy;
• the presence of a postoperative suture on the abdomen.

On the other hand, there are undeniable advantages - no need to use contraceptives, complete elimination of menstruation.
Read all uterine diseases here

How does adenomyosis affect fertility?

Is it possible to get pregnant with adenomyosis? It is possible, but the disease contributes to the development of infertility. Due to hormonal imbalance and autoimmune processes, the female cycle is disrupted and ovulation becomes rare. The changed environment of the uterus can negatively affect sperm activity. If pregnancy does occur, then due to increased contractility of the myometrium, spontaneous abortion may occur.

In general, adenomyosis and pregnancy are compatible. Timely therapy can completely restore reproductive function. There is a risk of spontaneous abortion in the early stages, but by using standard procedures to preserve it, the problem can be avoided. Of course, you will have to be under the supervision of specialists for the entire period of gestation and spend more than one time in the extragenital pathology department. Adenomyosis is not an indication for cesarean section, but if there are associated abnormalities, doctors may choose this route of delivery.

Adenomyosis is a disease that can be cured 100% only by radical removal of the organ. In other cases, it often recurs. Modern medicine can improve the quality of life of a patient with such a diagnosis, giving her the opportunity to remain a woman and become a mother. With timely treatment, the prognosis for periods of long-term remission is very high.
We recommend watching a video by a gynecologist about uterine adenomyosis

WHO SAID THAT IT IS HARD TO CURE INFERTILITY?

• Have you been wanting to conceive a child for a long time?
• Many methods have been tried, but nothing helps...
• Diagnosed with thin endometrium...
• In addition, for some reason the recommended medications are not effective in your case...
• And now you are ready to take advantage of any opportunity that will give you the long-awaited baby!

Adenomyosis is internal endometriosis of the uterine body. This is a condition when endometrial cells grow into the deep-lying tissues of the uterus - the myometrium, and there undergo the same cyclic hormonal changes as the normal endometrium.

Symptoms of adenomyosis

As a rule, symptoms of adenomyosis may include pain during menstruation, too heavy and prolonged periods, increased premenstrual syndrome (PMS), infertility, and miscarriage. On ultrasound, adenomyosis can be suspected based on the condition of the endometrium (hyperplasia) and myometrium, but a clear diagnosis is made on the basis of laparoscopy.

Treatment of adenomyosis

Adenomyosis is treated with hormonal drugs, including oral contraceptives (OCs), or surgery, depending on the severity of the disease. For more information, see the topic treatment of endometriosis.

1. I am diagnosed with uterine endometriosis. How to treat it, how serious is it and what consequences can there be? I have been taking Mercilon for the second year on the recommendation of a doctor.

Endometriosis is a hormonal-dependent disease, which is manifested by the penetration of tissue similar to the mucous membrane of the uterine body into the muscle of the uterus. Moreover, during menstruation, foci of endometriosis also menstruate, which leads to the development of inflammation. Symptoms of adenomyosis (endometriosis of the uterus) are heavy and painful menstruation, bleeding, spotting before and after menstruation. Endometriosis is often accompanied by infertility and miscarriage. Oral contraceptives promote regression of endometriosis lesions.

2. I was diagnosed with adenomyosis, histology showed that I have glandular endometrial hyperplasia. In this regard, I have had cleaning done 2 times over the past six months. I was also prescribed Norkolut. Could you write about my illness, as well as methods of treating it.

Adenomyosis is a disease characterized by the spread of tissue similar in structure to the endometrium (uterine mucosa) into the thickness of the uterine muscle. Endometrial hyperplasia is an increase in the thickness of the endometrium compared to normal. Both of these conditions are a consequence of increased levels of estrogen (female sex hormones). Hyperestrogenism can be absolute, i.e. the level of estrogen is higher than normal, or relative (the level of estrogen is normal, but the level of progesterone, another female sex hormone, is reduced). Treatment of these diseases consists of prescribing drugs that lack progesterone, or drugs that cause artificial menopause. In this case, the endometrium atrophies, i.e. foci of adenomyosis in the uterine muscle decrease or disappear and the thickness of the endometrium decreases. Norcolut is an analogue of progesterone.

3. I have adenomyosis and submucous fibroids. The condition is stable. Is it advisable to treat with duphaston 2 years after diagnostic curettage? Does it affect myoma.

If you have no complaints, you are not planning a pregnancy, the fibroids are not growing, then you do not need to take medications. Treatment of any disease is carried out according to indications. Duphaston is prescribed for severe symptoms of adenomyosis: heavy and painful menstruation, intermenstrual bleeding, to prepare for pregnancy. These same symptoms are also symptoms of uterine fibroids, and here duphaston also has a beneficial effect. But if there are no complaints, admission is not necessary.

4. I had aspiration done, endometrial polyps were removed and after that I was examined by ultrasound. Histological analysis showed an endometrial character, and the ultrasound result was as follows:
The body of the uterus is spherical, cellular, and normal in size. At the bottom of the uterus there is a subserous myomotous node d=2.5 cm. The thickness of the endometrium is 1.2 cm. Pronounced multiple endometriotic foci are identified in the cervical canal. The right ovary is 3.0x2.8 cm, the left is 3.0x3.0 cm with the presence of cystic inclusions. The analysis was done before menstruation on the 31st day of the cycle. Please explain to me what a cellular uterus is and do I have a chance of getting pregnant with such tests?

The spherical shape of the uterus and the cellular structure of the myometrium (the muscular layer of the uterus) are signs of internal endometriosis of the uterine body (adenomyosis). Sometimes with this disease pregnancy occurs on its own, sometimes it causes infertility, then it must be treated. The main manifestations of adenomyosis are heavy, painful menstruation, bleeding between menstruation. Subserous uterine fibroids will not prevent you from becoming pregnant, although they will increase during pregnancy, which will require constant monitoring.

5. I am 37 years old, with a history of adenomyosis; hr. s\ophoritis. What kind of diseases are these and can I go to the sauna?

Under the influence of thermal procedures, adenomyosis can progress. This is internal endometriosis of the uterus, a condition in which the endometrium (the lining of the uterus) grows into the muscles of the uterus. It manifests itself as painful menstruation, bleeding before and after menstruation, and the inability to get pregnant. If such complaints do not bother you, then the degree of adenomyosis is not pronounced, and the sauna is not contraindicated for you. It is necessary to do an ultrasound scan every six months and monitor the prevalence of adenomyosis and its dynamics: whether it increases or decreases.

Chronic salpingoophoritis is a chronic inflammation of the appendages. Manifested by pain in the lower abdomen, dysfunction of the pelvic organs due to adhesions and the inability to become pregnant due to adhesive obstruction of the tubes

6. I am 46 years old, on February 19 of this year I had an operation: Laporotomy Panhysterectomy The operation was performed urgently based on the results of ultrasound: infarction of the myoma node with malnutrition.
Diagnosis: Ademiosis. Endometriosis of the uterosacral ligaments. Chr. endometritis Chr. bilateral adnexitis. Endometrial polyp.
Histological examination: Glandular-cystic hyperplasia, uterine fibroids with areas
ademiosis. Ovary - sclerosis and hyamentosis of the walls of blood vessels and corpus luteum, follicular cysts,
Corpus luteum cysts. Pipe - wall sclerosis. Cervix - Nabothian cysts.
Based on the histology results, I was prescribed Norkolut for 3 months according to the regimen.
Almost immediately after the operation, I started having hot flashes (within an hour or more often).
With any physical and emotional stress, severe sweating. After a shower, relief comes, but not for long. I've been taking Remens for a month and I don't feel any improvement.
About two weeks ago pain in the rectum appeared. Can endometriosis develop again?
The pain is similar to that before surgery. An appointment is scheduled in a month. They don’t spend more than 5 minutes during an appointment.
Tell me, how can I alleviate my condition, reduce hot flashes, avoid complications such as osteoporosis, etc.? For what purpose am I prescribed a hormonal drug?
Can hot flashes go away on their own? If not, please advise what can be taken with the least side effect. Is it possible for me to go to a resort in half a year and take mud on my lower back? When can you start exercising to strengthen your abdominal muscles? The incision is made along the white line. What kind of physical activity can there be?

95% of the strength of the suture of the anterior abdominal wall is restored 3 months after surgery. Light loads can be started now.

Pain in the rectum may be a manifestation of retrocervical endometriosis. It is diagnosed with a routine examination and ultrasound. Also, after panhysterectomy, endometrioid lesions could remain on the pelvic peritoneum, giving complaints characteristic of endometriosis, as before the operation.

Norkolut is prescribed to you so that endometriosis does not progress. But apparently it doesn't help. It would be ideal to do a control laparoscopy and coagulation of foci of endometriosis in the peritoneum. But in any case, given the removed ovaries, endometriosis will not progress; on the contrary, it will gradually go away. But hot flashes and other signs of hormonal deficiency (osteoporosis, etc.) will increase. You are not contraindicated in taking hormone replacement therapy, since the doses and medications contained in modern medications will not affect the course of endometriosis, and will restore your health. After checking the condition of the mammary glands (mammography), blood biochemistry (lipids) and blood clotting, it is possible to prescribe continuous hormone replacement therapy with drugs such as Cliogest, Livial

7. I am 29 years old. After the second birth for 3 years, on the first day of menstruation, the temperature rises to 37.5 - 37.8, severe pain, cycle disorders - delays of up to 10 days. Ultrasound showed: adenomyosis of the uterine body (nodular form), ovarian endometriosis, retrocervical endometriosis, size of the uterus 77-48-52, endometrium 11 mm. There is a large number of leukocytes in the smear. The result for chlamydia is negative. The attending physician's diagnosis coincided with the ultrasound diagnosis plus chronic endometritis. Hormonal medications were recommended for the treatment of adenomyosis and endometriosis, but with the permission of a mammologist, because Immediately before this, I was operated on for fibroadenoma of the mammary gland. The mammologist explained that since I still have pronounced manifestations of diffuse mastopathy and taking into account my heredity (close female relatives have breast cancer at a young age), hormonal drugs are indicated for me only as a last resort. I consulted with several other gynecologists, their recommendations were different: some believed that hormonal treatment was required, others that it was not required. Moreover, different hormonal drugs were prescribed: microgenon, norkolut, duphaston, depo-provera. As a result, the attending physician and I decided to treat only endometritis. After the course of treatment, the temperature during menstruation became lower - 37.2 and the leukocytes in the smear returned to normal. This happened for 5 months after treatment. In the sixth month, the temperature again on the first day of menstruation rose to 37.8 and the smear showed leukocytosis again. A repeat ultrasound (one year after the first) showed that the size of the uterus and endometrium remained the same, but there were more endometriosis lesions. After another 2 months, a 6 cm cyst on the right ovary was discovered. I was again prescribed hormone therapy, and if it does not disappear in a month, then surgery. Moreover, they offer me to remove the entire right ovary. Please tell me,
1) Should I decide on hormone therapy and which drug is best for me (prolactin and progesterone are normal, but estradinol is not determined in our city). Do I need any more research and do I have time for this, or should I start hormone therapy immediately?
2) Are there types of operations that allow you to remove a cyst without an ovary, which ones exactly?
3) Are there treatments for endometriosis and adenomyosis other than hormone therapy? Including surgical ones?

1. The drugs that you listed are all drugs of the same group (gestagens). And they are absolutely not contraindicated for mastopathy, even if relatives had malignant tumors. Caution requires the use of estradiol, and gestagens, on the contrary, are indicated for mastopathy.
On the other hand, with such progressive endometriosis, gestagens are too mild a treatment method. It is advisable to start with surgery, remove the ovarian cyst, cauterize the endometriotic lesions, and in the postoperative period prescribe hormonal treatment to reduce lesions in the uterus and retrocervical endometriosis (temperature during menstruation is most likely caused by it). And these are hormonal drugs of other groups: nemestran. gestrinone, danazol, zoladex. They give more side effects, but are more effective against endometriosis

2. Laparoscopic surgery. Technically, it can sometimes be difficult to remove a cyst; this depends on the qualifications of the surgeon and is decided during the operation itself.

3. See paragraph 1. But uterine endometriosis can be surgically cured only by removing the uterus.

8. After hysteroscopy, the result was c/c polyp, endometrial polyposis, endometriosis along all ducts of the walls, glandular hyperplasia with foci of weak adenomatosis, adenomyosis. (I apologize if there are medical errors). Now they are reviewing the glass in MGOD. I have 3 questions
1.If the diagnosis is confirmed, what are the chances of a cure?
2.What do you know about Zolotex treatment?
3. Do you know the results of treatment with VISION drugs (Detox, Antiox, Lifepack, Women's Complex?). Are they not dangerous because they have not undergone clinical trials and are dietary supplements?

Answer: the diseases you listed are quite serious, especially when they are combined, and serious complications are possible. So treatment must be approached with all seriousness. Zoladex is a drug that is used to treat such conditions. Its action is based on the suppression of ovarian function, which causes artificial menopause. In this case, these diseases regress (decrease or disappear). If you are near menopausal age, then after stopping the drug, menstruation may not return. A side effect of Zoladex is manifestations of menopausal syndrome. However, in this situation, this is an alternative to surgical treatment. In such a situation, I do not recommend relying on dietary supplements.

9. Recently, pain in the uterus began to bother me (I can differentiate due to many years of practical experience of pain in the uterus before menstruation). Ultrasound revealed: the uterus is enlarged 6.2x4.9x6.8; the contours are smooth, the uterus is “round”, echolocation is moderately increased, the posterior wall is thicker, the nodes are not determined (differential fibroids? adenomyosis?). The cervix is ​​thickened 5x6.2 (a structural feature?) The structure is not entirely uniform: small brushes and bright linear fur... echo.. M-echo 0.7 cm evenly throughout. Right testicle 4.5x2.8 with cyst (follicle) 2 cm, left -4x2.3 with small follicles 0.5 cm. During the ultrasound, the doctor said that she really didn’t like her cervix. Please advise what to do. If previously there were pains only before the cycle, now almost every day. I live in Yakutia. There are practically no diagnostic tools in the village. One gynecologist for every 5,000 women. 5 minutes to take one. The doctor took a smear (races - no, other microorganisms - large quantity, leukemia - 3-4 in the subsection, epithelium - large quantity) and prescribed vitamins. Please advise what to do! how to get examined further (we are going on vacation)

Most likely, we are talking about endometriosis of the cervix and stage I adenomyosis (endometriosis of the uterine body). To clarify the diagnosis, you need further examination: colposcopy (examination of the cervix using a microscope), targeted biopsy followed by histological examination of the biopsy, diagnostic curettage of the cervical canal of the cervix and, if possible, hysteroscopy. Since you are going on vacation, you should know that if you are diagnosed with endometriosis, it is advisable to avoid exposure to the sun

10. 44 years old. Diagnosis: adenomyosis, left ovarian cyst, paraovarian cyst, cystic changes in the right ovary. Possible treatment methods? Can laparoscopy be used? If yes, where?

We do not advise you to consult in absentia - the range of diagnoses is quite serious. Apparently, in this case we are talking about a choice between hormonal and surgical treatment, and perhaps a combination of both. Without seeing the patient, without knowing the medical history, it is impossible to even say whether laparoscopic treatment is possible and whether it is necessary.

/Continuation/ A surgical operation is scheduled, but, as I was told, rehabilitation will take 2 months. Therefore, I would like to consult about laparoscopy. Please help me find out the phone numbers of organizations where such operations are performed.

Both during “conventional” and during laparoscopic surgery, the volumes are the same, but with laparoscopy, access to the operation site is made not through an incision in the abdominal wall, but through a puncture, so this operation is easier to tolerate. For example, discharge after a “regular” operation is 10-14 days, and after laparoscopy - 5-8. Laparoscopic operations are longer, they have a whole list of strict contraindications, for example, adhesions. Rehabilitation after laparoscopic surgery is just as necessary as after conventional surgery, because... tissue healing occurs within the same time frame. Laparoscopic equipment in Moscow is available in many scientific centers and hospitals, both commercial and urban. These are 1 city clinical hospital, 15 city clinical hospital, 7 city clinical hospital, mother and child center on Oparin street 4, MONIIAG on Chernyshevsky street, departments of medical institutes. Prices and conditions are different everywhere, so we advise you to “arm yourself” with a directory and call as many places as possible.

11. What is adenomyosis? what causes it? how is it treated? Is it possible to get pregnant with this diagnosis?

Adenomyosis is a hormonal disease of the uterus, characterized by an atypical arrangement of endometrial cells. The cause is hyperestrogenism against the background of a chronic inflammatory process. When planning a pregnancy, it is necessary to carry out anti-inflammatory and hormonal treatment, improve microcirculation, and prepare the endometrium for the upcoming pregnancy.
Adenomyosis is endometriosis of the uterus (a condition when cells of the endometrium - the mucous membrane of the uterus - grow into the muscular layer of the body of the uterus - the myometrium). The reasons for its occurrence are varied: trauma to the uterus during surgical interventions, for example, during abortion; hormonal changes in the body, reflux of menstrual blood - backflow into the abdominal cavity, which can occur, for example, during sexual activity on menstrual days; Immune forms of this disease are also considered. Endometriosis is a very common cause of infertility, since it is believed that endometrioid heterotopias (foci) are capable of phagocytizing (eating) sperm. There are also other causes of infertility with adenomyosis. Treatment of adenomyosis is hormonal therapy or surgery.

Folk remedies for treating adenomyosis are ineffective.

Adenomyosis is one of the most common gynecological diseases. It is also called internal endometriosis.

It is with the development of adenomyosis that most cases of constant pain in the lower abdomen in women of reproductive age are associated.

With this pathology, the cells lining the inner layer of the uterus begin to grow, going beyond their usual location.

In internal endometriosis, or adenomyosis of the uterus, the endometrium (the layer of cells lining the uterine cavity) grows into the myometrium (the muscular layer of the uterus).

In this case, the uterus takes on a round or spherical shape and increases significantly in size, often reaching the size of the uterus at 5-6 weeks of pregnancy.

Endometrial cells that end up in the muscle layer disrupt its normal functioning. This is the main danger of this disease.

This is a hormone-dependent disease, i.e. it is caused by an imbalance and relationship between certain hormones in a woman’s body.

The epithelium lining the inner surface of the uterus can penetrate the muscle layer to different depths. Depending on this, a certain stage of adenomyosis is distinguished.

The first stage is characterized by the germination of endometrial cells within the boundaries of the submucosal layer, i.e. without reaching the myometrium itself.

The second stage is characterized by germination of the endometrium to half of the myometrium (the muscular lining of the uterus).

The onset of the third stage, or degree, of adenomyosis is diagnosed when endometrial cells have grown into the muscle layer to more than half its thickness.

At the fourth stage, the endometrium grows through the wall of the uterus, reaching its serous membrane, and then, in the absence of treatment, the pathological process also affects the peritoneum. This is the most advanced stage.

Forms of adenomyosis

There are not only different stages (degrees), but also different forms of adenomyosis.

Diffuse form of adenomyosis– characterized by the fact that endometrial tissue grows into the myometrium evenly, without forming separate isolated areas.

Focal form- characterized by the fact that germination does not occur over the entire surface of the border between the inner and middle membranes of the uterus, but focally - only in some areas.

In this case, the stages of the disease are determined depending on the number of these areas and the depth of germination of the endometrium into the muscular layer.

Mixed form is a cross between the two options described above.

The form of adenomyosis is determined based on ultrasound or CT data.

Causes of adenomyosis development

If we talk about the reasons for the development of adenomatosis, then they all boil down to the fact that they lead either to a violation of the integrity, traumatization of the endometrium, or to a hormonal imbalance. 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.

Another important factor is hereditary predisposition. It creates a certain background that contributes to the development of this type of pathology. That is why, when patients are exposed to provoking factors, adenomyosis develops only in some of them.

Late or too early onset of menstruation– another important factor. However, as mentioned above, it is rather a consequence, a manifestation of hormonal imbalance or a tendency to develop it, which is already present in the patient.

Obesity. Obesity contributes to metabolic disorders in the body. The human body is integral, so isolated pathology is hardly possible.

If a pathology occurs in one organ or system, then, as a rule, this will somehow affect the functioning of the entire organism. This is especially true for obesity, when several systems are involved in the pathological process: endocrine, digestive, cardiovascular and reproductive.

The thing is that fat cells produce estrogen-like substances that disrupt the hormonal balance throughout the body.

In addition, obesity leads to metabolic disorders throughout the body, with almost all organs and tissues affected.

Starting sexual activity too late. Oddly enough, this factor also plays a role in the development of uterine adenomyosis. The onset of sexual activity triggers a number of changes in a woman’s hormonal background.

And if in Soviet times, the beginning of sexual activity at the age of 16 was considered almost shameless, now this state of affairs is a classic, the norm. And you will hardly surprise anyone with a girl who lost her virginity at 14 or even 13 years old.

But when is it too late for “this” thing? Here the views of doctors differ. It is generally accepted that the onset of sexual activity after 25 years can already be considered late and hormonal imbalance in such cases cannot be avoided.

Late pregnancy and late or complicated childbirth are also a factor in the development of adenomyosis, since they play a significant role in hormonal changes in a woman’s body.

Abortions, curettages or other manipulations inside the uterine cavity. Often, these procedures cause mechanical trauma to the endometrium, the epithelium lining the uterine cavity. It is precisely such micro-traumas that can become a trigger that initiates a chain of pathological changes leading to the growth of the endometrium into the myometrium.

. At the same time, it is not only the installation of an intrauterine device that is dangerous, which (as described above) can lead to mitrotraumatization of the endometrium; oddly enough, the factor provoking adenomyosis is also one of the most common methods of contraception - taking contraceptives.

This is due to the fact that contraception of this kind is provided by taking low doses of sex hormones, which, although to a small extent and in low doses, still change the hormonal background of a woman and affect it.

Chronic inflammatory diseases of the genitourinary system. It is widely known that a chronic inflammatory process does not lead to good, and yet, millions of women continue to initiate treatment for various types of adnexitis, cystitis, etc., explaining this by lack of time, money and other reasons.

Meanwhile, chronic inflammation progresses like an echo, echoing in the work of other organs, disrupting the structure of the inflamed organ and invariably leading to disruption of its function.

Serious physical activity also serve as a serious risk factor for the development of adenomyosis. The female body is not adapted for heavy physical labor, carrying heavy loads, therefore, if a woman is engaged in this kind of work, the risk of developing adenomyosis increases many times over.

Constant stress. It’s not for nothing that there is an old saying: “all diseases come from nerves.” A person’s psychological state undoubtedly plays a huge role in the development of one or another pathology. And if we are talking about the female body, namely the reproductive system, then everything here is even more subtle and sensitive to external influences.

The constant negative impact of stress is quite enough for a woman to develop adenomyosis, and more than once. That is why it is so important for the doctor to ask the patient in detail about the psychological climate in her family, her living conditions, and negative social factors that could potentially affect her health.

Extragenital pathology. The development of adenomyosis is also greatly influenced by the presence of extragenital pathology in the patient, i.e. other concomitant diseases that affect the course of adenomyosis or contribute to its development.

Symptoms

The symptoms of this disease are very varied. From a sluggish form of chronic adenomyosis, which practically does not manifest itself at all, to serious complications leading to hospitalization of the patient.

• Heavy menstrual bleeding is a fairly common symptom of adenomyosis. The danger of this condition, in addition to the significant discomfort of the woman herself, is the threat of developing anemia, which aggravates the patient’s condition. Especially in the case of advanced, untreated adenomyosis.
• Brownish discharge between periods. Some women mistake this discharge for an early onset of menstruation. Such mini-bleedings also contribute to the development of anemia and cause significant discomfort to the woman.
• Dyspareunia is a “terrible” medical term for sharp pain during sexual intercourse. This often becomes a serious problem for both partners. This a very common reason for a woman to seek help from a doctor, since such symptoms of adenomyosis become a cause of concern for a married couple and require immediate resolution. It is this, and not other symptoms, that often cause a patient to see a doctor.
• Intense pain in the lower abdomen immediately before, during and immediately after menstruation . Troubles such as pain during menstruation are more than common. In this regard, many women believe that these types of symptoms are not a sufficient reason to see a doctor and silently heroically endure the torment, washing down the pain that torments them with handfuls of painkillers. This approach is fundamentally wrong, since it can lead to more serious complications of adenomyosis in a woman.
• Disruptions in the well-functioning menstrual cycle. Most often, it becomes shorter, thereby bringing additional inconvenience to the woman;
• An instrumental examination reveals a significant increase in the size of the uterus. This can also be determined by palpation, when examining a woman by a gynecologist;

The most common symptoms of adenomyosis are quite easily confused with signs of other diseases.

Treatment

Treatment of this disease is often lengthy and requires a lot of patience, both on the part of the patient and on the part of the doctor treating her.

Therapy for adenomyosis can be divided into two main areas:

• conservative treatment
• surgery

Conservative treatment primarily means drug treatment. In this case, the woman is prescribed various types of hormonal drugs. These are both progestogens and androgens; In this case, oral contraceptives can also be very effective.

With the help of these drugs, it is possible to correct the hormonal imbalance present in a woman’s body. Well, when normal hormonal levels are restored, the doctor should pay attention to the main reason that led to this imbalance.

Methods of surgical treatment of adenomyosis can be extremely radical, including removal of the uterus. For this reason, most doctors still try to avoid this type of surgical intervention and place all their hopes on conservative treatment.

However, recently, more and more opponents of such radical methods of surgical intervention for adenomyosis have appeared among surgeons. In this regard, a number of organ-saving surgical techniques for this disease have been developed. Such organ-saving operations are performed by hysteroscopy and laparoscopically.