Why is the uterus spherical? Why is the uterus round?

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

Let's figure it out.

Adenomyosis sometimes referred to as "intrinsic endometriosis" equating this disease with 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). In the uterine cavity, the growth layer of the endometrium remains, 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 sprouts a dividing tissue (between the endometrium and the muscle) and begins to penetrate into the muscular wall of the uterus.

Important! The endometrium grows into the wall of the uterus not all the way, but only in places. For clarity, I will give an example. You have planted seedlings in a cardboard box, and if you have not transplanted them into the ground for a long time, then individual roots will sprout through the box. So, in the form of separate “roots” that penetrate into the muscular wall of the uterus, the endometrium germinates.

In response to the appearance of endometrial tissue in the uterine muscle, it begins to respond to the invasion. This is manifested by reactive thickening of individual bundles of muscle tissue around the invading endometrium. The muscle, as it were, is trying to limit the further spread of this ingrowth process.
Since the muscle increases in size, then, accordingly, the uterus begins to increase in size, acquires a spherical shape.

What are the forms of adenomyosis?

In some cases, the implanted endometrial tissue forms foci of its accumulation in the thickness of the muscle, then they say that this Adenomyosis is a focal form. If there is a simple introduction of the endometrium into the wall of the uterus 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, which has invaded 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 the glandular component and connective tissue predominate in the nodes of adenomyosis. This form of adenomyosis is called "nodal".

It can be very difficult with ultrasound to distinguish a uterine fibroid node from a nodular form of adenomyosis. In addition, it is believed that endometrial tissue can be introduced into already 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.

As a result of the diagnosis, it is very important to make the correct diagnosis and clearly determine what exactly is present in the uterus - uterine fibroids or adenomyosis nodular form. The treatment of 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 the formation of adenomyosis is still not known. It is assumed that all factors that violate the barrier between the endometrium and the muscular layer of the uterus can lead to the development of adenomyosis.

What exactly:

Curettage and abortion

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 experienced the interventions and diseases described above, as well as in young adolescent girls who have only recently begun menstruation.
In these rare cases, it is two reasons.

First reason associated with the occurrence of disorders during the prenatal development of the girl, which leads to the fact that the endometrium without any external factors is introduced into the wall of the uterus.

The second reason due to the fact that young girls may not open 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 on the barrier separating the endometrium and the muscular layer of the uterus. As a result, the introduction of the endometrium into the wall of the uterus can occur.

In addition, it is this mechanism that can play a role in the development of endometriosis, since if the outflow of menstrual secretions from the uterus becomes difficult, under the influence of high pressure, these secretions enter the abdominal cavity in large quantities through the tubes, where endometrial fragments are implanted on the peritoneum.

How does adenomyosis present?

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

Diagnosis of adenomyosis

The diagnosis of adenomyosis is most often made during ultrasound. At the same time, the doctor sees an “increased uterus, a heterogeneous structure of the myometrium (they also write “heterogeneous echogenicity”), the absence of a clear boundary between the endometrium and myometrium, “serration” in the area of \u200b\u200bthis border, the presence of foci in the myometrium.

The doctor can describe a 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 the examination on the chair, the doctor can say that the uterus is enlarged in size, a very important word is "the uterus is round."

The diagnosis of adenomyosis is also often made during hysteroscopy. During this procedure, the so-called "moves" are seen - these are red dots in the endometrium, which correspond exactly to the places where the endometrium was introduced into the uterine wall.

Rarely 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 myoma. 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 you are diagnosed with this.
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 scan and make a diagnosis of "adenomyosis", moreover, 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 need to urgently start treatment.

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

Adenomyosis in most cases is characterized by stable asymptomatic course, without the progression of the disease, if additional factors in the form of abortions and curettage are not created for this.

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 as symptoms and has a progressive course. Such "adenomyosis" requires treatment.

Treatment of adenomyosis

Adenomyosis cannot be completely cured unless, of course, removal of the uterus is taken into account. This disease spontaneously regresses after menopause. Up to this point, we can achieve a small 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 preparations 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 is manifested by prolonged heavy menstruation, bleeding and brownish discharge in the intermenstrual period, pronounced PMS, pain during menstruation and during sex. Adenomyosis usually develops in patients of childbearing age, fades after the onset of menopause. It is diagnosed on the basis of a gynecological examination, the results of instrumental and laboratory studies. Treatment is conservative, surgical or combined.

General information

Adenomyosis is the germination of the endometrium in the underlying layers of the uterus. Usually affects women of reproductive age, more often occurs after 27-30 years. Sometimes it is congenital. Self-extinguishes after the onset of 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 associated both with an increase in the number of immune disorders and with the improvement of diagnostic methods.

Patients with adenomyosis often suffer from infertility, however, a direct link between the disease and the inability to conceive and bear a child has not yet been definitely 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 system). The spread of cells occurs by contact, lymphogenous or hematogenous way. 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 the surrounding tissues and the development of adhesive processes. The frequency of the combination of internal and external endometriosis is unknown, however, 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 a 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 separating plate is possible during abortion, diagnostic curettage, the use of an intrauterine device, inflammatory diseases, childbirth (especially complicated ones), operations and dysfunctional uterine bleeding (especially after surgery or during treatment with hormonal agents).

Other risk factors for the development of adenomyosis associated with the activity of the female reproductive system include too early or too late onset of menstruation, late onset of sexual activity, oral contraceptives, hormone therapy and obesity, which leads to an increase in the amount of estrogen in the body. Risk factors for adenomyosis associated with impaired immunity 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 effect 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 in the presence of close relatives suffering from adenomyosis, endometriosis and tumors of the female genital organs. Possible congenital adenomyosis due to violations of intrauterine development of the fetus.

Classification of adenomyosis of the uterus

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

Focal adenomyosis. Endometrial cells are introduced into 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, surrounded by dense connective tissue resulting from inflammation.
Diffuse adenomyosis. Endometrial cells are introduced into the myometrium without the formation of clearly distinguishable 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:

1 degree- only the submucosal layer of the uterus suffers.
2 degree- no more than half of the depth of the muscular layer of the uterus is affected.
3 degree- more than half of the depth of the muscular layer of the uterus suffers.
4 degree- the entire muscle layer is affected, it may 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. Blood clots are often found. Brownish spotting is possible 2-3 days before menstruation and within 2-3 days after it ends. Sometimes intermenstrual uterine bleeding and brownish discharge in the middle of the cycle are observed. Patients with adenomyosis often suffer from severe premenstrual syndrome.

Another typical symptom of adenomyosis is pain. Pain usually occurs a few days before the onset 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 when the isthmus is affected and widespread adenomyosis of the uterus, complicated by multiple adhesions. When localized in the isthmus, pain can radiate to the perineum, when located in the area of the angle of the uterus - to the left or right inguinal region. Many patients complain of pain during intercourse, aggravated on the eve of menstruation.

More than half of patients with adenomyosis suffer from infertility, which is caused by adhesions in the fallopian tubes that prevent the egg from penetrating into the uterine cavity, endometrial structure disorders that make implantation of the egg difficult, as well as an accompanying inflammatory process, increased myometrial tone and other factors that increase the likelihood of spontaneous abortion . In the anamnesis, patients may have a lack of pregnancy with regular sexual activity or multiple miscarriages.

Abundant menstruation in adenomyosis often entails the development of iron deficiency anemia, which can be manifested by weakness, drowsiness, fatigue, shortness of breath, pale skin and mucous membranes, frequent colds, dizziness, fainting and pre-syncope. Severe PMS, long menstruation, constant pain during menstruation and deterioration of the general condition due to anemia reduce the resistance of patients to psychological stress and can provoke the development of neuroses.

Clinical manifestations of the disease may not correspond to the severity and prevalence of the process. Grade 1 adenomyosis is usually asymptomatic. At grades 2 and 3, both an asymptomatic or oligosymptomatic course, and severe clinical symptoms can be observed. Grade 4 adenomyosis, as a rule, is accompanied by pain due to widespread adhesions, the severity of other symptoms may vary.

During a gynecological examination, a change in the shape and size of the uterus is revealed. With diffuse adenomyosis, the uterus becomes spherical and increases in size on the eve of menstruation, with a common 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 found. With a combination of adenomyosis and fibroids, the size of the uterus corresponds to the size of the fibroids, the organ does not decrease after menstruation, the remaining symptoms of adenomyosis usually remain unchanged.

Diagnosis of adenomyosis

The diagnosis of adenomyosis is established on the basis of the anamnesis, the patient's complaints, the examination data on the chair and the results of instrumental studies. Gynecological examination is carried out on the eve of menstruation. The presence of an enlarged spherical uterus or tuberosities or nodes in the uterine region, combined with painful, prolonged, profuse menstruation, pain during intercourse and signs of anemia, is the basis for making a preliminary diagnosis of adenomyosis.

The main diagnostic method is ultrasound. The most accurate results (about 90%) are obtained when performing a transvaginal ultrasound scan, which, like a gynecological examination, is performed on the eve of menstruation. Adenomyosis is indicated by an increase and a spherical shape of the organ, various wall thicknesses and cystic formations larger than 3 mm, appearing in the wall of the uterus 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 rule out 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, violations of the structure of the myometrium and foci of endometrial penetration into the myometrium, as well as to assess the density and structure of the nodes. Instrumental diagnostic methods for adenomyosis are supplemented with laboratory tests (blood and urine tests, hormone tests), which allow diagnosing anemia, inflammatory processes and hormonal imbalances.

Treatment and prognosis for adenomyosis

Treatment of adenomyosis can be conservative, surgical or combined. The tactics of treatment is determined taking into account the form of adenomyosis, the prevalence of the process, the age and state of health of the patient, her desire to maintain childbearing 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 being treated. In the presence of neurosis, patients with adenomyosis are referred for psychotherapy, tranquilizers and antidepressants are used.

With the ineffectiveness of conservative therapy, surgical interventions are performed. Operations 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, the lack of effect in the treatment of hormonal agents for 3 months and contraindications to hormone therapy. As indications for removal of the uterus, the progression of adenomyosis in patients older than 40 years, the ineffectiveness of conservative therapy and organ-preserving surgical interventions, diffuse grade 3 adenomyosis or nodular adenomyosis in combination with uterine myoma, the threat of malignancy are considered.

If adenomyosis is detected in a woman planning a pregnancy, she is recommended to try to conceive no earlier than six months after undergoing a course of conservative treatment or endocoagulation. During the first trimester, the patient is prescribed gestagens. The question of the need for hormone therapy in the second and third trimester of pregnancy is determined taking into account the result of a blood test for progesterone. 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 growth rate of heterotopic endometrial cells.

Adenomyosis is a chronic disease with a high risk of recurrence. 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. In the menopause, self-recovery occurs.

Endometriosis is a systemic disease that occurs in women of childbearing 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 expelled by a mucosal layer, which grows during the monthly cycle, secretes, preparing for the adoption of the blastomere. If there is no fertilized egg, it is rejected and menstruation begins. Then the cycle repeats.

When a failure occurs in the body, glandular cells penetrate the barrier between the endometrium and the uterus, penetrate into its muscle layer, 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 muscular layer.

Spreading beyond its habitat, the endometrium works in accordance with its purpose. This causes inflammatory processes in altered tissues, leads to their rebirth. Since the epithelium is supplied with blood vessels, bleeding may occur. The uterus, in turn, responds to such interference and tries to reject cells that are not specific to the muscle layer. In the place of "struggle" seals are formed. Gradually, there are a lot of them, and the uterus acquires a spherical shape.

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

What is the difference between endometriosis and adenomyosis

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

Endometriosis is a broad concept. Leaving the uterine mucosa, cells can spread throughout the body, affecting almost all organs. They are found in the tissues of the genital organs, lungs, gastrointestinal tract, navel, 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 hormone-dependent tissue, then its pathological distribution can be affected by a malfunction of the endocrine system. Factors that can trigger the disease include:

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

How to recognize adenomyosis

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

Due to the large loss of blood, drowsiness, dizziness, lowering blood pressure, anemia are not uncommon. Pain for adenomyosis is characteristic only during menstruation. If the pain sensations are constant, then by their type and localization it is possible to determine which organs other than the uterus are involved in the process.

Adenomyosis, the symptoms of which are strongly lubricated, can be confirmed by laboratory and instrumental studies. Subfebrile condition in the first days of menstruation, an increase in ESR, leukocytes is a sign of inflammation. Ultrasound diagnostics is able to recognize the uneven structure of the muscular layer of the uterus, there is a heterogeneous echogenicity, an increase in the organ as a whole. If the ultrasound data is doubtful, an MRI can be used. Based on these studies, the final diagnosis is not made.

Types of treatment for adenomyosis

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

the age of the patient;
having children;
general condition;
localization of foci;
the 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 stopped by hemostatic drugs. In mild cases, nettle decoction is sufficient. To maintain a weakened immune system, it is necessary to systematically take vitamin complexes.

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

Conservative therapy

The basis of traditional treatment is the use of hormones, drugs that promote the resorption of nodes, and physiotherapy. Hormones come in the form of contraceptives: estrogen-gestagen, antiprogestins, antiestrogens, progestins. As concomitant therapy, immunomodulators, anti-inflammatory drugs, anemia remedies are used.

In the presence of somatic diseases, their compensation or remission is required. If there are diseases incompatible with taking hormones (diabetes mellitus, migraine, epilepsy), combined or radical methods of treatment 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 endometrial foci are excised through small holes. Such an 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:

a psychological barrier when a woman feels inferior;
impossibility of conception;
all the "charms" 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, the complete elimination of menstruation.
Read all diseases of the uterus here

How does adenomyosis affect fertility?

Can you get pregnant with adenomyosis? It is possible, but the disease contributes to the development of infertility. Due to a violation of the hormonal background, autoimmune processes, the female cycle is disrupted, ovulation becomes rare. The changed environment of the uterus can negatively affect the activity of spermatozoa. 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 termination of pregnancy in the early stages, but with the use of standard procedures for its preservation, the problem can be avoided. Of course, the entire period of gestation will have to be under the supervision of specialists, lie down more than once in the department of extragenital pathology. Adenomyosis is not an indication for caesarean section, but if there are concomitant abnormalities, doctors may choose this route of delivery.

Adenomyosis is a disease that can be 100% cured 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, give 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 of a doctor - gynecologist about uterine adenomyosis

WHO SAID THAT INFERTILITY IS HARD TO CURE?

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

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

Symptoms of adenomyosis

As a rule, symptoms of adenomyosis can be pain during menstruation, too heavy and prolonged menstruation, increased premenstrual syndrome (PMS), infertility, miscarriage. On ultrasound, adenomyosis can be suspected by the state of the endometrium (hyperplasia) and myometrium, but an unequivocal 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 of endometriosis treatment.

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

Endometriosis is a hormone-dependent disease that is manifested by the penetration of tissue similar to the mucous membrane of the uterine body into the uterine muscle. At the same time, 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 associated with infertility and miscarriage. Oral contraceptives contribute to the regression of endometriosis foci.

2. I was diagnosed with adenomyosis, histology showed that I have endometrial glandular hyperplasia. In this regard, I have had 2 cleanings in the last six months. Norkolut was also assigned to me. Could you write about my disease, as well as about the methods of its treatment.

Adenomyosis is a disease characterized by the spread of tissue similar in structure to the endometrium (the lining of the uterus) into the thickness of the uterine muscle. Endometrial hyperplasia is an increase in the thickness of the endometrium compared to the norm. Both of these conditions are the result of elevated levels of estrogen (female sex hormones). Hyperestrogenism can be absolute, i.e. the level of estrogen is above the norm, or relative (the level of estrogen is normal, but the level of progesterone, another female sex hormone, is reduced). Treatment of these diseases consists in prescribing drugs that lack progesterone, or drugs that cause artificial menopause. In this case, the endometrium atrophies, i.e. the foci of adenomyosis in the uterine muscle decrease or disappear and the thickness of the endometrium decreases. Norkolyut 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 the diagnostic curettage. Does it affect myoma?

If you have no complaints, you do not plan pregnancy, the fibroids do not grow, then you do not need medication. Treatment of any disease is carried out according to indications. Duphaston is prescribed for a pronounced clinic 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, it is not necessary to take it.

4. I was aspirated, endometrial polyps were removed and after that I was examined for ultrasound. Histological analysis showed an endometrial character, and the result of the ultrasound is as follows:
The body of the uterus is spherical, cellular, of normal 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. In the cervical canal, pronounced multiple endometrioid foci are determined. The right ovary is 3.0x2.8 cm, the left one is 3.0x3.0 cm with the presence of cystic inclusions. The analysis was made before menstruation on the 31st day of the cycle. Explain to me, please, what is a cellular uterus and do I have a chance to get 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 is the cause of infertility, then it must be treated. The main manifestations of adenomyosis are abundant painful menstruation, spotting between periods. Subserous uterine fibroids will not interfere with pregnancy, although it will increase during pregnancy, which will require constant monitoring.

5. I am 37 years old, from the anamnesis - adenomyosis; ridge with \ ophorit. What are these diseases 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. Manifested by painful menstruation, bloody discharge before, after menstruation, the inability to become pregnant. If such complaints do not bother you, then the degree of adenomyosis is not expressed, 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, the dynamics: it increases, decreases.

Chronic salpingo-oophoritis 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 underwent an operation: Laparotomy Panhysterectomy The operation was performed urgently based on the results of ultrasound: infarction of the myoma node with malnutrition.
Diagnosis: Ademiosis. Endometriosis of sacro-uterine ligaments. Chr. endometritis Chr. bilateral adnexitis. Endometrial polyp.
Histological examination: Glandular cystic hyperplasia, Uterine fibromyoma with areas
ademiosis. Ovary - sclerosis and hyamentosis of the walls of blood vessels and corpus luteum, follicular cysts,
corpus luteum cysts. Tube - sclerosis of the wall. Neck - Naboth cysts.
According to the results of histology, I was prescribed Norkolut for 3 months under the scheme.
Almost immediately after the operation, I had hot flashes (an hour or more).
With any physical and emotional stress, severe sweating. After the shower comes relief, but not for long. I drank Remens for a month, I don’t feel any improvement.
Two weeks, as there were pains in the rectum. Can endometriosis develop again?
Pains are similar, as to operational. Appointment scheduled in a month. Do not spend more than 5 minutes at the reception.
Tell me, how can I alleviate my condition, reduce hot flashes, avoid complications such as osteoporosis, etc.? What is the purpose of the hormonal drug prescribed to me?
Can hot flashes pass on their own? If not, then advise what can be taken with the least side effect. Can I go to a resort in half a year and take mud on my lower back? When can I start abdominal strengthening exercises? The incision was made along the white line. What can be physical activity?

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

Pain in the rectum can be a manifestation of retrocervical endometriosis. It is diagnosed during a routine examination and ultrasound. Also, after panhysterectomy, endometriotic lesions on the peritoneum of the small pelvis could remain, giving complaints characteristic of endometriosis, as before the operation.

Norkolut has been prescribed for you so that endometriosis does not progress. But it doesn't seem to help. It would be ideal to do a control laparoscopy and coagulation of endometriosis foci on the peritoneum. But in any case, given the removed ovaries, endometriosis will not progress, on the contrary, it will gradually pass. But hot flashes and other signs of hormonal deficiency (osteoporosis, etc.) will increase. Taking hormone replacement therapy is not contraindicated for you, since the doses and drugs contained in modern drugs will not affect the course of endometriosis, and your health will be restored. After checking the condition of the mammary glands (mammography), blood biochemistry (lipids) and blood coagulation, it is possible to prescribe continuous hormone replacement therapy with drugs such as Kliogest, 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 disturbances - delays of up to 10 days. 77-48-52, endometrium 11 mm. The smear contains a large number of leukocytes. Negative for chlamydia. The diagnosis of the attending physician coincided with the diagnosis of ultrasound plus chronic endometritis. For the treatment of adenomyosis and endometriosis, hormonal preparations were recommended, but with the permission of a mammologist, because. just before that, I had been operated on for breast fibroadenoma. 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 preparations are shown to me only as a last resort. I consulted with several more gynecologists, their recommendations were different: some believed that hormonal treatment was required, others that it was not. Moreover, different hormonal preparations were prescribed: microgenon, norkolut, duphaston, depo-prover. As a result, my doctor 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 was the case for 5 months after treatment. On the sixth month, the temperature again on the first day of menstruation rose to 37.8 and in the smear - again leukocytosis. Repeated ultrasound (one year after the first) showed that the size of the uterus and endometrium remained the same, but there were more endometriotic foci. After another 2 months, a 6 cm cyst of the right ovary was discovered. Hormone therapy was again prescribed for me, and if it does not disappear in a month, then an operation. And I was offered to remove the entire right ovary. Please tell me,
1) Should I decide on hormone therapy and which drug suits me best (prolactin and progesterone are normal, but estradiol is not determined in our city). Do I still need some research and do I have time for this, or hormone therapy should be started immediately.
2) Are there any types of operations that allow you to remove a cyst without an ovary, which ones?
3) Are there other treatments for endometriosis and adenomyosis other than hormone therapy? Including surgery?

1. Those drugs that you have listed are all drugs of the same group (gestagens). And they are absolutely not contraindicated in 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 method of treatment. 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 the lesions in the uterus and retrocervical endometriosis (the temperature during menstruation is most likely from it). And these are hormonal preparations of other groups: Nemestran. gestrinone, danazol, zoladex. They give more side effects, but are more effective against endometriosis.

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

3. See item 1. But endometriosis of the uterus can be surgically cured only by removing the uterus.

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

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

9. Recently, pains in the uterus began to bother me (I can differentiate due to many years of practical experience of pains in the uterus before menstruation). Ultrasound revealed: the uterus is enlarged 6.2x4.9x6.8; the contours are even, the uterus is "round", echolocation is moderately increased, the posterior wall is more thickened, the nodes are not detected (diff. fibroma? adenomyosis?). The cervix is thickened 5x6.2 (structural feature?) The structure is not quite homogeneous: small brushes and bright linear me ... echo .. M-echo 0.7 cm evenly throughout. Right testicle 4.5x2.8 with brushes (follicle) 2 cm, left - 4x2.3 with small falls 0.5 cm. During the ultrasound, the doctor said that she really did not like the cervix. Advise what to do. If earlier the pain was only before the cycle, now it is almost daily. I live in Yakutia. There are practically no diagnostic facilities in the village. One gynecologist for every 5,000 women. 5 minutes to receive one. The doctor took a swab (no races, other microorganism-large quantity, lake -3-4 in p / z, epithelium - large quantity) prescribed vitamins. Please, advise what to do and! how to continue to be examined (going on vacation)

Most likely, we are talking about endometriosis of the cervix and adenomyosis of the 1st stage (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 a 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 with a diagnosis of endometriosis, it is advisable to refrain from sun exposure.

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

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

/Continuation/ Surgery is scheduled, but, as I was told, rehabilitation is within 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 with "normal" and laparoscopic operations, 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 such an operation is easier to tolerate. For example, an extract after a "normal" operation goes on 10-14 days, and after laparoscopy - on 5-8. Laparoscopic operations are longer, they have a whole list of hard contraindications, for example, adhesions. Rehabilitation after laparoscopic surgery is just as necessary as after a conventional one, because. tissue healing occurs at the same time. Laparoscopic equipment in Moscow is available in many research centers and hospitals, both commercial and urban. These are the 1st City Clinical Hospital, the 15th City Hospital, the 7th City Clinical Hospital, the Center for Mother and Child on Oparin Street 4, the MORIAG on Chernyshevsky Street, the 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 such a diagnosis?

Adenomyosis is a hormonal disease of the uterus, characterized by an atypical arrangement of endometrial cells. The reason is hyperestrogenia against the background of a chronic inflammatory process. When planning pregnancy, it is necessary to carry out anti-inflammatory, hormonal treatment, improve microcirculation, and prepare the endometrium for the upcoming pregnancy.
Adenomyosis is endometriosis of the uterus (a condition in which cells of the endometrium, the lining of the uterus, grow into the muscular layer of the body of the uterus, the myometrium). The reasons for its occurrence are varied: traumatization of the uterus during surgical interventions, for example, during abortions; hormonal changes in the body, reflux of menstrual blood - a reverse reflux 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 very often the cause of infertility, since it is believed that endometrioid heterotopias (foci) are able to phagocytize (devour) spermatozoa. There are also other causes of infertility in adenomyosis. Treatment of adenomyosis is hormonal therapy or surgery.

Folk remedies for adenomyosis are ineffective.

Adenomyosis is one of the most common gynecological diseases. In another way, 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 localization.

In the case of 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).

The uterus at the same time acquires a round or spherical shape, significantly increases in size, often reaching the size of the uterus at 5-6 weeks of pregnancy.

Endometrial cells that are 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 a violation of the balance and ratio 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, some staging 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 the germination of the endometrium to half of the myometrium (the muscular membrane of the uterus).

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

In the fourth stage, the endometrium grows through the wall of the uterus through, 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 the 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 membrane.

mixed form is a cross between the two options above.

Determination of the form of adenomyosis is carried out on the basis of data from an ultrasound examination or CT scan.

Reasons for the development of adenomyosis

If we talk about the reasons for the development of adenomatosis, then they all come down to the fact that they lead either to a violation of the integrity, traumatization of the endometrium, or to a violation of the hormonal background. 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 kind 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 menses is another important factor. However, as mentioned above, it is rather a consequence, a manifestation of hormonal imbalance or a tendency to develop it, which are already present in the patient.

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

If a pathology occurs in one organ or system, then, as a rule, it will somehow affect the work of the whole organism. In particular, these concerns obesity, when several systems are involved in the pathological process at once: 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.

Too late onset of sexual activity. Oddly enough, this factor also plays a role in the development of adenomyosis of the uterus. The onset of sexual activity triggers a number of changes in the hormonal background of a woman.

And if in Soviet times, the beginning of sexual activity at the age of 16 was considered practically shameless, now - this state of affairs is a classic, the norm. And hardly anyone will be surprised by 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 physicians diverge. It is generally accepted that the onset of sexual activity after 25 years can already be considered late and an imbalance of hormones in such cases cannot be avoided.

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

Abortions, scrapings or other manipulations inside the uterine cavity. Often during these procedures, mechanical trauma to the endometrium occurs - the epithelium lining the uterine cavity. It is these micro-traumas that can become a trigger mechanism that triggers a chain of pathological changes leading to the germination of the endometrium into the myometrium.

. At the same time, not only the installation of an intrauterine device is dangerous, which (as described above) can lead to mitrotraumatization of the endometrium, oddly enough, the factor provoking adenomyosis is 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, affect it.

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

And chronic inflammation, meanwhile, progresses like an echo, echoing in the work of other organs, disrupting the structure of the inflamed organ and invariably leading to a violation 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 hard physical labor, carrying heavy loads, therefore, if a woman is engaged in this kind of work, the risk of adenomyosis in her increases many times over.

Constant stress. No wonder there is a long-standing saying "all diseases are from the nerves." The psychological state of a person undoubtedly plays a huge role in the development of a particular pathology in him. And if we are talking about the female body, namely the reproductive system, then everything is arranged even more finely and sensitively in relation to external influences.

The constant negative impact of stress is 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, negative social factors that could potentially affect her health.

Extragenital pathology. The presence of extragenital pathology in the patient also has a huge impact on the development of adenomyosis, i.e. other concomitant diseases that affect the course of adenomyosis or contribute to its development.

Symptoms

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

Heavy menstrual bleeding is a fairly common symptom of adenomyosis. The danger of such a 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 the early onset of menstruation. Such mini-bleeding also contributes to the development of anemia and causes significant discomfort to the woman.
Dyspareunia - such a "terrible" medical term is called sharp pain during intercourse. Often this 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 couple and require immediate resolution. It is this, and not other symptoms, that often cause the 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 such symptoms are not enough reason to see a doctor and silently heroically endure torment, washing down the pains that torment them with handfuls of painkillers. This approach is fundamentally wrong, as it can lead to more serious complications of adenomyosis in a woman.
Failures in the debugged menstrual cycle. Most often, it becomes shorter, thereby bringing additional inconvenience to the woman;
When conducting an instrumental examination, a significant increase in the size of the uterus is found. It can also be determined by palpation, when examining a woman by a gynecologist;

The most common symptoms of adenomyosis are fairly easy to confuse with signs of other diseases.

Treatment

The 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 of adenomyosis can be divided into two main areas:

conservative treatment
surgery

Conservative treatment implies primarily medical treatment. In this case, a woman is prescribed various kinds of hormonal drugs. These are both progestogens and androgens; including oral contraceptives can be very effective in this case.

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

Methods of surgical treatment of adenomyosis are extremely radical, up to the removal of the uterus. For this reason, most doctors still try to avoid this kind of surgery and put all their hopes on conservative treatment.

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