Adenomyosis diffuse form and the possibility of pregnancy. Adenomyosis and pregnancy: is it possible

Many modern young women are faced with the problem of internal endometriosis or adenomyosis. In addition to the unpleasant symptoms of the disease: heavy and painful periods, prolonged spotting, chronic pelvic pain, some patients are faced with a problem. Is pregnancy possible with adenomyosis of the uterus- you will find the answer to this question in our article.

Is it possible to get pregnant with adenomyosis?

First, let's understand a little about the concepts. Endometriosis is a broad group of diseases united by a common cause. The disease occurs due to the fact that the endometrium, from which, in fact, menstrual bleeding occurs, migrates outside the uterine cavity.

Endometrial areas can migrate both within the genital organs (ovaries, pelvic cavity, etc.), and far beyond the small pelvis. Sometimes areas or foci of endometriosis are found in the lungs, liver, and lymph nodes.

Despite the unusual location, the mucosal areas continue to respond to the action of sex hormones and undergo the usual cyclical changes: they grow, transform and are rejected with the release of blood.

Adenomyosis is an internal or screening of sections of the mucosa into the wall of the uterus. It can be diffuse in nature - that is, many small foci are found in the wall of the uterus, or focal or nodular - the endometrium grows in the form of one or more large areas of spherical shape.

This unusual disease is characterized by rather specific complaints:

Prolonged, profuse and extremely painful menstruation.
Prolonged "smearing" brown discharge before and after menstruation.
Chronic pain in the pelvis, lower back, sacrum, aggravated on the eve of menstruation and decreasing with its onset.
Infertility.

Ultrasound is usually performed to confirm the diagnosis. Unfortunately, ultrasound does not always reveal any specific signs of the disease, even with a vivid clinical picture. In such a situation, most often the diagnosis is established intuitively and a trial treatment is prescribed.

Features of pregnancy planning against the background of adenomyosis

As a rule, women after 30-40 years of age suffer from this disease, however, cases of a vivid picture of adenomyosis in young girls are not uncommon.

It is important to understand that the presence of even confirmed adenomyosis does not always threaten problems with the onset of pregnancy. As a rule, diffuse adenomyosis is less often associated with problems than its nodular form.

It is also important to consider whether we are dealing only with adenomyosis, or is present in the same patient. Often screenings in the uterine wall are combined with ovarian endometriosis, screenings in the small pelvis and a pronounced adhesive process against their background. In such cases, objective causes of infertility can be observed: obstruction of the fallopian tubes and dysfunction of the ovaries.

In these cases, doctors often have to resort to diagnostic laparoscopy or minimally invasive surgery. With the help of such an operation, the patient is coagulated (cauterized) foci of endometriosis in the pelvis and on the ovaries, the adhesions are separated and the patency of the tubes is restored.

If we are talking about isolated adenomyosis, then there are fewer problems with the onset of pregnancy. But since endometriosis is a disease with a proven hormonal influence, it responds quite well to hormonal treatment.

If a woman has not been able to conceive on her own for more than a year, she is offered several treatment options.

Prescribing combined oral contraceptives

It would seem that the patient is planning a pregnancy - why contraceptives? In fact, hormonal contraceptives even out the hormonal background and significantly inhibit the growth of endometriosis foci. Usually, these pills are taken for 6-12 months, then they stop taking them and try to get pregnant.

Gestagen preparations

Their action is to compensate for high levels of estrogen and to suppress excessive growth of the endometrium. These include:

Norkolut,
levonogestrel,
Bysanne,
Depo-Provera and others.

Of course, only a doctor prescribes such drugs. Against the background of taking one, pregnancy can occur and develop, against the background of others - it is strictly prohibited until the end of the course.

Antihormonal drugs

This is a fairly large group of drugs, with a fairly powerful effect, but, unfortunately, the same large number of side effects. These drugs can be called the last line of defense before surgery. These include, in particular:

preparations of the group of gonadotropin-releasing hormone agonists - Zoladex, Buserelin and others;
estrogen antagonists - Tamoxifen;

They are prescribed very selectively, in severe cases of endometriosis and as a final and supportive stage after surgical treatment.

Features of the course of pregnancy

We hasten to please our patients: the pregnancy that has already begun is a kind of cure for adenomyosis and other forms of endometriosis. A large amount of natural progesterone inhibits the growth of endometriosis foci, significantly reducing them in size until they disappear completely!

As a rule, pregnancy against the background of adenomyosis proceeds well, no different from such a period in healthy women. Sometimes, only in the early stages, patients are prescribed an additional intake of progesterone (Dufaston, Utrozhestan, Crinon and others). Very often, these drugs are prescribed unreasonably, to "calm" the patient and the attending physician.

Childbirth also occurs on time and proceeds quite normally. An important point is that in patients with a predisposition to endometriosis, natural childbirth is preferable! A caesarean section can provoke a new powerful wave of migration of endometrial sections outside the uterine cavity.

Alexandra Pechkovskaya, obstetrician-gynecologist, specially for the site

Useful video

Adenomyosis is a disease in which the mucous layer of the uterus - the endometrium - grows into the muscle layer - the myometrium. Pathology is manifested by prolonged and profuse menstrual bleeding, accompanied by soreness. Adenomyosis can be congenital, but most often occurs in reproductive age due to hormonal disorders. In this regard, the problems of reproduction begin from the moment of fertilization.

The entire period of pregnancy, a woman needs specialized monitoring and supportive care. During childbirth, there is a high risk of complications, up to heavy bleeding with subsequent removal of the uterus.

Show all

Reproductive system in adenomyosis

The reproductive system of a woman depends on many structural, hormonal and biochemical processes. Violation of any link can lead to infertility. In adenomyosis, the problem is often diffuse (not localized) and presents with multiple pathological changes. Of fundamental importance is the duration and prevalence of the disease.

The uterus plays a key role in the process of bearing a child. It is represented by three layers: mucous, muscular and serous. The inner layer lining the organ cavity is the endometrium. Under the condition of a physiological menstrual cycle and the absence of pregnancy, it is rejected every month, the woman sees it in the form of bleeding.

The regulation of the menstrual cycle and the frequency of endometrial rejection are carried out by hormones. They are produced in the ovaries, pituitary gland and other endocrine organs. With the development of pathological conditions in the body, uncontrolled germination of the endometrium into the muscular layer of the uterus occurs, and therefore its regular and physiological rejection is disturbed.

Unilateral adenomyosis

Germination of the endometrium can be local or diffuse. In the first case, a limited area of \u200b\u200bthe muscle layer is affected, in the second, most of the endometrium is tightly connected to the myometrium. The volume of growth is determined in the process of diagnosis, the appointment of therapeutic manipulations and the tactics of planning and managing pregnancy fundamentally depend on this.

Symptoms of pathology

Some experts believe that adenomyosis is the initial stage of endometriosis, while others distinguish it as a separate disease. At an early stage of development, both pathologies have similar signs and clinical symptoms.

Among the main manifestations of adenomyosis, the following symptoms are distinguished:

the duration of the menstrual cycle decreases;
menstruation lasts more than 5 days, at the beginning and end they differ in blood smearing;
a woman feels constant discomfort in the pelvic cavity;
pains are intense and pronounced from the moment of premenstrual syndrome and until the end of menstruation;
bleeding is profuse, which often leads to anemia.

Women of reproductive age are subject to mandatory examination in order to identify the true cause of adenomyosis, since many pathological conditions are related, the development of an oncological process is not excluded.

Causes of the disease

The etiology of adenomyosis is not fully understood. There is an assumption that the disease is provoked by hormonal disorders - an excess of estrogen. Contribute to the germination of the endometrium multiple births and abortions. In some women, the pathology is due to a genetic predisposition.

Often the disease is discovered by chance during a preventive examination or planning a pregnancy. However, it has not been possible to establish the root cause.

Provoking factors include:

uncontrolled intake of combined oral contraceptives;
neoplasms of the ovaries and pituitary gland, provoking hormonal dysfunction;
multiple and complicated childbirth;
surgical interventions on the uterus and pelvic organs;
sudden weight gain or weight loss;
physical overstrain with increased intra-abdominal pressure.

When conducting a comprehensive examination, several causes that contribute to adenomyosis are often identified at once. The greatest danger is represented by tumor formations of hormone-producing organs, which have a malignant course and are difficult to treat, causing irreversible consequences.

Adenomyosis and pregnancy

The possibility of fertilization, childbearing and physiological childbirth depends on the severity and type of the pathological process. For each specific condition, individual therapeutic tactics will be required, which is based on the features of the development of the disorder.

Degree/form of adenomyosis	Development mechanism	Impact on pregnancy
I degree	Germination of the endometrium is limited to the basal layer. Clinical manifestations are rare	With rational drug correction, pregnancy proceeds naturally, without complications.
II degree	The endometrium reaches the middle of the muscle layer	Throughout pregnancy, women are at risk of interruption, a special regimen and additional dynamic monitoring are needed.
III degree	Mucous sprouts through the muscle thickness and reaches the serous layer	A pronounced hormonal imbalance disrupts the menstrual cycle and impedes the process of fertilization, the possibility of miscarriage is not ruled out throughout pregnancy, and spontaneous bleeding often develops. During delivery, he uses the tactics of caesarean section, it is not excluded the complete removal of the uterus
IV degree	The pathological process passes through the serous layer and spreads to nearby organs	The possibility of pregnancy is difficult, women face difficulties even during the conception period, infertility often develops
Focal form	It develops as nodes or cysts, does not exceed 10% of the total number of cases of adenomyosis. Cavity formations have inclusions in the form of a brown liquid that accumulates as a result of menstruation	The prognosis of the course of pregnancy is usually favorable, especially if the nodes and the attached placenta are located on different walls of the uterus
diffuse form	The most common form of adenomyosis occurs in 2/3 of all cases. The pathological process is spread over the entire surface of the muscle layer, multiple fistulas are formed in the pelvic cavity and adhesions	The adhesive process often becomes an obstacle in the way of the spermatozoon, but even under the condition of fertilization, the zygote cannot fully gain a foothold on the mucous layer. Spontaneous abortion develops already in the first trimester

The earlier the diagnosis is made and adenomyosis is detected, the more favorable the process of pregnancy development and the less complications in the postpartum period. The main danger posed by pathology for women of reproductive age is the development of persistent infertility.

Fertilization

The main problem that women face with adenomyosis appears even at the time of conception. Given that the disease often occurs with hormonal imbalance, the duration of the menstrual cycle and the nature of the discharge are disturbed. For most women, the cycle becomes irregular, and it is not possible to reliably determine ovulation at home.

To calculate the most favorable days for conception, a woman needs to calculate ovulation for several months using the calendar method using marks on the onset of menstruation, conduct special tests and, if necessary, visit an ultrasound diagnostic room, which is the most informative of all possible methods.

Implantation

The next problem that arises in the development of pregnancy after fertilization has occurred is the impossibility of implantation. The fetus must attach to the endometrium, from where it will receive the necessary nutrition. Difficulties with implantation occur mainly in cases of a common pathological process.

If the mucous layer is severely damaged or the embryo is rejected by it, then pregnancy does not occur after fertilization. But this is due to the short life of one zygote. The next time you try to get pregnant, the situation can be radically different, so the diagnosis of infertility in this case is practically not made.

gestation

In most cases, pregnancy proceeds calmly, especially with nodal forms of the 1st and 2nd severity. To prevent premature delivery from the beginning of gestation, a woman is prescribed maintenance and corrective hormone therapy. The patient is shown sexual rest, limitation of physical and psycho-emotional overload, home regimen, especially in the first trimester.

At the 3rd, 4th degree of adenomyosis, when the process is diffuse and widespread, involving the entire muscle layer, the uterus is almost always in a state of tone, the risk of spontaneous abortion is always present. If fertilization and implantation did occur and a woman has the opportunity to bear a child, she spends most of her time in a hospital where specialized therapy is carried out.

Childbirth and the postpartum period

The tactics of delivery and observation in the postpartum period are completely dependent on the degree and form of the pathological process.

If adenomyosis is nodular in nature and the degree of its spread is insignificant, then it is recommended to carry out natural childbirth. But the situation changes when the attached placenta is in close proximity to adenomatous nodes, the risk of bleeding increases, the patient is under round-the-clock observation in the hospital for a longer period of time.

With diffuse spread of adenomyosis, the muscle layer is thin, there is a risk of uterine rupture during the period of attempts, difficulties arise with the physiological separation of the placenta, and the likelihood of bleeding is very high. A woman is prepared for childbirth in advance, often a week before the expected date she is hospitalized in a hospital.

Risk of infertility

A diagnosis of adenomyosis increases the risk of infertility. The disease occurs against the background of dyshormonal disorders, which in themselves may be incompatible with pregnancy. The endometrium not only grows into the deep layers, but also undergoes hypertrophy and changes that can interfere with pregnancy. The muscular layer of the uterus reacts to the introduction of thickening and restructuring, which prevents the bearing of the fetus.

On the other hand, if adenomyosis is detected at an early stage, it is recommended to give birth to a child if the pregnancy was planned. In the process of bearing the fetus, the hormonal background changes and there is no monthly rejection of the endometrium, and therefore the disease regresses. Sometimes after the birth of a child, it disappears completely, without any additional intervention.

Treatment

Therapy for adenomyosis depends on its severity and the age of the patient. Due to frequent systematic preventive examinations of the female population, neglected cases are quite rare. Therefore, conservative treatment is usually sufficient, with the help of which it is possible to achieve a complete recovery or a stable remission of the disease.

In the early stages of development, medications are prescribed, such as:

oral contraceptives;
non-steroidal anti-inflammatory drugs;
analogues of gonadotropin-releasing hormone - Duphaston;
analgesics;
hemostatic and some other means.

Only a specialist can determine the number of necessary drugs, the duration of the course and dosage after conducting a comprehensive examination and identifying the degree and form of the disease. Given that the pathology is serious, self-medication is not recommended. With the development of severe forms, changes can be irreversible, resulting in infertility.

In the absence of a positive effect from the used tablet preparations, local therapy is indicated. For 1-3 years, a Mirena intrauterine device is installed for a woman, which contains hormones that normalize the growth of the endometrium. The active substance comes out in doses, so there is no risk of overdose or other contraindications.

Intrauterine device in the uterine cavity

In severe cases of the disease and resistance to conservative therapy, diagnostic hysteroscopy is performed, during which a biopsy specimen (biomaterial) is taken to study and exclude the oncological process. A clear indication for the complete removal of the organ is diffuse adenomyosis of the 4th degree.

24 April 2017 16949 0

Adenomyosis is one of the most common pathologies of the female genital organs. The diagnosis of adenomyosis is much more common than other diagnoses. However, not all cases should be done.

Most women live with such a diagnosis without even knowing about it, and adenomyosis does not affect their quality of life or their reproductive function in any way. Let's first understand what adenomyosis is and what its mechanism is.

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

What is adenomyosis

Adenomyosis is a form of endometriosis. To understand the mechanism of this pathology, let's look at the structure and function of the uterus. The uterus is made up of smooth muscle. However, this is not enough to bear and give birth to a child. In order to accept a fertilized egg, the uterus produces a special “litter” for the adoption of the fetus each cycle. It is called the endometrium, which in turn consists of two layers - functional and basal. The functional layer is the layer that is intended for bearing the fetus, the basal layer is the layer from which the functional layer grows. Each cycle, if fertilization has not occurred, the functional layer is rejected and comes out with menstruation. On the next cycle, the uterus again begins to grow a functional layer. However, for various reasons, a failure occurs and the endometrium “breaks through” the basal layer and membrane and begins to grow in some places into the body of the uterus, into its muscular part. The uterus reacts to the invasion by forming thickening of the muscles around the “invader”, trying to limit its further spread. Due to this, the uterus increases in size. It is important to understand that ingrowth does not occur in the entire area, but in some places.

Since adenomyosis has become much younger in recent decades, many young women are interested in the question - is it possible to get pregnant with adenomyosis of the uterus? Below we will consider in more detail the causes of adenomyosis, methods of its treatment and its impact on the possibility of conception.

What causes adenomyosis

Today, there are many theories trying to explain the appearance of adenomyosis, especially in young women. There is still no single coherent theory that would clearly give a picture of the disorders leading to this pathology, however, several main factors that can provoke the development of adenomyosis can be identified:

Hormonal disorders - adenomyosis is a hormonally dependent pathology. This is evidenced by his regression during menopause and partly during pregnancy.
Injuries to the body of the uterus - it can be curettage, abortion, caesarean section, etc.
genetic predisposition.

However, none of these factors can explain the increasing frequency of diagnosing adenomyosis in very young girls 14-15 years old.

Symptoms of adenomyosis

In most cases, adenomyosis is asymptomatic and is diagnosed "accidentally" during a gynecological examination or ultrasound examination. However, in more complex and advanced cases, adenomyosis can manifest itself with a number of pronounced symptoms.

The main complaints during adenomyosis are pains of varying intensity in the lower abdomen, in the perineum, sometimes in the lower back. There are also unpleasant or painful sensations during intercourse. Pain before menstruation can become more intense, since the endometrium also contains hormonal receptors that respond to changes in a woman's hormonal background.

Against the background of pain before and after menstruation, the appearance of bloody or brownish discharge is also noted. The menstruation itself can proceed not only painfully, but also differ in heavy bleeding and duration. Sometimes there are also violations of the cycle - the intervals between menstruation become shorter, and the menstruation themselves are more protracted.

Uterine adenomyosis and pregnancy

What difficulties can a woman expect during adenomyosis if she is planning a pregnancy? In most cases, adenomyosis, as scientists suggest, is not an obstacle to conception and childbearing. So women who do not even suspect the presence of such a disease carry and give birth to children without any problems. However, this statement applies only to the initial and most simple forms of this pathology. We will consider what obstacles may arise in more severe forms of pathology.

Fertilization in adenomyosis

The main problem when trying to conceive a child can be a violation of the cycle. Women with adenomyosis may have some problems at this stage.

The menstrual cycle during the disease, as a rule, is irregular, it can be both shortened and prolonged. This, in turn, makes it difficult to determine the day of conception - that is, the time of ovulation. Women have to resort either to special tests or to measuring basal temperature. However, this is not the biggest problem. In more complex cases, when the process captures most of the uterus, adhesions may form. The adhesive process, in turn, can become an insurmountable obstacle for the spermatozoon during its movement to the egg.

However, this pathology is not so common, and is quite effectively solved by modern surgical methods. For example, a good result is given by hysteroscopy - the removal of adhesions in the uterine cavity. This is not a complicated operation that is performed in an outpatient clinic. As a rule, it gives a good result, but women who want to conceive a child need to understand that they do not have much time - the pathological process may begin to progress after some time.

Embryo implantation for adenomyosis

Another obstacle to the desired pregnancy may be the inability of a fertilized egg to attach to the wall of the uterus. When an embryo is formed at the mouth of the fallopian tube, it begins its movement to the uterus itself. There it is attached to the wall for further growth and development. In complex forms of adenomyosis, when most of the uterus is affected, the fertilized egg cannot find a place for implantation. It should be noted that this scenario concerns only the severe form of adenomyosis, when a large part of the uterus is involved in the pathological process.

Women who want to get pregnant and are afraid of the diagnosis of adenomyosis need to remember that you should not stop trying. In some cases, the desired pregnancy occurs from the fifth or tenth time. The human body is an unusually delicate and intelligent tool, and, in the end, the embryo will find a place for itself to implant. Many women managed to get pregnant with adenomyosis of the uterus, and they often write about it on the forum or in social networks. Once again, with mild forms, adenomyosis is not an obstacle to pregnancy.

Gestation problems with adenomyosis

As in the case of fertilization and the introduction of the embryo, gestation in the initial and mild forms of adenomyosis is not a problem. In rare cases, rather as a safety net, such women may be prescribed hormone therapy in the first months of pregnancy. In severe cases, the situation is somewhat different - due to pathological changes, the uterus may be in good shape, which in turn may threaten miscarriage or spontaneous abortion. Such women will have to spend a lot of time in the hospital, as they require constant medical supervision. Therefore, with more complex forms of adenomyosis, it is better to plan pregnancy in advance so that the doctor prescribes treatment that will prevent the possibility of miscarriage and prepare the uterus for normal gestation.

Childbirth with adenomyosis

Now let's consider the question of whether there are any features of the process of giving birth to a child with adenomyosis.

As with fertilization and gestation, the choice of method for giving birth to a child depends on the degree and form of adenomyosis. For example, with a nodal form of pathology of mild and moderate severity, natural childbirth will be the most optimal. But with a diffuse form of adenomyosis, the code of the body of the uterus is significantly thinned, most likely, a caesarean section will be needed. But in this case, everything is individual, the degree of involvement of the uterus in the pathological process can only be determined by a doctor and, according to the diagnosis, offer the best option.

How pregnancy and childbirth affect the course of adenomyosis

Despite the fact that adenomyosis in some cases can adversely affect the process of conception and gestation, pregnancy itself is the best "cure" for this pathology. Since during pregnancy the hormonal background of a woman changes and there is no cyclic exfoliation of the endometrium, during pregnancy, adenomyosis begins to regress. It is this property of pregnancy that can explain that even 100 years ago, when women gave birth often, adenomyosis was not a common pathology, but most likely was an exception.

Treatment of adenomyosis

Since adenomyosis is a hormone-dependent tumor that begins to regress during menopause and childbirth, hormone therapy is widely used to treat it. If she is not able to completely rid a woman of this disease, she will help keep it under control and prevent it from developing into more severe forms. As mentioned above, adenomyosis in the initial stages does not affect either the quality of life of a woman or her reproductive function. Trouble brings only a severe form of this disease. Therefore, hormone therapy and prevention of the development of adenomyosis with oral contraceptives are a priority in the treatment of adenomyosis.

As for the more severe forms of this disease, when the deep muscular layers of the uterus are involved in the process of pathology and when the pathology occurs against the background of other diseases (myoma, endometriosis), surgical intervention is indicated, up to the removal of the uterus. In some cases, as practice shows, adenomyosis responds well to the treatment of UAE. But this is only in those cases when it has a nodal form and when the nodes have vessels that feed them.

Bibliography

Aksenova T. A. Features of the course of pregnancy, childbirth and the postpartum period with uterine fibromyoma / T. A. Aksenova // Topical issues of pregnancy pathology. - M., 1978.- S. 96104.
Babunashvili E. L. Reproductive prognosis in uterine myoma: dis. cand. honey. Sciences / E. L. Babunashvili. - M., 2004. - 131 p.
Bogolyubova I. M. Inflammatory complications of the postpartum period in women with uterine myoma / I. M. Bogolyubova, T. I. Timofeeva // Nauch. tr. Center. Institute of Improvement of Doctors. -1983. -T.260. - S. 34-38.

A debatable issue for gynecologists - reproductologists is adenomyosis and pregnancy. In the scientific community, the possibility of pregnancy is being discussed, whether it can affect the child's gestation time and other aspects of pregnancy, but the mechanism of infertility in adenomyosis has not yet been disclosed.

concept of adenomyosis

The disease adenomyosis has other names, it occurs due to changes in the endometrium (the mucous layer of the uterus) and myometrium. The endometrium grows and grows into the muscular walls of the uterus (myometrium). The stage of the disease depends on the depth of germination in the uterine cavity and the type of foci.

The disease in the initial stages does not manifest itself in any way, but over time, a woman notices spotting after and before menstruation, bleeding between periods, pain in the pelvic area. It is possible that the first signal for a woman will be a problem with conceiving a baby.

The one who is most susceptible to it

According to the results of studies of various women with adenomyosis, it was determined who is at risk:

Women who underwent diagnostic intrauterine manipulations - abortions, cleansing and others.
If the female half of the family was prone to gynecological diseases, grandmothers and mothers suffered from benign (myoma) or malignant tumors.
If earlier operations were performed on the ovaries, fallopian tubes or women suffered from inflammatory diseases of the uterus.
Interestingly, women who have given birth are at risk, problems often arise when planning a secondary pregnancy.

Is it possible to get pregnant with adenomyosis of the uterus

There is evidence that in the case of external endometriosis there is no difference between primary or secondary infertility, while in the case of adenomyosis, women are 4 times more likely to have problems conceiving a second child, possibly indicating that the disease developed after the first pregnancy and childbirth .

In the course of a study of 150 patients diagnosed with internal endometriosis, the following data were obtained:

66 women with adenomyosis could not get pregnant, and in most cases it was secondary infertility, since 101 women already had one child.
15 patients had early miscarriages.
21 pregnancies with adenomyosis ended in premature birth.

It is not easy to answer the question why it is difficult to get pregnant with adenomyosis.

Infertility occurs under the influence of many factors, finding out which is a difficult task.

Possible causes of infertility in adenomyosis are:

The occurrence of adhesions in the pelvis.
Hormonal changes leading to the suppression of ovulation and other disorders.
Inability of the endometrium to perform its functions.
Disorders in the immune system.
Inability to have sexual intercourse due to severe pain.

It was previously believed that this disease is typical for premenopausal women, and the question: is it possible to get pregnant with adenomyosis was considered absurd, women were simply not included in studies due to age-related changes in the reproductive system. Now that nulliparous girls are also diagnosed with adenomyosis, the situation has changed.

In scientific circles, there is an opinion that “single” adenomyosis in most cases is not a problem for the onset of conception, more serious complications are caused by its combination with external genital endometriosis (this happens in 20-25% of cases) or with fibroids.

In practice, if a woman is suspected of infertility, tests and appropriate diagnostics show only small stages of adenomyosis, the examination goes into the following stages:

With a regular cycle and in the absence of a developing adhesive process in the pelvic organs, it is necessary to conduct a laparoscopic examination in order to exclude the possibility of external genital endometriosis.
An important indicator for diagnostic laparoscopy is a long-term unsuccessful expectation of the first pregnancy in a patient with healthy fallopian tubes.
Along with laparoscopy, it is necessary to take a biopsy of the endometrium in the middle of the luteal phase of the menstrual cycle in order to collect important information about the corpus luteum.

About the features of the course of pregnancy in adenomyosis

Any pathology in pregnant women is of concern, what is the effect of uterine adenomyosis on pregnancy?

It follows from the above that, firstly, in the case of adenomyosis, the risk of spontaneous abortion increases, and, secondly, the risk of preterm birth.

There is an assumption that with the development of the disease, the production of type F prostaglandins increases. Under normal conditions, they are responsible for uterine contraction, but their excess leads to the fact that the muscles of the uterus begin to convulsively and chaotically contract. Even if a woman is not pregnant, this condition is a deviation from the norm and leads to the fact that pain during menstruation intensifies.

During pregnancy, overproduction of prostaglandins leads to early miscarriages, due to the fact that the blastocyst cannot implant in the uterus. This assumption does not have rigorous evidence, however, in women in adenomyosis foci, the level of prostaglandins is abnormally increased.

Pregnancy after treatment

The diagnosis of infertility is not a verdict for adenomyosis, with the implementation of competent, complex treatment, the probability of pregnancy is 40-70%. With age, the chances decrease, but still in practice there were cases when adenomyosis did not interfere with pregnancy even after 40 years.

Treatment

The main treatment for infertility in adenomysis is to take hormonal drugs and perform organ-preserving operations.

The spread of the process, the symptoms will influence the choice of treatment methods.

Women should understand that adenomyosis is an incurable disease that can recur at any time, only removal of the uterus gives a 100% guarantee, but is it really possible to agree to this if you want to have children?

Some doctors say that pregnancy can cure adenomyosis, but this is not true, because in studies, many women indicate that it appeared or remained after childbirth.

Used in hormonal treatment of infertility

Oral contraceptives - Yarina, Jess and others. Against the background of discontinuation of the drug, pregnancy is possible, but according to the results of studies, oral contraceptives are not the most effective drugs. The course of therapy lasts 0.5 years.
Gestagens are chemical analogues of progesterone, and have recently been actively prescribed. Prominent representatives of this group of drugs are Duphaston, Byzanne. Dufaston is taken cyclically, it does not interfere with ovulation. The analogue of Duphaston is natural Utrozhestan.
Antigonadotropins (danazol, danoval, gestrinone) - quite recently they wrote that danazol is the most effective for achieving pregnancy, but at the moment, it is practically not used due to the fact that the drug has a pronounced side effect - excess weight, coarsening voices and others. When taking the drug, menstruation disappears, a month after stopping therapy, they should resume.
Gonadotropin-releasing hormone (aGnRH) agonists - zoladex, decapeptyl are heavy hormones and are used in the advanced stage of adenomysis. They are considered very effective drugs, but their use is limited by their high cost. In addition, long-term treatment with these drugs causes a persistent estrogen deficiency, which leads to a significant decrease in bone mineral density.

Hormone therapy affects ovulation and menstruation, therefore, the restoration of all reproductive functions occurs after 1-2 cycles after cancellation and pregnancy may occur at this time, however, after cancellation, it is necessary to control the process of egg maturation and if ovulation does not occur, it is necessary to use drugs that stimulate ovulation (gonadotropins) . With insufficiency of the corpus luteum, gestagens with vitamin E help, this vitamin is taken in the second phase of the cycle.

With the ineffectiveness of hormonal treatment, laparoscopic removal of adenomyosis nodes is used. This organ-preserving operation is used when. The essence of this operation lies in the fact that with the help of a laser there is an excision of both the node and the restoration of the walls of the uterus.

After organ-preserving operations, it is recommended to use hormonal preparations for six months, oral contraceptives in this case are of low efficiency, GnRH-a was best shown together with a course of radon baths.

If the patient has obstruction of the fallopian tubes, adhesions, microsurgical plastic surgery on the tubes is necessary to restore them.

It is very important to pay attention to the psychological state, if necessary, take sedatives.

The simplest treatment is adenomyosis of the cervix, it is easily diagnosed, and laser therapy can be actively used in its treatment, for easier and faster removal of painful foci. Pregnancy occurred in 90% or more cases with this diagnosis.

In adenomyosis, uterine artery embolization is also used, the effectiveness of this operation is poorly studied. During the operation, the vessels that feed the fibroids or foci of internal endometriosis are artificially “clogged” so that the nodes stop growing. According to the protocol, the blood flow of the uterus should be restored in a year and after that it is allowed to become pregnant, but according to reviews, many face further violations of the blood supply to the uterus.

If all attempts at medical and surgical treatment are unsuccessful, women can be referred for in vitro fertilization (IVF), but the effectiveness of this procedure in this case is two times lower than that of non-sick women.

Therapy to maintain pregnancy

If a woman managed to get pregnant while using Duphaston or Utrozhestan, then it is forbidden to abruptly stop taking the drug - this can provoke a miscarriage.

It is very important to control the level of progesterone, often its low level causes spontaneous abortions.

The mucous cavity of the uterus can grow an unlimited number of times under the influence of the hormonal system. This mechanism is important when pregnancy occurs. So she prepares to accept the egg, fertilized by the sperm, to allow it to infiltrate the uterine wall. If pregnancy does not occur in a particular cycle, then the endometrium, which lines the inner walls of the female organ, is rejected, and comes out through the vagina in the form of menstrual discharge.

In order to understand whether it is possible or not to become pregnant with uterine adenomyosis, you need to understand the features of the course of the pathology. In short, adenomyosis is a diagnosis that means that the tissues of the endometrium of the uterus grow beyond its cavity, penetrate deep into the walls of the organ.

Sometimes it happens that endometrial cells penetrate into the peritoneum. The reasons for this are various:

operations,
internal injury,
reflux of menstrual blood, etc.

In this case, the cells no longer take root on the surface of the uterus, but on the membranes of other organs, which provokes the development of inflammatory foci. Meanwhile, the endometrium grows into the uterine walls, into the walls of other internal organs, significantly disrupting their functioning.

Diagnosis means infertility?

Adenomyosis in the context: photo

The statistics are disappointing. In 40-80% of cases, it is adenomyosis that causes infertility in women. But it is important to remember something else: competent treatment will help you get pregnant in the end, even in severe cases. And sometimes pregnancy occurs without the help of a gynecologist. However, it is not worth hoping for this, especially after the age of 35, nulliparous.

For favorable gestation and delivery, doctors recommend first curing adenomyosis, and only then planning a pregnancy. With an undesirable outcome, the disease of the uterus will only progress, and rapidly, and give complications.

So, the question of whether it is possible to get pregnant with adenomyosis does not have a definite answer. One thing is clear: there are much fewer opportunities for conception than for an absolutely healthy woman, but there are chances. If you still managed to get pregnant, then the gestation process is constantly under threat of interruption.

Is it possible to get pregnant and endure with adenomyosis? The problem requires a detailed explanation. Why is fertilization not possible?

Adenomyosis is a disease in which the walls of the uterus are affected by pathological growths, often spreading to nearby organs. If the fallopian tubes are damaged, then conception is impossible. Due to the inflammatory process, adhesions form inside the pipes, making it difficult to pass.
Hormonal balance is disturbed. Because of this, the reproductive system does not work like clockwork. Failures occur, in particular, in the processes of maturation of the egg. This is expressed in the fact that a woman notices menstrual disorders: irregularity, prolonged and heavy periods, accompanied by painful sensations, daubs at the beginning and end of menstrual bleeding, etc.
Against the background of adenomyosis, the immune system is depressed. The female body perceives spermatozoa that have reached the uterine cavity as threatening agents and seeks to neutralize them. The same "fate" can befall the formed embryo. Damage and rejection occurs at an early stage, when implantation has not even occurred. Pregnancy with adenomyosis can end at a very early stage.
The uterus is characterized by increased contractility, exceeding the norm. Because of this, even if conception has occurred, the fertilized egg is embedded in the uterine wall, there is a risk of rejection of the fetal egg.
Adenomyosis and the chances of pregnancy after 40 years - one might say, are incompatible concepts. The probability is 50 to 50. Not only is the functioning of the female organs gradually slowing down at this age, there may also be other gynecological diseases. These are ovarian cysts, uterine fibroids, chronic inflammation in the sex glands, etc.

Now it is worth evaluating not only the physiological, but also the psychological aspect. With adenomyosis, sexual life can be greatly complicated. In addition to pain during intercourse, many women experience a depressed state, they do not have a positive general mood, there is no or severely reduced libido. The less frequent the meetings, the less chance of conception.

Oddly enough, but adenomyosis with a disturbed hormonal balance, increased contractile activity of the muscular tissue of the uterus is not always a 100% guarantee that pregnancy will not occur. But if it happened, then all these manifestations of the pathological process are one of the main risk factors that can lead to miscarriage.

Unwanted consequences of a miscarriage

Pregnancy with adenomyosis of the uterus is extremely important to save. Otherwise, when interrupted, there is a high chance of a strong relapse of the disease, often it develops into a severe form.

The specifics of the postpartum period

The period after childbirth in a woman with such a diagnosis as adenomyosis is considered quite dangerous. At this time, there is a risk of relapse and accelerated development of the disease, while there will be bleeding. After childbirth, the female body is restored, the menstrual cycle resumes, which provokes the growth of the endometrium of the uterus. But this does not mean that if it turned out to become pregnant with such a diagnosis, it is worth interrupting it. Abortion, spontaneous or artificial, only worsens the condition of the uterus.

Help doctor

For those who decide to get pregnant with adenomyosis, if this does not happen without the help of a doctor, there are still ways. For example, your doctor may prescribe appropriate birth control. After the abolition of oral contraceptives, pregnancy may occur.

Sometimes other hormonal agents are prescribed, such as Utrozhestan, Duphaston, Byzanne, etc. (strictly in agreement with the doctor!). With obstruction of the fallopian tubes, laparoscopy, hysteroscopy may be recommended.

Adenomyosis and pregnancy

Adenomyosis can be cured after pregnancy. If adenomyosis is at an early stage, a woman is less than 35 years old, then pregnancy can really become a kind of cure. There is no menstrual bleeding during this period. There is a so-called physiological menopause, during which the growth of the endometrium and its pathological growth also slow down.

The specifics of the course of pregnancy in adenomyosis

It is likely that a woman with such a diagnosis has a progesterone deficiency. And this means that the contractility of the uterus is high, there is a risk of miscarriage, the risk of damage in the late term. A caesarean section will likely be required.
Sometimes there are adhesions in the uterine cavity with adenomyosis. Because of them, the growth of the fetus is difficult, it is forced to take the wrong position, which also makes it impossible to give birth naturally.
If there is a focus of adenomyosis near the place of attachment, there is a risk of premature detachment of the placenta.
Due to the pathological process in the vessels that deliver nutrients to the fetal membranes, there is a high risk of damage to them. This causes placental insufficiency, which can hinder the development of the child.

Control at all stages: from preparation for conception to gestation and delivery - a guarantee that a happy pregnancy with such a diagnosis is still possible.