Adenomyosis of the uterus is a common gynecological problem, most common in women of reproductive age, and has a significant impact on the ability to conceive and bear a child. With this disease, the germination of the inner layer of the uterus (endometrium) into the region of the underlying muscle layer is noted. The approach to the treatment of this disease will directly depend on the degree of pathological changes. Today, both conservative and surgical methods are widely used. In this article, we will try to understand the causes of adenomyosis of the uterus, symptoms and treatment methods.
Reasons for the development of adenomyosis of the uterus
As we have already said, adenomyosis of the uterus is a disease in which the endometrium lining the uterus from the inside grows into the muscle layer, or myometrium. Such a pathological process is considered as one of the forms of endometriosis. It is noteworthy that this disease can have an asymptomatic course for a long time and be detected already at the stage of development of complications.
Adenomyosis is most often diagnosed in women of reproductive age, namely in the age range from 27 to 30 years. However, sometimes, although extremely rarely, such a pathology is congenital. Today, this disease ranks third in prevalence among all gynecological diseases, second only to salpingo-oophoritis and myoma. At the same time, in recent years, an increasing number of cases have been detected when adenomyosis is combined with uterine myoma.
Often, endometriosis, the treatment of which was not started on time, leads to quite serious complications. First of all, this can include problems when trying to conceive a child. Women suffering from such a disease often experience miscarriages, iron deficiency anemia, and neurotic disorders.
Currently, the exact causes of adenomyosis have not been established. Most scientists are inclined to believe that this pathological process is hormone-dependent. As predisposing factors are considered:
- History of abortion and diagnostic curettage;
- Installed intrauterine devices;
- Complicated childbirth and surgical interventions on gynecological organs;
- Dysfunctional uterine bleeding;
- Transferred inflammatory diseases from the reproductive system;
- Too early or too late formation of the menstrual function;
- Taking hormonal drugs, including oral contraceptives;
- Excess body weight;
- hereditary burden and much more.
Depending on the prevalence of pathological changes, it is customary to distinguish four degrees of severity. The first degree is established when the endometrium grows only into the submucosal layer. In the second degree, no more than 1/2 of the myometrium is affected, and in the third — more than 1/2. The fourth degree implies the defeat of the entire muscle layer, and sometimes neighboring tissues.
In addition, there are four forms of adenomyosis:
- Mixed diffuse-nodular.
The focal form is characterized by the formation of separate foci, and the nodal form is characterized by the formation of nodes (most often multiple). With a diffuse form, as a result of the germination of the endometrium, neither individual foci nor nodes are formed. The diffuse-nodular form is established when signs of both diffuse and nodal processes are found.
Adenomyosis of the uterus: symptoms and diagnosis
Earlier, we have already said that with adenomyosis of the uterus, any clinical signs may not be determined for a long time. The earliest symptom is usually problems with menstrual function.
With this disease, menstruation becomes too plentiful, prolonged and painful. A few days before their onset and some time after, spotting may be observed. Most patients complain of severe pain in the lower abdomen that occurs in the premenstrual period. Moreover, the more common pathological changes, the more intense the pain syndrome will be. Sometimes there is pain during sexual intercourse.
During a gynecological examination, a changed shape of the uterus can be detected. It becomes spherical with diffuse germination of the endometrium and bumpy with the nodular form of adenomyosis. It is noteworthy that before menstruation, the organ increases in size, and then decreases again.
In addition to a gynecological examination, a transvaginal ultrasound examination is mandatory.
In 2015, the results of the work of scientists from the Kuban State Medical University were published. The aim of the study was to develop an echographic algorithm for diagnosing adenomyosis in patients with diffuse changes in the echostructure of the uterine body. As a result, it was possible to establish that transvaginal echography with mathematical processing of study parameters makes it possible to diagnose diffuse adenomyosis in the absence of clinically significant uterine fibroids with a sensitivity of 96.3%.
However, hysteroscopy is considered the most effective diagnostic method today. If necessary, magnetic resonance imaging can be performed.
Treatment and prevention of adenomyosis
In adenomyosis, both conservative and surgical methods can be used. Patients are prescribed hormonal therapy, supplemented with anti-inflammatory drugs, immunomodulators, vitamins. In the event that conservative measures have not led to a decrease in the severity of pathological changes, the issue of surgical intervention may be decided. The volume of the operation is selected individually depending on the severity of the disease.
Prevention comes down to avoiding abortions and other traumatic effects on the uterus, timely correction of existing hormonal disorders, treatment of inflammatory diseases of the reproductive system, and so on.
Gynecology / Savelyeva G. M. — 2009
Ultrasound gynecology / Bulanov M. N. — 2012
Ultrasound diagnosis of adenomyosis / Pomortsev A. V., Lobanov K. A., Zubakhin A. G. and others. // Kuban Scientific Medical Bulletin — 2015 — #2