Adenomyosis: symptoms and treatment. Surgical treatment of uterine adenomyosis Is it necessary to treat adenomyosis

The asymptomatic course of the disease is even more dangerous, since the absence of problems does not allow women to seek medical help in time and leads to serious changes in the structure of the uterus.

What is adenomyosis

The body of the uterus consists of three layers of tissue: inner, middle and outer.

The inner functional layer (endometrium) is the mucous membrane of the organ. It tends to be completely renewed once a month, being rejected during menstrual bleeding and growing again by the middle of the cycle. The endometrium can be considered one of the most important tissues for a favorable pregnancy. It is on his condition that the possibility of attaching the fetal egg to the walls of the uterus, and subsequently the harmonious development of the placenta, depends.

The middle layer (myometrium) is the tissue of the uterus, consisting of smooth muscle fibers. Its main function is the contraction of the uterus during childbirth (contractions).

The outer layer (perimetry) is the serous membrane that covers the organ.

In a healthy state, the tissues of the uterus do not intersect and are located "parallel" to each other. But there are diseases that disrupt the natural arrangement of cells within an organ, one of which is adenomyosis.

Adenomyosis is an unnatural growth of endometrial cells deep into the tissues of the myometrium. At the same time, mucosal cells grow and are rejected according to the woman's monthly cycle, which causes disturbances in the functioning of the organ, inflammatory processes and unpleasant symptoms of the disease.

There are several forms of adenomyosis:

• diffuse adenomyosis - large areas of the endometrium evenly grow deep into the uterus;
• nodular (focal) adenomyosis - the formation in the myometrium of areas (nodes) consisting of endometrial glandular tissue and filled with blood or brown intercellular fluid;
• mixed adenomyosis consists in the simultaneous presence of diffuse and nodular forms of the disease in the uterus in one patient;

Determining the degree of adenomyosis directly affects how the disease should be treated:

• first degree - growth in the upper layer of the endometrium;
• the second degree - the endometrial cells penetrated about half into the myometrial tissue;
• third degree - the myometrium is damaged by more than half;
• fourth degree - endometrial cells have penetrated the myometrium, affect the serous membrane (if adenomyosis is not treated at the fourth stage of the disease, you can wait for the spread of the endometrium outside the uterus and the development of extensive endometriosis).

Symptoms of the disease

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

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

All these symptoms can indicate the development of a number of diseases of the reproductive system.

How to treat

Before prescribing treatment, the doctor sends the patient for a comprehensive examination, which includes:

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

According to the results, treatment is prescribed. At 1-3 degrees, drug therapy can be carried out. Drugs that are most often prescribed by a gynecologist.

• Combined oral contraceptives for a period of 4-6 months (preparations "Yarina", "Zhanin", "Belara" and others). COCs ensure the normalization of the balance of female sex hormones, which leads to a gradual decrease in the areas of affected tissue. Jeanine with adenomyosis is taken for 3-6 months, then the drug is completely canceled and the cure is monitored.
• Antigonadotropins (preparations "Danazol", "Danol"). Antigonadotropins reduce the production of hormones, reduce the efficiency of the ovaries, which leads to a decrease in the effect of hormones on endometrial tissue. Such drugs can only be taken under the supervision of a specialist.
• Progestogens (drugs "Duphaston", "Utrozhestan", "Norkolut"). A high concentration of progesterone reduces the concentration of estrogen, which does not allow the tissues of the uterine lining to multiply excessively.
• Antiestrogens (preparations "Gestrinone", "Medroxyprogesterone"). These drugs stimulate the artificial onset of menopause, so they try to prescribe such treatment to women after 40 years. The result of therapy, 5-6 months long, is the complete cessation of menstruation, the elimination of all symptoms of the disease and the complete stop of the growth of the endometrium.
• Antiandrogens (drug "Visanne"). While taking the drug, endometriosis foci are reduced by reducing the amount of estrogen and increasing the level of progesterone.
• An analogue of gonadoliberin (drugs "Buserelin", "Zoladex", "Decapeptil"). While taking the drug, the functions of the gonads first increase greatly, and then sharply decrease, which leads to a decrease in pathological tissue areas.

Duphaston

There is a lot of controversy about whether it is possible to treat adenomyosis with Duphaston. As you know, Duphaston is an artificial analogue of progesterone. That is why some experts argue that it makes no sense to treat progesterone-dependent tissue growth by increasing the level of this hormone.

However, experience shows that long-term use of the drug "Dufaston" in continuous courses does not allow the progression of adenomyosis, leads to a decrease in foci of mucosal growth and a significant decrease in the symptoms of the disease. Treatment allows:

• reduce the amount of estrogen, normalizing the work of the ovaries;
• reduce the spread of endometrial cells outside the tissue;
• stabilize the production of the body's own progesterone in the right amount.

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

Treatment of adenomyosis with Duphaston in the period of preparation for pregnancy allows you to improve the functioning of the reproductive system, successfully conceive, bear and give birth to a healthy child, without resorting to surgical intervention.

Contraindications for taking the drug "Dufaston":

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

If the doctor prescribes Dufaston, be aware of the possible side effects (for example, enlargement, tightness and pain in the chest, swelling of the face and body, migraines, weight gain) and be sure to tell about them at the appointment.

Surgery

The main surgical treatment for adenomyosis is removal of the uterus. But such an outcome can be avoided if the development of the disease is not allowed to the 4th degree, which is life-threatening.

Indications for the operation:

• failure of other treatments;
• combination of endometriosis with large uterine fibroids;
• with frequent relapses of the disease;
• the appearance of atypical cells;
• severe bleeding that cannot be corrected.

Hysterectomy is performed either open (cavitary) or laparoscopically (through three small incisions).

Patients very often hope for a miracle and try to cure adenomyosis with folk methods (using herbs, leeches, douching, acupuncture, etc.). But such methods are unable to eliminate the cause of the disease, and, therefore, lead only to the further spread of the disease and the appearance of complications. Alternative methods can only be beneficial in combination with traditional therapy under the supervision of the attending physician.

Treatment of adenomyosis of the uterus

Modern women devote little time to their health, which is why many diseases are detected in them during examinations as needed, and not on schedule.

Treatment of uterine adenomyosis, as one of the most common ailments, can take a lifetime with occasional relapses, or be completely absent due to its asymptomatic course.

What is it

Adenomyosis of the uterus should be understood as a disease of a benign nature, in which some of the cells that form its mucous membrane begin to divide more rapidly, affecting the serous and muscular layers of the organ by sprouting into them.

This process is hormonally dependent and progresses with a significant change in its background. In the state of menopause or pregnancy, it fades due to a decrease in estrogen levels.

As a rule, adenomyosis affects women after 30 years of age. There are also congenital anomalies in the development of the uterus.

Often the disease is the cause of infertility. To avoid this, it is important to start therapy on time.

Tasks and methods of therapy for uterine adenomyosis

The goal of therapeutic measures for adenomyosis is to achieve its stable remission, since it is impossible to achieve complete elimination of the affected areas.

To do this, the patient should be examined for:

• concomitant diseases and inflammatory processes in the pelvis;
• hormonal imbalance;
• malfunctions of the immune system;
• developing pregnancy, for which such a diagnosis can be fatal and lead to its termination, premature birth, habitual miscarriage.

It is important to take into account risk factors that require maximum minimization.

Often, adenomyosis of the uterus is diagnosed during a standard routine examination without accompanying complaints of the patient and disturbing symptoms or their mild severity. In this case, regular monitoring is required without additional interventions.

The same should be done when the problem is found in premenopausal women. It is generally accepted that during the attenuation of ovarian function, the level of estrogens decreases, and the development of endometriosis lesions stops.

It is impossible to leave without mandatory therapy women of childbearing age who are planning a pregnancy, but it does not occur due to the asymptomatic course of the disease.

The doctor selects the method of treatment of adenomyosis, the choice of drugs, their dosage, duration of administration and other details individually for each patient, taking into account:

• age;
• weight;
• chronic diseases;
• the presence of inflammatory foci, adhesions of the pelvic organs;
• the number of pregnancies in history and the result of their completion, induced abortions;
• heredity;
• psychoemotional state.

There are two main directions in the treatment of this disease: medical (conservative) and surgical.

Treatment of uterine adenomyosis with medications

Gonadoliberin is often taken in combination with estrogen and gestagens.

As for pregnancy, it occurs in the vast majority of cases in the first six months after therapy. This does not guarantee complete healing and is rather a temporary measure to alleviate the patient's condition.

Hormone therapy is subject to cancellation at the onset of pregnancy, so as not to cause disturbances in the development of the fetus.

Oral contraceptives have side effects, especially when taken for a long time, and are expressed as: weight gain, liver problems, deterioration of the skin and hair, decreased libido or its absence at all.

There are a number of contraindications to this type of treatment:

• severe pathologies of the cardiovascular system;
• kidney and liver problems;
• severe obesity;
• deep depression and emotional instability;
• diabetes;
• tendency to anaphylactic reactions to medications.

You need to be careful with epilepsy, an asthmatic component.

1. Taking medications that normalize the work of the pituitary gland and hypothalamus, as one of the most important hormone producers.
2. The use of a number of measures and procedures for immunomodulation, the removal of inflammation, pain syndromes, the protection of the liver from the effects of hormones, the cessation of bleeding, the elimination of iron deficiency anemia.
3. Restoration of the psycho-emotional state of the patient with the help of consultations of a psychologist, psychotherapist and the drugs prescribed by them.
4. Organization of rational nutrition, in which special attention should be paid to enriching it with protein. It is important to fill the deficiency of vitamins and microelements by taking balanced complexes.

Treatment of uterine adenomyosis with surgical methods

Surgical intervention can be carried out by removing the uterus or by a minimally invasive method - laparoscopy.

Naturally, the task of doctors is to eliminate the foci of the disease as efficiently as possible, returning the normal structure to the reproductive organs and maintaining full-fledged functions.

Abdominal surgery is an extreme method when the process becomes generalized and affects almost the entire uterus down to its deep layers, causing severe discomfort to the woman.

The latest medical developments are gradually being introduced into the treatment of uterine adenomyosis.

They are represented by the following procedures:

• Ablation, implying the destruction of superficial lesions of the organ.
• Embolization, the purpose of which is to stop the blood supply to the areas of the uterus with the germination of the endometrium into its muscle tissue.
• Electrocoagulation. It involves cauterization of endometriosis lesions with the help of electric current.

Accurate statistics on the success of these methods are not yet available. But in some cases they give a positive result.

Treatment of uterine adenomyosis requires an individual approach. To minimize the risk of an operative method of treatment, you should be attentive to your health and not miss scheduled examinations by a gynecologist.

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Treatment of adenomyosis

At the Center for Endovascular Surgery Prof. Kapranova is being treated for adenomyosis. Experienced professionals help patients cope with various manifestations of the disease. The therapy is carried out using modern methods.

Important! You can choose the clinic for therapy yourself. This allows you to take into account all the wishes for treatment, comfort of the wards, nutrition, staff qualifications and other important factors.

Operation cost:

General information

For many years, adenomyosis, especially complicated by uterine fibroids in patients with heavy menstrual bleeding, has been an indication for removal of the uterus - hysterectomy. Therefore, the introduction of progressive methods and methods of treating pathology into medical practice has become more relevant than ever. Using these innovative approaches, it became possible to cure patients who have not yet fulfilled their reproductive function, but wish to have children. In addition, another group of women with extragenital pathology can also undergo therapy for adenomyosis without risk to their health, because for many of them, the use of hormone therapy or surgery to remove the uterus is not possible for medical reasons.

What causes the development of the disease?

For what reasons adenomyosis develops, it is not known exactly. Unfortunately, the main mechanisms for the development of pathology have not been fully studied to date. We can only say that adenomyosis is a hormonally dependent disease.

Its development is facilitated by:

too early or late onset of menstruation;

use of an intrauterine device, oral contraceptives;

inflammatory diseases of the reproductive system;

Is pregnancy possible?

Adenomyosis is the second (after inflammatory diseases of the genital area) cause of female infertility. The connection is obvious. Chronically aggravated inflammation of the ovaries is caused precisely by internal endometriosis.

According to statistics, approximately 20-30% of patients lose their reproductive function.

Why does infertility occur?

Actually, there are several reasons. Consider the main ones:

Violation of the transport function of the fallopian tubes due to adhesive processes.

Pathological changes in the hormonal sphere. They prevent ovulation.

Autoimmune reactions leading to deactivation of spermatozoa.

Termination of pregnancy in the early stages. Pathology is associated with increased contractility of the endometrium.

Pain during intercourse. Discomfort leads to the fact that a woman can generally refuse sex.

Often infertility is caused by a number of reasons.

The main symptoms of the disease and the stage of its development

In some cases, adenomyosis is asymptomatic.

Adenomyosis is detected only during an examination for suspected other pathologies.

Often, the patient may note such signs of pathology as:

Abundant and prolonged menstruation. Bleeding lasting more than 7 days should alert the woman.

Spotting discharge (bloody). Usually they are noted by patients in the middle of the cycle.

Discharge of clots during menstruation.

Pain in the lower abdomen during sex.

Severe pain in the middle of the cycle or during menstruation. The nature of the discomfort deserves special attention. Pain in pathology is difficult to confuse with some other, since it is cramping, cutting.

With pathology, the uterus can increase by 2-3 times. Thanks to this, even during the initial examination, the gynecologist can detect the disease.

Specialists distinguish 4 degrees of the disease:

The endometrium is found in the submucosal layer.

The endometrium penetrates deeper. It can be found in the muscle layer. In this case, no more than 50% of such a layer is affected.

The foci of the disease are found in the muscle layer and affect more than half of its thickness.

This degree is characterized by a deep lesion. The endometrium grows into all layers of the body.

Focal adenomyosis. With this form of the disease, the endometrium forms separate islets (foci). Often the pathology is asymptomatic. The uterus with such a pathology is usually not removed.

Nodal. With this form of the disease, the endometrium forms separate nodes in the uterus. Pathology resembles a fibroid. The endometrium can fill the uterus.

diffuse. This form of the disease is characterized by the fact that the endometrium permeates the entire uterus.

Some women are diagnosed with several forms of the disease at once.

Women who have had childbirth (natural, by caesarean section).

Women who have undergone surgery to remove fibroids, for example.

All older women are also at risk.

The pathology is not life-threatening. This is due to the fact that it does not cause major changes. Nevertheless, bleeding can provoke anemia, severe pain significantly reduces the quality of life, leads to a feeling of anxiety, depression. Often a woman becomes closed. She tries to leave the house less often.

Important! You should be examined and treated as soon as possible. Only in this case can all the risks of the disease be prevented. You need to see a qualified doctor. It will help to cope with the symptoms, get rid of tissue pathology in the shortest possible time.

Have you found at least one of the symptoms of pathology? Consult a doctor!

The gynecologist will examine you. He will determine the need for a more thorough examination.

What research methods are used?

Ultrasound of the pelvic organs.

This survey is one of the most important. It allows you to exclude other diseases of the uterus and appendages.

The main signs of the disease on ultrasound include:

Heterogeneous structure of the endometrium.

An increase in the size of the uterus, a change in the shape of the organ.

The presence of various inclusions, cysts.

Diagnosis cannot be made on the basis of ultrasound and physical examination alone.

MRI (magnetic resonance imaging)

This technique is expensive. Not all patients agree to undergo an MRI. Meanwhile, it is precisely this diagnosis that allows us to clarify the structure of the muscle layer of the organ. The main signs of pathology include thickening, heterogeneity of the endometrium, foci in it.

This technique is used to exclude other causes of uterine bleeding (polyps, malignant tumors). During the examination, the doctor may take a sample of tissue for examination under a microscope (histology).

Hysterosalpinography and sonohysterography

These methods are used to exclude other diseases.

Should the disease be treated?

If the pathology does not threaten the woman's life, does not cause serious concern, then the doctor may limit himself to the prevention of complications. In this case, treatment is not carried out. It is not necessary, since the pathology does not cause complications and does not interfere with the life of a woman.

Usually, treatment is not prescribed for older women who are about to have menopause.

Important! The treatment process is mandatory for all the fair sex who are planning a pregnancy and take care of their health.

Surgery. Removal of nodes or nodes along with the uterus.

Medical treatment. Symptomatic and hormonal therapy.

Let's consider both methods:

Operation. Doctors always try to carry out organ-preserving interventions. Laparoscopy techniques, excision of endometriotic lesions are usually used. Relatively recently, uterine artery embolization has been introduced into practice.

Therapy using drugs. Usually, patients are prescribed drugs that can slow down the growth of the endometrium, reduce the rate of its rejection. The doctor always chooses such means taking into account the patient's condition. Also, experts take into account the woman's plans regarding pregnancy. In addition to hormonal drugs, vitamins, immunomodulators, and sedatives may be involved in the treatment. These funds are necessary to maintain a stable state of health of the patient.

When an operation is scheduled, is the uterus removed?

In the absence of the effect of hormone therapy, the nodal form of the disease, its combination with other pathologies, ovarian tumors, surgical intervention is prescribed. Moreover, its form is always chosen by the attending physician. Only he can draw the right conclusions about the indications for surgery.

The uterus and ovaries are removed if:

progressive course of pathology in women older than 40 years,

lack of effect of therapy,

combinations of several forms of the disease,

threat of malignant transformation.

How is the treatment carried out?

In the last five years, perhaps the most promising treatment for adenomyosis, used in modern medicine around the world, has become the so-called endovascular intervention, or uterine artery embolization (UAE). This type of minimally invasive intervention is also actively used today in the treatment of fibroids. Of course, only experienced professionals should deal with the treatment.

To date, Professor S. A. Kapranov and specialists from the Center for Endovascular Surgery have a unique experience for Russia in the use of endovascular embolization of arteries in the treatment of adenomyosis. All this makes it possible today to treat not only this disease, but also to combine methods of treating focal, diffuse and nodular forms of adenomyosis, uterine fibroids and endometrial pathology.

Indications for UAE are often uterine bleeding, which often leads to chronic iron deficiency anemia of varying severity.

Prior to endovascular intervention (UEA), most of our patients, due to the presence of severe uterine bleeding, had to undergo repeated unpleasant procedures for curettage of the uterine mucosa, many of them were prescribed ineffective hormonal therapy. As a result, women had to take strong hormonal drugs for a long time - from several months to 2 years. All this gave an insignificant effect, in rare cases - up to 6 months, many of the patients even treated adenomyosis to no avail.

The main advantages of the treatment method used

High efficiency. It has been clinically confirmed. It is not in vain that the technique is used in the treatment of not only such a disease as adenomyosis, but also a number of others.

minimal invasiveness. No incisions are required for the intervention. The doctor does not use general anesthesia.

Fast recovery. A woman can return to her normal life within a few days after the operation. In this case, long-term rehabilitation is not required. The patient spends only a few hours in the hospital. This time is enough to control her condition.

Minimal risk of complications. The development of adverse effects in UAE is 1%.

At this stage, Professor S. A. Kapranov and his colleagues have developed and are actively implementing special methods of endovascular treatment of adenomyosis - staged and partial embolization of vessels, and carefully select the size of emboli, taking into account the individual characteristics of the structure of the patient's vessels. Among other things, the use of only state-of-the-art embolization preparations makes it possible to achieve colossal positive results in the treatment of women with adenomyosis.

With adenomyosis, which proceeded without concomitant diseases and complications, only a month after UAE, about 50% of patients note the complete disappearance of symptoms of dyspareunia and algomenorrhoea. It is noteworthy that already 3 months after the passage of UAE, 100% of patients completely stabilize the regular menstrual cycle, and 5 months after this operation, there is a reduction in blood loss during menstruation to 48%, a significant increase in the level of hemoglobin in the blood, and the duration of menstruation stabilizes by 37%. %.

With all this, in patients in whom adenomyosis of the uterus was combined with myoma, the clinical effectiveness of endovascular intervention averages 97%. Six months after UAE, the sensations of acute pain syndrome, which was observed before surgery, disappeared in 78% of patients, menstrual function gradually stabilized and remained unchanged throughout the year.

Today Professor S. A. Kapranov and highly qualified staff of the Center for Endovascular Surgery offer:

targeted staged and partial embolization, taking into account the individual characteristics of the organism and the degree of the disease;

selection of drugs used depending on the size and shape of the vessels;

the use of only the most modern drugs, such as Contour (Boston Scientific), BeadBlock (Terumo, Japan) and Embosphere (Merit Medical, USA).

The range of prices and the final cost of treatment depend on many external factors (speed and convenience of preoperative examination, comfort and speed of hospitalization itself, etc.) that are not directly related to medical activities. Even with minimal investment, you get full-fledged professional assistance.

Do you want to start treatment? Are you planning to book an appointment for uterine artery embolization? Call Professor Kapranov's personal numbers:

Together with you, an experienced endovascular surgeon will choose a convenient time for the intervention and a suitable clinic. Sergey Anatolyevich will tell you everything about the method used, its main advantages. You can also ask questions regarding the risks, negative consequences of the intervention. You will learn all about embolization.

You can also call any of the clinics where Professor Kapranov accepts and make an appointment with the administrators. Be sure that soon adenomyosis will not spoil your life.

Kapranov S.A. - Center for Endovascular Surgery in Moscow

Treatment of adenomyosis of the uterus

First of all, it is necessary to explain what this disease means. With this pathological condition, endometrial tissue grows and grows into the muscular layer of the uterus.

The cause of this disease is surgical interventions in the uterus (including abortions), heredity, hormonal disruptions in the body, excessive visits to the solarium, the use of an intrauterine device, insufficient intensity of sexual activity, hard physical labor.

There are two methods of treatment for adenomyosis - medical and surgical.

1. Drug treatment involves the use of hormones, anti-inflammatory, sedative drugs, immunomodulators, vitamins, drugs that support the liver. In addition to medications, physiotherapy is recognized as effective. If the conservative method does not bring the desired result, they resort to surgical intervention.
2. Surgical treatment consists in the removal of endometrial lesions through laparoscopy. Perhaps resection of the uterus, ovaries entirely.

Laparoscopy for adenomyosis

Laparoscopy is a technique for clarifying the stage and localization of the spread of the disease to other tissues and organs of the abdominal cavity. It turns out this is due to a larger increase in the picture, as well as a functionality that allows you to explore both a static image and its dynamics for a long period of time.

Diet for adenomyosis

• limit yourself only to lean meats up to 200 grams per day;
• lean varieties of fish can be in the diet every day, oily sea fish - once every 7 days;
• fat-free dairy products are provided in an unlimited amount, low-fat cottage cheese is especially important;
• eggs should be in the diet;
• daily consumption of vegetables, both raw and thermally processed; it is allowed to add sunflower oil to salads;
• the daily diet should include cereals: buckwheat, oatmeal, rice, pearl barley (alternate), coarse bread;
• fruits can be eaten in unlimited quantities;
• steamed food, stewed or boiled; Eating is required in small portions up to 5 times a day.

Adenomyosis of the uterus: treatment with hormones

The treatment of such an anomaly as internal genital endometriosis is due to a symptomatic picture that worries the patient.

The use of analogues of gonadotropin-releasing hormones in case of obvious signs of endometriosis and adenomyosis.

In the process of taking these drugs, the patient stops having periods, the ovaries stop functioning for a certain time, and the concentration of sex hormones in the blood decreases. Due to this, the foci of the endometrium are reduced, and the signs of adenomyosis disappear or become less obvious.

Taking the drug Visanne.

This medicine contains the substance Dienogest, which prevents the increase in endometrial foci in the muscular structure of the uterine cavity. In some patients, this medicine can cause obvious uterine bleeding, so its use is recommended only after consultation with a doctor and under his scrupulous supervision.

Adenomyosis of the uterus treatment, drugs

If during the course of the disease the patient often has pain in the lower abdomen, then non-steroidal anti-inflammatory drugs are indicated.

For their effectiveness, tablets should be taken even before menstruation (taken 1-2 days before the planned day of menstruation and drink 1 tablet every 6 hours).

With internal genital endometriosis, patients often experience profuse uterine bleeding, menstrual irregularities, and spotting in the middle of the cycle. Contraceptives are prescribed to eliminate or reduce such manifestations of the disease as severe uterine bleeding and pain in the abdomen during menstruation.

The goal of medical treatment is:

• reduction of inflammation;
• elimination of pain syndrome;
• correction of anemia ( anemia);
• increased immunity;
• normalization of hormonal balance;
• providing psychological comfort;
• general strengthening of the body;
• mimic menopause.

Medical treatment of adenomyosis

Minimally invasive treatments for adenomyosis

Minimally invasive treatments for adenomyosis include:

• Ablation of the endometrium. Endometrial ablation is a minimally invasive procedure to remove the lining of the uterus ( endometrium) under the influence of physical factors - current, high and low temperatures. The procedure is performed under general or regional anesthesia. Ablation of the endometrium can significantly reduce the intensity of uterine bleeding, as well as reduce endometrial hypertrophy and save the uterus with myoma. To destroy the endometrium, electrosurgical ablation is used - an electrode is inserted into the cervix, through which a weak electric current is passed, which destroys the mucous layer. In hydrothermal ablation, a hot liquid is injected into the uterine cavity, which cauterizes the endometrium. Cryoablation is the destruction of the endometrium by freezing with liquid nitrogen. In microwave ablation, a thin probe is inserted into the uterine cavity, which emits microwave energy that destroys the inner layer of the uterus. The main serious complications are damage to neighboring organs, perforation of the uterus, inability to become pregnant. The recovery period takes several days. There may be some bleeding after the procedure. In case of increased bleeding and the appearance of an unpleasant odor, you should immediately consult a doctor.
• FUS - ablation. FUZ - focused ultrasound, ablation - rejection of part of the tissue under the influence of radiation. Thus, FUS - ablation - is the remote destruction of adenomyosis foci using focused ultrasound. The procedure is carried out under the control of magnetic resonance imaging. Passing through tissues, ultrasonic waves do not damage their integrity. But when they are focused, local tissue heating occurs up to 65°С - 85°С. This leads to thermal damage to the tissue and impaired blood supply. This effect is called thermal necrosis ( death) tissue. The duration of one exposure to a focused ultrasound pulse is from 10 to 40 seconds. The duration of the entire procedure is 3-4 hours. The advantages of FUS - ablation are - conducting without the use of anesthesia, atraumatic, short recovery period, no blood loss and postoperative scars, preservation of reproductive function. This technique is shown in the combination of uterine fibroids with adenomyosis, nodular and focal forms of adenomyosis.
• EMA ( uterine artery embolization). It is a painless, organ-sparing procedure that effectively treats adenomyosis and allows a woman to plan a pregnancy. This method is minimally invasive, safe and practically has no contraindications. Embolization of the uterine arteries is carried out by the endovascular method, that is, access through the vessel. The essence of the method is to block the lumen of the uterine arteries with the help of a special substance ( no more than 500 milligrams). As a result, blood flow to the affected area of ​​the uterus or fibroids stops ( benign tumor of the myometrium), which leads to tissue death or neoplasm due to lack of oxygen and nutrients. The severity of symptoms decreases almost immediately after the procedure. A year after the procedure, the size of myomatous nodes decreases by 4 times. The advantage of UAE is that it is carried out under local anesthesia, preservation of reproductive function, short duration of the procedure, rapid recovery of the patient, and immediate improvement in the condition.

Physiotherapy for adenomyosis

The main physical factors used in the treatment of adenomyosis are:

• Impulse currents of low frequency. These include diadynamic, rectangular, transcutaneous electrical nerve stimulation. The impulses have an anti-inflammatory, analgesic, regenerating effect. It does not stimulate the production of estrogen. Electrophoresis ( the introduction of drugs through the skin and mucous membranes under the influence of pulsed currents) allows you to administer drugs in small doses. Iodine is used for adenomyosis. It is deposited in the skin for up to 3 weeks and gradually enters the bloodstream. In the area of ​​inflammation, iodine helps to reduce edema, stimulate reparative and regenerative processes, and normalize the balance of hormones. Treatment is prescribed for 5 - 7 days of menstruation. The effect of the therapeutic action persists for 2-4 months after the procedure.
• Magnetotherapy. The essence of the method lies in the local impact on the body of an electromagnetic field. Used in the postoperative period. It has an anti-inflammatory, analgesic, sedative, protective effect. Normalizes microcirculation, reduces tissue swelling and improves metabolism.
• Electromagnetic oscillations of the optical ( light) range. The essence of the method lies in the local effect of short-wave ultraviolet radiation ( KUF) or laser radiation. Usually used in the early postoperative period in the wound area. Short-wave ultraviolet radiation has a pronounced bactericidal ( killing bacteria), wound-healing effect. Laser radiation has an anti-inflammatory, analgesic effect. Helps reduce tissue edema and normalize microcirculation in the wound area. The combined use of ultraviolet and laser radiation contributes to the speedy healing of the wound, prevents the formation of scars, infection and inflammation in the postoperative wound.
• Hydrotherapy. Treatment of adenomyosis is carried out with the help of coniferous, bischofite baths. The action is based on chemical and mechanical skin irritation. Such baths eliminate spasms, pain, have a sedative effect. The duration of the aftereffect is 3-4 months.
• Balneotherapy ( a complex of water procedures with mineral, fresh water). Adenomyosis is treated with radon and iodine-bromine baths. Radon helps to reduce estrogen levels and increase progesterone levels, has an anti-adhesion, sedative effect. The duration of the aftereffect of the procedure is about 6 months. Iodine-bromine baths have anti-inflammatory, analgesic, sedative effects, reduce estrogen levels. The duration of the aftereffect is 4 months.
• Climatotherapy. The essence of the method is to create certain climate conditions and avoid the action of certain physical factors. The patient should avoid prolonged exposure to sunlight, the use of therapeutic mud, paraffin, baths and saunas, massage of the lumbosacral region.

• the minimum number of contraindications;
• physiology ( impact of natural factors);
• lack of toxicity, adverse reactions;
• painless procedures;
• possibility of compatibility with other methods of treatment;
• aftereffect duration;
• low cost.

• Adenomyosis I, II, III degree ( surgically confirmed). In this case, physiotherapy complements hormone therapy or is used as the main treatment in between hormone therapy courses. Treatment is aimed at eliminating pain, inflammation and adhesions, improving blood circulation in tissues. Apply therapy with pulsed low-frequency currents, iodine electrophoresis, therapeutic baths. The duration and frequency of therapy is determined by a specialist.
• Impossibility of hormonal therapy, severe concomitant diseases. With contraindications for hormonal therapy, the appearance of severe side effects, physiotherapy can become the main effective method of treatment. Apply radon therapy, therapeutic baths and others.
• The young age of the patient. Physiotherapy has a positive effect on the hormonal background, allowing you to minimize or completely replace hormonal therapy, as well as avoid or delay the timing of surgical treatment. Conduct electrotherapy, therapy with therapeutic baths. Iodine-bromine baths are indicated for patients with an established menstrual cycle.
• Chronic pelvic pain, menstrual disorders, uterine bleeding, treatment of adhesions and inflammation after surgery. Iodine electrophoresis, balneotherapy, hydrotherapy and others are used. Such procedures reduce spasms, have analgesic, anti-inflammatory effects.
• Prevention of the formation of adhesions, complications in the early postoperative period ( in the surgical treatment of adenomyosis). They use laser and ultraviolet radiation therapy, magnetotherapy. Begin therapy on the first day after surgery. This allows you to reduce the time of wound healing, minimize the use of drugs, and also prevent scarring, inflammation and infection of the wound.

• all forms of adenomyosis requiring surgical treatment;
• III - IV stage of adenomyosis;
• severe psychoemotional disorders of the patient.

Also increase the effectiveness of the treatment of adenomyosis:

• massage- improves blood circulation, preventing stagnation of blood in the uterus;
• vacuum therapy ( cupping massage) - dilates blood vessels, improves blood circulation in the pelvic organs, eliminates blood stasis;
• reflexology ( impact on biologically active points on the skin by various physical factors - a magnet, stones, needles, etc.) - normalizes the balance in the nervous system, endocrine system, immune system, relieves stress, helps to relax muscles and reduce pain.

Is adenomyosis treated with folk remedies?

Benefits of herbal medicine(herbal therapy)are:

• availability;
• low cost;
• no side effects and contraindications ( possible individual intolerance);
• general strengthening and stimulating effect on the body;
• natural composition;
• use during pregnancy and lactation ( before use, you should consult a doctor);
• long period of use.

Decoctions and tinctures

For the treatment of adenomyosis use:

• Angelica. This medicinal plant contains phytohormones - estrogen and progesterone of plant origin. Angelica reduces the growth rate of adenomyosis foci, reduces pain and blood loss during menstruation, normalizes the menstrual cycle, has an anti-inflammatory effect, improves blood circulation and relaxes the muscles of the uterus. To prepare a decoction, 15 grams of the rhizome is boiled in 400 milliliters of water for about 10 minutes. Express and take 1 tablespoon 3 times a day before meals. You should not take a decoction of angelica during pregnancy, lactation, heavy uterine bleeding, while taking medications to thin the blood.
• Sabelnik ( marsh cinquefoil). Otar from cinquefoil is taken orally and by douching ( washing the vagina with various solutions of drugs or herbs using a medical pear). Pour 50 grams of grass with a liter of water, bring to a boil and cook over low heat for 10 - 15 minutes. Cool the broth, strain and take 200 milliliters 2 times a day after meals. Improvement is observed after 2 weeks of use. The effectiveness of treatment increases with simultaneous douching with a decoction of cinquefoil. Has antitumor activity.
• Boron uterus. The composition of the boron uterus plant contains unique plant components - flavonoids, which have a beneficial effect on women's health. It has antitumor, anti-inflammatory, tonic, hemostatic effect. Boron uterus and cinquefoil are the two most effective treatments for adenomyosis. Decoctions of these herbs should be used alternately. To prepare a decoction, the dried grass of the upland uterus is poured with boiling water and infused for no more than 15 minutes. The decoction is taken one hour before meals. Positive results of treatment are observed after a few weeks, but the course of treatment should be long enough until the signs of the disease disappear completely.
• red brush ( Siberian ginseng, Rhodiola four-cut). Phytohormones in the composition of the red brush help restore the disturbed hormonal background of a woman with adenomyosis. Cobalt, copper, selenium, molybdenum and other trace elements stop bleeding, restore blood circulation, prevent the development of anemia ( anemia) and neoplasms. To prepare a decoction, the dried root of the red brush ( 1 tablespoon) is poured with 300 milliliters of water and boiled over low heat for 15 minutes. Infuse for about an hour, filter and take 100 milliliters 3 times a day with a spoonful of honey. To prepare the tincture, 50 grams of the root is poured with 5 liters of vodka and infused for about a month in a glass container. Take orally 50 milliliters 1 time per day. Do not use decoctions and tinctures from the red brush for heart failure, high blood pressure.
• Yarrow. Decoctions of yarrow have hemostatic, anti-inflammatory, bactericidal action. Helps increase uterine contractions. It is used for uterine bleeding, irregular menstrual cycle, inflammatory processes of the female genital organs. To prepare a decoction, 1 tablespoon of chopped herbs is poured with 200 milliliters of boiling water and insisted for about an hour. Take 1/3 cup after meals three times a day. To prepare the tincture, 30 grams of chopped herbs are poured with 400 milliliters of alcohol or vodka. Insist 14 days in a dark cool place. Before use, strain, shake. Take 30 drops after meals three times a day.
• Wild yam. This plant contributes to the effective treatment of adenomyosis, inflammation of the female genital organs, and also prevents the appearance of menstrual cramps. To prepare a decoction, 1 - 3 grams of raw material is poured with 200 milliliters of boiling water and insisted for about half an hour. Express and take 1 time per day for 30 days. Contraindicated in children under 18 years of age, during pregnancy and lactation.

• A decoction of nettle leaves, shepherd's purse, cinquefoil root, serpentine root, knotweed grass. This composition of the decoction has a wide range of effects. Among them are a decrease in pain, a decrease in blood loss during menstruation, pain relief, a decrease in inflammation, and stimulation of the body's defenses. To prepare a decoction, herbs are mixed in dried form. Two tablespoons of the mixture is poured with 400 milliliters of boiled water. Insist, express and take 100 milliliters 3 times a day.
• A decoction of celandine ( soft part of the plant), plantain, birch buds, poplar buds, juniper berries. Mix all ingredients dry based on 200 milliliters of water), pour boiled water, leave for about an hour and strain. Taken in small amounts no more than 3 sips) 3 times a day after meals. The infusion contributes to the maturation of the egg, the onset of pregnancy.

• During egg maturation ( from the beginning of menstruation to the 14th day of the cycle). To prepare a decoction, a dried mixture of poplar buds, birch, calamus, tansy, plantain leaves and juniper berries is used. One teaspoon of the mixture is poured with 200 milliliters of boiling water, insisted for 1 hour. Filter and take 50 - 70 milliliters after meals. Take during 3-4 menstrual cycles.
• In the second phase of menstruation, in the period after ovulation, the maturation and release of the egg. One teaspoon of a mixture of licorice root, sage, fireweed, clover cones, currant berries, anise, eucalyptus leaves is poured with 200 milliliters of boiling water, insisted for one hour, filtered and drunk 50 milliliters a day after meals. The course of therapy lasts 3-4 menstrual cycles.

local therapy ( tampons, douches)

As a remedy, oil solutions of calendula and eucalyptus are used. To prepare a solution, 20 leaves of calendula and 100 grams of eucalyptus leaves are poured with warm olive oil for up to 20 days. The swab is moistened in the resulting solution and inserted into the vagina overnight. When using tampons, douching and other manipulations should not be done. Also, a steamed medicinal plant can be introduced into a tampon or a tampon can be moistened in a medicinal decoction and inserted into the vagina for 2 hours. The procedure should be carried out every other day.

Douching is washing the vagina with solutions, decoctions of medicinal herbs using a medical pear. Before douching, it is necessary to carry out a toilet of the external genitalia, process a medical pear. The water solution must be at room temperature, do not contain aggressive components ( alcohol, acids). It is better to drive the solution in the supine position, slowly and carefully. The duration of the procedure should not exceed 10 minutes. The first three days of the course, douching is done twice a day - in the morning and in the evening. Then 2 - 3 days only in the evening. After that, once a week before bed. Course duration - 7 - 10 days. Douching is contraindicated during pregnancy and the postpartum period, after curettage of the uterus, in acute inflammatory processes, during the menstrual cycle, and others. For douching, decoctions from the leaves of eucalyptus, calendula, yarrow, nettle, oak bark and others are suitable.

Hirudotherapy

Healing clay

What is the difference between adenomyosis and endometriosis?

The differences between adenomyosis and endometriosis are extremely minor. The main difference is that endometriosis can affect any organs and tissues outside of the uterus. This is explained by the spread of endometrial cells in the body with blood and lymph flow, as well as with mechanical trauma to the uterus. Adenomyosis affects exclusively the muscular layer of the uterus.

Endometriosis is classified into:

• genital form- affects the genitals of a woman ( vagina, fallopian tubes, ovaries, etc.);
• extragenital form- internal organs and tissues are affected ( intestines, bladder, postoperative scars and others);
• combined form- simultaneous damage to the genital organs and other internal organs and tissues of the body.

According to the stage of distribution, there are:

• stage I endometriosis- the appearance of one or more small foci of endometriosis, which do not have a significant effect on the body;
• stage II endometriosis- the existence of several lesions with the spread of endometriosis deep into the tissues of organs;
• III stage of endometriosis- a combination of several superficial and deep foci of endometriosis, the appearance of cysts, tumors, inflammatory processes;
• IV stage of endometriosis- Numerous deep lesions of internal organs with the appearance of benign and malignant neoplasms.

The main symptoms of endometriosis are:

• heavy bleeding during menstruation;
• pain at the site of endometriosis bladder, intestines and others) during physical exertion and menstruation;
• bleeding of the affected organ or tissue during menstruation;
• painful defecation and urination, painful intercourse;
• inflammatory processes in the focus of endometriosis, the appearance of neoplasms ( tumors);
• increase in body temperature.

Why is adenomyosis dangerous?

• development of anemia. As a result of regular heavy blood loss during menstruation and intermenstrual bleeding, hemoglobin is lost ( erythrocyte protein), which contains iron. The main function of hemoglobin is to carry oxygen and saturate tissues with oxygen. In case of a lack of hemoglobin, the organs suffer from hypoxia ( lack of oxygen). The brain and heart, which have the greatest need for oxygen, are especially affected. A woman develops shortness of breath, weakness, dizziness, loss of consciousness, memory impairment, and working capacity decreases.
• Infertility. In severe cases, adenomyosis can lead to infertility. One of the reasons is a violation of the hormonal background of a woman. With an excess of estrogen, ovulation is disturbed - the maturation and release of the egg into the fallopian tubes. The menstrual cycle becomes anovulatory. Also, the secretion phase does not occur in the endometrium. As a result of this, the fertilized egg cannot penetrate the mucous layer of the uterus, that is, implantation does not occur. Often adenomyosis is combined with endometriosis of the fallopian tubes. This leads to obstruction of the tube for the egg. Spermatozoa are able to pass through the fallopian tube. It is dangerous to develop an ectopic pregnancy - the development of a pregnancy outside the uterine cavity, which requires surgical intervention. If pregnancy does occur, then it can be interrupted by a miscarriage due to a lack of progesterone and dysfunction of the muscular layer of the uterus.
• Spread to neighboring organs. Foci of adenomyosis can spread beyond the muscular layer of the uterus - into neighboring organs ( intestines, bladder), postoperative scars, nerve bundles. Also, endometrial cells are transported throughout the body with the flow of blood and lymph. This can lead to damage to any organ. An inflammatory process, swelling, hemorrhage, the appearance of scars and adhesions appear around the focus of endometriosis. As a result, the function of the affected organs is disrupted, severe pain occurs during menstruation, neurological disorders ( in case of damage to nerve fibers).

Can you get pregnant with adenomyosis? What are the features of pregnancy with adenomyosis?

The main causes of infertility in adenomyosis are:

• anovulatory menstrual cycles- during anovulatory cycles, the egg does not mature and does not enter the uterine cavity;
• changes in the endometrium- Structural and functional changes in the endometrium lead to the impossibility of embryo implantation ( the process of implantation of a fertilized egg into the endometrium of the uterus);
• hormonal imbalance- maturation of the egg, fertilization, implantation of the embryo, the development of pregnancy, childbirth are regulated by hormones, therefore, with hormonal imbalance, all processes are disrupted;
• pathological changes in the structure of uterine smooth muscle cells- this leads to a decrease in the forward movement of spermatozoa, uterine tubal transport, a change in uterine contraction;
• genetic abnormalities- if there is a defect in the gene that affects the implantation of the embryo, then further development of pregnancy does not occur;
• inflammatory processes- inflammation leads to the replacement of normal scar tissue and the formation of adhesive processes.

The main problem with adenomyosis is not the impossibility of conception, but the bearing of the fetus. During pregnancy, such patients are under the supervision of a doctor, take hormonal drugs, regularly undergo ultrasound examination ( ultrasound) and, if necessary, magnetic resonance imaging ( MRI).

The main causes of complications during pregnancy with concomitant adenomyosis are:

• Low concentration of progesterone in the blood. Progesterone is one of the most important hormones during pregnancy. It plays an important role in the process of conception, implantation of the embryo in the mucous layer of the uterus, preparation of organs and systems for pregnancy and childbirth. A low level of progesterone indicates a threat of miscarriage and termination of pregnancy, as it stimulates the growth of the uterus, prevents its premature contraction, and prevents the rejection of the fetus by the woman's immune system.
• The formation of scars and adhesions. In the foci of adenomyosis, inflammatory processes appear. This leads to the replacement of the inflamed connective tissue, that is, scars are formed. Adhesions also appear - strands of connective tissue. As a result of scarring, the uterus loses its elasticity. This is dangerous due to the risk of uterine rupture and the incorrect position of the fetus in the uterus.
• Premature detachment of the placenta. Placental abruption can be a dangerous complication ( organ in which the fetus develops), if it is located near the focus of adenomyosis. The placenta is attached to the wall of the uterus and provides the fetus with nutrients, oxygen, and cells of the immune system. With its detachment, further development of pregnancy is impossible and there is a risk of massive bleeding. The first trimester of pregnancy is especially important, since it is during this period that the placenta develops. Therefore, a woman is prescribed maintenance hormonal therapy and with the help of ultrasound ( ultrasound) monitor the thickness of the placenta and the correctness of its development.
• Fetoplacental insufficiency. Fetoplacental insufficiency is a set of symptoms in which there are violations of the placenta or fetus. In this case, the fetus suffers from a lack of oxygen ( hypoxia), its development slows down, various pathologies of fetal development occur.

Is there any chance of getting pregnant with in vitro fertilization ( ECO) in adenomyosis?

The result of in vitro fertilization depends on the stage of adenomyosis, the age of the patient and her state of health. According to research conducted in the period 2010 - 2015. in 130 patients, the pregnancy rate after IVF with mild adenomyosis was 35% ( 19 women out of 130). With moderate severity - 21% ( 10 women out of 130), with a severe degree - 11% ( 3 women out of 130). reproductive losses ( miscarriage) accounted for 15% ( 3 patients out of 19), 40% (4 out of 10) and 67% ( 2 of 3) respectively. The risk of miscarriage is significantly increased with concomitant diseases of the uterus. Thus, reproductive losses in the combination of adenomyosis with uterine myoma are 48%.

To increase the effectiveness of infertility treatment for adenomyosis, it is necessary to conduct IVF in a timely manner without prior hormonal treatment. Pregnancy with adenomyosis is a high-risk pregnancy. With an increase in the severity of adenomyosis, the number of fertilized eggs introduced into the uterine cavity increases. This increases the chances of embryo implantation. Women with a severe degree of adenomyosis are shown surrogate motherhood - the implantation of the patient's embryo into the uterus of another healthy woman for bearing and giving birth to a child.

Can adenomyosis be completely cured and can it go away on its own without treatment?

The longest effect is observed with combined treatment - organ-preserving surgery in combination with hormonal therapy. Drug treatment also brings good results, but only in cases of grade I and II adenomyosis with mild symptoms.

The only way to completely cure adenomyosis is a radical operation, in which the internal genital organs of a woman are removed. This method of treatment is suitable for women who are not planning a pregnancy, women in menopause and concomitant fibroids ( benign tumor of the myometrium) uterus.

Adenomyosis cannot go away on its own without proper treatment. An improvement in the general condition of a woman is observed with the onset of menopause. During this period, there is a decline in ovarian function and a decrease in the level of estrogens responsible for endometrial hypertrophy. In case of accidentally detected adenomyosis without symptoms and complications, treatment is not carried out.

Adenomyosis is a condition in which the lining of the uterus (endometrium) grows into the muscular layer of the uterus (myometrium). Adenomyosis can cause painful menstruation and as well. Adenomyosis can be nodular or diffuse, affecting almost the entire uterus.

Rice. 1. This is what adenomyosis looks like - ingrowth of the endometrium into the muscular layer of the uterus (myometrium)

Usually the only solution to the suffering that adenomyosis- hysterectomy, that is, the removal of the uterus.

However, many women with adenomyosis do not want to lose their uterus, especially if a woman wants to preserve her childbearing function. For women who want to get pregnant and have children, this is a terrible decision. However, unlike or simply fibroids, which can easily be removed while preserving the uterus, because there is a clear boundary between the tumor and the true uterine musculature, when adenomyosis there is no such border. The muscles of the uterus (myometrium) are completely saturated with endometriosis tissue, which makes it much more difficult to perform an organ-preserving operation.

Rice. 2. MRI of a woman with extensive diffuse adenomyosis

Rice. 3. Temporary ligation of the uterine arteries before the procedure

The surgical procedure consists of a radical removal of adenomyosis (leave 1 cm of tissue above the endometrium and under the perimetrium), followed by triple plasty with the remaining flaps. The operation is performed through a small transverse suprapubic incision. The length of the incision depends on the size of the uterus, as the uterus must be brought into the wound from the abdominal cavity in order to adequately excise the adenomyotic lesions and control bleeding. The enlarged uterus is dissected in two with a scalpel along the midline to the uterine cavity with its opening (Fig. 4). Thus, the severity of adenomyosis becomes visible, and the most important landmarks - the endometrium and the serous membrane of the uterus are always in sight. The uterine cavity is opened wide enough to allow for the insertion of the index finger and to assist in the proper excision of the affected tissues. It is necessary to carefully monitor the mouths of the fallopian tubes so as not to damage them. The endometrium is sutured with interrupted 3-0 absorbable sutures. After that, the myometrial defect is closed by the method of overlapping with triple flaps and 2-0 absorbable material, as shown in the figure. Once uterine repair is complete, temporary clamping of the uterine arteries is stopped.

Rice. 4. Stages of Operation Siege

The results of the operation appear almost immediately - the severity of pain syndrome and menstrual bleeding decreases. The chance of pregnancy increases. According to Dr. Osada, pregnancy has been achieved in more than 50% of patients. Of course, such patients will in the future need a caesarean section to avoid uterine rupture, but this is a small price to pay for a preserved uterus and the possibility of motherhood.

Adenomyosis is a disease of the uterus that can cause prolonged uterine bleeding, spotting in the middle of the cycle, and severe pain in the lower abdomen.

They say about adenomyosis if the endometrium, which should normally be only in the uterine cavity, penetrates deep into the muscular layer of the uterus. Due to the fact that the endometrium begins to grow where it is not supposed to grow, an inflammatory reaction develops, and the uterus increases in size.

Adenomyosis and endometriosis

Adenomyosis is sometimes referred to as uterine endometriosis or internal endometriosis. Indeed, both adenomyosis and endometriosis develop for the same reason: if the endometrium begins to grow where it is not supposed to grow.

With endometriosis, endometrial foci can be found outside the uterus (on the ovaries, in the fallopian tubes, in the cervix, etc.) There is one on our website.

Often, both endometriosis and adenomyosis are found in the same woman at the same time.

Why does adenomyosis appear?

The causes of adenomyosis are not known. There are several theories explaining the possible causes of this disease, but so far none of them is generally accepted.

It is known that sex hormones (estrogen, progesterone, prolactin, FSH) play an important role in the development of adenomyosis. When the level of sex hormones in the blood decreases (this occurs in women during menopause), the symptoms of adenomyosis usually disappear.

Who is at increased risk for adenomyosis?

Adenomyosis is a fairly common disease among middle-aged women who have given birth (over 35-40 years old). An increased risk of adenomyosis is observed:

• in women who have given birth (either spontaneously or by caesarean section)
• in women who have had uterine surgery (for example,)
• in women older than 35-40 years

Forms of adenomyosis

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

• Focal adenomyosis: The endometrium forms separate islands, or foci of adenomyosis, in the muscular layer of the uterus. Focal adenomyosis is often asymptomatic or with mild symptoms.
• Nodular adenomyosis: The endometrium forms discrete nodes in the muscular layer of the uterus. Endometrial nodes in the nodular form of adenomyosis are also called adenomyomas, since they are very similar to uterine myoma.
• Diffuse adenomyosis: extensive areas of the endometrium grow almost evenly throughout the entire muscular layer of the uterus.

Some women may have several forms of adenomyosis at once: for example, a combination of diffuse and nodular forms (diffuse-nodular adenomyosis).

Degrees of adenomyosis

Depending on how deep the endometrium penetrated into the muscular layer of the uterus, there are 4 degrees of adenomyosis:

• 1 degree adenomyosis: shallow penetration of the endometrium deep into the uterus. The endometrium is found only in the submucosal layer of the uterus.
• 2 degree adenomyosis: deeper penetration of the endometrium deep into the uterus: foci of adenomyosis are found in the muscular layer of the uterus, but affect no more than half of the muscular layer.
• 3 degree adenomyosis: foci of endometriosis are found in the muscular layer of the uterus and affect more than 50% of its thickness
• 4 degree adenomyosis: deep defeat. The endometrium grows into all layers of the uterus.

Symptoms and signs of adenomyosis

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

• Prolonged and profuse periods that last more than 7 days in a row. Often with adenomyosis, uterine bleeding can be observed.
• Smearing in the middle of the cycle.
• During menstruation, blood is released in clots (lumps).
• Expressed or in the middle of a cycle. Pain in adenomyosis can be cramping or cutting.

With adenomyosis, the uterus can increase in size by 2-3 times. Because of this, some women manage to feel a round, dense formation in the lower abdomen (behind the pubic bone). This is the enlarged uterus.

Consequences of adenomyosis

Adenomyosis is not life-threatening and usually does not cause any serious complications. However, heavy bleeding from adenomyosis can cause anemia, and severe abdominal pain impairs quality of life and can lead to depressed mood, anxiety, and depression.

Adenomyosis and pregnancy

Despite the fact that adenomyosis is often found in women suffering from infertility, a direct link between this disease and the inability to conceive a child has not yet been established.

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

Diagnosis of adenomyosis

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

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

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

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

Despite the fact that during a routine examination, the gynecologist cannot notice the foci of adenomyosis in the uterus, the gynecological examination is very important. First of all, the gynecologist will be able to determine the size of the uterus: with adenomyosis, the uterus increases in size by 2-3 times and acquires a spherical shape. Secondly, during the examination, the gynecologist will rule out other possible causes of bleeding or abdominal pain.

Ultrasound is also not a definitive method for diagnosing adenomyosis, but this examination is very important, as it will allow you to exclude other possible diseases of the uterus or uterine appendages. The main signs (echo-signs, echo-picture) of adenomyosis on ultrasound are:

• an increase in the size of the uterus and a change in its shape
• the presence in the muscular layer of the uterus (myometrium) of hypoechoic inclusions
• heterogeneous structure of the myometrium
• the presence of small cysts in the muscular layer of the uterus (up to 5 mm in diameter)
• thickening of the walls of the uterus (especially common thickening of the back wall of the uterus)

It is important to understand that only on the basis of a general examination, no doctor can make a diagnosis of adenomyosis. Ultrasound only allows suspect the presence of adenomyosis.

MRI is a more expensive examination method that allows you to clarify the structure of the muscular layer of the uterus. The main signs of adenomyosis on MRI are thickening of the muscular layer of the uterus, heterogeneity of the myometrium and the presence of foci in it, which may be foci of the endometrium. MRI also allows you to exclude other possible diseases of the uterus.

Hysteroscopy can be used to exclude other possible causes of uterine bleeding (uterine polyps, endometrial hyperplasia, malignant diseases of the uterus, etc.) During hysteroscopy, the doctor may take a piece of tissue for further examination under a microscope. The procedure for taking material for research is called a biopsy, and the study of the material obtained under a microscope is a histological examination.

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

How is adenomyosis diagnosed?

Although adenomyosis is not a rare disease, it is very common for doctors to "miss" it or confuse it with other diseases that cause similar symptoms.

For example, uterine bleeding can occur both in adenomyosis and in submucosal uterine myoma, uterine polyps, hormonal disorders, endometrial hyperplasia, malignant diseases of the uterus, etc. Pain in the abdomen during menstruation can occur not only with adenomyosis, but also with primary dysmenorrhea and endometriosis.

In this regard, many experts are of the opinion that in order to make a diagnosis of adenomyosis, it is necessary to exclude all other possible diseases with similar symptoms. If all examinations performed did not reveal other disorders, but revealed indirect signs of adenomyosis, then the diagnosis of adenomyosis is considered confirmed. The final diagnosis can only be given by a histological examination of the uterus after its removal.

Should adenomyosis be treated?

As mentioned above, adenomyosis does not threaten a woman's life and, as a rule, does not cause any serious complications. In this regard, the treatment of adenomyosis is not required for all women. You do not need treatment if:

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

Can adenomyosis be completely cured?

Unfortunately, there are no drugs that can help get rid of adenomyosis. All drugs used in the treatment only help to cope with the symptoms of adenomyosis, but do not eliminate the disease itself. The only guaranteed way to get rid of adenomyosis is to remove the uterus.

Treatment of adenomyosis

Treatment for adenomyosis depends on the symptoms that bother the woman.

• Pain medications in the treatment of adenomyosis

If, with adenomyosis, a woman often has severe pain in the lower abdomen, then non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed: Ibuprofen, Ketoprofen, etc.

In order for them to really work, you need to start drinking tablets even before your period appears (1-2 days before the expected date of menstruation and take one tablet every 6 hours).

• Contraceptive pills in the treatment of adenomyosis

With adenomyosis, women often experience severe uterine bleeding, spotting in the middle of the cycle, and menstrual irregularities.

In order to regulate the menstrual cycle, the doctor may prescribe birth control pills (Janine, et al.). Contraceptive pills do not cure adenomyosis, but sometimes help eliminate or reduce symptoms of adenomyosis, such as severe uterine bleeding and.

• Mirena intrauterine device for adenomyosis

How to get pregnant with adenomyosis?

It is believed that adenomyosis cannot cause infertility, so you have every chance of getting pregnant with adenomyosis on your own, without treatment.

If you are unable to conceive for 12 months or more, then you and your husband need to be tested. What examinations should a woman undergo:

• Ultrasound of the pelvic organs
• blood test for hormones
• to assess the patency of the fallopian tubes
• for at least 3 consecutive months to determine if you are ovulating

What examinations should a man undergo:

• semen analysis (spermogram)

Depending on the results of the examination, the doctor prescribes treatment. So, for example, if obstruction of the fallopian tubes was detected, then a laparoscopic operation is prescribed to restore their patency. If a woman does not ovulate, treatment is prescribed to restore the normal functioning of the ovaries, or ovulation stimulation courses. If concomitant diseases (uterine polyps, fibroids, etc.) were found during the examinations, then appropriate treatment is prescribed.