Adenomyosis is a particular variant of endometriosis that directly affects the muscle tissue of the uterus.
With adenomyosis, the endometrioid tissue of the inner lining of the uterus, which tends to change depending on the phase of the menstrual cycle, is located in an atypical place for it – in the thickness of the muscle layer.
The exact reasons for the formation of adenomyosis are not yet fully understood. Various theories of the origin of this pathology have been proposed.
- The theory of implantation involves the throwing of fragments of the endometrium during menstruation into the region of the fallopian tubes, but it is poorly suited to explain the development of adenomyosis,
- The version of epithelial metaplasia suggests the formation of foci of endometriosis from residual cells of embryonic tissues, including inside the muscles of the uterus,
- The theory of induction assumes the occurrence of foci of endometriosis in the thickness of the muscles under adverse external and internal influences.
They also put forward a genetic theory of occurrence: adenomyosis occurs due to a deficiency of special substances – prostaglandins or other hormones.
Risk factors for the development of adenomyosis are:
- infections of the genital tract and urinary tract,
- interventions in the uterine cavity with endometrial injury,
- birth trauma of the endometrium and the body of the uterus,
- problems with the balance of hormones,
- hereditary predisposition.
Most often, adenomyosis affects women aged 20 to 45 years, with menstrual irregularities and painful periods, infertility and problems in the genital area.
Endometriotic lesions resemble normal endometrium, but have more active growth and functional activity.
Adenomyosis of the uterus can be of three types – focal, nodular or diffuse, according to the degree of prevalence, 4 degrees of penetration of foci of adenomyosis into the muscle layers of the uterus can be distinguished.
- at grade I, foci of adenomyosis grow to the muscle layer,
- at stage II, the lesion reaches the middle of the muscle layer,
- at grade III, the entire thickness of the muscles is affected up to the serous membrane,
- at IV – the lesion extends beyond the uterus into the peritoneum.
Symptoms of adenomyosis are usually:
- in the form of painful menstruation, which occurs as a result of the accumulation of blood in the tissues of the uterus and is accompanied by an inflammatory process against this background, the formation of adhesions in the uterus,
- violation of normal menstruation, increased bleeding, smearing secretions before and after menstruation,
- infertility associated with problems of implantation and gestation,
- with the presence of adhesions in the uterus,
- endocrine disorders of the ovaries, pituitary gland and other organs.
Symptoms of adenomyosis progress with age, if untreated, progress occurs within six months or a little more, but if pregnancy occurs, all symptoms may regress.
The basis for diagnosing adenomyosis is a thorough questioning of a woman and identifying problems with menstruation, its irregularity and soreness, the presence of bloody spotting, large amounts of blood loss.
The examination also plays a role – with adenomyosis, the uterus can be enlarged up to the eighth week of pregnancy, it is dense or bumpy, before menstruation it is painful to probe.
The uterus can be tightly adhered to the surrounding tissues; when it is displaced, soreness occurs.
The basis of diagnostics is pelvic ultrasound with a vaginal sensor, X-ray examination with a contrast agent, tomography of the uterus and hysteroscopy of the uterus.
With adenomyosis, diagnostic curettage of the uterine cavity and diagnostic laparoscopy are indicated.
The blood test also reveals the CA-125 tumor marker (its level increases with endometriosis and adenomyosis).
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
Adenomyosis is treated by gynecologists and endocrinologists. There are conservative and surgical methods of treatment.
- oral cotraceptives with the formation of amenorrhea (absence of menstruation), which lead to blocking of menstruation and removal of foci of endometriosis. Prescribe drugs with ethinyl estradiol at a concentration of 0.03 and higher for 6-12 months of a continuous course,
- gestagens (dydrogestenone, medroxyprogesterone, gestrinone), they lead to atrophy of endometrioid foci,
- androgens (danazol) with the formation of amenorrhea and removal of foci of endometriosis. But the drugs have a number of serious side effects,
- synthetic analogs of gonadoliberins (nafarelin, histrelin) in drops or sprays, intramuscularly to reduce estrogen levels.
The treatment has side effects and is carried out strictly under the supervision of a physician.
Self-medication of endometriosis and adenomyosis is life-threatening!
Surgical treatment of adenomyosis is the removal of the uterus – the only radical cure.
Conservative measures lead to relief, but full recovery is infrequent, and the process can spread and recur. The indications for such a radical operation must be very strict – the presence of children, the patient’s age and her desire for surgery.
The prognosis of adenomyosis in each case is individual, with small foci, favorable, with large ones, doubtful.
Prevention of adenomyosis is a regular visit to the gynecologist and examination at the slightest complaint.