Adenomyosis is defined as a disease caused by heterotopic growth of glands and stroma - the lining of the uterus, which is rejected monthly with. Although the disease is generally considered to be a benign process, cellular activity and progression often lead to pain and termination of normal pregnancy. Moreover, if for a long time allow adenomyosis to develop, and the most terrible consequence– infertility. One of the most important studies in diagnosing adenomyosis is ultrasound, which can provide basic information about the development of the pathology.

• Adenomyosis as a pathology of the endometrium

  Adenomyosis is a common disease. Frequent companions of this pathology are the (overgrowth) of the endometrium. In terms of frequency of occurrence, adenomyosis ranks third after inflammatory processes and uterine leiomyoma.

  Adenomyosis is one of the stages of endometriosis. According to the place of development, there is the following classification: genital and extragenital. The genital form, in turn, depending on the location, can be internal or external.

  External endometriosis affects the following:

  • parts of the cervix and body of the uterus,
  • retrocervical area,
  • the fallopian tubes,
  • vagina,
  • ovaries,
  • sheets of peritoneum,
  • Douglas space.

  The internal one targets the body of the uterus or the supravaginal part of the cervix.

  Most domestic doctors, following Western researchers, are inclined to believe that internal endometriosis is adenomyosis. The famous authors of the widespread classification of endometriosis B.I. Zheleznov and his colleague A.N. Strizhakov believe that adenomyosis is only the 2nd and 3rd degree of the internal form of endometriosis. Such degrees are characterized by hyperplastic processes of muscle tissue, as well as foci of endometrial invasion into myometrial tissue.

  There is also a classification of adenomyosis. Adenomyosis is divided into:

  • diffuse (spreading throughout the endometrium),
  • focal,
  • nodal.

  Reasons for development

  The cause of endometrial tissue pathologies, including adenomyosis, is uncertain, but several theories have been put forward. A common theory is the implantation of separated endometrial cells during retrograde reflux menstrual blood through .

  Other theories suggest metaplasia of the peritoneal mesothelium or spread by hematogenous and lymphatic routes. Genetic factors may also play a role, given the concordance of endometriosis in monozygotic twins. Much research has been carried out in search of a definitive cause of the disease, and such research is still ongoing.

  Risk factors

  Risk factors for the development of adenomyosis include increased levels of estrogen in the blood, early onset of menstruation, their abundance and increased duration (more than 8 days according to modern data), surgeries, the influence of an unfavorable environmental situation, smoking, obesity, prolonged stress, immune system disorders.

  There are studies that prove the presence of pathological contractility of uterine myocytes with adenomyosis, which indicates a possible genetic predisposition to this disease.

  Endometriosis and its symptoms are directly related to cyclical hormonal stimulation and are therefore only considered in women of reproductive age. Women who have undergone bilateral oophorectomy and rapid and complete removal ectopic endometrioid tissue, the disappearance or significant weakening of symptoms was observed. Natural menopause also brings gradual relief from symptoms. Without cyclic hormonal stimulation by the ovary, bleeding from ectopic lesions stops, which leads to a decrease in symptoms.

  Symptoms

  Symptoms of adenomyosis include:

  • pain of varying intensity in the lower abdomen and lumbar region,
  • worse during menstruation,
  • premenstrual syndrome,
  • painful sexual intercourse,
  • painful bowel movement,
  • spotting “chocolate” discharge after and before menstruation.

  Adenomyosis is often accompanied by infertility, which is associated with the presence of resistance to progesterone and decreased endometrial receptivity in such patients.

  Diagnostics

  Bimanual examination

  To diagnose this pathology, a bimanual examination is used. With this method, the doctor places one hand on the stomach and the other in the vagina. Such an examination makes it possible to determine, and quite often, poor mobility that develops due to adhesive process.

  Inspection in the mirrors

  Carrying out an examination in the mirrors on the chair is able to provide the doctor with information about the presence of endometriotic lesions in the vagina and on the surface of the vaginal part.

  Ultrasound diagnostics

  Based on the symptoms identified during questioning and initial examination, the gynecologist can refer the patient to. Moreover, if there is reason to believe that a woman has adenomyosis, it is better to perform a dynamic ultrasound to assess changes in the structure of the myometrium and endometrium, preferably.

  Preparation - cleansing the intestines on the eve of the study, it is advisable not to eat gas-forming foods (legumes, fresh cabbage, etc.) the day before.

  When the first (initial) stage of internal endometriosis is detected, the uterus may be slightly enlarged on ultrasound; small cystic inclusions up to 2-3 mm in diameter can be detected in the projection of the uterine walls. Cystic formations can affect the structure of the myometrium: it becomes heterogeneous. In this case, echogenicity increases slightly.

  An ultrasound scan may reveal a round, spherical shape of the uterus. This occurs because the anteroposterior size of the uterus increases and becomes more than 45 mm. In addition, ultrasound may reveal that the ratio of length to thickness of the uterine body increases to 1-1.1.

  When stage 2 or 3 of adenomyosis occurs, the muscular wall of the uterus is damaged towards the serous layer. This indicates diffuse damage to the uterus, in which the following symptoms may be observed:

  • characteristic echo pattern of myometrial heterogeneity like a “honeycomb”;
  • asymmetry of the thickness of the uterine walls;
  • linear striations and blurred outline are visualized;
  • thickening of the uterine connective zone more than 12 mm;
  • increased size of the uterus;
  • the echogenicity of the layers of the uterus closest to the sensor increases significantly, which makes inspection of the underlying uterine wall not the easiest task;
  • the size of the uterus is increased;
  • a large number of linear stripes of medium and low echogenicity that run perpendicular to the scanning plane (such stripes diverge in a fan shape from the ultrasound sensor).

  The nodular variety has the shape of a round formation. Such formations do not have very clear contours and are hyperechoic, which is caused by the absence of a connective tissue capsule.

  The heterogeneous structure of the uterus is caused by cystic inclusions of a nature that have a diameter of 2-6 mm. The uterine wall affected by adenomyosis is thicker than the healthy one. With focal lesions, the area of ​​the myometrium altered by adenomyosis contains several endometrioid nodes, often with cystic inclusions.

  Ultrasound picture in Doppler mode

  With adenomyosis, a slight increase in vascular resistance and increased blood flow in tissues affected by the disease can be detected. In addition, the vascular resistance index in the affected areas will be from 0.45 to 1.0. The adenomyosis inclusions themselves are not penetrated by vessels.

  Possible diagnostic errors

  Differential diagnosis of adenomyosis is not an easy matter. In this regard, errors often occur when diagnosing adenomyosis, due to the fact that its symptoms can imitate the signs of other diseases.

  For example, myomatous nodes can be confused with endometrial tissues located in unusual places for them. The former may be favored by the specific “bending around” of the node by the feeding vessel in the CDC or EDC mode. In addition, the pathology of the endometrium in this case can be indicated by the relative immutability of the structure of the fibroids, which is revealed during regular examinations during the menstrual cycle, and the clarity of its contours.

  Also, endometriosis (internal, diffuse form) can be visually confused with metroendometritis, in which swelling of the myometrium and changes in the echographic characteristics of its structure and the structure of the M-echo are also observed. However, with metroendometritis there will be characteristic clinical symptoms and laboratory test data.

  The nodular form of adenomyosis may resemble the structure of uterine sarcoma, however, this formation has characteristic hypervascularization in the CD mode with a low-resistant type of blood flow. An arteriovenous anomaly of the uterus can be distinguished from adenomyosis by also using. In this case, pathological vascular cavities will be displayed by color loci with a turbulent appearance of blood flow with a high systolic velocity.

  The effectiveness of adenomyosis directly depends on the following: the qualifications of the doctor, the choice of scanning method, and the correct assessment of the formed clinical picture.

  Often diagnostic difficulties that arise during a single visit to the office ultrasound diagnostics, are permitted with dynamic monitoring: visits to the ultrasound diagnostic room throughout the menstrual cycle.

  In this case, signs of endometrial pathologies can be assessed more effectively and with greater accuracy.

  An ultrasound doctor performing an examination on a woman with suspected adenomyosis must know the clinical symptoms of all possible gynecological diseases and have information about the echographic picture of internal endometriosis in order to avoid possible errors and loss of time for the patient and her attending physician.

  Adenomyosis on echograms

  

  

  

Adenomyosis is one of the most common gynecological diseases. It is also called internal endometriosis.

It is with the development of adenomyosis that most cases of constant pain in the lower abdomen in women of reproductive age are associated.

With this pathology, the cells lining the inner layer of the uterus begin to grow, going beyond their usual location.

In internal endometriosis, or adenomyosis of the uterus, the endometrium (the layer of cells lining the uterine cavity) grows into the myometrium (the muscular layer of the uterus).

In this case, the uterus takes on a round or spherical shape and increases significantly in size, often reaching the size of the uterus at 5-6 weeks of pregnancy.

Endometrial cells that end up in the muscle layer disrupt its normal functioning. This is the main danger of this disease.

This is a hormone-dependent disease, i.e. it is caused by an imbalance and relationship between certain hormones in a woman’s body.

The epithelium lining the inner surface of the uterus can penetrate the muscle layer to different depths. Depending on this, a certain stage of adenomyosis is distinguished.

The first stage is characterized by the germination of endometrial cells within the boundaries of the submucosal layer, i.e. without reaching the myometrium itself.

The second stage is characterized by germination of the endometrium to half of the myometrium (the muscular lining of the uterus).

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

At the fourth stage, the endometrium grows through the wall of the uterus, reaching its serous membrane, and then, in the absence of treatment, the pathological process also affects the peritoneum. This is the most advanced stage.

Forms of adenomyosis

There are not only different stages (degrees), but also various shapes adenomyosis.

Diffuse form of adenomyosis– characterized by the fact that endometrial tissue grows into the myometrium evenly, without forming separate isolated areas.

Focal form- characterized by the fact that germination does not occur over the entire surface of the border between the inner and middle membranes of the uterus, but focally - only in some areas.

In this case, the stages of the disease are determined depending on the number of these areas and the depth of germination of the endometrium into the muscular layer.

Mixed form is a cross between the two options described above.

Determination of the form of adenomyosis is carried out based on data ultrasound examination or CT.

Causes of adenomyosis development

If we talk about the reasons for the development of adenomatosis, then they all boil down to the fact that they lead either to a violation of the integrity, traumatization of the endometrium, or to a hormonal imbalance. In fact, the main, leading cause of the development of adenomyosis is still hormonal imbalance. It is this factor that is primary and underlies the pathogenesis of this pathology.

To others important factor is hereditary predisposition. It creates a certain background that contributes to the development of this type of pathology. That is why, when patients are exposed to provoking factors, adenomyosis develops only in some of them.

Late or too early onset of menstruation– another important factor. However, as mentioned above, it is rather a consequence, a manifestation of hormonal imbalance or a tendency to develop it, which is already present in the patient.

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

If a pathology occurs in one organ or system, then, as a rule, this will somehow affect the functioning of the entire organism. This is especially true for obesity, when several systems are involved in the pathological process: endocrine, digestive, cardiovascular and reproductive.

The thing is that fat cells produce estrogen-like substances that disrupt the hormonal balance throughout the body.

In addition, obesity leads to metabolic disorders throughout the body, with almost all organs and tissues affected.

Starting sexual activity too late. Oddly enough, this factor also plays a role in the development of uterine adenomyosis. The onset of sexual activity triggers a number of changes in a woman’s hormonal background.

And if in Soviet times, the beginning of sexual activity at the age of 16 was considered almost shameless, now this state of affairs is a classic, the norm. And you will hardly surprise anyone with a girl who lost her virginity at 14 or even 13 years old.

But when is it too late for “this” thing? Here the views of doctors differ. It is generally accepted that the onset of sexual activity after 25 years can already be considered late and hormonal imbalance in such cases cannot be avoided.

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

Abortions, curettages or other manipulations inside the uterine cavity. Often, these procedures cause mechanical trauma to the endometrium, the epithelium lining the uterine cavity. It is precisely such micro-traumas that can become a trigger that initiates a chain of pathological changes leading to the growth of the endometrium into the myometrium.

. At the same time, it is not only the installation of an intrauterine device that is dangerous, which (as described above) can lead to mitrotraumatization of the endometrium; oddly enough, the factor provoking adenomyosis is also one of the most common methods of contraception - taking contraceptives.

This is due to the fact that contraception of this kind is provided by taking low doses of sex hormones, which, although to a small extent and in low doses, still change the hormonal background of a woman and affect it.

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

A chronic inflammation meanwhile, it progresses like an echo, echoing in the work of other organs, disrupting the structure of the inflamed organ and invariably leading to disruption of its function.

Serious physical activity also serve as a serious risk factor for the development of adenomyosis. The female body is not adapted for heavy physical labor, carrying heavy loads, therefore, if a woman is engaged in this kind of work, the risk of developing adenomyosis increases many times over.

Constant stress. It’s not for nothing that there is an old saying: “all diseases come from nerves.” A person’s psychological state undoubtedly plays a huge role in the development of one or another pathology. And if we are talking about the female body, namely the reproductive system, then everything here is even more subtle and sensitive to external influences.

The constant negative impact of stress is quite enough for a woman to develop adenomyosis, and more than once. This is why it is so important for the doctor to ask the patient in detail about psychological climate in her family, her living conditions, negative social factors that could potentially affect her health.

Extragenital pathology. The development of adenomyosis is also greatly influenced by the presence of extragenital pathology in the patient, i.e. other concomitant diseases that affect the course of adenomyosis or contribute to its development.

Symptoms

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

• Heavy menstrual bleeding is a fairly common symptom of adenomyosis. The danger of this condition, in addition to the significant discomfort of the woman herself, is the threat of developing anemia, which aggravates the patient’s condition. Especially in the case of advanced, untreated adenomyosis.
• Brownish discharge between periods. Some women mistake this discharge for an early onset of menstruation. Such mini-bleedings also contribute to the development of anemia and cause significant discomfort to the woman.
• Dyspareunia is a “terrible” medical term for sharp pain during sexual intercourse. This often becomes a serious problem for both partners. This Very common reason when a woman seeks help from a doctor, since such symptoms of adenomyosis become a cause of concern for married couple and require immediate permission. It is this, and not other symptoms, that often cause a patient to see a doctor.
• Intense pain in the lower abdomen immediately before, during and immediately after menstruation . Troubles such as pain during menstruation are more than common. In this regard, many women believe that these types of symptoms are not a sufficient reason to see a doctor and silently heroically endure the torment, washing down the pain that torments them with handfuls of painkillers. This approach is fundamentally incorrect, since it can lead to more serious complications of adenomyosis in a woman.
• Disruptions in the well-functioning menstrual cycle. Most often, it becomes shorter, thereby bringing additional inconvenience to the woman;
• An instrumental examination reveals a significant increase in the size of the uterus. This can also be determined by palpation, when examining a woman by a gynecologist;

The most common symptoms of adenomyosis are quite easily confused with signs of other diseases.

Treatment

Treatment of this disease is often lengthy and requires a lot of patience, both on the part of the patient and on the part of the doctor treating her.

Therapy for adenomyosis can be divided into two main areas:

• conservative treatment
• surgery

Conservative treatment primarily means drug treatment. In this case, the woman is prescribed various types of hormonal drugs. These are both progestogens and androgens; In this case, oral contraceptives can also be very effective.

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

Methods of surgical treatment of adenomyosis can be extremely radical, including removal of the uterus. For this reason, most doctors still try to avoid this type of surgical intervention and place all their hopes on conservative treatment.

However, in Lately There are more and more opponents of such radical methods among surgeons surgical intervention with adenomyosis. In this regard, a number of organ-saving surgical techniques for this disease have been developed. Such organ-saving operations are performed by hysteroscopy and laparoscopically.

The modern rhythm of life leads to the fact that women pay less and less attention to their health, trying not to notice the symptoms of many diseases, including adenomyosis. This disease usually occurs after 30 years of age, and its prevalence is about 70%. It is believed that with the onset of menopause, the pathology goes away on its own, but during pregnancy, adenomyosis can become an unexpected obstacle.

Definition

This disease is also called internal genital endometriosis, and the symptoms of uterine adenomyosis are associated with hormonal processes occurring in the female body.

The internal cavity of the uterus is covered with a mucous membrane (endometrium), which during the menstrual cycle increases in volume in order to then surround the fertilized egg. If pregnancy does not occur, the excess endometrium is shed and leaves the body with discharge during menstruation. Normally, the uterine mucosa should grow into the organ cavity, but with various disorders it penetrates into the muscular (myometrium) and its other layers. This causes an increase in the myometrium and the entire uterus as a whole, which is a manifestation of adenomyosis. This happens when the functioning of the whole body is disrupted and the immune system is weakened.

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

Let's figure it out.

Adenomyosis sometimes called “internal endometriosis,” equating this disease to a type of endometriosis. Most researchers believe that although these diseases are similar, they are still two different pathological conditions.

What is adenomyosis?

Let me remind you that the uterine cavity is lined with a mucous membrane called the endometrium. The endometrium grows during the menstrual cycle, preparing to receive a fertilized egg, and if pregnancy does not occur, the surface layer (also called “functional”) is shed, which is accompanied by bleeding (this process is called menstruation). A growth layer of the endometrium remains in the uterine cavity, from which the endometrium begins to grow again in the next menstrual cycle.

The endometrium is separated from the muscular layer of the uterus by a special thin layer of tissue that separates these layers. Normally, the endometrium can only grow towards the uterine cavity, simply thickening during the menstrual cycle. With adenomyosis, the following happens: different places The endometrium grows through the separation tissue (between the endometrium and the muscle) and begins to penetrate the muscular wall of the uterus.

Important! The endometrium does not grow into the wall of the uterus along its entire length, but only in places. For clarity, I will give an example. You planted seedlings in a cardboard box and if you haven’t transplanted them into the ground for a long time, individual roots will grow through the box. This is how the endometrium grows in the form of separate “roots” that penetrate the muscular wall of the uterus.

In response to the appearance of endometrial tissue in the muscle of the uterus, it begins to react to the invasion. This is manifested by reactive thickening of individual bundles of muscle tissue around the invading endometrium. The muscle seems to be trying to limit the further spread of this ingrowth process.
As the muscle increases in size, the uterus accordingly begins to increase in size and acquires a spherical shape.

What forms of adenomyosis are there?

In some cases, the implanted endometrial tissue forms foci of its accumulation in the thickness of the muscle, then they say that this is “adenomyosis – focal form.” If there is simply implantation of the endometrium into the uterine wall without the formation of foci, they speak of “diffuse form” of adenomyosis. Sometimes there is a combination of diffuse and nodular forms of adenomyosis.

It also happens that the endometrium, embedded in the wall of the uterus, forms nodes very similar to the nodes of uterine fibroids. If uterine fibroids, as a rule, are represented by muscle and connective tissue components, then in adenomyosis nodes the glandular component and connective tissue predominate. This form of adenomyosis is called "nodal"

It can be very difficult to distinguish a uterine fibroid node from a nodular form of adenomyosis using ultrasound. In addition, it is believed that endometrial tissue can invade existing myomatous nodes. Quite often you can see a combination of adenomyosis and uterine fibroids. For example, against the background of diffuse adenomyosis, there are nodes of uterine fibroids.

It is very important as a result of the diagnosis to make the correct diagnosis and clearly determine what exactly is present in the uterus - uterine fibroids or adenomyosis nodular form. Treatment for uterine fibroids and adenomyosis is virtually the same, but the effectiveness is different, and this will affect the prognosis of treatment.

What causes adenomyosis?

The exact cause of adenomyosis is still not known. It is assumed that all factors that disrupt the barrier between the endometrium and the muscular layer of the uterus can lead to the development of adenomyosis.

What exactly:

Curettage and abortions

evil of uterine fibroids (especially with opening of the uterine cavity)

ChildbirthInflammation of the uterus (endometritis)Other operations on the uterus

In the same time, but very rarely, adenomyosis is found in women who have never had the interventions and diseases described above, as well as in young teenage girls who have only recently started menstruating.
In these rare cases it is assumed two reasons.

First reason is associated with the occurrence of disturbances during the intrauterine development of a girl, which leads to the fact that the endometrium without any disturbances external factors implants into the wall of the uterus.

The second reason due to the fact that young girls may have difficulty opening the cervical canal during menstruation. Muscular contractions of the uterus during menstruation in the presence of cervical spasm create very high pressure inside the uterus, which can have a traumatic effect on the endometrium, namely the barrier separating the endometrium and the muscular layer of the uterus. As a result, the endometrium may invade the uterine wall.

In addition, it is this mechanism that can play a role in the development of endometriosis, since when the outflow of menstrual discharge from the uterus is difficult, under the influence of high pressure, these discharges through the pipes in large quantities enter the abdominal cavity, where implantation of endometrial fragments on the peritoneum occurs.

How does adenomyosis manifest?

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

Diagnosis of adenomyosis

Most often, the diagnosis of adenomyosis is made during Ultrasound. In this case, the doctor sees “an enlarged uterus, a heterogeneous structure of the myometrium (they also write “heterogeneous echogenicity”), the absence of a clear boundary between the endometrium and myometrium, “jaggedness” in the area of ​​this border, the presence of foci in the myometrium.

The doctor can describe sharp thickening of one of the walls of the uterus compared to the other. These are the most common ultrasound descriptions of adenomyosis that you can read in your report. During an examination on the chair, the doctor can say that the uterus is enlarged in size, the very important word is “round uterus”.

The diagnosis of adenomyosis is also often made during hysteroscopy. During this procedure, the so-called “passages” are seen - these are red dots in the endometrium, which correspond exactly to the places where the endometrium has penetrated into the wall of the uterus.

Less commonly used to confirm the diagnosis MRI. This method is most indicated in cases where ultrasound cannot reliably distinguish between the nodular form of adenomyosis and uterine fibroids. This is important when planning treatment tactics.

Important! Since adenomyosis in more than half of women is asymptomatic and most women live their lives without knowing that they had adenomyosis (adenomyosis, like uterine fibroids and endometriosis, regress after menopause) - you should not immediately worry if during examination, you are given this diagnosis.
This is a fairly common situation– you come for a routine examination or with complaints of vaginal discharge – at the same time they do an ultrasound and diagnose you with “adenomyosis”, although that you do not have symptoms characteristic of this disease. The doctor is obliged to describe the changes that he saw, but this does not mean that you urgently need to start treatment.

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

Adenomyosis in most cases is characterized stable asymptomatic course, without progression of the disease, unless additional factors are created for this in the form of abortions and curettage.

In most women, adenomyosis exists as a “background” and does not require serious treatment, only preventive measures which I will describe below.

Adenomyosis as a serious problem is less common; as a rule, in this situation it immediately manifests itself with symptoms and has a progressive course. This “adenomyosis” requires treatment.

Treatment of adenomyosis

Adenomyosis cannot be cured completely, unless of course you take into account the removal of the uterus. This disease regresses on its own after menopause. Until this point, we can achieve a slight regression of adenomyosis and prevent further development diseases.

For the treatment of adenomyosis, virtually the same approaches are used as for the treatment of uterine fibroids.

Since adenomyosis regresses after menopause, GnRH agonist drugs are used (

Endometriosis of the uterine body

Based on ultrasound morphology, diffuse (adenomyosis) and local forms are distinguished.

Diffuse form of endometriosis: the uterus is enlarged up to 5-9 weeks of pregnancy, spherical in shape. Before and during menstruation, the size of the uterus increases compared to those in the intermenstrual period. The contours of the uterus are always clear and even. The spherical configuration of the uterus is the main symptom of adenomyosis.

Myometrial structure May be:

1. normal (small endometriotic inclusions are not visualized during echolocation)
2. heterogeneous due to echo-positive inclusions of a point or linear shape (depending on localization in the plane of the ultrasound section), 1-5 mm in size (endometrioid heterotopias and areas of local fibrosis), diffusely located throughout the thickness of all walls.

Myometrial echodensity average (normally it is low) - compare the echo density of the body with the cervix. An increase in the echo density of the endometrium is due to the presence of foci of endometriosis. There may be a decrease in the intensity of the image of the uterus before menstruation due to vasodilatation and the phenomenon of edema in the area of ​​endometriotic heterotopias.

With transvaginal ultrasound, especially in young patients with a short duration of the disease, diffusely dilated convoluted vessels, reminiscent of varicose veins, can be seen in the uterine wall. The same changes can occur with very pronounced activity of the pathological process.

Endometrium- expressed to a greater extent than it should be according to the duration of the menstrual cycle due to glandular hyperplasia, which in adenomyosis occurs without pathological transformation of the mucosal glands, and is accompanied only by an increase in their volume and number.

Ovaries- not enlarged, normal echostructure

Bladder- may be deformed from the pressure of the enlarged uterus on it. In isolated forms of endometriosis, the uterine body has no changes in the retrouterine and retrocervical spaces.

Control ultrasound during the treatment of adenomyosis: under the influence of drug treatment of endometriosis, the size of the uterus and the density of its tissue are significantly reduced, but the spherical shape remains unchanged. The positive dynamics of the course of adenomyosis is accompanied by significant clinical improvements, up to the complete disappearance of pain. This picture is typical for highly differentiated foci of endometriosis.

The lack of effectiveness of conservative treatment measures, significant progression of the pathological process with deterioration of all clinical indicators indicates the presence of poorly differentiated foci of endometriosis that are not amenable to hormone therapy. In this case, surgical treatment is indicated.

Ultrasound data of adenomyosis in other age periods

Teenage, youthful (from 12 to 20 years old)- the uterus may not be enlarged or enlarged slightly (up to 4-5 weeks). Often there is no change in the structure of the myometrium and no increase in its density. In young patients, the structure of the walls is usually normal, and the echo soundness may be reduced due to the predominance of vascular and muscular reactions, or normal. But a diffuse increase in the density of the uterine walls may be observed with its echostructure unchanged. In this case, a specific sign of adenomyosis is always present - globularity of the uterus.

During puberty during the initial phases of the disease, in the presence of an appropriate clinic, echographic symptoms of the disease may be completely absent (ultrasound-negative form of endometriosis). In the absence of specific treatment, the disease progresses with varying intensity of increase in subjective and objective manifestations, which can subsequently be recorded using ultrasound.

Menopause- the uterus decreases in size, but remains spherical.

Variants of echo picture of adenomyosis

1. Ultrasound-negative phase
2. There is no increase in the size of the uterus, but its shape is spherical or close to it; the structure of the myometrium is not changed, echo density may be reduced or normal
3. Enlargement of the uterus is insignificant or absent in the presence of a spherical shape and increased myometrial density in all parts
4. The uterus is spherical, enlarged from 4-5 to 6-7 weeks of pregnancy, the structure of the myometrium is homogeneous, its density is increased (medium, less often high)
5. In addition to the indicated signs and more pronounced enlargement of the uterus (up to 9 weeks of pregnancy), evenly spaced multiple small echo-positive inclusions are located in the thickness of the myometrium
6. Reverse development of pathological changes during menopause

Differential diagnosis

It is carried out with diseases and conditions accompanied by an increase in the size of the uterus: metroendometritis, diffuse form of fibroids, diffuse form of endometriosis, normal variant.

Note: Some increase in the size of the uterus can also occur in healthy tall women (large uterus), as well as before menstruation, after repeated births, in the presence of an intrauterine contraceptive device, with retroflexio or saddle-shaped uterus.

Unlike endometriosis, in the first four cases the uterus remains normal shape(oval or pear-shaped), and the myometrial density is assessed as low. It should be noted that with a pronounced bend, the size of the uterus may be larger than normal, and the shape approaches spherical. In such observations, the fact of a diffuse increase in myometrial density in adenomyosis and the absence of clinical manifestations of this disease in other conditions plays a decisive role.

In addition, 60-70% of women with diffuse endometriosis of the uterus have glandular endometrial hyperplasia to varying degrees.

Algorithm for differential diagnosis of adenomyosis, diffuse form of fibroids and metroendometritis

Local form of endometriosis: characterized by the presence in the myometrium of one (most often) to 4 compactly located echo-positive inclusions of irregular round, oval or blocky shape, without an acoustic shadow in the myometrium behind the echo-positive focus (the presence of such a shadow is evidence of a calcified fibromatous node). Their sizes range from 2 to 6 mm in diameter.

There is no significant enlargement of the uterus or changes in its shape.

Echopoietic inclusions in the myometrium in the local form of endometriosis are areas of limited fibrosis that have developed around endometrioid heterotopias and, as long as menstrual cyclic transformations occur in them, they can increase in size and take on the appearance of small, clearly defined nodes of irregular shape.
The endometrium is not changed.

Note: echo-positive inclusions of this form can also be observed in uterine fibroids, when the parenchymal component of the tumor is completely replaced by a mature fibrous tissue. Only for women reproductive period This is extremely rare. As a rule, a similar picture can be found in menopause, when the reverse development of long-existing fibroids occurs.

Content

Adenomyosis

The spherical shape of the uterus is a change in the shape and structure of the organ, which most often occurs as a result of a disease or pregnancy. The main cause is still adenomyosis.

Adenomyosis is the growth of the endometrium of the uterus into the muscle layer. Cell proliferation occurs by contact. At the same time, the organ increases in size and acquires a spherical shape. The uterus reaches the volume that is usually characteristic of 5-6 weeks of pregnancy. This pathological process, namely the ingrowth of endometrial cells into the muscle layer, disrupts the contractile function of the organ and leads to a number of serious consequences.

The disease usually occurs in women of childbearing age, especially after 27-30 years. Adenomyosis is the third most common disease of the female reproductive system and often occurs in combination with fibroids or external endometriosis. As the cells of the inner lining of the globular uterus divide, their appearance in the muscle layer can cause the formation of cysts, tumors or adhesions in the surrounding tissues.

Classification

• focal type. In this case, the cells of the inner membrane penetrate into the muscle layer, forming separate foci.
• node type. In this case, endometrial cells spread throughout the muscle layer in the form of nodes. The nodes are most often surrounded by connective tissue and have a cavity filled with blood.
• diffuse type. This type is not characterized by the formation of nodes or foci when the endometrium penetrates the myometrium. The uterus takes on a spherical shape and increases significantly in size.
• mixed type. In this case, the morphology and structure of the spherical uterus includes features of a nodular and diffuse type.

1. 1st degree. Violations are observed only in the submucous membrane of the spherical uterus.
2. 2nd degree. Endometrial cells penetrate into the myometrium to a shallow depth.
3. 3rd degree. The proliferation of mucosal cells occurs in most of the muscular layer of the globular uterus.
4. 4th degree. Structural changes are noted throughout the depth of the myometrium; in addition, the pathology can spread to neighboring organs and tissues.

In later stages, the disease can cause not only changes in the shape of the uterus, but also the spread of pathology to the organs and muscle fibers of the abdominal cavity.

Causes of the disease

The cause of a spherical uterus may also be a hereditary predisposition.

Chronic inflammatory diseases of the genitourinary system, regular excessive physical activity, stress and hard work - all these are prerequisites for disrupting the functioning of a woman’s reproductive system. That is why, to eliminate this or that pathology, doctors first of all recommend getting more rest and normalizing your work schedule.

Main symptoms

• Severe pain in the lower abdomen. Such pain is especially often associated with the menstrual cycle. Many women mistakenly believe that severe pain before, during or after menstruation is normal. However, this is absolutely not true. Such a symptom may indicate a serious disease of the reproductive system.
• Difficulties conceiving and bearing a child. A spherical uterus and a violation of the integrity of the muscular layer of the organ often causes adhesions in the fallopian tubes, which subsequently prevents the release of the egg and its fusion with the sperm. Increased myometrial tone due to the penetration of endometrial cells into it can cause spontaneous miscarriage, i.e. termination of pregnancy.

Diagnostics

The first thing they do to diagnose any disease is interview the patient, as well as study the medical history. Next, the gynecologist needs to conduct an examination on the chair using special instruments. It is best to carry out the examination a few days before the start of menstruation - this applies to ultrasound examination. During the examination, the doctor determines a change in the shape of the uterus and an increase in the size of the organ. There may also be tuberosity of the endometrium, the presence of nodes or bumps on the walls of the inner lining of the uterus.

The use of several diagnostic methods will allow you to obtain the most complete and accurate information about the patient’s condition, as well as select effective and safe treatment.

Treatment

One of the main signs of which is a spherical uterus, depends on the degree and type of the disease. The patient’s age, individual characteristics of the body, and whether the woman plans to become pregnant in the future are also taken into account.

There are two types of treatment.

• Conservative. It only means drug treatment. In this case, the doctor prescribes anti-inflammatory and hormonal drugs, vitamin complexes, as well as agents that activate the immune system.
• Surgical. If medication treatment does not help, surgery is performed. It can be of two types: radical, in which the affected organ is completely removed, or gentle, with preservation of the uterus. Complete removal occurs quite rarely, in the most extreme cases and only for patients over 40-45 years old. In other cases, the affected area of ​​the endometrium is cauterized with a laser or electric current.

Adenomyosis and changes in the shape of the uterus as a result of the disease are conditions that are characterized by a chronic course and regular development of relapses. In 70% of patients, after appropriate treatment, the disease recurs over the next 5 years. Women over 40 years of age are least susceptible to relapses, as the functioning of their ovaries begins to fade.

What is uterine adenomyosis grades 1, 2, 3 and 4?

I. Diffuse proliferation of endometrial cells in the submucosal layer of the uterus.

II. The pathological process penetrated into the muscular layer of the uterus, but captured no more than half of this layer.

III. The muscle layer is involved in the pathological process by more than half.

IV. Proliferation of endometrial cells outside the muscular layer, in the serosa of the uterus, with further transition to the peritoneum and involvement of the pelvic organs in the process.

What is the danger of adenomyosis (endometriosis)?

How many women suffer from adenomyosis?

What causes the development of adenomyosis?

Risk factors for developing adenomyosis include:

• unfavorable heredity for endometriosis, as well as for benign and malignant tumors female genital area;
• too early or late onset of menstruation;
• late onset of sexual activity;
• late birth;
• complicated childbirth;
• obesity;
• various manipulations on the uterus (abortion, diagnostic curettage);
• use of an intrauterine device;
• use of oral contraceptives;
• inflammatory diseases of the uterus and appendages, dysfunctional bleeding, especially if there have been surgical interventions and/or long-term hormonal therapy;
• the presence of systemic extragenital diseases (hypertension, diseases of the gastrointestinal tract);
• frequent infectious diseases, allergic reactions, indicating dysfunction of the immune system;
• low socioeconomic status;
• hard physical labor;
• stress, sedentary lifestyle;
• living in an environmentally unfavorable region.

Symptoms of uterine adenomyosis

• weakness;
• drowsiness;
• tendency to various infectious diseases;
• pallor skin and visible mucous membranes;
• in severe cases - shortness of breath with little physical exertion;
• dizziness;
• a sharp decrease in performance and the ability to adequately assess one’s own condition.

Symptoms pathognomic for adenomyosis also include the appearance of brown spotting 2-3 days before the onset of menstruation, and 2-3 days after it.

How does adenomyosis occur in combination with uterine fibroids?

Signs of a combination of adenomyosis and ovarian endometriosis

I. Point foci of endometriosis on the surface of the ovary and on the peritoneum, in the recess between the uterus and rectum.

II. Unilateral endometroid cyst no larger than 6 cm in size, adhesions in the area of ​​the uterine appendages without involving the intestines.

III. Bilateral endometroid cysts up to 6 cm in size, pronounced adhesions involving the intestines.

IV. Large bilateral cysts, transition of the process to the bladder and large intestine, widespread adhesions.

What tests are used to diagnose adenomyosis?

What are the echo signs of adenomyosis?

1. An increase in the anteroposterior size of the uterus, as a result of which the organ acquires a spherical shape.

2. Enlargement of the uterus up to 6 weeks of pregnancy or more.

3. Asymmetry of wall thickness.

4. The appearance on the eve of menstruation in the muscular lining of the uterus of cystic cavities measuring 3-5 mm or more.

What treatment is prescribed for uterine adenomyosis?

• the patient’s age and her desire to have children in the future;
• localization and prevalence of the pathological process;
• the severity of the clinical picture and the risk of complications;
• general condition of the body (presence of concomitant diseases, state of the immune system, etc.);
• duration of adenomyosis.

All medical measures to combat adenomyosis can be classified as follows:

I. Surgical treatment:

• radical (removal of the uterus and ovaries);
• organ-preserving (laparoscopy and excision of endometroid lesions).

II. Conservative treatment:

• hormone therapy;
• nonspecific anti-inflammatory therapy;
• sedatives (calming) drugs;
• vitamin therapy;
• maintaining liver function;
• elimination of anemia;
• immunomodulators;
• resorption therapy;
• physiotherapy.

III. Combined treatment.

• adenomyosis in combination with endometrial hyperplasia;
• functioning endometroid ovarian cysts (more than 5 cm in diameter);
• suppuration of the uterine appendages affected by endometriosis;
• adhesions in the ampullary section of the fallopian tubes (the main cause of infertility in endometriosis);
• ineffectiveness of hormonal therapy (no positive dynamics when treated with hormonal drugs for more than 3 months);
• the presence of somatic diseases that are contraindications to long-term hormonal therapy ( varicose veins veins and thrombophlebitis, serious illnesses liver, migraine, depression, epilepsy, cerebrovascular accidents, obesity, diabetes, hypertension, etc.).

Organ-conserving operations are not a radical method of treatment, since it is impossible to isolate all foci of endometriosis, however, they are the method of choice for women who want to restore and/or maintain reproductive function.

• progressive course of the disease in women over 40 years of age;
• lack of effect from combined treatment with organ-preserving operations;
• combination of nodular adenomyosis or diffuse adenomyosis of the 3rd degree with uterine fibroids;
• threat of malignant transformation.

Can adenomyosis be cured?

Is it possible to get pregnant with uterine adenomyosis?

1. Violation of the transport function of the fallopian tubes due to the adhesive process, or a decrease in their motor activity, so that the egg cannot get from the ovary to the uterine cavity.

2. Pathological changes in the hormonal sphere that prevent ovulation (the maturation of the egg and its release from the follicle). Some authors consider this reason to be the main reason for the occurrence of infertility with adenomyosis.

3. Autoimmune reactions leading to the deactivation of sperm in the uterine cavity, as well as preventing the implantation of a fertilized egg and the further development of the embryo.

4. Termination of pregnancy early stages due to increased myometrial contractility caused by inflammatory phenomena in the muscular layer of the uterus.

5. Pain during sexual intercourse, making regular sexual activity difficult.

Adenomyosis and pregnancy. Is there a chance of carrying and giving birth healthy?

1. In women with adenomyosis, the incidence of infertility is increased (from 40 to 80% according to various sources), however, timely comprehensive treatment of endometriosis in most cases leads to the restoration of the ability to bear children.

2. A frequent complication in women with adenomyosis is the threat of premature termination of pregnancy. However, adequate therapy in most cases allows the condition to stabilize. Treatment is carried out according to general standard scheme, as well as in women who do not suffer from adenomyosis.

3. Artificial or spontaneous termination of pregnancy leads to relapse or exacerbation of adenomyosis with subsequent accelerated development of the pathological process, therefore, if possible, one should strive to maintain pregnancy.

4. In most women with adenomyosis, childbirth proceeds safely, but in the afterbirth and early postpartum period there is an increased tendency to uterine bleeding, so the possibility of developing these complications should be taken into account.

5. After childbirth with restoration of menstrual function, activation of the process is possible, but it is always lower than in the case of artificial or spontaneous abortion.

6. After induced and spontaneous abortions, as well as after childbirth with restoration of menstrual function, patients with a history of adenomyosis must undergo anti-relapse treatment (hormonal therapy, immunomodulators, antioxidants, etc.).

What are the traditional methods of treating internal endometriosis?

(adenomyosis) of the uterus? Is it possible to cure adenomyosis with folk remedies?

What is a globular uterus

In some cases, the uterus may change its shape and become spherical, despite the fact that the organ is normally pear-shaped. Such changes occur either during pregnancy or with adenomyosis.

Adenomyosis

The spherical shape of the uterus is a change in the shape and structure of the organ, which most often occurs as a result of a disease or pregnancy. The main cause is still adenomyosis.

Adenomyosis is the growth of the endometrium of the uterus into the muscular layer. Cell proliferation occurs by contact. At the same time, the organ increases in size and acquires a spherical shape. The uterus reaches the volume that is usually characteristic of 5-6 weeks of pregnancy. This pathological process, namely the ingrowth of endometrial cells into the muscle layer, disrupts the contractile function of the organ and leads to a number of serious consequences.

The disease usually occurs in women of childbearing age, especially in their later years. Adenomyosis is the third most common disease of the female reproductive system and often occurs in combination with fibroids or external endometriosis. As the cells of the inner lining of the globular uterus divide, their appearance in the muscle layer can cause the formation of cysts, tumors or adhesions in the surrounding tissues.

Recently, research has been conducted in the field of science and medicine to establish the relationship between adenomyosis and infertility. It is believed that the pathological processes occurring in the spherical uterus can prevent the conception of a child.

Classification

There are two main classifications of adenomyosis, which is characterized by a spherical uterus. The first of them is based on morphology, cytology and histology. There are 4 main forms:

• focal type. In this case, the cells of the inner membrane penetrate into the muscle layer, forming separate foci.
• node type. In this case, endometrial cells spread throughout the muscle layer in the form of nodes. The nodes are most often surrounded by connective tissue and have a cavity filled with blood.
• diffuse type. This type is not characterized by the formation of nodes or foci when the endometrium penetrates the myometrium. The uterus takes on a spherical shape and increases significantly in size.
• mixed type. In this case, the morphology and structure of the spherical uterus includes features of a nodular and diffuse type.

The second classification option is based on the division of pathology into 4 degrees:

1. 1st degree. Violations are observed only in the submucous membrane of the spherical uterus.
2. 2nd degree. Endometrial cells penetrate into the myometrium to a shallow depth.
3. 3rd degree. The proliferation of mucosal cells occurs in most of the muscular layer of the globular uterus.
4. 4th degree. Structural changes are noted throughout the depth of the myometrium; in addition, the pathology can spread to neighboring organs and tissues.

Causes of the disease

The spherical shape of the uterus has several development paths. There are certain reasons for the growth of the endometrium, characterized by a change in the shape of the uterus to a spherical one. First of all, this is mechanical damage, injury or disruption of the integrity of the internal mucous membrane. Because of this, there is a strong growth of the endometrium, and the penetration of its cells into the muscular layer of the spherical uterus. Damage can occur during abortion, improper use of the intrauterine device, surgical curettage, as well as complicated childbirth.

The second important reason is changes in hormonal levels. It is this fact, according to many gynecologists, that is fundamental when changing the shape of the uterus to a spherical one. It follows that obesity or menstrual irregularities (periods started too early or too late) are also causes of the disease. Since both of these factors are most often provoked by serious disturbances in a woman’s hormonal system.

Changes in the functioning of the immune system play a key role in the development of the disease. A normal immune response will not allow endometrial cells to take root in unusual conditions.

Chronic inflammatory diseases of the genitourinary system, regular excessive physical activity, stress and hard work - all these are prerequisites for disrupting the functioning of a woman’s reproductive system. That is why, to eliminate this or that pathology, doctors first of all recommend getting more rest and normalizing your work schedule.

Main symptoms

There are absolutely specific symptoms, characteristic only of this disease, and general signs of dysfunction of the reproductive system. Some of them may practically not appear and may not cause discomfort to the patient. Everyday life, others can be quite serious and lead to complications.

Symptoms characteristic of adenomyosis, the main symptom of which is a spherical uterus:

• Heavy menstruation. The endometrium plays an important role in the menstrual cycle, because if fertilization does not occur, its cells are released from the body along with the blood. The growth of the endometrium into the muscle layer causes heavy bleeding. Often this process in its advanced form can lead to the development of anemia.
• Brown discharge before the onset of menstruation.
• Severe pain in the lower abdomen. Such pain is especially often associated with the menstrual cycle. Many women mistakenly believe that severe pain before, during or after menstruation is normal. However, this is absolutely not true. Such a symptom may indicate a serious disease of the reproductive system.
• Pain during sexual intercourse. Endometrial growth can cause discomfort or pain during sex. This is precisely what becomes a reason for a woman to see a doctor, after which the pathology of the genital organs is diagnosed.
• Difficulties conceiving and bearing a child. A spherical uterus and a violation of the integrity of the muscular layer of the organ often causes adhesions in the fallopian tubes, which subsequently prevents the release of the egg and its fusion with the sperm. Increased myometrial tone due to the penetration of epidermal cells into it can cause spontaneous miscarriage, i.e. termination of pregnancy.

In addition to all the listed symptoms, the patient may be bothered by frequent headaches, general malaise, nausea, gastrointestinal dysfunction, or frequent urination. However, these signs are only general for most diseases of the internal genital organs.

Diagnostics

The first thing they do to diagnose any disease is interview the patient, as well as study the medical history. Next, the gynecologist needs to conduct an examination on the chair using special instruments. It is best to carry out the examination a few days before the onset of menstruation - this applies to ultrasound examination. During the examination, the doctor determines a change in the shape of the uterus and an increase in the size of the organ. There may also be tuberosity of the endometrium, the presence of nodes or bumps on the walls of the inner lining of the uterus.

The main method for diagnosing most diseases of the internal genital organs is ultrasound. This method allows you to obtain the most accurate information about the location of the uterus, the features of its structure and structure, as well as its size and shape.

Hysteroscopy is another important method. It can be used to scrape and histological examination endometrium on glass, as well as detect places of penetration of endometrial cells into the myometrium of the uterus with video support.

Treatment

Treatment of adenomyosis, one of the main symptoms of which is a spherical uterus, depends on the degree and type of the disease. The patient’s age, individual characteristics of the body, and whether the woman plans to become pregnant in the future are also taken into account.

There are two types of treatment.

• Conservative. This means only drug treatment. In this case, the doctor prescribes anti-inflammatory and hormonal drugs, vitamin complexes, as well as agents that activate the immune system.
• Surgical. If medication treatment does not help, surgery is performed. It can be of two types: radical, in which the affected organ is completely removed, or gentle, with preservation of the uterus. Complete removal occurs quite rarely, in the most extreme cases and only in older patients. In other cases, the affected area of ​​the endometrium is cauterized with a laser or electric current.

Adenomyosis and changes in the shape of the uterus as a result of the disease are conditions that are characterized by a chronic course and regular development of relapses. In 70% of patients, after appropriate treatment, the disease recurs over the next 5 years. Women over 40 years of age are least susceptible to relapses, as the functioning of their ovaries begins to fade.

A spherical uterus can be observed in two cases: at 5-6 weeks of pregnancy, and also when the endometrium grows into the myometrium. In the second case, adenomyosis develops, diagnosis and treatment of which will help prevent anemia, problems with conception and pregnancy.

Ball-shaped uterus: an atypical shape of the reproductive organ

The accelerated rhythm of modern life draws a woman into a whirlpool of events, affairs, and interests. In this bustle, representatives of the fair sex do not always pay due attention to the state of their women's health. Without noticing the signs of many diseases, for a woman the diagnosis of a globular uterus may sound like a bolt from the blue. And although this phenomenon is by no means uncommon - it occurs in 70% of women who have crossed the thirty-year mark - not everyone imagines the features and scale of such a pathology.

What is a globular uterus?

Ball-shaped uterus - what is it? Alternative names for the pathology are adenomyosis, internal genital endometriosis. It is a pathology of the female reproductive organ, in which endometriosis grows into other uterine zones. In particular, this process can form in the area of ​​the uterus itself (ovaries, vagina, fallopian membranes) and outside it (lungs, intestines, urinary tract, sometimes - in postoperative wounds).

Ball-shaped uterus - pathology of the female reproductive organ

The norm is that the endometrium grows exclusively into the uterine cavity. With adenomyosis, the endometrium gradually penetrates the muscular wall of the organ.

By the way. The endometrium “populates” the uterine wall not everywhere, but locally, i.e. in some places. For comparison purposes, you can imagine seedlings planted in a cardboard box. When the seedlings have not been planted in the ground for a long time, the root system of the plants will gradually begin to grow through the cracks of the box. By the same principle, the endometrium penetrates the wall of the uterus.

The uterus itself does not remain inactive - it reacts to an uninvited invasion. As a result, individual areas of muscle tissue around the enlarged endometrium thicken. In this way, the uterus tries to stop further pathological growth. Gradually, following the muscle, the uterus itself enlarges, eventually becoming round in shape.

Causes

Atypical growth of endometrial cells can be caused by the following reasons:

• Various surgical interventions ( C-section, abortions, curettage) contribute to the destruction of the internal septum of the uterus. As a result, the endometrium is able to freely droop into the organ cavity.
• Disturbances in the intrauterine development of the reproductive system of the female embryo.
• Malfunctions of the endocrine system.
• Weak opening of the cervix during menstruation. At this moment, endometrial cells are under pressure, which causes its penetration into the wall of the uterus, and then into the peritoneal cavity.
• Adenomyosis often becomes a companion for women who love excessive sunbathing and visiting a solarium;
• Allergic reactions, infectious diseases, liver pathologies - all signs indicating low immunity can cause adenomyosis.
• Stress, nervous shock, as well as a sedentary lifestyle can provoke stagnant processes in the pelvis. For this reason, compactions form in the uterus, and adenomyosis begins.

The mechanism of pathology development

As a rule, during menstruation, excess endometrium begins to be rejected by the body. And if the uterus has the ability to remove “unusable” tissues, then other organs susceptible to adenomyosis do not have this opportunity. As a result, they swell and put pressure on the nerve endings, causing acute pain.

Heavy monthly bleeding is explained by the fact that the amount of excess uterine lining increases with adenomyosis. Subsequently, this “ballast” is thrown directly into the uterine cavity and provokes an increase in the volume of discharge.

Pain during menstruation becomes especially acute in the first day - this means that the rounded uterus is trying to get rid of excess endometrium. Depending on the location of the uterus, pain can be felt in different parts of the body. So, if the endometrium has spread in one of the uterine angles, the discomfort will be localized in the groin area. The affected cervix will make itself felt by pain in the area of ​​the rectum or vagina.

Symptoms of the anomaly

A spherical uterus does not always make its presence known in the female body. Sometimes the pathology is asymptomatic, and a woman may not even be aware of the presence of problems with the shape of the reproductive organ. However, in advanced cases, the following alarming symptoms may appear:

• Heavy bleeding during menstruation. A very characteristic sign of adenomyosis. In addition to the completely natural feeling of discomfort about this, a woman runs the risk of developing anemia, which is fraught with subsequent complications. Women with advanced stages of adenomyosis are especially at risk.
• Brownish spotting between periods. Some women mistake them for the beginning of menstruation. But such a discharge can cause anemia.
• Painful sensations during intimacy. Otherwise, this not the most pleasant phenomenon is called dyspareunia. This circumstance often becomes the cause of physiological and psychological problems in the intimate life of sexual partners. Pain during sex is one of the most common reasons that brings a woman to see a gynecologist.
• Pain immediately before, during and after the end of menstruation. Many women consider pain before and during menstruation to be an absolutely normal, typical phenomenon. This position is fundamentally wrong. Pain, especially sharp and prolonged pain, is a serious reason to consult a specialist.
• Disruptions in the menstrual cycle. Usually with adenomyosis it becomes shorter than usual.
• During a gynecological examination, the doctor diagnoses an enlarged uterus. This can easily be detected by palpation of the uterus by a gynecologist.

Important! Very often, the symptoms of adenomyosis are confused with manifestations of other gynecological diseases. To exclude all possible unfavorable options and diagnose pathology, you must immediately contact a gynecologist if you discover one or more alarming signs.

Diagnosis of a globular uterus

Ultrasound is considered the main method for diagnosing adenomyosis. Using this study, the size of the reproductive organ, its structure, the boundaries of the endometrium and myometrium are determined. Also, a similar method allows you to determine the degree of germination of the mucous membrane into the uterus. The accuracy of the results is about 90%.

An examination by a gynecologist can also confirm that the patient has a round uterus. The size of the organ varies from normal to atypical (corresponding to 6-8 weeks of gestation). The surface of the organ is uneven, touching certain places can cause pain.

For a more accurate diagnosis, a hysteroscopy procedure can be used. Its essence is the introduction of a specialized device into the uterine cavity. In this case, the walls of the organ are visualized from the inside and the doctor has the opportunity to assess the extent of the pathology, take a tissue sample for a biopsy, or perform therapeutic measures(cauterization of inflammation, removal of polyps, etc.).

Colposcopy is one of the methods for diagnosing and treating adenomyosis

In some cases, the doctor hesitates in making a diagnosis, since adenomyosis is similar in symptoms to uterine fibroids. To finally verify the correctness of the diagnosis, the patient may be sent for a magnetic resonance imaging (MRI) procedure.

Treatment methods for adenomyosis

According to medical research, the shape of the uterus and the ability to get pregnant are not directly related. In other words, adenomyosis itself is not considered a cause of infertility. But often the germination of the endometrium is accompanied by additional complications (fibroids or endometriosis), which can become an obstacle to the desired pregnancy. Cured adenomyosis increases the possibility of conception by 30-60%. If there are no complications throughout the pregnancy, a woman with a spherical uterus can safely give birth naturally. The only complication may be the risk of uterine bleeding.

Treatment of a uterus that has taken on an atypical shape is carried out in the following ways:

• Taking hormonal drugs. With their help, an artificial menopause is created. Upon completion of the treatment course, there is a risk of re-growth of the endometrium. Therefore, the doctor selects hormonal medications for the patient with the optimal dosage for continuous use. Modern treatments of this type cause virtually no damage to the female body.
• Embolization of the uterine arteries. Helps improve blood circulation in organ tissues.
• Surgical intervention. It is recommended to eliminate the affected tissue areas, nodes, or the entire organ as a whole.

Possible consequences, complications

Adenomyosis that is not detected and treated in time can lead to unpleasant consequences and provoke complications in the functioning of the reproductive organs. In particular, the consequences may be as follows:

• Iron-deficiency anemia;
• development of endometriosis into a malignant tumor;
• infertility.

Adenomyosis can cause infertility

Adenomyosis is a serious pathology of the female reproductive system. To prevent uterine deformation and further problems, a woman needs to carefully monitor her reproductive health. Regular visits to the gynecologist, proper nutrition and management are mandatory. healthy image life.

Adenomyosis of the uterus

A benign disease in which the inner layer of the uterus (endometrium) grows into the thickness of the uterus itself is called adenomyosis. In gynecology, there is another, more complex, definition of this disease: adenomyosis is internal genital endometriosis. We can say that this disease is not an independent phenomenon, that is, it is a certain form of endometriosis.

The main feature of adenomyosis is that the endometrium grows only into the myometrium (the middle layer of the uterus) and does not spread beyond it, that is, it does not affect nearby organs. It is worth noting that with endomitriosis, endometrial cells, on the contrary, do not have a specific localization. Independent foci of the disease can occur on any organ: be it the liver, intestines or external genitalia.

Cells of endometriotic tissue that have grown into the thickness of the uterus (myometrium) still continue to perform their main functions associated with the menstrual cycle. As a rule, this contributes to the development of a local inflammatory process, and frequent relapses cause degenerative changes in the myometrium. Naturally, over time, adenomyosis leads to pathological dysfunction of the uterus as a whole.

Causes of adenomyosis

The mechanism of development of adenomyosis can be said to be quite simple. Under the influence of certain factors, the endometrium begins to gradually grow into the muscle tissue of the uterus, without losing its basic functions. As expected, in the middle of the menstrual cycle, endometriotic cells increase in size to possibly secure a fertilized egg. The same thing happens with the endometrium, which has grown in the myometrium.

If pregnancy does not occur, then the excess endometrium leaves the uterine cavity in the form of menstruation. But in the muscle tissue of the uterus there is no outlet for the enlarged endometrial cells, so the uterine organ cannot free itself from unnecessary “ballast”. As a result, a so-called “minor hemorrhage” occurs in the myometrium, which leads to the development of an inflammatory process.

In gynecology, specific causes leading to the development of adenomyosis in women have not yet been established. However, there are a number of factors that can contribute to the growth of the endometrium into the thickness of the uterus, as well as its further growth. According to statistics, women with a history of uterine surgery or abortion are more likely to develop this disease. Women over 35 years of age are also at risk.

Some scientists are inclined to believe that adenomyosis has a genetic predisposition. But there is no 100% guarantee that a woman whose mother had adenomyosis will definitely develop the same disease. Based on these observations, most gynecologists deny any connection between the development of genital internal endometriosis and genetic predisposition.

The opinion of many women's doctors agrees on one thing: stress, heavy physical activity, a very active lifestyle, constant pressure– these are the main factors contributing to the “emergence” of adenomyosis. It should be noted that a sedentary lifestyle can also affect the development of this disease. Energy and blood stagnation occurs in the pelvic organs, which leads to thickening of endometriotic tissue, and then to adenomyosis.

Women who have any problems or disruptions in the endocrine system should carefully monitor their health. Pituitary gland diseases, thyroid gland, adrenal glands and female gonads, as a rule, negatively affect a woman’s hormonal levels and lead to disruption of the menstrual cycle. Naturally, such failures always contribute to the development of adenomyosis.

According to statistics, lovers of sunbathing and solariums suffer from this disease much more often than women who do not abuse ultraviolet radiation. These observations do not apply to young girls, because only after 30 years does the susceptibility to ultraviolet irradiation. So new and popular among women, mud baths are another factor in the development of adenomyosis.

Symptoms of adenomyosis

The main feature of adenomyosis is its asymptomatic course. As a rule, women do not notice any signs of the disease for a long time. The only thing that can make a woman think about the development of the disease is:

• heavy menstruation
• unusually long menstrual bleeding
• menstruation with large blood clots

As a result of heavy blood loss, most sick women experience a decrease in hemoglobin, which leads to iron deficiency anemia.

Against the backdrop of developed anemia, the woman begins to develop other signs of “disorder” in the body. The skin is pale, weakness and drowsiness appear. As a rule, working capacity decreases, and shortness of breath appears at the slightest physical exertion. Most women complain of constant dizziness, and sometimes short-term fainting.

Painful sensations during intimacy can be considered an important symptom of adenomyosis. Women especially notice increased pain a few days before or immediately after menstruation. Unpleasant and painful sensations have a clear localization - this is the area of ​​​​the isthmus of the uterus.

Bloody discharge is another characteristic sign of genital internal endometriosis. Many women suffering from this disease notice the appearance of spotting brown discharge a few days (three to five) before the start of menstruation. After the end of menstrual bleeding, spotting continues for some time (about three days). Quite often, along with discharge appear aching pain in the area of ​​the uterus affected by the pathological process.

A characteristic sign of adenomyosis can be safely considered - severe pain. Severe pain in the lower abdomen begins a few days before menstrual bleeding, continues throughout the entire menstruation, and persists after the end for one or two days. As a rule, bleeding and pain are a single whole, that is, discharge appears, and pain appears accordingly.

The pain has a clear localization, so it is quite easy to determine the specific location of the pathological process. If the area of ​​the uterine isthmus is affected, the pain radiates to the vagina or rectum. When the pathological endometrium is located in the corner of the uterus, the pain radiates to the groin area according to the affected side. On palpation, the entire body of the uterus is painful.

You should know that the clear clinical picture of adenomyosis directly depends on its degree and type. In gynecological practice, there are rare cases of identifying the disease by symptoms in the early stages, because the course of the disease is practically asymptomatic. Rather, it is a matter of chance. Diffuse adenomyosis grade 1-2 can only be determined by chance. Things are a little better with the nodular type - the larger the nodes, the brighter the clinical picture, and, accordingly, it is easier to establish an accurate diagnosis.

Types of adenomyosis

In gynecological practice, there are three main types of genital internal endometriosis:

• diffuse
• nodal
• mixed or combined (diffuse-nodular)

The latter form of adenomyosis is much more common than the previous two separately.

Diffuse adenomyosis is characterized by the growth of the endometrium into the thickness of the uterus, forming deep foci with pathological endometriotic tissue. The depth of penetration varies. In gynecology, there are cases where the diffuse form of this disease led to the formation of fistulas.

With nodular adenomyosis, pseudoendometrial cells invade the myometrium and form endometrioid ducts, in which they then grow safely. It is worth noting that the pseudoendometrium is endowed with the same hormonal functions as the real endometrium. During menstruation, new endometriosis cells are also rejected, but there is no way out for them. This is how nodes appear.

Multiple nodes are filled with brown liquid or blood, which appears as a result of the functional activity of the pseudoendometrium, that is, during menstruation. On the outside, the nodes are covered with dense connective tissue that forms a capsule.

Mixed or combined adenomyosis includes signs of diffuse and nodular. This type occurs much more often in women.

Degrees of adenomyosis

The degree of adenomyosis directly depends on the depth of penetration of the endometrium into the thickness of the uterus.

First degree. The first degree of adenomyosis is characterized by germination of the endometrium to the upper layer of the myometrium. In other words: the mucous layer does not affect the muscle tissue of the uterus, but only forms minor depressions in it. During the examination, no changes in the structure and relief of the uterus are observed.

The second degree of adenomyosis is characterized by germination of the endometrium to the middle of the muscle layer. The myometrium thickens, becomes uneven, and the uterine cavity loses its former elasticity. With this degree of disease, a woman may already experience the first problems with conceiving or bearing a fetus.

Third degree of adenomysis. The pathological process affects the myometrium to the serous layer. The structure and surface of the uterine body changes significantly. During the examination, certain areas that are enlarged in volume are visible, which do not have clear boundaries and contours. The walls of the uterus thicken significantly.

Fourth degree. Adenomyosis of this degree is diagnosed if there is growth of the endometrium beyond the body of the uterus. For example, into the abdominal cavity, ovaries, fallopian tubes, bladder. If the pathological process has affected the cervix, then the diagnosis is cervical adenomyosis, if the ovaries - ovarian adenomyosis.

The first and second degrees do not require surgical intervention, which cannot be said about the third and fourth. The last two are difficult to treat conservatively; more often, two methods are used in combination.

Diagnosis of adenomyosis

Diagnosing adenomyosis in the early stages is quite difficult. To identify it, a woman must undergo a thorough and in-depth clinical examination. Complex diagnostic measures includes:

• Bimanual or objective gynecological examination. During the study, the size of the uterus, its position, shape, mobility and pain are assessed. It is important to determine the presence of formations, the condition of the ovaries and fallopian tubes. With adenomyosis, the uterus increases in size and takes on a spherical shape.
• Mandatory collection of smears to determine the degree of vaginal cleanliness and cytological analysis
• Examination of the cervix with a colposcope. Under a microscope, you can still see a few sprouted endometrial cells. Indeed, stage 4 adenomyosis is characterized by the growth of the pathological process onto the cervix.
• Ultrasound of the pelvic organs. Transvaginal echography is most often used. In gynecological practice, several echogenic signs of adenomyosis have been identified: jaggedness of the basal layer of the endometrium, asymmetric thickening of the uterine walls, increased echogenicity in the affected areas and the round shape of the uterus.
• Hysteroscopy. Upon visual inspection inner surface endometriotic ducts are visible in the uterus. The even pale pink color of the uterine mucosa is disturbed by dark brown inclusions, from which blood is periodically released.
• Comprehensive clinical examination of all organ systems: respiratory, genitourinary, cardiovascular and digestive.

Only thanks to such a deep comprehensive examination is it possible to diagnose adenomyosis at an early stage, and at a later stage to correctly determine the extent of damage by the pathological process and its severity.

Drug treatment of adenomyosis

There are two ways to treat genital internal endometriosis: conservative and surgical treatment. Naturally, the treatment method directly depends on the degree of adenomyosis. As a rule, the first and second degrees, less often the third, can be treated conservatively, and the fourth can only be treated surgically.

First of all, a woman is prescribed hormonal drugs that artificially create menopause (cessation of menstruation for a certain period). The duration of treatment is from two to four months. At the end of the treatment course, it is necessary to continue hormonal therapy.

Uterine artery embolization is used quite often and widely in gynecological practice. This treatment method significantly improves blood circulation in the tissues, which is important for stagnation of blood and energy in the pelvis.

Electrocoagulation is another common treatment for adenomyosis. Using this method, the affected areas of the uterus are eliminated.

The radical treatment method includes two main methods:

• Laparoscopy is the most gentle. reproductive organ is not completely removed, but only the affected areas are excised.
• Complete removal of the uterus (hysterectomy), sometimes along with the appendages.

To prevent relapses of adenomyosis, women may be prescribed hormonal contraceptives, and at 1-2 degrees - as a method of treatment. Many gynecologists recommend special intrauterine devices that reduce pain and normalize menstrual bleeding.

In addition to specific therapy, general strengthening treatment is also necessary. To relieve pain, painkillers are prescribed, for example, Ibuprofen or Nurofen. Very often adenomyosis is accompanied by anemia, so it is advisable to undergo a course of iron treatment. To maintain the body, gynecologists recommend taking vitamins. Some women also need sedative (calming) medications.

Treatment with folk remedies

Along with drug treatment (with the permission of a doctor), you can use folk remedies for the treatment of adenomyosis. There are many herbal infusions that need to be taken not only for medicinal purposes, but also for general strengthening of the body and increased immunity. It is important to remember that any unconventional treatment should be discussed with the attending physician.

ABOUT medicinal properties Blue clay has been known to everyone for a long time. But few people know that it is what is widely used to treat adenomyosis. The method of application is quite simple. Blue clay must be mixed with water and stirred until smooth. The resulting mixture should be kept in a water bath for about 6 minutes, but no more. Then the blue clay is laid out on cellophane in an even layer no more than two centimeters thick. This compress should be placed on the lower abdomen and left for two hours. The course of treatment is five to seven full procedures.

An effective, but less pleasant way to cure adenomyosis is hirudotherapy. Principle of treatment: leeches select particularly active points for suction, as a result of which blood circulation and lymph flow in the pelvis are significantly improved. In addition, the substances that enter a woman’s blood during a leech bite have antiseptic properties, helping to relieve the inflammatory process in the uterus and prevent the development of adenomyosis.

Various medicinal herbs are widely used in gynecology. By using herbal infusions and decoctions normalize the cycle, correct hormone levels, regulate and accelerate metabolism. It is necessary to use herbs to treat adenomyosis with the permission of the attending physician and only under his vigilant supervision. During herbal treatment, medicinal hormone therapy is prohibited.

Recipes for decoctions and infusions:

• Plantain leaves (one spoon) must be crushed and then poured with boiling water. Infuse this decoction for at least two hours. Method of administration: Divide the decoction into 4 doses. The first one must be on an empty stomach, and the rest - during the day; taking the decoction does not have to be associated with meals.
• Nettle decoction will help stop menstrual bleeding, relieve inflammation in the uterus, and speed up metabolism. Preparation of the decoction: pour two tablespoons of nettle into a glass of boiling water. Let it brew and cool. Method of administration: divide the contents of the glass into four or five doses and consume throughout the day.
• Has medicinal properties Fresh Juice table beets. Method of administration: take one hundred grams of fresh juice every morning before meals.
• To strengthen the myometrium, you should undergo a course of treatment with a decoction of shepherd's purse. Preparation: pour one tablespoon with one glass of boiling water. Leave for one hour. Method of administration: take one full tablespoon at least four times a day. Important - half an hour before meals.
• Viburnum bark is another unique remedy to combat adenomyosis. Preparation: viburnum bark (one tablespoon) is also poured with one glass of boiling water, be sure to leave for about an hour. Method of administration: only three times a day, two tablespoons, it is not necessary to associate it with meals.

Decoctions of medicinal herbs to combat adenomyosis can be used for douching. An example of the most effective recipe: oak bark, mistletoe, eucalyptus, peony, yarrow and calendula are taken in equal portions, then the mixture is poured with boiling water and left to steep for one hour. Can be used daily for douching.

Herbal treatment is fraught with many nuances that you should know in mandatory. In addition to the correct dose and method of preparation, it is important to know when and what herbs are taken to treat adenomyosis. When used in medicinal purposes Some herbal teas need to take into account the stage (phase) of the menstrual cycle, since some are important to take during menstruation, while others - only a few days before it.

Collection before menstruation:

Preparation: a mixture of the above ingredients (one teaspoon) is brewed with one glass of boiling water. It is necessary to insist for at least one hour. Method of administration: a quarter glass three to four times a day, preferably after meals. During treatment with this collection, it is advisable to take drops of peony tincture twice a day every day. The course of treatment is from three to five menstrual cycles.

Collection during menstruation:

• Liquorice root
• Clover cones
• Fireweed and anise
• Eucalyptus leaves
• Currant berries

Preparation: pour the mixture (one teaspoon) with one glass of boiling water and leave. Method of administration: a quarter glass three times a day. Along with taking the collection, it is important to take daily drops of Eleutherococcus. The course of treatment is from three to five menstrual cycles.

Naturally, it is necessary to understand that a complete cure for genital internal endometriosis is possible only with the first and second degrees. At later stages, taking decoctions and tinctures of medicinal herbs can only stop the progression of the disease, and not cure. Each body reacts differently to treatment, that is, for some women, folk remedies permanently relieve the disease, while for others they bring temporary relief.

Prevention of adenomyosis

The first and most important way to prevent adenomyosis is to regularly visit a female doctor (once every six months). After all, the earlier the disease is diagnosed, the easier it is to treat. You shouldn’t wait and wait for it to go away on its own; the sooner the diagnosis is made, the faster the recovery will come. It is important to remember that any unpleasant and painful sensation in the lower abdomen is a reason to urgently visit a gynecologist to determine the causes.

Gynecologists believe that stress and constant overwork have a strong impact on women's health and can undoubtedly lead to the development of adenomyosis. To prevent the onset of the disease, a woman needs to: rest more, take relaxing baths, attend a massage, and be in a calm and comfortable environment more often. Procedures aimed at relieving muscle tension are another way to prevent adenomyosis.

A gynecologist, if he deems it necessary, can prescribe the necessary medications and physical procedures. Women over thirty should avoid unlimited sunbathing, or better yet, reduce ultraviolet radiation to a minimum.

Taking care of your health - main way prevention of not only adenomyosis, but also other equally dangerous diseases.

Adenomyosis and infertility

Specialists in the field of gynecology have proven that adenomyosis is a common cause of infertility. There are five main factors that can lead to infertility with this disease. Quite often there are cases when several factors are combined.

• According to many gynecological specialists, the main cause of infertility in genital internal endometriosis is pathological disturbances in the hormonal sphere.
• Adhesive processes in the fallopian tubes or a decrease in their motor ability. As a result of this pathology, the egg cannot move through the fallopian tube into the uterine cavity.
• An autoimmune reaction of the body, which leads to a decrease in sperm activity or difficulty in fixing the fertilized egg in the endometrium.
• Premature termination of pregnancy, mainly in the early stages, as a result of increased tone of the muscular layer of the uterus.
• Logical factor. With adenomyosis, most women experience severe pain, discomfort and discomfort during sexual intercourse, and therefore stop having regular sex life.

It is impossible to say unequivocally that adenomyosis is a death sentence. If infertility developed less than three years ago, then it is easier to restore the ability to conceive than in more advanced cases. Timely, comprehensive and correct treatment significantly increases the chance of getting pregnant and safely bearing a child. Naturally, adenomyosis is a cause of infertility, but there is also a treatment for this disease.

Adenomyosis and pregnancy

It is unequivocal to say that it is impossible to get pregnant with adenomyosis. After all, the disease may or may not be the cause of infertility. Naturally, quite often this disease is the main reason for a woman’s lack of children. Sometimes even long-term conservative or surgical treatment does not lead to the long-awaited pregnancy.

But it is important to note that adenomyosis is not a death sentence. A fairly large number of women with a history of this disease were still able to experience all the joy of motherhood. Pregnancy can proceed without any complications or peculiarities, and children are born absolutely healthy. If problems arise with conceiving a child or bearing it, then timely and adequate treatment is necessary.

Even women undergoing surgical treatment have a chance to get pregnant and safely carry a child to term. According to statistics, 40-60% of such women were able to conceive on their own and give birth normally. Of course, pregnant women with adenomyosis are constantly under special control from the antenatal clinic in order to provide timely assistance or take any measures to preserve the pregnancy.

Scientists have proven that pregnancy has a beneficial effect on the course and nature of the disease. At its core, pregnancy is a physiological menopause, which is so necessary for such a diagnosis. Excess endometrial cells are no longer rejected, and therefore its growth is significantly reduced. In addition, in gynecology there are many examples where a woman fully recovered after pregnancy.

It is important to know that adenomyosis in no way affects the normal development of the fetus.

Prognosis for adenomyosis

It is important to note that adenomyosis never takes a malignant course of the disease, that is, it does not degenerate into cancer. According to statistics, about 20% of women experience relapses. After five years, as a rule, the disease recurs in 75 percent of women.

The risk of relapse is significantly lower with mixed treatment. For example, laparoscopy and long-term use hormonal drugs. Although the risk is lower, relapses are inevitable. Premenopausal and post-menopausal women are more likely to never be diagnosed with adenomyosis again. This feature is caused by the physiological extinction of all ovarian functions.

Adenomyosis is internal endometriosis of the uterine body.

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

A hormone-dependent disease, which is manifested by the penetration of tissue similar to the mucous membrane of the uterine body into the muscle of the uterus. Moreover, during menstruation, foci of endometriosis also menstruate, which leads to the development of inflammation. Symptoms of adenomyosis (endometriosis of the uterus) are heavy and painful menstruation, bleeding, spotting before and after menstruation. Endometriosis is often accompanied by infertility and miscarriage. Oral contraceptives promote regression of endometriosis lesions.

I was diagnosed with adenomyosis, histology showed that I have glandular endometrial hyperplasia. In this regard, I have had cleaning done 2 times over the past six months. I was also prescribed Norkolut. Could you write about my illness, as well as methods of treating it.

Adenomyosis is a disease characterized by the spread of tissue similar in structure to the endometrium (uterine mucosa) into the thickness of the uterine muscle. Endometrial hyperplasia is an increase in the thickness of the endometrium compared to normal. Both of these conditions are a consequence of increased levels of estrogen (female sex hormones). Hyperestrogenism can be absolute, i.e. the level of estrogen is higher than normal, or relative (the level of estrogen is normal, but another female sex hormone is reduced). Treatment of these diseases consists of prescribing drugs that lack progesterone, or drugs that cause artificial menopause. In this case, the endometrium atrophies, i.e. foci of adenomyosis in the uterine muscle decrease or disappear and the thickness of the endometrium decreases. Norcolut is an analogue of progesterone.

I have adenomyosis and submucous fibroids. The condition is stable. Is it advisable to treat with duphaston 2 years after diagnostic curettage? Does it affect myoma?

If you have no complaints, you are not planning a pregnancy, the fibroids are not growing, then you do not need to take medications. Treatment of any disease is carried out according to indications. Duphaston is prescribed for severe symptoms of adenomyosis: heavy and painful menstruation, intermenstrual bleeding, to prepare for pregnancy. These same symptoms are also symptoms of uterine fibroids, and here duphaston also has a beneficial effect. But if there are no complaints, admission is not necessary.

I had aspiration done, endometrial polyps were removed, and after that I was examined by ultrasound. Histological analysis showed an endometrial character, and the ultrasound result was as follows:
The body of the uterus is spherical, cellular, and normal in size. At the bottom of the uterus there is a subserous myomatous node d=2.5 cm. The thickness of the endometrium is 1.2 cm. Pronounced multiple endometrioid foci are identified in the cervical canal. The right ovary is 3.0x2.8 cm, the left is 3.0x3.0 cm with the presence of cystic inclusions. The analysis was done before menstruation on the 31st day of the cycle. Please explain to me what a cellular uterus is and do I have a chance of getting pregnant with such tests?

The spherical shape of the uterus and the cellular structure of the myometrium (the muscular layer of the uterus) are signs of internal endometriosis of the uterine body (adenomyosis). Sometimes this disease occurs on its own, sometimes it causes infertility, then it must be treated. The main manifestations of adenomyosis are abundant painful menstruation, spotting between periods. Subserous uterine fibroids will not prevent you from becoming pregnant, although they will increase during pregnancy, which will require constant monitoring.

I am 37 years old, with a history of adenomyosis; hr. s\ophoritis. What kind of diseases are these and can I go to the sauna?

Under the influence of thermal procedures, adenomyosis can progress. This is internal endometriosis of the uterus, a condition in which the endometrium (the lining of the uterus) grows into the muscles of the uterus. It manifests itself as painful menstruation, bleeding before and after menstruation, and the inability to get pregnant. If such complaints do not bother you, then the degree of adenomyosis is not pronounced, and the sauna is not contraindicated for you. It is necessary to do an ultrasound scan every six months and monitor the prevalence of adenomyosis and its dynamics: whether it increases or decreases.

Chronic salpingoophoritis is a chronic inflammation of the appendages. Manifested by pain in the lower abdomen, dysfunction of the pelvic organs due to adhesions and the inability to become pregnant due to adhesive obstruction of the tubes

I am 46 years old, on February 19 of this year I had an operation: Laporotomy Panhysterectomy The operation was performed urgently based on the results of an ultrasound: infarction of the myoma node with malnutrition.
Diagnosis: Ademiosis. Endometriosis of the uterosacral ligaments. Chr. endometritis Chr. bilateral adnexitis. Endometrial polyp.
Histological examination: Glandular-cystic hyperplasia, uterine fibroids with areas
ademiosis. Ovary - sclerosis and hyamentosis of the walls of blood vessels and corpus luteum, follicular cysts,
cysts corpus luteum. Pipe - wall sclerosis. Cervix - Nabothian cysts.
Based on the histology results, I was prescribed Norkolut for 3 months according to the regimen.
Almost immediately after the operation, I started having hot flashes (within an hour or more).
With any physical and emotional stress, severe sweating. After a shower, relief comes, but not for long. I've been taking Remens for a month, but I don't feel any improvement.
About two weeks ago pain in the rectum appeared. Can endometriosis develop again?
The pain is similar to that before surgery. An appointment is scheduled in a month. They don’t spend more than 5 minutes during an appointment.
Tell me, how can I alleviate my condition, reduce hot flashes, avoid complications such as osteoporosis, etc.? For what purpose am I prescribed a hormonal drug?
Can hot flashes go away on their own? If not, please advise what can be taken with the least side effect. Is it possible for me to go to a resort in half a year and take mud on my lower back? When can you start exercising to strengthen your abdominal muscles? The incision is made along the white line. What kind of physical activity can there be?

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

Pain in the rectum may be a manifestation of retrocervical endometriosis. It is diagnosed with a routine examination and ultrasound. Also, after panhysterectomy, endometrioid lesions could remain on the pelvic peritoneum, giving complaints characteristic of endometriosis, as before the operation.

Norkolut was prescribed to you so that it does not progress. But apparently it doesn't help. It would be ideal to do a control laparoscopy and coagulation of foci of endometriosis in the peritoneum. But in any case, given the removed ovaries, endometriosis will not progress; on the contrary, it will gradually go away. But hot flashes and other signs of hormonal deficiency (etc.) will increase. You are not contraindicated in taking hormone replacement therapy, since the course of endometriosis is controlled by the doses and drugs contained in modern means, will not affect, but your health will be restored. After checking the condition of the mammary glands (mammography), blood biochemistry (lipids) and blood clotting, it is possible to prescribe continuous hormone replacement therapy with drugs such as Cliogest, Livial

I am 29 years old. After the second birth for 3 years, on the first day of menstruation the temperature rises to 37.5 - 37.8, severe pain, cycle irregularities - delays of up to 10 days. Ultrasound showed: adenomyosis of the uterine body (nodular form), ovarian endometriosis, retrocervical endometriosis, uterine dimensions 77-48-52, endometrium 11 mm. There is a large number of leukocytes in the smear. The result for chlamydia is negative. The attending physician's diagnosis coincided with the ultrasound diagnosis plus chronic endometritis. Hormonal medications were recommended for the treatment of adenomyosis and endometriosis, but with the permission of a mammologist, because Immediately before this, I was operated on for fibroadenoma of the mammary gland. The mammologist explained that since I still have pronounced manifestations of diffuse mastopathy and taking into account my heredity (close female relatives have breast cancer at a young age), hormonal drugs are indicated for me only as a last resort. I consulted with several other gynecologists, their recommendations were different: some believed that hormonal treatment was required, others that it was not required. Moreover, different hormonal drugs were prescribed: microgenon, norkolut, duphaston, depo-provera. As a result, my doctor and I decided to treat only endometritis. After the course of treatment, the temperature during menstruation became lower - 37.2 and the leukocytes in the smear returned to normal. This happened for 5 months after treatment. In the sixth month, the temperature again on the first day of menstruation rose to 37.8 and the smear showed leukocytosis again. A repeat ultrasound (one year after the first) showed that the size of the uterus and endometrium remained the same, but there were more endometriosis lesions. After another 2 months, a 6 cm cyst on the right ovary was discovered. I was again prescribed hormone therapy, and if it does not disappear in a month, then surgery. Moreover, they offer me to remove the entire right ovary. Please tell me,
1) Should I decide on hormone therapy and which drug is best for me (prolactin and progesterone are normal, but estradiol is not determined in our city). Do I need any more research and do I have time for this, or should I start hormone therapy immediately?
2) Are there types of operations that allow you to remove a cyst without an ovary, which ones exactly?
3) Are there treatments for endometriosis and adenomyosis other than hormone therapy? Including surgical ones?

1. The drugs that you listed are all drugs of the same group (gestagens). And they are absolutely not contraindicated for mastopathy, even if relatives had malignant tumors. Caution requires the use of estradiol, and gestagens, on the contrary, are indicated for mastopathy.

On the other hand, with such progressive endometriosis, gestagens are too mild a treatment method. It is advisable to start with surgery, remove the ovarian cyst, cauterize the endometriotic lesions, and in the postoperative period prescribe hormonal treatment to reduce lesions in the uterus and retrocervical endometriosis (temperature during menstruation is most likely caused by it). And these are hormonal drugs of other groups: nemestran. gestrinone, danazol, zoladex. They give more side effects, but are more effective against endometriosis

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

3. See paragraph 1. But uterine endometriosis can be surgically cured only by removing the uterus.

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

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

Recently, pain in the uterus has begun to bother me (I can differentiate due to many years of practical experience pain in the uterus before menstruation). Ultrasound revealed: the uterus is enlarged 6.2x4.9x6.8; the contours are smooth, the uterus is “round”, echolocation is moderately increased, the posterior wall is thicker, the nodes are not determined (differential fibroids? adenomyosis?). The cervix is ​​thickened 5x6.2 (a structural feature?) The structure is not entirely uniform: small brushes and bright linear fur... echo.. M-echo 0.7 cm evenly throughout. Right testicle 4.5x2.8 with cyst (follicle) 2 cm, left -4x2.3 with small follicles 0.5 cm. During the ultrasound, the doctor said that she really didn’t like her cervix. Please advise what to do. If before the pain was only before the cycle, now it’s almost daily. I live in Yakutia. There are practically no diagnostic tools in the village. One gynecologist for every 5,000 women. 5 minutes to take one. The doctor took a smear (races - no, other microorg - large quantity, leukemia - 3-4 in the subsection, epithelium - large quantity) and prescribed vitamins. Please advise what to do and! how to get examined further (we are going on vacation)

Most likely, we are talking about cervical endometriosis and grade I adenomyosis. (endometriosis of the uterine body). To clarify the diagnosis, you need further examination: (examination of the cervix using a microscope), targeted biopsy followed by histological examination of the biopsy, diagnostic curettage of the cervical canal of the cervix and, if possible, hysteroscopy. Since you are going on vacation, you should know that if you are diagnosed with endometriosis, it is advisable to avoid exposure to the sun

44 years old. Diagnosis: adenomyosis, left ovarian cyst, paraovarian cyst, cystic changes in the right ovary. Possible treatments? Can laparoscopy be used? If yes, where?

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

/Continuation/ A surgical operation is scheduled, but, as I was told, rehabilitation will take 2 months. Therefore, I would like to consult about laparoscopy and, of course, not by telephone. Please help me find out the phone numbers of organizations where such operations are performed.

Both during “conventional” and during laparoscopic surgery, the volumes are the same, but with laparoscopy, access to the operation site is made not through an incision in the abdominal wall, but through a puncture, so this operation is easier to tolerate. For example, discharge after a “regular” operation is 10-14 days, and after laparoscopy - 5-8. Laparoscopic operations are longer and have a whole list of strict contraindications, for example, adhesions. Rehabilitation after laparoscopic surgery is just as necessary as after conventional surgery, because... tissue healing occurs within the same time frame. Laparoscopic equipment in Moscow is available in many scientific centers and hospitals, both commercial and urban. These are 1 City Clinical Hospital, 15 City Clinical Hospital, 7 City Clinical Hospital, Center for Mother and Child on Oparin Street 4, MONIIAG on Chernyshevsky Street, departments of medical institutes. Prices and conditions are different everywhere, so we advise you to “arm yourself” with a directory and call as many places as possible.

The purpose of drug treatment is:

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

Drug treatment of adenomyosis

Group drugs	Drugs	Indications	Mechanism of therapeutic action	Side effects	Dosage and duration of treatment
Preparations of the progestogen group (gestagens, progestins - collective name of female steroid hormones)	Progesterone (Utrozhestan)	Prevention of adenomyosis, and in some cases treatment of adenomyosis ( effective in 40% of cases). Used for infertility due to adenomyosis, to maintain the menstrual cycle before in vitro fertilization ( often with adenomyosis), with the threat of miscarriage due to adenomyosis.	Analog of progesterone of plant origin. Stimulates the formation of normal secretory endometrium in the second phase of the menstrual cycle, which creates optimal conditions for implantation of a fertilized egg.	Menstrual irregularities, vaginal bleeding.	Orally or intravaginally ( vaginal insertion) in the form of capsules of 100 - 150 milligrams 2 times a day for 10 - 12 days.
	Medroxypro-gesterone (Clinovir, Farlutal, Provera)	Treatment of adenomyosis, prevention of endometrial changes during estrogen therapy during menopause.	Changes the lining of the uterus ( endometrium) leading to its atrophy ( thinning, exhaustion). Reduce pain in adenomyosis. Suppress ovulation - the maturation and release of an egg from the ovary when the follicle ruptures.	Menstrual irregularities, galactorrhea ( pathological discharge of fluid from the mammary glands, not associated with breastfeeding), cervical erosion and others. Infertility up to 22 months after the last injection, decreased bone mineral density.	Intramuscularly, 100 milligrams once every 2 weeks or 50 milligrams once a week for a course of at least 6 months. The first injection is carried out on day 5 normal menstruation to exclude possible pregnancy.
	Dydrogesterone (duphaston)	Treatment of adenomyosis, neutralization of the proliferative effect ( tissue proliferation due to increased cell division) estrogens on the endometrium during hormone replacement therapy.	Affects the endometrium, preventing its hyperplasia ( pathological tissue growth) with excess estrogen. Does not suppress ovulation ( maturation and release of the egg into the fallopian tube) and does not violate menstrual cycle.	Uterine bleeding, swelling and tenderness of the mammary glands.	Take 10 milligrams orally 2-3 times a day from 5 to 25 days of the menstrual cycle or continuously. The duration of treatment is determined by the doctor. If necessary, the daily dose is increased to 20 milligrams.
	Levonorgestrel (microshaft)	Prevention of endometrial hyperplasia with estrogen replacement therapy, reduction of menstrual pain and discharge in adenomyosis.	Neutralizes the growth of the endometrium under the influence of estrogens, reduces pain during the menstrual cycle.	Cyst formation ( pathological cavities with contents) ovaries, metrorrhagia ( uterine bleeding), benign formations of the mammary glands.	The dose is selected individually depending on the form medicine.
	Norethisterone (norkolut)	Adenomyosis, infertility, miscarriage, menstrual irregularities.	Inhibits proliferation ( tissue proliferation due to excessive cell division) with hyperplasia ( proliferation) endometrium.	Long-term use increases the risk of blood clots.	Prescribe 1 tablet per day ( 0.5 mg) from 5 to 25 days of the cycle for six months or half a tablet every 2 - 3 weeks for 4 - 6 months.
	Dienogest (bysanne)	Treatment of adenomyosis.	Suppresses the trophic effect ( nutrition, metabolism) estrogens on the endometrium, causing atrophy ( exhaustion, loss of vitality) foci of adenomyosis. Increases immunity.	Vaginal bleeding, breast pain, acne ( acne, inflammation of the sebaceous glands).	Take 1 tablet ( 2 milligrams) once a day for 6 months or more ( up to 15 months).
Androgenic drugs	Danazol	Treatment of adenomyosis with concomitant infertility.	Suppresses the synthesis of female sex hormones, helping to reduce foci of adenomyosis due to thinning of the endometrium. Leads to suppression of ovulation and the menstrual cycle, which resumes after 2 months after stopping the drug.	Increased blood pressure, excessive facial hair growth, weight gain, menstrual irregularities.	The dosage and duration of treatment are determined individually ( minimum effective dose - 200 mg) the maximum daily dose is 800 milligrams.
Drugs groups of oral contraceptives (last generations)	Yarina	Contraception, treatment of adenomyosis, reduction of pain before and after menstruation with adenomyosis.	Suppresses the production of estradiol ( female sex hormone) by the ovaries, thereby preventing the spread of foci of adenomyosis due to the strong antiproliferative effect ( prevent tissue proliferation), reduce the risk of developing endometrial cancer.	Arterial and venous thromboembolism ( blockage of the lumen of a blood vessel by a detached thrombus), vaginal bleeding between menstrual cycles, discharge from the mammary glands.	Take 1 tablet per day, the duration of use is determined by your doctor. Mirena is a T-shaped intrauterine contraceptive ( intrauterine device). Injected into the uterine cavity for up to 5 years. Releases 20 milligrams of levonorgestrel per day.
	Novinet
	Diecyclen
	Claira
	Chloe
	Lindineth
	Jess
	Regulon
	Janine
	Silhouette
	Mirena
Selective progesterone receptor modulator	Esmiya	Treatment of adenomyosis in combination with fibroids ( benign formation of the myometrium). Preparing the patient for surgery to remove fibroids.	Adenomyosis is often combined with uterine fibroids. Has a direct effect on the endometrium, causing a decrease in proliferation.	Menstrual irregularities, pain in bones, muscles, abdominal pain.	Take 1 tablet ( 5 mg) per day for no more than 3 months. Treatment begins in the first week of the menstrual cycle.
Gonadotropin-releasing hormone analogues (GnRH)	Triptorelin (diferelin)	Treatment of adenomyosis, preparing the patient for surgical treatment of adenomyosis.	These drugs cause a menopause-like condition by preventing ovulation and reducing estrogen levels. The uterus decreases in size, spasms and pain in the lower abdomen disappear, foci of adenomyosis decrease, and its spread stops.	Symptoms of menopause include hot flashes, vaginal dryness, mood swings, decreased bone density. Calcium supplements should be taken throughout the course of treatment.	Intramuscularly, 11.25 milligrams every 3 months, 3.75 milligrams every 4 weeks.
	Buserelin				Intramuscularly, 4.2 milligrams every 4 weeks for 4 to 6 months.
	Zoladex				The capsule is administered subcutaneously at 10.8 milligrams into the anterior abdominal wall every 12 weeks.
	Decapeptyl				Injected subcutaneously once a day, 0.5 milligrams for a week. Then 0.1 milligrams. For long-term treatment, 3.75 milligrams every 28 days.
Non-hormonal agents plant origin	Tazalok	Menstrual irregularities, complex therapy for adenomyosis.	Elimination of hormonal imbalance of estradiol and progesterone. Has antispasmodic, anti- proliferative effect, analgesic effect, anti-inflammatory effect.	The drug usually does not cause adverse reactions. Possible allergies.	The prescribed dose of tincture is dissolved in 100 milliliters of water and taken 30 minutes before meals 3 times a day for 3 months or more.
	Cyclodinone				Take 40 drops of tincture once a day or 1 tablet per day for 3 months.
Immunomodulatory agents	Wobenzym	Complex treatment of adenomyosis.	Increases immunity, reduces the severity of side effects from hormonal drugs, reduces inflammation.	Well tolerated by patients.	Orally from 3 to 10 tablets 3 times a day. The duration of the course depends on the severity of the disease.
Anti-inflammatory and painkillers (non-steroidal anti-inflammatory drugs)	Diclofenac sodium	Algomenorrhea ( painful menstruation), inflammatory processes in adenomyosis, pain in the lower abdomen.	They have a pronounced analgesic and anti-inflammatory effect, making menstrual bleeding less heavy.	Causes abdominal pain, nausea, constipation or diarrhea, formation of stomach ulcers, and gastrointestinal bleeding.	Orally 25 - 50 milligrams 2 - 3 times a day. Rectally - 1 suppository per day.
	Ketoprofen				Intramuscularly, 100 milligrams 1 - 2 times a day. Orally 300 milligrams 2 - 3 times a day.
	Indomethacin				Orally 25 milligrams 2 - 3 times a day.
	Nimesil				1 sachet inside ( 100 milligrams) 2 times a day.
dietary supplement (biologically active additives)	Gynecol	An auxiliary component in the treatment of adenomyosis, prevention of relapse of the disease after surgery.	Preventing the development of inflammatory processes in gynecological diseases, accelerates tissue regeneration.	Does not cause side effects.	Orally, 1 tablet 2 times a day during meals.
	Indinol		Normalizes the level of estrogen, preventing their negative effect on the endometrium, selectively destroys cells with abnormally high division.	Menstrual irregularities, pain in the stomach.	Orally, 1 capsule per day ( 300 milligrams) within 2 - 3 weeks.
Enzyme products	Longidaza	Treatment of adenomyosis with concomitant inflammatory processes of the pelvic organs.	Immunomodulating, anti-inflammatory effect. Reduces tissue swelling during inflammation, and also prevents the formation of scars and adhesions.	Local reactions in the injection area - swelling, pain.	Subcutaneously or intramuscularly 3000 IU ( international units) from 5 to 15 injections with an interval of 10 to 14 days between injections.

Medicines are taken as prescribed by a doctor under strict control of hormone levels.

Minimally invasive methods for treating adenomyosis

A minimally invasive treatment method is a treatment that does not imply damage to the integrity of the skin and mucous membranes.

Minimally invasive treatments for adenomyosis include:

• Endometrial ablation. Endometrial ablation is a minimally invasive procedure to remove the inner 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. Endometrial ablation can significantly reduce the intensity of uterine bleeding, as well as reduce endometrial hypertrophy and preserve the uterus in case of fibroids. To destroy the endometrium, electrosurgical ablation is used - an electrode is inserted into the cervix, through which a weak electricity, destroying the mucous layer. With hydrothermal ablation, a hot liquid is injected into the uterine cavity, which cauterizes the endometrium. Cryoablation - destruction of the endometrium by freezing liquid nitrogen. In microwave ablation, a thin probe is inserted into the uterine cavity and emits microwave energy to destroy the lining of the uterus. The main serious complications are damage to neighboring organs, perforation of the uterus, and inability to become pregnant. The recovery period takes several days. There may be some minor bleeding after the procedure. If bleeding increases and unpleasant odor You should immediately consult a doctor.
• FUS - ablation. FUS - focused ultrasound, ablation - rejection of part of the tissue under the influence of radiation. Thus, FUS ablation is the remote destruction of foci of adenomyosis 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 heating of the tissues occurs to 65°C - 85°C. This leads to thermal damage to the tissue and disruption of blood supply. This effect is called thermal necrosis ( death) fabrics. 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: it is carried out without the use of anesthesia, it is non-traumatic, it has a short recovery period, there is no blood loss and postoperative scars, it preserves reproductive function. This technique is indicated for the combination of uterine fibroids with adenomyosis, nodular and focal forms of adenomyosis.
• EMA ( uterine artery embolization). This is a painless, organ-preserving procedure that effectively treats adenomyosis and allows a woman to plan a pregnancy. This method is minimally invasive, safe and has virtually no contraindications. Embolization of the uterine arteries is carried out using the endovascular method, that is, access through the vessel. The essence of the method is to block the lumen of the uterine arteries using a special substance ( no more than 500 milligrams). As a result, blood flow to the affected area of ​​the uterus or fibroids stops ( benign myometrial tumor), which leads to the death of tissue 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 performed under local anesthesia, preserves reproductive function, short duration of the procedure, rapid recovery of the patient, immediate improvement in condition.

Physiotherapy for adenomyosis

In the treatment of adenomyosis, physiotherapeutic methods are used aimed at eliminating the main symptoms and causes of the disease. Physiotherapy is a complex medical procedures using physical factors - electric current, heat, light and others. The procedures are performed by a qualified doctor in a specially equipped room. The specialist will select the necessary treatment methods individually for each patient, coordinating the treatment with the obstetrician-gynecologist.

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

• Low frequency pulse currents. These include diadynamic, rectangular, transcutaneous electrical neurostimulation. The impulses have an anti-inflammatory, analgesic, and regenerating effect. At the same time, they do not stimulate the production of estrogen. Electrophoresis ( administration of drugs through the skin and mucous membranes under the influence of pulsed currents) allows the administration of drugs in small doses. For adenomyosis, iodine is used. It is deposited in the skin for up to 3 weeks and gradually enters the blood. In the area of ​​inflammation, iodine helps reduce swelling, stimulate reparative and regenerative processes, and normalize the balance of hormones. Treatment is prescribed on the 5th - 7th day of menstruation. The therapeutic effect lasts for 2 - 4 months after the procedure.
• Magnetotherapy. The essence of the method is the local effect on the body of electrical magnetic field. Used in the postoperative period. Has anti-inflammatory, analgesic, sedative, protective effect. Normalizes microcirculation, reduces tissue swelling and improves metabolism.
• Electromagnetic vibrations optical ( light) range. The essence of the method is local exposure to short-wave ultraviolet radiation ( KUF) or laser radiation. Typically 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 and analgesic effect. Helps reduce tissue swelling and normalize microcirculation in the wound area. The combined use of ultraviolet and laser radiation promotes rapid wound healing, prevents the formation of scars, infection and inflammation in the postoperative wound.
• Hydrotherapy. Treatment of adenomyosis is carried out using coniferous and bischofite baths. The action is based on chemical and mechanical irritation of the skin. Such baths eliminate spasms, pain, and have a calming effect. The duration of the aftereffect is 3 - 4 months.
• Balneotherapy ( complex of water procedures with mineral and fresh water). Adenomyosis is treated using radon and iodine-bromine baths. Radon helps reduce estrogen levels and increase progesterone levels, has an anti-adhesive, sedative effect. The duration of the aftereffect of the procedure is about 6 months. Iodine-bromine baths have an anti-inflammatory, analgesic, sedative effect, and 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 sun rays, using therapeutic mud, paraffin, visiting baths and saunas, massage of the lumbosacral region.

The beneficial features of physiotherapy are:

• minimal number of contraindications;
• physiology ( influence of natural factors);
• no toxicity or adverse reactions;
• painless procedures;
• Possibility of compatibility with other treatment methods;
• duration of aftereffect;
• low cost.

Indications for physiotherapy are:

• Adenomyosis I, II, III degrees ( surgically confirmed). In this case, physiotherapy complements hormonal therapy or is used as the main treatment in between courses of hormonal therapy. Treatment is aimed at eliminating pain, inflammation and adhesions, and improving tissue circulation. Low-frequency pulsed current therapy, iodine electrophoresis, and medicinal baths are used. The duration and frequency of therapy is determined by a specialist.
• Inability to carry out hormonal therapy, severe concomitant diseases. If hormonal therapy is contraindicated or severe side effects occur, physiotherapy may become the mainstay effective method treatment. Radon therapy, medicinal baths and others are used.
• Young age of the patient. Physiotherapy has a beneficial effect on hormonal levels, allowing you to minimize or completely replace hormonal therapy, as well as avoid or delay the timing of surgical treatment. Electrotherapy and medicinal bath therapy are carried out. Iodine-bromine baths are indicated for patients with an established menstrual cycle.
• Chronic pelvic pain, menstrual irregularities, uterine bleeding, treatment of adhesions and inflammation after surgery. They use iodine electrophoresis, balneotherapy, hydrotherapy and others. Such procedures reduce spasms and have analgesic and anti-inflammatory effects.
• Prevention of the formation of adhesions and complications in the early postoperative period ( for surgical treatment of adenomyosis). Use laser therapy and ultraviolet radiation, magnetic therapy. Therapy begins on the first day after surgery. This allows you to shorten the healing time of the wound, minimize the use of medications, and also prevent the formation of scars, inflammation and infection of the wound.

Contraindications to physiotherapy are:

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

The following will also increase the effectiveness of treatment of adenomyosis:

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

Is adenomyosis treated with folk remedies?

Adenomyosis is a serious disease caused by hormonal imbalance or various lesions of the uterus. It is impossible to cure adenomyosis with one dose of medicinal herbs, but herbal medicine ( herbal therapy) can be very effective in the complex treatment of adenomyosis. It has a beneficial effect on the general condition of a woman, strengthens the body, and helps reduce the inflammatory process. Therefore, folk remedies can become part of the treatment of adenomyosis or monotherapy ( use of only one drug or method in treatment) after surgery and drug treatment.
The use of medicinal herbs is also recommended for patients with adenomyosis that does not require drug or surgical treatment. Medicinal herbs have antiviral, antitumor, anti-inflammatory, antioxidant, hemostatic ( stopping bleeding), immunostimulating effect. They also have a beneficial effect on a woman’s hormonal levels. Medicinal herbs are used in the form of decoctions, tinctures and topically in the form of tampons and douching. Before starting treatment, you should definitely consult a doctor, undergo the necessary examinations and tests, since improper use of herbs can negatively affect your health.

Benefits of herbal medicine(herbal therapy)are:

• availability;
• low cost;
• no side effects or contraindications ( Possible individual intolerance);
• general strengthening and stimulating effect on the body;
• natural composition;
• use during pregnancy and breastfeeding ( Before use, you should consult your doctor);
• long period of use.

Decoctions and tinctures

Tinctures and decoctions can be made from one type of herb or complex compositions can be made from several types of herbs. Treatment should be carried out over several months.

For the treatment of adenomyosis use:

• Angelica. This medicinal plant contains phytohormones - estrogen and progesterone of plant origin. Angelica reduces the growth rate of foci of adenomyosis, 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 the decoction, boil 15 grams of rhizome in 400 milliliters of water for about 10 minutes. Decant and take 1 tablespoon 3 times a day before meals. You should not take a decoction of angelica during pregnancy, lactation, heavy uterine bleeding, or when taking medications to thin your blood.
• Sabelnik ( marsh cinquefoil). A flock of cinquefoil is taken orally and by douching ( washing the vagina with various solutions medicines or medicinal herbs using a medicinal bulb). Pour 50 grams of herb into 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 effect.
• Borovaya uterus. The boron uterus plant contains unique plant components - flavonoids, which have a beneficial effect on women's health. It has antitumor, anti-inflammatory, restorative, hemostatic effects. Hog queen and cinquefoil are two of the most effective treatments for adenomyosis. Decoctions of these herbs should be used alternately. To prepare the decoction, pour boiling water over the dried herb of the boron uterus and leave for no more than 15 minutes. Take the decoction an hour before meals. Positive results Treatments are observed within a few weeks, but the course of treatment should be long enough until the signs of the disease completely disappear.
• Red brush ( Siberian ginseng, Rhodiola four-cut). Phytohormones in the composition of the red brush help restore the disturbed hormonal balance of a woman with adenomyosis. Cobalt, copper, selenium, molybdenum and other microelements stop bleeding, restore blood circulation, and prevent the development of anemia ( anemia) and the appearance of neoplasms. To prepare the decoction dried root red brush ( 1 tablespoon) is filled with 300 milliliters of water and boiled over low heat for 15 minutes. Let it brew for about an hour, strain and take 100 milliliters 3 times a day with a spoonful of honey. To prepare the tincture, 50 grams of the root are poured with 5 liters of vodka and infused for about a month in a glass container. Take 50 milliliters orally once a day. Decoctions and tinctures of red brush should not be used for heart failure or high blood pressure.
• Yarrow. Yarrow decoctions have hemostatic, anti-inflammatory, and bactericidal effects. Promotes increased contraction of the uterus. Used for uterine bleeding, irregular menstrual cycle, inflammatory processes of the female genital organs. To prepare the decoction, pour 1 tablespoon of chopped herbs into 200 milliliters of boiling water and leave for about an hour. Take 1/3 cup after meals three times a day. To prepare the tincture, 30 grams of crushed herbs are poured with 400 milliliters of alcohol or vodka. Infuse for 14 days in a cool, dark place. Before use, strain and shake. Take 30 drops after meals three times a day.
• Wild yam. This plant promotes the effective treatment of adenomyosis, inflammation of the female genital organs, and also prevents the occurrence of menstrual cramps. To prepare a decoction, 1 - 3 grams of raw materials are poured with 200 milliliters of boiling water and infused for about half an hour. Express and take once a day for 30 days. Contraindicated in children under 18 years of age, during pregnancy and breastfeeding.

Of the complex compositions used:

• A decoction of nettle leaves, shepherd's purse, cinquefoil root, serpentine root, and knotweed herb. This composition of the decoction has a wide range of effects. These include reducing pain, reducing blood loss during menstruation, pain relief, reducing inflammation, and stimulating the body's defenses. To prepare a decoction, dried herbs are mixed. Two tablespoons of the mixture are poured with 400 milliliters of boiled water. Infuse, express and take 100 milliliters 3 times a day.
• Decoction of celandine ( soft part of the plant), plantain, birch buds, poplar buds, juniper fruits. Mix all ingredients in dried form ( based on 200 milliliters of water), pour boiled water, leave for about an hour and strain. Take in small quantities ( no more than 3 sips) 3 times a day after meals. The infusion promotes the maturation of the egg and the onset of pregnancy.

Depending on the menstrual cycle, decoctions are used:

• During the period of egg maturation ( from the beginning of menstruation to the 14th day of the cycle). To prepare the decoction, use a dried mixture of poplar, birch, calamus, tansy, plantain leaves and juniper berries. One teaspoon of the mixture is poured with 200 milliliters of boiling water and left for 1 hour. Strain 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, left for one hour, filtered and drunk 50 milliliters per day after meals. The course of therapy lasts 3 to 4 menstrual cycles.

Local therapy ( tampons, douching)

Tampons are used locally to treat adenomyosis. To prepare a tampon, the bandage is folded into several layers in the form of a bag. Leave a small “tail” for easy removal. Medicinal substance applied to the tampon immediately before use. The tampon is then inserted deep into the vagina for a period of 2 to 10 hours.

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

Douching is washing the vagina with solutions and decoctions of medicinal herbs using a medicinal bulb. Before douching, it is necessary to toilet the external genitalia and treat the medicinal bulb. The water solution must be at room temperature and not contain aggressive components ( alcohol, acids). It is better to administer the solution while lying on your back, 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 this, once a week before bed. Course duration is 7 - 10 days. Douching is contraindicated during pregnancy and the postpartum period, after curettage of the uterus, during acute inflammatory processes, during the menstrual cycle and others. Decoctions of eucalyptus leaves, calendula, yarrow, nettle, oak bark and others are suitable for douching.

Hirudotherapy

In addition to herbal medicine, treatment with leeches is used - hirudotherapy. The procedure is carried out by a specialist in a specially equipped room. Before hirudotherapy, the skin is treated with an antiseptic. Next, leeches are placed on the skin in the lower abdomen. They produce special substances that make their bite painless and stick to the patient. After saturation, the leeches disappear on their own. With hirudotherapy, microcirculation improves, blood stagnation in the pelvic organs decreases, and hormonal levels are normalized. The procedure should be applied at intervals of 2 - 3 days, in a course of 4 - 6 sessions.

Healing clay

Clay has unique properties. It contains a huge amount of microelements and macroelements, nutrients, salts ( calcium, potassium, magnesium and others), which have a beneficial effect on a woman’s body. For treatment, you can use red, black, green clay, but blue clay is especially effective in treating adenomyosis. You can buy clay at the pharmacy in powder form. To use, the clay should be diluted with warm water to the consistency of thick sour cream. To prepare the mixture, use only ceramic or glass dishes. Heat the mixture in a water bath and apply to the area of ​​the lower abdomen. Then cover the clay with film and wrap yourself in a warm blanket. The duration of the procedure is 2 hours. After this, wash off the remaining clay with warm water. The duration of the course depends on the symptoms and degree of damage.

What is the difference between adenomyosis and endometriosis?

Adenomyosis and endometriosis are not the same disease, although they have many similarities. Adenomyosis is considered a form of endometriosis. Endometriosis is gynecological disease, in which the cells of the inner layer of the uterus ( endometrium) grow beyond its borders. This is due to the fact that, under certain conditions, endometrial cells of the uterus enter some area of ​​the body ( where normally they should not occur), attach there and begin to divide. There is endometriosis of the uterus, ovaries, fallopian ( uterine) tubes, peritoneum, vagina, intestines, skin scar and even lungs. Endometriosis of the uterus was called adenomyosis or internal endometriosis. Currently, this pathology is independent disease and is referred to as “adenomyosis” rather than uterine endometriosis.

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

Endometriosis is classified into:

• genital form- the woman’s genitals are affected ( 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.

Endometriosis also has various stages of damage, which apply to all organs and tissues of the body.

According to the stage of distribution, they are distinguished:

• Stage I endometriosis- the appearance of one or several small foci of endometriosis that 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;
• Stage III 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.

Due to the larger area of ​​prevalence of the pathological process, the symptoms of endometriosis are more pronounced and varied.

The main symptoms of endometriosis are:

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

Diagnosis and treatment methods are basically the same. Endometriosis is much more difficult to treat and more often leads to dangerous complications. The difficulty in treating endometriosis lies in its prevalence in the body. This makes it impossible to completely remove endometriosis lesions even surgically.

Why is adenomyosis dangerous?

Adenomyosis without treatment leads to dangerous complications. Adenomyosis is often asymptomatic. The appearance of symptoms indicates that the disease is progressing. In this case, adenomyosis is more difficult to treat and the risk of complications increases.

Serious complications of adenomyosis include:

• Development of anemia. As a result of regular heavy blood loss during menstruation and intermenstrual bleeding, hemoglobin is lost ( red blood cell protein), which contains iron. The main function of hemoglobin is to transport oxygen and saturate tissues with oxygen. If there is 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 experiences shortness of breath, weakness, dizziness, loss of consciousness, memory impairment, and decreased performance.
• Infertility. In severe cases, adenomyosis can lead to infertility. One of the reasons is a woman’s hormonal imbalance. With an excess of estrogen, ovulation is disrupted - 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. Adenomyosis is often combined with endometriosis of the fallopian tubes. This leads to obstruction of the egg tube. Sperm are able to pass through fallopian tube. This is dangerous due to the development of an ectopic pregnancy - the development of pregnancy outside the uterine cavity, which requires surgical intervention. If pregnancy does occur, it can be interrupted by 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. Endometrial cells are also transported throughout the body through the blood and lymph flow. This can lead to damage to any organ. Around the focus of endometriosis, an inflammatory process, swelling, hemorrhage, the appearance of scars and adhesions appears. As a result, the function of the affected organs is disrupted, severe pain appears during menstruation, and neurological disorders ( in case of damage to nerve fibers).

In order to avoid the development of complications of adenomyosis, it is necessary to regularly undergo medical examinations (semiannually) and start treatment on time. Adenomyosis never turns into cancer, so if there are no symptoms or complaints from the patient, there is no need to rush into treatment.

Is it possible to get pregnant with adenomyosis? What are the features of pregnancy with adenomyosis?

Adenomyosis is often the cause of infertility and problems with pregnancy development. In infertile patients, adenomyosis is diagnosed in 15 - 45% of cases. In patients with adenomyosis, infertility occurs in 70% of cases.

The main causes of infertility with 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- egg maturation, fertilization, embryo implantation, pregnancy development, childbirth are regulated by hormones, therefore, with hormonal imbalance, all processes are disrupted;
• pathological changes in the structure of smooth muscle cells of the uterus- this leads to a decrease in the forward movement of sperm, uterine-tubal transport, and a change in uterine contraction;
• genetic abnormalities- if there is a defect in a 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 tissue with scar tissue and the formation of adhesions.

Adenomyosis does not always lead to infertility. But if over a long period ( more than a year) a woman cannot become pregnant, then it is necessary to undergo a course of treatment. The patient is prescribed hormonal drugs, anti-inflammatory drugs, vitamins, immunomodulators and others. Physiotherapy will also have a beneficial effect on health ( therapy using physical factors - magnetic field, light and others) and herbal medicine ( herbal therapy). In severe cases, surgical treatment is indicated. Six months after the course of treatment, you can plan pregnancy again. If pregnancy does not occur after treatment, the patient is offered in vitro fertilization ( ECO). IVF is a procedure for fertilization outside the patient's body, after which a few days later the embryo is inserted into the uterine cavity. But if the thickness of the endometrium is 10 millimeters or more, implantation is impossible. In this case, the only solution is surrogacy - carrying and giving birth to a child by another woman. To do this, the patient’s fertilized egg is injected into the uterus of a woman who will be able to carry and give birth to a healthy child.

The main problem with adenomyosis is not the impossibility of conception, but the impossibility of bearing a fetus. During pregnancy, such patients are under medical supervision, take hormonal medications, and regularly undergo ultrasound examinations ( 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 significant hormones during pregnancy. It plays an important role in the process of conception, implantation of the embryo into the mucous layer of the uterus, preparation of organs and systems for pregnancy and childbirth. Low level 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 woman’s immune system from rejecting the fetus.
• Formation of scars and adhesions. Inflammatory processes appear in foci of adenomyosis. This leads to the replacement of 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 incorrect position of the fetus in the uterus.
• Premature placental abruption. A dangerous complication can be placental abruption ( organ in which the fetus develops), if it is located near the focus of adenomyosis. The placenta attaches to the wall of the uterus and supplies the fetus nutrients, oxygen, cells of the immune system. If it is detached, 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, the woman is prescribed maintenance hormonal therapy and ultrasound examination ( Ultrasound) monitor the thickness of the placenta and the correctness of its development.
• Fetoplacental insufficiency. Fetoplacental insufficiency is a set of symptoms in which disturbances occur in the placenta or fetus. In this case, the fetus suffers from a lack of oxygen ( hypoxia), its development slows down, and various pathologies fetal development.

Pregnancy has a beneficial effect on the health of women with adenomyosis, since menstrual cycles stop during pregnancy. This is a kind of imitation of menopause, which is the basis of hormonal treatment. During pregnancy, the cyclic growth of the endometrium under the influence of estrogen stops. The patient experiences an improvement in well-being, a decrease or complete disappearance of symptoms, and correction of anemia ( due to lack of menstrual bleeding). After pregnancy, the menstrual cycle resumes and the disease returns.

Are there any chances of getting pregnant using in vitro fertilization ( ECO) with adenomyosis?

With many unsuccessful attempts to become pregnant with concomitant adenomyosis, a woman is offered in vitro fertilization ( ECO). This is a modern method of solving the problem of infertility. In vitro fertilization means "fertilization outside the body." To do this, several eggs are removed from the woman's ovaries. In vitro, they are fertilized with the partner's sperm. A fertilized cell is considered an embryo. The resulting embryos are placed for several days in an incubator - a special apparatus that creates conditions for embryo development that are close to physiological.
After 3-5 days, the embryo is transferred into the patient’s uterus through a special elastic catheter. This procedure does not require pain relief. Several embryos are introduced at once, since not all embryos are implanted and take root. This increases the chances of a future pregnancy. The maximum permissible number of inserted embryos is 4, usually 2 or 3. This number is calculated in order to avoid multiple pregnancies. The entire IVF procedure is carried out while taking hormonal medications.

The result of in vitro fertilization depends on the stage of adenomyosis, the patient’s age and her state of health. According to studies conducted in the period 2010 - 2015. on 130 patients, pregnancy rate after IVF with mild degree adenomyosis was 35% ( 19 women out of 130). At medium degree severity - 21% ( 10 women out of 130), with severe degrees - 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 increases significantly with concomitant diseases uterus Thus, reproductive losses when adenomyosis is combined with uterine fibroids are 48%.

To increase the effectiveness of infertility treatment for adenomyosis, timely IVF without prior hormonal treatment is necessary. Pregnancy with adenomyosis is a high-risk pregnancy. As the severity of adenomyosis increases, the number of fertilized eggs introduced into the uterine cavity increases. This increases the chances of embryo implantation. For women with severe adenomyosis, surrogacy is indicated - the implantation of a patient's embryo into the uterus of another healthy woman to carry and give birth to a child.

Is it possible to completely cure adenomyosis and can it go away on its own without treatment?

Adenomyosis is a chronic disease with relapses ( return of the disease after treatment and disappearance of symptoms). When treating adenomyosis, a conservative method is used ( medicinal), physiotherapy, herbal medicine, radical ( complete removal of internal genitalia) and non-radical ( organ-preserving) surgical operations. Treatment is aimed at improving the general condition of the woman, eliminating symptoms, the ability to become pregnant, and preventing the spread of foci of adenomyosis. With this therapy, adenomyosis cannot be completely cured. Some time after the symptoms disappear and seem to be cured, the disease returns. During the first year - in 20% of cases, within five years - in 75% of cases.

The most lasting 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 method of completely curing adenomyosis is radical surgery, in which a woman’s internal genitalia are removed. This treatment method is suitable for women who are not planning pregnancy, women in menopause and concomitant fibroids ( benign myometrial tumor) uterus.

Adenomyosis cannot go away on its own without appropriate treatment. An improvement in a woman's general condition is observed with the onset of menopause. During this period, ovarian function declines and the level of estrogens responsible for endometrial hypertrophy decreases. If adenomyosis is accidentally detected without symptoms or complications, treatment is not carried out.