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What is uterine adenomyosis: Symptoms and Treatment

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uterine adenomyosis - a benign hormone-dependent disorder characterized by infiltration of endometrial tissue in the fallopian other layers (the muscular, serous). It is a kind of endometriosis.

GENERAL

Under normal conditions, the endometrial cells, in accordance with its name, are located only in the inner layer of the uterus - the endometrium. When their distribution outside of the uterus occurs pathological condition - an endometriosis. A characteristic feature of the disease is to maintain the cyclic functional activity of these cells, which in this case often called "endometrioid heterotopia".

Endometrial tissue may spread in structure of female genitalia, as well as abroad - genital or extragenital endometriosis.

Facts about adenomyosis:

  • The term "adenomyosis» (adenomyosis) in Greek language literally means "degenerative changes in glandular muscle» ( «adeno» - iron; «Mys, myos» - muscle; suffix «is» characterizes degenerative transformation structure or body).
  • Synonymous with the name of the pathological condition is a "genital internal endometriosis", "endometriosis uterus."
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  • Localization endometrioid heterotopias cover body at adenomyosis uteri, intramural portion of the fallopian tubes, and cervix (cervical canal).
  • This disease is quite common. According to various sources, adenomyosis of varying severity is present in 8-45% of all women. Such a data run is due to frequent asymptomatic course of the disease.
  • Adenomyosis is the most common localization of endometriosis. Endometrioid heterotopias are found in 70-80% of all women diagnosed with endometriosis.
  • Hormone-dependent disease is a clear character. With the onset of pregnancy, or during the transition to menopause age adenomyosis symptoms regressed significantly or even disappear.
  • Ill, mostly women aged 30-45 years, although the first signs of uterine adenomyosis can occur in adolescents and in the period of the menstrual function.
  • During this disease often leads to infertility. According to statistics, more than half of women who are unable to become pregnant, revealed adenomyosis.
  • A feature of the flow adenomyosis is a tendency to recur. Thus, after the medical treatment and / or organ operations of the probability of occurrence of new episodes of the disease is approximately 20%. And in the period of five years after closure of such treatment adenomyosis relapse occurs in a more than 70% of cases.
  • The severity of symptoms and treatment of adenomyosis is directly dependent on the course of the duration and extent of the pathological process. That is why it is important to early detection of disease.

CAUSES

So far there is no consensus on the causes and mechanisms of development of endometriosis. There are several hypotheses etiopathogenic variants of the disease. However, none of them alone does not explain the essence of the pathological processes that occur in the uterus endometriosis.

It has been established that one of the reasons for adenomyosis is to develop hormonal imbalances against the background of dysfunction of the hypothalamic-pituitary-ovarian system. Also, in addition to hormonal disorders, plays a major role breach of the immune status and genetic predisposition.

All these hypotheses allow to allocate the risk factors, the existence and impact of which are most likely to predispose to the development of this pathology.

Risk factors for uterine endometriosis:

  • Genetic predisposition - the existence of endometriosis any location in the immediate family (mother, sister).
  • Early or, conversely, late sexual maturation.
  • Inflammatory pathology of the female reproductive system.
  • Gynecological diseases accompanied by hormonal imbalance - uterine leiomyoma, cystic ovaries, menstrual disorders and so on..
  • Prolonged wearing of intrauterine contraceptive.
  • Burdened obstetric and gynecological history - pathological labor, abortion, cesarean section, intrauterine surgical manipulation, etc...
  • Obesity.
  • Some somatic diseases - hypertension, diseases of the gastrointestinal tract.
  • Allergic diseases.
  • Frequent or chronic infectious processes.
  • Excessive or, conversely, lack of physical activity.
  • Long-term psycho-emotional overload.
  • The impact of environmental and socio-economic factors.

CLASSIFICATION

Genital internal endometriosis are classified by the degree of proliferation of endometriotic heterotopias in the uterus, as well as morphological form lesions.

Form of adenomyosis:

  • Alopecia. The formation of clusters of endometrial tissue in the thickness of the myometrium, having the appearance of fire. they are often multiple.
  • Nodal. The characteristic "knots" in the myometrium with adenomyosis are formed as a result of the germination of the endometrium into the muscle tissue. They are usually multiple, are surrounded by a connective tissue sheath of inflammatory origin, and are filled with fluid (menstrual blood). This form of the disease is sometimes misdiagnosed as uterine leiomyoma.
  • Diffuse. Endometrial cells spread evenly throughout the diseased uterus thicker.
  • Mixed. It combines the features of the above forms.

The clinical severity of the disease:

  • First. The pathological process spans the submucosal layer and a third column myometrium.
  • Second. Infestation half myometrium thickness.
  • Third. Endometrial cells penetrate substantially the whole muscular layer of the uterus.
  • Fourth. Apart from the myometrium, endometrioid heterotopia found in the visceral and parietal peritoneum and adjacent organs.

SYMPTOMS

Symptoms of uterine adenomyosis in the classic version of the disease are quite typical. Simply on the basis of such manifestations, in most cases it is possible to suspect this pathology.

Key features of the uterus of endometriosis:

  • The main symptom of uterine adenomyosis is a menstrual cycle giperpolimenorei type. Menstruation thus become abundant, prolonged (lasting longer than a week). Frequent uterine bleeding.
  • Almost always there is algomenorrhea - painful menstruation.
  • Often there are premenstrual spotting - the emergence of scarce bleeding ( "spotting") for a few days before the expected menstruation.
  • Pain in the lower abdomen is not always associated with menstruation. Sometimes they may have virtually permanent, radiate to the back and crotch area. This usually occurs in advanced endometriosis.
  • Dyspareunia - pain or discomfort during sexual intercourse.
  • Primary or secondary infertility.
  • Pathology of pregnancy - habitual miscarriage.
  • Neuropsychiatric disorders are found in almost all patients. These include irritability, emotional lability, sleep disturbances, and so on. N.

In some cases, especially in the early stages, the disease may be asymptomatic.

DIAGNOSTICS

Presumably diagnose uterine adenomyosis is already possible on the basis of specific complaints, and as a result of a pelvic exam. Clarify the diagnosis and determine the stage of the disease allows the carrying out of additional methods of examination.

Principles of diagnosis of adenomyosis:

  • Medical history - identify possible risk factors for the disease.
  • The study of patient complaints.
  • Gynecological examination. When adenomyosis is characterized by a moderate increase in uterine anteroposterior size, turning a "spherical" shape. Often reveals painful uterine body at the examination.
  • Ultrasound scan of the pelvic organs. This method confirms the uterine changes identified during the inspection. Also endometriosis uterine specific changes ultrasound pictures are: unevenness uterine contours strain M-echo acoustic disturbances myometrial structure.
  • Hysteroscopy. Identifies various pathological structures in the endometrium (spots, nodules, topography and roughness r. D.). In most cases of endometrial visualized opening moves.
  • Hysterosalpingography. Diagnosed uterine aquifer shadows, often revealed proximal occlusion tubarnaya.
  • Laparoscopy. It has diagnostic value in the third and fourth degree of adenomyosis. On the surface of the body of the uterus revealed nodular structure or point of blue or purple color.
  • Determination of hormone status - levels of estrogen, progesterone, follicle-stimulating and luteinizing hormones, etc...
  • Sometimes readings are held and other methods of examination - magnetic nuclear imaging, consultations related professionals, and so on..

TREATMENT

It is important to understand that adenomyosis - it is a disease that requires a holistic approach to therapy, given its multi-factor and the presence of a variety of physiological disorders.

Treatment of uterine adenomyosis is based on two principles: conservative and surgical. Choice of tactics of therapy depends on many criteria.

Selection Factors treatments adenomyosis:

  • The woman's age.
  • The location and extent of the pathological process.
  • Duration of disease.
  • The severity of clinical symptoms, the presence of complications.
  • The interest of women in the implementation of reproductive function.
  • The presence of concomitant gynecologic pathology.
  • The effectiveness of previous treatment.
  • The status of other organs and systems.

Conservative treatment of adenomyosis:

  • Basis - hormonal treatment. Depending on the availability of indications and contraindications for a particular type of hormone therapy used drugs different pharmacological groups: estrogen-progestogen, progestogen, antigonadotropiny, anti-estrogens, gonadotropin-releasing hormones (GnRH-a).
  • The dosage of hormone therapy drugs selected individually. Duration of treatment is at least six months with clinical and ultrasound inspection.
  • Non-specific anti-inflammatory therapy. With this purpose nonsteroidal antiinflammatories, protease inhibitors.
  • Drugs affecting the central nervous system - sedation, minor tranquilizers, psychotherapy.
  • Resolution therapy. For this purpose, for example, some enzyme preparations.
  • Correction of immune disorders (immunomodulators), antioxidants, vitamins and minerals and m. P.
  • Tools that support the normal function of the gastrointestinal tract and hepatobiliary system - gepatoprotektory.
  • In the presence of adhesions, severe pain syndrome are various methods of physical therapy effects: ultrasound, electrophoresis with drugs, balneotherapy, reflexology, magnet and t. d.
  • Required concomitant treatment of gynecological pathology and internal diseases.

Indications for surgical treatment of adenomyosis:

  • The sheer inefficiency of conservative therapy.
  • Infertility.
  • Suspicion of malignant degeneration.
  • Tumorous form of adenomyosis.
  • The combination with adenomyosis hyperplasia of the ovaries.
  • Adenomyosis, which is accompanied by endometrial hyperplasia, especially atypical of its forms.
  • The presence of a somatic pathology, which rules out long-term hormone therapy.

Methods of surgical treatment:

  • At the young age of being able to produce organ-operation laparotomy or laparoscopy. During this process the removal of lesions (excision, coagulation, and so on. D.).
  • At the age of perimenopause performed hysterectomy: a subtotal excision of the cervix or hysterectomy with tubes.

The main criteria for successful treatment of adenomyosis are: the absence of recurrence of the disease and restore a woman's reproductive function.

COMPLICATIONS

With long-term course of the disease often develop a variety of complications, some of them, unfortunately, are irreversible.

Complications of adenomyosis:

  • Hemorrhagic anemia. As a result of prolonged and heavy menstruation or uterine bleeding occurs a considerable loss of blood, which inevitably leads to the development of anemia.
  • Infertility, miscarriage.
  • Recurrence - the emergence of new after treatment of adenomyosis symptoms.
  • Distribution of endometrioid process to adjacent and distant organs.
  • Malignant transformation - uterine cancer. This complication is rare. However, endometriosis is often associated with endometrial hyperplasia or ovaries, which increases the risk of malignancy.

PREVENTION

Preventive measures to prevent the development of adenomyosis focused primarily on regular visits to the gynecologist for early detection of disease.

It is necessary to lead a healthy lifestyle, to use modern means of contraception for the purpose of preventing abortion. It should also be timely to identify and treat gynecological and somatic diseases.

FORECAST FOR RECOVERY

When the diagnosis of "uterine adenomyosis" prognosis for recovery is mainly determined, the degree of organ injury and proper treatment.

Note that this pathology is characterized by a tendency to recur, so anticipate a full recovery of the uterus endometriosis is difficult enough. However, if detected early and adequate complex treatment is considered more favorable prognosis of the disease.

After performing radical surgery combined with conservative therapy, as well as the transition between the counter menopause almost always comes a full recovery.

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