Surgical treatment of adenomyosis. Adenomyosis: symptoms and treatment. reasons to contact the Center for Gynecology, Reproductive and Aesthetic Medicine

Adenomyosis is a pathology in which pathological growth of the endometrium (inner layer of the uterus) occurs. How is adenomyosis treated? Is it possible to cure the disease without surgery?

General information about the disease

Adenomyosis is a special case of endometriosis. With this pathology, the inner layer of the uterus grows more than it should by nature. The endometrium penetrates into the thickness of the muscular and serous layer, interfering with the normal functioning of these structures. There are 4 stages of disease development:

Stage I – the pathological process does not penetrate beyond the uterine mucosa;
Stage II – the endometrium grows into the muscle layer;
Stage III - the endometrium passes to the serous membrane;
Stage IV – involvement of other pelvic organs in the process.

This is how the diffuse form of the disease manifests itself. In the nodular form, a separate node is formed, consisting of an accumulation of pathological tissue. This condition is often confused with uterine fibroids, a benign tumor of the myometrium.

The reasons for the development of adenomyosis are still not precisely known. It is assumed that the formation of the disease is influenced by the following factors:

unrealized reproductive function and first pregnancy delayed for a long time;
hormonal imbalance in adolescence;
heredity.

Internal endometriosis occurs at any age. Both teenage girls and menopausal women suffer from this disease. Among patients with infertility, this diagnosis occurs in 30% of cases. Some women develop extragenital forms of endometriosis.

Symptoms

Let's look at the main symptoms of adenomyosis that allow us to suspect this disease:

Changes in the nature of menstrual bleeding.
The appearance of intermenstrual discharge.
Iron deficiency anemia.
Autonomic disorders.
Infertility.

Menstruation with adenomyosis becomes abundant, prolonged and painful. They are often accompanied by brown spotting two days before and for two to three days after the end of bleeding. Characterized by severe pain in the lower abdomen - nagging, debilitating pain radiating to the groin, inner thighs, rectum, sacrum, and lower back. Such pain occurs in the first days of menstruation (algomenorrhea).

Algodismenorrhea is characterized by an increase in the number of hygiene products; usually a woman uses several packages of sanitary pads during menstruation. She often instinctively refuses to use tampons. You shouldn’t be embarrassed to tell your doctor about this at your appointment, because this is often how the doctor can figure out the amount of blood loss.

Common adenomyosis causes irregular bleeding during the intermenstrual period - metrorrhagia. Their intensity varies, but they are usually painless.

Such significant blood loss leads to the development of chronic posthemorrhagic anemia. By its nature, it is iron deficiency and is associated with depletion of iron reserves, necessary for the synthesis of new red blood cells to replace those lost during bleeding. External manifestations of iron deficiency anemia are pallor, dryness and sagging skin and mucous membranes, hair loss, early graying of hair, brittle and layered nails, weakness. The nervous system suffers. There is a tingling sensation in the tongue, a sensation of a foreign body in the throat, which makes it difficult to swallow food.

Myocardial dystrophy develops - a malnutrition of the heart muscle, accompanied by heart rhythm disturbances and shortness of breath on exertion. One of the signs to suspect a lack of iron is a perversion of taste - a woman wants to eat chalk, lime, clay and other inedible substances. Sometimes there is a craving for the smell of gasoline or paint. These are indirect signs of adenomyosis, indicating its severe course.

Autonomic disorders with adenomyosis also significantly reduce a woman’s quality of life. They are manifested by nausea, vomiting, attacks of dizziness, headache and fainting. These signs are associated with hormonal and reflex processes in response to bleeding from endometriotic lesions. Vegetative manifestations most bother the patient in the first days of menstruation. They go away along with the pain after taking antispasmodic drugs.

A more rare symptom of adenomyosis is dyspareunia - pain during sexual intercourse. It is more typical for cervical endometriosis. When lesions grow into neighboring organs - the bladder, rectum - their functions may be impaired (frequent urination mixed with blood, constipation or diarrhea, pain in the pelvic area).

One of the dangerous consequences of adenomyosis is infertility. It occurs due to dysfunction of the myometrium. If a fertilized egg is implanted into the wall of the uterus in the place where there is an extensive focus of endometriosis, it will not be able to receive full nutrition, and the chorion and placenta will not form. If the formation of these structures does occur, they will be defective, which will cause a delay in fetal development and the threat of miscarriage.

Often adenomyosis leads to the formation of adhesions in the uterine cavity. During fetal growth, they will interfere with its development. If the placenta forms at the site of a large focus of adenomyosis, in recent months this will be fraught with its premature detachment.

The following methods are used to diagnose the disease:

hysteroscopy;
endometrial biopsy;
laparoscopy.

Treatment methods

Treatment of uterine adenomyosis is a complex process that requires a lot of patience from the patient and her doctor. In some cases, doctors manage to cope with the disease using conservative methods. This approach is justified in young women, when therapy for adenomyosis is one of the stages of infertility treatment.

Drug therapy

Drug treatment includes the following:

COCs (combined oral contraceptives);
gonadotropin-releasing hormone agonists;
progestogens;
aromatase inhibitors.

The choice of treatment method will depend on the patient’s age, the severity of her condition and the individual characteristics of the body. Treatment of internal endometriosis in stages I and II of the disease is usually not carried out. To alleviate the condition, anti-inflammatory drugs are prescribed to relieve pain during menstruation. It is possible to use antispasmodics for moderate pain.

For the treatment of adenomyosis I and II in young patients suffering from infertility, oral contraceptives can be used. These drugs stabilize hormonal levels and suppress excessive growth of the endometrium. Gonadotropin-releasing hormone agonists are prescribed for the same purpose. The course of therapy lasts from 3 to 6 months. After completion of treatment, it is recommended to plan pregnancy in the next cycle.

Not all women tolerate hormone treatment well. While taking agonists, many patients develop the so-called false menopause. This condition is associated with a temporary shutdown of the ovaries and is accompanied by a number of unpleasant symptoms. Hot flashes, insomnia, mood swings, excessive sweating and other typical symptoms of menopause do not bring pleasure to any woman.

To eliminate such unpleasant symptoms, cover therapy is used. Its essence lies in the use of medications that eliminate the main manifestations of false menopause. Unfortunately, even the most modern means are not able to completely rid a woman of the side effects of agonists. Doctors often have to interrupt the course of therapy and decide whether to use other treatment methods.

There is now great debate about the advisability of using gestagens. It is believed that these drugs themselves are capable of stimulating the progression of the disease. In this regard, in recent years, emphasis has been placed on the development of new agents (for example, aromatase inhibitors). You can discuss the possibilities of using a particular drug with your doctor.

Non-drug methods

From the standpoint of evidence-based medicine, the use of non-drug therapy for the treatment of adenomyosis does not make sense. Massage or physical therapy does not bring noticeable relief and does not affect the course of the disease. For the same reason, adenomyosis is not treated with folk remedies. It is impossible to cure internal endometriosis with herbs and lotions.

Surgical treatment

Adenomyosis at any age is often accompanied by heavy bleeding, threatening the life and health of a woman. If this condition develops, the patient is hospitalized in a gynecological hospital on an emergency basis.

The main method of stopping bleeding is curettage of the uterine cavity. The procedure is performed under general anesthesia. During the operation, the doctor removes a layer of the overgrown endometrium, thereby stopping blood loss. The resulting material is sent for histological examination. If technically possible, hysteroscopy (examination of the uterine cavity using a special instrument) is performed simultaneously.

Episodes of heavy bleeding may recur many times throughout life. Blood loss can be quite significant, which seriously complicates the life of any woman. If the disease lasts for a long time and the treatment is ineffective, removal of the uterus is indicated.

During the reproductive period, subtotal hysterectomy is predominantly performed. During this operation, only the uterus is removed, while the cervix remains in place. Radical hysterectomy (removal of the uterus along with the cervix) is recommended during menopause, as well as when adenomyosis is combined with cervical endometriosis.

Rehabilitation after surgery takes from 2 to 8 weeks. After laparoscopic procedures, recovery takes much less time. In the postoperative period, physiotherapy and other procedures are prescribed to ensure a speedy return to normal life.

Prevention

Specific prevention of adenomyosis has not been developed. The following recommendations will help slightly reduce the risk of developing the disease:

timely implementation of your reproductive function;
treatment of menstrual disorders;
regular observation by a gynecologist;
prevention of abortions.

Paying attention to your health will reduce the likelihood of adenomyosis and all the problems associated with this disease.

Unique methods of treating adenomyosis

Laser drilling is a unique technique that is performed using a holmium laser during hysteroscopy and laparoscopy. The laser beam creates special channels in the uterine muscle that prevent the spread of endometriosis. The method allows you to preserve not only the uterus, but also the ability to conceive and carry a baby naturally.

Make an appointment with a gynecologist and we will solve the issue together!

The only non-invasive method in Russia that allows you to fight adenomyosis. It is carried out under the control of magnetic resonance imaging with focused ultrasound, which causes heating and removal of areas of adenomyosis in the uterine muscle.

Only careful attitude to your health and the help of a specialist will help you avoid many consequences.

Types of adenomyosis

Nodal If endometrial cells are concentrated in separate foci (nodes) located in the thickness of the walls of the uterus
Diffuse If endometrial cells are evenly “scattered” throughout the thickness of the uterine wall, without gathering into separate foci
Mixed Implies the appearance of both previous forms

Causes

To successfully prevent and treat adenomyosis, it is necessary to know the causes of its occurrence. Although the exact causes of adenomyosis have not yet been established, it can develop due to:

Rough intrauterine manipulation (especially abortion);
complicated childbirth;
genetic predisposition;
chronic stress;
obesity;
use of an intrauterine device;
late onset of the first menstruation;

Symptoms

Manifestations of the disease are individually expressed in each woman. They are often unpredictable and therefore require an individual approach

Adenomyosis can manifest itself in different ways. However, its most characteristic symptoms are:

infertility;
constant pelvic pain;
pain during intimacy.
dark brown spotting 2-3 days before or 3 days after menstruation;
menstrual irregularities;

Diagnostic methods

01.
Manual examination

Adenomyosis of the uterus can be recognized in various ways. The primary diagnosis can be made by a gynecologist after a manual examination. The doctor is able to assess the condition of the uterus, its size, shape, position, mobility. By palpating the organ with its appendages, he will be able to distinguish tumor growths. Painful manual examination may also indicate pathology.
02.
Ultrasound of the pelvic organs

An effective diagnostic method is pelvic ultrasound. Ultrasound can accurately assess the extent of uterine damage by adenomyosis and determine the form of adenomyosis (nodular, diffuse or mixed)
03.
Hysteroscopy

Hysteroscopy - insertion of a special camera into the uterine cavity and displaying an image on a monitor. The method allows you to see the condition of the walls of the uterus from the inside and identify foci of adenomyosis, which look like dark red dots against the background of pale pink mucosa. The method also makes it possible to detect uterine deformation, which often occurs in severe forms of adenomyosis. It is better to conduct this study on days 5-10 of the cycle. If necessary, a biopsy of the affected areas is possible.

3 reasons to apply
at the “Center for Gynecology, Reproductive and Aesthetic Medicine”

Treatment of adenomyosis

To defeat adenomyosis, treatment must be comprehensive. There are many factors to consider, including:

clinical manifestations;
severity of the disease;
existing complications;
woman's age;
desire to have children in the future.

If a woman is diagnosed with adenomyosis, treatment may include:

conservative;
surgical.

Conservative treatment

Conservative treatment is selected by the attending physician individually and depends on the clinical manifestations of the disease, severity, age of the patient, reproductive plans, and the presence of concomitant diseases

hormones;
vitamins;
anti-inflammatory;
increasing immunity.

Surgical treatment of adenomyosis

In some cases, there is a need for surgical treatment. Such cases may include:

Severe forms of adenomyosis
Lack of effect from conservative treatment
Presence of contraindications to drugs used in conservative treatment

In the vast majority of cases, operations are performed laparoscopically.

Treatment of adenomyosis with laser drilling

Laser drilling can treat diffuse adenomyosis. This treatment is carried out using laparoscopy or hysteroscopy. Modern technologies strive to minimize tissue trauma, so office hysteroscopy is increasingly used.

Drilling is performed using a holmium laser. This technology is the most modern today. Using a laser, foci of adenomyosis are destroyed without damaging healthy muscle tissue of the uterus. All this naturally occurs under the control of vision. The advantage of the laser method is that it is the most gentle, gentle and at the same time effective compared to other methods.

The method preserves both the uterus and its main function. In this case, postoperative scars are not formed.

Complications of adenomyosis

Adenomyosis itself is not life-threatening. However, it causes significant problems in the life of a modern woman.

Constant intense pelvic pain significantly worsens the quality of life, and painful menstruation leads to the need to miss work and entertainment. Pain during sexual intercourse deprives partners of a full intimate life. A woman avoids intimacy, she develops depression, a feeling of helplessness, irritability, and relationships between partners become tense. Prolonged bleeding leads to anemia. Anemia, in turn, leads to constant fatigue, weakness, and loss of performance.
Adenomyosis can cause infertility or miscarriage.

Prevention of adenomyosis

Prevention of adenomyosis involves regular visits to the gynecologist. Timely detection of an emerging problem allows you to take timely measures and avoid the development of adenomyosis and its complications. You should also lead a healthy lifestyle, give up bad habits, avoid casual sex and unwanted pregnancies.

Take care of your health with the specialists of our medical center!

Treating
doctors

Our center employs the most experienced and qualified personnel in the region

Attentive
and experienced staff

Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and Aesthetic Medicine, Candidate of Medical Sciences, doctor of the highest category, Associate Professor of the Department of Regenerative Medicine and Biomedical Technologies of Moscow State Medical University named after A.I. Evdokimova, board member of the Association of Aesthetic Gynecologists ASEG.

Graduated from the Moscow Medical Academy named after I.M. Sechenova, has a diploma with honors, completed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA named after. THEM. Sechenov.
Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
From 2009 to 2017 she worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.
She defended her dissertation for the degree of Candidate of Medical Sciences on the topic: “Opportunistic bacterial infections and pregnancy”

Myshenkova Svetlana Aleksandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

In 2001 she graduated from the Moscow State Medical and Dental University (MGMSU)
In 2003, she completed a course of study in the specialty “obstetrics and gynecology” at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
He has a certificate in endoscopic surgery, a certificate in ultrasound diagnostics of pathologies of pregnancy, fetus, newborn, in ultrasound diagnostics in gynecology, a certificate of a specialist in the field of laser medicine. He successfully applies all the knowledge acquired during theoretical classes in his daily practice.
She has published more than 40 works on the treatment of uterine fibroids, including in the journals “Medical Bulletin” and “Problems of Reproduction”. He is a co-author of methodological recommendations for students and doctors.

Kolgaeva Dagmara Isaevna

Head of the department of pelvic floor surgery. Member of the scientific committee of the association for aesthetic gynecology.

Graduated from the First Moscow State Medical University named after. THEM. Sechenov, has a diploma with honors
She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
Has certificates: an obstetrician-gynecologist, a specialist in the field of laser medicine, a specialist in intimate contouring
The dissertation is devoted to the surgical treatment of genital prolapse complicated by enterocele
The sphere of practical interests of Dagmara Isaevna Kolgaeva includes:
conservative and surgical methods of treating prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

Graduated from Ryazan State Medical University named after academician I.P. Pavlova with a degree in general medicine
Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology Clinic named after. V.F. Snegirev MMA named after. THEM. Sechenov
Proficient in a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access
The scope of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic operations for uterine fibroids (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

Graduated from the First Moscow State Medical University named after. THEM. Sechenov.
She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
She is certified as an obstetrician-gynecologist.
Possesses the skills of surgical treatment of gynecological diseases on an outpatient basis.
He is a regular participant in scientific and practical conferences on obstetrics and gynecology.
The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnosis and treatment of intrauterine pathology, cervical pathology

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, gynecological oncologist

In 2013 he graduated from the First Moscow State Medical University named after. THEM. Sechenov.
From 2013 to 2015, he completed a clinical residency in the specialty “Obstetrics and Gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
In 2016, he underwent professional retraining at the State Budgetary Institution of Healthcare of the Moscow Region MONIKI named after. M.F. Vladimirsky, specializing in Oncology.
From 2015 to 2017 he worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.

Mishukova Elena Igorevna

Obstetrician-gynecologist

Doctor Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. She completed clinical internship and residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
Mishukova Elena Igorevna has a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
Mishukova Elena Igorevna is an annual participant in Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
The dissertation is devoted to the topic of organ-preserving treatment of adenomyosis using FUS ablation. He has a certificate of obstetrician-gynecologist and a certificate in ultrasound diagnostics. Proficient in the full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
Author of a number of published works, co-author of a methodological guide for doctors on organ-preserving treatment of adenomyosis using FUS ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Ultrasound diagnostics doctor.

Gushchina Marina Yurievna graduated from Saratov State Medical University named after. V.I. Razumovsky, has a diploma with honors. She was awarded a diploma from the Saratov Regional Duma for excellent success in studies and scientific activities, recognized as the best graduate of Saratov State Medical University named after. V. I. Razumovsky.
She completed a clinical internship in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor, specialist in the field of laser medicine, colposcopy, endocrinological gynecology. She has repeatedly taken advanced training courses in “Reproductive Medicine and Surgery” and “Ultrasonic Diagnostics in Obstetrics and Gynecology”.
The dissertation work is devoted to new approaches to differential diagnosis and management tactics for patients with chronic cervicitis and early stages of HPV-associated diseases.
Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, hysterosalpingography) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
Gushchina Marina Yurievna has more than 20 scientific published works, is a regular participant in scientific and practical conferences, congresses and conventions on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, gynecologist for children and adolescents

Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the Faculty of Medicine of the First Moscow State Medical University. THEM. Sechenov.
He is certified as an obstetrician-gynecologist, ultrasound diagnostics doctor, specialist in laser medicine, pediatric and adolescent gynecology.
Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, cervical biopsy) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
She completed clinical residency in the specialty “Obstetrics and Gynecology” on the basis of the department of the Federal State Budgetary Educational Institution of Additional Professional Education “Institute for Advanced Training of the Federal Medical and Biological Agency.”
He has certificates: obstetrician-gynecologist, specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Ultrasound diagnostics doctor, obstetrician-gynecologist, candidate of medical sciences

Graduated from the Ivanovo State Medical Academy with a degree in general medicine.
Completed an internship at the Tambov Regional Clinical Hospital, specializing in obstetrics and gynecology.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor; specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
Repeatedly took advanced training courses in the specialty “obstetrics and gynecology”, “Ultrasonic diagnostics in obstetrics and gynecology”, “Fundamentals of endoscopy in gynecology”
Proficient in the full scope of surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal approaches.

At the Center for Endovascular Surgery, Prof. Kapranov is undergoing treatment for adenomyosis. Experienced professionals help patients cope with various manifestations of the disease. Therapy is carried out using modern techniques. OUR CENTER IS THE ONLY MEDICAL INSTITUTION IN RUSSIA, WHOSE SPECIALISTS HAVE EXTENSIVE EXPERIENCE IN THE FIELD OF INNOVATIVE ENDOVASCULAR TREATMENT OF ADENOMYOSIS.

Important! You can choose a clinic for therapy yourself. This allows us to take into account all wishes for treatment, room comfort, food, staff qualifications and other important factors.

Cost of the operation:

General information

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

What causes the development of the disease?

For what reasons adenomyosis develops is not known exactly. Unfortunately, the basic mechanisms of the development of pathology are not fully understood to date. We can only say that adenomyosis is a hormonally dependent disease.

Its development is promoted by:

unfavorable heredity;

too early or late onset of menstruation;

obesity;

complicated childbirth;

abortions, curettage;

use of an intrauterine device, oral contraceptives;

inflammatory diseases of the reproductive system;

dysfunctional bleeding;

frequent infections;

allergic reactions.

Is pregnancy possible?

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

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

Why does infertility occur?

In fact, there are several reasons. Let's look at the main ones:

Violation of the transport function of the fallopian tubes due to adhesions.

Pathological changes in the hormonal sphere. They prevent ovulation.

Autoimmune reactions leading to sperm deactivation.

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

Pain during sexual intercourse. Discomfort leads to the fact that a woman may refuse sex altogether.

Infertility is often caused by a number of reasons.

Main symptoms of the disease and stages of its development

In some cases, adenomyosis is asymptomatic.

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

Often the patient may note such signs of pathology as:

Heavy and prolonged menstruation. Bleeding lasting more than 7 days should alert a woman.

Spotting (bloody) discharge. Typically, patients notice them in the middle of the cycle.

Discharge of clots during menstruation.

Pain in the lower abdomen during sex.

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

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

Adenomyosis: degrees

Experts distinguish 4 degrees of the disease:

The endometrium is found in the submucosal layer.

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

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

This degree is characterized by deep damage. The endometrium grows into all layers of the organ.

Forms of the disease

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

Nodal. In this form of the disease, the endometrium forms separate nodes in the uterus. The pathology resembles fibroids. The endometrium can fill the uterus.

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

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

Risk group:

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

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

All women over 35-40 years of age are also at risk.

Consequences of the disease

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

Important! You should undergo examination and begin treatment as soon as possible. Only in this case can all risks of the disease be prevented. You must consult a qualified physician. It will help cope with symptoms and get rid of tissue pathology in the shortest possible time.

Diagnosis of the disease

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

The gynecologist will conduct an examination. He will determine the need for a more thorough examination.

What research methods are used?

Ultrasound of the pelvic organs.

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

The main signs of the disease on ultrasound include:

Heterogeneous structure of the endometrium.

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

The presence of various inclusions, cysts.

Thickening of the walls.

The diagnosis cannot be made based on ultrasound and physical examination alone.

MRI (magnetic resonance imaging)

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

Hysteroscopy

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

Hysterosalpinography and sonohysterography

These methods are used to exclude other diseases.

Does the disease need to be treated?

If the pathology does not threaten the woman’s life or does not cause serious concern, then the doctor can limit himself to preventing complications. In this case, no treatment is carried out. There is no need for it, since the pathology does not cause complications and does not interfere with a woman’s life.

Typically, treatment is not prescribed to women aged 45-50 years who are about to enter menopause.

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

Treatment of the disease

Surgical treatment. Removal of nodes or nodes along with the uterus.

Drug treatment. Symptomatic and hormonal therapy.

Let's consider both methods:

Operation. Doctors always try to carry out organ-preserving interventions. Laparoscopic techniques and excision of endometrioid lesions are usually used. Relatively recently, embolization of the uterine arteries was introduced into practice.

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

When is surgery scheduled to remove the uterus?

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

The uterus and ovaries are removed in the following cases:

progressive course of pathology in women over 40 years of age,

lack of effect of therapy,

combinations of several forms of the disease,

threats of malignant transformation.

How is the treatment carried out?

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

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

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

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

The main advantages of the treatment method used

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

Minimal invasiveness. There is no need to make any incisions for the intervention. The doctor does not use general anesthesia.

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

Minimal risks of complications. The development of adverse consequences with UAE is 1%.

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

With adenomyosis, which proceeded without concomitant diseases and complications, just a month after UAE, about 50% of patients report a complete disappearance of the symptoms of dyspareunia and algomenorrhea. It is noteworthy that already 3 months after undergoing UAE, the regular menstrual cycle is completely stabilized in 100% of patients, and 5 months after this operation there is a reduction in blood loss during menstruation to 48%, the level of hemoglobin in the blood significantly increases, and the duration of menstruation stabilizes by 37 %.

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

When visiting a gynecologist, many women are diagnosed with a disease such as adenomyosis. The doctor does not always correctly explain what kind of disease it is and how seriously you need to take it. In the early stages, conservative treatment can also help, but in advanced cases, only surgical intervention is required.

Adenomyosis is a disease of the internal female genital organs, in which endometrial tissue grows into the muscular layer of the uterus. In the affected areas, the muscle tissue becomes denser, causing the uterus to increase in size.

Adenomyosis was recently identified as a separate disease. It is quite widespread nowadays among women of different ages, but often occurs after 25 years.

According to the morphological picture, it is divided into 3 forms:

focal (endometrial tissue is embedded in the muscle layer only in some places, forming separate foci);
diffuse (uniform damage to the walls of the uterus);
nodular (muscle damage with the formation of nodes).

Based on the depth of penetration of endometrial tissue, it is customary to distinguish 4 degrees of adenomyosis:

I degree (only in the intermediate layer);
II degree (up to the middle of the muscle layer);
III degree (more than the middle of the muscle layer);
IV degree (damage to all layers and penetration into the abdominal cavity).

The first stages of adenomyosis respond quite well to therapeutic treatment. Grades III and IV can only be treated surgically.

In half of the cases, this disease does not manifest itself at all. Among the visible symptoms, a woman may note:

long or, conversely, short menstruation, accompanied by pain and bleeding;
brownish spotting at the beginning and end of menstruation;
presence of clots in menstrual flow;
spotting and bloody discharge between menstruation;
premenstrual syndrome (PMS) is pronounced;
dyspareunia (pain during sexual intercourse).

The period of menstruation is accompanied by severe pain. Usually simple painkillers are ineffective. With age, pain during menstruation increases.

The exact causes of this disease are unknown. It is generally accepted that the causes may be factors whose impact leads to disruption of the barrier layer, namely:

surgical manipulation of the uterus (curettage, caesarean section, abortion);
various inflammations of the uterus or appendages;
hormonal imbalances;
genetic predisposition;
the presence of an intrauterine device;
frequent trips to the solarium;
non-intense sex life;
frequent overwork;
failure of the immune system due to frequent stress.

There are cases when adenomyosis is diagnosed in women who have not tolerated any interventions or diseases, as well as in very young girls. In such cases, it appears without the influence of various external factors. The cause of the disease may be a disturbance during intrauterine development of the fetus.

The reason may be a weak opening of the cervix during menstruation in women, when it spasms and the muscles, contracting, build up high pressure in the uterus. At this moment, the barrier layer located between the endometrial and muscle may be injured. In this case, the outflow of secretions is hampered, which, under the influence of pressure, are released in significant quantities into the abdominal cavity through the appendages, where particles of endometrial tissue are implanted - and endometriosis develops.

There are several methods by which adenomyosis is diagnosed. Some of them are expensive, but only they allow you to make an accurate diagnosis and choose the right treatment.

Ultrasound examination (ultrasound) - allows you to see the enlargement of the uterus, the heterogeneous structure of the myometrium, blurring of the layers of the uterus, and the presence of individual foci. The walls of the uterus may not be the same thickness.
Inspection on the chair using mirrors. The gynecologist can detect an enlarged uterus (“round uterus”).
Colposcopy is performed using a special video colposcope device, which is used to examine the condition of the uterine cervix.
Hysteroscopy - several small incisions are made in the abdominal cavity, a small video camera is inserted through one, and instruments are inserted through the others. This method is used both for diagnosis and for surgical operations.
Laparoscopy – no incisions are made in the abdominal cavity, as a video camera and instruments are inserted through the vagina and cervix. This method is used both for diagnosis and for performing operations for mild stages of uterine adenomyosis.
Magnetic resonance imaging (MRI) is rarely used in such diagnostics. MRI is prescribed only after an ultrasound scan, which does not provide a clear understanding of whether it is a nodular form of adenomyosis or fibroids.

After a complete diagnosis, the necessary treatment is prescribed. Adenomyosis cannot be completely cured. You can only prevent further development of the disease and achieve regression until menopause, when regression occurs on its own.

There are two treatment options - conservative (therapeutic) and surgical (operative).

It is carried out in the presence of a single small focus of adenomyosis in the body of the uterus. Gonadotropin-releasing hormone (GnRH) agonists are usually prescribed - drugs: Lucrin depot, Buserelin-depot Zoladex, etc. They cause temporary reversible menopause. After completing the course of treatment, the cycle will be restored. The chances of becoming pregnant in women of reproductive age increase significantly. If symptoms are mild, over-the-counter medications are suitable for treatment.

Adenomyosis often recurs. To stabilize the positive results after undergoing the main treatment, it is necessary to take hormonal contraceptives. As an option, it is recommended to install a Mirena intrauterine device. Hormonal contraceptives provide prevention of adenomyosis and also stop its progression in the early stages of the disease. It is better to use the drugs according to the 63 + 7 regimen (3 packs without a break, then a 7-day break and again taking 63 days).

Surgical treatment is started if the full course of conservative therapy has been completed, and no positive changes are observed, as well as in severe cases, when the foci of adenomyosis are multiple and extensive (nodular and diffuse forms) or adenomyosis is combined with other diseases of the uterus.

Indications for surgery for uterine adenomyosis:

diffuse or nodular forms;
lack of a positive result after 3 months of conservative therapy;
myometrial hyperplasia with adenomyosis II – III degrees;
adenomyosis is combined with fibroids, ovarian tumors, etc.;
endometriotic ovarian cysts;
suppuration of the uterine appendages;
the presence of somatic diseases for which long-term hormonal therapy is contraindicated;
adhesive process.

Surgical intervention for adenomyosis is carried out using an open method, laparoscopy or hysteroscopy. The method of performing the operation is chosen by the doctor, taking into account the presence of concomitant diseases and contraindications. The severity of adenomyosis also matters.

If a woman of reproductive age is still planning a pregnancy, endometriotic tissue is removed, if possible, while preserving the uterus. A more radical approach is amputation of the uterus, sometimes with appendages. They resort to this method only as a last resort, if nothing else helps. The operation is performed on postmenopausal patients or if a woman of reproductive age is no longer interested in maintaining menstrual and reproductive function.

Ablation– a method of treating adenomyosis, applicable when endometrial tissue has penetrated only into the intermediate layer. The procedure is carried out in several ways:

laser;
electric shock;
exposure to high temperature (balloon intrauterine therapy).

Uterine artery embolization - blocking of blood vessels supplying blood to pathological lesions. In some cases it is an effective operation. After the procedure, a gradual decrease in lesions is observed.

Hysterectomy (removal of the uterus)- this is a radical measure. Various options for uterine amputation are used:

removal of the uterine body;
removal of the uterus and cervix;
removal of the uterus with the upper part of the vagina and adjacent tissues supporting these organs.

Sometimes appendages (tubes and ovaries) or neighboring organs infected with endometriosis (gallbladder, etc.) are also removed.

With the development of medical technologies, uterine amputation operations for uterine adenomyosis began to be performed using the laparoscopy method. Vaginal hysterectomy avoids external scarring. Often this operation is performed using a laparoscope, which makes it possible to establish visual control over the process. To insert it, a small incision is made on the abdomen. An incision is also made in the vagina near the uterus through which the uterus will be removed. For adenomyosis in the last stages, this method is not suitable, since the uterus is usually greatly enlarged and there are various types of neoplasms, the most common of which are fibrous. In this case, direct (abdominal) access to the uterus is necessary when an incision is made on the abdomen.

With vaginal access, there is a risk of damage to the urethra, but patients’ recovery after surgery is quite quick, and with abdominal access, the risk of such damage is minimal, but recovery takes a long period.

It is important at what period of the patient’s life the operation was performed. If before the onset of menopause, and the appendages are removed, the doctor must prescribe hormone replacement therapy. And if both the uterus and cervix are removed, this can become a problem in having sexual intercourse, which is especially important for women who have not yet reached menopause.

Women are often negligent about their health and do not attach importance to important negative symptoms, which is why the disease progresses slowly. There are a number of recommendations, following which, you can avoid many diseases of the uterus - in particular, adenomyosis:

lead a measured lifestyle, do not overwork;
reduce excessive psycho-emotional stress, if any;
do not get carried away with going to the solarium;
see a gynecologist twice a year.

Adenomyosis alone cannot lead to infertility, but it is often combined with other diseases of the uterus (fibroids, endometriosis) that lead to fertility. Therefore, women, while still young girls, should take care of their health.

Based on materials from matkahelp.ru

First of all, it is necessary to explain what this disease means. With this pathological condition, endometrial tissue grows and grows into the muscular layer of the uterus.
The cause of this disease is surgical interventions in the uterus (including abortion), heredity, hormonal imbalances in the body, excessive visits to the solarium, the use of an intrauterine device, insufficient intensity of sexual activity, and heavy physical labor.
There are two methods of treating adenomyosis – medication and surgery.

Drug treatment involves the use of hormones, anti-inflammatory, sedative medications, immunomodulators, vitamins, and drugs that support liver function. In addition to medications, physical therapy has been found to be effective. If the conservative method does not bring the desired result, they resort to surgical intervention.
Surgical treatment consists of removing endometriotic lesions through laparoscopy. Resection of the uterus and entire ovaries is also possible.

Laparoscopy is a technique for clarifying the stage and localization of the spread of the disease to other tissues and organs of the abdominal cavity. This is achieved due to a larger image magnification, as well as functionality that allows you to study both a static image and its dynamics for a long period of time.

limit yourself only to lean varieties of meat up to 200 grams per day;
lean varieties of fish can be in the diet every day, fatty sea fish - once every 7 days;
dairy products without fat are provided in unlimited quantities, low-fat cottage cheese is especially important;
eggs should be in the diet;
daily consumption of vegetables, both raw and thermally processed; It is allowed to add sunflower oil to salads;
the daily diet should include porridge: buckwheat, oatmeal, rice, barley (alternate), coarse bread;
fruits can be eaten in unlimited quantities;
steamed food, stewed or boiled; You need to eat small portions up to 5 times a day.

Treatment of such an anomaly as internal genital endometriosis is determined by the symptomatic picture that worries the patient.
The use of gonadotropin-releasing hormone analogues in case of obvious signs of endometriosis and adenomyosis.
While taking these medications, the patient stops having periods, the ovaries stop functioning for a certain time, and the concentration of sex hormones in the blood decreases. Due to this, endometrial foci shrink, and signs of adenomyosis disappear or become less obvious.
Taking Visanne.
This medicine contains the substance Dienogest, which prevents the enlargement of endometrial foci in the muscular structure of the uterine cavity. In some patients, this medicine can cause obvious uterine bleeding, so its use is recommended only after consultation with a doctor and under his scrupulous supervision.

Painkillers.
If during the course of the disease the patient often experiences pain in the lower abdomen, then non-steroidal anti-inflammatory drugs are indicated.
For their effectiveness, tablets should be taken before menstrual flow (take 1-2 days before the planned day of menstruation and drink 1 tablet every 6 hours).
Contraceptives.
With internal genital endometriosis, patients often experience heavy uterine bleeding, menstrual irregularities, and spotting in the middle of the cycle. Contraceptive drugs are prescribed to eliminate or reduce manifestations of the disease such as severe uterine bleeding and pain in the abdomen during menstruation.

Based on materials from detstrana.ru

Uterine adenomyosis is a complex hormone-dependent gynecological disease. In some cases, its diagnosis occurs only during the period of irreversible changes in the body of the uterus. Experts designate as such the third and fourth stages of the development of the disease. Unlike early manifestations of adenomyosis, advanced stages require mandatory surgical treatment, i.e. surgery. Untimely treatment of the disease is fraught with the development of infertility and serious inflammatory processes in the abdominal cavity.

Primary adenomyosis, stages 1st and 2nd, characterized by slight structural changes in the uterine mucosa. Under the influence of hormonal instability, the inner uterine layer thickens, increases in size, becomes loose and heterogeneous. This painful condition is successfully corrected by a course of hormonal medications. The algorithm for treating advanced forms of adenomyosis seems different.

Severe painful symptoms throughout the entire cycle, heavy menstruation, spotting in the middle of the cycle - all these are indicators of the complicated development of late adenomyosis (stages 3 and 4). As a rule, this period is characterized by a significant change in the structure of the uterine mucosa. Part of it grows into the underlying muscle layers, forming cystic seals. In the most advanced period of development of the disease, the uterine endometrium affects the adjacent reproductive sections and other organs (ovaries, fallopian tubes, peritoneal organs, intestines).

In this case, an accurate assessment of the damaging activity of the pathology is necessary, which makes it possible to determine the degree of surgical impact on adenomyosis. If a pathological condition of the uterus, as well as part of the woman’s reproductive system, is detected, a curettage procedure is prescribed. This means that only part of the atypical endometrium and the tissues affected by it are removed. At the same time, the overall functional capacity of the organ is preserved. In case of extensive inflammation, the entire uterus is removed.

Surgical treatment adenomyosis (stages complicated, late disease) entails a number of possible “unhealthy” consequences.

When scraping the abnormal mucous membrane, the inner muscular layer of the uterus is damaged, which can result in the formation of deep, through wounds. In this regard, the recovery period is significantly extended - the patient may complain of prolonged pain, the presence of periodic bleeding (not related to menstruation). In some cases, the use of surgical treatment for stage 3 and 4 adenomyosis provokes the formation of scars (adhesions) and the occurrence of inflammatory processes. Such complications can have a negative impact on the prospects of planning a pregnancy.

Total removal of the uterus (extirpation) is often the only way to relieve the patient of permanent (constant) pain syndrome and reduce the likelihood of malignant formations both in the reproductive system itself and in the peritoneal organs affected by adenomyosis.

When assessing all possible aggravating consequences, this method of influencing late adenomyosis is recognized by experts as the most gentle and effective. As a rule, the appearance of complications is possible only if medical recommendations are ignored, or refusal to take restorative medications or medical procedures.

Advanced forms of adenomyosis require immediate surgical treatment. This measure is explained by the impossibility of eliminating the pathological condition of the uterus using only medicinal methods of influence. Despite the complexity of surgical procedures, in some cases they make it possible to preserve the reproductive capacity of the uterus, as well as relieve the patient from extremely painful manifestations of the disease.

Based on materials from www.megamedportal.ru

If there are indications for surgery for endometrioid disease, the doctor will choose the most optimal type of operation. Laparoscopy for endometriosis is used for diagnostic and therapeutic purposes, allowing the removal of pathological foci from the abdominal cavity. Endoscopic intervention will give excellent results for endometrioid ovarian cysts and peritoneal endometriosis. Reviews from doctors indicate the high effectiveness of the laparoscopic technique for nodular forms of adenomyosis, especially in combination with subserous uterine leiomyoma. After surgery, you will need to continue medication treatment to prevent recurrence of the disease.

A guaranteed option for complete relief from endometrioid disease is surgical removal of heterotopias of any location. For young women who want to give birth to a child, the doctor will choose techniques that allow them to preserve reproductive function. For older women who have completed their childbearing function, radical surgery can be used.

Surgical treatment is indicated in the following cases:

endometrioid ovarian cysts;
adenomyosis with severe menstrual bleeding and anemia;
lack of effect from drug therapy;
combined pathology of the uterus (adenomyosis and leiomyoma, isthmus myomatous node and retrocervical endometriosis, duplication of the uterus in any form of endometrioid disease);
infertility due to endometriosis;
the presence of a malignant tumor of the reproductive organs due to adenomyosis;
diseases of internal organs that exclude the possibility of long-term hormonal therapy;
damage to neighboring organs (rectum, bladder, ureters and kidneys) by endometriosis.

Removal of the pathological focus will be the best option for getting rid of the disease, but subject to the correct choice of surgical method. In addition, it is necessary to continue conservative treatment after surgery. Reviews from women after surgery show that refusal of therapy can cause a relapse of the disease.

Depending on the type of endometrioid disease, the following types of surgical interventions are possible:

embolization of the uterine arteries, used for severe bleeding due to adenomyosis;
removal of the uterus or resection of a cystic ovarian tumor during abdominal surgery;
hysterectomy via vaginal access;
laparoscopic version of the operation.

Endoscopic surgery can effectively treat endometrioid disease while preserving a woman’s reproductive ability. Reviews from women who have undergone laparoscopy are encouraging: the majority become pregnant in the coming months after the operation.

Endometrioid ovarian cysts require mandatory surgical intervention. The laparoscopic technique is optimal because this type of cystic tumor is never very large in size. In addition, preliminary drug treatment can reduce the formation before surgery.

At the preparation stage it is necessary:

get tested;
treat anemia and remove chronic infections;
follow the doctor’s orders for preoperative hormone therapy;
get advice from specialists (general practitioner, cardiologist, endocrinologist).

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

What is adenomyosis

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

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

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

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

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

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

There are several forms of adenomyosis:

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

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

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

Symptoms of the disease

Symptoms of uterine adenomyosis in the initial stages may not be noticed. In this case, it will most likely not be possible to treat the disease with hormones.

pain in the lower abdomen, in the groin, in the vagina in the lower back;
any irregularities in the menstrual cycle (increased pain before or during menstrual periods, delays, decreased number of days in the cycle, acyclic bleeding and spotting, absence of menstruation);
symptoms of anemia - drowsiness, pale skin, dizziness, weakness, increased fatigue;
pain during sexual intercourse;
brown vaginal discharge.

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

How to treat

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

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

Treatment is prescribed according to the results. For grades 1-3, drug therapy can be performed. Drugs most often prescribed by a gynecologist.

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

Duphaston

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

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

reduce the amount of estrogen, normalizing ovarian function;
reduce the spread of endometrial cells outside the tissue;
stabilize the body’s production of its own progesterone in the required quantity.

"Duphaston", prescribed by a specialist, successfully treats grade 1 and 2 adenomyosis. The choice of treatment regimen and duration depends on the test results.

Treatment of adenomyosis with Duphaston during preparation for pregnancy allows you to improve the functioning of the reproductive system, successfully conceive, carry and give birth to a healthy child without resorting to surgery.

Contraindications for taking Duphaston:

serious kidney and liver diseases;
pedunculated fibroids;
risks of thrombosis;
endometriosis outside the uterus;
intolerance to the drug.

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

Surgical treatment

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

Indications for the operation:

ineffectiveness of other treatment methods;
combination of endometriosis with large uterine fibroids;
with frequent relapses of the disease;
the appearance of atypical cells;
severe bleeding that cannot be corrected.

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

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

Treatment of uterine adenomyosis

Modern women spend little time on their health, which is why many diseases are discovered in them when undergoing examinations out of necessity, and not according to schedule.

Treatment of uterine adenomyosis, as one of the most common ailments, can last a lifetime with periodic cases of relapses, or be absent altogether due to its asymptomatic course.

What is this?

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

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

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

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

Objectives and methods of treatment of uterine adenomyosis

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

To do this, the patient should be examined for:

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

It is important to consider the risk factors that require maximum minimization.

Often, uterine adenomyosis is diagnosed during a standard routine examination without the patient’s accompanying complaints and symptoms that bother her or their mild severity. In this case, regular monitoring without additional interventions is required.

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

Women of childbearing age who are planning pregnancy, but it does not occur due to the asymptomatic course of the disease, should not be left without mandatory therapy.

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

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

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

Treatment of uterine adenomyosis with medications

GnRH is often taken in combination with estrogen and gestagens.

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

Hormonal therapy must be discontinued upon pregnancy so as not to cause disturbances in the development of the fetus.

Oral contraceptives have side effects, especially when taken for a long time, and are expressed as: weight gain, liver problems, deterioration of skin and hair, decreased libido or no libido at all.

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

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

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

Taking medications that normalize the functioning of the pituitary gland and hypothalamus, as one of the most important hormone producers.
The use of a number of measures and procedures for immunomodulation, relieving inflammation, pain syndromes, protecting the liver from the effects of hormones, stopping bleeding, eliminating iron deficiency anemia.
Restoring the patient’s psycho-emotional state with the help of consultations with a psychologist, psychotherapist and medications prescribed by them.
Organizing a balanced diet, in which special attention should be paid to enriching it with protein. It is important to compensate for the deficiency of vitamins and microelements by taking balanced complexes.

Treatment of uterine adenomyosis with surgical methods

Surgery can be performed by removing the uterus or using a minimally invasive method - laparoscopy.

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

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

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

They are represented by the following procedures:

Ablation, which involves the destruction of superficial lesions of an organ.
Embolization, the purpose of which is to stop the blood supply to areas of the uterus with the growth of the endometrium into its muscle tissue.
Electrocoagulation. It involves cauterizing endometriotic lesions using an electric current.

There are no accurate statistics on the success of these techniques yet. But in some cases they give a positive result.

Treatment of uterine adenomyosis requires an individual approach. To minimize the risk of surgical treatment, you should be attentive to your health and do not miss routine examinations with a gynecologist.

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Bubnova

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As a specialist - excellent. My friend came to see Svetlana Ivanovna several times, she advised me, and I did not regret it.

Yakovleva

REVIEWS

I'm very pleased with everything. Anastasia Alekseevna is an attentive, competent doctor.

Kuzmenko

REVIEWS

Everything is fine. Olga Vyacheslavovna is a good specialist, attentive, a good professional.

Maksimova

REVIEWS

I'm simply delighted. I really liked the doctor - both as a person and as a doctor. I liked literally everything: how she communicates, how she explains, how she works. I'm happy.

Korogodskaya

REVIEWS

I liked the doctor! In any case, the doctor answered all the questions I asked and there was no such thing as wanting to hide any information. An absolutely adequate and wonderful person.

Talavira

REVIEWS

Yulia Anatolyevna is a polite, attentive doctor. I was pleased with the reception.

Azizova

REVIEWS

The reception was normal. Everything is fine, the puncture was done, everything was done. The only thing is that it is very expensive. Puncture 6 thousand. it was worth it. The doctor is very polite, very attentive. I liked it. It is very pleasant to communicate with her. Although, as they say, she is young!

Magratiy

REVIEWS

Everything was quite good, I have no complaints about the doctor. The doctor spoke quite politely, was pleasant, supported me morally, and did not notice anything negative.

Khoroshukhina

REVIEWS

Thanks to the doctor, the reception was very good, the consultation was very competent. How much of everything in the body is affected by the endocrine system. Prevention will never be superfluous.

Chulkova

REVIEWS

Opinion about the reception remained positive. And pleasant communication with the doctor, and if there is still a need, I will turn to her. There’s nothing I didn’t like at all, but I liked everything, the attitude and attentiveness and friendliness, now I’m waiting for the result from the appointment, as if I were hoping.