Adenomyosis - this is a very complicated disease process during the course of which in the muscle layer of the uterus (myometrium) appear on (the centers) with the presence of the elements inherent in the internal mucous layer (endometrium). In such outbreaks occur cyclical changes.Adenomyosis is a hormone-dependent diseases and therefore is diagnosed primarily in women of reproductive age.There are cases of adenomyosis in menopausal women and young girls.
mucous layer of the uterus has the unique ability to completely torn away and then restored.All processes in the endometrium occur cyclically involving hormone under the control of the central nervous system and are referred to the menstrual cycle.When adenomyosis in the myometrium appear plots and structure, and function similar to the endometrium.We can say that they mimic the menstrual cycle.As a result, in the uterus develop inflammatory and degenerative processes.
endometrial tissue has special properties that allow it t
- it formed pockets have a connective tissue capsule;
- it is able to penetrate, and infiltrative growth in presenting tissues, causing destruction;
- it is prone to metastasis of blood, lymph and by contact.
myometrium - not the only place of occurrence of this disease, although it is the most common site.A similar process can also occur in the cervix and vagina, ovaries and fallopian tubes, on the peritoneum, bladder and ureter.There are cases detection of endometrial lesions in the intestines.The medical literature describes the case of such pathology navel and scar after surgery in the crotch area.The emergence of the pathological process in only one body is optional.
term "adenomyosis" refers to pathological changes is in the womb, and is not used for any other word forms.If an ectopic localization process similar talk about endometriosis.Names like adenomyosis adenomyosis cervix or ovary are not correct.Adenomyosis endometrium - incorrect phrase.However, adenomyosis and endometriosis, uterine body - equivalent terms for a single process.
Adenomyosis - one of the most serious abnormalities of the reproductive system.It is the second most common disease causing infertility.In postmenopausal disease usually regresses.
All existing theories to explain the cause of adenomyosis are not conclusive.
embryonic origin theory is based on the observation of adenomyosis in children and suggests that the breach of the fetus in utero can cause congenital adenomyosis.
Implantation theory deserve the attention of more supporters, and argues that the individual elements of the viable endometrial fall and take root in the muscular layer, forming pockets (heterotopia).
Any manipulation in the uterus, accompanied by violation of the integrity of its internal layer (eg curettage), provoke extensive inflammation.Violated the integrity of the so-called "security zone" between the endometrium and muscle layer of the uterus, endometrial cells and then freely penetrate deeper, while continuing to perform its cyclic function.
Adenomyosis - hormone-dependent process.Adverse environmental conditions, chronic recurrent inflammation of the endometrium, increasing stress loads increase the risk of disease.
Adenomyosis is not a rare disease, but accurate data on the incidence of disease does not exist because a significant number of asymptomatic forms.
Signs and symptoms of adenomyosis
characteristic of adenomyosis is a close connection with the clinical manifestations of menstruation.A significant symptom is pelvic pain of varying intensity, and painful menstruation.The hallmark vnemenstrualnyh pain in adenomyosis is its cyclical nature - they become stronger shortly before the onset of menstruation.Their intensity and duration increases as germination hotbeds of disease through the entire thickness of the uterine wall until its serous cover.
menstrual disorder is another symptom of adenomyosis.More often it giperpolimenoreya, spotting and metrorrhagia intermenstrual spotting.Often against the background of such violations anemia.Many patients complain of dysuria and pain during intimacy on the eve of the next menstruation.
Asymptomatic adenomyosis is not uncommon, but in the absence of timely detection and treatment of the disease can progress and manifest itself clinically.
Girls with congenital adenomyosis complain of painful periods (usually - from the very first), and menstrual dysfunction.
adenomyosis is often the cause of infertility and miscarriage.Pathological changes in the hormonal regulation hinder the process of ovulation, degenerative processes interfere with implantation in the uterus ("growing") ovum, and inflammation of the myometrium lead to a breach of its contractile ability, and potentiate the termination of early pregnancy.
Practice shows that the severity of symptoms in adenomyosis may also depend on the extent of the process.For example, a diffuse process of 1 degree is almost always a chance discovery when examining the patient and asymptomatic.
gynecological examination of patients can be identified increase in size and tenderness of the uterus on the eve of the next menstrual period, and changing its shape and texture - it becomes more dense and spherical.If you want to specify the diagnosis, appoint additional methods of examination.
The most popular method of diagnosis is ultrasonography (US).The accuracy of transvaginal ultrasound scan exceeds 90%.It is carried out before menses (23-25 day cycle).
Adenomyosis in the US has a number of features:
- change the size and shape of the uterus;
- different thickness of the wall of the uterus;
- heterogeneous structure of the muscular layer, namely the appearance of cystic cavities species are larger than 3 mm.
Diffuse adenomyosis on ultrasound may not be evident, but the nodular form requires differential diagnosis of adenomyosis itself and fibroadenoma.If there gipereplasticheskogo process in the uterus, endometrial areas will render bad.In such cases, the method is rather informative hysteroscopy.Properly carried out the procedure allows us to consider the entire surface of the uterus and detect foci of adenomyosis that look like dark red pin holes on a pale pink background.
Modern diagnostic techniques can detect small and asymptomatic forms of the disease.Laboratory diagnosis helps to identify hormonal status, anemia and related inflammatory processes in the uterus.When the survey take into account the fact that may be associated with adenomyosis, endometrial hyperplasia and uterine.
attention must deserving young patient complaining of constant painful menstruation.At the first treatment they performed pelvic ultrasound.
degree and form of adenomyosis
pathological process in the form of diffuse adenomyosis may be distributed differently.
When you select the degree of adenomyosis take into account the depth (degree) ingrowth of elements to be endometrial layer of the uterus.Such degrees of 4:
I - foci of adenomyosis deepened slightly;
II - muscle layer grows by half;
III - involvement of more than half or all of the muscular wall of the uterus;
IV - growing through the serous layer of endometrial tissue outside the uterus migrate.When
II - IV degree of adenomyosis observed hyperplasia (swelling) of the myometrium and an increase in size of the uterus.This classification of adenomyosis is not international, but it is quite convenient and widely used.
penetrated into the muscle layer of the uterus endometrium grow elements are not always the same.By type of sprawl allocate 3 forms of adenomyosis: diffuse, focal and nodal.
Diffuse adenomyosis - a form in which the elements of the endometrium to the myometrium evenly distributed, without forming clusters.Morphologically, it looks like the presence of blind pockets, penetrating from the uterus to the full depth of its layers (can develop fistulas).The most likely causes of diffuse adenomyosis may be abortion, diagnostic curettage of the uterus and other manipulation, as well as pathological childbirth and chronic inflammatory processes in the uterus.
On focal adenomyosis say if endometrial growths are focal and are "islands" in the thickness of the endometrial lining of the uterus muscle.Focal adenomyosis well visualized during hysteroscopy.
If germination in the muscular wall of the endometrium accompanied by the formation of nodes talking about nodular adenomyosis.Multiple
and dense nodes in adenomyosis fills liquid color resembling chocolate, or blood.The presence of the liquid contents in the nodes explained glandular tissue ingrowth, which operates according to the menstrual cycle, and their dense consistency associated with the growth of surrounding connective tissue elements are type capsules.These units are similar to benign encapsulated education, but differ from them by the fact that outside of their "shell" may be endometrial tissue.
Hub similar to uterine adenomyosis and structurally characterized in that it consists of muscle tissue and not from glandular as fibroids.Having two diseases at the same time due to the fact that the mechanisms of their development have much in common.To suspect the presence of adenomyosis with uterine cancer when the doctor can gynecological examination.If the uterus does not accept the original size after menstruation, and is increased, it is possible to think about the presence of her fibroids.At the hub of uterine adenomyosis magnitude varies according to the phases of the menstrual cycle.
joint presence of diffuse and nodular form is called diffuse nodular (mixed) adenomyosis and has signs of both forms.
Adenomyosis in Pregnancy
Although adenomyosis is one of the most common causes of infertility, after timely and comprehensive treatment of pregnancy in women with the disease possible.Frequent complication of pregnancy in adenomyosis is a threat of termination, so these are observed in pregnant women at high risk.Careful monitoring and prompt correction of violations occurring in most cases help to avoid serious complications.
Paradoxically, in some cases, pregnancy can be a kind of "treatment" adenomyosis, because it is a "physiological menopause" (well-known fact - adenomyosis is a hormone-state and regress with menopause).In such a situation foci of adenomyosis become inactive and cease to grow.It is a mistake to believe that the disease will disappear.
Any case of pregnancy complicated by adenomyosis, requires an individual approach.Observation and treatment plan drawn up for each such patient and takes into account many factors, and have a value of the form and extent of adenomyosis, the presence of complications and the combination of adenomyosis with other pathological processes in the uterus, such as fibroids.If before pregnancy adenomyosis did not cause a woman's complaints and asymptomatic, her pregnancy can proceed safely.
Sometimes pregnant women with adenomyosis worried about the impact of the disease on the fetus.Such fears are groundless - adenomyosis does not threaten the normal fetal development.Treatment of pregnant women with adenomyosis is aimed at eliminating the threat of miscarriage and premature termination of pregnancy.Sometimes they used for this purpose, and non-hormonal hormonal therapy is similar to that of women with miscarriage and uterine myoma.
Unfortunately, the possibility of a doctor for the treatment of adenomyosis in a pregnant patient is limited.The chances of success are increased if the pathology is detected before pregnancy, as the arsenal of therapeutic measures in adenomyosis in nonpregnant much more.If a woman, being aware of the presence of at adenomyosis, plans to become a mother, she should seek medical advice in advance of the appropriate treatment.
Treatment of adenomyosis
In recent years, the diagnosis of adenomyosis is put more and more.However, talking about the increased number of cases prematurely.Such dynamics are primarily due to the advent of modern medicine, and more accurate methods of laboratory and functional diagnostics that identify asymptomatic forms of the disease.Thus, the total number of cases increased by mild forms of the disease.
should say at once that adenomyosis is a chronic relapsing disease hormone-are not amenable to a complete medical correction.Eliminate the process can be completely surgically by removing the uterus.All therapeutic measures are aimed at addressing the causes of its progression, prevention of complications.The goal of drug therapy of adenomyosis - long-term remission.
Clinical management and treatment of women with adenomyosis is characterized by diversity and individual character.First I must say that the treatment need not all patients.
If a woman makes no complaints, and the diagnosis of adenomyosis put it during an inspection ("accidentally found"), no specific treatment is not assigned to it.However, given the fact that under certain unfavorable conditions, adenomyosis can begin to make progress, ignore this category of patients is not recommended, especially if these women planning a pregnancy.
First we need to study the immune system of the patient, to determine hormonal status, the presence of other diseases.It is important to choose the right method of contraception, as interruption of unwanted pregnancy leads to more injury and subsequent inflammation of the endometrium.Typically, dynamic monitoring and preventive activities in women with asymptomatic and mild forms of adenomyosis is enough.Therapeutic activities, which may appoint a gynecologist, can not be directed to the treatment of adnomioza, and the elimination of precipitating factors.
Thus, adenomyosis do not treat if:
- he discovered by accident;
- no matter what a woman does not complain or complaints are minimal and do not cause inconvenience to her;
- adenomyosis symptoms are mild, and the woman is premenopausal (usually age 45-50 years).
exception is women with infertility who have been identified in the survey asymptomatic adenomyosis.In this case, the need for treatment is solved individually.
Treatment of adenomyosis is always a complex and multi-stage.
When selecting the method and extent of treatment will certainly take into account:
- age of the patient, her desire to have children, neuropsychiatric status;
-all characteristics of the pathological process;
- a combination of adenomyosis with the inflammation process, if there is scarring and adhesions changes, as well as the presence of uterine hyperplasia and destruction.
complex therapeutic measures can be divided into two large groups - the conservative (medication) and surgical treatment.In complex cases, both types of therapy are combined.
main stages of medical and surgical treatment are completed rehabilitation period, the aim of which is to prevent and remedy violations of postoperative for the early return of patients to normal life.
Conservative treatment of adenomyosis include:
♦ hormone therapy.