The body of the uterus is spherical, which means. Signs of the development of adenomyosis on ultrasound

The date: 19.10.2019

Endometriosis of the body of the uterus

According to ultrasound morphology, diffuse (adenomyosis) and local forms are distinguished.

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

The structure of the myometrium may be:

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

Echo density of the myometrium medium (normally it is low) - compare the echo density of the body with the cervix. An increase in echo density of the endometrium is due to the presence of foci of endometriosis. There may be a decrease in the intensity of the image of the uterus before menstruation due to the expansion of blood vessels and the phenomenon of edema in the area of endometrioid heterotopias.

At transvaginal ultrasound, especially in young patients with a short duration of the disease, diffusely dilated tortuous vessels resembling varicose ones can be seen in the uterine wall. The same changes can be with a very pronounced activity of the pathological process.

endometrium- expressed more than it should menstrual cycle due to glandular hyperplasia, which in adenomyosis proceeds without pathological transformation of the mucosal glands, and is accompanied only by an increase in their volume and number.

ovaries- not enlarged, normal echostructure

Bladder- can be deformed from the pressure of an enlarged uterus on it. In isolated forms of endometriosis of the body of the uterus, the retrouterine and retrocervical spaces are not changed.

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

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

Ultrasound data of adenomyosis in other age periods

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

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

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

Options for echocardiography of adenomyosis

Ultrasound-negative phase
There is no increase in the size of the uterus, but its shape is spherical or approaches it; the structure of the myometrium is not changed, the echo density may be reduced or normal
The increase in the uterus is insignificant or absent in the presence of a spherical shape and an increase in the density of the myometrium in all departments
The uterus is spherical, enlarged from 4-5 to 6-7 weeks of pregnancy, the structure of the myometrium is homogeneous, its density is increased (medium, rarely high)
In addition to these signs and a more pronounced increase in the uterus (up to 9 weeks of pregnancy), evenly spaced multiple small echopositive inclusions are located in the thickness of the myometrium.
Regression of pathological changes in menopause

Differential Diagnosis

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

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

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

In addition, 60-70% of women with diffuse uterine endometriosis have some degree of glandular endometrial hyperplasia.

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

Elements of the algorithm	Adenomyosis	Diffuse form of fibroids	Metroendometritis
Clinic	Algodysmenorrhea	Usually asymptomatic	Signs of a septic condition, constant pain in the lower abdomen, spotting
Sonographic characteristics of the uterus
Dimensions	Increased	Increased	Increased
Solitary tumor nodes	Not	Not	Not
The form	Correct spherical	Irregular oval or pear-shaped, but with the obligatory predominance of the longitudinal dimension over the diameter	Regular oval or pear-shaped
Circuit	Smooth	Wavy or wavy	Smooth or wavy
Pathological changes in the myometrium
Localization	Diffuse in all departments	In one or more parts of the uterus (focal nature of the lesion), less often - in all parts of the walls	Not
Structure	The degree of dispersion of the myometrium is increased due to multiple echo-positive inclusions of medium density, linear and dotted shape	Multiple indistinctly defined zones, where the myometrium loses its finely dispersed structure. Pathological foci are heterogeneous tissue of the spotty and glomerular type, low density
General echo density	Increased	In the area of pathological restructuring, it is lowered	Not
endometrium	Often glandular hyperplasia of the endometrium	Usually not changed	Unchanged or sharply thickened due to inflammatory infiltrate. A small amount of fluid is located in the uterine cavity
Dynamic Surveillance	Positive dynamics under the influence of hormone therapy (not always)	No dynamics. Tumor progression. Regression in menopause.	Regression of pathological changes as a result of anti-inflammatory treatment

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

There is no significant increase in the uterus and changes in its shape.

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

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

The accelerated rhythm of modern life involves a woman in a whirlpool of events, deeds, interests. In this fuss, the fair sex does not always pay due attention to the state of their women's health. Without noticing the signs of many diseases, for a woman, a diagnosis can sound like a bolt from the blue - a spherical uterus. And although such a phenomenon is by no means uncommon - it occurs in 70% of women who have crossed the thirty-year milestone - not everyone can imagine the features and extent of such a pathology.

Collapse

What is a spherical uterus?

Globular uterus - what is it? Alternative names for the pathology are adenomyosis, internal genital endometriosis. It is a pathology of the female reproductive organ, in which there is a germination of endometriosis in other uterine areas. In particular, this process can form in the area of the uterus itself (ovaries, vagina, fallopian shirts) and beyond (lungs, intestines, urinary tract, sometimes in postoperative wounds).

Spherical uterus - pathology of the female reproductive organ

The norm is the germination of the endometrium exclusively in the uterine cavity. With adenomyosis, the endometrium is gradually introduced into the muscular wall of the organ.

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

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

Causes

Atypical growth of endometrial cells can provoke such reasons:

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

The mechanism of development of pathology

As a rule, during menstruation, excess endometrium begins to be rejected by the body. And if the uterus has the ability to remove "unusable" tissues, then the rest of the organs prone to adenomyosis do not have such an opportunity. As a result, they swell and put pressure on the nerve endings, causing acute pain.

Abundant monthly bleeding is explained by the fact that the amount of excess uterine mucosa with adenomyosis increases. In the future, this "ballast" is thrown off straight into the uterine cavity and provokes an increase in the volume of secretions.

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

Symptoms of the anomaly

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

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

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

Diagnosis of the spherical uterus

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

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

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

Colposcopy is one of the methods for diagnosing and treating adenomyosis.

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

Treatment methods for adenomyosis

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

Treatment of the uterus, which has taken an atypical form, is carried out in the following ways:

Taking hormonal drugs. With their help, an artificial menopause is created. At the end of the treatment course, there is a risk of re-growth of the endometrium. Therefore, the doctor selects the patient hormonal drugs with the optimal dosage for continuous use. Modern remedies of this type practically do not cause damage to the female body.
Embolization of the uterine arteries. Helps improve blood circulation in the tissues of the body.
Surgical intervention. It is recommended to eliminate the affected areas of tissues, nodes, or the entire organ as a whole.

Possible consequences, complications

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

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

Adenomyosis can lead to infertility

Adenomyosis is a serious pathology of the female reproductive system. To prevent deformation of the uterus and further problems, a woman needs to carefully monitor her reproductive health. Mandatory is a systematic visit to the gynecologist, proper nutrition and maintaining a healthy lifestyle.

Endometriosis of the body of the uterus

According to ultrasound morphology, diffuse (adenomyosis) and local forms are distinguished.

The structure of the myometrium may be:

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

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

endometrium- it is expressed to a greater extent than it follows in terms of the menstrual cycle due to glandular hyperplasia, which in adenomyosis proceeds without pathological transformation of the mucosal glands, and is accompanied only by an increase in their volume and number.

ovaries- not enlarged, normal echostructure

Bladder- can be deformed from the pressure of an enlarged uterus on it. In isolated forms of endometriosis of the body of the uterus, the retrouterine and retrocervical spaces are not changed.

Ultrasound data of adenomyosis in other age periods

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

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

Options for echocardiography of adenomyosis

Ultrasound-negative phase
There is no increase in the size of the uterus, but its shape is spherical or approaches it; the structure of the myometrium is not changed, the echo density may be reduced or normal
The increase in the uterus is insignificant or absent in the presence of a spherical shape and an increase in the density of the myometrium in all departments
The uterus is spherical, enlarged from 4-5 to 6-7 weeks of pregnancy, the structure of the myometrium is homogeneous, its density is increased (medium, rarely high)
In addition to these signs and a more pronounced increase in the uterus (up to 9 weeks of pregnancy), evenly spaced multiple small echopositive inclusions are located in the thickness of the myometrium.
Regression of pathological changes in menopause

Differential Diagnosis

In addition, 60-70% of women with diffuse uterine endometriosis have some degree of glandular endometrial hyperplasia.

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

Elements of the algorithm	Adenomyosis	Diffuse form of fibroids	Metroendometritis
Clinic	Algodysmenorrhea	Usually asymptomatic	Signs of a septic condition, constant pain in the lower abdomen, spotting
Sonographic characteristics of the uterus
Dimensions	Increased	Increased	Increased
Solitary tumor nodes	Not	Not	Not
The form	Correct spherical	Irregular oval or pear-shaped, but with the obligatory predominance of the longitudinal dimension over the diameter	Regular oval or pear-shaped
Circuit	Smooth	Wavy or wavy	Smooth or wavy
Pathological changes in the myometrium
Localization	Diffuse in all departments	In one or more parts of the uterus (focal nature of the lesion), less often - in all parts of the walls	Not
Structure	The degree of dispersion of the myometrium is increased due to multiple echo-positive inclusions of medium density, linear and dotted shape	Multiple indistinctly defined zones, where the myometrium loses its finely dispersed structure. Pathological foci are heterogeneous tissue of the spotty and glomerular type, low density
General echo density	Increased	In the area of pathological restructuring, it is lowered	Not
endometrium	Often glandular hyperplasia of the endometrium	Usually not changed	Unchanged or sharply thickened due to inflammatory infiltrate. A small amount of fluid is located in the uterine cavity
Dynamic Surveillance	Positive dynamics under the influence of hormone therapy (not always)	No dynamics. Tumor progression. Regression in menopause.	Regression of pathological changes as a result of anti-inflammatory treatment

There is no significant increase in the uterus and changes in its shape.

Content

Adenomyosis

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

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

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

Classification

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

1 degree. Violations are noted only in the submucosa of the uterus of a spherical shape.
2 degree. Endometrial cells penetrate into the myometrium to a shallow depth.
3 degree. The spread of mucosal cells occurs in most of the muscular layer of the spherical uterus.
4 degree. Structural changes are noted throughout the depth of the myometrium, in addition, the pathology can spread to neighboring organs and tissues.

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

Causes of the disease

The cause of the spherical uterus may be hereditary predisposition.

Chronic diseases of the genitourinary system of an inflammatory nature, regular excessive physical activity, stress and hard work - all these are prerequisites for the disruption of the functioning of the reproductive system of a woman. That is why, in order to eliminate this or that pathology, doctors first of all recommend more rest and normalize their work schedule.

Main symptoms

Severe pain in the lower abdomen. Especially often such pains are associated with the menstrual cycle. Many women mistakenly believe that severe pain before, during or after menstruation is normal. However, this is absolutely not the case. Such a symptom may indicate a serious disease of the reproductive system.
Difficulty conceiving and bearing a child. The spherical uterus and violation of the integrity of the muscular layer of the organ is often the cause of adhesions in the fallopian tubes, which further prevents the release of the egg and its fusion with the sperm. An increased tone of the myometrium due to the penetration of endometrial cells into it can cause spontaneous miscarriage, i.e. termination of pregnancy.

Diagnostics

The first thing that is done to diagnose any disease is a survey of the patient, as well as a study of the anamnesis. Next, the gynecologist needs to examine the chair with the help of special tools. It is best to conduct an examination a few days before the onset of menstruation - this applies to ultrasound. During the examination, the doctor establishes a change in the shape of the uterus and an increase in the size of the organ. Tuberosity of the endometrium, the presence of nodes or bumps on the walls of the inner lining of the uterus may also be noted.

The use of several diagnostic methods will allow obtaining the most complete and accurate information about the patient's condition, as well as choosing an effective and safe treatment.

Treatment

One of the main signs of which is a spherical uterus, depends on the degree and type of the disease. The patient's age is also taken into account. individual characteristics body and whether the woman plans to continue pregnancy.

There are two types of treatment.

Conservative. Means under itself only medicamentous treatment. In this case, the doctor prescribes anti-inflammatory and hormonal drugs, vitamin complexes, as well as agents that activate the immune system.
Surgical. If medication does not help, surgery is performed. It can be of two types: radical, in which the affected organ is completely removed, or sparing with the preservation of the uterus. Complete removal is quite rare, in the most extreme cases, and only in patients older than 40-45 years. In other cases, cauterization of the affected area of the endometrium is carried out with a laser or electric current.

Adenomyosis and changes in the shape of the uterus as a result of the disease are those conditions that are characterized by a chronic course and regular development of relapses. In 70% of patients, after appropriate treatment, a relapse of the disease is observed within 5 subsequent years. Women over 40 are least likely to relapse, as the functioning of their ovaries begins to fade.

What is adenomyosis of the uterus 1, 2, 3 and 4 degrees?

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

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

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

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

What is the danger of adenomyosis (endometriosis)?

How many women have adenomyosis?

What causes the development of adenomyosis?

Risk factors for developing adenomyosis include:

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

Symptoms of adenomyosis of the uterus

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

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

How does adenomyosis proceed in combination with uterine fibroids?

Signs of a combination of adenomyosis with ovarian endometriosis

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

II. Unilateral endometroid cyst no larger than 6 cm, adhesive process in the area of the uterine appendages without involvement of the intestine.

III. Bilateral endometrial cysts up to 6 cm in size, a pronounced adhesive process involving the intestines.

IV. Large bilateral cysts, the transition of the process to the bladder and large intestine, a common adhesive process.

What tests are used to diagnose adenomyosis?

What are the echo signs of adenomyosis?

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

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

3. Asymmetry of wall thickness.

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

What is the treatment for adenomyosis of the uterus?

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

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

I. Surgical treatment:

radical (removal of the uterus and ovaries);
organ-preserving (laparoscopy and excision of endometrial foci).

II. Conservative treatment:

hormone therapy;
nonspecific anti-inflammatory therapy;
sedative (calming) drugs;
vitamin therapy;
maintenance of liver function;
elimination of anemia;
immunomodulators;
resolving therapy;
physiotherapy.

III. Combined treatment.

adenomyosis in combination with endometrial hyperplasia;
functioning endometrial ovarian cysts (more than 5 cm in diameter);
suppuration of the appendages of the uterus affected by endometriosis;
adhesions in the ampulla of the fallopian tubes (the main cause of infertility in endometriosis);
ineffectiveness of hormonal therapy (no positive dynamics in the treatment hormonal drugs for more than 3 months);
the presence of somatic diseases that are contraindications to long-term hormonal therapy (varicose veins and thrombophlebitis, severe liver disease, migraine, depression, epilepsy, disorders cerebral circulation, obesity, diabetes mellitus, hypertension, etc.).

Organ-sparing surgery is not a radical method of treatment, since it is impossible to identify all foci of endometriosis, but they are the method of choice for women who want to restore and/or preserve childbearing function.

progressive course of the disease in women over 40;
lack of effect from combined treatment with organ-preserving operations;
a combination of the nodular form of adenomyosis or diffuse adenomyosis of the 3rd degree with uterine myoma;
risk of malignant transformation.

Can adenomyosis be cured?

Is it possible to get pregnant with adenomyosis of the uterus?

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

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

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

4. Termination of pregnancy in the early stages due to increased contractility of the myometrium caused by inflammation in the muscular layer of the uterus.

5. Soreness during intercourse, making it difficult to have a regular sexual life.

Adenomyosis and pregnancy. Are there any chances to endure and give birth to a healthy

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

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

3. Artificial or spontaneous termination of pregnancy leads to a relapse or exacerbation of adenomyosis, followed by an accelerated development of the pathological process, so you should, if possible, strive to preserve the pregnancy.

4. Most women with adenomyosis give birth safely, however, in the afterbirth and early postpartum period, there is an increased tendency to uterine bleeding, so the possibility of developing these complications should be considered.

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

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

What are the alternative methods of treatment of internal endometriosis

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

What is a spherical uterus

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

Adenomyosis

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

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

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

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

Classification

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

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

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

1 degree. Violations are noted only in the submucosa of the uterus of a spherical shape.
2 degree. Endometrial cells penetrate into the myometrium to a shallow depth.
3 degree. The spread of mucosal cells occurs in most of the muscular layer of the spherical uterus.
4 degree. Structural changes are noted throughout the depth of the myometrium, in addition, the pathology can spread to neighboring organs and tissues.

Causes of the disease

The spherical shape of the uterus has several ways of development. There are certain reasons for the growth of the endometrium, characterized by a change in the shape of the uterus to a spherical one. First of all, it is mechanical damage, trauma or violation of the integrity of the internal mucosa. Because of this, there is a strong growth of the endometrium, and the penetration of its cells into the muscular layer of the spherical uterus. Damage can occur during abortions, improper use of the intrauterine device, surgical curettage, and complicated births.

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

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

Main symptoms

There are both completely specific symptoms characteristic only for this disease, and common features disruption of the reproductive system. Some of them may not practically appear and do not cause discomfort to the patient in everyday life, while others can be quite serious and lead to complications.

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

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

In addition to all these symptoms, the patient may be disturbed by frequent headaches, general malaise, nausea, disruption of the gastrointestinal tract, or frequent urination. However, these signs are only common to most diseases of the internal genital organs.

Diagnostics

The first thing that is done to diagnose any disease is to interview the patient, as well as to study the anamnesis. Next, the gynecologist needs to examine the chair with the help of special tools. It is best to conduct an examination a few days before the onset of menstruation - this applies to ultrasound. During the examination, the doctor establishes a change in the shape of the uterus and an increase in the size of the organ. Tuberosity of the endometrium, the presence of nodes or bumps on the walls of the inner lining of the uterus may also be noted.

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

Hysteroscopy is another important method. With it, you can carry out scraping and histological examination of the endometrium on glass, as well as detect the places of penetration of endometrial cells into the myometrium of the uterus with video support.

Treatment

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

There are two types of treatment.

Conservative. Means under itself only medicamentous treatment. In this case, the doctor prescribes anti-inflammatory and hormonal drugs, vitamin complexes, as well as agents that activate the immune system.
Surgical. If medication does not help, surgery is performed. It can be of two types: radical, in which the affected organ is completely removed, or sparing with the preservation of the uterus. Complete removal is quite rare, in the most extreme cases, and only in older patients. In other cases, cauterization of the affected area of the endometrium is carried out with a laser or electric current.

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

Spherical uterus: an atypical form of the reproductive organ

What is a spherical uterus?

Spherical uterus - pathology of the female reproductive organ

The norm is the germination of the endometrium exclusively in the uterine cavity. With adenomyosis, the endometrium is gradually introduced into the muscular wall of the organ.

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

Causes

Atypical growth of endometrial cells can provoke such reasons:

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

The mechanism of development of pathology

Symptoms of the anomaly

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

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

Diagnosis of the spherical uterus

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

Colposcopy is one of the methods for diagnosing and treating adenomyosis.

Treatment methods for adenomyosis

Treatment of the uterus, which has taken an atypical form, is carried out in the following ways:

Taking hormonal drugs. With their help, an artificial menopause is created. At the end of the treatment course, there is a risk of re-growth of the endometrium. Therefore, the doctor selects the patient hormonal drugs with the optimal dosage for continuous use. Modern remedies of this type practically do not cause damage to the female body.
Embolization of the uterine arteries. Helps improve blood circulation in the tissues of the body.
Surgical intervention. It is recommended to eliminate the affected areas of tissues, nodes, or the entire organ as a whole.

Possible consequences, complications

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

Adenomyosis can lead to infertility

Adenomyosis of the uterus

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

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

Sprouted cells of endometrial tissue in the thickness of the uterus (myometrium), still continues to perform its main functions associated with the menstrual cycle. As a rule, this contributes to the development of a local inflammatory process, and frequent relapses cause degenerative changes in the myometrium. Naturally, over time, adenomyosis leads to pathological dysfunctions of the uterus as a whole.

Causes of adenomyosis

The mechanism of development of adenomyosis, one might say, is quite simple. Under the influence of some specific factors, the endometrium begins to gradually grow into the muscle tissue of the uterus, while not losing its main functions. As expected, in the middle of the menstrual cycle, endometriosis cells increase in size for the possible fixation of a fertilized egg. The same thing happens with the endometrium, which has grown in the myometrium.

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

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

Some scientists tend to believe that adenomyosis has a genetic predisposition. But there is no absolute guarantee that a woman whose mother had adenomyosis must definitely get sick with the same. Based on these observations, most gynecologists deny any connection between the development of genital internal endometriosis and a genetic predisposition.

The opinion of many female doctors agrees on one thing: stress, heavy physical exertion, a very active lifestyle, constant stress are the main factors contributing to the “birth” of adenomyosis. It should be noted that a sedentary lifestyle can also affect the development of this disease. In the pelvic organs, there is a stagnation of energy and blood, which leads to a thickening of the endometriosis tissue, and then to adenomyosis.

Women who have any problems or disruptions in the endocrine system should carefully monitor their health. Diseases of the pituitary, thyroid, adrenal glands and female gonads, as a rule, adversely affect the hormonal background of a woman and lead to menstrual irregularities. Naturally, such failures always contribute to the development of adenomyosis.

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

Symptoms of adenomyosis

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

profuse menstruation
unusually prolonged menstrual bleeding
menstruation with impurities of large blood clots

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

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

Not unimportant symptom of adenomyosis can be considered painful sensations during intimacy. Women especially sharply note the increase in pain a few days before menstruation or immediately after it. Unpleasant and painful sensations have a clear localization - this is the area of \u200b\u200bthe isthmus of the uterus.

Bloody discharge is another characteristic sign of genital internal endometriosis. Many women suffering from this disease note the appearance of spotting brown highlight a few days (from three to five) before the onset of menstruation. After the end of menstrual bleeding, spotting remains for some time (about three days). Quite often, along with the discharge, aching pains appear in the area of \u200b\u200bthe areas of the uterus affected by the pathological process.

A characteristic sign of adenomyosis can be safely considered - a pronounced pain syndrome. Strong pain in the lower abdomen begins a few days before menstrual bleeding, continues throughout menstruation, and persists after they end for one to two days. As a rule, bloody discharge and pain syndrome are a single whole, that is, discharge appears, respectively, pain appears.

The pain has a clear localization, so it is enough to simply determine the specific location of the pathological process. If the isthmus of the uterus is affected, then the pain radiates to the vagina or rectum. When the pathological endometrium is located in the corner of the uterus, the pain radiates to the inguinal region, respectively, to the affected side. On palpation - soreness of the entire body of the uterus.

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

Types of adenomyosis

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

diffuse
nodal
mixed or combined (diffuse-nodular)

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

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

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

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

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

Degrees of adenomyosis

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

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

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

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

Fourth degree. Adenomyosis of this degree is exhibited if there are sprouting of the endometrium outside the body of the uterus. For example, in abdominal cavity, ovaries, fallopian tubes, bladder. If the pathological process has affected the cervix, then the diagnosis is cervical adenomyosis, if the ovaries are ovarian adenomyosis.

The first degree and the second do not require surgical intervention, which cannot be said about the third and fourth. The last two are difficult to conservative treatment, more often two methods are taken in combination.

Diagnosis of adenomyosis

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

Bimanual or objective gynecological examination. During the study, the size of the uterus, its position, shape, mobility and soreness are evaluated. It is important to determine the presence of formations, the condition of the ovaries and fallopian tubes. With adenomyosis, the uterus increases in size and takes on a spherical shape.
Obligatory collection of smears for the degree of purity of the vagina and cytological analysis
Examination of the cervix with a colposcope. Under a microscope, you can still see single germinated endometrial cells. Indeed, for the 4th degree of adenomyosis, the germination of the pathological process on the cervix is \u200b\u200bcharacteristic.
Ultrasound of the pelvic organs. The most commonly used transvaginal ultrasound. In gynecological practice, several echogenic signs of adenomyosis have been identified: serration of the basal layer of the endometrium, asymmetric thickening of the walls of the uterus, increased echogenicity on the affected areas and the rounded shape of the uterus.
Hysteroscopy. When visually examining the inner surface of the uterus, endometrioid passages are visible. The even pale pink color of the uterine mucosa is disturbed by dark brown inclusions, from which blood is periodically released.
Comprehensive clinical study of all organ systems: respiratory, genitourinary, cardiovascular and digestive.

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

Medical treatment of adenomyosis

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

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

Quite often and widely in gynecological practice, embolization of the uterine arteries is used. This method of treatment significantly improves blood circulation in the tissues, which is important in case of stagnation of blood and energy in the small pelvis.

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

The radical method of treatment includes two main methods:

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

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

In addition to specific therapy, general strengthening treatment is also necessary. Pain medications such as Ibuprofen or Nurofen are prescribed to relieve pain. Very often, adenomyosis is accompanied by anemia, so it is advisable to undergo iron treatment. To maintain the body, gynecologists recommend taking vitamins. Some women also need sedative (soothing) drugs.

Treatment with folk remedies

Along with drug treatment (with the permission of a doctor), folk remedies can be used to treat adenomyosis. There are many herbal preparations, which must be taken not only for therapeutic purposes, but also for general strengthening of the body, increasing immunity. It is important to remember that any alternative treatment should be discussed with the attending physician.

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

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

Various medicinal herbs are widely used in gynecology. With the help of herbal infusions and decoctions, they normalize the cycle, adjust the level of hormones, regulate and speed up the metabolism. It is necessary to use herbs for the treatment of adenomyosis with the permission of the attending physician and only under his vigilant control. During herbal treatment, drug hormone therapy is prohibited.

Recipes for decoctions and infusions:

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

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

Herbal treatment is fraught with many nuances that you should know without fail. In addition to the correct dose and method of preparation, it is important to know when and which herbs are taken to treat adenomyosis. When used in medicinal purposes some herbal preparations must take into account the stage (phase) of the menstrual cycle, since some are important to take during menstruation, while others - only a few days before it.

Collection before menstruation:

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

Collection during menstruation:

Liquorice root
clover cones
Fireweed and anise
eucalyptus leaves
currant berries

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

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

Prevention of adenomyosis

The first and most important way to prevent adenomyosis is to visit a female doctor regularly (once every six months). After all, the earlier the presence of the disease is diagnosed, the easier it is to treat it. You should not pull and wait for it to pass by itself, the sooner the diagnosis is made, the sooner the recovery will come. It is important to remember that any unpleasant and painful sensation in the lower abdomen - this is an occasion to urgently pay a visit to the gynecologist to establish the reasons.

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

A gynecologist, if deemed necessary, can prescribe the necessary medications and physiotherapy. Women over thirty should avoid sunbathing in unlimited quantity Better yet, keep UV exposure to a minimum.

Taking care of your health is the main way to prevent not only adenomyosis, but also other equally dangerous diseases.

Adenomyosis and infertility

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

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

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

Adenomyosis and pregnancy

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

But it is important to note that adenomyosis is not a death sentence. A fairly large number of women with a history of this disease still managed to feel the joy of motherhood. Pregnancy can proceed without any complications and features, and children are born absolutely healthy. If there are problems with the conception of a child or its bearing, then timely and adequate treatment is necessary.

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

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

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

Prognosis for adenomyosis

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

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

Adenomyosis is internal endometriosis of the body of the uterus.

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

Hormone-dependent disease, which is manifested by the penetration of tissue similar to the mucous membrane of the body of the uterus into the muscle of the uterus. At the same time, during menstruation, foci of endometriosis also menstruate, which leads to the development of inflammation. Symptoms of adenomyosis (endometriosis of the uterus) are heavy and painful menstruation, bleeding, spotting before and after menstruation. Endometriosis is often associated with infertility and miscarriage. Oral contraceptives contribute to the regression of endometriosis foci.

I was diagnosed with adenomyosis, histology showed that I have endometrial glandular hyperplasia. In this regard, I have had 2 cleanings in the last six months. Norkolut was also assigned to me. Could you write about my disease, as well as about the methods of its treatment.

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

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

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

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

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

I am 37 years old, from the anamnesis - adenomyosis; ridge with \ ophorit. What are these diseases and can I go to the sauna.

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

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

I am 46 years old, on February 19 of this year I underwent an operation: Laparotomy Panhysterectomy The operation was performed urgently based on the results of ultrasound: myoma node infarction with malnutrition.
Diagnosis: Ademiosis. Endometriosis of the sacro-uterine ligaments. Chr. endometritis Chr. bilateral adnexitis. Endometrial polyp.
Histological examination: Glandular cystic hyperplasia, Uterine fibromyoma with areas
ademiosis. Ovary - sclerosis and hyamentosis of the walls of blood vessels and corpus luteum, follicular cysts,
corpus luteum cysts. Tube - sclerosis of the wall. The cervix is Nabot's cysts.
According to the results of histology, I was prescribed Norkolut for 3 months according to the scheme.
Almost immediately after the operation, I had hot flashes (an hour or more).
With any physical and emotional stress, severe sweating. After the shower comes relief, but not for long. I drank Remens for a month, I don’t feel any improvement.
Two weeks, as there were pains in the rectum. Can endometriosis develop again?
Pains are similar, as to operational. Appointment scheduled in a month. Do not spend more than 5 minutes at the reception.
Tell me, how can I alleviate my condition, reduce hot flashes, avoid complications such as osteoporosis, etc.? What is the purpose of the hormonal drug prescribed to me?
Can hot flashes pass on their own? If not, then advise what can be taken with the least side effect. Can I go to a resort in half a year and take mud on my lower back? When can I start abdominal strengthening exercises? The incision was made along the white line. What can be physical activity?

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

Pain in the rectum can be a manifestation of retrocervical endometriosis. It is diagnosed during a routine examination and ultrasound. Also, after panhysterectomy, endometriotic lesions on the peritoneum of the small pelvis could remain, giving complaints characteristic of endometriosis, as before the operation.

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

I am 29 years old. After the second birth, for 3 years on the first day of menstruation, the temperature rises 37.5 - 37.8, severe pain, violations of the cycle - delays up to 10 days. Ultrasound showed: adenomyosis of the uterine body (nodular form), ovarian endometriosis, retrocervical endometriosis, uterus size 77-48-52, endometrium 11 mm. The smear contains a large number of leukocytes. On a clamidiosis - a negative result. The diagnosis of the attending physician coincided with the diagnosis of ultrasound plus chronic endometritis. For the treatment of adenomyosis and endometriosis, hormonal preparations were recommended, but with the permission of a mammologist, because. just before that, I had been operated on for breast fibroadenoma. The mammologist explained that since I still have pronounced manifestations of diffuse mastopathy and taking into account my heredity (close female relatives have breast cancer at a young age), hormonal preparations are shown to me only as a last resort. I consulted with several more gynecologists, their recommendations were different: some believed that hormonal treatment was required, others that it was not. Moreover, different hormonal preparations were prescribed: microgenon, norkolut, duphaston, depo-prover. As a result, my doctor and I decided to treat only endometritis. After the course of treatment, the temperature during menstruation became less - 37.2 and the leukocytes in the smear returned to normal. This was the case for 5 months after treatment. On the sixth month, the temperature again on the first day of menstruation rose to 37.8 and in the smear - again leukocytosis. Repeated ultrasound (one year after the first) showed that the size of the uterus and endometrium remained the same, but there were more endometriotic foci. After another 2 months, a 6 cm cyst of the right ovary was discovered. Hormone therapy was again prescribed for me, and if it does not disappear in a month, then an operation. And I was offered to remove the entire right ovary. Tell me please,
1) Should I decide on hormone therapy and which drug suits me best (prolactin and progesterone are normal, but estradiol is not determined in our city). Do I still need some research and do I have time for this, or hormone therapy should be started immediately.
2) Are there any types of operations that allow you to remove a cyst without an ovary, which ones?
3) Are there other treatments for endometriosis and adenomyosis other than hormone therapy? Including surgery?

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

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

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

3. See item 1. But endometriosis of the uterus can be surgically cured only by removing the uterus.

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

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

Recently, pains in the uterus have begun to bother me (I can differentiate due to many years practical experience pain in the uterus before menstruation). Ultrasound revealed: the uterus is enlarged 6.2x4.9x6.8; the contours are even, the uterus is "round", echolocation is moderately increased, the posterior wall is more thickened, the nodes are not detected (diff. fibroma? adenomyosis?). The cervix is thickened 5x6.2 (structural feature?) The structure is not quite homogeneous: small brushes and bright linear me ... echo .. M-echo 0.7 cm evenly throughout. Right testicle 4.5x2.8 with brushes (follicle) 2 cm, left - 4x2.3 with small falls 0.5 cm. During the ultrasound, the doctor said that she really did not like the cervix. Please advise what to do. If before the pain was only before the cycle, now it is almost daily. I live in Yakutia. There are practically no diagnostic facilities in the village. One gynecologist for every 5,000 women. 5 minutes to receive one. The doctor took a swab (no races, other microorganism - a large number, a lake - 3-4 in the p / s, an epithelium - a large number) prescribed vitamins. Please advise what to do and! how to continue to be examined (going on vacation)

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

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

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

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

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

The goal of medical treatment is:

reduction of inflammation;
elimination of pain syndrome;
correction of anemia ( anemia);
increased immunity;
normalization of hormonal balance;
providing psychological comfort;
general strengthening of the body;
mimic menopause.

Medical treatment of adenomyosis

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

Medications are taken when prescribed by a doctor under strict control of hormone levels.

Minimally invasive treatments for adenomyosis

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

Minimally invasive treatments for adenomyosis include:

Ablation of the endometrium. Endometrial ablation is a minimally invasive procedure to remove the lining of the uterus ( endometrium) under influence physical factors- current, high and low temperatures. The procedure is performed under general or regional anesthesia. Ablation of the endometrium can significantly reduce the intensity of uterine bleeding, as well as reduce endometrial hypertrophy and save the uterus with myoma. To destroy the endometrium, electrosurgical ablation is used - an electrode is inserted into the cervix, through which a weak electric current is passed, which destroys the mucous layer. In hydrothermal ablation, a hot liquid is injected into the uterine cavity, which cauterizes the endometrium. Cryoablation - destruction of the endometrium by freezing liquid nitrogen. In microwave ablation, a thin probe is inserted into the uterine cavity, which emits microwave energy that destroys the inner layer of the uterus. The main serious complications are damage to neighboring organs, perforation of the uterus, inability to become pregnant. The recovery period takes several days. There may be some bleeding after the procedure. In case of increased bleeding and the appearance of an unpleasant odor, you should immediately consult a doctor.
FUS - ablation. FUS - focused ultrasound, ablation - rejection of part of the tissue under the influence of radiation. Thus, FUS - ablation - is the remote destruction of adenomyosis foci using focused ultrasound. The procedure is carried out under the control of magnetic resonance imaging. Passing through tissues, ultrasonic waves do not damage their integrity. But when they are focused, local tissue heating up to 65°C - 85°C occurs. This leads to thermal damage to the tissue and impaired blood supply. This effect is called thermal necrosis ( death) tissue. The duration of one exposure to a focused ultrasound pulse is from 10 to 40 seconds. The duration of the whole procedure is 3-4 hours. The advantages of FUS - ablation are - conducting without the use of anesthesia, atraumatic, short recovery period, no blood loss and postoperative scarring, preservation of reproductive function. Shown this technique with a combination of uterine fibroids with adenomyosis, nodular and focal forms of adenomyosis.
EMA ( uterine artery embolization). It is a painless, organ-sparing procedure that effectively treats adenomyosis and allows a woman to plan a pregnancy. This method is minimally invasive, safe and practically has no contraindications. Embolization of the uterine arteries is carried out by the endovascular method, that is, access through the vessel. The essence of the method is to block the lumen of the uterine arteries with the help of a special substance ( no more than 500 milligrams). As a result, blood flow to the affected area of the uterus or fibroids stops ( benign tumor of the myometrium), which leads to tissue death or neoplasm due to lack of oxygen and nutrients. The severity of symptoms decreases almost immediately after the procedure. A year after the procedure, the size of myomatous nodes decreases by 4 times. The advantage of UAE is that it is carried out under local anesthesia, reproductive function is preserved, the procedure is short, the patient recovers quickly, and her condition improves immediately.

Physiotherapy for adenomyosis

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

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

Impulse currents of low frequency. These include diadynamic, rectangular, transcutaneous electrical nerve stimulation. The impulses have an anti-inflammatory, analgesic, regenerating effect. It does not stimulate the production of estrogen. Electrophoresis ( the introduction of drugs through the skin and mucous membranes under the influence of pulsed currents) allows you to administer drugs in small doses. Iodine is used for adenomyosis. It is deposited in the skin for up to 3 weeks and gradually enters the bloodstream. In the area of inflammation, iodine helps to reduce edema, stimulate reparative and regenerative processes, and normalize the balance of hormones. Treatment is prescribed for 5 - 7 days of menstruation. The effect of the therapeutic action persists for 2-4 months after the procedure.
Magnetotherapy. The essence of the method lies in the local impact on the body of an electromagnetic field. Used in the postoperative period. It has an anti-inflammatory, analgesic, sedative, protective effect. Normalizes microcirculation, reduces swelling of tissues and improves metabolism.
Electromagnetic oscillations of the optical ( light) range. The essence of the method lies in the local effect of short-wave ultraviolet radiation ( KUF) or laser radiation. Usually used in the early postoperative period in the wound area. Short-wave ultraviolet radiation has a pronounced bactericidal ( killing bacteria), wound-healing effect. Laser radiation has an anti-inflammatory, analgesic effect. Helps reduce tissue edema and normalize microcirculation in the wound area. The combined use of ultraviolet and laser radiation contributes to the speedy healing of the wound, prevents the formation of scars, infection and inflammation in the postoperative wound.
Hydrotherapy. Treatment of adenomyosis is carried out with the help of coniferous, bischofite baths. The action is based on the chemical and mechanical stimulation skin. Such baths eliminate spasms, pain, have a sedative effect. The duration of the aftereffect is 3-4 months.
Balneotherapy ( complex water procedures with mineral, fresh water). Adenomyosis is treated with radon and iodine-bromine baths. Radon helps to reduce estrogen levels and increase progesterone levels, has an anti-adhesion, sedative effect. The duration of the aftereffect of the procedure is about 6 months. Iodine-bromine baths have anti-inflammatory, analgesic, sedative effects, reduce estrogen levels. The duration of the aftereffect is 4 months.
Climatotherapy. The essence of the method is to create certain climate conditions and avoid the action of certain physical factors. The patient should avoid prolonged exposure sun rays, the use of therapeutic mud, paraffin, baths and saunas, massage of the lumbosacral region.

The benefits of physical therapy are:

the minimum number of contraindications;
physiology ( impact of natural factors);
lack of toxicity, adverse reactions;
painless procedures;
possibility of compatibility with other methods of treatment;
aftereffect duration;
low cost.

Indications for physiotherapy are:

Adenomyosis I, II, III degree ( surgically confirmed). In this case, physiotherapy complements hormone therapy or is used as the main treatment in between hormone therapy courses. Treatment is aimed at eliminating pain, inflammation and adhesions, improving blood circulation in tissues. Apply therapy with pulsed low-frequency currents, iodine electrophoresis, therapeutic baths. The duration and frequency of therapy is determined by a specialist.
Impossibility of hormonal therapy, severe concomitant diseases. With contraindications for hormonal therapy, the appearance of severe side effects, physiotherapy can become the main effective method of treatment. Apply radon therapy, therapeutic baths and others.
The young age of the patient. Physiotherapy has a positive effect on the hormonal background, allowing you to minimize or completely replace hormonal therapy, as well as avoid or delay the timing of surgical treatment. Carry out electrotherapy, therapy therapeutic baths. Iodine-bromine baths are indicated for patients with an established menstrual cycle.
Chronic pelvic pain, menstrual disorders, uterine bleeding, treatment of adhesions and inflammation after surgery. Iodine electrophoresis, balneotherapy, hydrotherapy and others are used. Such procedures reduce spasms, have analgesic, anti-inflammatory effects.
Prevention of the formation of adhesions, complications in the early postoperative period ( in the surgical treatment of adenomyosis). They use laser and ultraviolet radiation therapy, magnetotherapy. Begin therapy on the first day after surgery. This allows you to reduce the time of wound healing, minimize the use of drugs, and also prevent scarring, inflammation and infection of the wound.

Physiotherapy contraindications are:

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

Also increase the effectiveness of the treatment of adenomyosis:

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

Is adenomyosis treated with folk remedies?

Adenomyosis is a serious disease caused by hormonal imbalance or various uterine lesions. It is impossible to cure adenomyosis with one intake of medicinal herbs, but herbal medicine ( herbal therapy) can be very effective in the complex treatment of adenomyosis. It favorably affects the general condition of a woman, strengthens the body, helps to reduce the inflammatory process. Therefore, folk remedies can become part of the treatment of adenomyosis or monotherapy ( use of only one drug or method in treatment) after surgery and medical treatment.
Also, the use of medicinal herbs is recommended for patients with adenomyosis who do not require medical or surgical treatment. Medicinal herbs have antiviral, antitumor, anti-inflammatory, antioxidant, hemostatic ( stopping bleeding), immunostimulating effect. And also have a beneficial effect on the hormonal background of a woman. Medicinal herbs are used in the form of decoctions, tinctures and topically in the form of tampons and douching. Before starting treatment, be sure to consult with your doctor necessary examinations and get tested, as improper use of herbs can adversely affect health.

Benefits of herbal medicine(herbal therapy)are:

availability;
low cost;
no side effects and contraindications ( possible individual intolerance);
general strengthening and stimulating effect on the body;
natural composition;
use during pregnancy and lactation ( before use, you should consult a doctor);
long period of use.

Decoctions and tinctures

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

For the treatment of adenomyosis use:

Angelica. it medicinal plant contains phytohormones - estrogen and progesterone of plant origin. Angelica reduces the growth rate of adenomyosis foci, reduces pain and blood loss during menstruation, normalizes the menstrual cycle, has an anti-inflammatory effect, improves blood circulation and relaxes the muscles of the uterus. To prepare a decoction, 15 grams of the rhizome is boiled in 400 milliliters of water for about 10 minutes. Express and take 1 tablespoon 3 times a day before meals. You should not take a decoction of angelica during pregnancy, lactation, heavy uterine bleeding, while taking medications to thin the blood.
Sabelnik ( marsh cinquefoil). Otar from cinquefoil is taken orally and by douching ( washing the vagina with various solutions of drugs or herbs using a medical pear). Pour 50 grams of grass with a liter of water, bring to a boil and cook over low heat for 10 - 15 minutes. Cool the broth, strain and take 200 milliliters 2 times a day after meals. Improvement is observed after 2 weeks of use. The effectiveness of treatment increases with simultaneous douching with a decoction of cinquefoil. Has antitumor activity.
Boron uterus. The composition of the boron uterus plant contains unique plant components - flavonoids, which have a beneficial effect on women's health. It has antitumor, anti-inflammatory, tonic, hemostatic effect. Boron uterus and cinquefoil are the two most effective treatments for adenomyosis. Decoctions of these herbs should be used alternately. To prepare a decoction, the dried grass of the upland uterus is poured with boiling water and infused for no more than 15 minutes. The decoction is taken one hour before meals. Positive results of treatment are observed after a few weeks, but the course of treatment should be long enough until the signs of the disease disappear completely.
red brush ( Siberian ginseng, Rhodiola four-cut). Phytohormones in the composition of the red brush help restore the disturbed hormonal background of a woman with adenomyosis. Cobalt, copper, selenium, molybdenum and other trace elements stop bleeding, restore blood circulation, prevent the development of anemia ( anemia) and neoplasms. To prepare a decoction, the dried root of the red brush ( 1 tablespoon) is poured with 300 milliliters of water and boiled over low heat for 15 minutes. Infuse for about an hour, filter and take 100 milliliters 3 times a day with a spoonful of honey. To prepare the tincture, 50 grams of the root is poured with 5 liters of vodka and infused for about a month in a glass container. Take orally 50 milliliters 1 time per day. Do not use decoctions and tinctures from the red brush for heart failure, high blood pressure.
Yarrow. Decoctions of yarrow have hemostatic, anti-inflammatory, bactericidal action. Helps increase uterine contractions. It is used for uterine bleeding, irregular menstrual cycle, inflammatory processes of the female genital organs. To prepare a decoction, 1 tablespoon of chopped herbs is poured with 200 milliliters of boiling water and insisted for about an hour. Take 1/3 cup after meals three times a day. To prepare the tincture, 30 grams of chopped herbs are poured with 400 milliliters of alcohol or vodka. Insist 14 days in a dark cool place. Before use, strain, shake. Take 30 drops after meals three times a day.
Wild yam. This plant contributes to the effective treatment of adenomyosis, inflammation of the female genital organs, and also prevents the appearance of menstrual cramps. To prepare a decoction, 1 - 3 grams of raw material is poured with 200 milliliters of boiling water and insisted for about half an hour. Express and take 1 time per day for 30 days. Contraindicated in children under 18 years of age, during pregnancy and lactation.

Of the complex compositions used:

A decoction of nettle leaves, shepherd's purse, cinquefoil root, serpentine root, knotweed grass. This composition of the decoction has a wide range of effects. Among them are a decrease in pain, a decrease in blood loss during menstruation, pain relief, a decrease in inflammation, and stimulation of the body's defenses. To prepare a decoction, herbs are mixed in dried form. Two tablespoons of the mixture is poured with 400 milliliters of boiled water. Insist, express and take 100 milliliters 3 times a day.
A decoction of celandine ( soft part of the plant), plantain, birch buds, poplar buds, juniper berries. Mix all ingredients dry based on 200 milliliters of water), pour boiled water, leave for about an hour and strain. Taken in small amounts no more than 3 sips) 3 times a day after meals. The infusion contributes to the maturation of the egg, the onset of pregnancy.

Depending on the menstrual cycle, decoctions are used:

During egg maturation ( from the beginning of menstruation to the 14th day of the cycle). To prepare a decoction, a dried mixture of poplar buds, birch, calamus, tansy, plantain leaves and juniper berries is used. One teaspoon of the mixture is poured with 200 milliliters of boiling water, insisted for 1 hour. Filter and take 50 - 70 milliliters after meals. Take during 3 - 4 menstrual cycles.
In the second phase of menstruation, in the period after ovulation, the maturation and release of the egg. One teaspoon of a mixture of licorice root, sage, fireweed, clover cones, currant berries, anise, eucalyptus leaves is poured with 200 milliliters of boiling water, insisted for one hour, filtered and drunk 50 milliliters a day after meals. The course of therapy lasts 3-4 menstrual cycles.

local therapy ( tampons, douches)

Locally, tampons are used to treat adenomyosis. To prepare a tampon, the bandage is folded into several layers in the form of a bag. Leave a small "tail" for easy extraction. The medicinal substance is applied to the swab immediately before use. The tampon is then inserted deep into the vagina for a period of 2 to 10 hours.

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

Douching is washing the vagina with solutions, decoctions of medicinal herbs using a medical pear. Before douching, it is necessary to carry out a toilet of the external genitalia, process a medical pear. The water solution must be at room temperature, do not contain aggressive components ( alcohol, acids). It is better to drive the solution in the supine position, slowly and carefully. The duration of the procedure should not exceed 10 minutes. The first three days of the course, douching is done twice a day - in the morning and in the evening. Then 2 - 3 days only in the evening. After that, once a week before bed. Course duration - 7 - 10 days. Douching is contraindicated during pregnancy and the postpartum period, after curettage of the uterus, in acute inflammatory processes, during the menstrual cycle, and others. For douching, decoctions from the leaves of eucalyptus, calendula, yarrow, nettle, oak bark and others are suitable.

Hirudotherapy

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

Healing clay

Clay has unique properties. It contains a huge amount of microelements and macronutrients, useful substances, salts ( calcium, potassium, magnesium and others), which have a beneficial effect on the body of a woman. Red, black, green clay can be used for treatment, but blue clay is especially effective in the treatment of adenomyosis. You can buy clay in a pharmacy in the form of a powder. For application, clay should be diluted with warm water to the consistency of thick sour cream. To prepare the mixture, use only ceramic or glassware. Warm the mixture in a water bath and apply to the lower abdomen. Then cover the clay with foil and wrap yourself in a warm blanket. The duration of the procedure is 2 hours. After that, wash off the remaining clay with warm water. The duration of the course depends on the symptoms and the degree of damage.

What is the difference between adenomyosis and endometriosis?

Adenomyosis and endometriosis are not the same disease, despite the fact that they have a lot in common. Adenomyosis is considered a form of endometriosis. Endometriosis is a gynecological disease in which the cells of the inner layer of the uterus ( endometrium) grow outside of it. This is due to the fact that under certain conditions, the endometrial cells of the uterus enter any area of the body ( where normally they should not meet), attach themselves there and begin to divide. There is endometriosis of the uterus, ovaries, fallopian ( uterine) tubes, peritoneum, vagina, intestines, skin scar and even lungs. Endometriosis of the uterus was called adenomyosis or internal endometriosis. Currently this pathology is an independent disease and is designated by the term "adenomyosis", and not endometriosis of the uterus.

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

Endometriosis is classified into:

genital form- affects the genitals of a woman ( vagina, fallopian tubes, ovaries, etc.);
extragenital form- damage to internal organs and tissues intestines, bladder, postoperative scars and others);
combined form- simultaneous damage to the genital organs and other internal organs and body tissues.

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

According to the stage of distribution, there are:

stage I endometriosis- the appearance of one or more small foci of endometriosis, which do not have a significant effect on the body;
stage II endometriosis- the existence of several lesions with the spread of endometriosis deep into the tissues of organs;
III stage of endometriosis- a combination of several superficial and deep foci of endometriosis, the appearance of cysts, tumors, inflammatory processes;
IV stage of endometriosis- Numerous deep lesions of internal organs with the appearance of benign and malignant neoplasms.

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

The main symptoms of endometriosis are:

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

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

Why is adenomyosis dangerous?

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

Serious complications of adenomyosis include:

development of anemia. As a result of regular heavy blood loss during menstruation and intermenstrual bleeding, hemoglobin is lost ( erythrocyte protein), which contains iron. The main function of hemoglobin is to carry oxygen and saturate tissues with oxygen. In case of a lack of hemoglobin, the organs suffer from hypoxia ( lack of oxygen). The brain and heart, which have the greatest need for oxygen, are especially affected. A woman develops shortness of breath, weakness, dizziness, loss of consciousness, memory impairment, and working capacity decreases.
Infertility. In severe cases, adenomyosis can lead to infertility. One of the reasons is a violation of the hormonal background of a woman. With an excess of estrogen, ovulation is disturbed - the maturation and release of the egg into the fallopian tubes. The menstrual cycle becomes anovulatory. Also, the secretion phase does not occur in the endometrium. As a result of this, the fertilized egg cannot penetrate the mucous layer of the uterus, that is, implantation does not occur. Often adenomyosis is combined with endometriosis of the fallopian tubes. This leads to obstruction of the tube for the egg. Spermatozoa are able to pass through the fallopian tube. It is dangerous to develop ectopic pregnancy- the development of pregnancy outside the uterine cavity, which requires surgical intervention. If pregnancy does occur, then it can be interrupted by a miscarriage due to a lack of progesterone and dysfunction of the muscular layer of the uterus.
Spread to neighboring organs. Foci of adenomyosis can spread beyond the muscular layer of the uterus - into neighboring organs ( intestines, bladder), postoperative scars, nerve bundles. Also, endometrial cells are transported throughout the body with the flow of blood and lymph. This can lead to damage to any organ. An inflammatory process, swelling, hemorrhage, the appearance of scars and adhesions appear around the focus of endometriosis. As a result, the function of the affected organs is disrupted, severe pain occurs during menstruation, neurological disorders ( in case of damage to nerve fibers).

In order to avoid the development of complications of adenomyosis, it is necessary to undergo regular medical examinations ( semiannually) and start treatment on time. Adenomyosis never turns into cancer, so in the absence of symptoms and complaints from the patient, you should not rush into treatment.

Can you get pregnant with adenomyosis? What are the features of pregnancy with adenomyosis?

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

The main causes of infertility in adenomyosis are:

anovulatory menstrual cycles- during anovulatory cycles, the egg does not mature and does not enter the uterine cavity;
changes in the endometrium- structural and functional changes in the endometrium lead to the impossibility of embryo implantation ( the process of implantation of a fertilized egg into the endometrium of the uterus);
hormonal imbalance- maturation of the egg, fertilization, implantation of the embryo, the development of pregnancy, childbirth are regulated by hormones, therefore, with hormonal imbalance, all processes are disrupted;
pathological changes in the structure of uterine smooth muscle cells- this leads to a decrease in the forward movement of spermatozoa, uterine tubal transport, a change in uterine contraction;
genetic abnormalities- if there is a defect in the gene that affects the implantation of the embryo, then the further development of pregnancy does not occur;
inflammatory processes- inflammation leads to the replacement of normal scar tissue and the formation of adhesive processes.

Not always adenomyosis leads to infertility. But if for a long period ( over a year) a woman cannot become pregnant, then it is necessary to undergo a course of treatment. The patient is prescribed hormonal drugs, anti-inflammatory, vitamins, immunomodulators and others. Physiotherapy also has a positive effect on health ( therapy using physical factors - magnetic field, light and others) and phytotherapy ( therapy medicinal herbs ). In severe cases, surgical treatment is indicated. Six months after the course of treatment, you can plan pregnancy again. If pregnancy does not occur after the treatment, the patient is offered in vitro fertilization ( ECO). IVF is a fertilization procedure outside the body of the patient, after which, after a few days, the embryo is introduced into the uterine cavity. But with an endometrial thickness of 10 or more millimeters, implantation is impossible. In this case, the only way out is surrogate motherhood - the bearing and birth of a child by another woman. To do this, the patient's fertilized egg is injected into the uterus of a woman who can bear and give birth to a healthy child.

The main problem with adenomyosis is not the impossibility of conception, but the bearing of the fetus. During pregnancy, such patients are under the supervision of a doctor, take hormonal drugs, regularly undergo ultrasound examination ( ultrasound) and, if necessary, magnetic resonance imaging ( MRI).

The main causes of complications during pregnancy with concomitant adenomyosis are:

Low concentration of progesterone in the blood. Progesterone is one of the most important hormones during pregnancy. It plays an important role in the process of conception, implantation of the embryo in the mucous layer of the uterus, preparation of organs and systems for pregnancy and childbirth. A low level of progesterone indicates a threat of miscarriage and termination of pregnancy, as it stimulates the growth of the uterus, prevents its premature contraction, and prevents the rejection of the fetus by the woman's immune system.
The formation of scars and adhesions. In the foci of adenomyosis, inflammatory processes appear. This leads to the replacement of the inflamed connective tissue, that is, scars are formed. Adhesions also appear - strands of connective tissue. As a result of scarring, the uterus loses its elasticity. This is dangerous due to the risk of uterine rupture and the incorrect position of the fetus in the uterus.
Premature detachment of the placenta. dangerous complication may be placental abruption organ in which the fetus develops), if it is located near the focus of adenomyosis. The placenta is attached to the wall of the uterus and provides the fetus with nutrients, oxygen, and cells of the immune system. With its detachment, further development of pregnancy is impossible and there is a risk of massive bleeding. The first trimester of pregnancy is especially important, since it is during this period that the placenta develops. Therefore, a woman is prescribed maintenance hormonal therapy and with the help of ultrasound ( ultrasound) monitor the thickness of the placenta and the correctness of its development.
Fetoplacental insufficiency. Fetoplacental insufficiency is a set of symptoms in which there are violations of the placenta or fetus. In this case, the fetus suffers from a lack of oxygen ( hypoxia), its development slows down, various pathologies of fetal development occur.

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

Is there any chance of getting pregnant with in vitro fertilization ( ECO) in adenomyosis?

In many unsuccessful attempts to become pregnant with concomitant adenomyosis, a woman is offered in vitro fertilization ( ECO). This is a modern method of solving the problem of infertility. In vitro fertilization means "fertilization outside the body." For this, several eggs are removed from the woman's ovaries. They are fertilized in vitro with partner sperm. The fertilized cell is considered an embryo. The resulting embryos are placed for several days in an incubator - a special apparatus that creates conditions for the development of the embryo, close to physiological.
After 3-5 days, the embryo is transferred into the patient's uterus through a special elastic catheter. This procedure does not require anesthesia. Several embryos are injected at once, as not all embryos are implanted and take root. This increases the chances of a future pregnancy. The maximum allowable number of injected embryos is 4, more often 2 or 3. This number is calculated in order to avoid multiple pregnancy. The entire IVF procedure is carried out against the background of taking hormonal drugs.

The result of in vitro fertilization depends on the stage of adenomyosis, the age of the patient and her state of health. According to research conducted in the period 2010 - 2015. in 130 patients, the pregnancy rate after IVF with mild adenomyosis was 35% ( 19 women out of 130). With moderate severity - 21% ( 10 women out of 130), with a severe degree - 11% ( 3 women out of 130). reproductive losses ( miscarriage) accounted for 15% ( 3 patients out of 19), 40% (4 out of 10) and 67% ( 2 of 3) respectively. The risk of miscarriage is significantly increased with concomitant diseases of the uterus. Thus, reproductive losses in the combination of adenomyosis with uterine myoma are 48%.

To increase the effectiveness of infertility treatment for adenomyosis, it is necessary to conduct IVF in a timely manner without prior hormonal treatment. Pregnancy with adenomyosis is a high-risk pregnancy. With an increase in the severity of adenomyosis, the number of fertilized eggs introduced into the uterine cavity increases. This increases the chances of embryo implantation. Women with a severe degree of adenomyosis are shown surrogate motherhood - the implantation of the patient's embryo into the uterus of another healthy woman for carrying and giving birth to a child.

Can adenomyosis be completely cured and can it go away on its own without treatment?

Adenomyosis is a chronic disease with relapses ( return of the disease after treatment and the disappearance of symptoms). Used in the treatment of adenomyosis conservative method (medicinal), physiotherapy, herbal medicine, radical ( complete removal of the internal genital organs) and non-radical ( organ-preserving) surgical operations. Treatment is aimed at improving the general condition of the woman, eliminating symptoms, the possibility of becoming pregnant, preventing the spread of adenomyosis foci. With this therapy, it is impossible to completely cure adenomyosis. Some time after the disappearance of the symptoms and the apparent cure, the disease returns. During the first year - in 20% of cases, within five years - in 75% of cases.

The longest effect is observed with combined treatment - organ-preserving surgery in combination with hormonal therapy. Drug treatment also brings good results, but only in cases of grade I and II adenomyosis with mild symptoms.

The only way to completely cure adenomyosis is a radical operation, in which the internal genital organs of a woman are removed. This method of treatment is suitable for women who are not planning a pregnancy, women in menopause and concomitant fibroids ( benign tumor of the myometrium) uterus.

Adenomyosis cannot go away on its own without proper treatment. An improvement in the general condition of a woman is observed with the onset of menopause. During this period, there is a decline in ovarian function and a decrease in the level of estrogens responsible for endometrial hypertrophy. In case of accidentally detected adenomyosis without symptoms and complications, treatment is not carried out.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is adenomyosis?

Internal endometriosis (adenomyosis) is a disease uterus in which the endometrium, its inner mucosa, grows into other layers of the organ.

Most often, endometriosis nodes have a dense texture, since connective tissue grows around them. Such nodes are similar to benign encapsulated formations, however, endometrial cells can also be found outside the capsule-like connective tissue growths.

The mixed nodular-diffuse form is morphologically represented by both types of elements.

What signs determine the degree of adenomyosis of the uterine body?
What is adenomyosis of the uterus 1, 2, 3 and 4 degrees?

The classification of adenomyosis according to the degree of prevalence is not international, but it is quite convenient, and therefore it is often found in the domestic literature, and is carried out in practice.

The severity in this classification is determined by the depth of penetration of endometrial cells into the underlying layers of the uterus (used exclusively in relation to the diffuse form of adenomyosis of the uterine body).
I. Diffuse growths of endometrial cells in the submucosal layer of the uterus.
II. The pathological process penetrated into the muscular layer of the uterus, but captured no more than half of this layer.
III. The muscle layer is involved in the pathological process by more than half.
IV. Growth of endometrial cells outside the muscle layer, in the serous membrane of the uterus, with a further transition to the peritoneum and involvement of the pelvic organs in the process.

What is the danger of adenomyosis (endometriosis)?

Endometriosis is considered benign hyperplasia(pathological proliferation of tissue), since endometrial cells that have migrated to other organs and tissues retain their genetic structure. However, such features as the ability to germinate in other organs, the tendency to spread throughout the body and resistance to external influences make it related to malignant tumors.

The word "benign" also speaks of the prognosis of the disease - it lasts for years and decades, as a rule, without leading to severe exhaustion of the body and death. However, as in the case of malignant hyperplasia ( crayfish, sarcoma, etc.), adenomyosis (endometriosis) is difficult to treat conservatively, and operations for this pathology are much more voluminous than in the case of benign tumors, since it is difficult to determine the boundary between diseased and healthy tissue.

The most common complication of adenomyosis is due to the fact that endometrial cells functioning in accordance with the monthly cycle lead to heavy bleeding, which is fraught with the development of acute and/or chronic anemia. In some cases, patients have to be hospitalized, and even operated urgently for life-threatening bleeding.

Adenomyosis is prone to spreading the process to other organs and tissues, which leads to systemic lesions. With an extragenital location of endometrial cells, a number of complications are possible that require emergency medical intervention ( intestinal obstruction with endometriosis of the gastrointestinal tract, hemothorax (filling pleural cavity blood) with endometriosis of the lung, etc.).

And finally, another danger of endometriosis in general, and adenomyosis in particular, is the threat of malignant genetic transformation of migrating cells. Such a transformation is very real, since any hyperplasia has a more or less pronounced tendency to malignancy, and in a new place, endometrial cells are forced to exist in extremely unfavorable conditions.

How many women have adenomyosis?

In terms of prevalence, endometriosis ranks third among gynecological diseases (after inflammatory lesions of the appendages and uterine fibroids).

The incidence of endometriosis is about 20-90% (according to various sources). Such a scatter of digital data should not arouse suspicion. The fact is that many researchers add subclinical (asymptomatic) forms of the disease to these figures. According to clinical data, asymptomatic endometriosis accounts for up to 45% of all cases of pathology, and is detected in a study of women who seek help for a reason. infertility. Since endometriosis does not lead to infertility in all cases, the number of women with endometriosis can only be guessed at. Hence the inaccuracy of figures on the prevalence of pathology.

Endometriosis is most common in women reproductive age, but in some cases it is diagnosed in adolescents, as well as in women in menopause taking hormone replacement therapy. Previously, it was believed that the peak incidence occurs in late reproductive age and premenopause, but there are works that refute this statement.

In recent decades, there has been a marked increase in the incidence of endometriosis. This is due, on the one hand, to the violation of the immunological status of the population under the influence of many reasons ( environmental problems, stress etc.), and on the other hand, the introduction of the latest methods diagnostics that dramatically increased the detection of mild and asymptomatic forms (laparoscopy, MRI tomography, transvaginal ultrasound scanning).

What causes the development of adenomyosis?

Unfortunately, the causes and main mechanisms of development of endometriosis (adenomyosis) have not been fully studied to date.

We can only say with certainty that endometriosis is a hormonally dependent disease, the development of which is facilitated by disorders of the immune system.
Risk factors for developing adenomyosis include:

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

Symptoms of adenomyosis of the uterus

The main and pathognomic (characteristic only for this disease) sign of adenomyosis is heavy and / or prolonged menstrual bleeding, leading to secondary iron deficiency. anemia.

Anemia, in turn, is manifested by the following symptoms:

weakness;
susceptibility to various infectious diseases;
pallor of the skin and visible mucous membranes;
in severe cases - dyspnea with little physical activity;
a sharp decrease in working capacity and the ability to adequately assess one's own condition.

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

With common forms of adenomyosis, metrorrhagia can develop - uterine bleeding occurring in the middle of the menstrual cycle.

Another characteristic sign of adenomyosis is pain syndrome that occurs a few days before the onset of menstruation and, as a rule, disappears 2-3 days after it begins ( dysmenorrhea or algomenorrhea).

The nature and severity of pain depends on the localization of the process. A particularly strong pain syndrome is observed with damage to the isthmus of the uterus, as well as in the case of widespread adenomyosis with the development of an adhesive process.

Adenomyosis is often found in such a pathology as the accessory uterine horn, when affected by endometriosis, the clinic may resemble acute abdomen(menstrual blood is thrown into the pelvic cavity, and causes symptoms peritonitis).

By irradiation of pain, it is often possible to establish the localization of the pathological process. So, if the corner of the uterus is affected, the pain radiates to the corresponding inguinal region, and if the isthmus is affected, it radiates to the vagina or rectum.

Another characteristic symptom of adenomyosis is soreness during intercourse, especially on the eve of menstruation (most common with lesions of the isthmus of the uterus).

In a clinical examination of patients with adenomyosis, an increase in the uterus is determined, especially pronounced before menstruation and in the first days of the menstrual cycle. The diffuse form is characterized by a "spherical" uterus. With nodular adenomyosis, it is sometimes possible to palpate the nodes.

It should be noted that the severity of symptoms of adenomyosis to a certain extent depends on the degree of prevalence of the process. So, diffuse adenomyosis of the 1st degree is an accidental finding during certain examinations, and is asymptomatic. However, in diffuse adenomyosis grades 2 and 3, as well as in the nodular form of adenomyosis, the severity of clinical symptoms does not always coincide with the degree of prevalence of the process and the size of the nodes.

How does adenomyosis proceed in combination with uterine fibroids?

The probability of combining adenomyosis with uterine fibroids is very high (up to 85%, according to some authors), which is explained by similar mechanisms for the development of these pathologies.

An increase in the uterus in such cases, as a rule, corresponds to the size of the fibroids. The size of the organ does not return to normal after menstruation, as is the case with isolated diffuse adenomyosis.

However, the remaining symptoms of adenomyosis, when combined with fibroids, do not undergo pronounced changes. An exception is uterine fibroids with submucosal nodes, in such cases there are abundant acyclic uterine bleeding.

The combination of adenomyosis with uterine fibroids is difficult to treat conservatively, so it is with this combination of pathologies that patients are most often advised to decide on hysterectomy(uterus removal).

Signs of a combination of adenomyosis with ovarian endometriosis

Adenomyosis is often combined with ovarian endometriosis, which is explained by the spread of the process to them from the uterine cavity. Many researchers suggest that the formation of endometrial growths on the ovaries is associated with the throwing of menstrual blood through the fallopian tubes, which contains living endometrial cells capable of proliferation.

According to the prevalence of the process, four degrees of ovarian endometriosis are distinguished:
I. Point foci of endometriosis on the surface of the ovary and on the peritoneum, in the depression between the uterus and the rectum.
II. Unilateral endometroid cyst no larger than 6 cm, adhesive process in the area of the uterine appendages without involvement intestines.
III. Bilateral endometrial cysts up to 6 cm in size, a pronounced adhesive process involving the intestines.
IV. Large bilateral cysts, transition of the process to bladder and large intestine, a common adhesive process.

With the spread of endometriosis from the uterine cavity to the ovaries, a whole group of symptoms joins the signs of adenomyosis.

First of all, the pain syndrome is transformed. Unlike adenomyosis, pain is constant, periodically increasing in nature. The maximum increase in pain is typical for the onset of menstruation and the period ovulation(the release of a mature egg from the follicle in the middle of the menstrual cycle). Pain in endometriosis of the ovary is localized in the lower abdomen, in the projection of the uterine appendages, has a aching or pulling character, is given to the lumbar region, sacrum, and rectum.

For adenomyosis, combined with ovarian endometriosis, a pronounced premenstrual syndrome, often accompanied nausea , vomiting, cold extremities, a sharp decrease in working capacity. In the first days of menstruation, subfebrile condition is possible, a change in laboratory parameters of the general blood test(increase in the number leukocytes and ESR).

With the development of the adhesive process, there may be disturbances in the functioning of the intestines and bladder ( constipation, frequent and painful urination).

During a clinical examination, palpation of the appendages reveals their enlargement and soreness, sometimes it is possible to palpate endometriosis ovarian cysts. Cysts are palpable, as a rule, with sizes of more than 6 cm on the side and / or posterior to the uterus, as tumor-like formations of a densely elastic consistency, motionless due to the development of the adhesive process, sharply painful, especially on the eve and during menstruation.

For an accurate diagnosis, the same types of studies are needed as with isolated adenomyosis.

What tests are used to diagnose adenomyosis?

Of paramount importance for the correct diagnosis is the collection history with the determination of the existence of risk factors in this patient (adverse heredity, surgical manipulations on the uterus, certain somatic diseases, etc.) and the analysis of complaints (abundant and / or prolonged menstruation, accompanied by severe pain, pain during intercourse, symptoms anemia).

Then the doctor performs a physical examination (examination on the gynecological chair), during which, in the case of adenomyosis, as a rule, a spherical enlargement of the uterus is found, corresponding to 8-10 weeks of pregnancy (rarely more). Inspection is best done on the eve of menstruation, since at this time the increase in the uterus is most noticeable. With the nodular form of adenomyosis, it is often possible to feel the nodes or tuberosity of the surface of the uterus.

As a rule, a thorough history taking with an analysis of the data obtained, supplemented by a physical examination, makes it possible to correctly make a preliminary diagnosis of internal uterine endometriosis (adenomyosis).

To clarify the diagnosis, in particular, to determine the localization and extent of the process, additional instrumental studies are carried out to resolve the issue of further treatment tactics for the patient.

The gold standard of investigation for suspected adenomyosis is an ultrasound scan. In addition, survey methods such as nuclear magnetic resonance, hysterosalpingography and hysteroscopy.

What are the echo signs of adenomyosis?

Among all types of echography ( ultrasound) transvaginal ultrasound scanning is the most informative in adenomyosis. The accuracy of diagnosis with this method of examination exceeds 90%.

If adenomyosis is suspected, it is best to carry out echography on the eve of menstruation (on the 23-25th day of the cycle).

Per long years In the development of ultrasound diagnostics, the following pathognomic echo signs of internal endometriosis (adenomyosis) of the uterus have become generally recognized:
1. An increase in the anterior-posterior size of the uterus, as a result of which the organ acquires a spherical shape.
2. Enlargement of the uterus up to 6 weeks of pregnancy or more.
3. Wall thickness asymmetry.
4. The appearance on the eve of menstruation in the muscular membrane of the uterus of cystic cavities measuring 3-5 mm or more.

What is the treatment for adenomyosis of the uterus?

Adenomyosis is not suffering a separate body, but a chronic systemic disease of the body. Therefore, in the treatment of pathology, a purely individual approach is needed, taking into account all the mechanisms of the onset and development of the disease in a particular patient.

Thus, when choosing a method of therapy, many factors are taken into account, primarily:

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

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

radical (removal of the uterus and ovaries);
organ-preserving (carrying out laparoscopy and excision of endometrial lesions).

II. Conservative treatment:

nonspecific anti-inflammatory therapy;
sedative (calming) drugs;
vitamin therapy;
maintaining function liver ;
elimination of anemia;
immunomodulators;
resolving therapy;

III. Combined treatment.

The general algorithm for the treatment of patients with adenomyosis is as follows: first of all, appoint conservative treatment, and in case of its ineffectiveness, or if there are contraindications to the use of hormonal drugs, they turn to surgical methods treatment.

In recent years, organ-preserving endoscopic operations have been successfully used to treat patients of reproductive age. The main indications for their implementation are:

adenomyosis in combination with endometrial hyperplasia;
functioning endometrial ovarian cysts (more than 5 cm in diameter);
suppuration of the appendages of the uterus affected by endometriosis;
adhesions in the ampulla of the fallopian tubes (the main cause of infertility in endometriosis);
ineffectiveness of hormonal therapy (there is no positive dynamics in the treatment with hormonal drugs for more than 3 months);
the presence of somatic diseases that are contraindications to long-term hormonal therapy ( phlebeurysm and thrombophlebitis, severe liver disease, migraine, depressive states, epilepsy, cerebrovascular accidents, obesity, diabetes , hypertension etc.).

Radical surgery with removal of the uterus and / or ovaries is performed in the presence of the following indications:

progressive course of the disease in women over 40;
lack of effect from combined treatment with organ-preserving operations;
a combination of the nodular form of adenomyosis or diffuse adenomyosis of the 3rd degree with uterine myoma;
risk of malignant transformation.

Can adenomyosis be cured?

Adenomyosis is a chronically relapsing disease. The statistics of relapses after successful non-radical treatment (conservative therapy, organ-preserving operations) is about 20% per year. After five years, the recurrence rate reaches 74%.

The longest effect is observed with the combined use of surgical (organ-preserving operations) and conservative (hormonal therapy) methods of treating adenomyosis, however, in most cases, relapses are still inevitable.

The prognosis is somewhat better in premenopausal women, since with the physiological extinction of ovarian function, the activity of the process subsides.

In patients who have undergone radical operations(removal of the uterus and ovaries), the process does not resume.

Is it possible to get pregnant with adenomyosis of the uterus?

Adenomyosis is the second leading cause of female infertility after inflammatory diseases female genital area. And if, moreover, we take into account that some of the chronically aggravated adnexitis(inflammatory processes in the ovaries) is not caused by an infectious process, but by internal endometriosis, then the connection between adenomyosis and infertility becomes obvious.

According to statistical studies of various authors, infertility in adenomyosis is diagnosed in every third or second case, or even more often (according to some reports, among patients with adenomyosis, the level of infertility reaches 60-80%).

The mechanisms of infertility in adenomyosis are different in different patients, and, consequently, the prognosis and treatment tactics will be different.

We list the most common causes of infertility in patients with internal endometriosis of the uterus (in descending order of frequency of observations):
1. Violation of the transport function of the fallopian tubes due to adhesions, or a decrease in their motor activity, so that the egg cannot get from the ovary into the uterine cavity.
2. Pathological changes in the hormonal sphere that prevent ovulation (the maturation of the egg and its release from the follicle). Some authors consider this reason to be the main one in the occurrence of infertility in adenomyosis.
3. Autoimmune reactions leading to deactivation of spermatozoa in the uterine cavity, as well as preventing implantation fertilized egg and further development of the embryo.
4. Termination of pregnancy in the early stages due to increased contractility of the myometrium caused by inflammation in the muscular layer of the uterus.
5. Soreness during intercourse, making it difficult to have a regular sexual life.

Often, infertility in adenomyosis can be caused by several reasons at once, therefore, long-term complex treatment is necessary to restore reproductive function. The success of therapy is highly dependent on the duration of the period of infertility. So, best results receive if its duration does not exceed 3 years.

Thus, adenomyosis very often leads to infertility, however, timely complex treatment gives a chance to restore the ability to conception.

Adenomyosis and pregnancy. Are there any chances to endure and give birth to a healthy
child?

To date, a large amount of material has been collected along the flow pregnancy , childbirth and the postpartum period in women suffering from internal endometriosis of the uterus (adenomyosis). General conclusions from numerous studies can be summarized in the following provisions:
1. In women with adenomyosis, the incidence of infertility is increased (from 40 to 80% according to various sources), however, timely complex treatment of endometriosis in most cases leads to the restoration of the ability to bear children.
2. A frequent complication in women with adenomyosis is the threat of premature termination of pregnancy. However, adequate therapy in most cases can stabilize the condition. Treatment is carried out according to the general standard scheme, as well as in women who do not suffer from adenomyosis.
3. Artificial or spontaneous termination of pregnancy leads to a relapse or exacerbation of adenomyosis, followed by an accelerated development of the pathological process, so you should, if possible, strive to preserve the pregnancy.
4. Most women with adenomyosis have a successful delivery, but in the afterbirth and early postpartum period there is an increased tendency to uterine bleeding, so the possibility of these complications should be considered.
5. After childbirth with the restoration of menstrual function, activation of the process is possible, but it is always lower than in the case of artificial or spontaneous abortion.
6. After artificial and spontaneous abortions, as well as after childbirth with the restoration of menstrual function, patients with a history of adenomyosis should undergo anti-relapse treatment (hormonal therapy, immunomodulators, antioxidants etc.).

What are the alternative methods of treatment of internal endometriosis
(adenomyosis) of the uterus? Is it possible to cure adenomyosis folk
means?

There are a lot of different ways of alternative treatment of adenomyosis, some of them are recognized official medicine, and can be included in the complex treatment of pathology.

However, the network and the real quasi-medical literature contain a lot of useless and even extremely harmful advice, therefore, before using any of the popular recipes for the treatment of adenomyosis, it is necessary consult a doctor. In no case should you replace the treatment prescribed by the doctor with alternative methods.

Adenomyosis is a disease prone to relapse, so it is very problematic to completely cure it, both with the help of official and traditional medicine.

The body of the uterus is spherical, which means. Signs of the development of adenomyosis on ultrasound

What is a spherical uterus?

Causes

The mechanism of development of pathology

Symptoms of the anomaly

Diagnosis of the spherical uterus

Treatment methods for adenomyosis

Possible consequences, complications

Adenomyosis

Classification

Causes of the disease

Main symptoms

Diagnostics

Treatment

What is the danger of adenomyosis (endometriosis)?

How many women have adenomyosis?

What causes the development of adenomyosis?

Symptoms of adenomyosis of the uterus

How does adenomyosis proceed in combination with uterine fibroids?

Signs of a combination of adenomyosis with ovarian endometriosis

What tests are used to diagnose adenomyosis?

What are the echo signs of adenomyosis?

What is the treatment for adenomyosis of the uterus?

Can adenomyosis be cured?

Is it possible to get pregnant with adenomyosis of the uterus?

Adenomyosis and pregnancy. Are there any chances to endure and give birth to a healthy

What are the alternative methods of treatment of internal endometriosis

What is a spherical uterus

Adenomyosis

Classification

Causes of the disease

Main symptoms

Diagnostics

Treatment

Spherical uterus: an atypical form of the reproductive organ

What is a spherical uterus?

Causes

The mechanism of development of pathology

Symptoms of the anomaly

Diagnosis of the spherical uterus

Treatment methods for adenomyosis

Possible consequences, complications

Adenomyosis of the uterus

Causes of adenomyosis

Symptoms of adenomyosis

Types of adenomyosis

Degrees of adenomyosis

Diagnosis of adenomyosis

Medical treatment of adenomyosis

Treatment with folk remedies

Prevention of adenomyosis

Adenomyosis and infertility

Adenomyosis and pregnancy

Prognosis for adenomyosis

Adenomyosis is internal endometriosis of the body of the uterus.

Minimally invasive treatments for adenomyosis

Physiotherapy for adenomyosis

Is adenomyosis treated with folk remedies?

Decoctions and tinctures

local therapy ( tampons, douches)

Hirudotherapy

Healing clay

What is the difference between adenomyosis and endometriosis?

Why is adenomyosis dangerous?

Can you get pregnant with adenomyosis? What are the features of pregnancy with adenomyosis?

Is there any chance of getting pregnant with in vitro fertilization ( ECO) in adenomyosis?

Can adenomyosis be completely cured and can it go away on its own without treatment?

What is adenomyosis?

What signs determine the degree of adenomyosis of the uterine body? What is adenomyosis of the uterus 1, 2, 3 and 4 degrees?

What is the danger of adenomyosis (endometriosis)?

How many women have adenomyosis?

What causes the development of adenomyosis?

Symptoms of adenomyosis of the uterus

How does adenomyosis proceed in combination with uterine fibroids?

Signs of a combination of adenomyosis with ovarian endometriosis

What tests are used to diagnose adenomyosis?

What are the echo signs of adenomyosis?

What is the treatment for adenomyosis of the uterus?

Can adenomyosis be cured?

Is it possible to get pregnant with adenomyosis of the uterus?

What signs determine the degree of adenomyosis of the uterine body?
What is adenomyosis of the uterus 1, 2, 3 and 4 degrees?

Adenomyosis and pregnancy. Are there any chances to endure and give birth to a healthy
child?

What are the alternative methods of treatment of internal endometriosis
(adenomyosis) of the uterus? Is it possible to cure adenomyosis folk
means?