Adenomyosis is a disease of the uterus that can cause prolonged uterine bleeding, spotting in the middle of the cycle and severe pain in the lower abdomen.
They speak of adenomyosis if the endometrium, which normally should be only in the uterus, penetrates deep into the uterine muscle layer.
Due to the fact that the endometrium begins to grow where it is not supposed to grow, an inflammatory reaction develops, and the uterus increases in size.
Adenomyosis and endometriosis
Adenomyosis is sometimes called uterine endometriosis or internal endometriosis. Indeed, both adenomyosis and endometriosis develop for the same reason: if the endometrium begins to grow where it is not supposed to grow.
In endometriosis, endometrial foci can be found outside the uterus (on the ovaries, in the fallopian tubes, in the cervix and
Often, endometriosis and adenomyosis are simultaneously detected in the same woman.
Why does adenomyosis appear?
The causes of adenomyosis are not known. There are several theories explaining the possible causes of this disease, but so far none of them is generally accepted.
It is known that sex hormones (estrogen, progesterone, prolactin, FSH) play an important role in the development of adenomyosis. When the level of sex hormones in the blood decreases (this happens in women during menopause), the symptoms of adenomyosis usually disappear.
Who has an increased risk of adenomyosis?
Adenomyosis is a fairly common disease among women who have given birth to middle-aged women (over 35-40 years old). An increased risk of adenomyosis is observed:
- in women who gave birth (alone or by caesarean section)
- in women who have undergone surgery on the uterus (for example, removal of uterine fibroids)
- in women over 35-40 years
Forms of adenomyosis
Depending on how large the endometrial areas in the muscle layer of the uterus, there are several forms of adenomyosis:
- Focal adenomyosis: the endometrium forms separate islets, or foci of adenomyosis in the uterine muscle layer. Focal adenomyosis is often asymptomatic or with unexpressed symptoms.
- Nodular adenomyosis: endometrium forms separate nodes in the uterine muscle layer. Endometrial nodes in the nodular form of adenomyosis are differently called adenomyomas, since they are very similar to uterine myoma.
- Diffuse adenomyosis: extensive areas of the endometrium almost uniformly germinate the entire muscle layer of the uterus.
In some women, several forms of adenomyosis can be found at once: for example, a combination of diffuse and nodular forms (diffuse nodular adenomyosis).
Degree of adenomyosis
Depending on how deep the endometrium has penetrated the muscle layer of the uterus, there are 4 degrees of adenomyosis:
- 1 degree of adenomyosis. shallow penetration of the endometrium into the uterus. The endometrium is found only in the submucous layer of the uterus.
- 2 degree of adenomyosis. deeper penetration of the endometrium into the uterus: foci of adenomyosis are found in the muscle layer of the uterus, but affect not more than half of the muscle layer.
- 3 degree of adenomyosis. foci of endometriosis are found in the muscle layer of the uterus and affect more than 50% of its thickness
- 4 degree of adenomyosis. deep defeat. Endometrium germinates all layers of the uterus.
Symptoms and signs of adenomyosis
Sometimes adenomyosis can be asymptomatic and can only be detected by chance during an examination for another reason. But often with adenomyosis, the following symptoms are observed:
- Long and abundant periods, which last more than 7 days in a row. Often with adenomyosis uterine bleeding may occur.
- Spotting brown (bloody) discharge in the middle of the cycle.
- During menstruation, blood is secreted by clots (lumps).
- Severe abdominal pain during menstruation or in the middle of the cycle. Pain in adenomyosis can be cramping or cutting.
- Lower abdominal pain during sex
In adenomyosis, the uterus may increase in size by a factor of 2-3. Because of this, some women manage to grope in the lower abdomen (behind the pubic bone) rounded dense formation. This is the enlarged uterus.
Consequences of adenomyosis
Adenomyosis is not life-threatening and, as a rule, does not cause any serious complications. However, heavy bleeding with adenomyosis can provoke anemia, and severe abdominal pain worsens the quality of life and can lead to depressed mood, anxiety and depression.
Adenomyosis and pregnancy
Despite the fact that adenomyosis is often found in women suffering from infertility, the direct link between this disease and the inability to conceive a child has not yet been established.
Some experts believe that the cause of infertility in adenomyosis is not adenomyosis itself, but endometriosis associated with this disease. How to get pregnant with endometriosis, read the article on the link.
If you have adenomyosis and you cannot get pregnant, you may need a thorough examination and then treatment. How to get pregnant with adenomyosis, read below.
Diagnosis of adenomyosis
Consult your gynecologist if you have at least one of the above symptoms of adenomyosis. The gynecologist will perform a gynecological examination and clarify whether there is a need for more thorough examination.
The complexity of the diagnosis of adenomyosis is that there are no such methods of examination that would allow to make such a diagnosis with certainty. The only reliable method for the diagnosis of adenomyosis is the removal of the uterus and the subsequent examination of the tissues of the uterus under a microscope (histological examination).
Of course, the removal of the uterus for many women is an unacceptable diagnostic method, so alternative methods of examination have been used to clarify the diagnosis: ultrasound. MRI, hysterosalpingography. sonogisterography, uterus biopsy.
These examinations allow you to find signs of adenomyosis and exclude other diseases with similar symptoms: uterine myoma. uterine polyps, endometriosis, endometrial hyperplasia. Only if other possible diseases are excluded, a diagnosis of adenomyosis is made.
Gynecological examination in the chair
Despite the fact that during a routine examination, the gynecologist cannot notice the foci of adenomyosis in the uterus, the pelvic examination is very important. First of all, the gynecologist will be able to determine the size of the uterus: with adenomyosis, the uterus increases in size by a factor of 2-3 and becomes spherical. Secondly, during the examination, the gynecologist will rule out other possible causes of bleeding or abdominal pain.
Ultrasound of the pelvic organs
Ultrasonography is also not a definitive method for the diagnosis of adenomyosis, but this examination is very important because it will rule out other possible diseases of the uterus or uterine appendages. The main signs (echo signs, echo pattern) of adenomyosis on ultrasound are:
- increase in the size of the uterus and change its shape
- the presence in the uterine muscle layer (myometrium) of hypoechoic inclusions
- heterogeneous myometrium structure
- presence of small cysts in the uterine muscle layer (up to 5 mm in diameter)
- thickening of the walls of the uterus (especially common thickening of the posterior wall of the uterus)
It is important to understand that only on the basis of ultrasound of the pelvic organs and general examination, no doctor can diagnose adenomyosis. Ultrasound allows only suspect the presence of adenomyosis.
MRI (magnetic resonance imaging)
MRI is a more expensive method of examination, which allows to clarify the structure of the muscle layer of the uterus. The main signs of adenomyosis on MRI are thickening of the muscular layer of the uterus, heterogeneity of the myometrium and the presence of foci in it, which may be foci of the endometrium. MRI also eliminates other possible diseases of the uterus.
Hysteroscopy can be used to rule out other possible causes of uterine bleeding (uterine polyps, uterine fibroids, endometrial hyperplasia, malignant diseases of the uterus and
Hysterosalpingography (HSG) and sonogisterography
Hysterosalpingography and sonogisterography are also used to exclude other possible diseases of the uterus. In addition, if a woman has adenomyosis, then hysterosalpingography or sonogisterography can detect indirect signs of this disease. On our site there is a separate article on hysterosalpingography.
How is adenomyosis diagnosed?
Despite the fact that adenomyosis can not be called a rare disease, doctors often “miss” it or confuse it with other diseases that cause similar symptoms.
For example, uterine bleeding can occur in both adenomyosis and uterine submucous myoma, uterine polyps, hormonal disorders, endometrial hyperplasia, uterine malignant diseases and
In this regard, many experts are of the opinion that for the diagnosis of adenomyosis it is necessary to exclude all other possible diseases with similar symptoms. If all the conducted examinations did not reveal other disorders, but revealed indirect signs of adenomyosis, the diagnosis of adenomyosis is considered to be confirmed. The final diagnosis can only give a histological study of the uterus after its removal.
Should I treat adenomyosis?
As mentioned above, adenomyosis does not threaten the life of a woman and, as a rule, does not cause any serious complications. In this regard, the treatment of adenomyosis is required not for all women. You do not need to be treated if:
- Signs of adenomyosis have been discovered accidentally in your examination for another reason.
- you have no symptoms of adenomyosis, or the symptoms are not pronounced and tolerant
- symptoms of adenomyosis do not cause marked discomfort, you are over 45-50 years old and you should have menopause soon
Can adenomyosis be completely cured?
Unfortunately, there are no such drugs that could help get rid of adenomyosis. All medications used in treatment only help to cope with the symptoms of adenomyosis, but do not eliminate the disease itself. The only guaranteed way to get rid of adenomyosis is the removal of the uterus.
Treatment of adenomyosis
Treatment of adenomyosis depends on the symptoms that bother a woman.
- Pain relievers in the treatment of adenomyosis
If adenomyosis in a woman often has severe lower abdominal pain, then nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed: Ibuprofen, Ketoprofen, etc.
In order for them to really work, you need to start taking the pills before the menstrual periods appear (1-2 days before the expected menstruation date and take one pill every 6 hours).
- Contraceptive pills in the treatment of adenomyosis
With adenomyosis, women often have marked uterine bleeding, spotting in the middle of the cycle, and menstrual failures.
In order to regulate the menstrual cycle, the doctor may prescribe birth control pills (Janine, Yarin and others). Contraceptive pills do not treat adenomyosis, but sometimes help to eliminate or alleviate such symptoms of adenomyosis as severe uterine bleeding and abdominal pain during menstruation.
- Mirena intrauterine device for adenomyosis
The Mirena intrauterine device has proven efficacy in adenomyosis, endometriosis and uterine myoma. Mirena can relieve abdominal pain during menstruation and reduce blood loss during menstruation. In some women, prolonged wearing of the Mirena helix leads to a complete cessation of menstruation, which favorably affects the course of adenomyosis.
However, with the help of Mirena will not be able to get rid of adenomyosis. After the helix is removed, the menstruation returns, just as all the symptoms of adenomyosis can return.
- Utrogestan and Duphaston in the treatment of adenomyosis
The drugs Utrogestan and Duphaston are often used in the treatment of adenomyosis and endometriosis. On the background of treatment with these drugs, periods are not so abundant, and foci of adenomyosis can be reduced in size. The course of treatment can be from 6 to 9 months.
- Gonadotropin-releasing hormone analogues (Buserelin, Goserelin, Sinarel) in the treatment of adenomyosis
Buserelin, Goserelin (Zoladex), Sinarel and other drugs analogues of gonadotropin-releasing hormones are often prescribed for marked symptoms of adenomyosis and endometriosis.
While taking these medications, the woman stops her period, the ovaries temporarily stop working and the level of sex hormones in the blood decreases. All of these effects lead to the fact that the endometrial foci begin to decrease in size, and the symptoms of adenomyosis disappear or become less noticeable.
The duration of treatment of adenomyosis with these drugs is no more than 6 months, but after the end of the course of treatment, all symptoms of adenomyosis can return. In order to prolong the positive effect, after the end of the treatment, the doctor may prescribe the further administration of the contraceptive pill or the Vizann drug.
- Visanna in the treatment of adenomyosis
The drug Vizanna contains a substance dienogest, which prevents the growth of endometrial foci in the muscle layer of the uterus. This drug is prescribed not only for adenomyosis, but also for endometriosis.
It is noted that in some women with adenomyosis, the Vizanna drug can cause severe uterine bleeding, so taking this medication is possible only after consulting with the gynecologist and under his careful supervision.
Adenomyosis and menopause (menopause)
Often, adenomyosis can be found in women at the premenopausal age (a few years before the expected onset of menopause or menopause): at 45-50 years of age.
If at the same time there are no symptoms of adenomyosis, or if they do not cause great inconvenience, no treatment is prescribed. With minor symptoms (irregular periods, abdominal pain), birth control pills or painkillers may be prescribed. If the symptoms of adenomyosis worsen the quality of life, then the doctor may recommend removal of the uterus.
Surgery (removal of the uterus) for adenomyosis
Removal of the uterus in adenomyosis is not always required. The operation can be recommended in the following cases:
- if adenomyosis causes severe uterine bleeding that is not treatable and leads to a large loss of blood
- if the woman already has children and she is not planning a future pregnancy
- if the woman is in premenopausal age (over 45-50 years old) and not against the removal of the uterus
- if adenomyosis is combined with large uterine myoma
- if adenomyosis is combined with unwanted changes in the endometrium or cervix
How the operation goes, how to prepare for it and how to behave after the operation, you can read in separate articles on our website: Removal of the uterus (hysterectomy): before the operation and Removal of the uterus: after the operation, consequences.
How to get pregnant with adenomyosis?
It is believed that adenomyosis can not cause infertility, so you have every chance of becoming pregnant with adenomyosis yourself, without treatment.
If you cannot get pregnant for 12 months or more, then you and your husband need to get tested. What examinations should a woman undergo:
- Ultrasound of the pelvic organs
- blood test for hormones
- hysterosalpingography (HSG) to assess tubal patency
- basal temperature measurement for at least 3 consecutive months to determine if there is ovulation
What examinations a man must undergo:
- sperm analysis (spermogram)
Depending on the results of the examination, the doctor prescribes treatment. So, for example, if an obstruction of the fallopian tubes was detected, then a laparoscopic operation is performed to restore their patency. If the woman does not have ovulation, treatment is prescribed to restore normal ovarian function, or courses of ovulation stimulation. If during examinations were associated diseases (polyps of the uterus, myoma and