Can pain with adenomyosis be permanent? Causes of adenomyosis and its treatment. What is the disease

Pain due to adenomyosis worries almost every woman suffering from this disease. An exception may be cases of asymptomatic gynecological disease. Discomfort and pain appear due to swelling and inflammation in the muscle tissue of the uterus, which causes compression of many nerve endings in the uterine wall. Particular pain occurs during menstruation.

What causes pain

Endometrial cells that have penetrated the serosa and muscle tissue of the uterus continue to function. Their vital activity occurs due to female sex hormones - estrogens. Up to a certain point, such cells do not manifest themselves in any way, but with the onset of the so-called proliferation stage, tissues begin to reject them. However, there are no pathways for the removal of endometrium in the muscles and they have nowhere to go. As a result, a local inflammatory process and swelling of the smooth muscle tissue of the uterus - the myometrium - begins. This phenomenon often causes bleeding and pain with uterine adenomyosis.

Sometimes areas affected by adenomyosis break through and unnecessary accumulations enter the uterine cavity. Such processes cause disruption of the basal layer of the endometrium and provoke the formation of adhesions.

Gradually, the muscles of the organ become deformed and cannot contract normally, therefore, with severe symptoms of this disease, a woman cannot give birth. Pregnancy usually ends in embryo rejection or termination.

Types of pain syndrome

Women suffering from symptoms of the disease regularly or constantly experience severe pain. With adenomyosis, discomfort usually occurs:

lower abdomen;
in the lower back;
sometimes the pain radiates to the perineum or thighs.

Usually the intensity of unpleasant sensations increases sharply a few days before the onset of critical days. After the end of menstruation, the pain subsides or disappears completely. This is due to the fact that closer to the end of the cycle, the body rejects unnecessary endometrial cells, which should be released along with menstrual blood. The peak of pain occurs in the first 1-2 days after the onset of menstruation.

Symptoms of the disease

It also happens that the patient does not experience any pain with adenomyosis, so the subsequent treatment received is untimely and often ends in surgical interventions. Meanwhile, the female body gives signals about the occurrence of such a gynecological disorder. Common symptoms of the disease are:

Prolonged periods with heavy bleeding. With adenomyosis, the stomach, lower back and perineum hurt. Critical days can last more than a week, accompanied by the release of clots and lumps.
Pain during menstruation is accompanied by cramping and cutting attacks. Many women report an extremely painful form of premenstrual syndrome.
Brown or chocolate-colored spotting is present for a long time after the end of menstruation. Similar phenomena can begin several days before critical days.
Weakness, lethargy and drowsiness caused by large blood losses.
During sexual intercourse, attacks of severe pain in the lower abdomen occur.

With adenomyosis, the size of the main reproductive organ can increase several times, so often a woman, lying on her back, can independently feel a round, dense formation just below the navel - an enlarged uterus.

Diagnosis of adenomyosis

If at least one of the above signs is present, a woman should definitely consult a gynecologist. The doctor will examine you and determine the need for treatment. Already during the first examination on the chair, the gynecologist will be able to determine the shape, size of the uterus and its mobility. If the doctor suspects the presence of a disease, then, most likely, he will prescribe the necessary examinations for further diagnosis.

One of the key points in determining adenomyosis is the choice of research method. To clarify the diagnosis today the following are widely used:

ultrasound examinations;
MRI;
hysterosalpingography studies;
sonohysterography;
biopsy of uterine tissue.

During such a diagnosis, not only the signs of adenomyosis itself are determined, but other gynecological pathologies with similar symptoms are also excluded. First of all, it is necessary to determine whether the patient suffers from fibroids, polyposis, endometriosis or endometrial hyperplasia. The diagnosis of adenomyosis is made only if other possible uterine diseases are excluded.

Adenomyosis is a disease that occurs very often in women. However, doctors also often confuse it with other similar diseases or completely miss it. This happens due to the similar course of various gynecological ailments. For example, uterine bleeding can occur both with adenomyosis and with hormonal imbalance, fibroids or uterine polyps, endometriotic hyperplasia, malignant neoplasms and other diseases of the organ. And discomfort or pain in the lower back does not always occur with adenomyosis - unpleasant sensations can appear as a result of other inflammatory processes.

In this regard, most experts believe that to confirm this diagnosis, it is necessary to completely exclude other uterine diseases. Only in this case is adenomyosis considered confirmed. The final diagnosis can be made only after removal of the uterus and its histological examination. However, such methods are not always acceptable, so one can only trust traditional research methods.

Can adenomyosis be cured?

To date, there is no cure for adenomyosis. The drugs currently used only help relieve the symptoms of the disease, but are not able to completely eliminate the disease itself. The only guaranteed way to get rid of the disease is to remove the uterus.

Nevertheless, modern hormonal, antibacterial, anti-inflammatory and analgesic drugs give good results and relieve the acute course of symptoms. Many women, after properly selected treatment, can live a full life and are able to give birth to healthy children. In this case, the disease remains, but occurs in the background, without causing much damage to health.

Consequences of adenomyosis

Many women go through life without knowing that they had adenomyosis. The fact is that there are often cases of asymptomatic disease. The disease does not manifest itself in any way and proceeds as a background without disturbing the woman. After menopause, this disease regresses on its own. However, more often the disease has pronounced painful symptoms.

However, in any case, when this gynecological disorder is detected, it is important to monitor its course. Depending on the type and type of adenomyosis, its signs and manifestations, appropriate treatment should be carried out. Even with asymptomatic forms of the disease, its presence cannot be ignored. Untimely treatment of adenomyosis most often turns out to be useless and leads to surgery to remove the uterus.

In many online communities and on various women's forums, pain with adenomyosis is described by every second visitor. Reading the comments left by women suffering from this disease, there is an understanding of how widespread adenomyosis has become. It affects millions of women around the world. The consequences of untimely detection of the disease are non-fulfilling pregnancies, lifelong use of medications and hormonal drugs, and the risk of losing the uterus altogether. The picture of this gynecological disorder is embellished by incessant discomfort in the lower abdomen and pain in the lower back. With adenomyosis, even if you feel well, you cannot ignore the manifestation of the main symptoms - after all, women’s health in the future depends on it.

Adenomyosis is a condition in which the tissue of the inner lining of the uterus (endometrium) grows into the tissue of the muscular wall of the uterus - the myometrium. Adenomyosis can cause menstrual-like cramps, a feeling of pressure in the lower abdomen, severe bloating before your period, and unusually heavy menstrual bleeding. This disorder can be observed throughout the uterus or be localized. Although adenomyosis is not considered to be a health hazard, the frequent pain and heavy bleeding associated with this disorder can have a negative impact on a patient's quality of life.

Symptoms of adenomyosis

Although some women are asymptomatic, adenomyosis can cause:

Abnormally heavy and prolonged menstrual bleeding
Very severe spasmodic pain during menstruation, sometimes at other times
Feeling of pressure, tension and unnatural fullness in the lower abdomen

Who develops adenomyosis?

Adenomyosis is a common disorder. Most often it is diagnosed in middle-aged women and women with children. Some scientists also suggest that the risk of developing adenomyosis is quite high in women who have undergone uterine surgery. Although the exact causes of adenomyosis have not yet been established, various hormones, including estrogen, progesterone, prolactin, and follicle-stimulating hormone, are thought to be triggers for this disorder.

Until recently, the only reliable way to diagnose adenomyosis was to perform a hysterectomy and then examine the uterine tissue using a microscope. However, modern medical imaging technologies allow doctors to recognize adenomyosis without surgery, for example, using magnetic resonance imaging (MRI) or transvaginal ultrasound.

If adenomyosis is suspected, the first step in diagnosis will be a routine gynecological examination. Gynecological examination: an important component for women's health. during which you can understand that the uterus is enlarged, as happens with adenomyosis. Using an ultrasound, your doctor can look at the endometrium and myometrium. Ultrasound does not help to establish with certainty that the patient has adenomyosis, but it makes it possible to exclude some diseases that have similar symptoms.

Another technique that is sometimes used to evaluate symptoms associated with adenomyosis is called sonohysterography (SHS). MRI is typically used to confirm the diagnosis in women with abnormally heavy menstrual bleeding.

Due to the similarity of symptoms, adenomyosis is often misdiagnosed as uterine fibroids. These two diseases are not the same thing at all. Fibroids are growths on the wall of the uterus, while adenomyosis is an abnormal formation inside the wall of the uterus. Of course, correct treatment is only possible with the correct diagnosis.

The choice of treatment for adenomyosis depends on the symptoms, their severity, and whether the patient plans to have children in the future. Mild symptoms can be treated with over-the-counter medications; To relieve spasmodic pain, it is often enough to use a heating pad.

For severe pain associated with adenomyosis, your doctor may prescribe non-steroidal anti-inflammatory drugs. Usually they start taking them 1-2 days before the start of menstruation; the course of treatment lasts several days.

For very painful and heavy menstrual bleeding associated with adenomyosis, hormonal therapy is prescribed Hormone therapy - is it possible to deceive nature? .

There are other ways to treat adenomyosis.

Uterine artery embolization is a minimally invasive procedure that seals off the blood vessels supplying blood to formations caused by adenomyosis. The particles used to block the blood vessels are injected through a thin tube inserted into the vagina. In the absence of blood supply, benign formations gradually decrease.
Endometrial ablation. During this procedure, the lining of the uterus is destroyed. Endometrial ablation is effective for patients whose endometrial tissue has not yet penetrated too deeply into the muscular wall of the uterus.
The only way to completely get rid of the symptoms of adenomyosis is to completely remove the uterus. Hysterectomy (removal of the uterus) is a terrible necessity. Sometimes women who are too bothered by the symptoms of this disorder and who no longer plan to have children agree to this.

Can adenomyosis cause infertility?

Pain with adenomyosis almost always occurs. The exception is asymptomatic forms of the disease. The appearance of pain is associated with compression of numerous nerve endings located in the wall of the uterus. This is facilitated by inflammation and swelling that develop in the middle muscular layer of the uterine wall during menstruation.

Pain due to adenomyosis - why does it occur?

Having penetrated the muscular lining of the uterus, endometrial cells continue to function cyclically under the influence of female sex hormones (mainly estrogens). They grow (proliferation stage), and then are torn away from the tissues in which they are located, which is accompanied by bleeding. But since the blood and areas of the endometrium have nowhere to flow, they accumulate in the muscular layer, where an inflammatory process develops, accompanied by swelling. Swelling contributes to compression of the nerve endings - this causes prolonged aching pain.

Under the influence of various biologically active substances released during the inflammatory process, periodic spasms of the smooth muscles of the uterus occur, which leads to sharp compression of the nerve endings and severe spastic pain. Over time, the muscular layer of the uterus, in which the area of adenomyosis is located, undergoes metabolic-dystrophic changes, which leads to disturbances in the contractile function of the uterus. That is why adenomyosis is often accompanied by miscarriage .

Sometimes, areas of adenomyosis can open directly into the uterine cavity and shed unwanted tissue each menstrual cycle directly into the uterus. This contributes to the destruction of the basal layer of the endometrium (it is not normally rejected during menstruation and serves as the basis for the restoration of the rejected functional layer) and the development of adhesions in the uterine cavity, in which the pain is especially severe. Very severe pain occurs in the first days of menstruation, when endometrial shedding occurs.

With such a congenital anomaly of the uterus as an accessory horn, this area is affected by adenomyosis can cause very severe pain, reminiscent of a sharp stomach. This happens because menstrual blood is thrown into the pelvic cavity, and causes signs of inflammation of the peritoneum - peritonitis.

Nature and duration of pain

Pain with large adenomyotic nodes can be a constant aching character. They appear in the lower abdomen or in the lumbar region and radiate to the perineum and thighs. A few days before menstruation, the pain intensifies, and a few days after it begins, it decreases. After the end of menstruation, the pain may subside or disappear completely.

During the period of intensification of pain, constant aching pain can alternate with very strong spastic pain of greater or lesser duration. Sometimes the pain is so severe that signs of an acute abdomen appear - a symptom of irritation of the peritoneum covering the uterus.

Such pain more often occurs with third-degree adenomyosis, when areas of adenomyosis penetrate the muscular lining of the uterus and come into contact with its serous membrane, which is part of the peritoneum. Particularly severe pain occurs with adenomyotic lesions of the uterine isthmus and with the development of adhesions in the uterine cavity.

By the nature of the pain, it is sometimes possible to determine in which part of the uterus the adenomyotic nodes are located. Thus, when areas of adenomyosis are located in the corners of the uterus, pain is more often sent to the groin area, in the cervical area - to the rectum or vagina. Severe pain due to adenomyosis is difficult to relieve with conventional painkillers.

There may be no pain outside the menstrual cycle. Sometimes they occur during sexual intercourse, as well as during gynecological procedures or hygiene procedures (for example, douching).

Pain in adenomyosis and the extent of the process

Based on the depth of distribution of areas of endometriosis in the muscular layer of the uterus, three degrees of diffuse adenomyosis are distinguished. In grade I, only the inner layer of myometrial cells adjacent directly to the basal layer of the endometrium is affected. Degree II indicates that the lesion has reached the middle of the myometrium, and degree III indicates that endometriosis has penetrated the entire myometrium and is in contact with the outer serous membrane covering the uterus.

The intensity of pain in adenomyosis depends on the extent of the process. For example, diffuse adenomyosis of the first degree is almost never accompanied by pain, whereas with

Adenomyosis affects women of the most active social age - usually after about 30 years. Rarely, this disease is congenital, but most often develops as a type of endometriosis and is classified as an estrogen-dependent disease. The peculiarity of adenomyosis is the pain of its manifestations. When the endometrium, for various reasons, grows into the uterine muscle tissue, foci of inflammation are formed and uterine contractility is disrupted, leading to extremely painful periods. Signs of adenomyosis should prompt the doctor to conduct appropriate research and help the woman get rid of pain.

Signs of adenomyosis and their relationship with the causes of the disease

Signs of adenomyosis are directly related to the development of the pathological process. Since the essence of the disease is the growth of the endometrium deep into the underlying muscular layers of the uterus, and this disease itself is hormone dependent, the main signs by which a doctor can assume the development of adenomyosis in a patient are very severe pain and bleeding during menstruation. This is due to irritation of nerve endings, disruption of the contractile functions of damaged uterine walls, and the appearance of adhesions.

The most characteristic signs indicating the development of adenomyosis are the following:

heavy menstruation, spotting or even bleeding in the middle of the cycle, severe PMS;
severe pain before and during menstruation, pain can radiate to the perineum or groin area, and occur during sexual intercourse;
infertility, miscarriage;
iron deficiency anemia, neuroses, psychological disorders.

Today, doctors note that there are more and more patients with signs of adenomyosis. Perhaps it’s all about more advanced diagnostic methods, but the reason may also be a decrease in immunity in women.

Signs of adenomyosis and features of menstruation

The main symptom that patients with suspected adenomyosis complain about is very heavy bleeding during menstruation, and this is accompanied by very severe pain. Often, pain and spotting occur a couple of days before the start of menstruation and persist for 2-3 days after its end. Menstruation is long - seven days or more; clots can be seen in the released blood. Bloody smears or even quite distinct bleeding can bother the patient in the middle of the cycle, becoming an important diagnostic sign of adenomyosis.

If the foci of endometrial growth deep into the uterus are very numerous, many adhesions occur and inflammatory foci are localized in the isthmus area, then the pain can be especially severe, not only during menstruation, but also during sexual intercourse, radiating to the groin and perineum.

Problems with childbirth and signs of adenomyosis

Adhesions caused by damage to the fallopian tubes during adenomyosis often cause disruption of a woman’s reproductive function, and this can be another important sign of adenomyosis. If adhesions interfere with the free passage of the egg through the fallopian tubes, the patient faces infertility.

In addition, since with adenomyosis the structure of the endometrium is disrupted, an inflammatory process develops and the tone of the myometrium increases, it is difficult for the egg to attach to the uterine wall and stay on it. This leads to spontaneous miscarriages.

Neuroses, anemia and other disorders as signs of adenomyosis

Frequent fainting and dizziness, pale skin and shortness of breath against the background of painful menstruation become another important sign of adenomyosis. Excessive blood loss leads to the development of iron deficiency anemia, which often accompanies adenomyosis, causing, among other things, frequent colds and exacerbations of chronic diseases.

Pain and severe premenstrual syndrome cause neuroses in women and significantly worsen the quality of life.

Thus, the signs of endometriosis appear clearly enough so that the doctor has reason to prescribe additional tests, if necessary, and begin treatment for this disease.

Adenomyosis is one of the forms of genital endometriosis, characterized by hyperplasia of the internal functional epithelium of the uterus. This pathology is one of the most common female problems, along with fibroids, diseases of the mammary glands and inflammatory infections. Almost a third of young patients (from 20 to 40 years old) complain of symptoms of adenomyosis. In postmenopausal women, the number of cases of the disease is much less. According to the generally accepted classification, it is assigned ICD 10 code N80.0 (peritoneal endometriosis).

Changes in the body during illness (pathogenesis)

Let's consider the pathogenesis of the disease. The female reproductive system is represented by the ovaries, where the maturation of the egg occurs, the formation of the corpus luteum during ovulation and the secretion of hormones that are “responsible” for libido, changes in the body during pregnancy, secondary sexual characteristics, etc. The egg, ready for fertilization, descends into the uterus through the fallopian tubes. If conception occurs, it is fixed there; if not, it comes out along with the remnants of the mucous membrane during menstruation through the cervical canal and vagina. The structure of the uterine wall is divided into:

Functional endometrium. Its structure depends on hormonal changes. In the second phase, it becomes loose to facilitate the implantation of a fertilized egg. During menstruation, it is rejected, and the whole process begins again.
The myometrium is an interweaving of smooth muscle muscles. Its functioning ensures contraction of the uterus during menstruation and childbirth.
Superficial loose connective tissue that performs a protective function.

What is uterine adenomyosis? This is the name for the process of pathological hyperplasia of the endometrium and its growth into the myometrium. This is how it differs from endometriosis, which often affects all structures of the pelvis. However, in the later stages of adenomyosis, the connective tissue covering the uterus is also affected. Then the pathological process spreads to other organs.

Adenomyosis is a chronic disease, its symptoms can bother a woman throughout her life. With adequate treatment in the early stages, drug remission is possible. However, according to statistics, resumption of pathology occurs in more than 70% of cases, which is an indication for removal of the uterus. Depending on the physiological changes, the following stages of adenomyosis are distinguished:

Proliferation of the mucous membrane to the muscular layer.
Extension of the endometrium to half the thickness of the myometrium.
The pathology reaches the connective tissue.
Involvement of other structures of the pelvic cavity and peritoneum in the disease.

Due to hyperplasia of the mucous membrane in endometriosis and adenomyosis and pathological changes in the myometrium, the reproductive system ceases to function properly. The menstrual cycle is disrupted, the uterus increases in size. Over time, its gradual degradation begins. This condition serves as an indication for surgery to remove the organ.

Types of adenomyosis

The classification of the disease is based on changes that occur in the internal structure of the uterus. All types of pathology are characterized by the stages described above. There is no particular difference between them in the clinical picture. Thus, in gynecological practice, the following forms of endometrial hyperplasia are distinguished:

Diffuse adenomyosis, when large pockets filled with mucous tissue appear in the organ cavity.
Nodular type of internal adenomyosis. In this case, multiple nodes of various sizes, filled with blood, are formed in the myometrium. This will be especially pronounced before the onset of menstruation.
Mixed adenomyosis, including the appearance of signs of both forms.

It is impossible to determine such changes during a routine examination. This requires one of the endoscopic or x-ray examinations. At each stage of the pathology, the described signs become more and more pronounced. Sometimes endometrial hyperplasia develops into adenomyoma (or adenomatosis) - a polyp of smooth muscle tissue and stroma in the uterine cavity.

Etiology

To date, it has not been possible to fully determine the causes of adenomyosis. The disease practically does not occur in those women who have not yet given birth. Therefore, doctors associate the pathology with changes in the wall of the uterus during pregnancy. The processes occurring during adenomyosis are explained as follows:

damage associated with instrumental abortion, cleaning of the uterus after a complicated birth, installation of an IUD, and diagnostic procedures;
hormonal imbalances, especially increased concentrations of estrogen (often this is manifested by too early or, conversely, late onset of menstruation);
a burdened family history, since it has been proven that a predisposition to cancer, endometriosis and uterine fibroids is inherited;
frequent inflammatory and infectious diseases of the reproductive system;
the occurrence of acquired hormonal disorders due to uncontrolled use of COCs (combined oral contraceptives), diseases of the hypothalamic-pituitary system.

Also, with adenomyosis, symptoms occur after intense physical activity, constant depression and stress. Often the triggering factor for the disease is the weakening of the body’s defenses due to chronic infections and lack of vitamins and minerals in food. Excess weight and unfavorable environmental factors play an important role in the occurrence of adenomyosis. Often the causes of the development of the pathological process are determined by the symptoms and treatment of endometrial hyperplasia.

Clinical picture

With adenomyosis, the symptoms are varied. They are individual for each woman and depend on the stage of the disease, structural features of the reproductive system, and accompanying pathology. For example, in 60% of patients, uterine fibroids are also noted in parallel with the enlarged endometrium. Our adenomyosis usually manifests itself with the following symptoms:

Pain in the lower abdomen. At the initial stage they are not strong, but as they progress they become more intense. Their localization depends on the location of the uterine lesion. When hyperplasia covers the cervix, pain radiates to the external genitalia. The process on the posterior wall is characterized by irradiation into the intestine. If adenomyosis causes pain in the lumbar region, this may indicate that the process has spread beyond the reproductive system (to the kidneys or ureters). In addition, this symptom depends on the menstrual cycle. Patients note increased discomfort a few days before menstruation.

Treatment of adenomyosis with folk remedies, traditional medicine, at home

Adenomyosis. Treatment of adenomyosis with folk remedies

Treatment of endometriosis with herbs and folk remedies

Heavy discharge during menstruation. In terms of intensity and the presence of clots, they are significantly superior to normal ones. In the final stages of the disease, this can cause anemia and accompanying symptoms: weakness, fatigue, drowsiness.

Scanty spotting brown discharge in the middle of the cycle. With adenomyosis in combination with uterine fibroids, they can be more intense and watery. However, stages 3–4 of adenomyosis are characterized by:

metrorrhagia - heavy bleeding that does not depend on the timing of ovulation.
Delayed menstruation, persistent cycle disorders.
Pain during sex, with concomitant damage to the cervix, sometimes scanty discharge appears after intercourse.
Long periods (bleeds for more than 5 – 7 days).
Low-grade (up to 37.5°) temperature.
Psychosomatics associated with hormonal disorders. The woman becomes irritable and is constantly in a state of depression.

The listed signs sometimes do not appear for a long time. In a third of patients, the disease may occur without a pronounced clinical picture. The only concern is pain in the lower abdomen during menstruation. In such cases, symptoms of uterine adenomyosis are detected by chance during a preventive visit to the gynecologist.

Diagnostic methods

An experienced doctor can identify adenomyosis during an examination of the patient in a gynecological chair. If there are indirect signs of the disease, it is better to do it in the second half of the cycle, 5 - 6 days before the start of menstruation. During a bimanual examination, an enlarged uterus is felt, the size corresponding to 6–8 weeks of pregnancy (after menstruation, the organ returns to its normal shape). In addition, when pressing on the lower abdomen on the right or left to slightly displace the uterus, the patient complains of pain.

Such symptoms, especially in combination with the causes of adenomyosis in a woman, identified during the interview, indicate the need for further diagnosis. First of all, this is an ultrasound. The advantages of this procedure are its relatively low cost and availability. To accurately diagnose adenomyosis, ultrasound must be repeated several times during the menstrual cycle. Echographic signs of the disease are:

uneven structure of the myometrium and endometrium;
deviations in the thickness of the walls of the organ;
the appearance in the body of the uterus of inclusions of varying density, large cavities filled with liquid, these characteristic echo signs of adenomyosis are called honeycombs;
the presence of hyperechoic formations of a round shape with blurred contours.

To detect adenomyosis on ultrasound, the procedure is performed using a transvaginal sensor. With this method of examination, its accuracy exceeds 90%. But treatment of the disease consists of long-term hormonal therapy. Therefore, to confirm the diagnosis of adenomyosis, the patient is sent for an MRI. When deciphering the results, pay attention to the fact that the size of the uterine body is increased, and such echo signs as a spongy or nodular structure of the endometrium and myometrium are also characteristic.

If there is a suspicion of adenomyosis, an endoscopic examination or hysteroscopy is performed (in the medical history it is designated by the abbreviation HS). The procedure is carried out in this way: a thin endoscopic tube equipped with a camera and a light source is inserted into the body of the uterus through the cervical canal. The image is transmitted to a computer screen, and modern devices can record photos and videos of the examination progress. When examined by hysteroscopy, areas of pathological endometrium are visible; it looks like dark blue dots. Their size and degree of damage to the myometrium depends on the stage of the process.

Detection of other pathologies

It should be noted that such manifestations of adenomyosis rarely occur on their own. The disease is dangerous due to concomitant lesions of the uterus and other organs of the female reproductive system. Hormonal disorders can cause breast mastopathy, which is determined during examination by a mammologist. Often, during an ultrasound, the doctor discovers uterine fibroids - a benign neoplasm consisting of muscle tissue.

An ultrasound examination may reveal cysts of the left or right ovary. In this case, a differential diagnosis with other forms of endometriosis is necessary. Unlike adenomyosis, with this type of pathology, nearby organs are involved in the process. Often, endometrial hyperplasia may be accompanied by the replacement of normal cervical epithelium with atypical one. These diseases are called ectopia and leukoplakia.

During a comprehensive examination, it will be necessary to take blood tests. Inflammation is indicated by leukocytosis and increased ESR. A cytological smear is also taken from the cervix. If neutrophilic granulocytes are detected, additional tests should be done to detect human papillomavirus (HPV), Trichomonas and other representatives of pathogenic microflora.

The malignant course of adenomyosis can be determined by testing for markers of various types of cancer. If positive results are obtained, it is better to continue treatment in modern Moscow clinics. The Republican Perinatal Center in Ufa or other Russian cities is also famous. According to numerous reviews on specialized forums, the best gynecologists in the country work there. We are now talking about adenomyosis immediately after birth.

Hormonal therapy with gestagens

The doctor must decide how to treat uterine adenomyosis based on examination data and test results. Self-administration of drugs can lead to serious physiological complications, which result in surgical removal of the woman’s reproductive organs. The gold standard for treating uterine adenomyosis is hormonal therapy. Progestins are often prescribed and should be taken for at least 6 months.

These are synthetic analogues of the ovarian corpus luteum hormone progesterone. Increasing its concentration will help reduce the effect of estrogen and cause endometrial atrophy. However, 10% of patients show resistance to such hormonal therapy. The following drugs are used:

Depo-provera. It is available in the form of a suspension for intramuscular injections, which is not always convenient. In addition, it is not prescribed to women planning to give birth in the future, since the medicine strongly inhibits ovarian function.
Mirena intrauterine device. Determined by a doctor, it may cause long-term amenorrhea. The advantages include a long period of use - 5 years, continuation of ovulation, contraceptive effect, which eliminates the need for abortion during hormonal therapy.
Utrozhestan. The drug can be taken orally or used in vaginal capsules, which increases its effectiveness. Widely prescribed during IVF protocol.

When using such medications, people often complain of weight gain, deterioration of skin and hair, and breast swelling. Breakthrough uterine bleeding in the middle of the cycle is often observed. Treatment of endometriosis with urozhestan and other hormonal drugs is contraindicated in cases of dysfunction of the kidneys, liver and gallbladder, thrombosis and disorders of the circulatory system. If you feel worse or are ineffective, the medicine is changed.

Other hormonal drugs

Relatively recently, in order to cure adenomyosis, drugs began to be used - antagonists of gonadotropin-releasing hormones (GnRH). The fact is that the endocrine function of the ovaries is under the control of biologically active compounds secreted by the hypothalamic-pituitary system. These substances are called gonadotropic hormones. The mechanism of action of drugs from the GnRH antagonist group is based on blocking their effect on the female reproductive system. The following medications are prescribed:

Visanne and a complete analogue of this drug Visanne, containing dienogest. Available in tablet form and should be taken once a day. But their effectiveness is significantly reduced if there is an upset stomach (vomiting or diarrhea).
Buserelin acetate. The advantage of the medication is the possibility of treatment by injections or intranasally.
Tamoxifen citrate. Prescribed regardless of the menstrual cycle, the clinical effect appears after 3 months of therapy.
Klostilbegit. Reception begins on the 5th day after the start of menstruation and continues for 5 days.

When treating adenomyosis with these drugs, it is worth noting that there is a high risk of complications. These are consequences such as a sharp decrease in estrogen levels, which leads to hot flashes, lack of libido and other symptoms of perimenopause. There is also a significant loss of calcium, and bone fragility increases. To compensate for these complications, combined estrogen-gestagen drugs are prescribed. When treating adenomyosis, this is almost the “norm”.

Use of oral contraceptives

Contraceptives (contraceptives) contribute not only to the treatment, but also to the prevention of adenomyosis, which explains their widespread use in gynecological practice. The action is based on suppressing the ovulation process. All of them contain both estrogen and progestogen, only the concentration differs. Therefore, such medications are selected individually based on tests. Particularly popular are:

Novinet;
Janine;
Jess;
Qlaira is a relatively new three-phase drug that is as close as possible to natural hormonal fluctuations during the menstrual cycle;
Regulon;
Yarina;
Nuvaring vaginal ring.

When treating with Jess or any other drug in this group, use should begin on the first day of the menstrual cycle. Sometimes use from 3 or 5 days is allowed, but in this case there is a risk of pregnancy. The likelihood of side effects increases with smoking, obesity, predominance of simple carbohydrates in the diet, and a sedentary lifestyle. Doctors warn about the possibility of fluctuations in blood pressure, weather sensitivity, headaches, mood swings, and bleeding in the middle of the cycle.

Additional drug therapy

Conservative treatment of adenomyosis also involves the use of non-hormonal drugs. First of all, these are nonsteroidal anti-inflammatory drugs NSAIDs (Diclofenac, Indomethacin, Meloxicam, etc.). They are mainly prescribed to relieve pain. When taken for a long time, they can cause an increase in the acidity of the digestive tract, so NSAIDs are used in gynecology in the form of vaginal suppositories.

To relieve the symptoms of anemia, preparations containing iron are indicated. These are Sorbifer, Aktiferrin, Ferlatum, Maltofer. For concomitant inflammation, broad-spectrum antibiotics are used. One of the reasons for the development of adenomyosis is a disruption of the immune system, so special drugs are prescribed to strengthen it. For this purpose, treatment with the following medications is necessary:

Genferon 500 thousand IU 1 million IU in the form of rectal suppositories;
Viferon;
Giaferon.

It does not belong to the group of immunomodulators, but has a similar effect to Longidaza. Typically, drugs are taken throughout the course of treatment for adenomyosis. According to reviews, plant-based dietary supplements have a good healing effect. For example, Indinol Forte, Indole Forte and Epigallate suppress endometrial hyperplasia and normalize hormonal levels with slight changes. The source of vitamins is Silhouette Complex and Opti Woman.

It is also worth mentioning the increasingly popular drug ASD fraction 2. When using the product according to the manufacturer’s recommendations, many patients noted an improvement in their well-being, normalization of the menstrual cycle, and strengthening of the immune system. The natural composition guarantees the absence of complications and side effects. However, it is not worth treating uterine adenomyosis with dietary supplements alone; they should be combined with conservative drug therapy.

Many doctors are supporters of homeopathy and prescribe the drugs Sepia 6c, Acidum nitricum 12c. They can be purchased in specialized stores. The most common are Traumeel, which has an anti-inflammatory effect, and Cyclodinone, which normalizes hormonal levels. Homeopathic remedies are safe and can be used over a long period of time.

Physiotherapy methods and surgery

Special procedures will help increase the effectiveness of medications and shorten the course of taking hormonal medications. They are painless and are carried out in a district clinic or in sanatoriums or dispensaries. However, doctors warn that during physiotherapy (physiotherapy) it is necessary to use contraception. How can adenomyosis be treated? Here are some ways:

electrophoresis of small doses of iodine, normalizes the release of estrogens under the influence of pituitary hormones;
magnetic therapy has an anti-inflammatory effect;
ultraviolet or laser exposure promotes tissue healing, relieves pain, stops the inflammatory process;
radon baths and douching cause severe endometrial atrophy and restore hormonal levels;
pine baths have a sedative and antispasmodic effect;
hirudotherapy, leeches release more than 30 biologically active substances into the blood, thanks to this the method has gained wide popularity in the treatment of infertility.

However, if a combination of medication and physical therapy does not bring the desired result, then surgical treatment is often used for adenomyosis. Currently, gentle operations using laparoscopy are performed, aimed at maximizing the preservation of the organ. Thus, through small incisions, electrocoagulation of hyperplastic areas of the endometrium is performed. To consolidate the results of surgical intervention, hormonal drugs are additionally prescribed. Pictures detailing the progress of the operation can be found on specialized websites.

However, in the later stages of uterine adenomyosis, doctors note that the cells of the mucous membrane become resistant to medications. In this case, the only treatment option is removal of the uterus. The consequence of such an operation is irreversible infertility, adhesions, hormonal disorders, and early menopause. Also, the indication for the procedure is the risk of the formation of malignant neoplasms.

Phytotherapy

Methods of alternative medicine, and especially herbal medicine, have gained wide popularity thanks to E. Malysheva’s program “Live Healthy” and numerous websites on the Internet. Here are a few remedies that can easily be prepared at home. So, if you have been diagnosed with the disease adenomyosis, you should take 1 tablespoon of the grass of the hogweed or cinquefoil and pour two glasses of boiling water. Drink 10 ml after meals.

For weakened immunity, a collection with sage, mantle, calendula, raspberry leaves and burdock root helps. Mix the ingredients in a 1:1 ratio, take 1 tbsp. mixture, pour 200 ml of boiling water and simmer for 20 minutes. The decoction is intended for daily use, 50 ml 4 times a day. You can get rid of iron deficiency with beet or aloe juice mixed with honey.

Applications with blue clay also help with adenomyosis. To do this, it should be mixed with water to a pasty consistency, heated in a water bath and applied to the lower abdomen for 1 - 1.5 hours. Bleeding goes away when taking a decoction of the roots of the red brush (at the rate of 1 tablespoon per glass of boiling water). It should be taken 50-70 ml half an hour before meals for 3 months. In case of exacerbation of symptoms, it is recommended to do douching from a decoction of a mixture of celandine herbs, calendula, oak bark, peony, yarrow and nettle, and put candles with propolis and honey.

Prognosis and prevention

Adenomyosis and infertility are concomitant diagnoses. Endometrial hyperplasia makes it almost impossible for an egg to implant in the uterus, so the prognosis for getting pregnant is unfavorable. This is why it is important to start taking medications the sooner the better. According to clinical data, with adequately selected therapy, about 80% of women are cured. After completing the course of using the drugs, they have a chance of a successful pregnancy.

For the prevention and treatment of adenomyosis, an active lifestyle is recommended, it is necessary to play sports. The diet must include vegetables (broccoli, tomatoes, peppers), herbs and fruits. If you have problems with your figure, then you shouldn’t starve yourself, you just need to adjust your diet. A complex of gymnastics with elements of yoga helps effectively.