What happens to the uterus
Normally, there is a clear boundary between the inner lining of the uterus and its muscular layer. With adenomyosis, endometrial cells penetrate deep into the muscle, forming foci there that respond to hormones every cycle.
The muscle tissue around the lesions thickens and becomes denser, the uterus enlarges, sometimes to a size corresponding to several weeks of pregnancy. The ability of the muscle to contract correctly is impaired, and the blood vessels become more vulnerable - hence heavy and painful menstruation.
- Diffuse form - lesions are evenly distributed along the wall
- Focal form - separate accumulations in the thickness of the muscle
- Nodular form - a node resembling a fibroid, but without a clear capsule; it is often confused with a myomatous node
- Degrees from I to IV - according to the depth of germination into the uterine wall
Symptoms
- Heavy and prolonged menstruation with clots
- Severe pain during menstruation, often increasing over time
- Dark spotting before and after menstruation is a very characteristic sign
- Enlarged abdomen and feeling of heaviness below
- Pain during intercourse
- Chronic pelvic pain
- Anemia: weakness, fatigue, shortness of breath, hair loss
- Difficulty getting pregnant and miscarriage
- Sometimes - asymptomatic, detected incidentally on ultrasound
How is it different from fibroids and endometriosis?
- Myoma is a benign node of muscle tissue with a distinct capsule; it can be removed while preserving the uterus
- Adenomyosis is a diffuse growth of endometrioid tissue into the muscle without a clear boundary; It is usually impossible to “hustle” it separately
- External endometriosis - lesions outside the uterus: on the peritoneum, ovaries, ligaments
- All three conditions often coexist in one woman
- With fibroids, the uterus is lumpy, with adenomyosis - evenly enlarged and dense
The practical consequence of this difference is significant: for fibroids, organ-sparing myomectomy is possible, but for severe diffuse adenomyosis, removal of the uterus remains a radical method. That is why in women of reproductive age the emphasis is on drug control.
Diagnostics
- Examination by a gynecologist - enlarged dense uterus, painful on the eve of menstruation
- Transvaginal ultrasound, preferably in the second phase of the cycle - wall thickening, heterogeneity of the myometrium, small cysts in the muscle
- MRI of the pelvis is the most accurate method for assessing the depth of the lesion
- Hysteroscopy - examination of the uterine cavity, identification of characteristic changes
- Pipelle biopsy of the endometrium - exclusion of endometrial hyperplasia and pathology during bleeding
- Complete blood count and ferritin - assessing anemia
- Hormonal examination for cycle disorders
Treatment
- Non-steroidal anti-inflammatory drugs - reduce pain and blood loss
- The intrauterine hormonal system is one of the most effective methods for heavy bleeding, especially in women who are not planning a pregnancy in the near future.
- Combined hormonal contraceptives in continuous mode
- Progesterone preparations
- GnRH agonists - short course for severe forms or as preparation for surgery
- Tranexamic acid to reduce blood loss during menstruation
- Mandatory treatment of anemia with iron supplements
- Uterine artery embolization - in selected cases
- Hysterectomy is a radical method for severe symptoms in women who have completed reproductive plans
- Endometrial ablation - in the absence of plans for pregnancy and certain conditions
Adenomyosis and pregnancy
- Adenomyosis may reduce the chance of embryo implantation
- Increased risk of miscarriage and premature birth
- When planning pregnancy, preparatory therapy is prescribed to improve the condition of the endometrium.
- After a course of hormonal preparation, the chances of implantation increase
- If implantation fails in IVF programs, adenomyosis is considered as one of the possible causes
- Pregnancy with adenomyosis requires more careful monitoring
Where is adenomyosis treated in Tashkent
High-quality ultrasound in the second phase of the cycle, access to MRI, hysteroscopy and the possibility of surgical treatment for severe forms are required.
In Tashkent, examination and treatment of adenomyosis is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have heavy, painful menstruation, be sure to get a complete blood count and ferritin test: anemia with adenomyosis develops gradually and often goes unnoticed, although it explains constant fatigue. Clinic contacts are below.
