Adenomioz – a disease at which the internal cover (endometrium) sprouts in muscular tissue of a uterus. Is a kind of endometriosis. It is shown by long plentiful periods, bleedings and brownish allocations during the intermenstrual period, the expressed PMS, pains during periods and during sex. Adenomioz usually develops at patients of childbearing age, dies away after approach of a climax. It is diagnosed on the basis of gynecologic survey, results of tool and laboratory researches. Treatment is conservative, quick or combined.
Adenomioz – germination of endometrium in the subject uterus layers. Usually strikes women of reproductive age, arises after 27-30 years more often. Sometimes happens congenital. Independently dies away after approach of a climax. Is a gynecologic disease, the third on prevalence, after an adneksit and myoma of a uterus and it is often combined with the last. Now gynecologists note incidence growth adenomiozy that can be connected both with increase in number of immune violations, and with improvement of methods of diagnostics.
Patients adenomiozy often have infertility, however direct link between a disease and impossibility to conceive and take out the child is definitely not established so far, many experts consider what is the reason of infertility not , and the accompanying endometriosis. Regular plentiful bleedings can cause anemia. The expressed PMS and intensive pains during periods negatively influence psychological state of the patient and can become the reason of development of neurosis. Treatment of an adenomioz is performed by experts in the sphere of gynecology.
Communication between adenomiozy and endometriosis
Adenomioz – a kind of endometriosis, disease at which cells of endometrium breed outside a mucous membrane of a uterus (in uterine tubes, ovaries, a gastrointestinal, respiratory or urinary system). Distribution of cages happens in the contact, limfogenny or hematogenic way. Endometriosis is not a tumoral disease as geterotopichesk the located cages keep the normal structure.
At the same time, the disease can cause a number of complications. All cages of an internal cover of a uterus regardless of their location under the influence of sex hormones undergo cyclic changes. They intensively breed, and then are torn away during periods. It involves formation of cysts, an inflammation of surrounding fabrics and development of adhesive processes. Frequency of a combination of internal and external endometriosis is unknown, however experts assume that most of patients adenomiozy a uterus has geterotopichesky centers of cells of endometrium in various bodies.
Reasons of an adenomioz
The reasons of development of this pathology are definitely not found out so far. It is established what is a hormonedependent disease. Development of a disease is promoted by violations of immunity and damage of the thin layer of the connecting fabric dividing endometrium and miometriya and interfering endometrium growth deep into of a uterus wall. Damage of a dividing plate is possible at abortions, diagnostic vyskablivaniye, use of an intrauterine spiral, inflammatory diseases, childbirth (especially – complicated), operations and dysfunctional uterine bleedings (especially – after operations or against the background of treatment by hormonal means).
Among other risk factors of development of an adenomioz connected with activity of female reproductive system – too early or too late beginning of periods, the late beginning of sex life, reception of oral contraceptives, hormonal therapy and the obesity involving increase in amount of estrogen in an organism. Carry a bad ecological situation, allergic diseases and frequent infectious diseases to the risk factors of emergence of an adenomioz connected with immunity violations.
Negative influence on a condition of immune system and the general reactivity of an organism are also rendered by some chronic diseases (diseases of a gastrointestinal tract, a hypertension), excess or insufficient physical activities. In development of an adenomioz adverse heredity has a certain value. The risk of developing of this pathology increases in the presence of the close relatives suffering adenomiozy, endometriosis and tumors of female genitals. It is possible congenital owing to violations of pre-natal development of a fruit.
Classification of an adenomioz of a uterus
Taking into account a morphological picture distinguish four forms of an adenomioz:
- Focal . Cells of endometrium take root into the subject fabrics, forming the separate centers.
- Uzlovaya . Cells of endometrium settle down in a miometriya in the form of knots (adenomiy), in a form reminding myoma. Knots, as a rule, multiple, contain the cavities filled with blood, are surrounded with the dense connecting fabric which is formed as a result of an inflammation.
- Diffusion . Cells of endometrium take root in miometry without formation of accurately distinguishable centers or knots.
- Mixed diffusion and nodal . Represents a combination of a nodal and diffusion adenomioz.
Taking into account depth of penetration of cells of endometrium allocate four degrees of an adenomioz:
- 1 degree – suffers only a submucous layer of a uterus.
- 2 degree – are surprised no more than a half of depth of a muscular layer of a uterus.
- 3 degree – suffer more than a half of depth of a muscular layer of a uterus.
- 4 degree – are surprised all muscular layer, distribution on the next bodies and fabrics is possible.
Symptoms of an adenomioz
The most characteristic sign of an adenomioz are long (over 7 days), painful and very plentiful periods. In blood clots quite often come to light. In 2-3 days prior to periods and within 2-3 days after its termination the brownish smearing allocations are possible. Intermenstrual uterine bleedings and brownish allocations in the middle of a cycle are sometimes observed. Patients adenomiozy often suffer from a heavy premenstrual syndrome.
One more typical symptom of an adenomioz are pains. Pains usually arise for several days prior to the beginning of periods and stop 2-3 days later after its beginning. Features of a pain syndrome are defined by localization and prevalence of pathological process. The most severe pains arise at the defeat of an isthmus and a widespread adenomioz of a uterus complicated by multiple solderings. At localization in the field of an isthmus of pain can irradiate in a crotch, at an arrangement in the field of a uterus corner – to the left or right inguinal area. Many patients show complaints to the pains during sexual intercourse amplifying on the eve of periods.
More than a half of patients with adenomiozy has infertility which reason the solderings in uterine tubes interfering penetration of an ovum into a cavity of a uterus, violation of structure of endometrium, complicating implantation of an ovum, and also the accompanying inflammatory process, increase in a tone the miometriya and other factors increasing probability of spontaneous termination of pregnancy are. In the anamnesis at patients lack of pregnancy at regular sex life can come to light or multiple abortions.
Plentiful periods at an adenomioza quite often involve development of iron deficiency anemia which can be shown by weakness, drowsiness, bystry fatigue, short wind, pallor of skin and mucous, frequent colds, dizzinesses, faints and preunconscious states. Heavy PMS, long periods, constant pains during periods and deterioration in the general state owing to anemia reduce resistance of patients to psychological stresses and can provoke development of neurosises.
Clinical displays of a disease can not correspond to weight and prevalence of process. 1 degree of an adenomioz, as a rule, proceeds asymptomatically. At 2 and 3 degrees both the asymptomatic or malosimptomny current, and the expressed clinical symptomatology can be observed. The 4th degree of an adenomioz, as a rule, is followed by the pains caused by widespread adhesive process, expressiveness of other symptoms can vary.
During gynecologic survey change of a form and the size of a uterus comes to light. At a diffusion adenomioz the uterus becomes spherical and increases at a rate of the day before periods, at widespread process the size of body can correspond to 8-10 weeks of pregnancy. At a knotty adenomioz the bugristost of a uterus or opukholevidny educations in walls of body is found. At a combination of an adenomioz and myoma the size of a uterus corresponds to the myoma size, the body does not decrease after periods, other symptoms of an adenomioz usually remain without changes.
Diagnostics of an adenomioz
The diagnosis is established on the basis of the anamnesis, complaints of the patient, data of survey on a chair and results of tool researches. Gynecologic inspection is performed on the eve of periods. Existence of the increased spherical uterus or bugristost or knots in a uterus in combination with painful, long, plentiful periods, pains at sexual intercourse and symptoms of anemia is the basis for statement of the preliminary diagnosis "".
The main method of diagnostics is ultrasonography. The most exact results (about 90%) are provided when carrying out transvaginal ultrasonic scanning which, as well as gynecologic survey, is carried out on the eve of periods. The increase and spherical shape of body, various thickness of walls and cystous educations more than 3 mm in size appearing in a uterus wall shortly before periods testifies to an adenomioza. At a diffusion adenomioz efficiency of ultrasonography decreases. The most effective diagnostic method at this form of a disease is hysteroscopy.
Hysteroscopy is also used for an exception of other diseases, including – myomas and a polypose of a uterus, a giperplaziya of endometrium and malignant new growths. Besides, in the course of differential diagnostics of an adenomioz MRT during which it is possible to reveal thickenings of a wall of a uterus, violations of structure a miometriya and the centers of introduction of endometrium in miometry is applied, and also to estimate density and structure of knots. Tool methods of diagnostics at an adenomioza supplement with the laboratory researches (blood test and urine, a research on hormones) allowing to diagnose anemia, inflammatory processes and violations of hormonal balance.
Treatment and the forecast at an adenomioza
Treatment of an adenomioz can be conservative, quick or combined. Tactics of treatment is defined with a form of an adenomioz, prevalence of process, age and the state of health of the patient, her desire to keep genital function. In the beginning carry out conservative therapy. To patients appoint hormonal medicines, resolvents, vitamins, immunomodulators and means for maintenance of function of a liver. Carry out treatment of anemia. In the presence of neurosis of patients adenomiozy direct to psychotherapy, apply tranquilizers and antidepressants.
At inefficiency of conservative therapy carry out surgical interventions. Operations at an adenomioza can be radical (a pan-hysterectomy, a hysterectomy, nadvlagalishchny amputation of a uterus) or organ-preserving (endocoagulation of the centers of endometriosis). Indications to endocoagulation at an adenomioza are the endometrium giperplaziya, suppuration, existence of the solderings interfering hit of an ovum in a uterus cavity, lack of effect at treatment by hormonal means within 3 months and a contraindication to performing hormonal therapy. As indications to removal of a uterus are considered progressing of an adenomioz at patients 40 years, inefficiency of conservative therapy and organ-preserving surgical interventions, diffusion 3 degrees or nodal in combination with uterus myoma, threat of an ozlokachestvleniye are more senior.
If comes to light at the woman planning pregnancy to it recommend to make conception attempts not earlier than in half a year after passing of a course of conservative treatment or carrying out endocoagulation. During the first trimester of the patient appoint gestagena. The question of need of hormonal therapy for the second and third trimester of pregnancy is defined with result of blood test on the content of progesterone. Pregnancy is a physiological menopause, is followed by profound changes of a hormonal background and positively influences the course of a disease, reducing the speed of growth of geterotopichesky cells of endometrium.
Adenomioz – a chronic disease with high probability of development of a recurrence. After performing conservative therapy and organ-preserving surgeries within the first year a recurrence of an adenomioz comes to light at every fifth woman of reproductive age. Within five years the retsidivirovaniye is observed more than at 70% of patients. Patients of preklimakterichesky age have a forecast at an adenomioza more favorable that is caused by gradual fading of function of ovaries. After a pan-hysterectomy a recurrence is impossible. In the climacteric period there occurs independent recovery.