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Adenomyosis, what is it? - causes, symptoms and treatment

Adenomyosis is a painful condition associated with the growth of the endometrium in the inner muscular layer of the uterus. The disease is often asymptomatic, pronounced symptoms are recorded in advanced cases.

Although pregnancy can accelerate recovery, 2/3 of women have a relapse of the disease. We will consider in detail what it is, what causes lead to the development of pathology and methods of medical therapy.


Uterus adenomyosis: what is it?

Adenomyosis of the uterus To understand what is adenomyosis, you must have an idea about the structure of the uterine wall. Its inner layer, the endometrium, increases in thickness during the menstrual cycle, expanding into the uterine cavity. The endometrium is separated from the myometrium (muscle layer) by a thin demarcation layer.

Adenomyosis of the uterus is intrastential germination of the endometrial layer in the myometrium. Often the disease is called internal endometriosis.

However, adenomyosis has significant differences:

  • the endometrium grows inside, affecting the muscle layer (in case of endometriosis its thickening occurs in the uterus, the myometrium does not suffer);
  • germination in the muscle in places (with endometriosis, the inner layer thickens over the entire area).

The endometrial cells that have penetrated the muscular layer continue to perform physiological functions: they expand and then are rejected during menstrual bleeding through endometrial passages.

Although adenomyosis is considered to be a benign pathology, the ability of pseudo-endometrium to grow into other organs (vagina, abdominal space and intestines, lung) is comparable to the malignant process.

Causes of uterine adenomyosis

The main causes of adenomyosis are hormonal disorders and weakness of the immune system. Risk group - women from 30 years. The risk factors for doctors include:

  1. Hereditary predisposition (oncological inclusive).
  2. Hormonal abnormalities - early / late puberty and the onset of sexual activity, long-term use of oral contraceptives and hormonal drugs.
  3. Trauma to the uterus - inflammatory diseases of the female organs, the use of the intrauterine device, abortion and cesarean section, removal of polyps and myomatous nodes, late or difficult labor.
  4. Side pathology - diseases of the gastrointestinal tract, obesity and other endocrine diseases, allergic conditions and diseases that reduce the immune defense.
  5. External provocateurs - stress, low physical activity, ultraviolet abuse (tanning beds), low socio-economic security, physical overload, dysfunctional ecology.

As a result of exposure to often several factors, menstrual bleeding results in incomplete rejection of the endometrium. The remaining particles of it are gradually being introduced into the muscle layer, overcoming the demarcation layer.

Another mechanism for the spread of pseudo-endometry may also work: if the cervix does not open sufficiently during menstruation, the intrauterine pressure increases, and the rejected tissue through the tubes enter the abdominal space and attach to the peritoneum.

Degrees and forms

Depending on the type of germination, adenomyosis is distinguished:

  • diffuse form - non-uniform invasion of vsevdoendometriya in the muscular;
  • nodular forms - in the myometrium endometrial foci are formed, separated from the endometrium;
  • mixed or diffuse-nodular form - often diagnosed type of adenomyosis.

The disease is also diagnosed by the depth of the lesion:

  • Grade 1 - small endometrial recesses in the muscle layer, the structure of the uterus is not affected;
  • Grade 2 - damage to 50% of myometrial thickness, focal thickening of the muscle layer, loss of muscle elasticity;
  • Grade 3 - the germination of myometrium throughout the depth, pronounced asymmetry of the shape of the uterus;
  • Grade 4 - damage to other organs, depending on the localization of pathological endometrial foci, adenomyosis of the ovaries, peritoneum, bladder, cervix and vagina is distinguished.

Signs and symptoms of adenomyosis

symptoms of adenomyosis of the uterus photo

symptoms of adenomyosis of the uterus photo

Adenomyosis can slowly develop and be asymptomatic over the years. More than half of the patients do not even realize that they have a pathological process. That is why it is difficult to suspect adenomyosis of the uterus on the basis of primary signs, and painful symptoms and infertility often speak of a developed pathology.

The deeper the penetration of pseudo-endometry, the brighter the symptoms of the disease appear:

  1. Severe pain localized in the lower abdomen and extending to the entire pelvis. Not related to the menstruation cycle. Soreness (cramps, "dagger" pain) increases with sexual contact with a partner and sometimes makes it impossible. In this case, painkillers do not give effect.
  2. Sudden discharge of dark clots, not associated with menstruation.
  3. Menstrual irregularities - shortening of the period between menstruation, copious or prolonged periods .
  4. Infertility - occurs already with 2 degrees of adenomyosis.
  5. The deterioration of the general condition - weakness, fainting and other signs of anemia, which developed as a result of significant blood loss.

Adenomyosis is hormone-dependent and regresses after menopause.


It is very important to know that pseudo-endometry never degenerates into cancer. However, the disease is fraught with, although less dangerous to the life of a woman, but rather serious complications:

  • relapse after treatment (after 5 years in 75% of patients);
  • bleeding and anemia;
  • germination in other organs and the violation of their functions;
  • infertility.

Adenomyosis and pregnancy

In a third of patients with adenomyosis, infertility is diagnosed. However, the disease itself is not a direct cause of non-occurrence of pregnancy. Often, adenomyosis is combined with myoma and other pathologies, which together prevent physiological pregnancy.

The most dangerous adenomyosis of the ovaries - this condition is fraught with persistent infertility.

The onset of pregnancy with initial endomerioid growth usually proceeds normally. Moreover, pregnancy is a kind of menopause, and after birth, there is often a complete restoration of the structure of the uterus and the normalization of hormonal levels. This disease does not adversely affect the development of the fetus.

About half of women undergoing minimal traumatic treatment of adenomyosis, can become pregnant by physiological means. The disease, which developed to the 3-4 degree, often causes miscarriage in the early stages.


Most often, adenomyosis, especially in the initial stages of development, is detected by ultrasound, carried out with a preventive purpose or to identify the cause of infertility. Signs of uterine adenomyosis on ultrasound:

  • globular uterus,
  • asymmetric thickening of the uterine wall,
  • affected areas of increased echogenicity,
  • uneven border of the basal (sprout) layer of the endometrium.

More complete information the doctor receives with transvaginal ultrasound.

To differentiate adenomyosis from fibroids, adnexitis and inflammatory diseases (including sexually transmitted infections), the gynecologist conducts a gynecological examination of the patient and prescribes a number of laboratory and instrumental studies:

  • vaginal swab sampling and cytology;
  • blood test for hormones;
  • colposcopy - the detection of small pseudo-endometrium in the vagina and cervix;
  • diagnostic hysteroscopy - endoscopic examination of the uterus, fixation of endometrial pathways, visible as dark inclusions on the pink mucosa with periodic blood leakage from them;
  • MRI - in case of insufficiency of ultrasound data for the differentiation of adenomyosis and myomatous catch;
  • examination of target systems — respiratory, gastrointestinal, cardiovascular and urinary — to determine the boundaries of the lesion in the later stages.

Treatment of uterine adenomyosis

Treatment of uterine adenomyosis

It is rather difficult to completely eliminate the process of endometrial ingrowth into the muscle layer. For this you need:

Suspend the pathological process

To stop the growth of the endometrium creates artificial menopause. The effect is achieved by taking within 3-6 months of the hormonal preparations Lyukrin, Zoladex.

The same result is obtained when treating adenomyosis with Duphaston. The reached state of menopause is reversible, the menstrual cycle is restored after 1-1.5 months after discontinuation of the drug. Conservative tactics are appropriate for grade 1-2 adenomyosis.

Remove formed endometriotic foci in myometrium

The method of uterine artery embolization is suitable for a sufficiently good blood supply to adenomyosis tissue. A minimally traumatic method is to turn off the uterine vessels from the circulation by introducing chemical agents.

It is possible to remove endometriotic foci using nitrogen (cryodestruction), electric current (electrocoagulation), radio frequency waves (RFA). Minimally invasive treatments for adenomyosis allow the uterus to be preserved for subsequent pregnancy.

The most radical treatment - removal of the uterus (hysterectomy) - is advisable with deep damage to the myometrium, combined with the involvement of appendages, and the ineffectiveness of conservative measures.

Hormonal treatment of adenomyosis before menopause

A good result is achieved by using the hormonal Mirena intrauterine device, established for 5 years. At the same time, the woman notes a decrease in the monthly volume and the disappearance of pain.

Another way to prevent the further spread of adenomyosis is hormonal contraceptives. The most effective scheme is 63 + 7: taking three packs without a break, 7 days for withdrawal bleeding and repeat the course again.

Restorative treatment

In the treatment of adenomyosis, drugs are needed to eliminate anemia, enhance immune protection and relieve nervous tension.

Only timely diagnosis of adenomyosis and its treatment with drugs and, if necessary, by operative methods will help to avoid deterioration and negative effects in women of childbearing age. Having survived menopause , a woman can no longer worry about the disease.


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