What Is the Difference Between Endometriosis and Adenomyosis?

Adenomyosis is a diffuse or localized lesion of endometrial glands and interstitial invasion of the myometrium. Like endometriosis, it is a common and difficult disease in gynecology. Uterine adenomyosis mostly occurs in the mid-women who are 30 to 50 years old, but it can also be seen in young women who have not given birth, which may be related to the increase in various uterine cavity operations. About 15% of patients have endometriosis, and about 50% have uterine fibroids. The treatment of this disease can be treated with drugs or surgical treatment, but radical cure is difficult. Only patients with postmenopausal adenomyosis can gradually relieve themselves. Therefore, the choice of clinical treatment plan needs to be individualized according to the patient's age, symptoms and fertility requirements.

Basic Information

English name: adenomyosis
Visiting department: Obstetrics and Gynecology

Multiple groups: 30 to 50 years old women
Common causes: Endometrial glands and stroma invade the myometrium causing lesions
Common symptoms: Prolonged menstrual periods, high volume, drip bleeding before and after menstruation, dysmenorrhea, etc.

Causes of adenomyosis

The cause of adenomyosis is unknown. The current consensus is that because the uterus lacks a submucosal layer, the basal cells of the endometrium proliferate and invade the uterine myometrium, accompanied by compensatory hypertrophy of the surrounding myometrial cells to form lesions.

Traditional Chinese medicine believes that the disease is caused by stagnation of blood stasis, cold coagulation, heat burning, qi deficiency, and kidney deficiency caused by stasis and blood stasis, and dysmenorrhea. Stasis and blood stasis are the main pathogenesis.

Clinical manifestations of adenomyosis

Uterine adenomyosis mostly occurred in menopausal women over the age of 40, but in recent years it has gradually become younger, which may be related to the increase in uterine cavity surgery such as cesarean section and induced abortion.

Symptoms

(1) Menstrual disorders (40% to 50%) are mainly manifested by prolonged menstrual periods and increased menstrual flow. Some patients may also have spot bleeding before and after menstruation, and severe patients can cause anemia.

(2) Dysmenorrhea (25%) is characterized by secondary progressive dysmenorrhea. It usually appears one week before menstrual cramps, and it will be relieved when the menstrual period ends. Taking analgesics at the beginning of dysmenorrhea can relieve it, but as the disease progresses, the dose of analgesics required for dysmenorrhea increases significantly, making the patient intolerable.

(3) About 35% of other patients have no obvious symptoms.

2. Signs

Gynecological examination of the uterus often enlarges uniformly and spherically, and adenomyomas can appear as hard nodules. The uterus generally does not exceed the size of 12 weeks of pregnancy. Near the menstrual period, the uterus feels tenderness; during the menstrual period, the uterus enlarges, the texture becomes soft, and the tenderness is more obvious than usual; after menstruation, the uterus shrinks. The uterus often adheres to the surrounding, especially the posterior rectum, and moves poorly. 15% to 40% have endometriosis, and about half of the patients have uterine fibroids.

Adenomyosis

Imaging examination

Is the most effective way to diagnose the disease before surgery. Vaginal ultrasound has a sensitivity of 80% and a specificity of 74%, which is more accurate than an abdominal probe. Ultrasound B-mode ultrasound showed increased uterine homogeneity and unequal echo during adenomyosis; Ultrasound B-mode ultrasound showed uterine uneven increase and local bulge during adenomyosis, with heterogeneous hyperechoic lesions. MRI can objectively understand the location and scope of the lesion before surgery, which is of great help in determining the treatment method. The MRI of diffuse adenomyosis showed diffuse thickening of the uterine binding band on T2WI; the localized adenomyosis showed low-signal mass shadows on the T2WI that were similar to the signal of the binding band, with blurred borders.

2.Serum CA125

Some patients with adenomyosis have elevated serum CA125 levels, which has certain value in monitoring the efficacy.

Adenomyosis diagnosis

A preliminary diagnosis can be made based on typical medical history and signs, combined with imaging examinations, such as pelvic or vaginal B-ultrasound, MRI, CA125, etc., can be diagnosed. Pathological examination is required to obtain lesion tissue through surgery.

Adenomyosis treatment

There are many treatments for this disease, and clinical decisions need to be individualized based on the patient's age, symptoms, and fertility requirements. Surgery and medication options can be selected simultaneously.

Drug treatment

(1) Symptomatic treatment has mild symptoms and only requires relief of dysmenorrhea. You can choose to treat non-steroidal anti-inflammatory drugs such as fenbutide, indomethacin or naproxen during dysmenorrhea.

(2) Pseudopregnancy therapy is relatively mild for patients with no fertility requirements and near menopause. Oral contraceptives or progestins can cause ectopic endometrial decidualization and atrophy to control the development of adenomyosis. effect.

(3) For those with large menstrual periods and dysmenorrhea who have no fertility requirements, the intrauterine device can choose a contraceptive device containing high-efficiency progesterone. The local release of progesterone in the uterus to control the development of ectopic lesions requires Remove or replace after five years.

(4) False menopause therapy ("pharmacological ovariectomy" or "pharmacological pituitary resection") drugs that reduce the lesions before surgery and reduce recurrence after surgery. GnRHa injection makes the hormone levels in the body reach the menopausal state, so that the ectopic endometrium gradually shrinks and plays a therapeutic role. After applying GnRHa, the uterus can be significantly reduced, and it can be used as a preoperative medicine for some patients with large lesions and difficult surgery. Wait until the uterus becomes smaller before surgery, the risk and difficulty will be significantly reduced. Side effects will appear menopausal symptoms, and even cause severe cardio-cerebral vascular complications and osteoporosis. Therefore, it is recommended to add estrogen in the opposite direction to relieve complications after 3 months of GnRHa application. In addition, GnRHa is expensive, so it is not currently used as a long-term treatment plan. Once the drug is stopped, the recovery of menstruation may cause the disease to progress again.

(5) Chinese medicine treatment Chinese medicine believes that adenomyosis is related to internal resistance of blood stasis, and the formation of blood stasis is related to pathogenic factors such as qi deficiency, cold coagulation, qi stagnation, and phlegm. Therefore, in terms of treatment, both the principle of promoting blood circulation and removing blood stasis should be taken into account, and the causes of blood stasis and the differences between reality and reality should be considered. Oral Chinese medicines such as Huazheng Zhitong Granules, Sanjie Analgesic Capsules, Daner Fukang Decoction, Shaofu Zhuyu Pills, or decoctions adjusted according to individual circumstances. Can also be used to promote blood circulation to remove blood stasis retention enema, dressing and ion implantation of Danshen injection. You can also take acupuncture points in Guanyuan, Hegu, Sanyinjiao or ear acupuncture before or during menstruation, or take acupuncture points such as uterus, endocrine and liver.

2. Surgical treatment

Surgical treatment includes radical surgery and conservative surgery. Radical surgery is hysterectomy. Conservative surgery includes resection of adenomyosis (adenomyoma), endometrial and muscular resection, myometrial electrocoagulation, uterine artery occlusion, and presacral neurotomy. And patella neurotomy.

(1) Hysterectomy

It is suitable for patients with no fertility requirements, extensive lesions, severe symptoms, and ineffective conservative treatment. Moreover, in order to avoid residual lesions, total hysterectomy is preferred, and partial hysterectomy is generally not recommended.

(2) Excision of adenomyosis

Suitable for patients with fertility requirements or young. Because adenomyosis is often diffuse and the boundary with the normal muscle tissue of the uterus is not clear, how to choose a resection method to reduce bleeding, residue and facilitate postoperative pregnancy is a more difficult problem.

3. Interventional Therapy

Selective uterine arterial embolization can also be used as one of the treatment options for adenomyosis. Its mechanism of action is: ectopic endometrial necrosis, reduced prostaglandin secretion, relieve dysmenorrhea, reduce menstrual flow, and reduce the recurrence rate; the establishment of eutopic endometrial collateral circulation, which can gradually grow and recover from the basal layer. However, uterine arterial embolization can affect the blood flow to the uterus and ovaries, which can adversely affect pregnancy. May cause infertility, miscarriage, premature delivery and increased cesarean delivery.

Prognosis of adenomyosis

Uterine adenomyosis has a higher recurrence rate, but it can be cured with hysterectomy and postmenopausal disease. The rate of malignancy is low. Endometriosis, a disease similar to adenomyosis, is reported at 1.5% in China and 0.7% to 1.0% in foreign countries. In contrast, malignant changes in adenomyosis are rare.

Adenomyosis prevention

1. Do a good job in family planning, and do as little abortion and curettage as possible. Seek medical treatment early to avoid excessive uterine cavity operation.

2. Do your own health care during the menstrual period, do not do strenuous activities, pay attention to control emotions, don't be stuffy, otherwise it will lead to endocrine changes. Forbidden sex during menstruation can reduce the incidence of adenomyosis to a certain extent.

3. Pay attention to keeping warm and cold; adjust your emotions; your diet should be rich in nutrients, correct partial eclipse and abnormal eating habits, and should not eat irritating or cold food.