What Is Uterine Adenomyosis?

Adenomyosis is a diffuse or localized lesion of endometrial glands and interstitial invasion of the myometrium, and is a common gynecological disease. Uterine adenomyosis mostly occurred in men and women over the age of 40, but in recent years it has gradually become younger, which may be related to the increase in cesarean section, abortion and other operations. There are many treatments for this disease, and clinical decisions need to be individualized based on the patient's age, symptoms, and fertility requirements. And often combined with surgery, drugs and other comprehensive treatment programs.

Basic Information

nickname: Endometriosis
English name: adenomyosis
Visiting department: Gynecology

Common locations: uterus
Common causes: Cesarean section, abortion
Common symptoms: Menstrual disorders, dysmenorrhea
Contagious: no

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. There are four theories of the factors that cause the invasion of endometrial basal cell proliferation: it is genetically related; uterine damage, such as curettage and cesarean section, will increase the incidence of adenomyosis; hyperestrogens and Prolactinemia; virus infection; obstruction of the reproductive tract, which increases uterine pressure during menstruation, causing endometriosis to the myometrium of the uterus.

Clinical manifestations of adenomyosis

Uterine adenomyosis mostly occurred in men and women over the age of 40, but in recent years it has gradually become younger, which may be related to the increase in cesarean section, abortion and other operations.

Symptoms

(1) Menstrual disorders (40% to 50%) are mainly manifested by prolonged menstrual periods and increased menstrual volume, and some patients may also have spot bleeding before and after menstruation. This is because the uterine volume increases, the endometrial area of the uterine cavity increases, and the lesions between the uterine muscle wall affect the uterine muscle fiber contraction. 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. This is because the ectopic endometrium in the uterine muscle layer is congested, swollen, and bleeding under the influence of ovarian hormones during menstruation. At the same time, the blood volume of the uterine muscle layer is increased, and the thick uterine muscle layer is expanded, causing serious Dysmenorrhea.

(3) Some patients have no obvious symptoms. About 35% of the 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. This periodic change in signs is one of the important basis for the diagnosis of this disease. 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.

2. Vaginal ultrasound

The sensitivity is 80% and the specificity is 74%, which is more accurate than the abdominal probe.

3.MRI

Objectively understand the location and extent of the lesion before surgery, which is of great help in determining the treatment method.

4.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 a typical medical history and signs, and a confirmed histopathological examination is required.

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. And often combined with surgery, drugs and other comprehensive treatment programs.

Drug treatment

(1) Symptomatic treatment For those who have mild symptoms and only require relief of dysmenorrhea, especially those near menopause, you can choose to treat non-steroidal anti-inflammatory drugs symptomatically during dysmenorrhea. Because the ectopic endometrium will gradually shrink after menopause, such patients will be relieved after menopause without surgery.

(2) False menopause GnRHa injection can make the hormone levels in the body reach the menopausal state, so that the ectopic endometrium gradually shrinks and plays a therapeutic role. This method is also known as "pharmacological oophorectomy" or "pharmacological pituitary resection".

(3) Some scholars on pseudopregnancy therapy believe that oral contraceptives or progesterone can make ectopic endometrium decidualization and atrophy and play a role in controlling the development of adenomyosis, but some scholars believe that adenomyosis is different Most of the uterine endometriums are basal endometrium, which are not sensitive to progestin. So the effect of progesterone on adenomyosis is still controversial.

2. Surgical treatment

Including 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 is used in patients without fertility requirements, and the lesions are extensive, the symptoms are severe, and conservative treatment is ineffective. Moreover, in order to avoid residual lesions, total hysterectomy is preferred, and partial hysterectomy is generally not recommended.

(2) Resection of adenomyosis is suitable for patients with fertility requirements or young patients. Because adenomyosis is often diffuse and the boundaries between uterine normal muscle tissue are not clear, how to choose the method of resection to reduce bleeding, residue and facilitate postoperative pregnancy is a very confusing problem. Different scholars have different schemes, and currently there is not a unified technique.

3. Interventional Therapy

In recent years, with the continuous progress of interventional treatment technology. Selective uterine arterial embolization can also be used as one of the treatment options for adenomyosis. The mechanism of action is: ectopic endometrial necrosis, reduced prostaglandin secretion, and relief of dysmenorrhea; the uterine body becomes softer after embolization, the volume and endometrial area decrease, reducing menstrual flow; uterine volume continues to shrink and smooth muscle contraction , Block the microchannels that cause endometriosis and reduce the recurrence rate; the local estrogen level and the number of receptors decrease; the establishment of the collateral circulation of the in situ endometrium, which can gradually grow and recover from the basal layer.

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.

References:

1. Feng Youji, Shen Yan, Obstetrics and Gynecology, People's Medical Publishing House, 2005, 395-396.

2. Cao Zeyi, Chinese Obstetrics and Gynecology, People's Medical Publishing House, 1999, 1264-1302.