What Is the Most Common Adenomyosis Treatment?

Adenomyosis (adenomyosis) is a diffuse or localized lesion of the endometrial glands and stroma that invades the myometrium and is a common gynecological disease. It often causes symptoms such as secondary dysmenorrhea and increased menstrual flow, which seriously affects women's physical and mental health. At present, there are many treatment options, and individual treatment is often performed according to the age and fertility needs of the patient.

Adenomyosis

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Adenomyosis (adenomyosis) is a diffuse or localized lesion of the endometrial glands and stroma that invades the myometrium and is a common gynecological disease. It often causes symptoms such as secondary dysmenorrhea and increased menstrual flow, which seriously affects women's physical and mental health. At present, there are many treatment options, and individual treatment is often performed according to the age and fertility needs of the patient.

Chinese name

Adenomyosis

Foreign name

adenomyosis

Also known as

Adenomyosis

Nature

Gynecological Common Diseases

Happen

Women over 40 years old

Symptom

Increased dysmenorrhea and menstrual flow

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, invade the uterine myometrium, and are accompanied by compensatory hypertrophy of the surrounding myometrial cells to form lesions. There are four theories of the factors that cause 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 high Prolactinemia; viral infection; obstruction of the reproductive tract, which increases uterine pressure during menstruation, causing endometriosis to the myometrium of the uterus.

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.

symptom

1. Menstrual disorders (40-50%): Mainly manifested by prolonged menstruation and increased menstrual flow, 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%): 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. Approximately 35% of patients are asymptomatic.

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. About 15-40% are complicated by endometriosis, and about half of the patients are complicated by uterine fibroids. [1]

A preliminary diagnosis can be made based on a typical medical history and signs, and a confirmed histopathological examination is required.

Imaging 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. MRI can objectively understand the location and scope of the lesion before surgery, which is of great help in determining the treatment method.

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

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.

1. Drug treatment

Symptomatic treatment: For those who have mild symptoms and only require relief of dysmenorrhea, especially 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.

False menopause therapy: 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". Generally within 3-6 weeks of medication, the serum estrogen in the body reaches the level of castration, which can relieve dysmenorrhea. And after applying GnRHa, the uterus can be significantly reduced, which 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. However, long-term application of GnRHa will cause menopausal symptoms, and even cause severe cardio-cerebral vascular complications and osteoporosis. Therefore, it is recommended to reversely add estrogen after 3 months of GnRHa to relieve complications. In addition, the cost of GnRHa is relatively high, requiring about RMB 1,000-2,000 per month, 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. Therefore, GnRHa is currently used as the drug of choice to reduce lesions before surgery and reduce recurrence after surgery.

False pregnancy therapy: Some scholars believe that oral contraceptives or progestin can make ectopic endometrial decidualization and atrophy and play a role in controlling the development of adenomyosis. Some patients choose Shangman Yuele to release high-efficiency progesterone locally in the uterus to control the endometriosis between the uterine muscle walls. However, some scholars believe that the ectopic endometrium of adenomyosis is mostly the endometrium of the basal layer, and they are not sensitive to progestin. Therefore, the effectiveness of progestin (oral contraceptives and Man Yuele) in treating adenomyosis is still controversial.

Traditional Chinese Medicine Treatment: According to the understanding of traditional Chinese medicine, adenomyosis is related to internal resistance of blood stasis, and the formation of blood stasis is related to pathogenic factors such as cold coagulation, qi stagnation and phlegm. Therefore, in terms of treatment, both the principle of promoting blood circulation and removing blood stasis must be taken into account, and the cause of blood stasis and the degree of weakness must be considered.

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.

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.

Excision of adenomyosis:

Suitable for patients with fertility requirements or young. 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. Takeuchi et al. Reported that a laparoscopic uterine lesion made a transverse H-shaped incision can reduce the risk of penetrating the uterine cavity when the lesion is removed, and fold and sew the muscle layer surrounding the lesion. Wang Bin reported that the U-shaped myometrium was removed by laparotomy. Masato Nishida chose a central longitudinal resection of the uterine body without postoperative adjuvant therapy. She could be pregnant 3 months after surgery.

3. Interventional treatment

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: 1. ectopic endometrial necrosis, decreased prostaglandin secretion, and relief of dysmenorrhea; 2. uterine body becomes softer after embolization, and the volume and endometrial area decrease, reducing menstrual flow; And smooth muscle contraction, blocking the microchannels that cause endometriosis and reducing the recurrence rate; 4, the local estrogen level and the number of receptors decrease; 5, the establishment of eutopic endometrial collateral circulation, which can gradually recover from the basal layer's transitional growth Features. Ravina et al reported that uterine arterial embolization for adenomyosis reduced menstrual flow by about 50% and the dysmenorrhea relief rate reached more than 90%. Wang Yitang and others reported that among 128 patients with uterine arterial embolization for adenomyosis, 80 patients (62.5%) completely disappeared postoperative dysmenorrhea, 42 patients (32.8%) were significantly relieved, and 6 patients (5%) were partially relieved. Twenty-one cases of normal pregnancy and delivery of healthy babies occurred 9 to 36 months after surgery.

However, some scholars believe that uterine arterial embolization will affect the blood flow of the uterus and ovaries, which will adversely affect pregnancy. May cause infertility, miscarriage, premature delivery and increased cesarean delivery.

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. ^[1-2]