Adenomyosis is a separate name for endometriosis foci located inside the uterine muscle membrane, i.e. myometrium. Adenomyosis can be divided into one that is located within the genital organs and that occurs outside, for example, in the intestine or bladder area.
Adenomyosisstill has undetermined causes, however, it is assumed that they remain multifactorial. The traumatic factor and developing inflammation are the most often attributed to the theory of the disorder in question. Under natural conditions, the uterus of a he althy woman has elements that constitute a kind of barrier between the myometrial layer and the endometrium. These are mechanical factors, as well as a whole cascade of immune components. Due to such mechanisms, the glands of the uterine mucosa do not grow excessively into the muscle structures. Of course, the ingrowth process itself does not take place every day. The right conditions must be created. An example of such a situation is a mechanical trauma caused, for example, as a result of curettage of the uterine muscle, performed cesarean section or the process of termination of pregnancy. The protective barrier can also be damaged during physiological labor.
Another theory of origin assumes cell metaplasia, when undifferentiated cells of Wolff's or Müller's ducts, i.e. structures of great importance in the embryonic development of the reproductive system, give rise to the development of adenomyosis.
There is also talk of the role of hormonal factors. The concentration of prolactin, FSH, LH and estrogens is of great importance.
Symptoms of adenomyosis
In many cases, the adenomyosis process is completely asymptomatic, in the remaining cases the most frequently reported complaints are abnormal vaginal bleeding, uterine pain or discomfort before each menstruation recognized as more severe PMS. It happens that pain accompanies women throughout the menstrual cycle. There may be abnormal vaginal bleeding like heavy, prolonged menstrual bleeding, or vaginal bleeding at irregular intervals, not related to menstruation. Menstrual bleeding may then last even 8-14 days, and the increased blood loss translates into the patient's morphology, resulting in anemia. Sometimes excessivethe bleeding is accompanied by cramping pain in the lower abdomen. When the adenomyosis foci are located outside the uterus, the complaints reported by the patient concern the affected structures, i.e. the urinary bladder or the intestine.
The consequence of anemia is general weakness of the body, pale skin, reduced exercise tolerance.
Adenomyosis: diagnosis
The problem of adenomyosis should not be delayed and, above all, go to the gynecologist. On an internal examination, the doctor finds a hard, enlarged uterus, painful when palpated in the perimenstrual period. It should be emphasized that the lack of abnormalities in the internal examination is not a factor disqualifying from this diagnosis. In case of doubt, an ultrasound examination should be performed in which the foci can be identified. The uterine body then takes a patchy form. Moreover, the most important thing is the patient's clinical picture and the complaints she reports. In rare cases, MRI is used as a diagnostic tool, which shows the boundary between the endometrium and myometrium. The final diagnosis is made on the basis of the pathomorphological picture.
Adenomyosis treatment
The treatment of adenomyosis consists primarily in the elimination of ailments. The peak incidence of adenomyosis is around 35-50 years of age, the disorder also occurs in older age, although the symptoms should not be so severe. Therefore, young women experience the greatest discomfort and it is them who are dedicated to various forms of therapy.
If a woman is of childbearing age and has plans for mothers, conservative methods are used, i.e. local enucleation of the lesion. Another form of therapy is hysterectomy, but it applies to older women due to radical treatment. Due to the progress in surgical techniques, the laparoscopic method of removing the uterus is used, which reduces tissue traumatization. Sometimes forms of pharmacotherapy are introduced, i.e. gonadoliberin analogues, progestogens, whose task is to create pharmacological menopause.