What is adenomyosis?
A: Adenomyosis is a non-neoplastic lesion of the uterus, but many of the signs and symptoms are very similar to those of fibroids. Adenomyosis is a diffuse or limited invasion of the endometrial glands and mesenchyme into the myometrium. During menstruation, bleeding from these ectopic endometrial tissues directly into the myometrium can cause pain. As the blood accumulates, the surrounding muscles swell and form fibrous tissue. This swelling is located within the muscle layer of the uterus and is called an adenomyoma because it feels like a fibroid on ultrasound and is often confused with a fibroid. Adenomyosis can be mildly symptomatic or completely asymptomatic, or it can be very symptomatic and can cause severe bleeding and menstrual pain during menstruation. Adenomyosis is present in about 10% of women and is therefore not as common as fibroids, although it has been documented in 70% of women aged 40-50 years.
What are the causes of adenomyosis?
A: The cause of adenomyosis is still unknown. Experts believe that possible causes include:
Implanted tissue growth: Some experts believe that adenomyosis stems from the direct implantation of endometrial tissue cells from the endometrium into the myometrium. Some surgical operations on the uterus, such as cesarean sections and abortions, may implant endometrial cells directly into the myometrium.
Developmental origin: Other experts have speculated that adenomyosis originates in the fetal period of the woman during the formation of the uterus, when some endometrial tissue is deposited in the muscular layer of the uterus.
Inflammation of the uterus associated with childbirth: Another theory suggests a relationship between adenomyosis and childbirth. Inflammation of the endometrium during the postpartum period may lead to a break in the normal layers of tissue, resulting in implantation of the endometrium.
Origin of stem cells: A recent theory suggests that bone marrow stem cells may invade the uterine muscle and cause adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the secretion of cyclic hormones in the female body. When estrogen production decreases after menopause, adenomyosis will eventually disappear.
What are the clinical manifestations of adenomyosis?
A: The signs and symptoms of adenomyosis are as follows.
1, symptoms: some times adenomyosis does not have symptoms, or mild discomfort, some patients will have more serious symptoms
(1) Menstrual disorders: mainly manifested as prolonged periods and increased menstrual flow, which can lead to anemia in severe cases.
(2) Dysmenorrhea: severe cramping or knife-like pain during menstruation that lasts throughout the period and worsens with age, which is usually the main reason for patients to seek medical attention. The pain can be relieved by taking pain medication in the early stages of dysmenorrhea, but as the condition progresses, the dose of pain medication required for dysmenorrhea increases significantly, making it intolerable for the patient.
(3) Painful sexual intercourse.
(4) Bleeding between periods.
2. Physical signs
The uterus is enlarged to 2-3 times its normal size on gynecological examination. Tenderness in the uterus near your period. Although you may not be aware of your enlarged uterus, you may notice that your belly seems larger or has tenderness. In patients with adenomyosis, about half of them have a combination of fibroids.
How can I be clearly diagnosed with adenomyosis?
A: The initial diagnosis can be made based on the typical medical history and signs, combined with imaging examinations such as pelvic or vaginal ultrasound, MRI, CA125, etc. The diagnosis can be confirmed by surgery to obtain lesions for pathological examination.
1.Imaging examination
It is the most effective means to diagnose this disease before surgery. The sensitivity of vaginal ultrasonography is 80% and the specificity is 74%, which is more accurate than the abdominal probe. MRI can be used to objectively understand the location and extent of the lesion before surgery, which is helpful in deciding the treatment method. In diffuse adenomyosis, MRI shows diffuse thickening of the uterine binding zone on T2WI; in limited adenomyosis, T2WI shows a low-signal mass with similar signal to the binding zone and blurred borders.
2.Serum CA125
Some patients with adenomyosis have elevated serum CA125 levels, which are valuable in monitoring the efficacy of treatment.
How is adenomyosis treated?
A: There are many treatment options for this disease, and clinical decision making needs to be individualized to take into account the patient’s age, symptoms and fertility requirements. Surgical and pharmacological treatment options can be chosen simultaneously.
1.Pharmacological treatment
Pharmacological pain treatment: symptomatic treatment for those who have mild symptoms and only require relief of dysmenorrhea, can choose to give symptomatic treatment with non-steroidal anti-inflammatory drugs such as fenbendazole, anti-inflammatory pain or naproxen at the time of dysmenorrhea.
Hormone therapy: Patients with significant dysmenorrhea can be treated with hormone therapy, such as levonorgestrel extended-release intrauterine device (trade name: Manuel), aromatase inhibitors and gonadotropin-releasing hormone analogs.
2.Surgical treatment
Surgical treatment includes radical surgery and conservative surgery. The radical surgery is hysterectomy, and the conservative surgery includes adenomyosis (adenomyoma), endometrial and myomectomy, myometrial electrocoagulation, uterine artery block, anterior sacral neurectomy and sacral neurectomy, etc.
Hysterectomy
It is suitable for patients who have no requirement for childbirth and have extensive lesions with severe symptoms and ineffective conservative treatment. Moreover, in order to avoid residual lesions, total hysterectomy is preferred and partial hysterectomy is generally not advocated.
Focal hysterectomy for adenomyosis
It is suitable for patients who have fertility requirements or are young. Since adenomyosis is often diffuse and poorly defined from the normal muscle tissue of the uterus, it is a difficult problem to choose the way of excision to reduce bleeding and residual and to facilitate postoperative pregnancy.
3.Interventional treatment
Selective uterine artery embolization is one of the treatment options for adenomyosis. This is a minimally invasive interventional procedure that involves entering the blood supply artery of the uterus through a 1-2mm thin catheter and then injecting very tiny PVA microspheres (300-500um) to cause necrosis and detachment of adenomyosis tissue due to interruption of nutrient and nutrient supply to achieve the purpose of disease treatment, with the following mechanisms of action: necrosis of ectopic endometrium, reduction of prostaglandin secretion, relief of dysmenorrhea, reduction of menstrual flow, and reduction of recurrence rate.
What are the advantages of interventional treatment for adenomyosis?
A: Interventional treatment of uterine adenomyosis, also called selective uterine artery embolization (UAE), has the following advantages
Non-hormonal treatment: it does not affect a woman’s endocrine and menstrual cycles.
Preservation of the uterus: treatment can be performed without damaging the normal tissues and organs of the uterus.
Minimal trauma: No incision or anesthesia is required, and the treatment can be done only through the eye of a puncture needle in the femoral artery at the root of the thigh. You can be discharged from the hospital 1-2 days after the operation.
Definite efficacy: according to a 10-year experience review in major foreign centers, the long-term efficiency rate of symptom relief is 75.7%-92.9%, and the latest literature published (2015) shows that with the improvement of techniques and equipment, the clinical efficiency rate reaches 97% in the 3-year follow-up period.
No serious side effects: in addition to perioperative pain, another side effect is that it can cause early menopause in women approaching menopause (on the other hand, the disease is completely cured after menopause). There is no conclusive evidence on the effect on pregnancy.
How are minimally invasive interventions for adenomyosis performed?
A: The procedure of adenomyosis intervention is as follows: the femoral artery is touched at 0.5 cm below the midpoint of the inguinal ligament as the puncture point, and the puncture enters the arterial system of the human body. -The uterine artery is then embolized by pushing a certain size and amount of embolic pellets through the catheter to embolize the blood vessels supplying the uterine fibroids and certain peripheral vessels of the normal uterine artery branches.
What is the principle of uterine artery embolization in the treatment of adenomyosis?
A: The treatment principle of interventional embolization of adenomyosis.
(1) The blood supply to the ectopic endometrium of adenomyosis can be directly cut off, and the ectopic endometrial tissue cells are completely ischemic and necrotic within a short period of time.
(2) Adenomyosis is sex hormone dependent and estrogen promotes the growth of ectopic endometrial tissue. Cutting off the adenomyoma blood supply can block estrogen from entering the ectopic endometrial tissue via blood flow, and the estrogen level of the lesion decreases significantly, forming a local hormonal environment similar to menopause and further shrinking the lesion.
(3) After uterine artery embolization, the uterine blood supply decreases significantly, the endometrial growth is inhibited and the menstrual flow decreases, and the menstrual period returns to normal. Anemia was gradually improved and restored.
What are the postoperative reactions after interventional treatment of adenomyosis? How to deal with it?
A: Minimally invasive interventional treatment for uterine fibroids, because of minimal trauma and no need for anesthesia, generally has no particularly serious adverse reactions during and after the operation, the following reactions may occur.
1. Ischemic pain: It is the most common adverse reaction. 88.66% of patients will have different degrees of lower abdominal distension and cramping pain after the treatment, with different duration, ranging from 5-6 hours on the short side to 3 days on the long side, which can be relieved by giving symptomatic treatment for pain relief.
2, fever: 25% of patients, especially patients with large myoma, can have a low fever temperature around 38°C within a week after embolization. Generally, no special treatment is needed, and it will subside on its own after a week.
3.Soreness and weakness of lower limbs: 60% of patients feel soreness and weakness of both lower limbs after embolization, which will disappear naturally after about 20 days.
4.Irregular vaginal bleeding: A small amount of irregular vaginal bleeding can occur in a small number of patients after embolization, accompanied by endometrial shedding, which may be related to the insufficient blood supply to the uterus to maintain endometrial growth after embolization.
5. Premature menopause: The chance of occurrence is very low, seen in female patients close to pre-menopause. Those with severe menopausal symptoms can be treated with psychological relief or hormone replacement therapy. On the other hand, the painful symptoms of menopausal adenomyosis do not occur again, and the disease is cured.
What other diseases other than adenomyosis can be treated by uterine artery embolization?
A: Another common disease in women of childbearing age, uterine fibroids, can also be treated by a minimally invasive intervention called uterine artery embolization. (More on this in a separate article)
Also postpartum hemorrhage, placental implantation, ectopic pregnancy, scar pregnancy and other gynecological emergencies can be treated with uterine artery embolization to preserve the uterus, treat the disease and save lives.
How to prevent adenomyosis?
A: The prevention of the disease can be done in the following ways
1, good family planning, as little as possible to do abortion and scraping. Early medical treatment for gynecological diseases, avoid excessive uterine operations.
2, the menstrual period should do a good job of their own health care, do not do strenuous activities, pay attention to control emotions, do not sulk, otherwise it will lead to endocrine changes. Prohibit sex during menstruation, can reduce the occurrence of adenomyosis to a certain extent.
3, pay attention to keep warm and cold; adjust their emotions; diet should be rich in sufficient nutrition, correct partial diet and abnormal eating habits, should not crave for stimulating or cold food, etc.