Yu D Wei, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine, Zhao Ruihua, Department of Gynecology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine, Zhao Ruihua
Adenomyosis is a common gynecological disease. Do you know about adenomyosis? We will answer you through the following six questions.1. Q: What is adenomyosis? A: When the endometrial glands and mesenchyme invade the myometrium, it is called adenomyosis (disease). It occurs mostly in menstruating mothers over 40 years of age. About 30% of patients have a combination of uterine fibroids, about 20-50% of patients have a combination of endometriosis, and a combination of pelvic adhesions is also common. 2. A: Be alert to adenomyosis when you have gradually increasing menstrual pain, which often starts a week before your menstrual flow and ends when your menstrual flow increases as well as when your menstrual flow lasts longer and when you are infertile after marriage. During gynecological examination the doctor may find a uniform enlargement of the uterus, usually not exceeding the size of the third trimester of pregnancy, otherwise it may be combined with uterine fibroids. The uterus is hard in texture and there is significant pressure pain. However, 30% of patients do not have any clinical symptoms.3. Q: How can I confirm if I have adenomyosis? A: In combination with clinical symptoms, some auxiliary tests are also needed. Ultrasonography is the most commonly used method. Transvaginal color Doppler ultrasound (color ultrasound) is more accurate than abdominal ultrasound. Small cyst-like echogenicity within the myometrium can be seen, and star-shaped blood flow signals can be detected within it. Blood CA125 levels are significantly elevated in patients with adenomyosis, and there is a positive correlation between CA125 levels and uterine size, with the larger the uterus, the higher the CA125 level. MRI is recognized as the most reliable non-invasive method to diagnose adenomyosis at home and abroad, but it is expensive and generally not considered.4. Q: The B-ultrasound result is adenomyoma, is there any difference between this and adenomyosis? A: Adenomyoma belongs to the category of adenomyosis. There are two types of adenomyosis lesions: diffuse and limited. The growth is generally diffuse, thickening the uterine muscle wall. A few invasive endometrium is confined to one part of the myometrium, forming nodules or masses, similar to interstitial fibroids, called adenomyoma. 5. Q: What is the difference between adenomyoma and fibroid? A: Uterine fibroids have a smooth surface, with obvious boundaries with the surrounding muscle tissue, which can be easily peeled out during surgery and have a swirling structure on the cut surface. Some patients may have symptoms such as increased menstrual flow, prolonged menstrual period and back pain, and generally no obvious menstrual pain. The uterine adenomyoma is poorly defined from the surrounding tissues with no surrounding envelope, making it difficult to peel it out from the myometrium, and there is no obvious and regular swirling structure in the dissection. The patient’s uterus rarely exceeds the size of the third trimester of pregnancy and most often has progressively worse dysmenorrhea. Sometimes it is difficult to distinguish between the two.6. Q: How should adenomyosis be treated? A: Treatment should depend on the patient’s symptoms, age and fertility requirements. For older patients without fertility requirements, hysterectomy or conservative surgery is feasible; for those who are not willing to undergo surgery near menopause or young with fertility requirements, western medicine uses drugs such as Danazol, progesterone, gonadotropin-releasing hormone analog or agonist (GNRH-a), but the side effects are obvious. We use Chinese herbal medicine to treat adenomyosis with a combination of diseases that can significantly relieve the patient’s symptoms, have fewer side effects and improve the conception rate. For patients with fertility requirements, the clinical efficacy is remarkable by identifying and using drugs according to different periods of menstruation, and we attach a case: Wang, female, 30 years old, married. She has not been pregnant for 2 years without contraception and has not been pregnant for 2 years after embryo abortion in 2009. Her last menstrual period was on March 7, with more blood clots. On February 8, 2012, ultrasound at the maternity hospital indicated adenomyosis and uneven echogenicity of the endometrium (polyps were not excluded). The tongue is dark red, the coating is white and slightly thick, and the pulse is stringent and slippery. The evidence belongs to Qi stagnation and Blood stasis, the treatment is to regulate Qi and activate Blood stasis. Prescription: Chai Hu 10g, Poria 10g, Fried Atractylodes 15g, Radix Aromaticus 15g, Salvia 15g, Radix Paeoniae 15g, Curcuma 10g, Job’s Tears 30g, Licorice 10g, Radix et Rhizoma Chicken 20g, 7 doses, second consultation: March 21. After taking the medicine, the frequency of stool increased, 2-3 times/day, the quality is acceptable, the rest is not uncomfortable, and the sleep is acceptable. The tongue is dark red, the coating is white and slightly thick, and the pulse is stringent and slippery. Considering that she is in premenstrual period, Yin is full and Yang is long, the treatment is to seek Yang in Yin and add products that nourish the kidney and benefit Yin. Radix Bupleurum 10g, Poria 15g, Atractylodes Macrocephala 15g, Radix Aromaticum 15g, Radix Angelicae Sinensis 15g, Radix Zeleniae Sinensis 10g, Radix Ligustrum lanceolatae 15g, Radix Chuanjian 20g, Radix Cuscutae 20g, Radix Lycii 20g, Radix Glycyrrhiza Uralensis 10g. The last menstruation was on April 7, with less dysmenorrhea than before, but still with blood clots. Now he is sleepy, sleepy, stool 1-2 times/day, with acceptable texture. The tongue is dark, the coating is white and slightly thick, and the pulse is stringent and slippery. On October 31, she was found to be pregnant and was treated with Chinese herbal medicine for fetal preservation. Note that the treatment plan will be different for each patient because of individual differences. Patients need to visit the hospital to determine the treatment plan according to their individual constitution. If you want to continue communication with me after the consultation, but are not convenient to come to the hospital, you can apply for telephone consultation service, and I will give you guidance according to your specific situation.