I. What is adenomyosis?
When the endometrial glands and interstitium invade the myometrium, it is called uterine adenomyosis. It occurs mostly in menstruating mothers aged 30-50 years old. About 15% of them are combined with endometriosis, and about half of them are combined with uterine fibroids.
What are the causes?
1, hormones: high estrogen levels in women’s bodies for long-term stimulation, will cause the endometrial tissue overgrowth, if the endometrium invades the myometrium, it will cause adenomyosis, so women should pay more attention to the daily diet, life and other aspects.
2, trauma: with the widespread use of uterine surgical techniques, such as abortion, curettage, caesarean section, multiple pregnancies or births, etc., can cause damage to the uterus, thus making it easy for the endometrium to invade the myometrium, resulting in the occurrence of adenomyosis.
3, inflammation: some chronic endometritis, often leading to the boundary between the myometrium and the endometrium becomes indistinct, resulting in the endometrium to the myometrium growth, will also induce adenomyosis.
Third, what are the clinical manifestations of adenomyosis?
Dysmenorrhea with progressive aggravation, menstrual abnormalities, infertility, painful intercourse, pelvic pain and other uncomfortable symptoms.
(1) Menstrual disorders (40% to 50%) are mainly manifested by prolonged menstruation, increased menstrual volume, and some patients may also have spotting bleeding before and after menstruation. This is triggered by an increase in the size of the uterus, an increase in the area of the endometrium of the uterine cavity and an intermyometrial lesion affecting the contraction of the uterine muscle fibers. Severe cases can lead to anemia.
(2) Dysmenorrhea (25%) Dysmenorrhea is characterized by secondary progressive worsening dysmenorrhea. It often begins to appear a week before the menstrual period and is relieved when the period ends; in some cases, it extends to 1-2 weeks after the period. This is because the ectopic endometrium in the myometrium during menstruation is congested and swollen as well as bleeding under the influence of ovarian hormones, and also increases the blood volume in the blood vessels of the myometrium, which expands the firm and thick myometrium and causes severe dysmenorrhea.
(3) Infertility Uterine adenomyosis can also lead to infertility. In recent years, with the widespread use of uterine operation techniques, some young women also have the onset in women aged 16-30, and women of childbearing age can also lead to the onset of infertility.
4. How to diagnose adenomyosis?
1. Secondary progressive dysmenorrhea, which occurs in middle-aged women of childbearing age, should be considered as having adenomyosis. If it is accompanied by excessive menstruation, prolonged periods and an enlarged uterus, adenomyosis should be considered.
2, gynecological examination of the uterus uniformly enlarged or limited bulge, hard and painful. The uterus is often uniformly enlarged and spherical on gynecological examination, and adenomyoma may appear as a hard nodule. The uterus usually does not exceed the size of 12 weeks of pregnancy. Near menstruation, the uterus is painful to the touch; during menstruation, the uterus increases in size, becomes softer in texture, and pressure pain is more pronounced than usual; after menstruation, the uterus shrinks. This cyclic occurrence of changes in signs is one of the important bases for the diagnosis of this disease. The uterus is often poorly mobile with adhesions to the surrounding, especially the rectum behind. 15% to 40% of patients have combined endometriosis, and about half of patients have combined fibroids.
3.Imaging examination:It is the most effective means to diagnose this disease before surgery.
Vaginal ultrasonography: sensitivity up to 80%, specificity up to 74%, higher accuracy than abdominal probe.
V. How to treat adenomyosis?
Depending on the patient’s symptoms, age and fertility requirements
At present, there is no curative effective drugs, for patients with mild symptoms, fertility requirements and near menopause can try non-steroidal anti-inflammatory drugs, Danazol, progesterone or GnRH-a treatment, can relieve symptoms, but need to pay attention to the side effects of drugs, and symptoms can return after discontinuation. Treatment with GnRH-a should pay attention to the patient’s risk of bone loss, and anti-additive and calcium supplements can be given.
Sixth, Chinese medicine treatment methods and advantages
Adenomyosis is the name of a disease in Western medicine, but according to its clinical symptoms and signs, it can be classified as “dysmenorrhea”, “excessive menstruation” and “prolonged menstruation” in Chinese medicine. From the perspective of Chinese medicine, dysmenorrhea, menstrual disorders, and obstruction of the masses are all related to internal stasis of blood, and the formation of blood stasis is related to pathogenic factors such as cold condensation, qi stagnation, phlegm and dampness.
1.Qi stagnation and blood stasis
Main manifestations: distending pain or spasmodic pain in the abdomen during menstruation, refusing to press, accompanied by irritability, pain in the chest and breasts, heavy menstruation or prolonged menstruation, enlarged uterus, stasis on the tongue and stringiness of the pulse.
Treatment: Diversify liver and Qi, resolve blood stasis and eliminate symptoms.
Remedy: Xiangling Pill with added flavor. Mu Xiang, Qing Pi, Neem, Clove, Trigonella, Curcuma longa, Citrus aurantium, Yu Jin, Leech, Yuan Hu, etc.
2.Phlegm coagulation and blood stasis
Main manifestations: pain in the abdomen, refusal to press, heavy and scanty menstrual flow, blood clots, distention and fullness in the stomach, vomiting and vomiting, enlarged uterus. Uterus enlargement. Usually, there may be a large amount of discharge with white color and thick texture. The tongue coating is white and greasy, and the pulse is sunken and slippery.
Treatment: Eliminate phlegm and dampness, resolve blood stasis and eliminate symptoms.
Radix: Kai Yu Er Chen Tang with Live Liao Xiu Ling Dan plus reduction. Radix Panax notoginseng, Chen Pi, Fu Ling, White Mustard Seed, Angelica sinensis, Zitangshen, Trigonella, Curcuma longa, Yu Jin, Chuanxiong, etc.
3.Cold clotting and blood stasis evidence
The main manifestations: menstrual cramps or cold pain in the abdomen, severe pain and refusal to press, but can be relieved by hot compresses, is the characteristic of this type of evidence. The menstrual flow is heavy but purple and dull in color with lumps, accompanied by cold extremities and fear of cold, dull tongue and sunken tight pulse.
Treatment: Warming and dispersing cold evil, but also invigorating blood and eliminating fetishes.
Remedy: Shaofu Bangyu Tang plus reduction. Medicines such as gunpowder ginger, Xiao Yin Xiang, Chuanxiong, Gui Zhi, Yuan Hu, Ling Li, Myrrh, Angelica, San Ling, Curcuma longa, Dan Shen, Fu Ling, etc.
While giving oral tonics, it can also be combined with acupuncture or external application to enhance the therapeutic effect.
Acupuncture points: Zhongji, Qihai, Guanyuan, Sansanli, Sanyinjiao, Diji, etc., starting 1 week before menstruation, once a day, to treat dysmenorrhea.
Zhongji: in the anterior midline of the body, 4 inches below the umbilicus.
Qihai: located in the lower abdomen, on the anterior median line, 1.5 inches below the middle of the umbilicus.
Guan Yuan: 3 inches below the umbilicus on the midline of the abdomen.
Foot San Li: located on the lateral side of the calf, 3 inches below the calf nose, on the line connecting the calf nose and Xie Xi.
Sanyinjiao: 3 inches straight up from the tip of the inner ankle, on the posterior edge of the tibia.
Diji: on the inner calf, when the tip of the inner ankle is on the line of Yinlingquan, 3 inches below Yinlingquan.
External application of Chinese herbs: Cinnamon, Chuanxiong, Wu Yu, Yuan Hu, Wu Yao and Myrrh can be used, finely grinded and mixed with paste of Vantuulin, applied to Guan Yuan point and fixed with gauze. The application is started 5-7 days before menstruation.
The advantages of Chinese medicine in the treatment of adenomyosis:
1.No incision, no pain
Avoid the risk and pain of surgery, safe, no sequelae.
2, the identification of the evidence, not easy to recur
According to the clinical symptoms and different physical evidence treatment, comprehensive endocrine regulation, eliminate the cause of recurrence.
3.Care for the uterus, protect the uterus and help pregnancy
Chinese herbal medicine has the effect of nourishing qi and blood, invigorating blood, etc. It is safe and has no side effects, protects the uterus and ovaries, and helps pregnancy.
4.Significant efficacy and good effect
Chinese medicine combined with acupuncture is effective in treating adenomyosis, which can quickly relieve patients’ symptoms, with long-lasting effect and not easy to recur.
Seven, adenomyosis precautions.
1, keep a good state of mind is very important A, uterine fibroids are likely to occur in the “yellow face” body, in fact, women who are often in a poor state of mind easily triggered by uterine adenomyosis. Pay attention to adjusting your emotions, keep an optimistic and cheerful state of mind, so that the function of the body’s immune system is normal.
2, because myometriosis is also a cold coagulation, then this disease is needed to keep warm, to avoid becoming serious because of the cold. The actual fact is that you should pay attention to your own warmth and avoid feeling cold.
3, for women suffering from adenomyosis, if women in the physiological period, must pay attention to the body care. During menstruation, all strenuous sports and heavy physical labor are prohibited.
4, as little as possible to do abortion and scraping, good family planning.
5, the menstrual period to do a good job of their own health care, pay attention to control their emotions, do not sulk, otherwise it will lead to endocrine changes.
6, girls should avoid fright during puberty, so as not to lead to amenorrhea can be formed overflow.
7, women must be prohibited from sexual intercourse during menstruation.
8, diet: diet should be light, not suitable for eating mutton, shrimp, crab, eel, salted fish, black fish and other things. Avoid eating chili, pepper, raw onion, raw garlic, white wine and other stimulating foods and drinks. Forbid the consumption of cinnamon, red dates, acacia, royal jelly and other hot, clotting and hormone-containing foods. Eat more lean meat, chicken, eggs, quail eggs, grass carp, snapper, white fish, cabbage, asparagus, celery, spinach, cucumber, winter melon, shiitake mushrooms, tofu, fruits, etc.