It should be said that a woman should be happy to have regular menstruation, which means that her ovaries are functioning normally and not aging yet. However, many women have a sad face at the mention of menstruation because it causes them pain that is difficult to bear. Progressive menstrual pain and increased menstrual volume, even anemia, seriously affect their life and work. In my clinic, many patients come to me with progressive menstrual pain, followed by increased menstrual flow and even anemia. I tell them that they are suffering from a common gynecological disease, namely adenomyosis. There are some patients who have never heard of this disease, and some patients who know that they have adenomyosis but suffer from lack of professional treatment. I’ll give you some information about this disease today. A. What is adenomyosis exactly what is a disease? Adenomyosis refers to: the appearance of the endometrium in the myometrium, under the influence of hormones bleeding, muscle fiber connective tissue proliferation, the formation of diffuse lesions or limited lesions, but also focal formation of uterine adenomyoma lesions. This may be too specialized for people to understand. Then I will talk about it in layman’s terms. Let’s talk about the structure of the uterus. We all know that the uterus is an organ for women to conceive embryos and menstruate. The uterus is like a house, the innermost layer of the uterus is called the endometrium, like wallpaper, and the thickest layer of the uterus is called the myometrium, like the walls. Normally, just like wallpaper clings to the walls, the endometrium clings to the myometrium but does not invade it, and the myometrium is largely uniform. The endometrium sheds and bleeds once a month under the influence of the cyclic hormones in a woman’s body, and menstruation is formed. But when the endometrium grows into the myometrium due to abnormal conditions, adenomyosis, as we talked about, occurs! The endometrium grows into the myometrium and still bleeds periodically under the influence of the cyclic hormones in the female body, and this bleeding does not flow out of the body through the cervical opening like menstruation, but accumulates in the myometrium and cannot be discharged from the uterus. Progressive intensification, the uterus also progressively enlarges, as the uterus increases, the area of the endometrium also gradually increases, so that the patient’s menstruation becomes more and more frequent, which leads to various clinical manifestations of adenomyosis: 1. Progressive intensification of dysmenorrhea dysmenorrhea is often the first symptom of patients, pain often begins a week before the onset of menstruation, to the end of menstruation, pain is located in the middle of the lower abdomen, with time, if The pain is located in the middle of the lower abdomen. If the pain is not treated, the dysmenorrhea will gradually increase, and even painkillers cannot relieve it, which seriously affects the life and work of the patient. Patients who have been suffering from adenomyosis for a long time often complain to me in my clinic, saying that when menstrual pain is severe, they really want to pull out their uterus and throw it far away, which shows how unbearable the pain caused by menstrual pain is! When there is too much blood loss, the patient may become anemic, dizzy and weak, with palpitations, and in case of severe anemia, hospitalization or even blood transfusion is required. Therefore, if a woman finds that her menstrual flow is significantly higher than before, she must not take it lightly and must go to the hospital to find out the cause. In the gynecological clinic, the most common disease that causes excessive menstruation is adenomyosis, in addition to fibroids, and the two diseases often exist together. 3, infertility patients suffering from adenomyosis are not easy to get pregnant. It is usually believed that infertility in adenomyosis is due to the destruction of the tolerance of the endometrium, which affects the process of embryo implantation. 4. Gynecological examination of the uterus may reveal a uniformly enlarged uterus or a limited nodular bulge with a hard and painful texture. With the development of the disease, the uterus can be progressively enlarged, I often find in the gynecological clinic that the patient’s uterus is enlarged such as the size of the third trimester of pregnancy. Second, how does adenomyosis occur? What groups of people are susceptible to adenomyosis? The cause of adenomyosis is still not very precise, on the current domestic and international research, the onset of adenomyosis is mainly related to the following factors: 1, genetic factors adenomyosis with hereditary is based on research, we can often see in the clinic, mother and daughter or sisters suffering from the disease at the same time, so the mother or sister with adenomyosis of the female population, is a high-risk group of the disease. 2, endometrial basal layer damage As we mentioned earlier, under normal circumstances the endometrium is close to the myometrium and does not invade the myometrium. But if the patient has damaged the endometrium for some reason, for example, multiple pregnancies, scraping or chronic endometritis, the endometrium may “invade and migrate” to the myometrium through the surgical or inflammatory injury site, leading to the occurrence of adenomyosis. Therefore, women who have frequent scrapes and abortions are prone to adenomyosis. 3, hyperestrogenemia research shows that changes in sex hormones, especially estrogen, may stimulate the invasion and implantation of the endometrium into the myometrium through certain cellular signaling pathways in the body, while adenomyosis tissue itself can produce estrogen, stimulating the proliferation and expansion of ectopic endometrium in the myometrium. This suggests that adenomyosis is an estrogen-dependent disease, and that the most productive period for estrogen production in women is from puberty to about 30 years before menopause, with a high incidence of adenomyosis between 30 and 45 years of age. As women approach menopausal age or after menopause, the estrogen level in the body decreases and the condition gradually subsides. But here, patients often have a misconception that many patients have adenomyosis, do not pay attention to it, do not follow up, think that as long as the age of menopause will be good, but in fact, the end is not so, many patients therefore delayed treatment, and finally can only remove the uterus! Third, after suffering from adenomyosis, how should I follow up and treat it? Many patients have adenomyosis, there are mainly two situations, one is that patients feel that their symptoms are not obvious, so they do not pay attention to the observation of the disease, miss the best time for treatment, and finally the condition is aggravated or even need to remove the uterus; the other situation is that patients with obvious symptoms, but can not find professional advice and treatment, in the year after year of non-standard treatment, delayed the disease, and eventually can only Removal of the uterus. For patients with adenomyosis, the traditional treatment is to remove the uterus openly, but with the development of medicine, the treatment of many diseases is constantly improving, and now there are many ways to treat adenomyosis, so it is not terrible to have adenomyosis, but it is important to get professional consultation and guidance, so as to maximize the control of the disease and preserve the uterus to obtain a higher quality of life! The following is an introduction to the treatment measures for adenomyosis: 1. Medication Uterine adenomyosis has significant estrogen dependence, the disease does not occur before a woman’s first menstruation, and with the decline in estrogen levels, adenomyosis lesions in menopausal women will rapidly subside. Therefore, in the early stages of the disease, if medication is used as early as possible, the disease can be controlled and the uterus preserved. There are many drugs used clinically to control adenomyosis, including progestins, androgen derivatives, gonadotropin-releasing hormone agonists (GNRH-a), etc. The mechanism of treatment is to reduce estrogen levels in the patient’s body, but most of them cannot be used for a long time because of their side effects. Currently, there is a birth control ring with progesterone that is known as a miracle cure for adenomyosis. It is called Mandelol. It releases a small amount of progestin into the endometrium on a daily basis, which avoids the adverse effects of systemic medication and has a minimal impact on reproductive endocrinology, making it more acceptable to patients. It is safe and effective in improving symptoms such as dysmenorrhea and increased menstrual flow in patients with adenomyosis. However, in patients with moderate to severe adenomyosis, the uterus is significantly enlarged and can be easily dislodged after the placement of Manmole, which affects the efficacy of the treatment. Also, Mannorrhea has a contraceptive effect, so it should not be used in patients with fertility requirements. Therefore, for those patients with adenomyosis who are detected at an early stage, who do not have a significantly enlarged uterus and who do not have fertility requirements, Manuel is the ideal treatment option. 2.Surgical treatment If the patient’s clinical symptoms are heavy and the effect of medication is not obvious, then surgical treatment can be chosen. Since there are many surgical methods, the most suitable surgical treatment should be selected after considering the patient’s age, fertility requirements, location of the lesion, the patient’s wishes, and the surgeon’s surgical experience. (1) Hysterectomy Hysterectomy is an effective method to solve the various conditions of adenomyosis more thoroughly. It is suitable for patients with extensive lesions, ineffective conservative treatment and who are older and do not require fertility. Although hysterectomy solves the patient’s pain, the removal of the uterus, an important female organ, may have a negative impact on both the physical and psychological aspects of the woman. Of course, the negative effects of hysterectomy can be minimized if the patient is followed up and conditioned according to the instructions of a medical professional. Open hysterectomy is the most widely used surgical route and is usually the better choice for patients with extensive dense pelvic adhesions and a significantly enlarged uterus. Laparoscopic hysterectomy, on the other hand, is suitable for patients with a small uterus and no severe adhesions. (2) Adenomyosis focal resection is suitable for patients with clear diagnosis and who require preservation of reproductive function. Adenomyosis focal resection is less invasive, faster recovery, and preserves the patient’s reproductive function while treating the disease. For patients with diffuse adenomyosis, due to the extensive lesions, the increase of pregnancy rate after resection of most of the lesions is not obvious, but it can significantly improve symptoms such as dysmenorrhea and increased menstrual flow, and still has therapeutic value. 3, other treatment (1) uterine artery interventional embolization treatment is through the double uterine arteries or double internal iliac arteries after super-selective cannulation of the anterior trunk, the appropriate amount of embolic agent (usually gelatin sponge) is injected into it, so that the adenomyosis lesions are ischemic, hypoxic, necrotic, dissolved and absorbed, to achieve the purpose of treatment. The short-term effect of its treatment of adenomyosis is more significant, but the effect usually lasts until about 1 year, and the recurrence rate is usually high after 2 years, so it is still less used clinically. (2) High-intensity focused ultrasound whose treatment principle is under the real-time monitoring of on-board ultrasound or magnetic resonance, the high-intensity ultrasound emitted outside the body is focused to the lesion in the body, instantly generating high temperature of 60℃ and above, making the lesion coagulation bad. However, because its clinical application is still short, the long-term efficacy needs to be further explored. Maybe after so much talk, there are still many patients who are not clear about how to follow up and treat adenomyosis if they have it, so I will talk about my own experience in treating adenomyosis: First, if any women find themselves with progressive aggravation of dysmenorrhea or increased menstrual flow, they must go to a more regular local hospital (preferably a local tertiary hospital) gynecology department to clarify whether they have adenomyosis. Secondly, if the diagnosis is adenomyosis, the condition is not too serious, the uterus is not significantly enlarged, and the patient has no fertility requirements, it is recommended to put on the Manuelle ring as early as possible; if the uterus is significantly enlarged, it is recommended to treat with GNRH-a for 3 to 4 cycles first, and after the uterus shrinks, it is also necessary to put on the Manuelle ring as early as possible. Mannorrhea can effectively relieve the symptoms of dysmenorrhea and excessive menstruation. In many patients, the condition is effectively controlled after the IUD, and when the body estrogen decreases after the near menopause, the lesions slowly shrink, and it is possible to eventually avoid surgery or even preserve the uterus and obtain a good treatment outcome. It is important to note here that the sooner the Mannish is taken, the better, because if adenomyosis is not treated as early as possible, the condition of most patients will gradually worsen, and when the uterus is significantly enlarged, a significant number of patients, even with the use of drugs to shrink the uterus after the IUD, still cannot control the condition, resulting in the eventual need to remove the uterus. Third, if the diagnosis of adenomyosis, patients have fertility requirements, in this case, if the condition is not too serious, patients should prepare for pregnancy as soon as possible, because adenomyosis itself can lead to infertility, and pregnancy can effectively control the progress of the disease. If the patient has fertility requirements and the adenomyosis is more severe and leads to infertility, this requires a joint assessment of the patient’s condition with a reproductive physician to develop an individualized treatment plan. Fourth, if adenomyosis, which is serious and medication is ineffective, requires surgery, the main surgical options are hysterectomy and excision of adenomyosis lesions. The choice of the surgical procedure is determined by the patient’s age, the type of adenomyosis (mainly diffuse and focal) and the patient’s wishes. In the past, open surgery was used, but nowadays, with the development of minimally invasive techniques, laparoscopic surgery is becoming more and more popular among patients, but the most important feature of severe adenomyosis is that the pelvic adhesions are obvious and the uterus is significantly enlarged, which greatly increases the difficulty of laparoscopic surgery, so the surgeon’s surgical experience and surgical skills are very important. In conclusion, adenomyosis is not a terrible disease, but it cannot be delayed or waited for. Only timely professional treatment can maximize the control of the disease and make it possible to avoid surgery and even save the uterus.