Adenomyosis is one of the most common diseases in gynecology, and the incidence of adenomyosis is increasing, which brings a great impact on women’s health. If you are suffering from adenomyosis, and if you are still hesitant about how to treat your adenomyosis, then please read this article carefully, it will definitely help you.
A. Adenomyosis basics
1. What is adenomyosis?
Adenomyosis is the invasion of the endometrium inside the uterine cavity into the myometrium, like the bark of a tree growing into the trunk. It is a type of endometriosis and can coexist with endometriosis in other areas such as the pelvis or ovaries.
If the invading endometrium is diffusely present in the muscle wall, we call it diffuse; if the invading endometrium is locally entangled in a mass, we call it adenomyoma. Diffuse adenomyosis is the most common.
2.What are the symptoms of adenomyosis?
(1) Dysmenorrhea: secondary, progressively increasing dysmenorrhea occurs in about 80% of women and is the main symptom of the disease.
(2) Menstrual disorders: mainly manifested as increased menstrual flow and prolonged periods; in severe cases, it may cause anemia.
(3) Infertility: 40% of women have infertility due to exudation, adhesions and changes in the local uterine environment.
3. What is the difference between adenomyoma and uterine fibroid?
Both adenomyoma and fibroid are common benign tumors in women and are two different diseases of the uterus.
Uterine fibroids are the proliferation of smooth muscle in the uterus and can occur in the interstitial, subplasma and submucosa. The growth of fibroids accelerates during pregnancy and stops after menopause, and even shrinks and disappears.
Adenomyoma is caused by the invasion of the endometrium in the uterine cavity into the myometrium, which is mainly confined to the myometrium. Some women with adenomyoma shrink on their own during pregnancy, and their symptoms are relieved and improved.
The fibroids are clearly demarcated from normal tissue and have a pseudo-envelope, so they can be well peeled out from normal tissue, whereas adenomyoma lesions are poorly demarcated from normal tissue and no pseudo-envelope exists, so it is difficult to peel adenomyoma from the myometrium.
Adenomyosis and fibroids may also occur together.
4. Causes of adenomyosis
A very important cause of adenomyosis is: medically induced injury. It is generally believed that a history of multiple miscarriages, repeated uterine operations, trauma to the uterine wall during childbirth, caesarean section, and invasive uterine surgery are the main causes of this disease. When the above operations cause an artificial channel between the endometrium and the myometrial wall, it provides a convenient door for the endometrium in the uterine cavity to invade the myometrium.
In addition, due to the lack of submucosal layer under the basal lining of the endometrium and the fact that adenomyosis is often combined with uterine fibroids and excessive endometrial hyperplasia, there is also a view that the invasion of the basal endometrium into the myometrium may be related to the stimulation of high estrogen.
5.How to prevent adenomyosis?
(1) Avoid uterine surgery, gynecological examination, and gynecological surgery during menstruation.
(2) Pay attention to menstrual hygiene and prohibit sexual intercourse during menstruation.
(3) Good family planning, avoid abortion and curettage.
(4) Avoid medical injury and reduce invasive uterine surgery
(5) pay attention to the regulation of emotions, maintain an optimistic and cheerful mood, so that the body immune system and endocrine system to maintain normal.
6.Will adenomyosis recur?
Adenomyosis lesions are diffuse and poorly defined, so it is almost impossible to completely remove the lesions, so the pain relief rate is low and the recurrence rate is high after the removal of adenomyosis lesions.
It is not possible to cure adenomyosis, which is a persistent gynecological problem, unless the uterus is removed or menopause occurs. In addition, if there is a combination of endometriosis in other parts of the uterus, even the removal of the uterus will not completely treat endometriosis.
Treatment of adenomyosis
1.The purpose of adenomyosis treatment
Adenomyosis is invasive and recurrent, and is a difficult disease to treat. Many invasive treatments may themselves aggravate the invasion of the endometrium into the uterus and extra-uterine places.
The aim of current medical treatment is mainly: to reduce and destroy the lesions and to relieve and relieve the symptoms.
2.Principles of adenomyosis treatment
The treatment of adenomyosis is mainly comprehensive, depending on the requirement of fertility, the severity of symptoms, the extent of lesions and previous treatment and personal wishes to choose a combination of different treatment modalities. At present, ultrasound ablation + Manned Ring can achieve better treatment results in most women.
3.The advantages and disadvantages of various adenomyosis treatment methods
(1) Medication: mainly hormonal drugs are used to cause “false pregnancy” or “false menopause” and “pharmacological oophorectomy”. It can improve the symptoms of increased menstruation, but the course of drug use is long, and the symptoms of menopause caused by the drugs and recur after stopping the drugs.
(2) Hysterectomy: fast-acting and non-recurring, but may not be effective in some cases of combined ectopic endometriosis. (2) hysterectomy: fast and effective, no recurrence, but may not be effective in some cases of combined ectopic endometriosis.
(3) laparoscopy: laparoscopy used to be the gold standard for diagnosis and treatment, but laparoscopy itself may cause pelvic adhesions, resulting in new ectopic lesions aggravating adenomyosis and increasing the difficulty of treating it again after recurrence.
(4) Manned IUD: It can continuously and quantitatively release highly effective progestin locally, which not only has good contraceptive effect, but also has better therapeutic effect on dysmenorrhea and excessive menstrual flow in adenomyosis. However, not all patients are suitable for this IUD. In addition, during the first three months of IUD placement, there is obvious bleeding from the uterus, spotting bleeding for about ten days on average, oily skin people will have acne, individuals will have breast swelling and pain, ovarian cysts, etc.
(5) Ultrasound ablation: It treats ectopic lesions on the uterus in a non-invasive way and can be repeated without causing new endometriosis and pelvic adhesions while treating them; especially for women with fertility requirements, it can improve the possibility of pregnancy after surgery. However, as a local treatment and limited by the unclear demarcation of the adenomyosis itself, this method can not be a complete treatment.
Ultrasound ablation for adenomyosis
1.The principle of ultrasonic ablation for adenomyosis
The principle of ultrasound ablation treatment is to use ultrasound to penetrate human tissue and focus on specific target lesions, gather energy to sufficient intensity, reach instant high temperature at the lesion, destroy the target tissue and cause coagulative necrosis. It has the characteristics of non-invasive treatment, no incision, no bleeding, no scar and less complications, as well as fast recovery, less pain, and will not cause pelvic adhesions and affect the pelvic internal environment.
2.Advantages of ultrasonic ablation for adenomyosis
Ultrasonic ablation is an ideal treatment modality that can inactivate lesions and inhibit the formation of new lesions at the same time. It can avoid scars and organ adhesions caused by open surgery and medically induced endometriosis.
During the treatment process, the positioning is precisely determined by computer and monitoring system, the operation is fully visualized, the ultrasonic treatment head is moved, the focusing depth of ultrasonic waves is changed, and the combined scanning mode of point-line surface-body is adopted, and the treatment effect can be judged immediately by MRI, ultrasonography and other examination methods after the treatment.
3.Effects of ultrasonic ablation in treating adenomyosis
The treatment of adenomyosis with ultrasound ablation technology can significantly relieve the symptoms of menstrual pain, reduce menstrual bleeding, and significantly reduce the size of the uterus and the scope of the lesion. The efficiency is about 85% and the treatment can be repeated to achieve the desired effect. However, this method is mainly used to treat ectopic lesions on the uterus, and the effect of Hepatitis may not be good if it is combined with ectopic lesions on other organs such as ovaries or pelvis.
4.The effect of ultrasound ablation treatment on fertility
Forty percent of women are infertile due to adenomyosis, but some of them cannot fully restore their fertility after treatment of adenomyosis, probably because of pelvic adhesions caused by invasive surgery, which is the main cause of infertility. More and more women have realized their wish to become mothers after ultrasound ablation. The main reason may be that ultrasound ablation does not operate, which solves adenomyosis to the greatest extent while avoiding the possibility of pelvic adhesions and protecting the function of the reproductive system to the greatest extent. Of course, the prerequisites for pregnancy after ultrasound ablation are normal ovulation of the ovaries and open fallopian tubes.