At the gynecologist’s appointment, young women knock down the conclusion of uterine adenomyosis. What it is is often not even explained. A similar disease has been diagnosed recently at a younger age. Adenomyosis and pregnancy, causes and risks - this is the article below. We will try to figure out whether a woman should worry about the benign pathological proliferation of the uterine mucosa, and what are the predictions in the development of this pathology.
A little knowledge of anatomy
The uterine cavity of the woman is lined with the mucous membrane - the endometrium. This membrane increases in thickness throughout the entire menstrual cycle. She must take a fertilized egg. But if pregnancy does not occur, the functional layer of the endometrium is rejected. It is the exit of this mucosa that we call menstruation.
Only a thin germ layer of the endometrium remains in the uterus, which gives rise to a new cycle of mucosal growth. This layer is normally separated from the muscle tissue of the uterus by a thin layer of connective tissue, which prevents the endometrium from growing in the other direction, with the exception of the uterine cavity. With internal endometriosis (this is what adenomyosis is sometimes called), this part of the mucous membrane violates the integrity of the separation layer and begins to grow into the muscle tissue of the uterus.
What happens next
In response to the invasion of foreign tissue into the muscles, reactive thickenings in individual fibers begin in it. Thus, the uterine muscles try to limit the alien invasion. Increasing in size, the uterine muscle tissue leads to the formation of its spherical shape. It should be noted that the endometrium often grows not on the entire surface, but only in some areas.
Depending on the degree of germination, a focal (with nodules) and diffuse (without clear foci of ingrowth) form of uterine adenomyosis is distinguished. What is it, and how do these nodules differ from myoma nodes? With myoma (benign formations in the muscle tissue of the uterus), the composition of the nodules is limited by connective tissue, and with adenomyosis, the glandular tissue is also in the nodules. Moreover, the differentiation of these two pathologies is often difficult. On ultrasound, adenomyosis and fibroids are often indistinguishable. In addition, with a diffuse form of endometrial pathology, parts of it can grow into fibroids.
The endometrium can be found not only in the uterus
Endometrial cells may not only be in the uterus. They can be located in the external and internal organs of the reproductive system, urinary tract, in the gastrointestinal tract, in postoperative wounds and the navel. When they are concentrated in other organs, endometrial cells continue to function in accordance with the monthly cycles, which leads to glandular tissue degeneration, inflammatory processes of a local nature and to general disorders of the body’s homeostasis.
Forms of pathology
As already mentioned, the following forms of endometrial hyperplasia are distinguished by the degree of growth and damage to muscle tissue:
- The diffuse form of adenomyosis. In the endometrium, blind outgrowths form, which penetrate into the myometrium (muscle tissue of the uterus) at different depths.
- The focal, or nodular form is characterized by clearly marked nodes in the myometrium around the germination of the glandular epithelium.
- A mixed form of adenomyosis. In this case, a combination of the above manifestations is observed.
Stages of Adenomyosis
In accordance with the international classification, four stages of pathology are distinguished. We only note that this applies only to the diagnosis of diffuse adenomyosis (ICD-10 code No. 85.1).
- Stage 1 - the growth of the endometrium in the submucous layer of the uterus.
- Stage 2 - the endometrium grows into the myometrium and at the same time affects no more than half of it.
- Stage 3 - more than half of the myometrium is involved in the pathology.
- Stage 4 - endometrial cells germinate to the serous membrane of the uterus, which subsequently leads to involvement of the pelvic organs in the pathological process.
Benign does not mean harmless
As already mentioned, adenomyosis is characterized by benign proliferation of glandular epithelium. Nevertheless, the ability of endometrial cells to develop and grow in other tissues and organs equates this pathology with malignant ones. As a benign formation, this pathology can take years and does not cause exhaustion or severe consequences for the body.
But at the same time, by analogy with malignant diseases, adenomyosis is difficult to conservative treatment. And surgical intervention with such a pathology helps to completely get rid of it. An operation to remove the uterus is performed with adenomyosis. Surgical intervention is more voluminous due to the inability to establish clear boundaries of the pathology.
Complications of pathology
Complications are directly related to the cyclical growth of endometrial cells. So, when they grow, they can cause bleeding and acute or chronic forms of anemia. The tendency to spread of these cells leads to systemic lesions of internal organs: intestinal obstruction, hemothorax of the lungs (filling the pleural cavity with blood when the endometrial cells are populated in the lungs). Do not forget about the ability of malignant degeneration of cells and the development of formations in malignant.
Etiology of the disease
The causes of adenomyosis are still not fully understood today. It is known that more often pathology is recorded in women who have crossed the threshold of thirty years. It is also known that adenomyosis and pregnancy are quite compatible, but at the same time, degeneration and regression of the pathology are observed. In the genesis of the disease, there are two directions:
- Genetic predisposition associated with malfunctions of the hormonal program.
- Implant implantation - the rejected endometrium remains completely or partially in the woman’s body. The reasons for this may be adhesions in the uterus.
Nevertheless, among the risk factors, the following are distinguished:
- First of all, this is a hereditary predisposition.
- Too late or early onset of menstruation in girls.
- Late or complicated birth.
- Surgical manipulations (abortion and curettage) and inflammatory processes in the uterus.
- The use of intrauterine devices.
- Immune system disorders and decreased immunity.
- Heavy physical work or a sedentary lifestyle.
- Obesity and stress.
Characteristic symptoms
Exclusively for this pathology, abundant or long periods are characteristic, accompanied by a pain syndrome that occurs before the onset of menstruation, and ends a few days after the end of the period. Often a similar pathology is accompanied by the presence of discharge several days before and after the menstrual period itself.
Menstruation itself is characterized by profuse blood loss, which can even lead to a decrease in hemoglobin in the blood. Characteristic is pain during intercourse, especially before menstruation. Pregnant women often have an increased tone of the uterus.
Symptoms may vary depending on the stage and form of the pathology. For example, with diffuse adenomyosis of the 1st degree, the disease is generally asymptomatic and can only be detected by chance when planning a pregnancy. Adenomyosis is almost asymptomatic both in the 2nd and 3rd stages of a diffuse and nodular form.
Diagnosis of the pathological process
Diagnosis of adenomyosis includes the following steps:
- History taking - regularity of menstruation, their soreness and profusion.
- Gynecological examination - the structure of the uterus, its shape, soreness.
- Ultrasound examination using an optical tube - vaginal examination provides very accurate data on the gestational age and on the size of the uterus, the presence of cysts and nodules.
- Magnetic resonance imaging provides information on the structure of tissues and foci of the pathological process in the uterus.
- Hysteroscopy - an assessment of the structure of the endometrium, the condition of the uterine cavity.
- Laparoscopic examination is rarely used.
Treatment and prognosis
For treatment, either drug therapy or surgery is performed. Diagnosis and purpose of treatment is performed by a gynecologist, which takes into account the stages of development of pathology. Drug therapy is aimed at not stopping the foci of pathology and includes the use of drugs of the androgen group (for example, Danazol) or progestins (for example, Gestrion or Dydrogestrion).
Adenomyosis is a fairly common uterine disease that often regresses after menopause. Therefore, do not be scared when a routine examination is diagnosed with adenomyosis. Is it possible to get pregnant at the same time? There are no restrictions on the onset of pregnancy, with the exception of rare cases of degeneration of neoplasms into a malignant form.
Uterine adenomyosis and pregnancy
Reviews of gynecologists and patients on the issue of bearing a child and the course of pregnancy with this pathology are reduced to the following theses:
- If a pregnant woman has a history of diagnosed adenomyosis, there is a risk of miscarriage or premature birth. Therefore, patients are constantly monitored by obstetrician-gynecologists.
- Abortions and surgical interventions can provoke the development of a pathological process. Therefore, doctors advise women who have a history of this to maintain a pregnancy.
- With such a pathology, there are no problems during pregnancy. And adenomyosis is not a reason for refusing a natural birth. Danger can occur in the postpartum period and manifest as prolonged bleeding.
- There is no direct relationship between adenomyosis and pregnancy or infertility. This pathology can lead to infertility only in the presence of other diseases of the pelvic organs.
- After pregnancy and childbirth, a large number of patients experience complete regression of endometrial hyperplasia. Physiological menopause during pregnancy can slow down the growth of the endometrium.
What does traditional medicine advise
Fees and tinctures of medicinal herbs help normalize the menstrual cycle and metabolic processes in the body, eliminate stress and improve well-being. It is worth considering that many drugs are incompatible with the active substances in the infusions. Therefore, mandatory consultation with your doctor is recommended.
With this disease, infusions with a shepherd’s bag, nettle, and plantain have proven themselves well. An excellent hemostatic agent is freshly squeezed table beet juice, which is recommended to be drunk in the morning on an empty stomach.
When applied topically in the form of douching, oak bark, peony, mistletoe, calendula and yarrow have good properties.
How to exclude yourself from the risk group
When conducting prophylaxis, the following rules should be followed:
- At least once every six months to undergo an examination with a gynecologist.
- For any deviations from the norm, consult a doctor immediately.
- Minimize stressful situations and provide the body with a good rest.
- Do not abuse tanning beds and sunbathing.
- Moderate physical activity and a healthy lifestyle will always support the body and strengthen its immune status.
Summarizing
Adenomyosis and pregnancy - this combination is purely individual and unique for each individual case. For some, such a pathology becomes the reason for the inability to conceive or bear a child. For others, it is asymptomatic, and the woman does not even realize the pathological processes in the muscle tissue of the uterus. In any case, regular visits to the gynecologist, especially for those who want to become a mother, will be a good start to physical health and the harmony of sexual relations.