Adenomyosis is a benign disease in which endometrial tissue exists in the myometrium. Clinical diagnosis mainly depends on symptoms, internal diagnosis, tumor index CA-125, and ultrasound. Patients usually have a history of dysmenorrhea. They often begin to feel pain one or two days before the onset of menstruation, which lasts for the whole period and will still feel pain a few days after the end of menstruation. Some women have problems such as excessive menstrual blood, sexual pain, and infertility.
However, about half of the patients are asymptomatic because pathological examination unexpectedly found adenomyosis after hysterectomy for other diseases. Internal diagnosis can find diffuse uterus hypertrophy, usually spherical but rarely larger than the standard of 12 weeks of pregnancy.
During menstruation, the uterus will swell, there will be tenderness during internal diagnosis, and it will shrink slightly at the end, and the tenderness will disappear. Ultrasound examination reveals that the whole uterus is enlarged, the uterine wall is thickened, especially the posterior wall, and the ultrasonic echo is enhanced. If the myometrium is thickened into a lump of the tumor with strong echo characteristics, it is generally called Myoma.
Recently, someone has also used three-dimensional energy ultrasound to display the hemorheology of myometrium for diagnosis. In addition, the tumor index CA-125 of patients with adenomyosis sometimes increases, which can be used as a reference for diagnosis. However, it is still necessary to determine the diagnosis by surgical or laparoscopic hysterectomy and then send it for pathological examination.
Prevalence of age and reason
Adenomyosis usually occurs in women between 30 and 50, especially in women who are in menopause. It is only found in gynecological and obstetric examinations because of irregular menstruation and excessive menstrual blood. The true pathogenesis is not clear. It has been reported that cesarean scar and curettage may also cause adenomyosis. Cut and observe the hypertrophic uterus removed by surgery, and you can find fresh or old myometrial bleeding, which is caused by ectopic endometrial tissue in the myometrium.
Some ectopic endometrial tissues in the myometrium may even have changes similar to the menstrual cycle, such as proliferation, secretion, decidualization, etc. Interestingly, about 30 - 50% of adenomyosis will co-exist with hysteromyoma and endometriosis.
Does adenomyosis affect fertility and lead to infertility? Is it suitable for pregnancy?
Statistically, adenomyosis often occurs in women between 30 and 50, especially in women who enter menopause. Usually, most of these patients have completed the reproductive task, so they don't have to worry about infertility. Young patients in their twenties have less chance of getting adenomyosis. But for young patients, once they get adenomyosis, the most concerned question is whether it will affect fertility and lead to infertility.
It is generally believed that severe adenomyosis, especially those with endometriosis, can easily lead to infertility. This type of patient has a thick uterus and is prone to pelvic adhesion, which is not conducive to ovulation and embryo implantation. The natural pregnancy rate is not high. Fortunately, serious adenomyosis is rare in young women. Patients with mild adenomyosis still have a chance of getting pregnant. In addition, if you have a localized adenoma, you can surgically remove the tumor to keep the uterus and still have a chance to be pregnant in the future.
For young patients with reproductive needs and women close to menopause, conservative treatment is the first consideration to try to save the uterus from a total hysterectomy. Drug treatment is the primary treatment method.
Clinically, treating adenomyosis, whether using analgesics to relieve pain or taking hormones to cause amenorrhea or pseudopregnancy artificially, is a temporary relief of the disease. Once menstruation recovers, there is the possibility of recurrence and aggravation.
Therefore, the patients who choose drug treatment are more likely to be treated with traditional Chinese medicine, such as Dr. Lee's
Fuyan Pill. It can eliminate the pain and other symptoms of patients. More importantly, it can clean up the patient's uterine environment and increase the chance of natural pregnancy.
For localized adenoma, the uterus can be preserved as long as the adenoma is removed by surgery. If it is diffuse adenomyosis, the uterus wall can be thinned surgically and then given postoperative drug treatment. There is a chance of pregnancy, but some drugs still have the possibility of recurrence after treatment for some time.
The cure is hysterectomy for patients over 40 who have completed reproductive tasks and suffer from severe menstrual pain or excessive menstrual blood that affects their quality of life.
There are many treatment methods for adenomyosis, and individual selection should be made according to the patient's age, symptoms, and fertility requirements. No matter which treatment you choose, visit the hospital for examination and treatment in time.
In short, the cause of adenomyosis is still unclear. The age range of preference is between 30 and 50 years old women, especially those in menopause. Although the probability of women under 30 getting this disease is relatively low, it is one of the possible reasons for the difficulty of pregnancy. Therefore, it is best for young patients who want to have children to try to conceive as soon as possible while the conservative treatment is still effective without recurrence. There is still a chance of successful pregnancy.