The best treatment for adenomyosis

Adenomyosis has a great impact on women's health. The more obvious symptoms are abdominal distension and pain, aggravated menstrual pain, etc. Severe cases can also lead to infertility. Once you are diagnosed with adenomyosis, you should seek medical treatment promptly to avoid delaying treatment and causing the condition to worsen. There are two ways to treat adenomyosis: medication and surgery. So, which treatment is better?

Causes

The cause of adenomyosis is still unknown. The current consensus is that because the uterus lacks a submucosal layer, the basal cells of the endometrium proliferate and invade the myometrium, accompanied by compensatory hypertrophy and hyperplasia of the surrounding myometrial cells, forming a lesion.

Traditional Chinese medicine believes that this disease is caused by qi stagnation, cold stagnation, heat burning, qi deficiency, and kidney deficiency, which lead to blood stasis blocking the Chong, Ren, and uterus, and dysmenorrhea when menstruation is not smooth. The main pathogenesis is blood stasis blocking Chong, Ren and Baogong.

Clinical manifestations

In the past, adenomyosis mostly occurred in multiparous women over 40 years old, but in recent years it has shown a trend of gradually becoming younger, which may be related to the increase in intrauterine surgeries such as cesarean sections and artificial abortions.

1. Symptoms

(1) Menstrual disorders (40%-50%) are mainly manifested by prolonged menstruation and increased menstrual volume. Some patients may also experience spotting before and after menstruation. Severe cases may lead to anemia.

(2) Dysmenorrhea (25%) is characterized by secondary and progressive dysmenorrhea. It often begins a week before menstruation and is relieved when the menstrual period ends. Taking painkillers can relieve dysmenorrhea in the early stages, but as the disease progresses, the dosage of painkillers required for dysmenorrhea increases significantly, making it impossible for patients to tolerate it.

(3) About 35% of other patients have no obvious symptoms.

2. Physical signs

Gynecological examination shows that the uterus is often uniformly enlarged and spherical, and adenomyoma may appear as hard nodules. The uterus is generally no larger than 12 weeks of pregnancy. As the menstrual period approaches, the uterus feels tender; during the menstrual period, the uterus enlarges, becomes softer, and the tenderness is more obvious than usual; after the menstrual period, the uterus shrinks. The uterus is often adhered to the surrounding area, especially the rectum at the back, and has poor mobility. 15% to 40% of patients have concomitant endometriosis, and about half of the patients have concomitant uterine fibroids.

examine

1. Imaging examination

It is the most effective means of preoperative diagnosis of this disease. The sensitivity of vaginal ultrasound examination is 80% and the specificity is 74%, which is more accurate than abdominal probe. In case of adenomyosis, B-ultrasound shows that the uterus is uniformly enlarged and has uneven echoes; in case of adenomyoma, B-ultrasound shows that the uterus is unevenly enlarged, with local protrusions and heterogeneous high echoes in the lesions. MRI can objectively understand the location and extent of the lesion before surgery, which is very helpful in deciding the treatment method. The MRI of diffuse adenomyosis shows diffuse thickening of the uterine junction zone on T2WI; localized adenomyosis shows a low-signal mass shadow with a signal similar to that of the junction zone on T2WI, with blurred boundaries.

2. Serum CA125

The serum CA125 level is elevated in some patients with adenomyosis, which is of certain value in monitoring the therapeutic effect.

diagnosis

A preliminary diagnosis can be made based on typical medical history and physical signs, combined with imaging examinations such as pelvic or vaginal B-ultrasound, MRI, CA125, etc. The diagnosis can be made. Confirmation requires surgery to obtain the diseased tissue for pathological examination.