How to classify adenomyosis into mild and severe

Adenomyosis is a common disease in the uterine area, which deeply troubles many female friends. Women of childbearing age are prone to this disease, and it is difficult to cure it. The only thing they can do is pay attention to their normal daily living habits. If symptoms of adenomyosis occur, you should go to the hospital for treatment in time. You can judge for yourself in advance whether it is mild or severe, and then face the disease together with the doctor. So, how do we determine whether adenomyosis is mild or severe?

1. 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 menstrual period and increased menstrual volume. Some patients may also experience spotting before and after menstruation. Severe patients may develop anemia.

(2) Dysmenorrhea (25%) is characterized by secondary 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 menstruation approaches, the uterus feels tender; during menstruation, the uterus enlarges, becomes softer, and the tenderness is more obvious than usual; after menstruation, 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.

2. Inspection

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.

3. 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.