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Surgical treatment of adenomyosis. Treatment of adenomyosis

Unique methods treatment of adenomyosis

Laser drilling is a unique technique that is performed using a holmium laser during hysteroscopy and laparoscopy. Laser beam creates special channels in the uterine muscle that prevent the spread of endometriosis. The method allows you to preserve not only the uterus, but also the ability to conceive and carry a baby naturally.

Make an appointment with a gynecologist and we will solve the issue together!

The only non-invasive method in Russia that allows you to fight adenomyosis. It is carried out under the control of magnetic resonance imaging with focused ultrasound, which causes heating and removal of areas of adenomyosis in the uterine muscle.

Only careful attitude to your health and the help of a specialist will help you avoid many consequences.

Types of adenomyosis

Nodal If endometrial cells are concentrated in separate foci (nodes) located in the thickness of the walls of the uterus
Diffuse If endometrial cells are evenly “scattered” throughout the thickness of the uterine wall, without gathering into separate foci
Mixed Implies the appearance of both previous forms

Causes

To successfully prevent and treat adenomyosis, it is necessary to know the causes of its occurrence. Although the exact causes of adenomyosis have not yet been established, it can develop due to:

Rough intrauterine manipulation (especially abortion);
complicated childbirth;
genetic predisposition;
chronic stress;
obesity;
use of an intrauterine device;
late offensive first menstruation;

Symptoms

Manifestations of the disease are individually expressed in each woman. They are often unpredictable and therefore require an individual approach

Adenomyosis can manifest itself in different ways. However, its most characteristic symptoms are:

infertility;
permanent pelvic pain;
pain during intimacy.
dark brown spotting 2-3 days before or 3 days after menstruation;
menstrual irregularities;

Diagnostic methods

01.
Manual examination

It is possible to recognize uterine adenomyosis in various ways. The primary diagnosis can be made by a gynecologist after a manual examination. The doctor is able to assess the condition of the uterus, its size, shape, position, mobility. By palpating the organ with its appendages, he will be able to distinguish tumor growths. Painful manual examination may also indicate pathology.
02.
Ultrasound of the pelvic organs

In an efficient way diagnosis is ultrasound of the pelvic organs. Ultrasound can accurately assess the extent of uterine damage by adenomyosis and determine the form of adenomyosis (nodular, diffuse or mixed)
03.
Hysteroscopy

Hysteroscopy - insertion of a special camera into the uterine cavity and displaying an image on a monitor. The method allows you to see the condition of the walls of the uterus from the inside and identify foci of adenomyosis, which look like dark red dots against the background of pale pink mucosa. The method also makes it possible to detect uterine deformation, which often occurs in severe forms of adenomyosis. It is better to conduct this study on days 5-10 of the cycle. If necessary, a biopsy of the affected areas is possible.

3 reasons to apply
at the “Center for Gynecology, Reproductive and Aesthetic Medicine”

Treatment of adenomyosis

To defeat adenomyosis, treatment must be comprehensive. There are many factors to consider, including:

clinical manifestations;
severity of the disease;
existing complications;
woman's age;
desire to have children in the future.

If a woman is diagnosed with adenomyosis, treatment may include:

conservative;
surgical.

Conservative treatment

Conservative treatment is selected by the attending physician individually and depends on clinical manifestations disease, severity, age of the patient, reproductive plans, presence concomitant diseases

hormones;
vitamins;
anti-inflammatory;
increasing immunity.

Surgical treatment of adenomyosis

In some cases, there is a need for surgical treatment. Such cases may include:

Severe forms of adenomyosis
Lack of effect from conservative treatment
Presence of contraindications to drugs used in conservative treatment

In the vast majority of cases, operations are performed laparoscopically.

Treatment of adenomyosis with laser drilling

Laser drilling can heal diffuse adenomyosis. This treatment is carried out using laparoscopy or hysteroscopy. Modern technologies strive to minimize tissue trauma, so office hysteroscopy is increasingly used.

Drilling is performed using a holmium laser. This technology is the most modern today. Using a laser, foci of adenomyosis are destroyed without damaging healthy muscle tissue of the uterus. All this naturally occurs under the control of vision. Advantage laser method in that it is the most gentle, gentle and at the same time effective compared to other methods.

The method preserves both the uterus and its main function. In this case, postoperative scars are not formed.

Complications of adenomyosis

Adenomyosis itself is not life-threatening. However, it causes significant problems in the life of a modern woman.

Constant intense pelvic pain significantly worsens the quality of life, and painful menstruation leads to the need to miss work and entertainment. Pain during sexual intercourse deprives partners of a full intimate life. A woman avoids intimacy, she develops depression, a feeling of helplessness, irritability, and relationships between partners become tense. Prolonged bleeding leads to anemia. Anemia, in turn, leads to constant fatigue, weakness, loss of performance.
Adenomyosis can cause infertility or miscarriage.

Prevention of adenomyosis

Prevention of adenomyosis involves regular visits gynecologist. Timely detection of an emerging problem allows you to take timely measures and avoid the development of adenomyosis and its complications. You should also lead a healthy lifestyle, give up bad habits, avoid casual sex and unwanted pregnancies.

Take care of your health with the specialists of our medical center!

Treating
doctors

Our center employs the most experienced and qualified personnel in the region

Attentive
and experienced staff

Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and aesthetic medicine, PhD, doctor highest category, associate professor of the department rehabilitation medicine And bio medical technologies MGMSU named after A.I. Evdokimova, member of the board of the association of specialists in aesthetic gynecology ASEG.

Graduated from the Moscow Medical Academy named after I.M. Sechenova, has a diploma with honors, completed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA named after. THEM. Sechenov.
Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
From 2009 to 2017 she worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.
She defended her dissertation for the degree of Candidate of Medical Sciences on the topic: “Opportunistic bacterial infections and pregnancy"

Myshenkova Svetlana Aleksandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

In 2001 she graduated from the Moscow State Medical and Dental University (MGMSU)
In 2003, she completed a course of study in the specialty “obstetrics and gynecology” at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
Has a certificate for endoscopic surgery, certificate in ultrasound diagnostics of pathology of pregnancy, fetus, newborn, ultrasound diagnostics in gynecology, certificate of a specialist in the field of laser medicine. He successfully applies all the knowledge acquired during theoretical classes in his daily practice.
She has published more than 40 works on the treatment of uterine fibroids, including in the journals “Medical Bulletin” and “Problems of Reproduction”. Is a co-author methodological recommendations for students and doctors.

Kolgaeva Dagmara Isaevna

Head of Surgery pelvic floor. Member of the scientific committee of the association for aesthetic gynecology.

Graduated from the First Moscow State Medical University named after. THEM. Sechenov, has a diploma with honors
She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
Has certificates: an obstetrician-gynecologist, a specialist in the field of laser medicine, a specialist in intimate contour plastic surgery
Dissertation work dedicated to the surgical treatment of genital prolapse complicated by enterocele
The sphere of practical interests of Dagmara Isaevna Kolgaeva includes:
conservative and surgical methods treatment of prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

Graduated from Ryazan State Medical University named after academician I.P. Pavlova with a degree in general medicine
Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology Clinic named after. V.F. Snegirev MMA named after. THEM. Sechenov
Proficient in a full range of surgical interventions gynecological diseases, including laparoscopic, open and vaginal access
The scope of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic operations for uterine fibroids (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

Graduated from the First Moscow State Medical University named after. THEM. Sechenov.
Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State University medical university them. THEM. Sechenov.
She is certified as an obstetrician-gynecologist.
Possesses skills surgical treatment gynecological diseases on an outpatient basis.
He is a regular participant in scientific and practical conferences on obstetrics and gynecology.
The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnostics and treatment intrauterine pathology, pathology of the cervix

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, gynecological oncologist

In 2013 he graduated from the First Moscow State Medical University named after. THEM. Sechenov.
From 2013 to 2015, he completed a clinical residency in the specialty “Obstetrics and Gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
In 2016 passed professional retraining on the basis of GBUZ MO MONIKI named after. M.F. Vladimirsky, specializing in Oncology.
From 2015 to 2017, he worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.

Mishukova Elena Igorevna

Obstetrician-gynecologist

Doctor Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. She completed clinical internship and residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
Mishukova Elena Igorevna has a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingo-oophoritis, etc.
Mishukova Elena Igorevna is an annual participant in Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine. Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 First Moscow State Medical University them. THEM. Sechenov.
The dissertation is devoted to the topic of organ-preserving treatment of adenomyosis using FUS ablation. He has a certificate as an obstetrician-gynecologist and a certificate in ultrasound diagnostics. Proficient in the full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
Author of a number of published works, co-author of a methodological guide for doctors on organ-preserving treatment of adenomyosis using FUS ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Doctor ultrasound diagnostics.

Gushchina Marina Yurievna graduated from Saratov State Medical University. V.I. Razumovsky, has a diploma with honors. Awarded a diploma from the Saratov Regional Duma for excellent academic achievements and scientific activity, recognized as the best graduate of SSMU named after. V. I. Razumovsky.
She completed a clinical internship in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor, specialist in laser medicine, colposcopy, endocrinological gynecology. She has repeatedly taken advanced training courses in “Reproductive Medicine and Surgery” and “Ultrasonic Diagnostics in Obstetrics and Gynecology”.
The dissertation is devoted to new approaches to differential diagnosis and tactics for managing patients with chronic cervicitis and early stages of HPV-associated diseases.
Proficient in a full range of minor surgical interventions in gynecology, performed on an outpatient basis (radiocoagulation and laser coagulation erosions, hysterosalpingography), and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
Gushchina Marina Yurievna has more than 20 scientific published works, is a regular participant in scientific and practical conferences, congresses and conventions on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, gynecologist for children and adolescents

Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the Faculty of Medicine of the First Moscow State Medical University. THEM. Sechenov.
He is certified as an obstetrician-gynecologist, ultrasound diagnostics doctor, specialist in laser medicine, pediatric and adolescent gynecology.
Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, cervical biopsy) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
Completed clinical residency in the specialty "Obstetrics and Gynecology" on the basis of the department of the Federal State Budgetary educational institution additional vocational education"Institute for Advanced Studies of the Federal Medical and Biological Agency."
He has certificates: obstetrician-gynecologist, specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Ultrasound diagnostics doctor, obstetrician-gynecologist, candidate of medical sciences

graduated from Ivanovo State University medical academy specializing in general medicine.
Completed an internship at the Tambov Regional Clinical Hospital, specializing in obstetrics and gynecology.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor; specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
Repeatedly took advanced training courses in the specialty “obstetrics and gynecology”, “Ultrasound diagnostics in obstetrics and gynecology”, “Fundamentals of endoscopy in gynecology”
Owns full volume surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal approaches.

Adenomyosis is a condition in which the inner lining of the uterus (endometrium) grows into muscle layer uterus (myometrium). Adenomyosis may cause painful menstruation and , as well as . Adenomyosis can be nodular or diffuse, affecting almost the entire uterus.

Rice. 1. This is what adenomyosis looks like - ingrowth of the endometrium into the muscular layer of the uterus (myometrium)

Usually the only solution suffering that can cause adenomyosis- hysterectomy, that is, removal of the uterus.

However, many women with adenomyosis they do not want to lose their uterus, especially if a woman wants to maintain reproductive function. For women who want to get pregnant and have children, this is a terrible decision. However, unlike or simply fibroids, which can easily be removed while preserving the uterus, because there is a clear boundary between the tumor and the true uterine musculature, with adenomyosis there is no such border. The muscles of the uterus (myometrium) are completely saturated with endometriotic tissue, which greatly complicates the performance of organ-preserving surgery.

Rice. 2. MRI of a woman with extensive diffuse adenomyosis

Rice. 3. Temporary ligation uterine arteries before the procedure

The surgical procedure consists of radical removal of adenomyosis (1 cm of tissue is left above the endometrium and below the perimeter), followed by triple plasty with the remaining flaps. The operation is performed through a small transverse suprapubic incision. The length of the incision depends on the size of the uterus, since the uterus must be brought out into the wound from the abdominal cavity in order to adequately excise foci of adenomyosis and control bleeding. The enlarged uterus is cut in two with a scalpel midline to the uterine cavity with its opening (Fig. 4). Thus, the severity of adenomyosis becomes visible, and the most important landmarks - the endometrium and serous lining of the uterus are always in sight. The uterine cavity is opened wide enough to allow insertion index finger and help carry out high-quality excision of affected tissue. It is necessary to carefully monitor the mouths fallopian tubes so as not to damage them. The endometrium is sutured with interrupted sutures using 3-0 absorbable material. After this, the myometrial defect is closed using triple flaps of 2-0 absorbable material, as shown in the figure. Once the uterine repair is complete, the temporary clamping of the uterine arteries is stopped.

Rice. 4. Stages of Operation Siege

The results of the operation appear almost immediately - the severity of the pain syndrome decreases and menstrual bleeding. The likelihood of pregnancy increases. According to Dr. Osada, pregnancy was achieved in more than 50% of patients. Of course, such patients will subsequently need a cesarean section to avoid uterine rupture, but this is a small price to pay for a preserved uterus and the possibility of motherhood.

At the Center for Endovascular Surgery, Prof. Kapranov is undergoing treatment for adenomyosis. Experienced professionals help patients cope with various manifestations diseases. Therapy is carried out using modern techniques. OUR CENTER IS THE ONLY MEDICAL INSTITUTION IN RUSSIA, WHOSE SPECIALISTS HAVE EXTENSIVE EXPERIENCE IN THE FIELD OF INNOVATIVE ENDOVASCULAR TREATMENT OF ADENOMYOSIS.

Important! You can choose the clinic for therapy yourself. This allows us to take into account all wishes for treatment, room comfort, food, staff qualifications and other important factors.

Cost of the operation:

General information

For many years, adenomyosis, especially complicated by uterine fibroids in patients with heavy menstrual bleeding, was an indication for removal of the uterus - hysterectomy. Therefore, implementation in medical practice progressive methods and methods of treating pathology. Using data innovative approaches, it became possible to cure patients who have not yet fulfilled their reproductive function, but wish to have children. In addition, another group of women with extragenital pathology, can also undergo treatment for adenomyosis without risk to their health, because for many of them, the use of hormonal therapy or surgery to remove the uterus is impossible for medical reasons.

What causes the development of the disease?

For what reasons adenomyosis develops is not known exactly. Unfortunately, the basic mechanisms of pathology development are not fully understood to date. We can only say that adenomyosis is a hormonally dependent disease.

Its development is promoted by:

unfavorable heredity;

too early or late onset of menstruation;

obesity;

complicated childbirth;

abortions, curettage;

use of an intrauterine device, oral contraceptives;

inflammatory diseases of the reproductive system;

dysfunctional bleeding;

frequent infections;

allergic reactions.

Is pregnancy possible?

Adenomyosis is the second (after inflammatory diseases genital area) cause female infertility. The connection is obvious. Chronically worsening inflammation of the ovaries is caused precisely by internal endometriosis.

According to statistics, approximately 20-30% of patients lose their reproductive function.

Why does infertility occur?

In fact, there are several reasons. Let's look at the main ones:

Violation transport function fallopian tubes due to adhesions.

Pathological changes in hormonal sphere. They prevent ovulation.

Autoimmune reactions leading to sperm deactivation.

Termination of pregnancy at early stages. The pathology is associated with increased contractility of the endometrium.

Pain during sexual intercourse. Discomfort leads to the fact that a woman may refuse sex altogether.

Infertility is often caused by a number of reasons.

Main symptoms of the disease and stages of its development

In some cases, adenomyosis is asymptomatic.

Adenomyosis is detected only during an examination for suspected other pathologies.

Often the patient may note such signs of pathology as:

Abundant and long periods. Bleeding lasting more than 7 days should alert a woman.

Spotting (bloody) discharge. Typically, patients notice them in the middle of the cycle.

Discharge of clots during menstruation.

Pain in the lower abdomen during sex.

Severe pain in the middle of the cycle or during menstruation. Special attention deserves a character of discomfort. Pain in pathology is difficult to confuse with any other pain, as it is cramping and cutting.

With pathology, the uterus can increase 2-3 times. Thanks to this, even during initial examination a gynecologist can detect the disease.

Adenomyosis: degrees

Experts distinguish 4 degrees of the disease:

The endometrium is found in the submucosal layer.

The endometrium penetrates deeper. It can be found in the muscle layer. In this case, no more than 50% of this layer is affected.

Foci of the disease are found in the muscle layer and affect more than half of its thickness.

This degree is characterized by deep damage. The endometrium grows into all layers of the organ.

Forms of the disease

Focal adenomyosis. With this form of the disease, the endometrium forms separate islands (foci). Often the pathology is asymptomatic. With this pathology, the uterus is usually not removed.

Nodal. In this form of the disease, the endometrium forms separate nodes in the uterus. The pathology resembles fibroids. The endometrium can fill the uterus.

Diffuse. This form of the disease is characterized by the fact that the endometrium permeates the entire uterus.

Some women are diagnosed with several forms of the disease at once.

Risk group:

Women who have undergone childbirth (natural, by caesarean section).

Women who have undergone surgery to remove fibroids, for example.

All women over 35-40 years of age are also at risk.

Consequences of the disease

The pathology is not life-threatening. This is because it does not cause major changes. Nevertheless, bleeding can provoke anemia; severe pain significantly reduces the quality of life and leads to feelings of anxiety and depression. Often a woman becomes withdrawn. She tries to leave the house less often.

Important! You should undergo examination and begin treatment as soon as possible. Only in this case can all risks of the disease be prevented. You must consult a qualified physician. It will help cope with symptoms and get rid of tissue pathology in the shortest possible time.

Diagnosis of the disease

Have you detected at least one of the symptoms of pathology? Consult a doctor!

The gynecologist will conduct an examination. He will determine the need for a more thorough examination.

What research methods are used?

Ultrasound of the pelvic organs.

This examination is one of the most important. It allows you to exclude other diseases of the uterus and appendages.

The main signs of the disease on ultrasound include:

Heterogeneous structure of the endometrium.

An increase in the size of the uterus, a change in the shape of the organ.

The presence of various inclusions, cysts.

Thickening of the walls.

The diagnosis cannot be made based on ultrasound and physical examination alone.

MRI (magnetic resonance imaging)

This technique is expensive. Not all patients agree to undergo an MRI. Meanwhile, it is precisely this kind of diagnosis that makes it possible to clarify the structure of the muscular layer of the organ. The main signs of pathology include thickening, heterogeneity of the endometrium, and foci in it.

Hysteroscopy

This technique is used to exclude other causes uterine bleeding(polyps, malignant formations). During the examination, the doctor may take a tissue sample to examine it under a microscope (histology).

Hysterosalpinography and sonohysterography

These methods are used to exclude other diseases.

Does the disease need to be treated?

If the pathology does not threaten the woman’s life or does not cause serious concern, then the doctor can limit himself to preventing complications. In this case, no treatment is carried out. There is no need for it, since the pathology does not cause complications and does not interfere with a woman’s life.

Typically, treatment is not prescribed to women aged 45-50 years who are about to enter menopause.

Important! The treatment process is mandatory for all representatives of the fair sex who are planning a pregnancy and monitoring their health.

Treatment of the disease

Surgical treatment. Removal of nodes or nodes along with the uterus.

Drug treatment. Symptomatic and hormone therapy.

Let's consider both methods:

Operation. Doctors always try to carry out organ-preserving interventions. Laparoscopic techniques and excision of endometriotic lesions are usually used. Relatively recently, embolization of the uterine arteries was introduced into practice.

Therapy using drugs. Typically, patients are prescribed drugs that can slow down the growth of the endometrium and reduce the rate of its rejection. The doctor always chooses such remedies taking into account the patient’s condition. Specialists also take into account the woman’s plans regarding pregnancy. In addition to hormonal drugs, vitamins, immunomodulators, and sedatives may be involved in treatment. These funds are necessary to maintain the patient’s stable health condition.

When is surgery scheduled to remove the uterus?

In the absence of the effect of hormone therapy, the nodular form of the disease, its combination with other pathologies, ovarian tumors, it is prescribed surgery. Moreover, its form is always chosen by the attending physician. Only he can draw correct conclusions about the indications for surgery.

The uterus and ovaries are removed in the following cases:

progressive course of pathology in women over 40 years of age,

lack of effect of therapy,

combinations of several forms of the disease,

threats of malignant transformation.

How is the treatment carried out?

In the last five years, perhaps the most promising treatment method for adenomyosis used in modern medicine around the world, the so-called endovascular intervention, or uterine artery embolization (UAE), has become common practice. This type minimally invasive intervention is also actively used today in the treatment of fibroids. Of course, treatment should only be carried out by experienced professionals.

Today, Professor S. A. Kapranov and specialists from the Center for Endovascular Surgery have unique experience in Russia in the use of endovascular arterial embolization in the treatment of adenomyosis. All this makes it possible today to treat not only this disease, but also to combine methods of treating focal, diffuse and nodular forms of adenomyosis, uterine fibroids and endometrial pathology.

Indications for UAE are often uterine bleeding, which often leads to chronic iron deficiency anemia varying degrees gravity.

Before endovascular intervention (EMA), most of our patients, due to the presence of severe uterine bleeding, had to undergo multiple unpleasant procedures curettage of the uterine mucosa, many of them were prescribed ineffective hormonal therapy. As a result, women had to take strong hormonal drugs for a long time - from several months to 2 years. All this had little effect, in rare cases- up to 6 months, many of the patients were treated for adenomyosis to no avail.

The main advantages of the treatment method used

High efficiency. It is clinically confirmed. It is not in vain that the technique is used in the treatment of not only such diseases as adenomyosis, but also a number of others.

Minimal invasiveness. There is no need to make any incisions for the intervention. The doctor does not use general anesthesia.

Quick recovery. A woman can return to her normal life within a few days after the operation. In this case, long-term rehabilitation is not required. The patient spends only a few hours in the hospital. This time is enough to control her condition.

Minimal risks of complications. Development adverse consequences with EMA it is 1%.

At this stage, Professor S. A. Kapranov and his colleagues have developed and are actively implementing special methods for endovascular treatment of adenomyosis - staged and partial embolization of vessels, and carefully select the size of emboli taking into account individual characteristics the structure of the patient's blood vessels. Among other things, the use of only ultra-modern embolization drugs makes it possible to achieve enormous positive results in the treatment of women with adenomyosis.

With adenomyosis, which proceeded without concomitant diseases and complications, just a month after UAE, about 50% of patients report a complete disappearance of the symptoms of dyspareunia and algomenorrhea. It is noteworthy that already 3 months after undergoing UAE, the regular menstrual cycle is completely stabilized in 100% of patients, and 5 months after this operation there is a reduction in blood loss during menstruation to 48%, the level of hemoglobin in the blood significantly increases, and the duration of menstruation stabilizes by 37 %.

With all this, in patients in whom uterine adenomyosis was combined with fibroids, clinical effectiveness endovascular intervention averages 97%. Six months after UAE, the sensation of acute pain syndrome that was observed before surgery disappeared in 78% of patients and gradually stabilized. menstrual function and remained unchanged throughout the year.

When visiting a gynecologist, many women are diagnosed with a disease such as adenomyosis. The doctor does not always correctly explain what kind of disease it is and how seriously you need to take it. On early stages Conservative treatment can also help, but in advanced cases only surgical intervention is required.

What is adenomyosis?

Adenomyosis is a disease of the internal female genital organs, in which endometrial tissue grows into the muscular layer of the uterus. In affected areas muscle tissue becomes denser, causing the uterus to increase in size.

Adenomyosis was recently identified as separate disease. It is quite widespread nowadays among women. different ages, but often occurs after 25 years.

Forms of adenomyosis

According to the morphological picture, it is divided into 3 forms:

focal (endometrial tissue is embedded in the muscle layer only in some places, forming separate foci);
diffuse (uniform damage to the walls of the uterus);
nodular (muscle damage with the formation of nodes).

Based on the depth of penetration of endometrial tissue, it is customary to distinguish 4 degrees of adenomyosis:

I degree (only in the intermediate layer);
II degree (up to the middle of the muscle layer);
III degree (more than the middle of the muscle layer);
IV degree (damage to all layers and penetration into the abdominal cavity).

The first stages of adenomyosis respond quite well therapeutic treatment. Grades III and IV can only be treated surgically.

Symptoms

In half of the cases, this disease does not manifest itself at all. Among the visible symptoms, a woman may note:

long or, conversely, short menstruation, accompanied by pain and bleeding;
brownish spotting at the beginning and end of menstruation;
presence of clots in menstrual flow;
spotting and bloody discharge between menstruation;
premenstrual syndrome (PMS) is pronounced;
dyspareunia (pain during sexual intercourse).

The period of menstruation is accompanied by severe pain. Typically, simple painkillers are ineffective. With age painful sensations increase during menstruation.

Why does adenomyosis appear?

The exact causes of this disease are unknown. It is generally accepted that the causes may be factors whose impact leads to disruption of the barrier layer, namely:

surgical manipulation of the uterus (curettage, caesarean section, abortion);
various inflammations of the uterus or appendages;
hormonal imbalances;
genetic predisposition;
the presence of an intrauterine device;
frequent trips to the solarium;
non-intense sex life;
frequent overwork;
failure of the immune system due to frequent stress.

There are cases when adenomyosis is diagnosed in women who have not tolerated any interventions or diseases, as well as in very young girls. In such cases, it appears without the influence of various external factors. The cause of the disease may be a violation during intrauterine development fetus

The reason may be a weak opening of the cervix during menstruation in women, when it spasms and the muscles contract and contract in the uterus. high blood pressure. At this moment, the barrier layer located between the endometrial and muscle may be injured. In this case, the outflow of secretions is hampered, which, under the influence of pressure, are released in significant quantities into the abdominal cavity through the appendages, where particles of endometrial tissue are implanted - and endometriosis develops.

Diagnostic methods

This is what adenomyosis looks like on ultrasound

There are several methods by which adenomyosis is diagnosed. Some of them have a high cost, but only they allow you to deliver accurate diagnosis and choose the right treatment.

Ultrasound examination (ultrasound) - allows you to see the enlargement of the uterus, heterogeneous structure myometrium, blurring of the layers of the uterus, the presence of individual foci. The walls of the uterus may not be the same thickness.
Inspection on the chair using mirrors. The gynecologist can detect an enlarged uterus (“round uterus”).
Colposcopy - performed using special device video colposcope, which is used to examine the condition of the uterine cervix.
Hysteroscopy - several small incisions are made in the abdominal cavity, a small video camera is inserted through one, and instruments are inserted through the others. This method is used both for diagnosis and for surgical operations.
Laparoscopy - no incisions are made in the abdominal cavity, because the video camera and instruments are inserted through the vagina and uterine cervix. This method is used both for diagnosis and for performing operations for mild stages of uterine adenomyosis.
Magnetic resonance imaging (MRI) is rarely used in such diagnostics. MRI is prescribed only after an ultrasound scan, which does not provide a clear understanding of whether it is a nodular form of adenomyosis or fibroids.

Many women live with adenomyosis their entire lives.

...and they don’t even suspect that they have it. Therefore, do not be alarmed if, after an examination, the doctor makes this diagnosis. Perhaps only prevention is required.

After full diagnostics appointed necessary treatment. Adenomyosis cannot be completely cured. Can only be prevented further development disease and achieve regression until menopause, when regression occurs independently.

There are two treatment options - conservative (therapeutic) and surgical (operative).

Conservative treatment

It is carried out in the presence of a single small focus of adenomyosis in the body of the uterus. Gonadotropin-releasing hormone (GnRH) agonists are usually prescribed - drugs: Lucrin depot, Buserelin-depot Zoladex, etc. They cause temporary reversible menopause. After completing the course of treatment, the cycle will be restored. Chances of getting pregnant in women reproductive age increase significantly. If symptoms are mild, over-the-counter medications are suitable for treatment.

Adenomyosis often recurs. To stabilize the positive results after undergoing the main treatment, it is necessary to take hormonal contraceptives. As an option, it is recommended to install a Mirena intrauterine device. Hormonal contraceptives provide prevention of adenomyosis and also stop its progression in the early stages of the disease. It is better to use the drugs according to the 63 + 7 regimen (3 packs without a break, then a 7-day break and again taking 63 days).

Surgical treatment for adenomyosis

They begin surgical treatment if the full course conservative therapy, but no positive changes are observed, as well as in severe cases when foci of adenomyosis are multiple and extensive (nodular and diffuse forms) or adenomyosis is combined with other diseases of the uterus.

Indications for surgery for uterine adenomyosis:

diffuse or nodular forms;
absence positive result after 3 months of conservative therapy;
myometrial hyperplasia with adenomyosis II – III degrees;
adenomyosis is combined with fibroids, ovarian tumors, etc.;
endometriotic ovarian cysts;
suppuration of the uterine appendages;
availability somatic diseases in which long-term hormonal therapy is contraindicated;
adhesive process.

Surgical intervention for adenomyosis is carried out open method, by laparoscopy or hysteroscopy. The method of performing the operation is chosen by the doctor, taking into account the presence of concomitant diseases and contraindications. The severity of adenomyosis also matters.

If a woman of reproductive age is still planning a pregnancy, endometriotic tissue is removed, if possible, while preserving the uterus. A more radical approach is amputation of the uterus, sometimes with appendages. This method is used only when as a last resort, if nothing else helps. The operation is performed on postmenopausal patients or if a woman of reproductive age is no longer interested in maintaining menstrual and reproductive function.

Ablation– a method of treating adenomyosis, applicable when endometrial tissue has penetrated only into the intermediate layer. The procedure is carried out in several ways:

laser;
electric shock;
influence high temperature(balloon intrauterine therapy).

Uterine artery embolization - overlap blood vessels, feeding pathological foci with blood. In some cases it is an effective operation. After the procedure, a gradual decrease in lesions is observed.

Hysterectomy (removal of the uterus)- this is a radical measure. Apply different options uterine amputation:

removal of the uterine body;
removal of the uterus and cervix;
removal of the uterus from top part vagina and adjacent tissues supporting these organs.

Sometimes appendages (tubes and ovaries) or those infected with endometriosis are also removed. neighboring organs (gallbladder etc.).

With the development of medical technologies, uterine amputation operations for uterine adenomyosis began to be performed using the laparoscopy method. Vaginal hysterectomy avoids external scars. Often this operation is performed using a laparoscope, which makes it possible to establish visual control over the process. To insert it, a small incision is made on the abdomen. An incision is also made in the vagina near the uterus through which the uterus will be removed. For adenomyosis last stages This method is not suitable, because the uterus is usually greatly enlarged and there are various types of neoplasms, the most common of which are fibrous. In this case, direct (abdominal) access to the uterus is necessary when an incision is made on the abdomen.

With vaginal access, there is a risk of damage to the urethra, but patients’ recovery after surgery is quite quick, and with abdominal access, the risk of such damage is minimal, but recovery takes a long period.

It is important at what period of the patient’s life the operation was performed. If before the onset of menopause, and the appendages are removed, then the doctor mandatory prescribes hormone replacement therapy. And if both the uterus and cervix are removed, this can become a problem in having sexual intercourse, which is especially important for women who have not yet reached menopause.

Of great importance in rehabilitation is psychological assistance and support for women who have undergone surgery, so meetings with a psychologist are recommended for patients.

Prevention of adenomyosis

Women are often negligent about their health and do not attach importance to important negative symptoms, because of which the disease slowly but progresses. There are a number of recommendations, following which, you can avoid many diseases of the uterus - in particular, adenomyosis:

lead a measured lifestyle, do not overwork;
reduce excessive psycho-emotional load, if any;
do not get carried away with going to the solarium;
see a gynecologist twice a year.

Adenomyosis alone cannot lead to infertility, but it is often combined with other diseases of the uterus (fibroids, endometriosis) that lead to fertility. Therefore, women, while still young girls, should take care of their health.

Adenomyosis is a pathology in which pathological growth endometrium (inner layer of the uterus). How is adenomyosis treated? Is it possible to cure the disease without surgery?

General information about the disease

Adenomyosis is a special case of endometriosis. With this pathology inner layer the uterus grows more than it should be by nature. The endometrium penetrates into the thickness of the muscular and serous layer, interfering normal operation these structures. There are 4 stages of disease development:

Stage I – pathological process does not penetrate beyond the mucous membrane of the uterus;
Stage II – the endometrium grows into the muscle layer;
Stage III - the endometrium passes to the serous membrane;
Stage IV – involvement of other pelvic organs in the process.

This is how the diffuse form of the disease manifests itself. In the nodular form, a separate node is formed, consisting of an accumulation of pathological tissue. This condition is often confused with uterine fibroids - benign tumor myometrium.

The reasons for the development of adenomyosis are still not precisely known. It is assumed that the formation of the disease is influenced by the following factors:

unrealized reproductive function and postponed for for a long time first pregnancy;
hormonal imbalance V adolescence;
heredity.

Internal endometriosis occurs at any age. Both teenage girls and menopausal women suffer from this disease. Among patients with infertility, this diagnosis occurs in 30% of cases. Some women develop extragenital forms of endometriosis.

Symptoms

Let's look at the main symptoms of adenomyosis that allow us to suspect this disease:

Changes in the nature of menstrual bleeding.
The appearance of intermenstrual discharge.
Iron deficiency anemia.
Autonomic disorders.
Infertility.

Menstruation with adenomyosis becomes abundant, prolonged and painful. They are often accompanied by spotting brown two days before and for two to three days after the end of bleeding. Characterized by severe pain in the lower abdomen - nagging, debilitating pain radiating to the groin areas, internal surfaces hips, rectum, sacrum, lower back. Such pain occurs in the first days of menstruation (algomenorrhea).

Algodismenorrhea is characterized by an increase in the number of hygiene products; usually a woman uses several packages of sanitary pads during menstruation. She often instinctively refuses to use tampons. You shouldn’t be embarrassed to tell your doctor about this at your appointment, because this is often how the doctor can figure out the amount of blood loss.

Common adenomyosis causes irregular bleeding during the intermenstrual period - metrorrhagia. Their intensity varies, but they are usually painless.

Such significant blood loss leads to the development of chronic posthemorrhagic anemia. By its nature, it is iron deficiency and is associated with depletion of iron reserves, necessary for the synthesis of new red blood cells to replace those lost during bleeding. External manifestations iron deficiency anemia - pallor, dryness and sagging skin and mucous membranes, hair loss, early graying of hair, brittle and layered nails, weakness. The nervous system suffers. There is a tingling sensation in the tongue foreign body in the throat, making it difficult to swallow food.

Myocardial dystrophy develops - a malnutrition of the heart muscle, accompanied by heart rhythm disturbances and shortness of breath on exertion. One of the signs that allows one to suspect a lack of iron is a perversion of taste - a woman wants to eat chalk, lime, clay and other inedible substances. Sometimes there is a craving for the smell of gasoline or paint. This indirect signs adenomyosis, indicating its severe course.

Significantly reduces a woman’s quality of life and autonomic disorders with adenomyosis. They are manifested by nausea, vomiting, attacks of dizziness, headache and fainting. These signs are associated with hormonal and reflex processes in response to bleeding from endometriotic lesions. Vegetative manifestations most worry the patient in the first days of menstruation. They go away along with the pain after taking antispasmodic drugs.

A more rare symptom of adenomyosis is dyspareunia - pain during sexual intercourse. It is more typical for cervical endometriosis. When lesions grow into neighboring organs - bladder, rectum - possible disturbances in their functions (frequent urination mixed with blood, constipation or diarrhea, pain in the pelvic area).

One of dangerous consequences adenomyosis is infertility. It occurs due to dysfunction of the myometrium. If a fertilized egg is implanted into the wall of the uterus in the place where there is an extensive focus of endometriosis, it will not be able to receive full nutrition, and the chorion and placenta will not form. If the formation of these structures does occur, they will be defective, which will cause a delay in fetal development and the threat of miscarriage.

Often adenomyosis leads to the formation of adhesions in the uterine cavity. During fetal growth, they will interfere with its development. If the placenta forms at the site of a large focus of adenomyosis, in recent months this will be fraught with its premature detachment.

The following methods are used to diagnose the disease:

hysteroscopy;
endometrial biopsy;
laparoscopy.

Treatment methods

Treatment of uterine adenomyosis is complex process, which requires a lot of patience from the patient and her attending physician. IN in some cases doctors manage to cope with the disease conservative methods. This approach is justified in young women, when therapy for adenomyosis is one of the stages of infertility treatment.

Drug therapy

Drug treatment includes the following:

COCs (combined oral contraceptives);
gonadotropin-releasing hormone agonists;
progestogens;
aromatase inhibitors.

The choice of treatment method will depend on the patient’s age, the severity of her condition and the individual characteristics of the body. Treatment of internal endometriosis in stages I and II of the disease is usually not carried out. To alleviate the condition, anti-inflammatory drugs are prescribed to relieve pain during menstruation. It is possible to use antispasmodics with moderate pain syndrome.

For the treatment of adenomyosis I and II in young patients suffering from infertility, oral contraceptives can be used. These drugs stabilize hormonal background and suppress excessive growth of the endometrium. Gonadotropin-releasing hormone agonists are prescribed for the same purpose. The course of therapy lasts from 3 to 6 months. After completion of treatment, it is recommended to plan pregnancy in the next cycle.

Not all women tolerate hormone treatment well. While taking agonists, many patients develop the so-called false menopause. This condition is associated with the temporary shutdown of the ovaries and is accompanied by a number of unpleasant symptoms. Hot flashes, insomnia, mood swings, increased sweating and others typical manifestations No woman enjoys menopause.

To eliminate such unpleasant symptoms, cover therapy is used. Its essence is to use medicines, eliminating the main manifestations of false menopause. Unfortunately, even the most modern means are not able to completely rid a woman of the side effects of agonists. Doctors often have to interrupt the course of therapy and decide whether to use other treatment methods.

There is now great debate about the advisability of using gestagens. It is believed that these drugs themselves are capable of stimulating the progression of the disease. In this regard, in recent years emphasis is placed on the development of new agents (eg, aromatase inhibitors). You can discuss the possibilities of using a particular drug with your doctor.

Non-drug methods

From the perspective evidence-based medicine application non-drug therapy for the treatment of adenomyosis does not make sense. Massage or physiotherapy does not bring noticeable relief and does not affect the course of the disease. For the same reason, adenomyosis is not treated with folk remedies. It is impossible to cure internal endometriosis with herbs and lotions.

Surgical treatment

Adenomyosis at any age is often accompanied by heavy bleeding, threatening the life and health of a woman. If this condition develops, the patient is hospitalized in gynecological hospital on an emergency basis.

The main method of stopping bleeding is curettage of the uterine cavity. The procedure is performed under general anesthesia. During the operation, the doctor removes a layer of the overgrown endometrium, thereby stopping blood loss. The resulting material is sent to histological examination. If technically possible, hysteroscopy is performed simultaneously (examination of the uterine cavity using special tool).

Episodes heavy bleeding can be repeated many times throughout life. Blood loss can be quite significant, which seriously complicates the life of any woman. At long term In case of illness and ineffectiveness of the treatment, removal of the uterus is indicated.

During the reproductive period, subtotal hysterectomy is predominantly performed. During this operation, only the uterus is removed, while the cervix remains in place. Radical hysterectomy (removal of the uterus along with the cervix) is recommended during menopause, as well as when adenomyosis is combined with cervical endometriosis.

Rehabilitation after surgery takes from 2 to 8 weeks. After laparoscopic procedures, recovery takes much less time. IN postoperative period Physiotherapy and other procedures are prescribed to ensure a speedy return to normal life.