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Diffuse adenomyosis

Diffuse adenomyosis is a form of adenomyosis in which endometrial (the inner layer of the uterus) tissue grows throughout the myometrium (the muscle layer of the uterus) without clearly defined areas. This is more common and is usually more difficult to treat because the uterine involvement is diffuse, making it less clear to detect and treat.

Symptoms of diffuse adenomyosis:

Lower abdominal pain, often worse during menstruation.
Irregular menstruation or bleeding between menstruations.
Increased volume and duration of menstruation.
Pain during intercourse.
Infertility or difficulty conceiving.
In some cases, a change in the shape or enlargement of the uterus.

Causes of diffuse adenomyosis:

Causes of diffuse adenomyosis are similar to other forms of this disease and include:
Hormonal changes, particularly elevated estrogen levels.
Uterine trauma, such as cesarean section or other surgeries.
Heredity.
Frequent pregnancies and childbirth.

Diagnosis of diffuse adenomyosis:

Diffuse adenomyosis can be more difficult to diagnose because there are no clear, demarcated areas of involvement. The main diagnostic methods include:
Ultrasound (US): Ultrasound can help determine if the uterus is enlarged and if there are any changes in its structure.
Magnetic resonance imaging (MRI): This is the most accurate method for detecting diffuse adenomyosis because it allows for an accurate assessment of the extent of myometrial involvement.
Hysteroscopy: Used to evaluate the inner lining of the uterus and to rule out other conditions such as polyps or fibroids.

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Treatment of diffuse adenomyosis:

Treatment of diffuse adenomyosis is usually complex and may include:

Medical treatment:

Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain.
Hormonal drugs, such as progestins, oral contraceptives, hormonal spirals (Mirena), as well as drugs that block the production of estrogen.
Gonadotropin-releasing hormone (GnRH) agonists - to temporarily stop menstruation and reduce symptoms.

Surgical treatment:

Laparoscopy can be used to remove endometriotic foci.
Hysterectomy (removal of the uterus) - in the most severe cases, when other treatments are not effective, and if the patient no longer plans to have children.

Prognosis:

The prognosis for diffuse adenomyosis depends on many factors, such as the extent of the disease, the woman's age, and the presence of comorbidities. This disease can significantly affect the quality of life, especially in the case of chronic pain and infertility. Timely diagnosis and proper treatment can significantly improve a woman's condition and preserve reproductive health.

How is the consultation for suspected diffuse adenomyosis?

Initial examination: The doctor conducts a detailed conversation with the patient, asking about the symptoms: pain during menstruation, duration and nature of bleeding, pain during intercourse, other manifestations of the disease.
Medical history assessment: The doctor finds out the presence of chronic diseases, previous surgeries, the presence of gynecological diseases such as endometriosis, as well as their impact on the patient's health.
Gynecological examination: The doctor palpates the abdomen and uterus to detect changes in its size or tenderness. If necessary, the presence of painful areas is determined during palpation of the uterus or its walls.

Diagnostic procedures:

Ultrasound examination (USG): Used to detect possible changes in the uterus, such as thickening of the walls or changes in the structure of the tissues.
Magnetic resonance imaging (MRI): Provides a more accurate picture of the extent of the disease and the depth of penetration of endometriotic foci into the myometrium.
Hysteroscopy: Examination of the uterus using a special camera to detect the presence of polyps or changes on the inner surface of the uterus.
Laboratory tests: Include complete blood counts (to detect anemia), hormone tests, and tests for infections that may have similar symptoms.

Discussion of the treatment plan: After receiving the diagnostic results, the doctor presents the patient with a treatment plan. This may be drug therapy (hormonal drugs, anti-inflammatory drugs) or surgery. The doctor discusses possible surgical options, if necessary, and also provides information about the pros and cons of each method.

Preparation for treatment: If drug treatment is prescribed, the doctor explains how to take the medication correctly and what side effects to look out for. If surgery is required (for example, laparoscopy or hysterectomy), the patient undergoes additional examinations and consultations with an anesthesiologist. The doctor gives recommendations on preparation for surgery: restriction of food and fluid intake, performance of certain tests and examinations before surgery.

Consultation is an important stage in the treatment of diffuse adenomyosis, as it allows to accurately determine the need for laparoscopy or other treatment methods and prepare the patient for surgery, ensuring maximum comfort and minimal risks.