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Uterine fibroids with adenomyosis

Uterine fibroids with adenomyosis are the simultaneous presence of two diseases: myoma (benign uterine tumor) and adenomyosis (penetration of endometrial tissue into the muscular layer of the uterus). This is a fairly common combination, and although myoma and adenomyosis have different mechanisms of development, they can mutually complicate each other's course.

Causes and mechanisms of development:

Both diseases, myoma and adenomyosis, often appear against the background of hormonal disorders, in particular increased estrogen levels. They can develop independently of each other, but the presence of one of them increases the risk of developing the other.

Main risk factors:

Hormonal disorders: Increased estrogen levels are the main cause of the development of both myoma and adenomyosis.
Age of the woman: Both diseases usually develop in women of reproductive age, especially after 30 years.
Previous gynecological surgeries: For example, abortions or cesarean sections can contribute to the development of adenomyosis and also increase the likelihood of developing fibroids.

Symptoms of uterine fibroids and adenomyosis:

The clinical manifestations of both conditions can overlap, so it is important to identify each separately for a correct diagnosis. The main symptoms include:
Lower abdominal pain: The pain is usually more pronounced during menstruation, which is why women often experience severe pain with fibroids and adenomyosis at the same time.
Irregular menstruation: Fibroids can cause an increase in the duration of menstruation or bleeding between menstruation, and adenomyosis can aggravate these symptoms.
Menorrhagia (heavy menstruation): Fibroids can cause excessive bleeding, and adenomyosis can increase the volume of menstruation.
Infertility or difficulty conceiving: Both fibroids and adenomyosis can cause fertility problems, although the mechanisms of their effects are different.
Pain during intercourse: Both fibroids and adenomyosis can cause pain during intimacy.

Diagnostics:

The following methods are used to diagnose uterine fibroids in adenomyosis:

Ultrasound (US): This is the most accessible method for detecting fibroids and assessing the structure of the uterus, as well as for determining possible changes in uterine tissues in adenomyosis.
Magnetic resonance imaging (MRI): Provides an accurate picture of the localization of the fibroid, its size and interaction with surrounding tissues. MRI also allows you to assess the degree of adenomyosis.
Hysteroscopy: Allows you to examine the inner surface of the uterus and detect changes that are characteristic of adenomyosis and fibroids.
Laparoscopy: Used if necessary to clarify the diagnosis or to perform operations.

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Treatment of uterine fibroids with adenomyosis:

Treatment of the combination of these two diseases is usually individual and depends on the severity of symptoms, the woman's age, her plans for children and her general health:

Medication:

Hormonal drugs: To reduce symptoms and stop the growth of fibroids and endometrial tissue. These can be contraceptives, hormonal spirals (Mirena), progestins or drugs that block the production of estrogen (gonadotropin-releasing hormone agonists).
Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.
Analgesics: To relieve menstrual pain.

Surgical treatment:

Laparoscopy: Used to remove fibroids or reduce endometrial foci in adenomyosis.
Hysterectomy (removal of the uterus): A last resort in cases of severe disease or if other treatments are ineffective.
Uterine artery embolization: A method that reduces the size of fibroids by restricting their blood supply.

Prevention:

Regular gynecological examinations and timely treatment of hormonal disorders can help prevent the development of fibroids and adenomyosis or reduce the risk of their complications. Maintaining normal hormonal balance is important for the prevention of these diseases.
Uterine fibroids with adenomyosis can significantly affect a woman's quality of life, so it is important to consult a doctor in a timely manner for diagnosis and selection of the optimal treatment method.

How is the consultation for uterine fibroids and adenomyosis?

Consultation for suspected simultaneous presence of uterine fibroids and adenomyosis usually includes several stages for an accurate diagnosis and determination of the optimal treatment.

1. Initial examination

The gynecologist conducts a detailed interview of the patient to find out the symptoms and medical history.
The main questions include:
The nature of menstruation: duration, volume, presence of pain.
Whether there is pain in the abdomen or lower abdomen, especially during menstruation or sexual intercourse.
The presence of irregular bleeding between menstruations.
Problems with fertility or difficulty getting pregnant.
Previous surgeries on the uterus (for example, abortions, cesarean section).

2. Gynecological examination

The doctor palpates the abdomen and uterus to detect painful areas, uterine enlargement or the presence of seals, which may be characteristic of fibroids.
Determining the size and shape of the uterus, as well as the presence of painful areas.
Detecting changes in the cervix or its walls that may indicate the presence of diseases.

3. Diagnostic procedures

To clarify the diagnosis, the doctor prescribes additional examinations:
Ultrasound examination (US): To detect changes in the structure of the uterus, the presence of fibroids and signs of adenomyosis, such as thickening of the uterine wall or changes in its texture.
Magnetic resonance imaging (MRI): For a more detailed assessment of fibroids, their size, location and interaction with surrounding tissues. MRI also allows you to detect the depth of penetration of endometrial foci in adenomyosis.
Hysteroscopy: A method that allows you to examine the uterine cavity using a special camera to detect changes on the inner surface of the uterus, characteristic of adenomyosis and fibroids.
Laboratory tests: Complete blood tests to detect anemia, hormone tests, as well as tests to detect infections that can cause symptoms similar to these diseases.

4. Discussion of the treatment plan

After collecting all the necessary information and diagnostic results, the doctor presents the patient with treatment options. This may include:
Medical treatment: The doctor may prescribe hormonal drugs to control symptoms and stop the growth of fibroids and endometrial lesions, as well as painkillers to relieve pain.
Surgical treatment: If medical treatment does not work or the disease progresses, laparoscopy may be recommended to remove the fibroids or reduce the endometrial lesions. In difficult cases, a hysterectomy (removal of the uterus) may be recommended.
Uterine artery embolization: This method is used to reduce the size of fibroids by cutting off their blood supply.

5. Preparation for treatment

After determining the treatment plan, the doctor explains how to properly prepare for the prescribed therapy or surgery:
If medical treatment is required, the doctor provides instructions on taking medications, possible side effects and indicators for monitoring.
If surgery is prescribed, the patient is given recommendations for preparing for the procedure: tests, restricting food and fluid intake before surgery, consultations with an anesthesiologist, etc.

Consultation is an important part of the diagnosis and treatment of uterine fibroids and adenomyosis, as it allows for an accurate determination of the stage of the disease, possible treatment options, and the selection of the most effective and safest method for the patient.