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Focal adenomyosis

Focal adenomyosis is a form of adenomyosis in which endometrial cells (the inner layer of the uterus) invade the myometrium (the muscle layer of the uterus) in discrete foci or pockets, resulting in thickening of the uterine tissue. This condition may be less common than diffuse adenomyosis, but it can also have a serious impact on a woman's health.

Symptoms of focal adenomyosis:

Lower abdominal pain, especially during menstruation, which can be intense and prolonged.
Irregular menstruation, sometimes with prolonged or heavy bleeding.
Pain during intercourse.
Pain when palpating the uterus during a gynecological examination.
Infertility or difficulty conceiving due to uterine dysfunction.
In some cases, an enlarged uterus.

Causes of focal adenomyosis:

The main risk factors for the development of focal adenomyosis include:
Hormonal changes, including increased estrogen levels.
Trauma to the uterus, including after a cesarean section or other surgical procedures.
Frequent pregnancies and childbirth, as well as late menopause.
Heredity.
Chronic inflammation or infection of the uterus.

Diagnosis of focal adenomyosis:

Diagnosis of focal adenomyosis can be difficult due to the lack of obvious symptoms in the early stages of the disease, so it is important to undergo a series of examinations:

Gynecological examination: The doctor palpates the abdomen and uterus to detect changes in its size or painful areas.
Ultrasound examination (USG): Helps to detect possible changes in the uterus, such as the formation of foci in the myometrium, thickening of the uterine walls, or other abnormalities.
Magnetic resonance imaging (MRI): The most accurate method for detecting focal adenomyosis, as it allows you to clearly assess the size and localization of foci in the myometrium.
Hysteroscopy: Used to examine the inner surface of the uterus, which allows you to clarify the diagnosis and exclude other diseases.
Laboratory tests: Complete blood tests to assess hemoglobin levels (to detect anemia) and hormonal tests to assess estrogen levels and other important indicators.

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Treatment of focal adenomyosis:

Treatment of focal adenomyosis depends on the severity of the disease and symptoms:

Medication:

Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
Hormonal drugs: Progestins, oral contraceptives, hormonal spirals (Mirena), gonadotropin-releasing hormone (GnRH) agonists, which help reduce estrogen levels and, as a result, reduce the development of foci.
Analgesics to reduce pain.

Surgical treatment:

Laparoscopy to remove endometriosis foci or reduce their size.
Hysterectomy (removal of the uterus) in case of severe disease, if other methods are ineffective, and if the patient no longer plans to become pregnant.

Prevention:

The prognosis of focal adenomyosis depends on the size of the foci, their location, and the presence of complications. Early detection of the disease and timely treatment significantly improve prognosis.

How is the consultation for suspected focal adenomyosis?

Initial examination: The doctor asks the patient about symptoms: pain during menstruation, duration and nature of bleeding, pain during intercourse and other problems that concern her.
Medical history assessment: It is important to find out about the presence of chronic diseases, previous surgeries, uterine injuries, abortions and other risk factors.
Gynecological examination: The doctor palpates the uterus to detect its enlargement or painful areas.
Diagnostic procedures: After examining and collecting anamnesis, the doctor may refer for ultrasound, MRI or hysteroscopy for a more accurate diagnosis.
Discussion of the treatment plan: After analyzing the diagnostic results, the doctor draws up an individual treatment plan, which may include drug therapy or surgery.

Treatment of focal adenomyosis requires an individual approach, and timely consultation with a gynecologist allows you to effectively control the disease and reduce the risk of complications such as infertility or chronic pain.