Post Date August, 26 2023
Adenomyosis is a disease of the female uterus that requires our attention, especially in terms of its harm and timely and reasonable treatment.
Can adenomyosis of the uterus lead to pregnancy
Whether Adenomyosis leads to infertility has not been clearly determined. Adenomyosis is often associated with Endometriosis, and fertility function decreases. The reason of infertility caused by Adenomyosis may be the combination of Endometriosis, the adhesion of lesion site, and the obstruction of egg picking and transportation function in serious cases. At the same time, the autoimmune reaction caused by Endometriosis will affect sperm activity. It is generally believed that severe Adenomyosis, especially in patients with Endometriosis, is easy to cause infertility. This type of patient has a thick uterus and is prone to pelvic adhesions, which is not conducive to ovulation and embryo implantation, and the natural pregnancy rate is not high.
The above is a representative point of view. In general, the pregnancy rate of patients with Adenomyosis is lower due to changes in the Internal environment of the uterus, which is easy to understand. Patients with Adenomyosis can become pregnant after proper treatment. Here the author reminds medical staff and patients that due to the special performance of patients with Adenomyosis, whether patients with Adenomyosis are pregnant must be carefully judged to avoid missed diagnosis.
Hazards of Adenomyosis
1. Infertility: In recent years, with the widespread use of uterine cavity manipulation techniques, some young women have also developed infertility between the ages of 16 and 30, and women of reproductive age have also experienced infertility.
2. Excessive menstruation: Regarding the causes of excessive menstruation, from a traditional perspective, an increase in uterine volume and endometrial area can increase the chance of bleeding. However, currently, clinical observations of adenomyosis often show that the uterus is smaller than 3 months pregnant.
3. Dysmenorrhea: Dysmenorrhea is accompanied by sexual deterioration, discomfort symptoms such as menstrual abnormalities, infertility, sexual pain, pelvic pain, low fever, increased vaginal discharge, and physiological pain. The reason for dysmenorrhea is that the ectopic endometrium bleeds with changes in the ovaries, and the local pressure outside the lesion increases. The surrounding smooth muscle tissue is stimulated, causing spasms and contractions, resulting in pain.
4. Uterine enlargement: Gynecological examinations often reveal uterine enlargement, which occurs during or before menstruation and gradually decreases in size in the future. However, if it does not exceed the size of 3 months of pregnancy, if it exceeds 3 months, it often indicates complications.
Treatment of adenomyosis of the uterus
1. Medication treatment:
(1) Symptomatic treatment: those who have mild symptoms and only need to relieve dysmenorrhea can choose to take Nonsteroidal anti-inflammatory drug such as fenbid, indomethacin or Naproxen during dysmenorrhea.
(2) Pseudo pregnancy therapy: For patients with mild symptoms, no fertility requirements and near menopause, oral contraceptives or Progestogen can make ectopic endometrium deciduate and shrink and control the development of Adenomyosis.
(3) Intrauterine device: For those with heavy menstruation, dysmenorrhea, and no fertility requirements temporarily, they can choose a device containing highly effective Progestogen, which can control the development of ectopic lesions by continuously releasing Progestogen in the local uterus. It needs to be taken out or replaced five years later.
(4) Pseudomenopausal therapy: medication that reduces the size of the lesion before surgery and reduces recurrence after surgery. Injecting GnRHa causes hormone levels in the body to reach a menopausal state, thereby gradually shrinking the ectopic endometrium and playing a therapeutic role. After applying GnRHa, the uterus can be significantly reduced and can be used as a preoperative medication for some patients with larger lesions and difficult surgery. After the uterus becomes smaller, the risk and difficulty of surgery significantly decrease. Side effects can lead to menopausal symptoms and even serious cardiovascular and cerebrovascular complications, as well as osteoporosis. Therefore, it is recommended to use GnRHa for 3 months and add estrogen in reverse to alleviate the complications. In addition, due to the high cost of GnRHa, it is currently not a long-term treatment option, and menstrual recovery after discontinuation may lead to further progression of the disease.
(5) Traditional Chinese medicine treatment: Traditional Chinese medicine believes that Adenomyosis is related to blood stasis, and the formation of blood stasis is related to qi deficiency, condensation, qi stagnation, phlegm and dampness. Therefore, in terms of treatment, it is necessary to adhere to the principle of promoting blood circulation and resolving stasis, taking into account the reasons for the formation of stasis and the differences between deficiency and excess. Traditional Chinese patent medicines and simple preparations such as Huazheng Zhitong Granules, Sanjie Zhentong Capsules, Dan'e Fukang Decoction, Shaofu Zhuyu Pills, or decoction drugs adjusted according to individual conditions, are delicious. Traditional Chinese medicine for promoting blood circulation and resolving stasis can also retain enema, pasting, and ion introduction of Danshen injection. You can also use acupuncture and moxibustion at Guanyuan, intermediate, Hegu, Sanyinjiao and other acupoints or ear acupuncture at uterus, endocrine, liver and other acupoints before and on physiological days.
2. Surgical treatment: Surgical treatment includes radical surgery and conservative surgery. The radical operation is Hysterectomy, and the conservative operation includes adenomyosis furnace (Adenomyoma) resection, endometrial and myometrial resection, Myometrium coagulation, uterine artery resection, anterior sacral nerve resection, sacral nerve resection, etc.
(1) Hysterectomy: It is applicable to patients with no fertility requirements, extensive lesions, severe symptoms, and ineffective Conservative management. In addition, in order to avoid residual lesions, priority is given to the removal of the entire uterus, and it is generally not recommended to remove a portion of the uterus.
(2) Focal resection of Adenomyosis: applicable to young patients with fertility requirements. Because the focus of Adenomyosis is often diffuse and the boundary between adenomyosis and normal uterine muscle tissue is not clear, how to choose the way of resection to reduce bleeding, residual and conducive to postoperative pregnancy is a thorny problem.
3. Interventional therapy: Selective uterine artery embolization is also one of the programs for the treatment of Adenomyosis. Its mechanism of action is the establishment of collateral circulation of endometrium with necrosis of ectopic endometrium, reduction of Prostaglandin secretion, relief of dysmenorrhea, reduction of menstruation, and reduction of recurrence rate. The basal layer can gradually move, grow, and recover its function. However, uterine artery embolization can affect the blood flow of the uterus and ovaries and have adverse effects on pregnancy. May lead to increased infertility, miscarriage, premature birth, and cesarean section.
Dietary Precautions for Adenomyosis
1. Eating a light diet and avoiding seafood such as lamb, shrimp, crabs, eels, salted fish, and black fish.
2. Avoid spicy foods and drinks such as pepper, green pepper, onion, garlic, Baijiu, etc.
3. Longan, jujube, ass hide glue, Royal jelly and other hot, coagulative and hormonal foods
4. Strictly avoid foods related to animal reproductive systems and foods containing hormones (including processed and natural foods). This includes dairy and its products, eggs, and animal meat raised with hormones.
5. Avoid plant-based foods such as pomegranates, sweet potatoes, radishes, and legumes.
