Adenomyosis is a non-neoplastic lesion of the uterus, but many symptoms and signs are very similar to uterine fibroids. Adenomyosis is a diffuse or localized lesion caused by the invasion of endometrial glands and stroma into the myometrium. In the early stage, the bleeding of these ectopic endometrial tissues directly enters the myometrium, causing pain. With the accumulation of blood, the surrounding muscles swell and swell and form fibrous tissue. This swelling is located in the myometrium of uterus, which is called adenomyoma, because it feels like a myoma during ultrasound examination and is often confused with myoma of uterus. Adenomyosis can have mild symptoms or no symptoms at all, and there will be patients with very severe symptoms, which may lead to severe bleeding and severe dysmenorrhea. About 10% of women have adenomyosis, so it&;s not as common as hysteromyoma, but there are also reports that 70% of women aged 40-50 have adenomyosis. If it is only found by imaging examination without symptoms, follow-up observation can be made without urgent treatment. The etiology of adenomyosis The etiology of adenomyosis is still unknown. Experts believe that the possible reasons include: 1. Implanted tissue growth. Some experts believe that adenomyosis originates from the direct implantation of endometrial tissue cells into the muscular layer from the endometrium. Some uterine operations, such as caesarean section and abortion, may directly implant endometrial cells into the uterine muscle wall. 2. The origin of development Other experts speculate that adenomyosis originated from the female fetal period when the uterus was formed, and some endometrial tissues were deposited in it when the myometrium was formed. 3. Uterine inflammation related to childbirth Another theory shows the relationship between adenomyosis and childbirth. Inflammation of the endometrium after delivery may lead to the rupture of normal tissue level and the implantation of endometrium. 4. The Origin of Stem Cells A recent theory holds that bone marrow stem cells may invade uterine muscles and cause adenomyosis. No matter how adenomyosis is formed, its growth depends on the secretion of periodic hormones in women. After menopause, estrogen production decreases, and adenomyosis will eventually disappear. Clinical manifestations of adenomyosis 1. Symptoms Sometimes adenomyosis has no symptoms or slight discomfort, and some patients have more serious symptoms. (1) Disorder: It is mainly manifested by prolonged menstrual period, disorder and increased amount. Severe patients can lead to anemia. (2) Dysmenorrhea: severe colic or knife-like pain, which lasts for the whole menstrual period and gets worse with age. This is usually the main reason for patients to seek medical treatment. The focus located in the posterior wall of uterus is often accompanied by the feeling of door heaving during menstruation. Taking analgesic drugs in the early stage of dysmenorrhea can relieve it, but as the disease progresses, the dosage of analgesic drugs needed for dysmenorrhea increases obviously, which makes patients unable to tolerate it. With the progress of the disease, dysmenorrhea will be prolonged until the non-menstrual pain persists. The pain part will also be generalized, and I feel pain outside the uterine cavity. (3) Pain: It affects the normal life of husband and wife, and even becomes the inducement of divorce. (4) Bleeding between menstrual periods. 2. Signs Gynecological examination The uterus is enlarged to 2-3 times of normal. Near the menstrual period, the uterus feels tender. Although you may not know that your uterus is enlarged, you may notice that your lower abdomen seems to be moreOr have a feeling of flexibility. About half of patients with adenomyosis are complicated with hysteromyoma. The diagnosis of adenomyosis can be made according to the typical medical history and physical signs. Combined with imaging examination, such as pelvic cavity or B-mode ultrasound, MRI, CA125, etc., it can be diagnosed. The final diagnosis needs to obtain pathological examination of diseased tissues through surgery. 1. Imaging examination is the most effective means to diagnose this disease before operation. Ultrasound has a sensitivity of 80% and a specificity of 74%, which is more accurate than abdominal probe. In adenomyosis, B-ultrasound showed that the uniformity of uterus increased and the echo was uneven. In adenomyoma, B-ultrasound showed that the uterus was unevenly enlarged, locally raised, and the lesion was heterogeneous and hyperechoic. MRI can objectively understand the location and scope of the lesion before operation, which is helpful to determine the treatment method. MRI of diffuse adenomyosis showed diffuse thickening of the uterine junction zone on T2WI. On T2WI, localized adenomyosis showed a low signal mass shadow similar to that of the binding band, and the boundary was blurred. 2. Serum CA125 level in some patients with adenomyosis is increased, which has certain value in monitoring curative effect. There are many treatments for adenomyosis, and the clinical decision-making should be individualized according to the patient&;s age, symptoms and fertility requirements. It can be selected at the same time as the surgical drug treatment plan. 1. Drug therapy: Symptomatic treatment is for those who have mild symptoms and only need to relieve dysmenorrhea. You can choose to give symptomatic treatment with non-steroidal anti-inflammatory drugs such as Fenbid, indomethacin or naproxen during dysmenorrhea. Hormone therapy: Patients with obvious dysmenorrhea can be treated with hormones, such as levonorgestrel-releasing intrauterine device (trade name: Manyuele), aromatase inhibitor and hormone analogue. 2. Surgical treatment Surgical treatment includes radical surgery and conservative surgery. Radical surgery is hysterectomy, while conservative surgery includes excision of adenomyosis focus (adenomyoma), excision of endometrium and myometrium, electrocoagulation of myometrium, uterine artery occlusion, presacral nerve resection and sacral nerve resection, etc. Hysterectomy: It is suitable for patients who have no fertility requirements, and have extensive lesions, severe symptoms, and ineffective conservative treatment. Moreover, in order to avoid residual lesions, total hysterectomy is the first choice, and partial hysterectomy is generally not recommended. Usually, adenomyosis is a diffuse or localized lesion caused by the invasion of endometrial glands and stroma into the myometrium, which is very similar to endometriosis and belongs to gynecological frequently-occurring and difficult diseases. Adenomyosis mostly occurs in multiparous women between the ages of 30 and 50, but also in young childless women, which is mostly related to the increasing number of uterine cavity operations.