In women, a diffuse change in the myometrium occurs quite often. This pathological process is called endometriosis, or adenomyosis. Among all the gynecological diseases, this ailment in terms of prevalence gives way only to uterine myoma and inflammatory diseases.
The onset of pathology
Diffuse changes in myometrium (average muscle layer of the uterus) are manifested by the growth of the endometrioid tissue. Why this happens, no one knows for sure. However, hormonal disorders are of great importance in this process - an increase in the level of estrogen (female sex hormones) and a decrease in progesterone. First it leads to a significant expansion of the functional endometrial layer, then to its rejection, which is accompanied by intensive bleeding. The cells of the rejected shell penetrate in an unexplained manner through the basal layer of the endometrium (it is believed that heredity is important in this process) and begin to germinate in myometrium, permeating it through and through. To foreign cells successfully sucked into any tissue, there should be a violation of immunity, so it always accompanies endometriosis.
Diffusive changes in the uterine myometrium
The disease manifests itself by thickening the uterine wall to four to five centimeters, but, if it develops already in the elderly, the wall thickens slightly. Endometrioid cells permeate the tissue of the myometrium, as a result of which it becomes pale pink and acquires a cellular structure. Sometimes in the muscle layer endometrioid cysts are found along with bloody contents. In the thickness of the uterine wall, foci of tissue develop, formed by glands of different shapes and sizes.
Degrees of the pathological process
Diffuse change in myometrium does not always occur in the same way, it all depends on the speed and depth of the endometrioid tissue along the muscular layer of the uterus. Often the disease proceeds asymptomatically, especially at the initial stages.
There are three degrees of endometriosis:
The first degree - the inner layers of the myometrium, adjacent to the basal layer, germinate at a shallow depth; The criterion is the magnitude of the field of view in the case of a small increase in the microscope.
The second degree - the endometrioid tissue sprouts up to the middle of the muscular uterine membrane.
The third degree - the endometrioid tissue sprouts up to the serous (external) uterine membrane, that is, the entire myometrium is permeated with this tissue.
Some specialists now offer a somewhat different classification and distinguish four degrees of adenomyosis. In this case, the third degree is characterized by the germination of the endometrioid tissue to a depth that is equal to two-thirds of the myometrium, and the fourth degree means complete penetration of the muscle layer by endometrioid cells.
Symptoms of diffuse changes in myometrium
At the initial stages of the pathological process (at the first and partly second degrees of spread), symptoms are usually not observed. The thickness of the uterine wall can thus increase very slightly, so it is often difficult to identify the ailment. In a large number of women, a diffuse change in the myometrium lasts for years without progressing, and they do not even suspect the existence of the disease. Pathology under favorable circumstances throughout life can not be manifested. However, there are a number of factors that can provoke the activation of the process. These include all kinds of trauma to the uterus, for example, due to severe labor, diagnostic curettage, abortion. This all can lead to intensive germination in the muscular layer of the uterus of the endometrioid tissue.
Diffuse change in myometrium with a significant spread begins to show strong uterine bleeding and pain. Usually they occur against the background of an extended cycle of menstruation. With the passage of time, acyclic bleeding may also occur. As a result, iron deficiency anemia develops, manifested by apathy, dizziness, lethargy, headaches, drowsiness, fainting. Such anemia can not be cured until blood loss is eliminated.
The pains are cyclical - two to three days before menstruation appear in the lower abdomen and persist for several days after their onset. The emergence of pain is due to the fact that the tissues swell and squeeze the nerve endings in the uterine wall. Painful sensations can be aching and paroxysmal, giving into the perineum, waist, or thigh area. Discomfort can also occur during gynecological manipulations, sexual contacts, hygiene procedures, such as syringing.
Treatment of endometriosis
There are two main methods of treatment:
1) hormonal therapy (not always effective);
2) surgical intervention ("cauterization" of affected areas is performed).