We’ve all heard about endometriosis, 子宫内膜一种子宫内膜(子宫内膜)在子宫外发育，并在腹部的其他器官上生长的情况, including the ovaries. 子宫内膜还会发生另一种情况，称为子宫子宫腺肌症. This condition affects women, mostly in child-bearing years, and can be quite painful. 尽管大多数女性从未听说过它，但近20%的女性受到了它的影响.
History and Definition of Adenomyosis
Whereas it was described as early as 1860, 直到20世纪早期，子宫腺肌症才被正确诊断或命名. In 1908, Thomas Cullen investigated its causes and named it, determining it was not an inflammation of the uterus, because it did not present any signs.
Not until 1972 did a proper definition come about, made by Dr. Charles C Bird, MD. At that time, adenomysis was described a “benign invasion of endometrium into the myometrium, 产生一个弥漫性扩大的子宫，在显微镜下显示出异位的非肿瘤, endometrial glands and stroma, surrounded by the hypertrophic and hyperplastic myometrium”.
What Is Adenomyosis?
Adenomyosis is a condition in which the endometrium, instead of growing out into the uterus, grows into the uterine wall (myometrium). Each time the lining (endometrium) is stimulated, during the menstrual cycle, 被困在子宫肌层的内层也会受到刺激，导致痛经和疼痛加剧. This can disrupt the quality of life for the women who have to deal with it. 因为子宫腺肌症症状随着雌激素水平的升高和下降而变化, the menstrual cycle brings more discomfort than usual.
The condition can either be generalized adenomyosis, spread out over a large area of the uterine wall, or localized a small area or spot, also known as adenomyoma. 受子宫腺肌症影响的区域称为子宫内膜-肌层交界处, where the endometrium and myometrium meet. 正是这个连接的中断——子宫腺肌症——被认为是导致卵子无法在子宫内沉淀和停留的一个因素, thus preventing women from becoming pregnant.
Symptoms and Treatment
- Painful periods (dysmenorrhea)
- Heavy periods (menorrhagia)
- Bloody discharge or spotting between periods (metrorrhagia)
- Bloating during pre-menstruation
- Pain during or after sex (dyspareunia)
- Chronic pelvic pain
- Tender uterus and larger than normal in size
女性还可能遭受抑郁、易怒和生育力下降或不孕. However, when women go into menopause and their estrogen levels drop, so do the symptoms of adenomyosis.
Drugs and Hormones
Adenomyosis treatments vary with the severity of the symptoms that present themselves. If the symptoms are mild enough, doctors can treat them with anti-inflammatory drugs and hormonal treatments. Usually they include contraceptive pills and IUDs. Certain surgeries can be performed that will treat the condition as well.
Uterine Artery Embolization
This procedure is usually used for uterine fibroids, but if the adenomyosis is just a small area or spots, this surgery could take care of it. The blood supply to the affected area is cut off and the adenomyosis shrinks. A 2007 study showed that after three to five years, 症状性疼痛减少了一半，手术的成功率约为60%. This minimally invasive procedure leaves no scars.
Considered as a last resort procedure, 当其他方法都不能缓解症状时，可以进行子宫内膜消融. Because it destroys the endometrium, this is a permanent solution, 就像子宫切除术，只有当妇女不想再怀孕时才会做. It does, however, relieve the symptoms of adenomyosis, and the woman either has no more periods or has reduced bleeding. 如果子宫内膜浸润到子宫肌层(子宫肌壁)太深，这可能不起作用。.
MRI引导聚焦超声手术(MRgFUS)使用MRI实时监测聚焦的高强度波，产生热量并破坏目标组织. This is an early stage, 需要在医院或外科中心过夜的非侵入性手术. Because the uterus remains, this procedure allows a woman to still have children. The side effects are few and the prognosis is good, but it is not recommended for a woman who also has endometriosis.
子宫切除术是唯一有效和永久消除所有子宫腺肌症症状的k8彩乐园返点官网下载下载方法. Hysterectomies have been the treatment for years, 但只有在病情严重和不想再怀孕的情况下才会进行. To prevent early menopause, the ovaries may be left in, if they are not affected by endometriosis, which can be a co-occurring condition.
Risk Factors and Causes
Middle-aged women who already have had children (the more children, the greater the risk) or who have had uterine surgery, such as a cesarean, or an inflammation after childbirth are more at risk for adenomyosis, however it can affect any woman before menopause. But a root cause has still not been found.
One of the risks of having adenomyosis is anemia from the blood loss each month. Anemia is a condition caused by an iron deficiency. 这意味着人体无法产生足够的红细胞将氧气输送到身体的各个部位. Dizziness, fatigue, and irritability ensue and can lead to depression and anxiety.
In the past, 诊断子宫腺肌症的唯一方法是术后，它从来没有完全的特征，也没有任何流行病学研究, 主要是因为手术切除也是消除症状的唯一方法. Adenomyosis was severely understudied and understood until recently, when better diagnostic tools became available. However, 近年来，医生们做了广泛的研究，并从信息中发现了很多.
A 2008 study determined that adenomyosis was just a variant and not a disease on its own. The symptoms that are associated with this condition, are also symptomatic of endometriosis and uterine fibroids, 因此，建议子宫切除术以消除所有症状仍然是最好的解决办法.
A paper written in 2010 cited several studies on adenomyosis, one of which was done in Italy in 2009, that concluded women who had had induced abortions, dysmenorrhea or chronic pelvic pain were more likely to have adenomyosis. 另一项研究证实痛经和慢性盆腔疼痛是子宫腺肌症的症状, adding depression as another factor. 第三项研究表明，被诊断为子宫腺肌症的女性极有可能也患有子宫内膜异位症.
One of the preoperative diagnostic tools used are biopsies, using keyhole surgery or laparoscopy in order to take a tissue sample. With the addition of a camera, it has been easier to get a sample, but still no guarantee to get the “right” sample, because adenomyosis doesn’t always present itself readily, like endometriosis. As in the past, several samples would have to be taken to get a good diagnosis. The best way is through the vagina, 然而，这可能会损害子宫，并可能使其更难在未来有孩子, and going through the abdomen is still only good for endometriosis diagnoses.
With the advent of MRI’s, diagnoses have been easier to make. With the MRI, 子宫内膜和肌层界限清晰，子宫内膜-肌层交界处也清晰可见. 子宫壁受影响区域的增厚现在也被认为是子宫腺肌症的确认. An adenomyosis ultrasound or more specifically, a Transvaginal ultrasound (TVU) is another way to diagnose possible adenomyosis. TVU is able to identify myometrial cysts but most importantly, disparities of myometrial texture and composition, which signal the presence of adenomyosis.
Medical Care for Adenomyosis
子宫腺肌症是两种常见的子宫内膜相关疾病之一. It can cause painful and heavy periods, as well as chronic pelvic pain, bloating and an enlarged, tender uterus. The causes are mostly unknown, however women who have had uterine surgery or trauma, are more at risk than others. Diagnosis can be done more accurately nowadays with MRIs and TVUs, although the best way to get rid of all symptoms, especially if they are extremely painful and risk quality of life, is getting a hysterectomy.
对于那些只有轻微症状或还想要孩子的人来说，这可能不是最好的答案. There are less invasive and permanent treatments, 例如激素k8彩乐园返点官网下载下载或小手术切除子宫.
If you have any of the symptoms and suspect you may have adenomyosis, it’s best to check with your doctor as soon as possible. 在盆腔检查之后，他或她可能会安排你去做核磁共振或电大检查，以便看得更清楚.
Arizona Gynecology Consultants is located in the Phoenix and Mesa metropolitan areas. 我们为各个年龄段的妇女提供专业和个性化的健康和医疗k8彩乐园下载, treating each patient as a unique person. 我们的团队专注于女性健康的各个方面，我们致力于在女性护理方面实现卓越.
SCHEDULE A CONSULTATION TO SEE IF ADENOMYOSIS IS THE ROOT CAUSE OF YOUR DISCOMFORT.
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Dr. Kelly Roy是妇科外科和高级腹腔镜(和宫腔镜)的专家。. 她是亚利桑那州的长期居民，在1997年完成亚利桑那大学医学博士学位之前，她在亚利桑那州立大学获得了生物医学工程学士学位.
Dr. 罗伊在当时的“班纳撒玛利亚慈善医院”(现在的班纳大学医学中心)完成了她在妇产科的住院医师实习。, in Phoenix Arizona in 2001.
Well known for her teaching and surgical ability, 她是班纳大学医学中心和凤凰城中部圣约瑟夫医院住院医师项目的教员，也是亚利桑那大学医学院的临床助理医学教授, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.
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