ademoniosis y ambarazo

Adenomyosis and pregnancy

There are several pathologies in the gynecological area that, despite being common in people, are not known by most of them. Among these disorders is adenomyosis.

This is a disease that is usually related to women’s fertility, and that is often ignored or not detected in time. We usually talk about adenomyosis and pregnancy, since it is usually at the time of planning a baby that this anomaly is diagnosed.

What is adenomyosis?

It is a disorder of a gynecological nature that causes endometrial tissue (tissue lining the uterine cavity) to penetrate the inside of the uterine wall (the myometrium), causing thickening of the uterus.

This disease is suffered by women, and when the tissue that has been displaced continues with its normal cyclical functioning: increasing its thickness, stabilization, degradation and bleeding throughout the menstrual cycle, but out of its normal place.

So far it is known for certain that the disease is not hereditary. However, it has not been possible to determine precisely what factors generate it.

On the other hand, this disorder usually occurs in women between the ages of 35 and 50 who have experienced at least one pregnancy.

According to studies carried out by specialists in the area, this disease affects 0.8% of the female population in general, and has a higher incidence in women aged 40 years and older, with a rate of 1.5%.

It is common for adenomyosis to be confused with endometriosis, because it generates similar symptoms. About 20% of the time, both occur at the same time.

On the other hand, adenomyosis is linked to the hormonal activity of the ovaries, especially estrogen.

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Symptoms and diagnosis of adenomyosis

This condition can cause various symptoms that may go unnoticed, others that are really noticeable, and in some cases there are no symptoms at all.

Among the most common signs are the following:

  • Acute pelvic pain that in some cases becomes chronic.
  • Dyspareunia or pain during sexual intercourse.
  • Dysmenorrhea or pain during menstruation.
  • Heavy and prolonged vaginal bleeding during menstruation.
  • On the other hand, the uterus may increase in size causing pressure in the pelvic area, as well as tenderness in the abdominal area.

When it comes to the diagnosis of adenomyosis, this can be somewhat complex, but thanks to optimizations in ultrasound equipment, and especially 3D ultrasound equipment, the detection of this female disorder is more easily performed. However, the definitive diagnosis must be histopathological.

In order to diagnose this disorder, a pelvic examination should be performed first. Through this evaluation it is possible to visualize the size of the uterus, which may be two or three times larger than normal.

As a second step, a uterine ultrasound or MRI should be performed. This second option is used when insufficient information has been obtained with ultrasound.

Is adenomyosis and pregnancy possible?

The condition has an impact on a woman’s fertility, however some women with adenomyosis are mothers without problems. However, it has the ability to alter the transfer of sperm to the egg, interfering negatively with fertilization and can also interfere with embryo implantation, complicating natural pregnancy.

In other words, the combination of adenomyosis and natural pregnancy can be problematic in some cases. On the other hand, when a woman undergoes assisted reproduction treatment, she may choose to inhibit ovarian function with the use of GnRH to improve the results. The effectiveness of this alternative is not in all cases, but to date it is one of the best therapeutic alternatives.

In order for the conjugation of uterine adenomyosis and pregnancy to work, the first stage must involve ovarian stimulation in order to obtain as many oocytes as possible for fertilization in the laboratory. After this, the transfer must be performed as the next step of the in vitro fertilization treatment. Vitrification can also be performed, so that the woman can decide the best time to become pregnant.

It is also important to note that diffuse adenomyosis and pregnancy can result in implantation failure and repeated miscarriages.

However, this condition generally does not affect assisted reproductive treatments, such as in vitro fertilization or egg donation. This is provided that the pathology is known to exist, the necessary considerations are taken at the time of embryo transfer, and the corresponding treatment is applied to the endometrial preparation with GnRH.

In short, pregnancy and adenomyosis can coexist if the right measures are taken.

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Treatment of adenomyosis

As already mentioned, this anomaly consists of the leakage of endometrial tissue into the muscle of the uterus. This regularly causes bleeding on the inside of the muscle. To treat this condition, the hormonal function is blocked so that the endometrium does not grow.

Failure to treat causes the muscle of the uterus to continue to infiltrate and become engorged with bleeding, resulting in increased pain and uterine growth.

So if you are one of the women to whom this phrase applies: I have adenomyosis and I am pregnant, just make sure you see a specialist.

On the other hand, it is also important for you to know that the disease develops in the midst of a high estrogen level, which causes concentric growth of the uterus generating pain and abundant bleeding during menstruation. For this reason, the most advisable thing to do is to treat it with the opposite of estrogen, which is progesterone, thus preventing any link with endometrial hyperplasia.

Another alternative is to treat the pathology with anovulatories to stop hormonal dyscontrol. The option of surgery should also be considered, depending on the level of adenomyosis.

This gynecological abnormality naturally resolves with menopause. However, hormonal and anti-inflammatory medication is available to ease the symptoms.

In summary, treatment will depend on the characteristics of the patient and the progression of the disease.