ADENOMYOSIS

Definition: Adenomyosis is a condition where there is ingrowth of the endometrium, both the glandular and stromal components, directly into the myometrium.

CAUSES: The cause of such ingrowth is not known. It may be related to repeated childbirths, vigorous curettage or excess of estrogen effect. Pelvic endometriosis co-exists in about 40 percent.

Pathogenesis: Histologically, it is characterized by the extension of endometrial glands and stroma beneath the endometrial—myometrial interface (EMI). As the submucosa is absent, endometrial glands lie in direct contact with the underlying myometrium. It forms nests, deep within myometrium. Subsequently, threre is myometrial hyperplasia around the endometriotic foci. Myometrial zone anatomy was observed by MRI. A junctional zone (with low signal intensity on T2 weighted images) is defined at the innermost layer of myometrium. It is thought that the disturbance of normal junctional zone (JZ) predisposes to secondary infiltration of endometrial glands and stroma to inner myometrial zone. The disturbance of junctional zone (JZ) may be due to the endometrial factors, genetic predisposition or altered immune response. Trauma to the deeper endometrium (repeated curettage), causing breakdown of EMI is also taken as an important etiologic factor.

CLINICAL FEATURES : In about one-third, it remains asymptomatic being discovered on histological examination.

Patient profile: The patients are usually parous with age usually above 40.

SYMPTOMS: Menorrhagia (70%)—The excessive bleeding is due to increased uterine cavity, associated endometrial hyperplasia and inadequate uterine

contraction. During normal menstruation, there are antegrade propagation of subendometrial contractions from the fundus to the cervix. In adenomyosis with distorsion of junctional zone myometrial contractions are abnormal and inadequate (see below).

Dysmenorrhea (30%)—Progressively increased colicky pain during period is due to retrograde pattern of uterine contractions. It also depends on the number and depth of adenomyotic foci in the myometrium.

When the depth of penetration is > 80% of the myometrium, the pain is severe. Other causes of pain are—local tissue edema and prostaglandins.

Dyspareunia or frequency of urination—are due to enlarged and tender uterus.

Infertility: Women with adenomyosis have a higher incidence of infertility and miscarriage.

The reasons are:

(a) abnormal function of the subendometrial myometrium,

(b) retrograde myometrial contractions,

(c) interference in sperm transport and blastocyst implantation and

(d) abnormal endomerial immune respose and nitric oxide level.

SIGNS: Abdominal examination may reveal a hypogastric mass arising out of the pelvis and occupying the midline. The size usually does not exceed 14 weeks' pregnant uterus.

Pelvic examination—reveals uniform enlargement of the uterus. The findings, however, may be altered due to associated fibroid or pelvic endometriosis.

HOMOEOPATHIC MANAGEMENT OF ADENOMYOSIS: -

Calcarea carb:- One of the best Remedies for Adenomyosis and it is suitable for fat,flabby persons. There is a bearing down sensation in the pelvis and a sense of weight and soreness in the uterus. A sense of shuddering and painful pressure within the uterus. Menses too early, long lasting, too profuse resulting in to anaemia.

Thlaspi bursa:- There is Metrorrhagia, too frequent and profuse bleeding. Scarcely recovers from one period before another begins. Haemorrhage with violent Uterine colic. Every alternate period is very profuse. Sore pain in Uterus on rising.

Calcarea Flour:- Very suitable for hard and large Fibroids in uterus.

Phosphorus:- Excellent remedy for tall and slender persons. Menses profuse, and bright red. Large Fibroids, myoma, and tumours in Uterus. Phosphorus patients prefer ice cream and cold drinks.

Fraxinus Americana:- Another excellent remedy for Adenomyosis. Uterus enlarged, and patulous. Fibroids with bearing down sensation, cramping in feet, worse in the afternoon and night. Dysmenorrhoea with profuse bleeding.

Hydrastis:- Effective for Adenomyosis with Metrorrhagia, from fibroid Uterus.

Silicea:- The best remedy for Adenomyosis with myoma,and Uterine fibroids. There is discharge of blood between menstrual periods with paroxysms of icy coldness over whole body.