Moderately pronounced diffuse changes in the uterus. Diffuse changes in the ovaries - what is it? Diagnosis and differential diagnosis of pathological changes in the uterine wall

Diffuse changes in the uterine myometrium are not an independent diagnosis, but one of the signs of certain diseases of the uterus. For what reasons does this symptom occur, what does it mean and how to treat it?

The myometrium is the muscle tissue of the uterus located directly behind the endometrium.

It consists of muscle fibers. More precisely, from 3 layers of smooth muscles.

They are located in a certain sequence:

The inner layer consists of longitudinal fibers. This layer is located inside the uterus, just behind the endometrium.
The middle layer consists of circular fibers, so it is responsible for contractions of the uterus during childbirth. Inside it are blood vessels that supply this organ.
Outer layer (subserosal). It consists of circular and longitudinal fibers, covered on top with a serous membrane.

The functions of the uterus are to protect the fetus during pregnancy and protect from injury. And then - help the child be born. It is thanks to the structure of the myometrium that the uterus contracts so quickly after childbirth and becomes several times smaller in a matter of days.

Why do changes in the myometrium occur?

If, during examination, diffuse changes in the myometrium are detected in a woman, this indicates the presence of some kind of pathology. This symptom means that the muscle tissue of the uterus is heterogeneous, and foci of heterogeneous tissue can be dispersed over different areas of the myometrium. The reasons that trigger the onset of such changes:

abortions;
difficult childbirth;
inflammatory diseases of the reproductive organs;
hormonal disorders;
somatic diseases;
severe stress;
endometriosis;
hereditary factor.

Often diffuse disorders occur due to adenomyosis. This is a disease in which endometrial tissue seems to grow into the myometrium. It is also sometimes called internal endometriosis. For a long time, such a disease was rare because it was quite difficult to diagnose. Modern methods research makes it possible to do this without problems. Factors that increase the risk of developing the disease are childbirth and age 35-40 years.

Signs of adenomyosis, and as a consequence, symptoms of such a phenomenon as diffuse changes in the myometrium, can be as follows:

heavy and prolonged bleeding during menstruation, sometimes with clots;
painful menstruation;
discomfort during sexual intercourse;
bleeding between periods.

Due to adenomyosis, the size of the uterus can increase several times. The causes of this disease are not fully understood. The main ones are considered to be:

Penetration of endometrial cells into muscle fibers due to surgical interventions on the uterus.
According to some scientists, endometrial cells can enter the muscular layer of the uterus during fetal development.
Inflammation of the uterus, especially after a difficult birth. As a result of this process, endometrial cells can penetrate where they are not supposed to be.

Whatever the cause of this condition, it directly depends on the woman’s hormonal background. More specifically, on estrogen levels. Therefore, during menopause, when the level of this hormone decreases greatly, this disease goes away on its own.

Signs of diffuse changes in the myometrium can also be caused by a disease such as endometriosis. Unlike adenomyosis, in the case of endometriosis, cells of the inner layer of the uterus can spread not only deep into the uterus, but also into other organs. The symptoms of this disease are similar to adenomyosis, it also causes long and painful menstruation.

Diagnosis and treatment

Such changes are diagnosed using ultrasound of the pelvic organs.

With this study, you can see the thickness of the endometrium and identify its pathological growth. Ultrasound also shows the heterogeneity of the muscular layer of the uterus.

Not all women will need treatment. Since this disease does not pose any danger, with moderate symptoms you just need to be constantly monitored by a doctor. This disease is not an obstacle to bearing a child.

If the symptoms are severe, the doctor will prescribe appropriate symptomatic treatment, because, unfortunately, there is no cure for this disease.

The effectiveness of intrauterine devices for adenomyosis and endometriosis has been proven. These contraceptives reduce bleeding and the length of menstruation. However, they cannot completely get rid of the disease.

Hormonal medications can also somewhat reduce the symptoms of the disease. Treatment with hormones is a rather lengthy process that takes about 6-9 months.

In addition, they have a lot of side effects. In the most severe cases, surgery to remove the uterus is indicated. It is performed in the following cases:

at very heavy bleeding, not amenable to treatment;
in the presence of large fibroids;
in the presence of other pathologies of the uterus.

Although this pathology is not life-threatening, the presence of adenomyosis requires observation and treatment.

Therefore, you should undergo regular examination by a gynecologist, and if you have complaints, consult a doctor immediately.

Take care of yourself, dear women!

Before talking about changes in the structure of the uterine wall and understanding what diffuse changes in the myometrium are, it is necessary to take a closer look at the concept of “myometrium”. What is it?

The myometrium is the muscular layer of the uterus, consisting of 3 layers of smooth muscle. Moreover, all 3 layers have a different structure and are arranged in the following sequence:

The outer layer (subserosal) - includes longitudinal and circular muscle fibers, and is covered on the outside with a serous membrane.
The middle layer (muscle) is considered the most powerful, because it consists exclusively of circular muscle fibers. It is in this layer that the main main vessels that carry out trophism of the entire uterus are located.
Inner layer (longitudinal) – consists of longitudinal fibers.

Due to these layers, the uterus is able to act as a receptacle for the fetus during pregnancy, and at the end of the gestation period, muscle contraction helps expel the fetus during childbirth.

If a diffuse change in the myometrium is detected in a woman, then this deviation is called endometriosis, and with ultrasound examination (ultrasound), the doctor sees heterogeneous myometrium. Among gynecological diseases, this ailment occurs quite often and is the cause of infertility, because the altered structure makes it impossible for the implantation of a fertilized egg.

Causes of changes in the myometrium

With diffuse changes in the myometrium, an atypical growth of the uterine mucosa and ingrowth of endometrial cells into the thickness of the muscle layer occurs. The exact reason for the development of this pathological process scientists cannot identify. However, there is genetic predisposition and the hormonal theory of the onset of the disease, according to which endometriosis develops as a result of disturbances in the levels of hormones in female body(increased estrogen levels and decreased progesterone).

Initially, this kind of hormonal imbalance contributes to the growth of the endometrium, and then can provoke its rejection, accompanied by severe bleeding.

The rejected cells somehow penetrate the basal layer of the endometrium and begin to grow into the myometrium. On ultrasound, up to 4-5 cm is observed, its echostructure is disturbed. In addition, with endometriosis, changes are detected in the muscular layer of the uterus with hyperechoic inclusions, diffusely located in the thickness of the organ, the size of which is 1-5 mm.

Myometrial heterogeneity develops for several reasons, among which are the following:

abortion or any other intervention in the uterine cavity;
childbirth that injures the inner wall of the uterus;
C-section;
diagnostic curettage;
endocrine disorders;
genetic predisposition to the disease;
stress as a consequence of neurogenic disorders.

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Signs of diffuse changes in the myometrium depend on the speed and depth of spread of endometrioid tissue in the muscular layer of the uterus.

Most often on initial stages symptoms of this disease invisible. It is customary to distinguish between 3 degrees of endometriosis:

In the first degree, slight germination of the inner layers of the myometrium occurs.
In the second degree, tissue growth occurs to the middle of the myometrium.
In the third degree, endometrioid tissue grows through all layers, right up to the serous membrane of the uterus.

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Diffuse changes in the myometrium - diagnosis and signs of the disease

According to scientists, in 1/3 of cases female infertility patients are diagnosed with endometriosis. The woman undergoes an ultrasound, where the doctor sees that the myometrium is heterogeneous, which means it was subject to changes. The causes and symptoms of these types of changes can be completely different. Some patients report pain when urinating or before menstruation, others report discomfort during sexual intercourse, and still others experience bleeding between periods. Pain occurs due to tissue swelling and compression of nerve endings in the uterine wall. As a rule, the pain is aching or paroxysmal in nature and can radiate to the perineum, lower back and thigh area.

Over time, a woman may experience acyclic bleeding, leading to the development of iron deficiency anemia, which is accompanied by apathy, lethargy, dizziness, headaches, and drowsiness. This condition cannot be cured until the blood loss is eliminated.

In addition to the usual ultrasound examination of the pelvic organs, specialists may also prescribe an endoscopic examination. If these examination methods reveal that changes have occurred, then they indicate the presence of endometriosis and the need for a course of drug therapy that allows one to become pregnant and bear a healthy child.

What is myometrium? The myometrium is the middle layer of the muscles of the uterus, which in turn consists of three layers of muscles. Its structure is as follows:

The first layer (also known as the outer layer) is the subserosal layer of muscles, which are located in the longitudinal and circular directions. Above this layer is lined the serous membrane.
Under the first layer is the strongest one - the middle one. It is represented by circular muscles. This layer contains in its structure the arteries and veins that nourish the uterus.
The inner layer is represented only by longitudinal muscle fibers.

Thanks to these three layers, the uterus has the ability to contract, expelling blood during menstruation and the fetus during pregnancy. The hormones estrogen, oxytocin and progesterone influence muscle contraction. Their secretion is most intense during menstruation and pregnancy. Normally, a woman should not feel the uterus. It is felt only during labor, birth or pathologies.

Characteristic signs

What are diffuse changes in the myometrium? Such changes cannot be considered any disease or diagnosis. This is just a diagnostician’s conclusion about the state of the structure of the uterine tissue. From these observations the patient's diagnosis is made. Basically, diffusely heterogeneous myometrium is a benign neoplasm that occurs due to improper functioning of the endometrium.

During an ultrasound examination, it is often noted that the structure of the myometrium is heterogeneous. All pathological foci, as a rule, are located at different points of the uterus. Then they begin to study the problem in detail. Endoscopic examination may be used.

Often diffuse changes in the myometrium are a symptom of a more serious pathology. And the causes of this symptom may be:

changes in a woman’s hormonal levels;
autoimmune diseases (thyroiditis);
operations on the uterus: caesarean section, removal of foreign bodies, etc.;
miscarriages, abortions;
blood diseases (anemia);
infectious diseases;
adenomyosis, endometriosis;
stressful situations;
genetic predisposition.

Risk factors include women over 40 years of age who have undergone childbirth, as well as uterine surgery. Adenomyosis and endometriosis are among the most common causes of diffuse changes in the uterus.

Adenomyosis is a pathological process that is characterized by the growth of the endometrium into the muscular wall of the uterus. It is worth noting that the endometrium grows into the muscle only in places. As a result of this germination, the muscles begin to thicken around the problem area. This case is referred to as a focal form of adenomyosis. If there are no foci, then they speak of a diffuse form.

However, this pathology is quite rare and can be confused with endometriosis. Very often, when a diffusely heterogeneous structure of the myometrium is noted during diagnosis, two diagnoses are made at once: adenomyosis and endometriosis.

The reasons may be: congenital pathology, postpartum problems and inflammation, unsuccessful surgical operations.

Symptoms of adenomyosis may include:

Menstrual cycles with pain.
Unpleasant sensations during sex.
Bleeding from the genital tract outside of menstruation.
Pain in the lower abdomen.
On ultrasound and during palpation, an increase in the size of the uterus is noted.

What to do if a pathology is detected?

Treatment is carried out with hormonal and non-steroidal drugs. IN difficult cases Extraction of the uterus is performed - removal of the organ. Endometriosis is a pathology similar in principle to adenomyosis. The difference is that the endometrium grows into all layers of the uterus, and not just into the muscles. In addition, benign neoplasms are formed. More than 1/3 of all examined women with diffuse changes in the uterus suffered from endometriosis. Symptoms are also similar to adenomyosis.

There are several forms of pathology:

Genital endometriosis - involvement of both external and internal genital organs in the pathological process;
Extragenital endometriosis - in addition to the genital organs, other body systems are affected: gastrointestinal tract, genitourinary system and even the respiratory system;
Mixed form is a combination of the two above forms in the pathological process.

Treatment is carried out conservatively (with the help of drugs) or surgically. Quite often these paths are combined for the best result. If we talk about medications, hormonal drugs are mainly prescribed. However, this can greatly aggravate the condition of the body as a whole, as the woman’s hormonal background changes. Because of this, there may be problems with the menstrual cycle and fertilization.

The surgical method is more radical. In this way, doctors can excise the foci of the disease, or (in the worst case) remove the uterus altogether. Diffuse changes in the myometrium can be caused by other reasons.

A woman’s hormonal background depends on external factors affecting her body. Stress, illness, bad external environment, hard work and family problems often affect women's health in the best possible way. Autoimmune diseases, such as autoimmune thyroiditis, also have a strong impact on hormonal levels and health in general. This means that it is worth carrying out full examination patient.

To treat stress and resist external factors, you should resort to the following actions:

Normalize sleep. It should last between 8 and 9 hours.
Eat properly and balanced. You need to include breakfast, lunch and dinner in your diet. You should not skip meals, especially breakfast.
Refuse bad habits(alcohol, smoking, drugs).
Create your own daily routine. It is very important that rest and work are harmonized.
If you are worried about any psychological problems and you need to talk it out, you can do this by turning to a psychologist.
Start playing sports. Physical exercise have a positive effect on health and help lift your mood.

Anemia is characterized by the inability of red blood cells to transport oxygen to the body's tissues, which can cause organ problems. Diffuse changes are also a consequence of anemia. To understand whether a person has anemia, you need to evaluate his condition according to certain criteria:

Does the person have shortness of breath?
Assess skin color - with anemia, it becomes pale.
Assess your heart rate - increased heart rate may occur.
Do you have pain in your head?
Strange appetite - craving for eating chalk, earth and other inedible things.
Hair loss and brittle nails.

Causes of anemia:

poor diet (you need to add meat, apples, pomegranate), accompanying illnesses(Crohn's disease);
pregnancy;
a loss large quantity blood.

To correct the situation, it is worth resorting to rationing the diet (add beef, liver, apples and pomegranates, seafood, etc.) and taking iron supplements. If you follow these recommendations, the anemia will soon go away. But before that, you should consult a doctor.

Diffuse changes in the uterine myometrium are an undoubted cause for concern about your health, but it is completely curable. You should not delay treatment of diseases of the uterus, as this can irreversibly affect the ability to give birth. If pain begins to bother you and it becomes confusing menstrual cycle, you need to go to a gynecologist without any doubt.

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The structure of the muscle layer has three components:

Internal, which consists of longitudinal fibers;
The middle one, which is a circular muscle. This layer is the strongest. Thanks to the availability blood vessels the uterus is provided with the necessary useful elements;
External, consisting of longitudinal muscles and covered with a serous membrane.

The ability to contract is ensured precisely due to the presence of different layers of the myometrium. This ability is necessary to ensure the release of menstrual fluid. In addition, this structure of the myometrium helps the uterus perform the function of the so-called “storage” during pregnancy. As the fetus grows, the uterus also increases in size, and after the end of the gestation period, with the help of the same muscles, the fetus is expelled from the woman’s body.

Reasons for changes in the myometrium

The exact reason for the appearance of such a sign as diffuse changes is unknown to science. It is believed that endometriosis appears and progresses due to hormonal imbalance in the body, when the level of estrogen increases and progesterone, on the contrary, decreases.

First, hormonal disorders lead to diffuse changes in the myometrium of a moderate type, then endometrial rejection can occur and, as a consequence, heavy uterine bleeding.

In general, the main causes of myometrial heterogeneity are:

Difficult childbirth with injury to the organ wall;
C-section;
Curettage of the uterine cavity for diagnostic indications;
Surgical interventions in the uterine cavity (abortion);
Disturbances in the functioning of the endocrine system;
Genetic predisposition to gynecological diseases;
Experiences and stress;
Inflammatory diseases and infections.

How to identify

When discomfort and the first signs characteristic of endometriosis appear, the patient is prescribed a thorough diagnosis. A visit to a gynecologist and an ultrasound scan are necessary to make a correct diagnosis. You can assume the presence of endometriosis at an appointment with a gynecologist based on the enlarged size of the uterus. But the most accurate result can only be given by ultrasound diagnostics, which makes it possible to identify diffuse changes in the myometrium, determine the degree of heterogeneity of the echostructure and the depth of endometrial growth.

Sonographic changes

The main indicator that allows you to diagnose heterogeneous endometrium is diffuse changes of the echographic type. When performing an ultrasound, an indicator such as echogenicity is assessed - the ability of tissues to reflect ultrasound.

If the functions and structure of the uterus are normal, then the echogenicity will be low. An increase in echogenicity means the development of adenomyosis of varying severity, which is characterized by a heterogeneous echostructure of the organ and blurred contours. This pathology is also characterized by noticeable thickening of the walls up to 4-5 cm, which occurs due to the proliferation of the endometrium.

There are three forms of endometriosis, in which diffuse changes in the muscle layer occur: nodular, focal and diffuse. In the diffuse form, there are minor changes in the structure. They are endometriotic growths on the entire surface of the endometrium and myometrium.

Features of the diffuse form of the disease include:

Damage to the muscle layer by endometriotic cavities with a cellular structure;
The presence of minor hyperechoic inclusions;
There are characteristic echo signs of diffuse changes, i.e. an increase in the size of the uterus and a change in its shape;
In the presence of pinpoint endometriotic areas, heterogeneous heterogeneity in the structure of muscle tissue is visualized;
The surface of the uterus becomes heterogeneous, pain is felt on palpation.

In the nodular form of the disease, there is a proliferation of formations from endometrial cells that have a round shape with a diameter of up to 6 mm and unclear contours.

Focal endometriosis is characterized by the formation of endometrioid formations up to 1.5 cm in size in certain areas. At the same time, the mobility of the uterus decreases, and its displacement leads to severe pain.

Endometriosis as a common cause

Clinical manifestations of the disease can be of various nature. It all depends on the severity of diffuse changes. Diagnostics allows us to identify three degrees of development of pathology according to the type of adenomyosis:

1st degree: the myometrium has a heterogeneous structure with minor changes;
2nd degree: endometrial germination reaches the middle of the muscle layer;
Grade 3: endometrial tissue completely grows into the myometrium, and can reach the serous membrane.

At first, endometriosis is asymptomatic, so women may not even be aware of the changes occurring in the body. When the disease reaches a complex stage, characteristic signs are noted. The main symptom is uterine bleeding and strong pain. Spotting appears in the middle of the cycle, and the menstrual cycle itself in most cases lengthens.

The advanced form of the disease often causes anemia, drowsiness, frequent dizziness and fainting. Until treatment is given, these symptoms will not go away.

Symptoms

The initial stage of the disease often has a latent (asymptomatic) course. However, further germination of the endometrium is more pronounced. The main signs of diffuse changes in the myometrium include:

Abundant bloody issues during menstruation, accompanied by severe pain;
Aching pain in the lower abdomen in the middle of the cycle;
Spotting a few days before the start of menstruation;
Noticeable increase in the size of the uterus;
Feeling of discomfort during sexual intercourse;
Pain when pressing over the uterine area and when urinating;
Problems with conception and pregnancy.

Treatment methods

If a woman is diagnosed with diffuse changes in the myometrium, it is necessary to select the most appropriate therapy. To do this, the severity of the pathology and the presence of accompanying symptoms are first determined. To get rid of the consequences of endometriosis, the following methods are used:

Medicinal (drug) treatment;
Surgery.

Medicinal

Drug therapy is based on the use of hormones: gestagens, antigonadotropins, estrogen-gestogens and other groups. All these drugs turn out to be very effective in combating diffuse changes only at the initial stage of pathology development. When is endometriosis diagnosed? neglected form, it is not always possible to achieve results.

Surgical

If conservative treatment with hormonal drugs does not bring the expected effect, surgery comes to the rescue. Previously, women who were diagnosed with diffuse changes in the myometrium had surgery to remove the uterus, but now modern medicine allows the use of surgical intervention while preserving female organ– laparoscopy.

This operation allows you to remove foci of endometriosis, while restoring the woman’s reproductive function. However, after surgical treatment there is a risk of relapse - re-development of the pathology. To reduce this likelihood, patients are prescribed hormone therapy in combination with herbal preparations to normalize hormonal levels.

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Causes

The myometrium acts as the muscular layer of the reproductive organ. It contains several types of fibers, a characteristic structure, and three shells. The first layer consists of the serosa and circular muscle fibers.

The middle part of the myometrium is the most powerful, since it contains only muscle tissue, while the structure is supplemented by large main vessels. The inner layer consists only of longitudinal fibers.

The structure of the uterus is heterogeneous precisely due to the fact that the myometrium is quite diverse in terms of constituent elements. There may be several reasons for the development of diffuse changes, and they are divided into traumatic and less traumatic.

In the first case, the heterogeneous structure in the uterus may be due to previous abortions, against the background of which pathological foci appeared. Low-traumatic causes include childbirth, or spontaneous termination of pregnancy, in which a miscarriage occurs.

Diseases

If the structure of the uterus is heterogeneous, what this means should be explained by the attending physician. The fact is that such a condition of the lining layer of the reproductive organ can develop as a result of progression gynecological diseases. Let's consider several of the most common pathologies in which the structure of the uterus is revealed to be heterogeneous, what this can mean.

Endometriosis. The presented disease is quite often diagnosed in the fairer sex. of different ages. The main feature of the pathology is that as it progresses, there is a diffuse enlargement of the uterus, namely, the endometrial layer.

Violations are detected through a diagnostic procedure such as ultrasound. It is this procedure that makes it possible to notice that the endometrium has begun to grow beyond the reproductive organ, and the echostructure is heterogeneous.

Endomyometritis. With the development of the inflammatory process, diffuse changes in the myometrium of the uterine body may be observed. The pathological focus is located on the mucous membrane of the reproductive organ, as well as in the muscle layer. Distinctive feature The disease is characterized by the fact that it develops with severe symptoms.

Since the uterus contains pathogenic bacteria, a woman complains of a high-grade painful syndrome. Microorganisms can penetrate the reproductive organ during artificial abortion, labor activity, or during diagnostic gynecological procedures.

Myoma. Considering the conditions in which there is a diffusely heterogeneous structure of the uterus, what it is and how it manifests itself, it is necessary to remember about fibroids, which are represented by a benign tumor. As this disease progresses, the patient experiences changes in the homogeneity of the myometrium and also develops calcification. To confirm the diagnosis, vaginal ultrasound screening or three-dimensional echography is performed.

Myometritis. A pathological process in which the structure of the uterus is diffusely heterogeneous can also develop as a result of oversaturation of the vaginal environment with infections, in which bacteria settle on the mucous membrane of the reproductive organ. With the development of this disease, a woman will experience symptoms similar to endometriosis, so differential diagnosis is required.

During pregnancy

Women carrying a child may experience signs of diffuse changes in the uterus. What this is should be determined by the attending physician, since such a condition is not the root cause of pregnancy, but acts as a sign or complication of a concomitant disease.

In order to monitor the process of fetal development, a woman is prescribed ultrasound diagnostics. Thanks to this procedure, the doctor can also monitor the condition of the uterine walls. That is why, if the patient is at risk with an increased likelihood of developing diffuse changes in the uterus, she is recommended to undergo regular ultrasound examinations.

This will help to promptly recognize the progression of the pathology and prescribe necessary treatment. As for the prognosis for recovery, it directly depends on how correctly the doctor chose the treatment, as well as whether the woman listened to the specialist’s recommendations.

If a diffuse change in the uterus is discovered in a woman during pregnancy, only the leading specialist can discuss what this means. However, she needs to understand that such a condition can cause premature birth or miscarriage. If the pregnancy was nevertheless carried to term, the type of delivery will also determine the lie. If there is an increased likelihood of myometrial rupture, a Caesarean section is recommended.

It is strictly forbidden to make a diagnosis on your own, as well as interpret the results of ultrasound examinations. If diffuse changes in the uterus have been identified, what it is, and whether it is necessary to immediately carry out therapy, should be determined by a gynecologist. In some cases, there is no need to start treatment immediately.

The doctor will definitely have to take into account all the features of the clinical case, establish the reasons for the development of this symptom, as well as the severity of the symptoms. Only after this can a decision be made as to how best to influence the body of a pregnant woman.

Understanding such a condition as diffuse changes in the uterus, what it is, it is necessary to say that the pathology can be detected even before pregnancy. In this case, the woman is necessarily identified as a risk group, which includes patients who have high level the likelihood of primary miscarriage, spontaneous abortion, or placental insufficiency may develop.

The doctor will have to make sure that the woman does not have uterine fibroids. If found benign tumor, pregnancy should also be placed under special registration, since the development of abnormal conditions during labor is possible, including a high probability of severe bleeding.

The same applies to patients who have a history of fibrosis or scarring. All this can cause the birth canal to rupture during pushing.

Diagnostics

Nowadays, there are many techniques that can help identify diffuse changes in the uterus in the early stages, which will allow timely treatment to begin and quickly get rid of the disease.

The main method of identifying pathological condition considered an ultrasound examination. During diagnostic procedure the doctor has the opportunity to determine the echostructure of the layer. If an atypical condition of muscle tissue is detected, this will become a direct signal to a specialist who will be able to suspect the development of endometriosis or other concomitant pathology.

Ultrasound screening is a fairly simple procedure, so the patient does not need to undergo lengthy preparations before undergoing it. Diagnosis is performed using a transvaginal sensor. During the examination, the patient may feel slight discomfort, since the sensor penetrates quite deeply.

The main reasons for prescribing an ultrasound are the following conditions:

Lack of stability in the menstrual cycle, for example, if there are long delays;
Worried about pain in the lower abdomen;
Woman notices atypical bleeding in the middle of the cycle;
There are problems conceiving a child, or infertility develops.

After the doctor carefully examines the uterine cavity, he will be able to accurately determine the size of the reproductive organ, how it is located, whether there are structural anomalies and other factors that may indicate the development of pathology.

If during diagnosis the myometrium was characterized as homogeneous, then the possibility of diffuse changes is excluded. However, if an atypical structure or thickening of the muscle layer is detected, additional examination will be carried out, which will help to accurately make a diagnosis.

In addition to ultrasound screening, a specialist may recommend the following medical procedures:

Magnetic resonance imaging, which will help evaluate the structure of the uterine walls;
Performing a bimanual examination, through which the condition of the reproductive organ is determined;
Donating blood to perform biochemical analysis, which will determine the level of hormones in a woman’s body;
Standard gynecological examination on a chair to determine the condition of the cervix and vagina;
A thorough history taking will allow you to identify associated symptoms, and also determine how long ago the woman started having them.

Such a complete diagnostic examination is necessary in order to accurately determine the type of pathological process, the degree of its neglect, and also to develop the most complete and correct treatment regimen.

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Causes of changes in the myometrium

With diffuse changes in the myometrium, an atypical growth of the uterine mucosa and ingrowth of endometrial cells into the thickness of the muscle layer occurs. Scientists cannot identify the exact cause of the development of this pathological process. However, there is a genetic predisposition and a hormonal theory of the occurrence of the disease, according to which endometriosis develops as a result of a violation of the hormone levels in the female body (increased estrogen levels and decreased progesterone).

Initially, this kind of hormonal imbalance contributes to the growth of the endometrium, and then can provoke its rejection, accompanied by severe bleeding.

The rejected cells somehow penetrate the basal layer of the endometrium and begin to grow into the myometrium. Ultrasound shows a thickening of the uterine wall up to 4-5 cm, its echostructure is disturbed. In addition, with endometriosis, changes are detected in the muscular layer of the uterus with hyperechoic inclusions, diffusely located in the thickness of the organ, the size of which is 1-5 mm.

Myometrial heterogeneity develops for several reasons, among which are the following:

abortion or any other intervention in the uterine cavity;
childbirth that injures the inner wall of the uterus;
C-section;
diagnostic curettage;
endocrine disorders;
genetic predisposition to the disease;
stress as a consequence of neurogenic disorders.

Signs of diffuse changes in the myometrium depend on the speed and depth of spread of endometrioid tissue in the muscular layer of the uterus.

Most often, in the initial stages, the symptoms of this disease are invisible. It is customary to distinguish between 3 degrees of endometriosis:

In the first degree, slight germination of the inner layers of the myometrium occurs.
In the second degree, tissue growth occurs to the middle of the myometrium.
In the third degree, endometrioid tissue grows through all layers, right up to the serous membrane of the uterus.

Diffuse changes in the myometrium - diagnosis and signs of the disease

According to scientists, in 1/3 of cases of female infertility, patients are diagnosed with endometriosis. The woman undergoes an ultrasound, where the doctor sees that the myometrium is heterogeneous, which means it was subject to changes. The causes and symptoms of these types of changes can be completely different. Some patients report pain during urination or before menstruation, others report discomfort during sexual intercourse, and still others experience bleeding between periods. Pain occurs due to tissue swelling and compression of nerve endings in the uterine wall. As a rule, the pain is aching or paroxysmal in nature and can radiate to the perineum, lower back and thigh area.

In addition to the usual ultrasound examination of the pelvic organs, specialists may also prescribe an endoscopic examination. If these examination methods reveal that the echostructure of the myometrium is changed, then they indicate the presence of endometriosis and the need for a course of drug therapy that allows one to become pregnant and bear a healthy child.

Treatment of diffuse changes in the myometrium

It is very important to promptly identify the first signs of endometriosis in women and promptly begin appropriate treatment. After all, it depends on how much the patient’s general well-being and her reproductive function will improve, which has great value for women of reproductive age.

If echo signs of diffuse changes were recorded on ultrasound, the following types of treatment are used:

hormone therapy;
surgical treatment;
therapy with homeopathic medicines.

Treatment with hormones used orally does not always have the desired therapeutic effect. More often hormonal drugs They are only able to block the growth of the endometrium for a while, and after completing the course, its development can begin again. That is why doctors prescribe maintenance treatment as the next step.
As for surgical methods treatment, then laparoscopy is considered the most optimal in modern medical practice, which can significantly reduce the risk of complications and maintain the full functioning of the genital organs.

Treatment of diffuse changes in the myometrium with the help of herbal preparations that can restore hormonal levels, increase immunity, and also improve the functioning of most organs and systems is considered quite effective.

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Structure of the uterine myometrium:

Three layers of smooth muscle fibers

The outer subserosal layer consists of muscle fibers located longitudinally and circumferentially. The serous membrane is visible from the outside;
The middle layer of the myometrium - the strongest - is a circular muscle, in cellular structure which contains vessels and veins that supply the uterus with useful substances;
The inner layer includes longitudinal fibers.

Due to the presence of different layers of the myometrium, the uterus acquires the ability to contract, which is necessary for the release of menstrual blood during menstruation.

Thanks to the myometrium, the uterus acts as a storage facility for the fetus during pregnancy; it grows along with the growth of the baby. And when the pregnancy is over, it expels the fetus from the mother’s body using the same muscles.

Most causes of diffuse changes are:

Endometriosis;
Adenomyosis;
Stress;
Anemia;
Bad heredity;
C-section;
Abortion and various mechanical cleansing of the uterus;
Infectious diseases;
Penetration of infection into the uterine cavity during menstrual bleeding;
Hormonal imbalances in the body.

Signs of diffuse changes in the myometrium:

Heavy and excessively painful monthly bleeding;
Pain during sex;
Pain when urinating;
Nagging pain in the lower abdomen on days 12-16 of the cycle (during ovulation);
Bleeding in the middle of the cycle;
Inability to conceive a child.

Diagnosis of diffuse changes in the myometrium is made using:

Endoscopic examination.

Echographic signs are detected during an ultrasound; if the echo reveals any anomalies or focal abnormalities, the diagnosis of endometriosis or adenomyosis is suspected.

Adenomyosis

With adenomyosis, the inner layer of the uterus (endometrium) grows into muscle tissue - the myometrium and only into it, unlike endometriosis.

The number of cases of this disease is small, as it is often difficult to distinguish from endometriosis. It is not uncommon for women to be diagnosed with both diseases.

Sometimes adenomyosis is completely asymptomatic, but there are also the following signs:

Painful periods (pain lasts all days) with the release of blood clots;
Unpleasant sensations during sexual intercourse;
Spontaneously occurring bleeding from the genital tract;
Noticeable enlargement of the uterus;
Pain in the lower abdomen on palpation.

There are 4 stages of adenomyosis:

The uterine mucosa is affected;
The affected areas include the endometrium;
The tumor grows to the serous uterine layer;
Damage to the peritoneal organs.

Doctors believe the causes of adenomyosis are:

Entry of endometrial cells into the muscular layer of the uterus (during surgery);
Congenital pathology;
Inflammation of the uterus after childbirth.

Most often, patients are women over 40 or during menopause.

Treatment of adenomyosis:

Medication:

Non-steroidal anti-inflammatory drugs (Ibuprofen);

Hormonal drugs (oral contraceptives);

Surgery consists of removing the uterus (hysterectomy);
Taking warm baths.

Endometriosis

Endometriosis is the ingrowth of the inner mucous layer of the uterus into the muscular layer with the appearance of benign neoplasms.

Ultrasound diagnoses endometriosis in a third of women with diffuse changes in the myometrium.

Symptoms of endometriosis are in many ways similar to those of adenomyosis:

Pain during trips to the ladies' room and sex;
Painful periods, irregular bleeding.

There are several forms of the disease:

Genital endometriosis, which affects the ovaries and uterine cavity, fallopian tubes, vulva and even the external genitalia of a woman;
Extragenital - when the number of affected organs, in addition to the genitals, includes the lungs, intestines and other closely located components human body;
Combined endometriosis is a mixture of the two forms described above.

Treatment of endometriosis consists of the following points:

Treatment with hormonal drugs, which involves mandatory blood donation for hormones;
Cauterization of foci of the disease to prevent its further spread.

Signs of stress:

Headaches that appear with enviable frequency;
General impotence;
Nausea;
Vomit;
Diarrhea;
Chronic constipation;
Sleep disorders;
Lack of sexual desire;
Tachycardia;
Sweating;
Hand trembling;
Lump in the throat;
Nervous excitability;
Low self-esteem of the patient.

If, due to stress, a woman has infertility or pain during menstruation, then it is necessary to contact a qualified specialist.

Treatment of stress or how to get rid of depression:

Eat a balanced diet, avoid diets;
Sleep 8-9 hours a day;
Don't get nervous over trifles;
Talk about what you feel;
Do not drink alcohol or use drugs;
Leave time for yourself;
Communicate with family and best friends;
Exercise regularly (endorphin, the hormone of happiness, is released).

Anemia

The causes of anemia are considered to be a lack of hemoglobin or red blood cells.

Signs of anemia include:

Pale skin;

Cardiopalmus;

Problems with hair and nails;

Pain in the head;

Craving for eating non-traditional foods.

Doctors believe the causes of anemia are:

Poor diet (you need to eat meat, liver, pomegranates and apples);
Pathology of iron absorption by the body (for example, with celiac disease or Crohn's disease);
Sudden growth spurts in children (especially under 3 years of age). When growth slows, anemia goes away on its own;
Pregnancy;
Large blood loss (during menstruation or injury).

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Features of the structure of the layers of the uterus

At any age, the normal structure of the myometrial layer should be homogeneous, without pathological inclusions.

At the beginning of the female cycle, the mucous layer (endometrium) is thin, usually 1 - 2 mm, before monthly bleeding it can reach a thickness of 12 - 15 mm.

After 45–50 years, both layers gradually become thinner.

Since mucous and muscle tissue are interconnected, abnormal processes and pathological changes in tissue structure usually affect both layers.

In a normal pregnancy, if the patient did not show signs of adenomyosis before conception, the muscle layer is homogeneous and does not have echo signs of diffuse changes.

Thus, diffuse changes in the myometrium are heterogeneities in the tissue structure evenly distributed throughout the muscle thickness, which are visible during ultrasound examination and indicate the development of adenomyosis.

Adenomyosis and endometriosis - what's the difference?

If on an ultrasound the doctor discovers that the myometrial tissue is diffusely heterogeneous due to focal changes, this means that the likelihood of endometriosis or adenomyosis is high.

What is the difference between these two states?

With endometriosis, elements of the endometrium (the mucous membrane of the uterine body) at different stages are able to grow into all layers of the organ, up to the peritoneal layer, and even spread beyond the uterus, penetrating the ovaries and peritoneum (ectopic endometriosis).

With adenomyosis, mucosal cells penetrate only into the muscle tissue of the myometrium, without going beyond its boundaries. That is, adenomyosis is considered the first phase of endometriosis.

Causes

Doctors try to identify the exact cause of the development of abnormal diffuse changes in the myometrium through various types of research - theoretical and clinical.

But at the moment there is certain confirmation from specialists that the causes of significant or moderate diffuse changes in the myometrium, and therefore endometriosis, can be:

medical interventions affecting uterine tissue, including abortion, childbirth, caesarean section;
diagnostic curettage, removal of cysts, uterine polyps, fibroids;
endocrine pathologies - thyroid diseases, diabetes mellitus, autoimmune processes, obesity;
disorders of the function of the gonads, leading to hormonal disorders that provoke pathological growth of the endometrium;
hereditary predisposition;
severe and prolonged stress causing neurogenic disorders;
sexual infections of any nature;
inflammatory diseases of the reproductive organs;
prolonged and frequent sun exposure.

Sonographic changes

Echo signs of diffuse changes recorded during the ultrasound procedure are the main indicator of myometrial heterogeneity.

Echogenicity - what is it? First of all, this is an important parameter in ultrasound diagnostics.

The term refers to the ability of tissue to reflect ultrasonic waves. With a normal organ structure, echogenicity is low. Increased echogenicity of the myometrium indicates adenomyosis of varying degrees. Abnormal zones are characterized by blurred contours and heterogeneity of the echostructure of the myometrium.

With endometriosis (adenomyosis), diffuse changes in the structure of the myometrium with hyperechoic inclusions, that is, with abnormal compactions that have a very high reflectivity, are recorded in the muscle layer. In addition, ultrasound shows a thickening of the uterine wall up to 40 - 50 mm due to the growth of the mucous layer.

If the examination shows a discrepancy between the thickness of the endometrium and the phase of the menstrual cycle, and the structure of the myometrium is diffusely changed, this means a high probability of pathology, the degree of which depends on the severity of echo signs.

Echo signs and types of endometriosis

Endometriosis (or adenomyosis), in which changes in the myometrium are detected, has 3 forms:

A diffuse form, in which small structural changes are detected in the form of endometriotic growths over the entire surface of the mucous membrane and muscular layer of the uterus.

Peculiarities:

the myometrium is diffusely affected by special endometriotic cavities, which are determined by ultrasound as a cellular structure;
hyperechoic inclusions can be insignificant - from 1 to 2 mm and quite large - 3 - 5 mm, scattered throughout the entire thickness of the uterine body;
characteristic echo signs of diffuse changes in the uterus are: changes in its shape and size. With the diffuse form, the uterus increases to a size of 5–9 weeks of pregnancy and looks like a ball, becoming even larger before and during monthly bleeding;
in the initial stage of the disease, signs of diffuse changes in the myometrium may be insignificant, and sometimes the tissue structure does not show abnormal areas at all due to very small inclusions. Further, there is a clear thickening of the endometrium, and the echogenicity of individual areas increases.
if point, linear endometriotic areas are present in the muscle layer, muscle tissue with a heterogeneous (heterogeneous) structure is observed on ultrasound;
the surface of the uterus becomes uneven and in some areas painful when palpated.

Symptoms of diffuse changes in the myometrium

At an early stage, adenomyosis may occur without noticeable symptoms, but as the endometrium grows into the thickness of the uterine wall and heterogeneity of the myometrium appears, the following symptoms are observed:

heavy monthly bleeding, in which the blood contains clots of varying volumes, consisting of fragments of the mucous layer;
painful menstruation, since the enlarged endometrium is rejected with more active contractions of the uterus;
aching pain in the lower abdominal segment during ovulation (egg release) on days 11–15 of the cycle;
spotting between periods;
enlargement of the uterus to the size of 8 weeks of pregnancy;
discomfort during intimacy;
pain over the uterine area when pressed, when urinating;
difficulties with conception, early miscarriages in existing pregnancies.

Consequences

Since diffuse changes in the myometrium are considered one of the symptoms of endometriosis at different stages of development, their progression can lead to serious consequences:

Treatment

To avoid unpleasant consequences when detecting diffuse changes in the myometrium, it is necessary early diagnosis and active treatment of adenomyosis.

Methods for getting rid of this pathology include medication, surgery and combination treatment.

Drug therapy

Treatment of diffuse changes in the myometrium with medications is aimed at:

to prevent complications;
to stop the progression of pathology by suppressing estrogen production;
to preserve reproductive function;
to eliminate pain syndromes and prevent cancer.

All groups of drugs have many side effects and serious contraindications, therefore they are taken only as prescribed by a gynecologist and after a detailed study of the complete (and not introductory) instructions for the drug by the patient herself.

Main groups of medications:

Estrogen-progestogen contraceptives (Jess, Janine, Diane 35, Yarina, Demoulin, Non-ovlon, Marvelon).

Able to suppress ovulation and estrogen secretion. They help in the initial stages of structural changes in the endometrium and myometrium. Prohibited if you are prone to thrombosis or have high blood viscosity.

Progestin drugs - Visanne, Duphaston, Norkolut, Utrozhestan, Getstrinone. Prescribed for varying degrees of myometrial damage.
Antigonadotropic (agonists of gonadotropic releasing hormones), including Nemestran, Danol, Buserelin-Depot, Danogen, Lucrin-Depot, Zoladex, Diferelin.

When used as injections once every 28 days, significant atrophy of diffuse, nodular and focal changes in the body of the uterus is achieved.

The main advantage of these drugs is the combination of a more pronounced therapeutic effect with minimum percentage side effects and relapses.

With combined treatment, including medications and surgery, relapses are diagnosed in only 7 to 12 patients out of a hundred.

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Symptoms and signs of diffuse proliferation of the endometrium, endometriosis

Among the most characteristic symptoms abnormal growth of the internal mucous layer of the uterus can be distinguished as follows:

1 heavy painful menstruation;

2 uterine bleeding in the middle of the cycle;

3 spotting that occurs a few days before the start of menstruation and after it ends;

4 impossibility of conception;

5 discomfort during sexual intercourse;

6 painful pulling sensations in the lumbar region;

7 malfunctions of neighboring organs, which manifest themselves in the form of constipation, increased urge to urinate, or blood in the urine;

8 painful sensations during bowel movements.

It should be noted that in the initial stages the pathology does not manifest itself in any way, so a woman may not even be aware of it for a long time.

Reasons for changes in the myometrium, why do they occur?

Modern science tends to conclude that the main causes of the development of endometriosis are several factors:

1 Heredity.

2 Hormonal imbalance. This theory is supported by characteristic changes in the foci of the disease that occur during the menstrual cycle. In addition, endometriosis can regress on its own during menopause and pregnancy.

3 Movement of endometrial cells and their subsequent attachment to the outer surface of the uterus and other reproductive organs. This can happen both during menstruation and during surgery, complicated childbirth, insertion of intrauterine devices, and other things.

4 Reduced defenses of the body and associated neuro-endocrine pathologies. This condition can be provoked by regular stressful situations, poor nutrition, various somatic diseases, sexually transmitted infections, etc. There has been a proven connection between endometriosis and disorders of the thyroid gland, autoimmune thyroiditis and malfunction of the pituitary gland.

Due to the abundance of various causes for the development of endometriosis, its treatment is always comprehensive and aimed at restoring the body’s defenses, endocrine system and reproductive organs. In some cases, changes in the structure of the endometrium are asymptomatic and can be detected completely by accident during an ultrasound or routine gynecological examination.

Sonographic changes

Sonographic signs of pathological growth of the endometrium are its uniform or local thickening, which does not correspond to the day monthly cycle, as well as heterogeneity of structure. The term echogenicity refers to the ability of human body tissue to reflect ultrasonic waves. Healthy internal organs and various glands have normal echogenicity or, as it is also called, isoechoicity. If the ultrasound sensor detects increased echogenicity and heterogeneity of tissue structure, then this may be evidence pathological changes in the lining of the uterus.

The diagnosis of endometriosis can be confirmed by identifying lesions with abnormal density that are able to perfectly reflect ultrasound waves. In addition, ultrasound determines the thickness of the uterine walls and in the case of endometriosis, this indicator can vary within 4-5 cm.

What are the echo signs and types of endometriosis?

IN medical science There are three main forms of this disease:

1 Diffuse. It is characterized by the presence of endometrial foci located on the mucous membrane of the uterus.

2 Nodal. A rather rare occurrence in which nodular lesions of the endometrium are diagnosed. Treatment in this case is usually surgical, since taking medications does not bring the expected result.

3 External or genital. It is the growth of endometroid tissue on the surface of the reproductive organs, with the exception of the uterus. In the vast majority of cases, this form of endometriosis affects the fallopian tubes and ovaries.

The most common form of endometriosis is diffuse, and when diagnosing it, an ultrasound specialist may notice the following changes:

1 cellular structure of the inner mucous layer of the uterus;

2 foci of endometriosis, which can be either small or quite large (about 0.5 cm). They are located over the entire surface of the uterus;

3 change in the size of the uterus. Sometimes this organ increases to a size corresponding to the 9th week of pregnancy. The shape of the uterus in a woman with endometriosis becomes spherical;

4 heterogeneity in the structure of muscle tissue;

5 uneven surface of the uterus. This leads to pain during palpation.

It should be noted that in the initial stages of the disease, even an experienced specialist may not notice the signs of endometriosis, since they are very small and insignificant.

Endometriosis is the cause of myometrial changes

The detection of an uneven structure and thickness of the endometrium on ultrasound in most cases means the development of endometriosis - a benign process, as a result of which tissue grows outside the uterine mucosa, resembling the structure of the endometrium. During the study, peculiar focal growths in the myometrium may be detected.

Clinically, this disease manifests itself as irregular menstruation and pain in the lower abdomen and lumbar region. One of the serious complications of endometriosis is the inability to conceive, since the most important reproductive organs are damaged: the ovaries, fallopian tubes and uterus. In this case, the lack of pregnancy is caused not by the endometriosis lesion itself, but by its complications, for example, lack of ovulation, a large number of adhesions in the pelvis, or the impossibility of implantation of a fertilized egg. Treatment of endometriosis is quite lengthy and is aimed primarily at eliminating its cause, if it can be accurately determined. Complex therapy consists of taking hormonal medications, performing physiotherapeutic procedures and surgical intervention, if necessary.

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What is myometrium?

This is one of the layers of the uterus (muscular), which is covered inside with endometrium. Muscle tissue in the uterus plays an important function during labor, because it is with the help of its periodic contractions that the child moves through the birth canal.

Nowadays, diffuse changes in the myometrium are quite often diagnosed in women. By their nature, they are certain formations of a benign structure. Their appearance is due to the fact that endometrial cells begin to function incorrectly, and as a result, the mucous membrane begins to grow in a way that is not typical for it. Such a diagnosis threatens every 3rd woman with the absence of children and infertility. These pathological changes in muscle tissue are called endometriosis, or adenomyosis.

Reasons contributing to the development of changes in meometry

Scientists have put forward several theories why endometriosis develops due to sweating or other reasons.

Genetic predisposition.
Hormonal changes. In the female body, the quantitative ratio of hormones is disturbed. This theory can be confirmed by observing the affected tissue during the menstrual cycle, pregnancy and postmenopausal women.
Implantation theory. It implies that small particles of the endometrium that have been rejected contribute to the occurrence of the pathological process.

Such situations include:

injuries during the birth process;
surgical abortions;
when during menstruation, blood enters the uterine cavity, this occurs due to cramps (painful menstruation);

Other causes include stressful situations, diseases of other organs and systems, and sexually transmitted infections.

Research shows that diffuse changes in the myometrium can cause disruptions in the endocrine system (thyroid gland).

Symptoms that accompany endometriosis

The clinic is expressed in the following symptoms:

menstruation, which is accompanied by painful sensations;
bleeding (uterine);
spotting discharge a couple of days before the start of menstruation and after the end;
infertility;
nagging pain in the lumbar region;
possible unpleasant, painful sensations during sexual intercourse;
painful bowel movements (rare);
when the pathological process also affects neighboring organs, constipation may occur, frequent urge to urinate, and there may be blood in the urine;

If endometriosis develops in the cervix, then in the middle of the menstrual cycle, bloody discharge may appear. When endometriosis affects the walls of the vagina, the discharge is bloody a few days before the start of menstruation and after.

It is worth noting that diffuse changes may not cause any clinical picture, in such cases, the woman does not even know about the development of pathology.

It is important to go for routine examinations to a specialist doctor, which should include a visit to the ultrasound room and tests.

Diagnosis of endometriosis

First of all, you need to undergo an examination by a gynecologist, he visually assesses the nature of the discharge and the condition of the cervix and vagina, and only then prescribes the following methods.

examination with a colposcope, this makes it possible to more accurately determine the boundaries affected by the pathological process;
CT scan;
a commonly used method is ultrasound;
use of a laparoscope. With the help of this device, it is possible to consider the number of focal lesions, in what phase of activity they arrive;
use of hysteroscope in diagnostics;

Methods aimed at treating diffuse biometric changes

Whatever treatment regimen the doctor prescribes, in any case it should be aimed at:

relieving pain;
avoid further progression of pathological processes in muscle tissue, relieve inflammation;
treatment of infertility caused by diffuse changes in the myometrium;

The treatment method will depend on the following:

symptoms;
stages of the disease;
age characteristics of the woman;
the patient’s desire to become pregnant;

Based on this, you can use therapeutic treatment, and treatment with surgery.

Therapeutic treatment includes the prescription and administration of hormone-containing medications. These include combined oral contraceptives. You need to take such drugs for at least 6 months. As you know, such contraceptives are aimed at suppressing ovulation in women, which in turn allows the endometrium to not change so much. In addition, some symptoms will simply disappear once you start taking it. For example, the menstrual cycle returns to normal, pain disappears.

But like any drugs, combined hormonal contraceptives have their contraindications.

Start taking it only as prescribed by your doctor and after consultation.

There are also many hormonal drugs, and even an intrauterine device, that are used in the treatment of endometriosis.

Medicines are also prescribed to relieve spasms and inflammatory processes. Sedatives, multivitamins.

Surgical methods of treatment

Surgical interventions for this pathology are carried out using microsurgery, namely laparoscopy. But as the doctors themselves say, a favorable outcome from surgical treatment is only possible if it also includes drug treatment. There are 2 treatment regimens for endometriosis:

A woman first takes hormonal medications, a certain course, and only after that does laparoscopy.
The woman first undergoes surgery and begins taking medications.

In any case, both drug and surgical therapy, and their complex, gives a woman the opportunity to become a mother.

What complications can undiagnosed and untreated endometriosis lead to?

Infertility can rightfully be considered the most dangerous complication; it can develop against the background of diffuse changes in almost 60% of women. Possible violations from nervous system when the trunks of nerve endings are subjected to compression. Anemia is a consequence of frequent blood loss (bleeding). As a result, the woman quickly gets tired, pale skin, rapid heartbeat, and weakness. The most threatening to a woman’s health is the transition from a benign to a malignant formation.

Preventive actions

Preventive measures need to be applied not only to those women who were unlucky enough to be beaten, diagnosed with pathological changes and subsequently treated, but also to those who have not encountered this. Such measures include:

At any age, a woman should not neglect routine examinations by a gynecologist. This will make it possible to exclude or diagnose the disease.
During your period, avoid sexual intercourse.
If there excess weight, then you need to fight it.
Use contraceptives (hormonal) to avoid unwanted pregnancy and abortion.
Calmness in any situation to avoid stress.

In women, diffuse changes in the myometrium are quite common. This pathological process is called endometriosis, or adenomyosis. Among all, this disease is second only to uterine fibroids and inflammatory diseases in terms of prevalence.

Beginning of pathology

Diffuse changes in the myometrium (the middle muscular layer of the uterus) are manifested by the proliferation of endometrioid tissue. Why this happens, no one knows for sure. However great importance in this process there are hormonal disorders - an increase in the level of estrogen (female sex hormones) and a decrease in progesterone. First, this leads to a significant growth of the functional endometrial layer, then to its rejection, which is accompanied by intense bleeding. Cells of the rejected membrane penetrate through the basal layer of the endometrium in an unclear way (it is believed that heredity plays a role in this process) and begin to grow into the myometrium, penetrating it through and through. In order for foreign cells to successfully take root in any tissue, there must be a violation of the immune system, which is why it always accompanies endometriosis.

Diffuse changes in the uterine myometrium

The disease manifests itself as a thickening of the uterine wall up to four to five centimeters, but if it develops in old age, the wall thickens slightly. Endometrioid cells penetrate the myometrial tissue, as a result of which it becomes pale pink and acquires a cellular structure. Sometimes endometriotic cysts are found in the muscle layer along with bloody contents. In the thickness of the uterine wall, tissue foci develop, formed by glands of different shapes and sizes.

Degree of spread of the pathological process

Diffuse changes in the myometrium do not always occur in the same way; it all depends on the speed and depth of spread of endometrioid tissue throughout the muscular layer of the uterus. Often the disease is asymptomatic, especially in the initial stages.

There are three degrees of endometriosis:

First degree - the inner layers of the myometrium adjacent to the basal layer grow to a small depth; The criterion is the size of the field of view in the case of low magnification of the microscope.

Second degree - endometrioid tissue grows to the middle of the muscular uterine lining.

Third degree - endometrioid tissue grows to the serous (outer) uterine membrane, that is, the entire myometrium is penetrated by this tissue.

Some experts currently propose a slightly different classification and distinguish four degrees of spread of adenomyosis. In this case, the third degree is characterized by the growth of 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.

Signs of diffuse changes in the myometrium

At the initial stages of the pathological process (with the first and partially second degrees of spread), symptoms, as a rule, are not observed. The thickness of the uterine wall may increase quite slightly, so it is often difficult to identify the disease. U large number In women, diffuse changes in the myometrium continue for years without progressing, and they do not even suspect the existence of the disease. Pathology under favorable circumstances may not manifest itself in any way throughout your life. However, there are a number of factors that can trigger the activation of the process. These include all kinds of trauma to the uterus, for example, due to difficult childbirth, diagnostic curettage, abortion. All this can lead to intensive germination of endometrioid tissue in the muscle layer of the uterus.

Diffuse changes in the myometrium, with significant spread, begin to manifest themselves as severe uterine bleeding and pain. They usually occur against the background of lengthening the menstrual cycle. Over time, acyclic bleeding may occur. As a result, it develops Iron-deficiency anemia, manifested by apathy, dizziness, lethargy, headaches, drowsiness, fainting. Such anemia cannot be cured until blood loss is eliminated.

The pain is cyclical in nature - two to three days before menstruation, it appears in the lower abdomen and persists for several days after its onset. The occurrence of pain is due to the fact that the tissues swell and compress in the uterine wall nerve endings. Painful sensations may be aching and paroxysmal, radiating to the perineum, lower back or thigh area. Discomfort can also occur during gynecological procedures, sexual intercourse, and hygiene procedures such as douching.

Treatment of endometriosis

There are two main methods of treatment:

1) hormonal therapy (not always effective);

2) surgical intervention (cauterization of the affected areas is performed).

Diffuse changes in the myometrium are not a separate disease, but only a symptom of a primary pathology. Symptoms, in turn, will differ depending on the underlying cause.

Causes of heterogeneity of uterine myometrium

The myometrium is the muscular layer of the walls of the uterus, which is formed by three layers of fibers that have their own specific structure and have a certain sequence:

The outer subserosal membrane of the myometrium, which is formed by longitudinal and circular muscle fibers.
The middle layer of the myometrium, which is formed by muscle fibers. This layer is the most powerful of all. In this area, the passage of the main large main vessels is observed.
The inner longitudinal shell, which is formed only by longitudinal fibers.

Thanks to the above layers of the myometrium, the uterus performs the function of fertilization during pregnancy. It is the muscle layer of this organ that performs a protective function, preventing its possible rupture during fetal growth. During childbirth, muscle fibers ensure the process of the baby leaving the uterus.

Heterogeneous myometrium is a phenomenon that has its own causes, which can be divided into traumatic and low-traumatic. The first type of reasons includes abortions, which have consequences in the form of diffuse focal changes. Low-traumatic causes include childbirth. Another source of change is miscarriage.

Possible diseases

The heterogeneous structure of the myometrium can be observed during the development of many diseases. The most common of them include:

Endometriosis. The most common pathology, which is accompanied by changes in the structure of the myometrium. In this case, endometrial cells grow beyond the boundaries of the uterus. Using such a diagnostic measure as echostructure, heterogeneity of the myometrium can be detected.
Endomyometritis is an inflammatory process in the anterior wall of the uterine mucosa, as well as in its muscular layer. This disease occurs with pronounced pain symptoms, which is observed due to bacteria introduced into the organ, for example, during childbirth or abortion. The chronic form of endomyometritis develops with improper treatment. The disease occurs only against the background of an existing defect in the mucous membranes in the uterus.
Myoma is a benign neoplasm, which during its development is accompanied by a change in the homogeneity of the myometrium and the development of calcification. Intrauterine ultrasound or three-dimensional echography will help confirm the diagnosis.
Myometritis is a disease caused by infections that have penetrated and settled on the mucous membranes of the uterus. Symptoms in in this case similar to the manifestations of such pathologies as endometriosis. For this reason it is necessary differential diagnosis.

Changes in the structure of the myometrium during pregnancy

As a rule, diffuse changes in the uterine myometrium during pregnancy are not the root cause, but are diagnosed during planning or, what happens most often, even before it. In pregnant women, ultrasound helps not only to determine the dynamic assessment of the baby's development, but also to monitor the condition of the uterine walls. This means that the doctor will be able to prescribe timely correct treatment and make a further prognosis. It is the timeliness of identifying changes that determines what the percentage of the threat of myometrial rupture during childbirth will be, as well as how they will take place (natural or by cesarean section).

Self-diagnosis of this pathological condition during pregnancy is strictly prohibited. Only the attending physician should interpret the results of an ultrasound examination. The diffusely heterogeneous structure of the myometrium is not a reason for immediate initiation of treatment. Therapy is determined strictly according to individually, taking into account clinical and echographic examination data, etiology and severity of symptoms.

If changes in the uterine myometrium are diagnosed before " interesting situation"women, she is brought into the group increased risk on miscarriage and the occurrence of chronic placental insufficiency. If fibroids are present, they may cause abnormalities during labor, including abnormal bleeding. The presence of fibrosis and scar changes is the source of the rupture birth canal when pushing.

How is pathology diagnosed?

Thanks to diagnostic developments in the field of medicine, it is possible not only to detect diffusely heterogeneous changes in the uterine myometrium at an early stage of their development, but also to prescribe appropriate treatment in a timely manner, which will only increase the chances of a complete recovery.

The main method for diagnosing such changes is an ultrasound examination of the organ, during which the doctor determines its echostructure. If an atypical structure of the muscle layer is detected, a specialist may suspect the development of endometriosis or another provoking disease.

As such, no special preparation is needed before performing an intravaginal ultrasound examination. During the procedure, discomfort may occur due to deep penetration of the sensor. Ultrasound is most often prescribed for the following symptoms:

irregular menstruation (long delays);
pain syndrome in the lower abdomen;
spotting during the intermenstrual phase;
suspicion of infertility.

Based on the diagnostic results, it is possible to determine the size of the uterus, its location, wall thickness, and myometrial structure. When a homogeneous state of the myometrium is diagnosed, the specialist does not have any suspicions about the development of diseases in this area. If changes are detected in the structure or thickness of the muscular layer of the uterus, this already indicates a pathological process.

In addition to ultrasound examination, the doctor may carry out other diagnostic measures:

Magnetic resonance imaging is prescribed to evaluate the structure of the uterine walls.
A bimanual examination is necessary to determine the condition of the organ cavity.
A biochemical blood test is a diagnostic method that is carried out to determine the volume of hormones in a woman’s body.
A gynecological examination is prescribed to determine the condition of the cervix and vagina.
A survey of the suspected patient, during which the specialist receives information about the period of limitation for the occurrence of warning symptoms.

Treatment and prevention

Therapy for diffusely heterogeneous changes in the uterine myometrium is strictly prescribed by a doctor after all confirmatory diagnostic measures have been carried out. When determining treatment tactics, the specialist takes into account the woman’s age, what diseases she suffered in the past, how the previous pregnancy proceeded (if any), and also the degree of damage to the uterus. As a rule, the following methods of treating changes in the myometrium are used:

Taking medications. Treatment includes hormonal medications, which reduce the production of certain hormones and slow down the growth of endometrial cells. Drug therapy is more suitable for asymptomatic pathology, as well as if a woman has been diagnosed with infertility or there is a need to restore fertility. Side effects from this treatment are extremely rare.
Surgery, such as laparoscopy or laparotomy. Such therapy is provided if other methods are ineffective, when individual intolerance is observed medicines or extensive damage to the uterine myometrium is diagnosed. The organ is completely removed if the pathology is progressive, which usually occurs in women over the age of 40.

To prevent the appearance of heterogeneous changes in the uterine myometrium and diseases that provoke this process, it is recommended to systematically undergo preventive examinations by a gynecologist. This is especially true for teenagers whose first periods are accompanied by pain syndrome. It is also recommended to visit a specialist from time to time after surgical interventions in this organ.

Since the risk group for developing diseases of the female reproductive organs includes women aged 30-45 years, they need to especially carefully monitor their health. If suspicious symptoms arise, there is no need to postpone going to the doctor, because only timely identification and treatment of the causes will help to achieve a speedy recovery.