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Is Surgery the Only Effective Treatment for Adenomyosis?

Dysmenorrhea, even enlargement of uterus, prolonged menstrual periods, heavy menstrual flow, painful intercourse, anemia, infertility and high abortion rate after pregnancy and other typical symptoms of adenomyosis cause great pain and inconvenience to patients, and the number of patients is also increasing year by year, now adenomyosis has become one of the common gynecological diseases.

Adenomyosis occurs mostly in women of childbearing age between 35 and 45 years old, the endometrial cells invade into and grow in the uterine muscular layer, and women will have swelling, bleeding and exfoliation during menstruation, but they can not be discharged as normal menstruation, leading to vasodilation, increased blood volume and uterine spastic receipt in the uterine muscular layer, resulting in dysmenorrhea and irregular menstruation and other symptoms of diseases. So how to treat adenomyosis? So we must take surgical treatment?
1. Drug therapy
It is often used in the initial treatment of patients with adenomyoma or adenomyosis, i.e. those who have not been treated before or with mild conditions, and those who want to prevent recurrence after surgery, such as compound short-acting oral contraceptives, gonadotropin-releasing hormone agonists, etc.  Besides, patients can also actively take the natural medicine Fuyan Pill to consolidate the treatment, the effect of natural herbs in the formula can reach the focus and has a very good therapeutic effect in the treatment of adenomyosis.
2. Surgical treatment
① Mirena
In recent years, the Mirena contraceptive ring can continuously and quantitatively release high-efficiency progesterone locally. It not only has a good contraceptive effect but also has a good therapeutic effect on dysmenorrhea and experienced adenomyosis. Mirena has been reported in the treatment of adenomyosis both at home and abroad, and the results of its application in recent years are satisfactory. The ring is usually placed in the uterine cavity for 3-5 days during menstruation.
② Hysterectomy
Cesarean hysterectomy: it is a traditional surgical method with mature technology, definite curative effect, and low recurrence rate.
Laparoscopic hysterectomy: This is a popular minimally invasive surgery in clinical application in recent years. The curative effect is the same as that of laparotomy.
③ Subtotal hysterectomy
Laparoscopic excision of the tumoured uterus and preservation of the cervix. Cervix can be retained, with little impact on sexual life. However, the cervical lesions can occur again after the cervix.
④ Lesionectomy
For young patients with adenomyoma of the uterus or those with fertility requirements, focal resection may be tried, but it is easy to recur after an operation. Laparoscopic presacral nerve resection and sacral nerve resection can also treat dysmenorrhea. About 80% of the patients'pain disappeared or relieved after an operation.
⑤ Interventional therapy
Under the guidance of imaging equipment, the Seldinger technique is used to precisely introduce a micro-catheter along the femoral artery into  the uterine artery from the root of the patient's thigh, inject embolic agents, close the tumor vasculature bed, make the myoma ischemia, necrosis and atrophy, so as to achieve the purpose of eliminating symptoms and protecting the normal physiological function of the uterus. The uterus of the patients can be reduced, the symptoms of increased menstruation, anemia and dysmenorrhea are alleviated, mental and physical strength is enhanced, and the quality of life is significantly improved.
⑥ Uterine artery embolization
The ovaries are reserved, but one of the blood supply pathways is removed, so the function of the ovaries may be affected slightly. The short-term effect after embolization is generally good, but half of the patients will relapse after a few years, because the natural repair function of the human body will cause the lesion to form collateral circulation, but for 40-year-olds, especially after 45-year-olds, ovarian function gradually declines, so the recurrence will cause serious consequences.
However, hysterectomy has a certain impact on women's physiology and psychology, and even on the stability of marriage and family. Therefore, it is very important for women to retain the uterus. Therefore, we should not blindly choose to remove the uterus, but choose appropriate treatment according to their actual conditions.
In conclusion, for some patients with adenomyosis whose symptoms are mild or who are near menopause, the condition from endometriosis to uterine myometrium is not serious, and the symptoms of uterine enlargement are not obvious. The disease can be observed first, and the condition can be controlled by drugs under the guidance of doctors. Some progesterone and gossypol can be used. To alleviate symptoms.
In addition, patients with mild adenomyosis and reproductive requirements can positively try to get pregnant, and then choose the treatment method according to the condition of the disease after delivery. Because the estrogen secretion of pregnant women is reduced and ovarian function is not affected by menstruation, women's endometrium will atrophy during this period, which also has a certain control effect on adenomyosis. 
However, because adenomyosis can make the uterine cavity environment worse, which can easily lead to miscarriage, so patients should pay attention to the protection of the fetus after pregnancy.
Therefore, at present, all kinds of non-surgical treatment methods are only suitable for patients with adenomyosis whose condition is not serious or near menopause. For those patients whose condition is serious or the effect of drugs and other treatments is not obvious, surgery is recommended.

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