How is uterine endometriosis manifested in women. Uterine endometriosis - what is it, causes, signs, symptoms and treatment of endometriosis in women

Content

There are many gynecological diagnoses that can unsettle a woman. Endometriosis is one of such insidious diseases. Find out useful information about the forms in which this ailment appears and for what symptoms it is worth suspecting. Information about traditional and folk methods of treating the disease can also be useful to you.

Forms of endometriosis

Today this disease is a very common pathology in gynecology, which can lead to various complications if it is not treated in a timely manner. For this reason, a woman who monitors her health should be aware that endometriosis is what it is and how this ailment is manifested. This disease is a chronic overgrowth of the endometrium - the glandular mucous tissue that normally only covers the inner surface of the uterus - outside this organ. In medical practice, there are different forms of the disease:

1. The extragenital form of the disease is diagnosed when endometrioid tissue grows on other organs located both in the abdominal cavity - the intestines, urinary system, etc., and outside it - for example, to the lungs.
2. The combined form of the disease manifests itself if heterotopy - the atypical placement of endometrial tissues - is localized on the genitals and other internal organs.
3. Genital endometriosis. With this form of the disease, there are:

• internal uterine endometriosis (adenomyosis) - the growth of nodular seals in the muscle layer of the uterus, fallopian tubes, ovaries;
• external or external endometriosis - retrocervical (posterior), damage to the vagina and peritoneum of the pelvis.

Stage of endometriosis

The highest incidence of endometriotic disease occurs in the internal genital form of the disease - adenomyosis. Many women are diagnosed with this when they see a doctor complaining of heavy, painful periods. What is adenomyosis, if you look in detail? This is a pathological process, which is characterized by the fact that foci of endometriosis occur in the myometrium - the muscle layer of the body and the isthmus of the uterus.

Depending on the nature of the localization of endometrial cells, focal, diffuse or nodular adenomyosis is distinguished. In order to choose the treatment regimen correctly, when diagnosing, gynecologists pay special attention to the stage of the disease according to this classification:

• I - the surface layer of the endometrium grows into the basal layer to the borders of the myometrium;
• II - the muscle layer of the uterus is affected to the middle of its thickness;
• III - the lesion extends to the serous cover;
• IV - endometriotic lesions extend to the peritoneum lining the walls of the abdomen.

Cause of disease

It is a well-known fact that many diseases can be avoided by excluding factors provoking them from your life. Why in this way it is impossible to prevent this ailment and get rid of the many troubles that it causes? The fact is that medicine cannot unambiguously determine the causes of endometriosis in women. There are several theories why this disease occurs:

1. The implantation of endometrial cells outside the uterine cavity due to their casting outside the body during menstruation.
2. Hormonal disorders in the body.
3. Hereditary predisposition.
4. Immunity disorders when the body’s defense system does not recognize the abnormal arrangement of endometrial cells and does not destroy them.
5. Malformation of the genitals in the prenatal period.
6. Damage to the uterine mucosa during medical procedures - diagnostic curettage, abortion.
7. Inflammatory and infectious diseases of the genitourinary system.
8. Incorrectly selected contraceptives, prolonged use of the intrauterine device, etc.

Signs

It is not easy to independently recognize this ailment in the early stages, therefore it is very important not to miss periodic examinations by a gynecologist. A woman may suspect endometriosis if she begins to notice the following symptoms:

• increased pain in the lower abdomen and in the pelvic region during menstruation;
• an increase in the number of menstrual flow and the duration of menstruation;
• an increase in body temperature on critical days and immediately after them;
• bleeding or spotting between periods;
• pain during intercourse;
• general weakness, dizziness.

You need to know that these symptoms of endometriosis in women are characteristic not only for this, but also for other, even more dangerous gynecological diseases. For example, do you know what endometrial hyperplasia is? This disease is also characterized by the growth of endometrioid tissue due to hormonal disruptions in the body, manifested by changes in the nature of menstruation, but in the absence of proper treatment, it can go into oncology. To distinguish between these similar symptoms of disease is possible only after a full examination.

Diagnostics

A gynecologist needs to combine instrumental and laboratory research methods to confirm this ailment in a patient. In rare cases, the diagnosis of endometriosis helps confirm colposcopy, much more informative results - accuracy of more than 90% - gives transvaginal ultrasound. By echo signs, you can determine whether the thickness of the mucous layer in the uterus is normal, and also notice other possible pathologies: hypoplasia, malnutrition, endometrial dysplasia.

The diffuse and nodular form of endometriosis is well diagnosed during hysteroscopy - examination with a special device of the uterine cavity through the mouth of the cervical canal. Laparoscopy is also effective for making a diagnosis - a procedure during which not only an examination of the pelvic cavity is performed, but also cauterization of foci of endometriosis. Also, the patient will need to pass an analysis for endometriosis - check the level of hormones, and also undergo an examination for whether she has developed anemia.

How to treat endometriosis

If a woman has been diagnosed with this diagnosis, she needs to know that this disease is not completely cured, but a correctly selected course of therapy will help level the consequences of the disease and live a full life. Check out what are the treatments for endometriosis.

1. Conservative drug therapy - a long course of hormone-containing drugs: Dufaston, Janine, etc.
2. Symptomatic treatment of the manifestations of endometriosis with the use of anti-inflammatory, analgesic tablets and suppositories, drugs for anemia.
3. Ablation is the process of destroying the uterine mucosa with a laser, radio, microwaves, cryodestruction, and other methods.
4. Electrocoagulation - cauterization of foci of the disease by electric shock.
5. Physiotherapy - is applied comprehensively during hormonal or postoperative treatment of endometriosis, is carried out by methods of pulsed currents, hydro-, laser-, magnetotherapy, balneotherapy.
6. Surgical manipulations - often the removal of foci of mucosal growth is carried out by laparoscopic surgery, cryodestruction, and in severe cases, the affected areas are excised with a scalpel.

Alternative treatment

To get rid of the manifestations of this disease, patients often use available methods of alternative medicine. It is important to remember that such healing should not occur on its own, but can only be used as an additional effect as part of complex therapy only after consultation with your doctor. In practice, endometriosis is often treated with a pine uterus. Here are some simple ways to use this medicinal plant:

1. 2 tbsp. l Dried herbs pour 0.5 liters of vodka, insist 2 weeks in a dark place. Take tincture three times a day before meals, 30 drops, slightly diluting it with water.
2. 2 tbsp. l dry chopped herbs add in 1 tbsp. refined vegetable oil. Insist the remedy also 2 weeks, then strain the resulting infusion. Introduce a swab soaked in this medicine into the vagina at night.

What is dangerous endometriosis

Do not let this disease drift, because it is fraught with many serious consequences. So, it has been established that endometriosis and infertility are interrelated states, therefore, a woman planning a pregnancy must be treated with this ailment to realize her reproductive function. Endometrioid cyst on the ovary can lead to loss of the appendage. If endometriosis occurs with uterine myoma, then this combination often threatens with irreversible consequences, which entail organ removal.

Prevention

How to prevent this disease? The most important rule in the prevention of endometriosis is to regularly see a doctor 2 times a year, because it has been proven that endometriosis often develops for childbearing reasons, and only with menopause such risks are reduced. If there are delays in the menstrual cycle, this often indicates a violation of ovarian function, which is also a favorable background for the disease. You can not ignore the symptoms that appear and simply anesthetize the discomfort - you must immediately contact a gynecologist.

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One of the pathologies of the female body that are part of the practice of gynecology is endometriosis symptoms and the treatment of which can only be determined and prescribed by a doctor with full confidence. Endometriosis is characterized by a different manifestation and in the initial stages the symptoms can be attributed to another disease.

When you need to contact a gynecologist, if his visit to the lady is not a regular visit, as provided for each representative of the beautiful half every six months. What symptoms clearly indicate endometriosis, the treatment of which requires a serious mood of the patient and contact an experienced specialist? Details in the article.

What is endometriosis?

Endometriosis is only a female disease associated with its reproductive function. A lady of reproductive age, if there are no gynecological pathologies, monthly comes menstruation, which is mucus accumulated in the uterus during the preparation of the genital organs for conception.

If fertilization has not occurred, the process of renewal of the uterine mucosa, the so-called endometrium, and expulsion of the corpus luteum, dead egg and exfoliated endometrium from the uterine cavity and the ovary cavity are started. At the exit of the vagina, it looks like a total blood mass interspersed with clots, mucus. This is a normal process for a healthy woman.

But for reasons not fully understood, in some women, the exfoliated endometrium goes not only outward, as it should, but is also thrown into the internal organs (fallopian tubes, on the walls of the uterus, into the abdominal cavity and beyond), where it is attached to the mucosa of the walls of these organs and begins to grow (this is endometriosis). In gynecology, vaginal endometrial tissues are commonly referred to as endometrioid heterotopies.

The situation is complicated by the fact that this vaginal endometrium continues to function in the same way as in the reproductive organs during the menstrual cycle. More precisely, the tissue is regenerated throughout the cycle and at the time of menstruation, particles of the old endometrium (heterotopies) exfoliate and rush on, joining in the same organ or, together with the flow of blood or plasma, travels through the body.

Foci of endometriosis are found in the cavity of the lungs, kidneys, heart, eyes, on the nasal mucosa. Such reproduction of the endometrium in the body makes it difficult to diagnose and treat endometriosis, because the symptoms that patients complain about do not always indicate a gynecological problem.

The difficulty in treating endometriosis is that the symptoms may not appear immediately, but after a long time, when conservative treatment can eliminate only somatic symptoms. And overgrown tissues with endometriosis have to be removed by surgical treatment.

Wikipedia gives the following definition of what endometriosis is “a gynecological disease in which the cells of the endometrium (uterine inner layer) grow outside this layer,” that is, the uterine endometrium, where it should be by the nature of the structure of the female genital organs. Endometrioid tissue, referring to Wikipedia, is endowed with receptors for hormones, like the inner layer of the walls of the uterus, and therefore undergoes the same changes, expressed in monthly bleeding.

Only bleeding with endometriosis from heterotopy leaves the cavity of the affected organs, causing certain symptoms - pain, enlarged organs, adhesions in the abdominal cavity, with damage to the reproductive organs - infertility. These are complications of endometriosis.

Bleeding with endometriosis provokes an inflammatory process in the surrounding tissues.

Having understood what endometriosis is, you need to clearly understand what symptoms accompany endometriosis, so as not to miss the moment when the treatment will be effective.

Attention: Do not forget that endometriosis is dangerous by infertility or the inability to bear a pregnancy, because endometriotic nodules will interfere with the development of the embryo or placenta.

Different forms of endometriosis provoke different symptoms

Before talking about the symptoms and treatment of endometriosis, it is necessary to consider the types of endometriosis according to the location and degree of growth.

There are two classifications of endometriosis in gynecology at the site of formation of endometrioid nodes:

Genital Endometriosis

Tissue grows only in the genitals of a woman. Endometries can settle only inside the uterus (internal genital endometriosis) or go beyond it and rush into other genital organs - the fallopian tubes, ovaries, vagina, abdominal pelvic cavity (external genital endometriosis).

If we approach the issue of classification of genital endometriosis in more detail, then in gynecology there are the following terms:

• Endometrial damage to the ovaries, pelvic cavity, fallopian tubes is defined as peritoneal endometriosis.
• Damage to the vagina, cervix, rectovaginal septum is defined as extraperitoneal endometriosis.
• The attachment of nodules directly to the walls of the uterus is called internal endometriosis or adenomyosis. A symptom of such a localization of heterotopia is an increase in the size of the uterus before the gestational age of five, six weeks, although there was no fertilization. The growth of the endometrium in this case, some ladies perceive as a banal weight gain, although the situation is much more complicated.

Extragenital Endometriosis

The endometrium with the flow of blood or lymph scatters throughout the body and can be found in the most unexpected places that have nothing to do with the genitals. Endometriosis is formed in the gastrointestinal tract, urinary system, and in the upper respiratory tract.

Quite often, gynecologists diagnose a mixed form of endometriosis, when pathological changes are present in the genital organs and in systems that are far from the genital.

Usually these are advanced stages of endometriosis, when a woman simply ignored the symptoms of endometriosis and did not seek treatment, or the symptoms of endometriosis were hidden until a certain point and the lady felt fine. Although during a routine examination by a gynecologist, the visual symptoms of endometriosis still appear, and if a gynecologist suspects a disease, an additional examination and the necessary treatment are prescribed for the patient.

In addition to the classification of endometriosis according to the place of localization, there is a gradation of pathology according to the degree of growth of endometrioid nodes:

A separate classification has intrauterine endometriosis (adenomyosis), because the degree of growth in the walls of the uterus have a different degree. Sometimes treatment of endometriosis involves the complete removal of the uterus in order to avoid degeneration into malignant tumors.

Signs of endometriosis are clearly manifested in the premenstrual period, a few days before the onset of menstruation. Some ladies consider this the norm, because from adolescence they experience pain during menstruation and do not seek treatment. But the symptomatology of pain with endometriosis is stronger and can be expressed by attacks that cannot be stopped even by strong analgesics.

Important: The symptom of pain with endometriosis can be removed only with special treatment that is prescribed for endometriosis.

The main symptoms of endometriosis

There are various symptoms of endometriosis reported by patients at the doctor’s appointment. But they talk about them only at a time when endometriosis is already in a progressing stage and serious treatment of endometriosis is required.

At the initial stage of endometriosis, there are no specific symptoms that indicate this gynecological disease. Specific symptoms can occur only when endometriosis passes into the second, third or fourth degree of endometriosis. What to look for:

Symptoms of endometriosis are presented in a single manifestation or in a complex. It depends on the location of endometriosis and the degree of progression of gynecological pathology. The sooner a diagnosis is made, the more effective is the treatment of endometriosis and the complete elimination of the problem is possible.

What triggers the development of endometriosis

Research into the causes leading to improper disposal of waste material from the menstrual cycle is still ongoing. There are several theories that cannot be recognized as the only true ones, but it is worth knowing about them:

1. One of the assumptions regarding the causes of endometriosis is the theory of retrograde menstruation. Most physicians are inclined to this justification. The bottom line is that at the time of exile of the exfoliated tissue, part of the endometrium rushes not into the vaginal cavity, but to the other side, more precisely, into the cavity of the fallopian tubes or abdominal cavity. Under favorable conditions, the endometrium attaches to the walls of organs and continues a cyclic existence. In the absence of pregnancy, under the influence of hormones, hemorrhage occurs, not only outward, as provided by nature, but in the same cavity where the exfoliated uterus exfoliated from the uterus fell under the current conditions. Inflammation appears due to the presence of foreign tissue in the organ, particles of the endometrium with blood. The phenomenon of retrograde menstruation may be present in a woman, but certain conditions become the impetus for the development of endometriosis - heredity from the mother, physiological peculiarity of the structure of the fallopian tubes, depression, and decreased immunity.
2. The second theory is that gene mutation is the cause of endometriosis.. There is an assumption that in the genes of some people there are the rudiments of endometriosis, which under certain conditions are activated and lead to serious female pathology. There is no practical evidence for this.
3. The third theory is that with embryonic development, part of the endometrium from the uterus enters the body of a future girl and eventually manifests itself in the form of endometriosis.

Regardless of what exactly is the root cause of such a complex process leading to the disease, factors that help trigger this mechanism are well established:

• Any inflammatory processes in the genital tract, with frequent episodes, but without the right treatment.
• Instrumental interventions in the female reproductive system, for example, circulation and other operations, treatment methods.
• Severe birth process requiring treatment.
• Tumors are malignant or benign in the area of \u200b\u200bthe uterus or other genital organs, the treatment of which did not give a positive result.
• Anemia, the treatment of which requires a separate approach.
• Addiction to alcohol, tobacco.
• Hypothermia.
• Colds and viral diseases, the treatment of which has not been completed.
• Pathologies in the endocrine system, for example, dysfunction of the thyroid gland or other glandular organs responsible for the synthesis of hormones.
• Weakened immunity.
• Autoimmune diseases.

Important: Finding the exact cause of endometriosis is difficult, but you need to pay attention to the symptoms so that the treatment of endometriosis with medication is effective.

The key to effective treatment of endometriosis is the correct and timely diagnosis

Gynecologists constantly urge women to undergo a professional examination twice a year so as not to miss the symptoms of a serious gynecological pathology. In the case of endometriosis, this is doubly relevant, because endometrial damage to various organs is considered one of the most serious and dangerous diseases of a woman, who do not always have vivid symptoms and are treatable due to late visits to the doctor.

The following diagnostic procedures are required to confirm and treat the endometriosis indicated by the symptoms:

1. Examination by a gynecologist on a viewing chair using special tools. It is better to conduct such a study on the eve of menstruation.
2. Genital biomaterial sampling during colposcopy and hysterosalpingoscopy.
3. Ultrasound of the pelvic organs and abdominal cavity to clarify the place of attachment of the endometrium and the overall clinical picture for the choice of treatment for endometriosis.
4. X-ray of the fallopian tubes and uterus to determine endometriosis in the cavity of these organs and the degree of their reproduction.
5. Computed or magnetic resonance imaging of the whole organism to identify foci of endometriosis not only in the reproductive system, but also in other organs and tissues.
6. Laparoscopy with the aim of examining the focus of endometriosis and to assess the prospect of treatment.
7. Special blood tests for tumor markers of various types (malignant, benign). If the body has foci of endometriosis, then the performance of these studies will be exceeded.

If the listed research methods for endometriosis are not enough to make an accurate diagnosis, shape, size and localization of the endometrium, the gynecologist will offer additional procedures.

Principles of treatment of endometriosis

The treatment of endometriosis is complex and complex, but the choice of method depends on the specific condition of the patient, the symptoms of endometriosis, her age, the presence of children, the general physical form, the history of surgical interventions in the genital organs of a woman, the neglect of the disease and the desired result.

The following methods of treating endometriosis are distinguished:

• Medication - it is used for the symptoms of the initial stage of endometriosis, when the foci do not have a wide localization or the nodules have not reached such dimensions that they block the functions of the affected organs. If the goal of treatment for symptoms is to maintain the ability to become pregnant, doctors will gradually prescribe different types of drugs that should stop the progressive process of endometriosis. For some time, the ovulation phase may be blocked so that menstruation does not occur, then the foci of endometriosis will not pour out blood in the wrong place and continue their reproduction, the symptoms of endometriosis may disappear. Hormone therapy comes first in drug treatment. The production of the female hormone estrogen and the process of ovulation are suppressed. Treatment with hormonal drugs lasts from 3 to 8 months to exclude the casting of a new batch of endometrial tissue. Side effects from treatment may appear. Together with hormones for endometriosis, analgesics, anti-inflammatory drugs, and immunostimulants are prescribed to push natural immunity and remove the symptoms of pain.

• Surgery it is assumed if drug treatment is not enough or foci of endometriosis reach a diameter of 3 cm and this is a serious threat to a woman. During surgical treatment, laparoscopy is preferred if a woman needs to maintain a childbearing function. The surgeon locally removes the endometrioid nodes, due to which the inflammation is removed and the symptoms of pain recede with proper treatment. If endometriosis has reached the IV degree, then complete removal of the uterus, overlapping of the fallopian tubes is required to save a woman's life and remove the source of cyclic endometrial functioning in different places of the body. On this, the menstrual cycle stops and the progression of endometriosis also.

Important: It is not worth it to deal with the treatment of endometriosis on your own, because only the doctor can choose the treatment regimen based on the clinical picture of a particular patient.

Endometriosis is a very serious gynecological disease that dramatically changes the life of a woman if you do not consult a doctor in a timely manner. Do not forget that the symptoms of endometriosis can be sluggish or completely absent before complications occur.

Finally

Endometriosis, the symptoms and treatment of which are discussed in detail in the article, may not disturb a woman if she monitors her health and performs preventive measures by visiting a gynecologist once every six months.

At the initial stage, treatment of endometriosis is effective even with hormone therapy and reproductive function does not suffer from this. Pregnancy is calm under the watchful eye of a gynecologist.

The uterine cavity of a healthy woman inside consists of a unique tissue - the endometrium. Depending on the phase of the woman’s menstrual cycle, the endometrium changes: it gradually increases, and during menstruation it is rejected by the uterus and goes outside.

But sometimes the endometrium begins to appear not only in the uterus, but also in the ovaries, bladder, rectum, scar after Cesarean section, and even in organs and tissues remote from the uterus. In this case, the work of these organs can be significantly disrupted.

How to treat endometriosis, why does this disease appear and what are its symptoms?

Endometriosis is a pathological hormone-dependent process in which the growth of the glandular tissue of the uterus (namely, the endometrium) is observed outside it, in other organs and tissues: ovaries, fallopian tubes, in the thickness of the uterus, bladder, surface of the peritoneum, in the rectum, etc. Fragments of the endometrium, growing in other organs, undergo the same cyclic changes as the endometrium in the uterus, in accordance with the phases of the menstrual cycle. These changes in the endometrium are manifested by pain, an increase in the affected organ in volume, monthly bloody discharge from heterotopia, violation of menstrual function, discharge from the mammary glands, infertility.

Endometriosis is very common in the population. According to the frequency of occurrence among gynecological pathology, only inflammatory diseases and uterine fibroids are superior to it.

The vast majority of detected cases of endometriosis occur in the reproductive period. It is also diagnosed in approximately 10% of girls during the formation of menstrual function and in 2-5% of cases in women in the menopause.

Causes of Endometriosis

Unfortunately, scientists are still not aware of the exact causes of endometriosis in women, despite numerous studies and experiments in this area. Usually it is weak immunity that “allows” the endometrium to settle where it is not needed. Doctors also trace the connection between this disease and such causes as pathological birth, repeated surgical abortions, Caesarean section, installation of coils, cauterization of erosion, chronic pelvic inflammatory processes.

However, most often gynecologists are inclined to believe that the cause of the disease is a genetic predisposition against the background of hormonal imbalance. After all, the disease manifests itself only during menstruation. With the onset of menopause or pregnancy, the painful process stops, and sometimes completely disappears.

Many experts are inclined to the theory of retrograde menstruation (or implantation theory). According to this theory, in some women there is a hit (reflux) of menstrual blood with particles of the endometrium into the abdominal cavity, fallopian tubes. In some cases, endometrial cells, attaching to tissues of various organs, continues to function cyclically. In the absence of pregnancy, the endometrium from the uterus is rejected during menstruation, while microorganism occurs in other organs, accompanied by the development of the inflammatory process.

Presumptive factors for endometriosis:

• features in the structure of the fallopian tubes,
• immunosuppression
• heredity.
  

The role of a hereditary predisposition in the development of endometriosis is beyond doubt in anyone. Therefore, it is believed that the probability of transmission of this disease from mother to daughter is quite high.

Other theories of the development of endometriosis, which are not widespread, consider one of the possible causes of gene mutations, deviations in the functions of cellular enzymes, and failure of the reaction of receptors with respect to hormones.

Symptoms of Endometriosis

The course of endometriosis can be varied. The onset, as a rule, is asymptomatic. That is why it is possible to detect its presence in time only with regular professional examinations. However, there are reliable symptoms indicating the presence of endometriosis.

• Pelvic pain. It accompanies endometriosis in 16-24% of patients. The pain can be clearly localized or diffuse throughout the pelvis, occur or intensify immediately before menstruation, or be present continuously. Often, pelvic pain is caused by inflammation that develops in organs affected by endometriosis.

• Painful intercourse (dyspareunia). Discomfort and pain during sexual intercourse is especially pronounced with the localization of foci of endometriosis in the vagina, wall of the rectovaginal septum, in the region of the sacro-uterine ligaments, and the utero-rectal space.

• Pain during bowel movements or urination.

• Menorrhagia - heavy and prolonged menstruation. It is observed in 2-16% of patients with endometriosis. Often accompanies adenomyosis and concomitant diseases: uterine fibroids, polycystic ovaries, etc.

• The development of posthemorrhagic anemia. It occurs due to significant chronic blood loss during menstruation. It is characterized by increasing weakness, pallor or yellowness of the skin and mucous membranes, drowsiness, fatigue, dizziness.

Classification of endometriosis

By localization, genital and extragenital forms of endometriosis are distinguished.

In the genital form of endometriosis, there are:

• peritoneal endometriosis - with damage to the ovaries, pelvic peritoneum and fallopian tubes;
• extraperitoneal endometriosis, localized in the lower parts of the reproductive system - the external genitalia, in the vagina, vaginal segment of the cervix, rectovaginal septum, etc .;
• internal endometriosis (adenomyosis), developing in the muscle layer of the uterus. With adenomyosis, the uterus becomes spherical, enlarged in size up to 5-6 weeks of pregnancy.
  

The localization of endometriosis can also be mixed, as a rule, in the absence of timely detection and treatment of the disease.

With the extragenital form of endometriosis, foci of heterotopia occur in the intestine, in the lungs, in the kidneys, in the umbilical ring and in postoperative scars.

There are 4 degrees of endometriosis, which depend on the depth and distribution of focal growths of the endometrium:

I degree - foci of endometriosis are superficial and single;

II degree - foci of endometriosis are deeper, in greater numbers;

III degree - deep multiple foci of endometriosis, endometrioid cysts on one or both ovaries, individual adhesions on the peritoneum;

IV degree - multiple and deep foci of endomeriosis, bilateral large endometrioid cysts on the ovaries, dense adhesions, endometrial germination in the walls of the vagina and rectum. IV degree of endometriosis is characterized by the prevalence and severity of the lesion, it is difficult to treat.

According to the degree of myometrial damage, there is a classification of uterine adenomyosis (internal endometriosis), in the development of which there are four stages:

Stage I - the initial germination of the myometrium;

Stage II - the spread of foci of endometriosis at half the depth of the muscle layer of the uterus;

Stage III - germination of the entire myometrium up to the serous membrane of the uterus;

Stage IV - germination of the walls of the uterus with the spread of foci of endometriosis to the peritoneum.

Endometrioid foci can vary in size and shape: from rounded formations a few millimeters in size to shapeless growths a few centimeters in diameter. Usually they have a dark cherry color and are separated from the surrounding tissues by connective tissue whitish scars.

The foci of endometriosis become more noticeable on the eve of menstruation due to its cyclical maturation. Spreading to the internal organs and peritoneum, areas of endometriosis can grow deep in the tissue or located superficially. Ovarian endometriosis is expressed in the appearance of cystic growths with dark red contents. Heterotopies are usually arranged in groups.

The degree of endometriosis is evaluated in points, taking into account the diameter, depth of germination and localization of foci. Endometriosis is often the cause of adhesions in the pelvis, limiting the mobility of the ovaries, fallopian tubes, uterus, leads to menstrual irregularities, infertility.

What is the danger of endometriosis?

Often, endometriosis can be asymptomatic, gradually leading to infertility. Numerous adhesions that form during endometriosis provoke obstruction of the fallopian tubes, as a result of which pregnancy becomes impossible. Statistics show that about half of cases of infertility are the result of untreated endometriosis.

In patients with endometriosis, infertility is 25-40%. So far, gynecology cannot accurately answer the question of the mechanism of the development of infertility in patients with endometriosis. Among the most likely causes of infertility, in addition to changes in the ovaries and tubes, are: violation of general and local immunity, concomitant violation of ovulation.

Endometriosis dramatically reduces the chances of having a baby and can provoke a spontaneous miscarriage, so pregnancy with endometriosis should be carried out with constant medical supervision. The probability of pregnancy after the treatment of endometriosis ranges from 15 to 56% the first 6-14 months.

Endometriosis Complications

Hemorrhages and cicatricial changes in endometriosis cause the development of adhesions in the pelvis and organs of the abdominal cavity. Another common complication of endometriosis is the formation of endometrioid ovarian cysts filled with old menstrual blood (“chocolate” cysts). Both of these complications can cause infertility. Compression of the nerve trunks can lead to various neurological disorders. Significant blood loss during menstruation causes anemia, weakness, irritability, and tearfulness. Infrequently, malignant degeneration of foci of endometriosis occurs.

Diagnosis of endometriosis

In the diagnosis of endometriosis, it is necessary to exclude other diseases of the genital organs, proceeding with similar symptoms. If there is a suspicion of endometriosis, a collection of complaints is required, an anamnesis, in which pain is indicative, information about past diseases of the genital organs, operations, the presence of gynecological pathology in relatives. Further examination of a woman with suspected endometriosis may include:

• gynecological examination (vaginal, rectovaginal, in the mirror) is most informative on the eve of menstruation;
• colposcopy and hysterosalpingoscopy to clarify the location and form of the lesion, obtain a tissue biopsy;
• ultrasound examination of the pelvic organs, abdominal cavity to clarify the localization and dynamic picture in the treatment of endometriosis;
• spiral computed tomography or magnetic resonance in order to clarify the nature, localization of endometriosis, its relationship with other organs, etc. The accuracy of the results of these methods with endometriosis is 96%;
• laparoscopy, allowing you to visually examine the foci of endometriosis, to assess their number, degree of maturity, activity;
• hysterosalpingography (x-ray pictures of the fallopian tubes and uterus), hysteroscopy (endoscopic examination of the uterine cavity), allowing to diagnose adenomyosis with an accuracy of 83%;
• the study of tumor markers CA 125, CEA and CA 19-9 and the PO test, the parameters of which in the blood with endometriosis increase several times.

Endometriosis treatment

Therapeutic tactics depend on various factors: the woman’s age, her plans for pregnancy, location, prevalence of endometriosis, the number of pregnancies, childbirth, the presence of other diseases of the pelvic organs.

Methods of treating endometriosis are divided into medical, surgical (laparoscopic with removal of foci of endometriosis and preservation of the organ, or radical - removal of the ovaries with the uterus) and combined.

The treatment of endometriosis aims not only to eliminate the active manifestations of the disease, but also its consequences (adhesions, cystic formations, neuropsychiatric manifestations, etc.).

Indications for the conservative treatment of endometriosis are its asymptomatic course, the young age of the patient, premenopause, the need to maintain or restore reproductive function. The leading method of drug treatment of endometriosis is hormone therapy with the following groups of drugs:

• combined estrogen-progestogen drugs (marvelon, silest, nonlonon, etc.). These drugs, containing small doses of gestagens, inhibit the production of estrogen with ovulation. They are indicated at the initial stage of endometriosis, because they are not effective with the prevalence of the endometrioid process, ovarian cysts. Side effects are expressed by nausea, vomiting, intermenstrual bleeding, tenderness of the mammary glands.

• gestagens (norkolut, uterozhestan, non-mestran, duphaston). Indicated at any stage of endometriosis, continuously - from 6 to 8 months. Reception of progestogens may be accompanied by intermenstrual hemorrhage, depression, tenderness of the mammary glands.
  

• antigonadotropic drugs (danazol, danogen, danol, etc.). Suppress the production of gonadotropins by the hypothalamus-pituitary gland system. They are used in a continuous course for 6-8 months. Contraindicated with their own hyperandrogenism (excess of androgen hormones). Side effects include sweating, hot flashes, weight gain, coarsening of the voice, increased oily skin, increased hair growth intensity.
  

• agonists of gonadotropic releasing hormones (triptorelin, goserelin, etc.). The advantage of this group of drugs for the treatment of endometriosis is the possibility of using the drugs once a month, the absence of serious side effects. Releasing hormone agonists inhibit the process of ovulation and estrogen levels, leading to suppression of the spread of foci of endometriosis.

In addition to hormonal drugs, immunostimulants and symptomatic therapy are used in the treatment of endometriosis: antispasmodics, analgesics, anti-inflammatory drugs.

  Organ-preserving surgical treatment with the removal of heterotopia is indicated for moderate and severe stages of the course of endometriosis. Treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, dissection of adhesions. It is carried out in the absence of the expected effect of drug therapy, the presence of contraindications or intolerance to medications, the presence of lesions with a diameter of more than 3 cm, impaired bowel, bladder, ureters, and kidneys. In practice, it is often combined with drug treatment of endometriosis. It is carried out by laparoscopic or laparotomy approaches.

Radical surgical treatment of endometriosis (hysterectomy and removal of the appendages) is performed for patients after 40 years with active disease progression and ineffective conservative surgical measures. Unfortunately, radical measures in the treatment of endometriosis are required by 12% of patients. Operations are performed by laparoscopic or laparotomy methods.

Endometriosis has a tendency to relapse, which sometimes forces you to resort to repeated surgery. Relapses of endometriosis occur in 15-40% of patients and depend on the prevalence of the process, its severity, localization, radicality of the first operation.

In childbearing age, the success of the treatment of endometriosis is determined by the restoration or preservation of childbearing function. At the current level of surgical gynecology, the widespread use of gentle laparoscopic techniques, such results are achieved in 60% of patients with endometriosis aged 20 to 36 years. In patients with endometriosis, after radical operations, the disease does not resume.

The most commonly used medical and surgical methods in combination. Conservative treatment consists in the appointment of hormonal drugs that suppress the activity of the ovaries, as well as funds that strengthen the woman's immunity.

Be sure to operate on endometrioid ovarian cysts, as well as extensive endometriosis, if it is combined with uterine myoma. Surgical intervention is also carried out with the ineffectiveness of conservative methods of treatment, in the case of progression of endometriosis against the background of the treatment.

Endometriosis Prevention

Often, a woman can recognize the early manifestations of endometriosis on her own if she is sufficiently attentive to herself. Failures of the menstrual cycle along with mood changes, nervousness, headaches may indicate a disease in the early stages. If unpleasant symptoms occur, it is better not to wait for severe pain, but immediately seek medical help.

Attempts at self-treatment or wait-and-see tactics regarding endometriosis are absolutely not justified: with each subsequent menstruation, new foci of endometriosis appear in the organs, cysts form, cicatricial and adhesion processes progress, and patency of the fallopian tubes decreases.

The main activities aimed at the prevention of endometriosis are:

• a specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) in order to exclude endometriosis;
• observation of patients who have had an abortion, other surgical procedures on the uterus to eliminate possible consequences;
• timely, complete cure of acute and chronic genital pathology;
• taking oral hormonal contraceptives.
  

The risk of developing endometriosis is higher in the following groups of women:

• noting a shortened menstrual cycle;
• suffering from metabolic disorders, obesity, overweight;
• using intrauterine contraceptives;
• after the age of 30-35 years;
• having elevated estrogen levels;
• immunosuppressed;
• having a hereditary predisposition;
• after surgery on the uterus;
• smoking women.

Definition of the disease. Causes of the disease

Endometriosis - a chronic disease of the female reproductive system, characterized by germination of the tissue of the mucous membrane of the uterine cavity - the endometrium - beyond. Endometriosis is manifested by chronic pain and infertility. Most often, endometrioid tissue, structurally slightly different from normal endometrial tissue, is located on the peritoneum of the pelvis, ovaries, fallopian tubes and ligaments of the uterus. Damage to adjacent organs: the colon, bladder, and ureters can be observed. Also, endometrioid foci are found on the cervix, vagina and external genitalia. Endometriosis can penetrate beyond the woman’s reproductive system — into the lungs, kidneys, and eye chamber, and can also be found in postoperative scars on the anterior abdominal wall and navel. Separately, uterine endometriosis - adenomyosis. In this case, endometrioid tissue “grows” into the uterus muscle, contributing to the formation of “passages”, “foci” and “nodes” in it.

The causes of endometriosis are still unknown. If you believe the first of the three existing theories, endometrial tissue during menstruation through the fallopian tubes enters the abdominal cavity and is implanted there on the peritoneum covering the internal organs.

The second theory involves the transformation of the epithelium into endometrioid tissue, the third suggests that endometrial particles can enter various organs and tissues through the circulatory or lymphatic systems.

There is evidence of the role of heredity in the development of endometriosis; this disease is more common in women whose relatives also suffered from endometriosis.

Risk factors for the development of endometriosis:

1. A small number of births, late first births;
2. Early onset of menstruation;
3. A short period between menstruation, a long period of menstruation;
4. Low weight;
5. Alcohol abuse;
6. Anomalies of the uterus that impede the flow of menstruation.

Endometriosis occurs only during the woman's reproductive period, only isolated cases of the disease are described before the onset of menstruation and after menopause. During pregnancy and in the lactational period, the manifestations of endometriosis temporarily cease.

Endometriosis occurs in 5-6% of women in the general population and in more than 50% of women suffering from infertility.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of Endometriosis

The most common symptom of the disease is pain, and in 70% of cases it is associated with menstruation. In 25% of cases, the course of the disease is asymptomatic. Usually there are aching, jerking, cutting pains that are localized in the lower abdomen, lower back, sacrum, radiating to the leg, rectum. Most often, they are observed before and during menstruation, but can continue throughout the cycle. The main complaints of patients are pain during sexual intercourse, during urination and defecation. In addition, a manifestation of endometriosis can be spotting spotting a few days before and after menstruation. Adenomyosis is characterized by very painful and heavy menstruation.

Extragenital forms of endometriosis can manifest themselves in different ways: for example, foci in the lungs can cause hemoptysis, in the chamber of the eye - bloody tears, in the kidney or bladder - blood in the urine. The presence of endometriosis in the skin is manifested by the formation of infiltrates or cyanotic vesicles, which are often manifested by local pain. All manifestations of extragenital endometriosis, as a rule, are observed during menstruation, and at other times can be asymptomatic.

In addition to the manifestations described above, there are other symptoms: fatigue, constipation, diarrhea, bloating and nausea, especially during menstruation.

The stage of the disease does not affect the severity of the pain syndrome. So, there can be very intense pain with a minimal prevalence of endometriosis and vice versa - with multiple lesions there will be no symptoms.

The pathogenesis of endometriosis

The foci of endometriosis are small formations of various colors: black, dark blue, red, white, yellow and colorless, consisting of tissue that is similar to the tissue of the normal uterine mucosa and which also has a reaction to fluctuations in hormones during the menstrual cycle the form of "miniature menstruation." As a result, inflammation occurs at the location of the endometrioid foci, followed by the formation of scar tissue. Another manifestation of such inflammation is adhesions that occur in the abdominal cavity, disrupting the location of internal organs, pulling them together. “Infiltrative forms” of endometriosis are distinguished separately, in which germination of endometrioid tissue is observed in neighboring organs (large intestine, bladder, ureters, posterior vaginal fornix - retrocervical endometriosis).

With adenomyosis (uterine endometriosis), endometrial tissue grows in the underlying muscle layer of the uterus, forming passages, foci and nodes in the tissue. Muscle tissue is hypertrophied, and the uterus itself can increase in size.

A manifestation of ovarian endometriosis is the formation of “endometrioid” cysts - rounded formations lined with endometrioid tissue from the inside. The miniature menstruation that occurs in it leads to the fact that menstrual discharge accumulates in the cyst, which determines its growth. Concentrated menstrual flow resembles chocolate, so these cysts are also called “chocolate”. The size of endometrioid cysts can reach 10 centimeters or more, but, as a rule, they are diagnosed with smaller sizes.

Classification and stages of development of endometriosis

The following forms of endometriosis are:

1. External genital endometriosis (endometriotic foci are located on the peritoneum of the pelvis: tubes, ovaries, uterine ligaments);
2. Endometrioid ovarian cyst (a type of external genital endometriosis);
3. Retrocervical endometriosis (a type of external genital endometriosis) is an infiltrative variant in which endometrioid tissue is located behind the uterus and can grow into the posterior vaginal fornix and intestine;
4. Adenomyosis - uterine endometriosis;
5. Extragenital endometriosis is a very rare form of endometriosis, in which foci of endometriosis are found in the lungs, kidneys, eye chamber, postoperative scars, navel, and perineal skin.

For external genital endometriosis, a surgical classification has been developed according to the prevalence of the pathological process in the small pelvis and the severity of the adhesive process. There are 4 stages from a minimal lesion to an extremely pronounced one.

Uterine adenomyosis is also divided into three stages: Stage 1 - germination of one third of the uterine wall, 2nd - half of the wall; 3rd — complete germination of the uterine wall up to the serous membrane.

Endometriosis Complications

The most frequent and significant complication of endometriosis is infertility, which occurs on average in 50% of patients with this disease. Two factors can lead to infertility. Firstly, the formation of adhesions may damage the fallopian tubes, violating their patency. The second mechanism that prevents conception can be developing disorders in the immune system of the abdominal cavity, which leads to damage to the sperm and egg. These mechanisms are not fully understood. It is important to remember that half of patients with endometriosis, despite the presence of this disease, become pregnant without any treatment.

A complication of adenomyosis is iron deficiency anemia, which develops as a result of heavy menstrual blood loss. Whether adenomyosis affects the possibility of pregnancy is not fully known. Reproductologists note that the presence of adenomyosis can reduce the chances of pregnancy in IVF cycles.

Infiltrative forms of endometriosis can damage the intestines and ureters, leading to impaired function of these organs.

Diagnosis of endometriosis

The presence of endometriosis can be suspected already according to the patient's complaints, that is, on the basis of a question about the nature and localization of pain and their connection with the menstrual cycle. During examination on the chair, you can identify the local pain points: with retrocervical endometriosis, painful “spines” are palpated in the posterior vaginal fornix, a characteristic sign of this form of the disease. In the presence of adenomyosis, the uterus can be increased in size, have a characteristic spherical shape. Large endometrioid cysts will manifest themselves by an increase in the uterine appendages.

Examination of the cervix and external genitalia reveals characteristic “dark blue eyes” indicating the presence of endometriotic foci.

Ultrasound reveals adenomyosis and endometrioid ovarian cysts. Ultrasound diagnosis of these diseases, as a rule, does not cause difficulties, since there are specific echographic signs. External genital endometriosis with ultrasound can not be detected, with the exception of infiltrative forms (retrocervical endometriosis), as well as skin localizations.

MRI capabilities are not required so often, mainly to confirm the presence of uterine adenomyosis and to detect infiltrative forms of endometriosis.

There are no specific markers for the diagnosis of endometriosis. It is known that the CA125 tumor marker can be increased with endometriosis, especially with adenomyosis, but this marker is not specific, its increase is possible with many other pathological conditions, therefore it is not used for the diagnosis of endometriosis.

As a rule, endometriosis is diagnosed using laparoscopy. The introduction of a special chamber into the abdominal cavity allows you to see the foci of endometriosis under magnification and evaluate its prevalence. A biopsy is taken from the foci to confirm the diagnosis, since visual confirmation is not always enough.

Hysteroscopy (examination of the uterine cavity using a miniature camera) reveals the presence of “endometrioid passages” in the walls confirming the presence of adenomyosis, but this method is generally not very informative and necessary, since the presence of adenomyosis is easily detected by ultrasound, in addition, hysteroscopy does not allow to assess the degree of prevalence of the pathological process, and ultrasound - allows.

Endometriosis treatment

It is impossible to completely cure endometriosis today. This disease stops on its own after menopause. During the reproductive period, it is possible to eliminate the symptoms, remove the manifestations of the disease (foci, cysts, infiltrative tissue), but it is not yet possible to achieve a complete cure.

The main objectives of the treatment of endometriosis:

1. Relieving the patient from pain
2. Elimination of the manifestations of the disease, if they affect the work of internal organs (ovaries, intestines, bladder, fallopian tubes)
3. Solving the problem of infertility, if it is assumed that its cause is endometriosis
4. Termination of heavy painful menstruation (with adenomyosis)
5. Provision of prevention of disease progression, relapse of the disease after treatment

Treatment of individual forms of endometriosis

External genital endometriosis.The main manifestation of this form of endometriosis is pain and infertility. The pain syndrome can be stopped even by simple prescription of contraceptives in a prolonged mode, that is, without interruption in menstruation. If such treatment is not enough, it is possible to conduct a course of therapy with drugs that create artificial menopause in the woman's body (GnRH agonists - zoladex, diferelin, buserelin), the duration of such a course is usually no more than 6 months. After the end of this course, a drug is prescribed containing a special modified hormone - gestagen (Vizanne), which is taken continuously, ensuring the absence of a relapse of the disease. Alas, the drug must be taken either before a planned pregnancy or before menopause, since without such supportive therapy, the manifestations of endometriosis return quite quickly.

If drug treatment is ineffective, laparoscopic destruction of the foci of endometriosis is carried out, after which the treatment regimen described above is prescribed, since only surgical removal of endometriosis is not enough - the disease has an increased risk of relapse.

Surgical treatment of endometriosis should be put in first place if the patient initially deals with the problem of infertility. Laparoscopy allows not only to confirm the diagnosis, but also to remove the foci, to divide the commissures and, if possible, to restore the patency of the fallopian tubes (if damage is detected).

Endometrioid ovarian cysts.Endometrioid ovarian cysts are removed only by laparoscopic access, drug treatment for this form of the disease is ineffective. Not all cysts are subject to removal, but only cysts whose size is more than 3-4 cm. Smaller cysts do not affect ovarian function, and their growth can be restrained by the use of contraceptives or Visann's drug. The presence of such cysts does not affect the possibility of pregnancy and bearing; they do not grow during pregnancy.

It is important to remember that surgical removal of endometrioid cysts is the most common cause of a decrease in the ovarian reserve of the ovaries, in other words, their working time. This is due to the inevitable damage to the healthy part of the ovary during cyst removal. Therefore, the removal of small, non-hazardous cysts does more harm to a woman than good. There are frequent cases when, after removal of endometrioid cysts, a woman experiences premature termination of the ovaries, this is especially tragic if the patient has plans for pregnancy.

After removal of endometrioid cysts, an anti-relapse treatment is also prescribed - the Byzanne drug or hormonal contraceptives in a continuous mode.

Infiltrative forms of endometriosis.They can only be removed surgically, often with the involvement of surgeons of other specialties (abdominal surgeons, urologists), especially if there is a germination of endometrioid tissue in adjacent organs. As in all cases of surgical treatment of endometriosis, after surgery, drug therapy (Byzanne, COC) is prescribed before menopause.

AdenomyosisSurgical treatment of adenomyosis is practically not used, since it is extremely difficult to excise an altered tissue from the uterus that does not have clear boundaries with an unchanged muscle.

Drug treatment of adenomyosis consists in creating artificial menopause with GnRH group drugs (Zoladex, Buserelin, Diferelin, etc.) for 6 months and further, the introduction of the Mirena intrauterine hormone-containing spiral, which is set for five and a half years or the purpose of the drug Vizanne - for a long time, up to menopause. The main objective of this treatment is to stop heavy and painful menstruation, it is impossible to cure adenomyosis in this way.

A sufficiently effective treatment for adenomyosis is embolization of the uterine arteries. The essence of the technique is as follows: by means of puncture of the femoral artery, a special catheter is inserted into the vascular bed, which, under the control of X-ray, is carried out first into the left, then into the right uterine artery. When installing a catheter in the uterine artery, a suspension of special balls is introduced through it, which clog the lumen of pathologically overgrown vessels. As a result, endometrioid tissue dies, the uterus decreases in size to a normal size, and heavy and painful periods stop. The effectiveness of uterine artery embolization in the treatment of adenomyosis reaches 82%. After EMA, in contrast to other methods of treatment, in the future, no additional drugs are required. At the moment, embolization of the uterine arteries can be considered the most effective method of treating adenomyosis and give it preference in the first place.

Forecast. Prevention

Endometriosis, alas, is an incurable disease that stops only after menopause. In some patients, endometriosis is asymptomatic, for example, it is simply detected during laparoscopy or during an ultrasound scan. In such cases, the prognosis is favorable. In other cases, the treatment is mainly symptomatic and lengthy, the main task is to bring the patient to menopause.

There is no specific prevention of endometriosis, however, it is known that prolonged use of hormonal contraceptives can reduce the likelihood of developing this disease.

Many women have probably heard about a disease such as endometriosis. What is this, however, not all representatives of the fair sex know. Although for sure almost everyone knows that this is a common gynecological pathology. It is also not a secret that quite often uterine endometriosis occurs in women suffering from infertility.

Uterine endometriosis - what is it?

The essence of the disease is the pathological proliferation of the endometrium. The endometrium, in plain language, is the mucous membrane of the uterine cavity. An endometrium is necessary for a woman to attach a fertilized egg to the uterus and develop the fetus.

Despite the fact that the cause of the disease is the pathology of the uterine tissue, however, the disease often affects not only the uterus. Endometriosis is a disease that can be found in the tissues of other organs, and not only genital. The reason for this is the spread of endometrial cells throughout the body, which makes this disease similar to cancer. Depending on the location of the foci of proliferation of the mucous membrane, a genital form of the disease (which includes, in particular, uterine endometriosis) and extragenital are isolated.

Disease prevalence

The most common uterine endometriosis occurs in women aged 25-30 years. However, contrary to popular belief, this disease occurs not only in mature women. Symptoms of the disease can occur in adolescent girls and women in menopause. In extremely rare cases, the disease can occur even in men.

Causes of the development of the disease in women

For the onset of the disease, two main factors are necessary: \u200b\u200bthe presence of endometrial cells, congenital or due to casting with menstrual flow, in inappropriate places for this, and hormonal disorders, accompanied by increased secretion of estrogen by the ovaries.

At the moment, there are several versions that explain the causes of the spread of particles of endometrial tissue and, as a consequence, the spread of foci of the disease in the body of a woman. Among them are the following:

• transportation of endometrial cells from the uterus during menstruation;
• the spread of tissue particles already affected by endometriosis, with lymph flow;
• residues of embryonic tissues in other organs.

When endometrial cells are transferred during menstruation, they can be fixed in the tissues of the cervix, on the walls of the vagina, and on the external genitalia. In addition, there is the so-called retrograde menstruation, which contributes to the throwing of endometrial tissues into the ovaries, peritoneal cavity, and pelvic organs

The theory of the spread of tissue particles with lymphatic flow explains the localization of pathological foci in organs and tissues that are not connected by other pathways to the uterine cavity.

The embryonic theory says that the rudiments of the embryonic tissue of the genitourinary system may not be transformed and can remain in other organs in small quantities, developing pathological activity under the influence of adverse factors.

A hereditary predisposition may also affect the likelihood of developing a disease.

The following factors significantly increase the likelihood of developing pathological foci of endometrial overgrowth:

• frequent infectious, inflammatory processes in the abdominal cavity, pelvic organs and reproductive system;
• neoplasms, tumors,;
• invasive procedures (cesarean section, surgical procedures, abortion, cleaning the uterine cavity, surgical treatment of cervical erosion, etc.);
• labor process with complications;
• endocrine disorders, hormonal imbalances of various etiologies;
•   violation of the immune defense;
• smoking, excessive drinking of alcohol, caffeinated drinks and drugs.

Endometriosis, Symptoms and Treatment

The symptomatic picture may be unexpressed, blurry, consistent with signs of other diseases and dysfunctions. In some women, the disease proceeds without visible symptoms. There are no specific signs inherent only to this disease, however, the growth of the endometrium in the uterine membrane and reproductive organs can be suspected by the following manifestations:

• painful sensations, sometimes pronounced and prolonged, in the lower abdomen, giving in the groin, lower back, the so-called "chronic pelvic pains";
• increased pain during intercourse, bowel movements, gynecological examinations;
• prolonged painful menstruation with copious discharge (up to anemic conditions), menstrual irregularities;
• primary, secondary infertility.

If the endometrial tissues are located outside the female reproductive organs, then, depending on the location, clinical symptoms such as nosebleeds, the presence of blood in saliva, urine, sputum, feces, tears, blood discharge from the navel, etc. can be noted.

The tactics of treatment largely depend on the localization, as well as the stage of the disease. In some cases, conservative treatment with hormonal drugs is sufficient; in others, surgery is required.

Symptoms and treatment in women after 40

The occurrence of the disease in women older than 40 years is most often associated with impaired immunity. The most common symptoms during menopause:

• pelvic pain, especially during menstruation,
• heavy bleeding during menstruation,
• pain during bowel movements or urination,
• stool disorders
• symptoms of intoxication and fever.

Symptom analysis and treatment in women older than 40 years should be carried out by a specialist, self-medication in this case is dangerous. Not all treatment methods suitable for young patients are suitable for women after 40. The most commonly used are conservative treatment, hormonal and pain medication.

Disease classification

In most cases, the disease is classified by place of occurrence. The most common pathology associated with the body of the uterus (in about 90% of cases). This type of disease is called internal genital. The remaining species, in which, for example, lesions of the ovaries or peritoneum are observed, are called external. However, often the internal type of the disease is combined with the external.

Uterine endometriosis - symptoms prescribed treatment

The growth of the endometrium of the uterus is also often called adenomyosis. This disease is characterized by the growth of endometrial cells, their germination in the muscle layer of the uterus, up to the serous membrane. With this phenomenon, significant blood loss during the menstrual period, uterine bleeding, leading to the development of anemia, severe pain syndrome are noted. Often adenomyosis is accompanied by infertility, preventing the onset of pregnancy and / or the process of gestation.

Treatment begins with the appointment of a course of hormonal drugs. In the absence of effectiveness, they resort to surgical treatment (surgical procedures for cauterizing or removing foci of endometrial proliferation). With expressed indications and a threat to health, the neglected stages may require prompt removal of the uterus or part of it.

Cervical endometriosis

The increase in the number of cases of endometrial overgrowth in the cervix is \u200b\u200bassociated with surgical treatment of cervical erosion. If cauterization or other manipulations were carried out in the premenstrual period, there is a chance of implantation of endometrial cells during their transportation with menstrual flow.

A typical symptom with this localization is intermenstrual bleeding; painful periods are possible.

Treatment of this type of disease is also based on hormonal therapy. If necessary, surgical methods of treatment are used, in particular, cauterization and excision of foci of pathological proliferation of the endometrium.

Ovarian endometriosis - symptoms and treatment

Damage to ovarian tissue by endometrioid cysts is one of the common forms of the disease. In such a case, the reproductive function of the body is disrupted: ovarian cysts interfere with the ovulation process.

If the disease affects the ovaries, then this situation is fraught with depletion of the reserve of follicles, female infertility. The main symptom is sharp, stitching pains in the lower abdomen, especially during or after intercourse. Ovarian pathology is diagnosed using ultrasound. Differentiation of endometrioid and functional cysts is necessary, for which examination is carried out several times during the menstrual monthly cycle.

Upon confirmation of the diagnosis, surgical treatment with laparoscopy is prescribed. During treatment, part of the altered tissues and the cyst itself are removed. If the endometrium affects the ovaries in a significant amount, then they resort to removal of the ovary.

Localized peritoneal disease

With the localization of foci of proliferation of the endometrium in the pelvic cavity, peritoneum, but outside the genital organs, they speak of a peritoneal type of disease. The etiology of its occurrence is associated with the transportation of endometrial cells during retrograde menstruation, the germination of cells from other foci of endometriosis through the tissues of affected organs, as well as during deviations during the development of the fetus.

Symptoms are manifested by pain in the pelvic region, arising or intensifying during intercourse, defecation, during menstruation. Diagnosis of this form of the disease is difficult, most often foci are detected during an operation that performs both diagnostic and therapeutic functions.

For the treatment of this type of disease, hormonal drugs, immunomodulators are used. If after six months it turns out that conservative methods of treatment are ineffective, an operation is prescribed.

Causes and symptoms of proliferation of the endometrium in the vagina

Uterine endometriosis can spread not only to the neck of the organ, but also to the vagina, especially if it has inflammatory processes, wounds, abrasions that violate the integrity of the surface.

The clinical picture of the disease consists of pain and spotting during intercourse, localization of pain in the vagina during menstruation.

Diagnosis is carried out during a gynecological examination of patients and taking material for research.

Medication is mainly used, in particular, hormonal drugs are prescribed. In the absence of effectiveness from the course of medicines, a surgical treatment technique is used, consisting in manipulations to excise and cauterize the foci.

Rectovaginal form

With this form of the disease, the development of the endometrium in the genital area, body and cervix, vagina is observed. In addition, endometrial cells affect the intestines, in particular the rectum.

This type of disease is characterized by severe pain, especially during bowel movements, as well as bloody inclusions in the feces on the days of menstruation. Diagnosis is by rectal examination, surgical treatment.

Features of the pathological process in the bladder

Damage to the walls of the bladder by endometrium is quite rare. Among the reasons for the development of this form of the disease, retrograde blood reflux with endometrial cells during menstruation, endometrial germination through the uterine wall, and the spread of cells by endometrioid cysts of other organs are distinguished.

A situation is not uncommon when the disease is asymptomatic and is diagnosed only during surgical operation of the abdominal region for other indications. However, with the growth of the endometrium on the back wall of the bladder or in the mouth of the ureters, difficulties, pain during urination, increased urgency, and a feeling of heaviness, especially in the premenstrual period, are possible.

Such a clinical picture often leads to erroneous diagnosis and treatment for cystitis. To facilitate the correct diagnosis, it is necessary to pay attention to the correlation of symptoms and the menstrual cycle. The final diagnosis is carried out using the cystoscopy method.

Complications and Prevention

If you do not take measures to treat the disease, then it threatens infertility. A similar phenomenon occurs with approximately half of the patients. Infertility may be due to the following factors:

• violation of ovulation due to hormonal changes;
• the occurrence of endometrium in the fallopian tubes, as well as inflammatory processes provoked by damage to the pelvic organs, lead to obstruction, tube deformation, which prevents the fertilization of the egg;
• with intrauterine growth of the endometrium, the process of egg implantation is disrupted, which leads to abortion in the early stages;
• with damage to the ovaries, cystic formation prevents the maturation of follicles and provokes the depletion of the ovarian reserve;
• foci of the disease not only negatively affect a woman’s health, but also secrete substances toxic to the fetus.

Bearing is complicated by hormonal disorders, and childbirth with damage to the organs of the reproductive system often goes pathologically, with complications dangerous to health.

Other common complications include anemia due to regular blood loss, peritonitis, as well as damage to nerve fibers in the foci of the endometrium, leading to neurological disorders.

One of the most important factors provoking the disease is a decrease in immunity. Experts recommend: in order not to get sick, you need to eat right, give up bad habits and do not neglect physical activity.

Regular visits to the gynecologist, examination of the condition of the neck, vagina, proper selection of contraceptives will help to avoid the disease or detect and cure endometriosis and other diseases at an early stage.