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Endometriosis of the uterus - what it is, causes, signs, symptoms and treatment of endometriosis in women

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Endometriosis is the appearance of cells in the inner layer of the uterus (endometrium) in unusual places: on the peritoneum, in the ovaries, fallopian tubes, wall and cervix, in the bladder, rectum and other organs and tissues.

This is one of the most mysterious female diseases. Despite the fact that this diagnosis is made quite often, the question - what kind of disease is it, why and how to treat it, often remains unanswered. And what if a woman with endometriosis is planning a pregnancy - should something be done in this case?

Statistics show that endometriosis in one form or another affects up to 30% of women of reproductive age.

What it is: causes

Why does endometriosis occur, and what is it? The causes of the disease are not established and remain the subject of controversy. Numerous hypotheses of endometriosis have been proposed, but none of them has become conclusively proven and generally accepted.

  1. One theory points to the process of retrograde menstruation, when a part of the menstrual tissue penetrates into the abdominal cavity, grows into it and increases.
  2. Genetic theory suggests that the genes of some families contain the rudiments of endometriosis and, thus, members of these families are prone to endometriosis.
  3. There is also a theory explaining the occurrence of endometriosis by the fact that tissue affected by endometriosis spreads to other parts of the body through the lymphatic system.
  4. Others believe that the remnants of tissue from the phase when the woman was in its infancy, may later develop into endometriosis, or that part of this tissue, under certain conditions, does not lose the ability to reproduce.

The probability of illness increases with:

  • frequent genital inflammations,
  • tumors (uterine myoma),
  • difficult childbirth,
  • uterus surgery,
  • abortions,
  • anemia,
  • drinking alcohol
  • smoking
  • excessive "love" for products containing caffeine,
  • endocrine system organs (thyroid, adrenal glands, hypothalamus,
  • pituitary, female genital glands),
  • reduced immunity.

Despite these studies, the real incidence of endometriosis is unknown, due to the fact that in most cases the disease is asymptomatic and very difficult to diagnose.

Therefore, regularly undergo a routine examination by a gynecologist. This is especially important for those who have had any operations on the uterus (abortion, cesarean section, cauterization of cervical erosion, etc.). Timely diagnosis is the key to successful treatment without consequences.

Can I get pregnant with endometriosis?

Endometriosis significantly reduces a woman’s chances of becoming pregnant, but cannot harm the development of the fetus. If a woman with endometriosis still conceived a child, there is every reason to believe that the symptoms of the disease will become much weaker during the entire period of pregnancy.

If you have endometriosis, before you start trying to conceive a child, you should discuss with your gynecologist the possibility and risks of pregnancy in your particular case.

Symptoms of endometriosis

The symptomatology of this disease is so diverse that it is sometimes capable of misleading even experienced specialists. Endometriosis of the uterus may be accompanied by both pronounced symptoms, and their absence.

However, certain symptoms must alert the woman:

  1. Pains of varying intensity, up to acute. May be localized in the lower abdomen, to give to the groin area, anus, leg. Pain either occurs in the first days of menstruation, and disappears with its termination, or does not leave the woman throughout the cycle, but at the end of the menstruation they weaken.
  2. Spotting dark bloody discharge from the genital tract 2-5 days before and after menstruation, especially if these same menses are quite abundant and long,
  3. Uterine bleeding in the intermenstrual period (metrorrhagia),
  4. Spotting can be with sexual contact.

Menstruation with endometriosis become abundant, with clots, which leads to the development of chronic post-hemorrhagic anemia:

  • brittle nails,
  • dyspnea,
  • weakness, drowsiness
  • dizziness,
  • pallor of the skin and mucous membranes,
  • low blood pressure
  • frequent colds and stuff.

Unfortunately, in some cases, the symptoms of endometriosis appear very weakly or not at all. For this reason, you should visit the gynecologist's office every six months. Only timely diagnosis can protect against the development of undesirable consequences of endometriosis.

Endometriosis 1, 2 and 3 degrees

In the uterine wall, foci of endometriosis are detected at different depths, so endometriosis of the uterus can have four degrees of spread:

  • 1 degree. There are one or more small foci of endometriosis.
  • 2 degree. There are several small foci of endometriosis, which penetrate into the thickness of the affected organs.
  • 3 degree. There are many superficial foci and several deep foci of endometriosis or several cysts on the ovaries ("chocolate" cysts - the name is due to the characteristic dark brown color of cysts attached to cysts by disintegrating blood).
  • 4 degree. Multiple and deep foci of endometriosis, multiple large cysts on the ovaries, adhesions between the organs of the small pelvis are diagnosed.

There is no linear relationship between the extent of endometriosis and the strength of the symptoms of the disease. Often, common endometriosis is less painful than mild, in which there are only a couple of small lesions.

Diagnostics

In the effective treatment of endometriosis, the most important point is the timely and correct diagnosis. To determine the presence of endometrial foci, you can use:

  • X-ray contrast methods (hysterosalpingography)
  • endoscopic examinations (for example, hysteroscopy),
  • Ultrasound.

However, the complaints and clinical symptoms listed above are of great importance. Endometriosis is sometimes diagnosed and during pregnancy - as a result, the treatment of such patients is ineffective due to difficulties in selecting a drug that minimally affects the fetus.

Prevention

The main activities aimed at the prevention of endometriosis are:

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

Complications

Endometriosis of the uterus may not be symptomatic, and may not affect the quality of life of a woman. On the other hand, endometriosis not diagnosed in time and the lack of adequate treatment can lead to complications.

The most likely consequences are:

  • adhesions in the pelvis,
  • fertility disorders
  • anemia due to heavy bleeding,
  • endometrial cysts,
  • malignancy.

How to treat endometriosis

Methods of treating endometriosis have been improving for many years and are currently divided into:

  • surgical,
  • medication,
  • combined.

Drug therapy methods include the use of different groups of drugs:

  • combined estrogen-progestin drugs,
  • progestin, antigonadotropic drugs,
  • gonadotropic releasing hormone agonists.

The earlier a woman is diagnosed, the greater the likelihood of using only drugs.

Conservative therapy

Conservative treatment is indicated for asymptomatic uterine endometriosis, at a young age, in the permenopausal period, for adenomyosis, endometriosis and infertility, when it is necessary to restore the genital function.

Drug treatment includes a fairly traditional therapy:

  • hormonal,
  • anti-inflammatory,
  • desensitizing,
  • symptomatic.

The main drugs with a proven effect for the treatment of confirmed endometriosis are:

  • progesterone drugs
  • danazol
  • Gestrinon (Nemestran),
  • gonadotropin releasing hormone agonists (GnRH),
  • monophasic combined oral contraceptives.

The duration of hormonal therapy courses and the intervals between them are determined by the results of the treatment and the general condition of the patient, taking into account the tolerability of the drugs and the indicators of functional diagnostics tests.

Other groups of drugs, "helpers" in the fight against painful symptoms of the disease:

  • NSAIDs (anti-inflammatory therapy),
  • antispasmodics and analgesics (analgesic action),
  • sedatives (elimination of neurological manifestations),
  • vitamins A and C (correction of the deficiency of the antioxidant system),
  • iron preparations (elimination of the consequences of chronic blood loss),
  • physiotherapy.

Currently, research is underway on the possibility of using immunomodulators for the treatment of endometriosis, especially for the treatment of infertility associated with it.

Surgical treatment of endometriosis

Surgical intervention is indicated in the absence of the effect of conservative therapy for 6-9 months, with endometrial ovarian cysts, with endometriosis of postoperative scars and the navel, with continued stenosis of the lumen of the intestine or ureters, with intolerance to hormonal means or the presence of contraindications to their use.

Surgical methods for treating endometriosis consist in removing endometriotic formations (most often cyst) from the ovaries or other lesions. Modern surgery prefers gentle operations - laparoscopy.

After removal of the foci of the disease, physiotherapy and drug treatment is indicated to consolidate the result and restore the cycle. Severe forms of endometriosis are treated by removal of the uterus.

The results of treatment depend on the amount of surgery, on the usefulness of hormonal therapy. The rehabilitation period in most cases passes favorably: the reproductive function is restored, the pain during menstruation is significantly reduced. After treatment, a dynamic observation by a gynecologist is recommended: gynecological examination, ultrasound monitoring (1 time in 3 months), control of the CA-125 marker in the blood.

Prognosis for endometriosis

This disease often recurs. For example, the frequency of recurrence of endometriosis after surgery to remove lesions during the first year is 20%, that is, 1 out of 5 operated women in the first year after surgery will again be confronted with the same problems as before the operation.

Hormonal correction has a good effect, but the problem with this method of treatment is a violation of the process of natural maturation of the endometrium of the uterus, and hence the impossibility of the natural conception of a child. When pregnancy occurs, as a rule, the symptoms of endometriosis disappear for the entire period of pregnancy. When menopause occurs, endometriosis also disappears.

What is endometriosis?

Endometriosis is a common gynecological disease in which endometrial cells (the inner layer of the uterus wall) grow outside of this layer. The proliferation of the endometrium may be within the reproductive system (then they are talking about the genital form) and outside it (extragenital form). Internal endometriosis accounts for the vast majority of cases of the disease.

Most women endometriosis develops as a result of a lack of, or, conversely, increased synthesis of estrogen - the main female hormone that regulates the activity of the reproductive system, the reproductive organs and is responsible for the appearance of skin, nails and hair.

Clinical manifestations depend on the localization process. Common symptoms are pain, an increase in endometriotic nodes, bleeding from the outer areas before and during menstruation.

Previously, this disease occurred mainly in women aged 30-50 years. Unfortunately, today it is much younger, patients with endometriosis of 20-25 years are becoming more and more common.

  • between the ages of 25 and 45, about 10% of women suffer,
  • up to 30% are diagnosed with infertility,
  • up to 80% with pain in the pelvic area of ​​a chronic nature.

Types and degrees

According to the localization of foci, endometriosis is divided:

  • Genital - foci are localized within the reproductive organs of a woman.
  • Extragenital - when detecting pathological foci outside the organs of the reproductive system.

There are 3 forms of endometriosis of the uterus:

  • diffuse adenomyosis - proliferation of endometrioid heterotopies over the entire surface of the uterine mucosa with the formation of cavities in the myometrium,
  • nodular adenomyosis - the growth of endometrial foci locally with the formation of nodes that do not have a capsule,
  • focal endometriosis - only certain parts of the uterine wall are affected.

Depending on the volume of the pathological process, that is, from the depth of penetration of the endometrium, several stages of endometriosis of the uterus are distinguished:

  • the mucous membrane is affected up to the layer of myometrium (to the middle, muscular layer, as mentioned earlier),
  • several lesions capable of penetrating into the myometrial circular layer,
  • multiple foci of endometriosis, localized throughout the muscular layer of the uterus,
  • pathological endometrium affects the serous membrane as well.

In particular, it is the minimum stage, the stage is light, moderate and heavy. Difficult stage, as it is easy to assume, is the most painful for patients, as well as the most difficult in terms of the implementation of measures aimed at the treatment of endometriosis.

With prolonged illness and in the later stages of the course of the disease, endometriotic cells can even occur in the intestine, organs of the urogenital system, and in the lungs. But, fortunately, this happens quite infrequently and is not the norm.

Endometriosis is a polyetiological disease. This means that there are many reasons for its occurrence, and still in some cases it is not possible to establish the true cause.

The main theories of the development of pathology are considered:

  • Implant hypothesis. According to it, the ability of endometrial tissue to adhere (adhesion) and implant (implant) increases under the influence of hormonal and immune disorders. Under conditions of increasing intrauterine pressure, such functionally altered cells migrate to other structures, where they continue to grow and form endometriosis in the uterus.
  • Metaplastic theory. It boils down to the fact that endometrial cells do not take root themselves in unusual areas, but only stimulate tissue to pathological changes (to metaplasias).
  • Heredity. This factor is relevant in many diseases that a person has to face, and endometriosis can also be considered as a disease associated with this factor.
  • Immune theory. The body's defense systems remove any tissue and neoplasm that appeared in the wrong place. When immunity decreases, endometrial cells outside the uterus do not die, but take root and function normally.
  • Do not forget about the ecological microclimate in which the woman resides. So, the scientifically proven fact is that young women who are in places with a high content of dioxin, more than others suffer from endometriosis.

Other likely factors leading to the onset of endometriosis include:

  • history of abortion
  • environmental impact,
  • iron deficiency in the body
  • surgery on the pelvic organs,
  • obesity,
  • inflammatory diseases of the female genital organs,
  • wearing intrauterine device,
  • abnormal liver function, etc.

To date, one of the most common causes of endometriosis are surgical interventions ever performed in the uterus. These include abortion, cesarean section, cautery erosion, and other procedures. In view of this, after such operations, it is necessary to pass examinations with a doctor with strict regularity.

Medications

  • Non-hormonal drugs - non-steroidal anti-inflammatory drugs - as an effective means of dealing with pain.
  • Hormone therapy - involves long-term treatment, allows you to reduce the likelihood of relapse, to achieve stabilization of the process after the surgical intervention.

As for drug treatment, it is aimed at suppressing the growth / reproduction of endometrial cells. Basically, for endometriosis, the following groups of drugs are used:

  1. The intrauterine device Mirena is successfully used in the early stages. Its inner part is filled with hormones that can replace female progesterone, the lack of which provokes the growth of the endometrium.
  2. combined oral contraceptives (marvelon, femoden, diane-35, etc.),
  3. drugs representing the group of antigonadotropins (gestrinone, danazol, etc.). Danazol is used for 6 months. After 1-2 months of treatment with danazol, amenorrhea usually occurs (cessation of menstrual flow). The menstrual cycle is restored 28–35 days after stopping.
  4. drugs representing a group of progestins (depressant, duphaston, etc.),
  5. drugs of the agonist group (decapepl-depot, zoladex, etc.),
  6. antiestrogens (tamoxifen, etc.).

Other groups of drugs - helpers in combating symptoms:

  • In addition to the main treatment for adjuvant therapy, they can prescribe anti-inflammatory, relieving spasms, sedatives: Novo-Passit, Ibuprofen, No-shpa, as well as vitamins,
  • Sedatives (elimination of neurological manifestations),
  • Immunomodulators (normalization of impaired immune status),
  • Vitamins A and C (antioxidant deficiency correction system),
  • Iron preparations (elimination of the consequences of chronic blood loss),
  • Physiotherapy.

Hormonal treatment should begin with the first menstrual cycle after surgery. Duration is 3–9 months, depending on the degree of distribution and the severity of the process.

As mentioned above, only your gynecologist can determine the treatment regimen and control the effect.

Self-medication for endometriosis with hormonal drugs is contraindicated due to the many side effects of these drugs and the need to monitor the effectiveness of the treatment.

Recovery after surgery

After successful surgery, rehabilitation treatment is recommended:

  • procedures using electrophoresis with the addition of zinc, iodine,
  • therapeutic effect of ultrasound,
  • radon-enriched water baths
  • syringing medicinal anti-inflammatory compounds.

In exceptional cases, when neither the first nor the second methods help, surgery may be required to remove the uterus. Doctors do their best to avoid this, not only from the desire to preserve the ability to bear children, but also because the whole life of a woman directly depends on the hormonal background, and the removal of the uterus and ovaries greatly changes it, which means it changes the life of a woman.

Folk remedies

For a long time traditional folk remedies have been used for the treatment of endometriosis, but they are by no means a substitute for the medical or surgical method.

  1. Dried and shredded cucumber shoots are recommended to brew like tea and drink without restriction.
  2. Beet Juice It is necessary to take only freshly squeezed juice, and not more than 100 ml three times throughout the day. It is necessary to start treating endometriosis with this means with small dosages. If no allergic reactions occur, its amount can be increased to the above. However, remember: before you drink the medicine, you must first defend it for 4 hours.
  3. Infusion of boron uterus with endometriosis. It is made from 2 tablespoons of herbs. They are poured with boiling water (2 cups), covered with a lid and wrapped. Give brew for 15 minutes, then filter. This infusion is taken in several dosages: either 4 times a day for half a glass for half an hour before meals, or (a more benign method) for a tablespoon 3 times for an hour before meals.
  4. Castor oil helps the body get rid of excess tissue and toxins. It should be used at the beginning of the menstrual cycle when the spasms begin.
  5. Chamomile has anti-inflammatory properties that help reduce inflammation as well as tumors.

General information and classification of endometriosis

Manifestations of endometriosis depend on the location of its foci. In this regard, endometriosis is classified according to localization. According to localization, genital and extragenital forms of endometriosis are distinguished. In the genital form of endometriosis, heterotopias are localized on the tissues of the genital organs, while in the extragenital form, outside the reproductive system.

In the genital form of endometriosis, there are:

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

Localization of endometriosis can be mixed, it occurs, as a rule, when the disease is neglected. In the extragenital form of endometriosis, heterotopy foci occur in the intestine, navel, lungs, kidneys, and postoperative scars. Depending on the depth and distribution of focal growths of the endometrium, there are 4 degrees of endometriosis:

  • I degree - superficial and isolated foci of endometriosis,
  • II degree - foci of endometriosis deeper and in greater numbers
  • Grade III - deep multiple foci of endometriosis, endometrial cysts on one or both ovaries, separate commissures 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, difficult to treat.

There is also a generally accepted classification of uterine adenomyosis (internal endometriosis), in the development of which there are four stages according to the degree of muscle lesion (myometrium):

  • Stage I - the initial germination of 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 thickness of the myometrium up to the serous membrane of the uterus,
  • Stage IV - the germination of the uterus and the spread of endometriosis foci on the peritoneum.

Endometriotic foci can vary in size and shape: from rounded formations a few millimeters in size to shapeless growths several centimeters in diameter. Usually they have a dark cherry color and are separated from surrounding tissues by connective tissue whitish scars. Endometriosis foci become more noticeable on the eve of menstruation due to its cyclic ripening. Spreading to the internal organs and peritoneum, areas of endometriosis can grow deep into the tissue or be located superficially. Endometriosis of the ovaries is expressed in the appearance of cystic growths with dark red contents. Heterotopies are usually arranged in groups. The degree of endometriosis is assessed in points, taking into account the diameter, depth of germination and localization of foci. Endometriosis is often the cause of adhesive processes in the small pelvis, which limit the mobility of the ovaries, fallopian tubes and uterus, leads to irregularities in the menstrual cycle and infertility.

Causes of Endometriosis

There is no consensus among experts about the causes of endometriosis. Most of them are inclined to the theory of retrograde menstruation (or implantation theory). According to this theory, in some women, menstrual blood with endometrial particles enters the abdominal cavity and fallopian tubes - the so-called retrograde menstruation. Under certain conditions, there the endometrium attaches to the tissues of various organs and continues to function cyclically. In the absence of pregnancy, the endometrium is rejected from the uterus during menstruation, while in other organs microbleeds occur, causing an inflammatory process.

Thus, women with such a feature as retrograde menstruation are prone to endometriosis, but not in all cases. Such factors as peculiarities in the structure of the fallopian tubes, immunosuppression, heredity increase the likelihood of endometriosis. The role of hereditary susceptibility to the development of endometriosis and its transfer from mother to daughter is very high. Knowing about her heredity, a woman must observe the necessary preventive measures. Promote the development of endometriosis surgery on the uterus: surgical abortion, cauterization of erosions, cesarean section, etc. Therefore, after any operations on the uterus, medical observation is necessary for the timely detection of abnormalities in the reproductive system.

Other theories of endometriosis development, which are not widely spread, consider gene mutations, deviations in the function of cellular enzymes and hormone receptor responses as its causes.

Endometriosis treatment

When choosing a method for treating endometriosis, such indicators as the patient's age, the number of pregnancies and deliveries, the prevalence of the process, its localization, the severity of manifestations, the presence of comorbidities, the need for pregnancy, are guided. The methods of treatment of endometriosis are divided into medical, surgical (laparoscopic with removal of foci of endometriosis and organ preservation or radical - removal of the uterus and oophorectomy) and combined.

The treatment of endometriosis is aimed not only at eliminating the active manifestations of the disease, but also of its consequences (adhesive and 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 preserve or restore fertility. Leading in the medical treatment of endometriosis is hormone therapy with the following groups of drugs:

  • combined estrogen-progestin preparations.

These drugs, containing small doses of gestagens, suppress estrogen production and ovulation. Shown at the initial stage of endometriosis, because they are not effective in the prevalence of the endometrial process, ovarian cysts. Side effects are expressed by nausea, vomiting, intermenstrual bleeding, tenderness of the mammary glands.

  • progestin (norethisterone, progesterone, gestrinone, didrogesterone).

Shown at any stage of endometriosis, continuously - from 6 to 8 months. Reception of gestagens may be accompanied by intermenstrual hemorrhage, depressive state, tenderness of the mammary glands.

  • antigonadotropic drugs (danazol, etc.)

Suppress the production of gonadotropins in the hypothalamus-pituitary gland. Apply in a continuous course for 6-8 months. Contraindicated in hyperandrogenism in women (an excess of androgenic hormones). Side effects are sweating, hot flashes, changes in weight, coarsening of the voice, increased skin oily skin and increased hair growth.

  • gonadotropic releasing hormone agonists (triptorelin, goserelin, etc.)

The advantage of drugs of this group in the treatment of endometriosis is the possibility of using drugs once a month and the absence of serious side effects. Release hormone agonists cause suppression of the ovulation process and estrogen content, leading to the suppression of the spread of endometriosis foci. In addition to hormonal drugs in the treatment of endometriosis, immunostimulants are used, symptomatic therapy: antispasmodics, analgesics, anti-inflammatory drugs.

Organ-preserving surgical treatment with removal of heterotopias is indicated for moderate and severe stages of endometriosis. The treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, dissection of adhesions. Conducted in the absence of the expected effect of drug therapy, the presence of contraindications or intolerance to medication, the presence of lesions with a diameter of more than 3 cm, dysfunction of the intestine, bladder, ureters, kidneys. In practice, often combined with medical treatment of endometriosis. It is performed by laparoscopic or laparotomic approaches.

Radical surgical treatment of endometriosis (hysterectomy and adnexectomy) is performed for patients over the age of 40 years with active progression of the disease and the ineffectiveness of conservative surgical measures. Unfortunately, radical measures in the treatment of endometriosis require 12% of patients. Operations are performed by laparoscopic or laparotomic methods.

Endometriosis tends to recur processes, in some cases forcing to resort to repeated surgical intervention. Endometriosis recurrences occur in 15–40% of patients and depend on the extent of the process in the body, its severity, location, and radicalness of the first operation.

Endometriosis is a terrible disease for the female body, and only its detection in the early stages and stubborn treatment leads to complete relief from the disease. The criteria for cure of endometriosis are a satisfactory state of health, the absence of pain and other subjective complaints, the absence of relapses for 5 years after undergoing a full course of treatment.

In childbearing age, the success of treatment of endometriosis is determined by the restoration or preservation of fertility. With the current level of surgical gynecology, widespread use of gentle laparoscopic techniques, such results are achieved in 60% of patients with endometriosis between the ages of 20 and 36 years. In patients with endometriosis after radical surgery, the disease does not recur.

What is this ailment

All that concerns endometriosis - assumptions. The true causes and mechanism of disease formation is unknown. Therefore, there are many theories about the occurrence of pathology.

The essence of endometriosis can be described as follows. Normally, endometrial cells should only be inside the uterus. They undergo cyclic changes - the layers of the endometrium gradually increase, and towards the end of the cycle, the upper tissues begin to reject - menstruation occurs. Menstrual blood is represented not only by the liquid part with erythrocytes, leukocytes and platelets, it contains a large number of cells of the rejected endometrium.

For reasons that are not fully understood, foci similar in structure to the inner layer of the uterus are found in other, uncharacteristic places. Namely:

  • deep in the muscle layer of the uterus,
  • on the cervix,
  • outside and inside the fallopian tubes,
  • on the ovaries,
  • on the peritoneum (covers part of the internal organs, muscles).

In addition to the genital organs, the adjacent organs are first involved in the process (bladder, rectum, ureters, large and small intestines), and then distant ones. The literature describes cases of endometriosis of the tissues of the brain, retina, liver, spleen, very often there are areas in the area of ​​scars on the skin in places of postoperative wounds.

The focus of endometriosis, wherever it is, undergoes cyclical changes and highlights a special secret. If the cavity is closed (as in the ovary), a cyst is formed; if the area is on the surface of an organ, adhesions with adjacent tissues are formed.

Causes

The mystery and subject of discussion is the question of how endometriotic tissue enters other tissues and why it gets accustomed. There are many assumptions, and each is based on some known facts about the disease.

  • Implant theory. The most common and accepted. According to her, endometrial cells retrograde flow into the fallopian tubes, and then into the abdominal cavity and "settle" there. Allowed the option of moving cells with the flow of lymph and venous blood. The proof of this theory is the fact that in 90% of cases the foci of endometriosis are located in the pelvis.
  • Embryonic origin. According to this view, endometriosis develops from tissue sites that remained after histogenesis and organogenesis in the prenatal period. The theory is based on the observation of cases of endometriosis in children.
  • The theory of histogenesis. According to these ideas, endometriosis is formed from normal cells that cover the organs. But under the influence of certain factors, normal tissues turn into endometrioid-like ones.
  • Heredity. Considering that in 70% of cases of endometriosis, hereditary susceptibility is detected, it is customary to attribute this ailment to family diseases associated with impaired functioning of the immune system.

Who is most often found

To predict the occurrence of endometriosis can be. The risk group includes the following women:

  • burdened heredity - if mom, grandmother, sister, aunt had endometriosis, the probability of getting sick increases,
  • frequent diseases in childhood - a pattern has been revealed between a girl’s pain and the likelihood of endometriosis, this is attributed to changes in the work of the immune system,
  • violations in the period of menarche - if the girl had a period of formation of menstrual function longer or with juvenile uterine bleeding and vitamin deficiency,
  • complicated births - ruptures of the cervix and vagina, manual examination of the uterus, cesarean section increase the likelihood of mechanical separation of endometrial cells to other genital organs,
  • operations - even non-gynecological interventions increase the risk of endometriosis, this is due to both random cell transfer and changes in the endocrine and nervous systems,
  • frequent stressful situations - interruptions in the brain structures are disturbed, which leads to a change in the functioning of the genital organs.

Paradoxically, hormonal imbalance in women does not lead to endometriosis. Недуг сам является причиной нарушения соотношения между эстрогенами и гестагенами, провоцируя увеличение доли андрогенов.

Нарушение менструального цикла

Для эндометриоза характерны следующие расстройства:

  • обильные менструации – при поражении тела матки (аденомиозе),
  • bloody daub - it occurs a few days before the beginning of menstruation and continues even after the completion of the main secretions, in color - dark brown, “dirty”,
  • rhythm disturbance - the duration of the menstrual cycle increases or breakthrough bleeding occurs, often women against the background of spotting secretions are confused in terms.

Not uncommon, when endometriosis is detected only with a thorough examination of infertility. Problems with conception occur for the following reasons:

  • lack of regular ovulation
  • failure of the second phase of the cycle,
  • obstruction of the fallopian tubes due to adhesions.

The defeat of other organs and postoperative scar

If there are lesions in the bladder, rectum, the following symptoms occur:

  • blood in urine and feces on the eve of menstruation,
  • lower abdominal pain, in the sacrum, in the crotch area.

The most common endometriosis postoperative scar develops after gynecological operations and cesarean section. Foci are formed in the subcutaneous adipose tissue and inside the dermis. Such formations appear in a few months or even years after the intervention.

With scar endometriosis, the woman notes his pain and swelling on the eve of menstruation, while the symptoms are almost not disturbed on other days of the cycle. Dark-blue or violet rounded foci may be noticeable on the skin surface, also on the eve of menstruation, and pass after them. Sometimes during menstruation, dark-brown discharge may appear on the skin of the abdomen, if the areas have a message with the surface of the skin.

What can be the complications and consequences of endometriosis?

With endometriosis, the growth of endometrial cells occurs (mucous membrane of the inner surface of the uterus) in organs where they normally do not occur. Although these cells may be far from the uterus, during the menstrual cycle they undergo the same changes as normal endometrial cells (that is, they multiply rapidly under the influence of the female estrogen hormones).

Endometriosis can affect both genitals (with genital form), and other body tissues (with extragenital form) - intestines, lungs, liver and so on.

The consequences of the disease are determined by:

  • affected organ
  • the severity of growth of endometrial tissue,
  • timeliness and adequacy of the treatment.
Endometriosis can be complicated:
  • violation of the menstrual cycle,
  • the formation of adhesions in the pelvis,
  • the formation of endometrial cysts,
  • neurological disorders
  • rupture of the affected organ
  • violation of childbirth,
  • intestinal obstruction
  • malignancy (rebirth into a malignant tumor),
  • infertility
Violation of the menstrual cycle
Violations of the menstrual cycle are characterized by prolonged menstruation (more than 5 days), during which a large amount of blood is released (more than 150 ml). The reason for this may be excessive proliferation of endometrial tissue in the uterus, germination in the walls of the uterus and in the external genitalia. When menstruation begins, rejection of the entire endometriotic tissue occurs, which usually leads to heavy bleeding. Frequent and prolonged blood loss can lead to the development of anemia - a pathological condition characterized by a decrease in the concentration of red blood cells (red blood cells) and hemoglobin in the blood. Severe anemia (hemoglobin concentration less than 70 g / l) represents an immediate threat to the life of a woman and requires urgent hospitalization and treatment (blood transfusions).

The formation of adhesions in the pelvis
The appearance of endometrial cells in the organs in which they are usually not found, leads to the development of an inflammatory process characterized by the migration of a large number of white blood cells (immune system cells that protect the body) to the center of inflammation. They surround the "alien" cells, trying to prevent their further spread throughout the body. As the disease progresses, special cells, fibroblasts, that produce large amounts of fibrin protein and collagen fibers, may appear in the inflammatory focus. Of them subsequently formed adhesions, representing the growth of connective (cicatricial) fabric. Increasing adhesions can overlap the lumen of the fallopian tubes and uterus, with intestinal endometriosis, compression of its loops and violation of the passage of fecal masses can occur. “Gluing” between different organs of the small pelvis and the abdominal cavity can occur, which leads to a violation of their function.

Formation of endometrial cysts
If the abnormal growths of endometrial cells are located on the surface of the affected organ (ovarian, uterus or other) then during menstruation they are rejected, as a result of which they enter the abdominal cavity or are excreted through the vagina with menstrual blood. If the focus of endometrial tissue is located deep in the body (that is, surrounded on all sides by normal tissue), the rejected cells of the endometrium cannot stand out, as a result of which they remain in the resulting cavity (together with a certain amount of blood bleeding from damaged vessels), that is, a cyst is formed.

Such a pathological process will be repeated every month, when a woman has a menstruation period, as a result of which the size of the cyst and the volume of blood contained in it will gradually increase. The cyst will gradually squeeze the surrounding tissues, leading to dysfunction of the organ. When the size of the cyst reaches a critical size, its wall may break and the contents will flow out. Sometimes this is manifested by abundant bleeding that occurs during the next menstruation. If the contents of a ruptured cyst falls into the abdominal cavity, peritonitis develops (inflammation of the peritoneum - the thin membrane surrounding the internal organs of the abdominal cavity and small times).

Neurological disorders
The proliferation of endometrial cells in various tissues can lead to compression of the nerve structures that pass in a given area. As a result, intestinal motility may be impaired, which will manifest constipation or frequent diarrhea, abdominal distension, and so on. Impaired neural regulation of the bladder can lead to frequent urination or urinary incontinence.

Rupture of the affected organ
The germination of endometrial cells in the walls of various organs violates their integrity and strength. The rupture of the wall of the large intestine can occur with increasing load on them, which is observed with constipation, intestinal obstruction, the use of coarse and poorly processed food. The penetration of fecal masses into the abdominal cavity can lead to the development of fecal peritonitis requiring urgent surgery. Uterine wall rupture may occur at various stages of pregnancy (depending on the degree of damage of the myometrium - the muscular layer of the uterus) and without urgent surgical intervention can lead to the death of the fetus and mother.

Violation of childbirth
During childbirth, the myometrium begins to contract, contributing to pushing the fetus out of the uterus. The germination of the endometrium in the tissue of the muscular layer of the uterus significantly violates the contractility of the organ, as a result of which weakness of the labor activity can be observed (that is, the uterus cannot contract with enough force to ensure the birth of a child). In addition, the load on the muscle fibers of the body during labor pains increases several times, which during endometriosis can lead to rupture of the uterus.

Intestinal obstruction
Violation of the passage of fecal masses may develop as a result of a pronounced proliferation of endometrial tissue in the intestinal cavity. When this occurs, the mechanical overlap of its lumen and the development of intestinal obstruction. Another cause of this complication may be the formation of adhesions in the abdominal cavity. As they grow, they squeeze the intestinal loops from the outside, as a result of which the passage of fecal masses is also disturbed.

Malignancy
One of the theories of the development of endometriosis is considered the tumor degeneration of ordinary organ cells. If we consider endometriosis from this point of view, it refers to benign tumors, since the expanding cells of the endometrium do not destroy, but rather push back the stands of normal tissues. However, malignant degeneration of endometrioid cells into cancer cells can sometimes occur. In this case, the rate of development of the pathological process is accelerated, cancer cells begin to destroy the adjacent tissues and organs, and metastases appear - distant tumor foci, which are formed as a result of migration of cancer cells with blood and lymph flows.

Infertility
The most frequent complication of endometriosis is infertility, which is observed in more than 60% of women suffering from this disease. Adhesions, endometrial cysts in the ovaries, as well as the development of inflammatory reactions in the uterine mucosa, which prevent the fertilized egg from attaching and the onset of pregnancy, can cause infertility.

It is worth noting that the onset of pregnancy at any stage of endometriosis stops the progression of the disease. This is due to the suppression of the secretion of female sex hormones (estrogen) which are responsible for proliferation (sprawla) endometrial tissue. The longer a woman suffers from endometriosis, the less likely she is to get pregnant.

Can I have sex with endometriosis?

Sex in endometriosis is not contraindicated, however, in some forms of the disease, having sex can bring certain inconveniences to a woman or even cause a visit to a doctor.

For sex with endometriosis affects:

  • The form of the disease. The most dangerous in this regard is endometriosis of the uterus and external genital organs. In this case, the proliferation of endometrial cells (uterine lining) leads to functional disorders in the affected organ, and can also cause a number of complications. Endometriosis of other organs (for example lung) usually does not affect the sexual life of women.
  • The severity of the disease. In endometriosis, the appearance of endometrial cells in various organs occurs. The larger the focus of endometriosis, the more the surrounding tissues are compressed and the more affected the function of the affected organ.
Sex with endometriosis can cause:
  • Bleeding In endometriosis of the cervix or vagina, the affected tissue can be penetrated by a large number of endometriotic foci. During sexual intercourse, their mechanical damage may occur, resulting in bleeding. The intensity of blood loss varies depending on the severity of the endometrial process and the affected organ.
  • Be ill. Acute stitching pains are usually observed with endometriosis of the body and cervix, vagina, intestines. An inflammatory process develops around the endometrial cells, which is accompanied by an increased sensitivity of the tissue of the affected organ. During intercourse, the overgrown endometrial tissue is squeezed, which causes the occurrence of pain. Its intensity varies from mild to intolerable (what can cause rejection of sex). Another cause of pain may be vaginal dryness, often seen in the treatment of endometriosis with hormonal drugs, as well as the development of adhesions in the pelvis.
As mentioned earlier, it is not necessary to completely exclude sex. This is only necessary in severe cases of the disease, when having sex is accompanied by severe pain in the lower abdomen and abundant bleeding.

In milder cases, it is recommended to reduce the frequency of having sex in the first half of the menstrual cycle whenever possible. This is due to the fact that during this period under the action of female sex hormones (estrogen) endometrial growth occurs in the uterus and in the foci of endometriosis, which may be accompanied by a deterioration of the woman’s condition and the development of more serious complications.

Is it possible to sunbathe with endometriosis?

With endometriosis, prolonged exposure to the sun is not recommended, as this may lead to a deterioration of the general condition and the development of severe complications.

With endometriosis, the growth of endometrial cells occurs (uterine lininga) bodies where they are normally not found. Under the influence of female sex hormones (estrogen) there is increased endometrial growth (both in the uterus and in the foci of endometriosis), as a result, it squeezes the surrounding tissue, leading to a violation of their functions.

Sunburn with endometriosis can cause:

  • Faster disease progression. Exposure to ultraviolet rays or simply high temperatures accelerates metabolic processes throughout the body, including in the foci of endometriosis. This is followed by accelerated division (breeding) endometrial cells, which worsens the course of the disease. In addition, exposure to high temperatures can lead to the emergence of new foci of endometriosis in previously unaffected organs and tissues.
  • The development of cancer. Endometriosis, in fact, is a benign tumor. Since cell division in the foci of endometriosis is very intense (especially in the first half of the menstrual cycle), in them with a high degree of probability a mutation may occur, which will result in a malignant tumor degeneration and cancer development. Under normal conditions, this does not happen, since the female immune system quickly finds mutated (tumor) cells and destroys them. However, when exposed to ultraviolet radiation, the speed and number of mutations increases several times, while increasing the risk of developing a malignant tumor.
However, it is also not recommended to completely exclude exposure to the sun, since this is fraught with the development of other, no less dangerous diseases. Moderate and adequate insolation will provide the body with the necessary amount of ultraviolet radiation, without aggravating the course of endometriosis.

Women with endometriosis are not recommended:

  • live in countries with hot climates,
  • sunbathe in the hot time of the day (approximately from 10 - 11 am to 4 - 5 pm),
  • sunbathe more than 30 minutes continuously,
  • to visit the bath and / or sauna,
  • visit the solarium.

Is IVF effective for endometriosis?

ECO (in vitro fertilization) can be a good option for solving the problem of infertility in women with endometriosis. However, it is worth noting that in some cases this procedure may be ineffective.

Endometriosis is characterized by pathological proliferation of endometrial cells (uterine lininga) bodies where they are normally not found. Infertility in this disease leads to a number of factors that need to be considered and studied before IVF.

Endometriosis is characterized by:

  • Violation of patency of the fallopian tubes. When endometrium grows in the fallopian tubes, their lumen overlaps, resulting in spermatozoa (male reproductive cells) can not reach the egg (female reproductive cell) and fertilize her. Even if this process occurs, the probability that the fertilized egg will fall into the uterine cavity and attach to its wall will also be significantly reduced.
  • Adhesive disease. In the organs affected by endometriosis, an inflammatory process develops, characterized by swelling of the tissues and the release of the liquid part of the blood from the vascular bed. Also, the development of inflammation contribute to bleeding, often observed with the defeat of the pelvic organs (ovarian, uterine wall, intestine, bladder). As the disease progresses, fibrin plaque is deposited on the walls of the organs (special plasma protein), which leads to the formation of adhesions, “gluing” the organs together. Adhesions can compress the ovaries or fallopian tubes, which disrupts the process of development and fertilization of the egg.
  • Immune system disorders. Endometriosis is characterized by immune restructuring (protective) female body systems. With extensive damage to the uterine wall, inflammatory changes in the organ mucosa can be observed, which can also cause infertility.
  • The formation of cysts in the ovaries. Endometrioid ovarian cyst is a blood-filled cavity, which is formed as a result of repeated bleeding observed in the foci of endometriosis during each menstruation. Since blood has nowhere to stand out, it accumulates in the ovarian tissue, leading to a violation of their function (first of all, to the disruption of the process of maturation of the egg).
IVF is the process of artificial insemination of an egg. Initially, a course of hormonal therapy with female sex hormones is prescribed, which leads to the simultaneous maturation of several eggs (in normal, one of the menstrual cycle matures only one of them). After that, the eggs are removed (surgery is performed under general anesthesia) and placed in a nutrient medium, where sperm are subsequently added (male reproductive cells). Другим вариантом оплодотворения является введение сперматозоида в яйцеклетку с помощью ультратонкой игры (при этом используется специальная аппаратура).

Fertilized eggs are placed in a special incubator for 3 to 5 days, after which the transfer 2 (in some cases - 4) embryos in the uterine cavity. This procedure is painless and takes only a few minutes. If the process of their attachment happens normally, pregnancy will occur.

Indications for IVF with endometriosis are determined by:

  • The prevalence of the disease. If the cause of infertility was impaired fertilization (with adhesive disease, ovarian cysts or obstruction of the fallopian tubes), IVF allows you to get pregnant in almost 90% of cases. In the presence of inflammatory changes in the uterus and the violation of the hormonal background of a woman, the effectiveness of the method is significantly reduced.
  • The effectiveness of previous treatment. If there are not many endometriotic foci and they did not cause serious functional and anatomical disorders in the uterus, fallopian tubes and ovaries, medical treatment of endometriosis is first foreseen. After that, the woman is recommended to try to get pregnant naturally for a year. If she fails, IVF is assigned.
  • Age women. If a woman is younger than 35 years old, it is recommended to carry out the treatment described above before IVF and adhere to waiting tactics for 1 year. If the patient is over 35 years old, IVF is performed as early as possible (after doing all the necessary research and a short course of treatment with hormonal drugs).
If the embryo has got accustomed and the pregnancy has come, in almost 100% of cases there is a complete remission of endometriosis (symptoms of the disease disappear for the entire period of pregnancy). This is due to the fact that during gestation of a fetus the hormonal background of a woman changes - estrogens responsible for the growth of endometrial tissue are secreted in smaller quantities, as a result of which endometriotic foci decrease in size and completely disappear. It should be noted that almost half of women after childbirth, the disease resumes.

Do I need a special diet for endometriosis?

There are a number of recommendations for eating, compliance with which will help reduce the severity of the clinical manifestations of the disease and prevent a number of complications.

Endometriosis is a pathological condition in which endometrial cells (mucous membrane lining the uterus) appear in other tissues and organs (where normally they are not found). The central component of this disease is the proliferation of endometrial tissue outside the uterus. This is due to an increase in the concentration of female sex hormones (estrogen) in the first half of the menstrual cycle. During the next menstruation, the endometrium is rejected, with the result that a certain amount of blood flows from the damaged vessels.

Clinical manifestations of endometriosis are due to:

  • Localization and size of foci of endometriosis. This disease can affect almost any organ of the human body. The growing endometrial tissue puts pressure on the normal cells of the affected organ, which, as the disease progresses, leads to disruption of its function, the development of inflammatory processes and the appearance of pain of varying intensity.
  • The amount of blood loss. During normal menstruation, a woman loses no more than 100 ml of blood. However, with endometriosis, bleeding develops in all foci of the disease, which in severe cases can lead to massive blood loss and severe anemia.

Classification of Endometriosis

Endometriosis is classified as follows:

  • Genital form. This means that endometriosis affects the genitals: the uterus, ovaries, tubes, external genitals, the cervix, the vagina and the pelvic peritoneum.
  • Extragenital form. A form of endometriosis in which the remaining organs are affected: the intestines, lungs, scars after operations, organs of the urinary system
  • Mixed forms

There is another classification, by stages:

  1. only the mucous membrane is affected
  2. myometrium is affected to the middle
  3. endometrium affected to serous (outer) membrane
  4. endometriosis germinates the entire thickness of the uterus and the peritoneum covering it

The main symptoms of endometriosis

  • Dysmenorrhea (painful menstruation). Dysmenorrhea is expressed in varying degrees. In the initial stage of dysmenorrhea is often almost not expressed. Over time, the pain becomes more pronounced. The prevalence of endometriosis does not correlate with the severity of pain. Often there is a pronounced pain syndrome in women with single heterotopias and minor pain in patients with common endometriosis. The pain appears before menstruation and increases during it. This phenomenon is associated with a menstrual-like reaction in endometrioid heterotopies. Read more about dysmenorrhea here:Dysmenorrhea: Causes and Treatment
  • Dyspareunia (painful sexual contact).
  • Spotting before menstruation. This symptom is in 35% of women suffering from endometriosis. A few days before the expected menstruation.
  • Infertility.

On examination, foci of endometriosis can be found on the perineum and on the external genitals, as well as on the cervix and vagina. The uterus is painful at displacement, it can be rejected backwards and firmly fixed in this position. Endometrioid ovarian cysts can be detected.

Endometriosis can affect not only the genitals, but also the urinary system: the bladder, urethra, ureters, and kidneys. This can lead to serious consequences, such as hydronephrosis, kidney blockade and loss of its function.

Infertility is detected in 25-40% of women suffering from endometriosis.

Consequences of endometriosis

Endometriosis can be asymptomatic and not affect the quality of life of a woman. On the other hand, endometriosis not diagnosed in time and the lack of adequate treatment can lead to complications. The most likely complications are:

  • Adhesions in the pelvis
  • Fertility disorders
  • Anemia due to heavy bleeding
  • Endometrial cysts
  • Malignancy

Is there prevention of endometriosis?

Since the reliable causes of endometriosis are unknown, there is no effective prevention. However, you can influence the development and outcome of the disease, if you follow a number of recommendations:

  • Regularly visit a gynecologist as a preventive examination
  • Timely treatment of identified diseases
  • Regulation of body weight and its maintenance within normal limits
  • Sexual rest on “critical” days
  • Taking COCs as a contraceptive
  • Lack of abortion

Endometriosis and pregnancy

Endometriosis violates the fertility of a woman, but this does not mean that pregnancy is impossible or contraindicated. On the contrary, many experts recommend pregnancy, as it has a beneficial effect on the course of the disease. The fact is that during pregnancy a state of prolonged anovulation occurs, menstruation is absent, and the body is under the influence of progesterone for 9 months. All these conditions contribute to the regression of heterotopias.

However, endometriosis itself is a risk factor in pregnancy, as it can cause a threat of miscarriage. Therefore, it is recommended to conduct pregravid training for women suffering from endometriosis, and during pregnancy to carry out prevention of miscarriage and placental insufficiency. To do this, it is recommended to visit a gynecologist before pregnancy, and register as early as possible. Endometriosis has no direct effect on the child, so there is no need to fear for the health of the baby. However, the indirect effect can be manifested in the development of placental insufficiency, when the child does not receive enough nutrients and oxygen due to disruption of the placenta.

Cervical Endometriosis

With the defeat of endometriosis of the cervix, endometrioid heterotopies are located on the cervix and visualized by a doctor when viewed on a gynecological chair. They look like small red color formations. Since heterotopies are subject to cyclic changes in the menstrual cycle, they undergo the same changes in different phases as the endometrium. During menstruation, endometriotic lesions are bleeding formations. Endometriosis can also be localized in the cervical canal. In this case, infertility may develop over time due to the formation of adhesions in the cervical canal.

On the cervix, endometriosis often occurs after manipulations performed on it and in the uterus - cauterization, curettage, abortion. Treatment of endometrioid heterotopias involves the destruction of foci using liquid nitrogen, radio wave therapy or a laser.

Retrocervical endometriosis

Approximately 6-7% of all localizations of endometriosis are retrocervical endometriosis. The process is located in the posterior surface of the cervix at the level of the sacro-uterine ligaments. Heterotopies can grow into the depths, down to the rectum and Douglas space. This form of endometriosis can bring a woman to complete disability. Manifested in the form of pain in the lower abdomen and in the lumbar region with irradiation to the rectum during menstruation, the pain increases. During sexual intercourse, there may be bleeding (if endometriotic foci are localized in the vaginal vaults). If endometriosis affects the rectum, then another symptom during menstruation joins - blood discharge from the rectum during bowel movements.

Ovarian Endometriosis

Ovarian endometriosis may not manifest for a long time and is asymptomatic. Over time, the peritoneum is involved in the process, the lesions spread, and the adhesive process is formed. As with other forms of endometriosis, there are characteristic abdominal pains, aggravated during menstruation. Pain in the rectum, groin. Menstruation is always painful, dyspareunia is also present (painful intercourse).

Small cysts gradually increase, can even merge with each other, forming endometriomas, which are well palpated during a bimanual examination, can be clearly seen on ultrasound. Cysts contain a dark brown substance, thanks to the scab, they are called "chocolate" cysts. Treatment is carried out mainly laparoscopically, the volume of the operation depends on the reproductive plans of the woman and the degree of distribution.

The main signs of endometriosis

Endometriosis has no severe clinical symptoms, therefore, it is impossible to diagnose the disease without a special examination. Even an examination on the chair with a gynecological mirror does not always allow to determine the pathological growth of endometrial cells, so the symptoms of the disease must be treated very carefully. It is important to inform the doctor about all the existing violations, because endometriosis is characterized by a combination of four symptoms that manifest themselves in virtually every woman with endometriosis.

The diagnosis of "infertility" is made if the pregnancy does not occur after a year of regular sex life without using contraceptive methods. The main reason for the lack of pregnancy in endometriosis are anatomical changes in the endometrium, in which it becomes impossible to attach and preserve a fertilized egg. Hormonal disruptions that cause pathological growth and changes in the structure of the endometrium, affect the synthesis of hormones necessary for the development of pregnancy.

Location of foci of endometriosis

If the cells of the epithelial layer extend beyond the organ (into the ovarian region, cervix, fallopian tubes, etc.), adhesions can form in the space of the fallopian tubes — compacted regions of connective tissue that connect two or more organs. Adhesions cause obstruction of the fallopian tube - one of the causes of infertility with internal endometriosis.

Note! Chronic endometriosis negatively affects the state of the immune system and inhibits its activity. Even if the pregnancy comes, the probability of its interruption or fading of the fetus will be very high - more than 65%.

Pain syndrome

Pain in endometriosis can have a different nature, intensity and localization. Acute pain, usually cutting or stabbing, is localized in the lower abdomen. Chronic pain can be dull, pulling. Their intensity is usually moderate, so most women do not pay attention to them, taking this symptom for manifestations of premenstrual syndrome or the result of increased stress.

Frequency and combination of symptoms in endometriosis

Chronic pain in endometriosis can be aggravated by the following factors:

  • intimacy
  • menstrual flow,
  • weight lifting.

Important! Pain in chronic endometriosis is easily stopped by painkillers, so many ignore this symptom. The distinctive feature is a constant, chronic course, that is, the symptom weakens or disappears while the drug is acting, after which the pain returns.

Bleeding

In almost all cases of endometriosis, regardless of its location, a woman is concerned about contact bleeding that appears after sexual intimacy. If the lesion has affected the organs of the urogenital system or intestinal sections, blood drops or blood veins can be found in the urine or feces.

Endometriosis sites

Non-abundant discharge of blood with marked pain syndrome is observed several days before the beginning of menstruation (approximately 4-5 days). Hemating continues usually 1-3 days, after which it passes, and after 24-48 hours, the woman begins menstruation.

Menstruation may be accompanied by the formation of blood clots of dark scarlet or brown. Their size can reach several centimeters, and the appearance of something a bit like a raw liver. Clots themselves are not a symptom of endometriosis, as they can occur in other pathologies (for example, endometrial hyperplasia), but in combination with other signs, you can almost certainly suspect the pathological growth of epithelial cells.

Irregular menstrual cycle

Women with this disease always have menstrual irregularities. These include:

  • constant cycle oscillations
  • lack of periods for several months in a row,
  • copious and prolonged menstruation (menorrhagia).

In case of any cycle failures, women should immediately consult a doctor, since in the absence of timely treatment the risk of serious consequences and complications will be very high. Untreated endometriosis can lead to the formation of benign tumors, infertility, and inflammatory processes.

Endometriosis lesions on the uterine mucosa

Signs and symptoms of various types of endometriosis

Ovarian cystic masses

Ultrasound images for endometriosis

The role of the psychological factor in the diagnosis

Nearly 80% of women with chronic forms of endometriosis have psychological problems. They are prone to depressive disorders, psychosis, their emotional state is disturbed, and a tendency to sudden mood swings. Some women may completely disappear interest in the events happening around. They cease to monitor their appearance, reduce communication with friends and close people, avoid appearing in public places.

Distinctive symptom of pathology (subject to the presence of other clinical manifestations) is anxiety, unreasonable fear. In severe cases, panic attacks may occur.

Important! Some women begin to take sedatives to cope with emerging psychological problems. It is important to understand that such treatment will give a short-term result, since the cause of the pathology will not go anywhere.

How does the disease manifest itself in older women?

Some people mistakenly believe that endometriosis is a disease of women of reproductive age. Pathological growth of the endometrium beyond the epithelial layer can occur at any age, and in women older than 45 years the risk of developing the disease is several times higher, since after the onset of menopause, progesterone production is blocked. Contribute to the emergence of pathology can other factors that are often found in women of advanced age. These include:

  • overweight,
  • diabetes,
  • disorders of the thyroid gland,
  • a large number of infectious diseases in history
  • transferred operations (regardless of the localization of the pathological process).

Elderly women suffering from endometriosis often have headaches, dizziness, and nausea. In severe cases, single vomiting is possible. Pain syndrome usually has a weak or moderate intensity, exacerbations rarely occur. The psychological state of a woman is also different from normal indicators: irritability, aggression towards others, tearfulness appear.

Goals of endometriosis treatment

Important! A distinctive feature of the disease during menopause are bloody discharge. They may be non-abundant (hemase) or bulky - in this case it is already a bleeding. This clinical picture is characteristic of endometriosis of the uterus.

Symptoms of internal endometriosis

On ultrasound, the doctor detects nodules on the surface of the uterus that indicate the development of pathology. During palpation of the uterus, a strong pain appears. In the period between menstruation, pain is localized mainly in the lower abdomen, is acute. The intensity of sensations increases during sexual contact and the lifting of heavy objects. If during this period, to examine the blood of a woman, you can see signs of anemia that are associated with persistent bleeding.

Symptoms of the disease after cesarean section

Delivery by cesarean section is considered a simple operation (if we talk about the technique of execution), but it is important that it be performed by a qualified surgeon. It is also worth checking with the doctor what kind of material will be used for suturing, as some types of surgical threads can cause itching, discomfort in the area of ​​the suture and increase the risk of gynecological pathologies.

The proliferation of epithelial cells in the suture and postoperative scar is found in 20% of cases. Suspected pathological changes in the body of a woman after a cesarean section can be for the following symptoms:

  • poor healing of the scar surface
  • the release of brown fluid from the seam,
  • severe itching in the suture area,
  • probing the nodules under the seams,
  • severe pulling pain in lower abdomen.

Drug therapy for endometriosis

When these signs are detected, a woman is advised to contact a antenatal clinic to see the doctor who led the pregnancy. In some cases, hospitalization may be required to eliminate suppuration and inflammation of the stitches, so you should not ignore the pathological symptoms.

About pathology

Endometriosis is a disease in which the glandular tissue of the internal cavity of the uterus grows beyond its limits.

Mucosal cells can attach to the surface of the fallopian tubes, ovaries, rectum, and other organs. They are subject to the menstrual cycle, and therefore begin to reject in the days of menstruation and stand out in the form of bloody mucus.

Localization of the endometrium in other organs in women leads to a number of consequences:

According to the frequency of diagnosis in women, endometriosis is the third after uterus inflammation and fibroid development. Most often, pathology occurs at the reproductive age and very rarely during menopause.

The causes of the disease are not exactly known. Of great importance is the genetic factor. If a woman suffers from endometriosis, her daughter will probably have the same pathology.

Experts call the cause of hormonal imbalances in the body, reduced immunity.

The risk factors for developing the disease are as follows:

  • complicated childbirth,
  • first birth at the age of more than 30 years,
  • Caesarean delivery,
  • abortion
  • infectious, inflammatory diseases of the reproductive organs.

Degrees and types of pathology

Lesions in women can be in different places and at different depths, so the disease is divided into four degrees:

  • 1 degree. There are one, two or more endometrial foci.
  • 2 degree. There are several inflammatory foci of small size, which are characterized by penetration into the thickness of other organs.
  • 3 degree. There are both superficial and deep lesions, endometrioid cysts.
  • 4 degree. It is characterized by a large number of extensive lesions, large cysts on the ovaries, adhesions on the reproductive organs.

Dividing the pathology into species depending on the place of localization. There are endometriosis:

  • the body of the uterus, another name - adenomyosis,
  • necks,
  • ovaries, cysts appear,
  • vagina,
  • rectum,
  • peritoneum,
  • Bladder.

Very rarely, but the disease still affects other organs, such as the lungs, stomach, etc.

Can I get pregnant?

The probability of conception with endometriosis is small. But pathology is not capable of harming a developing fetus.

If a woman has a conception with the disease, the symptoms are more likely to decrease during the child's bearing period.

If attempts to conceive are unsuccessful, you should consult a doctor to begin treatment and determine the risks of a future pregnancy.

Diagnostic methods

Diagnosis of pathology is possible only when visiting a doctor, taking tests and passing additional methods of examination.

Apply the following methods:

  • Examination by a gynecologist. An increase in the size of the affected uterus, appendages, and the presence of endometrial cysts on the ovaries can be determined.
  • Colposcopy. The technique allows to diagnose endometriosis of the vagina and retrocervical.
  • Ultrasound procedure. Adenomyosis, that is, damage to the body of the uterus, cysts on the ovaries is detected by ultrasound.
  • Hysteroscopy. The method allows to diagnose adenomyosis, to examine the surface of the uterus, fallopian tubes, to reveal foci.
  • Blood test for endometriosis marker (CA-125). Often, with pathology, the level of SA-125 is significantly higher than normal. This makes it possible to determine the degree and severity of the disease or assess the effectiveness of therapy.

How is treatment carried out?

If there are specific manifestations, the treatment of endometriosis of the uterus or other organs is carried out in two ways and can be:

Therapy with the use of drugs is aimed at correcting hormonal activity, which character for the development of pathology.

The following groups of drugs are prescribed:

  • Progestins - Duphaston, Depostate.
  • Oral combined contraceptives - Diane 35, Femoden, Marvelon.
  • Antigonadotropins - Danazol, Gestrinon.
  • Antiestrogens - Tamoxifen.
  • Agonists - Zoladex, Dekapeptil Depot.

Operational intervention is carried out with the rapid deterioration of the woman and the growing threat of infertility. Sometimes patients suffer from severe pain, which is accompanied by the rapid growth of endometrial foci.

The type of surgery depends on the location of the lesions. Conduct the following types of intervention:

  • Endoscopy. Assign with the defeat of the vagina, cervix. This is cauterization and removal of lesions.
  • Laparoscopy. Conducted with the localization of abnormal cells on the ovaries, fallopian tubes, peritoneum.
  • Hysterectomy. It is indicated for severe damage to the uterus, represents the complete removal of the organ.

Possible complications

Sometimes the disease is asymptomatic and does not affect the quality of life. But endometriosis not diagnosed in a timely manner and the lack of therapy leads to the development of complications.

What consequences can be:

  • appearance of adhesions in the pelvic organs,
  • loss of reproductive function
  • endometrial cysts,
  • heavy uterine bleeding,
  • development of anemia,
  • the transition of the affected areas in the malignant form.

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Content

Genital endometriosis is divided into:

1. External genital endometriosis, which includes endometriosis of the ovaries and pelvic peritoneum.

2. Internal genital endometriosis (adenomyosis), in which the endometrium “grows” into the myometrium. At the same time, the uterus acquires a round or spherical shape and can be enlarged to the size typical for 5-6 weeks of pregnancy. Quite often, patients with adenomyosis are combined with uterine myoma, since these processes have similar developmental mechanisms [1].

According to the distribution and depth of tissue damage by endometriosis, there are 4 degrees of the disease:

I degree - single superficial foci.

Grade II - several deeper foci.

Grade III - a variety of deep foci of endometriosis, small endometrial cysts of one or both ovaries, thin peritoneal commissures.

Grade IV - Many deep foci, large bilateral endometrioid ovarian cysts, dense fusion of organs, germination of the vagina or rectum.

Endometriosis affects women of reproductive age, its exact prevalence is unknown. Many women do not go to the doctor, considering pain as a normal part of the menstrual cycle. Endometriosis is one of the leading causes of pelvic pain and the basis for laparoscopic surgery in many countries. The average age of patients with endometriosis is 25-30 years. Endometriosis is less common in postmenopausal women. A higher prevalence of endometriosis among women of the Caucasian race than among women of the Negroid and Mongoloid races.

In a healthy organism, during each menstrual cycle, in the event of an egg non-fertilization, the endometrial surface tissue is rejected and removed from the uterus along with the blood flowing from the uterus vessels [3]. In some cases, menstrual blood is thrown into the abdominal cavity through the fallopian tubes, where the endometrial cells inoculate and begin to grow. This process gives rise to external endometriosis. With internal endometriosis, endometrial cells “grow” into the muscle layer of the uterus.

  1. Pelvic pain. Pain, as a rule, are cyclical (appear or increase before menstruation), but may be permanent.
  2. Strengthening and lengthening of menstrual bleeding.
  3. Pain during intercourse (dyspareunia).
  4. Pain when emptying the bowel or bladder (in the fourth stage)
  5. Infertility.
  6. Bloody tear (very rare)

During a medical examination, endometriosis may indicate tension in the area of ​​the appendages, uterus and Douglas space. Ultrasound is not an effective diagnostic method, since most of the nodes of endometriosis are not visible on it. Thus, negative ultrasound readings do not indicate the absence of endometriosis. The gold standard for the diagnosis of endometriosis is laparoscopy [4].

Treatment of endometriosis [5] is recommended to start with the simplest, cheapest and least invasive methods [4].

Pain Treatment Edit

Endometriosis pain syndrome significantly reduces the quality of life of patients, therefore, sufficient attention should be paid to pain relief. For this purpose, simple analgesics (paracetamol) and NSAIDs are used. In 2003, a systematic review was conducted, revealing the greater efficacy of NSAIDs in the treatment of algomenorrhea compared with placebo. It is characteristic that a large percentage of women in this study had endometriosis [6].

With regard to the effectiveness of COCs for pain syndrome, there is little evidence, but they are still used and considered effective [7].

The effectiveness of progesterone drugs according to the results of the studies was the same as that of any other drugs with a confirmed diagnosis of endometriosis [8] [9]. Due to their good tolerability and a small number of side effects, they remain suitable for use in this disease.

Hormone Therapy Edit

Drug therapy for endometriosis was widespread before the advent of laparoscopic treatment. The main drugs with a proven effect for the treatment of proven endometriosis are:

There is no evidence of the greatest efficacy of any of these drugs. The choice is made on the basis of the spectrum of side effects, personal portability and price. There is evidence of the effectiveness of these drugs in preparation for the operation [10] [11] [12], as well as evidence that their use in the postoperative period has a much longer analgesic effect [13] [14] [15].

Surgical treatment Edit

It implies the complete removal of foci of endometriosis (nodes) by any of the surgical methods. Currently used: resection, electrocoagulation, laser vaporization. All of them have a proven effect [16] [17], but any of the techniques have no significant superiority over others. Many surgeons believe that resection allows you to better remove all the nodes, especially large sizes, which may not completely disappear after vaporization or electrocautery. This technique also allows you to simultaneously take the material for biopsy [4].

Endometrial ovarian cysts are best suited for excision with complete removal. Symptomatic relief after this operation is proven to exceed the effect of drainage and ablation methods [18] [19], and also allows for timely taking material for histological examination to exclude rare ovarian tumors.

Surgeries for severe stages of endometriosis involving the large intestine, bladder and Douglas space should be performed in large centers specializing in gynecological laparoscopy, if possible, under the supervision of a urologist and colorectal surgeon. Surgery in these cases may include resection of the intestine, bladder and reimplantation of the ureters. The removal of the uterus and appendages is being used less and less often; most methods focus on removing only foci of endometriosis and restoring the normal anatomy of the pelvic area [4].

It is believed that endometriosis can disrupt the process of maturation of the egg and the process of its ovulation. Naturally, these violations affect the possibility of conception, and the chances of getting pregnant, respectively, are reduced. In addition, during long-term endometriosis, adhesions form in the genitals, which also increases the risk of infertility.

But at the same time, endometriosis is not a guarantee of infertility. There are facts of the accidental discovery of this disease in women who have never had problems with conception. Also, after the treatment of endometriosis, many women succeed in becoming pregnant [20].

Forms of endometriosis

Today, this disease is a very common pathology in gynecology that can lead to various complications if it is not treated promptly. For this reason, a woman who cares about her health should be aware, endometriosis - what it is and how this disease manifests itself. This disease is a chronic proliferation of the endometrium - glandular mucous tissue, normally covering only the inner surface of the uterus - beyond the limits of this organ. In medical practice there are different forms of the disease:

  1. The extragenital form of the disease is diagnosed when the endometriotic tissue grows into other organs, both in the abdominal cavity — the intestine, urinary system, etc., as well as outside of it — for example, the lungs.
  2. The combined form of the disease manifests itself if heterotopia — the atypical placement of endometrial tissue — is localized on the genitals and on other internal organs.
  3. Genital endometriosis. In this form of the disease are distinguished:
  • internal uterine endometriosis (adenomyosis) - proliferation of nodal seals in the uterine muscle layer, fallopian tubes, ovaries,
  • external, or external endometriosis - retrocervical (pozadisheechny), the defeat of the vagina and peritoneum of the small pelvis.

Stages of Endometriosis

The highest incidence of endometriotic disease occurs in the internal genital form of the disease - adenomyosis. Many women are given this diagnosis when they go to the doctor with complaints of heavy, painful menstruation. 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 muscular layer of the body and the isthmus of the uterus.

Depending on the nature of localization of endometrial cells, focal, diffuse, or nodular adenomyosis is distinguished. In order to choose the right treatment regimen, gynecologists pay special attention to the stages 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 spreads to the serous cover,
  • IV - endometriotic lesions spread to the peritoneum lining the walls of the abdomen.

Cause of disease

The well-known fact that many diseases can be avoided if we exclude the factors that provoke them from their lives. Why is it impossible to prevent this ailment in this way and get rid of the many troubles it delivers? The fact is that medicine cannot unambiguously identify the causes of endometriosis in women. There are several theories why this disease occurs:

  1. Implantation of endometrial cells outside the uterus due to their throwing out of the organ 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 location of endometrial cells and does not destroy them.
  5. Malformation of the genital organs in the prenatal period.
  6. Damage to the mucous membrane of the uterus during medical procedures - diagnostic curettage, abortion.
  7. Inflammatory and infectious diseases of the genitourinary system.
  8. Incorrectly chosen contraceptives, long-term use of the intrauterine device, etc.

It is not easy to recognize this ailment on your own in the early stages, therefore it is very important not to skip periodic examinations by a gynecologist. A woman may be suspected of having endometriosis if she begins to notice such symptoms in herself:

  • 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,
  • повышение температуры тела в критические дни и сразу после них,
  • 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 proliferation 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 turn into oncology. It is possible to differentiate these symptomatic diseases only after a full examination.

Folk 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 independently, but can only be used as an additional effect in the complex therapy only after consulting with your doctor. In practice, endometriosis is often treated with a boron uterus. Here are a few 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 the tincture three times a day before meals, 30 drops, a little diluting it with water.
  2. 2 tbsp. l dry chopped herbs add to 1 tbsp. purified vegetable oil. Insist means too 2 weeks, then strain the resulting infusion. Introduce a tampon soaked with this medicine into the vagina at night.

What is dangerous endometriosis

It is impossible to let this disease take its course, because it is fraught with many serious consequences. So, it has been established that endometriosis and infertility are interconnected states, therefore, a woman planning a pregnancy, for the realization of her reproductive function, should definitely treat this ailment. An endometrioid cyst on the ovary can lead to a loss of the appendage. If endometriosis occurs together with uterine myoma, then this combination often threatens with irreversible consequences, leading to the removal of an organ.

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