Diagnosis of endometriosis and methods of treatment. Endometriosis is a dangerous hormonal disorder. What are the features of the disease

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Endometriosis is a common disease that has rather mild symptoms. For this reason, it is diagnosed at a fairly late stage. However, it is dangerous and can lead to infertility, as well as to the risk of an oncological process. For this reason, treatment this disease you need to start in a timely manner, and women should know how it manifests itself and what characterizes endometriosis of the 2nd degree for a timely visit to the doctor.

general characteristics

Endometriosis is a hormone-dependent disease, it develops under the condition high content in the blood of estrogen and general hormonal imbalance. In such a situation, endometrial cells begin to actively divide, as a result, tissues grow. It should be noted that typical cells divide with standard cellular structure. If the dividing cells become atypical (differ in size, shape, number of organelles, etc.), then this may indicate a cancerous process.

At the same time, tissue growth occurs both deep into, into the myometrium, and in breadth, that is, the foci occupy all large area. With such a disease running, endometrial tissues can be found on the intestines, ureters, and even lungs.

Endometrizus itself can initially develop on any organ where there is endometrium - the uterus (internal and external surface), fallopian tubes, ovaries, etc. another name for this disease is adenomyosis.

But what are the features of endometriosis of the 2nd degree? So what's this? This initial stage the development of the disease. Whereas in the first stage the foci are single and not merged with each other, in the second stage they grow, their number increases, the area of the lesion becomes much larger, the foci are connected to each other. But at this stage, its endometrial tissues do not affect neighboring organs and do not penetrate into the myometrium, therefore the symptoms are mild.

To this extent, the disease almost does not give symptoms. Therefore, it is diagnosed extremely rarely, mostly by accident. If, on average, about 30% of women suffer from endometriosis reproductive age, then in most of them it was diagnosed at the third or fourth stage.

Symptoms

Symptoms at this stage are rare. There may be such signs:

Menstrual irregularities;
Increased pain during premenstrual syndrome and during menstruation;
Acyclic bleeding;
Increased blood loss during menstruation;
Discomfort and pain during intercourse with the localization of foci of growth on the cervix or in the vagina.

As can be seen from the list, a typical for many gynecological diseases, painting. For this reason, the treatment of this condition can only begin after a very thorough diagnosis.

Diagnostics

Diagnosis at this stage is difficult, as many methods are powerless. The following studies are assigned:

Blood test for hormones, tumor markers;
Ultrasound, although it most often does not show anything at this stage;
MRI as the most exact method diagnostics;
Colposcopy;
Hysteroscopy.

Often the disease is diagnosed by indirect signs, such as hormonal imbalance. And it is he who is treated in the first place.

Impact on pregnancy

Pregnancy with this disease at any stage is undesirable. Endometriosis is extremely Negative influence to the fruit. During gestation, the following risks and conditions are present:

Hypertonicity of the uterus as a result of hormonal imbalance;
The threat of miscarriage in the first and second trimesters;
The likelihood of a missed pregnancy;
The likelihood of premature birth;
Insufficient blood supply to the placenta;
Incorrect placenta previa;
The risk of rupture of the walls of the uterus due to their thinness;
Indications for caesarean section due to reduced compliance of the cervix (in some cases).

The threat of miscarriage with this diagnosis is so high that pregnant women, if they do not want to have an abortion, are prescribed a special supporting hormone therapy. And also sometimes hospitalization is shown to them.

By itself, endometriosis significantly reduces the likelihood of pregnancy, both as a result of hormonal imbalances and due to the affected endometrium, which rejects the embryo. However, only 40% of all patients with this diagnosis are diagnosed with infertility.

With the second degree of development of the disease, this percentage is even lower. Thus, getting pregnant with endometriosis is possible, although not as easy as without it, but it is undesirable to do so. Replenishment can be planned approximately six months after the end of drug therapy for the disease.

Ways and methods of treatment

Treatment of this condition is carried out using two approaches - conservative and radical. The first involves a cure through the use of medicinal hormonal drugs. The second involves surgery. Three types of surgery are used:

Cauterization (coagulation) with nitrogen, laser, electric shock or otherwise using a laparoscope. It is used for focal endometriosis resistant to hormonal treatment. In combination with hormone therapy, the method is quite effective, and is good because it can be used in both parous and nulliparous patients;
The endometrial scraping method can only be used in women who have given birth. It helps with extensive lesions, with insensitivity to hormonal treatment. In this case, access to the uterine cavity is carried out through the cervical canal;
Complete removal of the uterus in case of disease in the second degree of development is almost never used. The exception is cases of multiple relapses and patients in post-reproductive age.

Drug treatment with such a diagnosis is used more often. It consists in the use of hormonal drugs of various types. Combined oral contraceptives are the basis of such therapy. They are applied in courses lasting from three to six months. These are drugs such as Regulon, Marvelon, Jeanine, etc. They normalize the menstrual cycle and hormonal levels.

In other cases, funds are used to increase the content of progesterone in the body. These are drugs Duphaston, Nemestran. Their regular intake causes a stop to the growth of foci of endometriosis. The principle of action of such drugs is that they form a condition resembling a false pregnancy.

Gonadotropin-releasing hormone agonists, such as Zoladex and Buserelin, affect the menstrual cycle, leading to thinning of the endometrium. As a result, it ceases to grow, and the foci of growth degrade. Such drugs are administered mainly by injection. The duration of the course of treatment is at least six months. At the same time, sometimes one injection per month is enough.

Sometimes second-degree endometriosis is treated with antiprogestins such as Mitfepristone. These funds have a direct effect on the foci of endometriosis, restraining their growth. They have many side effects such as weight gain and swelling.

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Endometriosis 1 degree - the initial form of the disease, which is treatable and does not yet violate reproductive function. It is important to identify its symptoms in time and consult a doctor.

During therapy at this stage, the risk of complications is minimal.

Endometriosis - female disease reproductive system. Due to hormonal failure and weakened immunity, the mucous layer of the uterus, lining its internal cavity, grows pathologically.

The endometrium grows into the walls of the organ () and, if untreated, goes beyond it. Further affects the cervix, tubes, ovaries, goes to the peritoneum, bladder.

Endometriosis 1 degree

Internal endometriosis of the 1st degree is difficult to diagnose, since there is no pronounced:

there are no violations of the menstrual cycle or they are not significant;
there are pains in the lower abdomen, but the woman associates them with the onset of menstruation;
conception may occur when planning a pregnancy;
on ultrasound, changes in the cavity of the organ are not always detected, since they are minimal.

Endometriosis of the body of the uterus initial form more often they are detected by chance when a woman turns to a gynecologist for another reason.

How is it diagnosed?

There are two options for the development of the disease of the 1st degree:

diffuse form. There are multiple small pathological foci that grow to the submucosal layer of the uterus.
Nodal form. There are one or two endometrioid nodes that reach muscle tissue organ.

To diagnose the disease, an ultrasound examination is performed twice - before and after menstruation.

Grade 1 signs that can be detected on ultrasound:

change in blood flow in the lesions;
uneven endometrium in the uterus;
determination in the cavity of the organ of areas of reduced and increased echogenicity;
the size of the uterus is asymmetric, one wall may be visually larger than the other.

To confirm the diagnosis, additionally appoint:

hysteroscopy + endometrial biopsy;
blood test for oncomarker Ca-125.

How to treat?

Adenomyosis 1 degree responds well to therapy. Prescribe hormonal drugs. If a woman is not planning a pregnancy in the near future, these are contraceptives.

The following tablets are prescribed:

Yarina.

If a woman plans pregnancy, then in the first degree they prescribe:

Utrozhestan;
Duphaston.

the threat of miscarriage in the 1st and 2nd trimesters;
spontaneous interruption in the early stages;
abnormal placenta previa, impaired blood supply;
premature birth.

Endometriosis of the first stage does not carry great risks if detected in time. Appointed drug treatment leads to regression of the disease, suppresses pathological growth endometrial cells.

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One of the complications of endometriosis is the spread of the disease to other internal organs. Endometriosis of the 4th degree is the extreme stage of the pathology, which is dangerous with complications, and often develops asymptomatically.

Characteristics of the disease

Inflammatory foci in the last stage of endometriosis deeply affect tissues internal organs, grow to large sizes and numerous. Cause fusion of organs, contribute to the formation of cysts.

Classification of pathology depending on the location of foci of cell growth:

IN pathological process all cell layers and tissues of the uterus are involved.
The disease begins to spread to the pelvic organs (bladder, rectum).
Cysts of endometrial origin. Large tissue formations (about 6 cm) affect the internal organs, into which adhesions begin to develop.
Retrocervical endometriosis. The organs located behind the uterus (ureters, rectum), as well as the tissues of the uterus itself, are involved in the formation of large adhesions.
peritoneal endometriosis. It is characterized by damage to all organs located in abdominal cavity near the uterus.

The development of the fourth degree of endometriosis can occur in a short period of time. The causes of the disease are as follows:

genetic predisposition,
hormonal disorders endocrine system, thyroid dysfunction,
operations performed on the pelvic organs, various injuries of organs,
infectious and inflammatory diseases of the reproductive organs,
low level of immunity
low levels of hemoglobin in the blood, anemia,
stressful situations
liver disease.
irregular cycle of menstruation.

Symptoms

In the last stage of endometriosis, the manifestation of symptoms is more pronounced:

Pain that is constantly observed. The intensity of the pain depends on the periods of the menstrual cycle. The pain intensifies during defecation, urination, intimacy.
Disorders of the nervous system that occur against the background of constantly experienced pain. Nervousness, irritability, despondency, etc.
Failure of the menstrual cycle, in which menstruation can be plentiful or, conversely, scanty.
Infertility.
The skin is pale in color due to the development of anemia.
Low blood pressure.
Frequent infectious and inflammatory diseases that develop against a background of low immunity.
General malaise, weakness, dizziness, shortness of breath, drowsiness, etc.

Diagnostic methods

ultrasound. Ultrasound procedure is uninformative in endometriosis. It allows you to detect the development of the disease, but additional methods are used to determine the degree of organ damage.
Computed tomography and MRI. The study is carried out using a special contrast agent, which allows you to determine the degree of endometriosis.
Hysteroscopy. It is used to examine the uterine cavity, cervix, vagina. Using an optical device, you can visually assess the condition of the reproductive organs.
Laparoscopy. The optical device is inserted through a puncture into abdominal wall. Also visually, the method allows you to determine the degree and number of lesions.
Blood test for the presence of tumor markers.

Possibility of pregnancy

Infertility is one of the complications of the disease, which develops as a result of hormonal disorders. The formation of cysts, adhesions on the reproductive organs also interferes with ovulation, attachment of the fetal egg and the onset of pregnancy.

Endometriosis 4 degrees and pregnancy can be combined, subject to prior treatment of the disease. Conception in a natural way, or with the help of IVF, is possible after a course of therapy in six months, a year, with constant monitoring by a gynecologist.

With the onset of pregnancy against the background of endometriosis, it is necessary to strictly follow the recommendations of the doctor, because. possible:

Miscarriage or the birth of a premature baby. This is due to low levels of progesterone in the blood. To reduce the risk of abortion at a certain stage of fetal development, hormonal drugs are prescribed.
Uterine bleeding during childbirth. To prevent profuse blood loss, the doctor decides on a caesarean section.
After the birth of a child, as a result of changes in the hormonal background, endometriosis can go into an exacerbation stage.

Treatment Methods

Treatment of endometriosis of the 4th degree is carried out using an integrated approach. Several methods are used together, the tasks of which are as follows:

removal of foci of proliferation of endometrial cells,
restoration of the regularity of the menstrual cycle,
elimination of the cause of chronic pain,
prevention of disease recurrence,
preparing the body for the upcoming pregnancy.

Surgical method of treatment

Surgery is the main method of treatment of the 4th degree of the disease. Applicable:

With numerous foci of pathology, when it is impossible to cut them all out, a complete or partial removal of the internal organ is carried out.

Hysterectomy is the removal of the uterus. During the operation, the removal of cysts formed in the ovaries and foci of pathology located inside the abdominal cavity is also carried out.
Cystectomy - removal of the uterine appendages.
Removing a Part Bladder or an area of the rectum affected by endometriosis.

Medical treatment

A course of hormonal drugs is prescribed after surgery to eliminate the remaining foci of endometriosis, to prevent the recurrence of the disease. For getting positive result hormone therapy is carried out for a long time from six months or longer.

Drugs used in treatment:

Containing estrogen and progestogen - Yarina, Klaira, Janine. The hormones contained in the preparations prevent the growth of endometrial cells, inhibit the function of the endometrial tissue, which leads to a decrease in the foci of the disease.
Containing progesterone - Utrozhestan, Norkolut, Duphaston. Active substance drugs suppresses the production of its own estrogen, which provokes the development of pathology.
Antiprogestins - Gestrinone, Mifepristone. The drugs reduce the level of estrogen, have an antiandrogenic effect, and inhibit the development of endometrial cells.
Antiestrogens - Tamoxifen. Reduces the susceptibility of tissues to the action of estrogen, reduces the synthesis of inflammatory mediators that cause pain.
Gonadotropic hormone inhibitors - Danazol. It inhibits ovarian function, which leads to a decrease in the level of sex hormones. Amenorrhea sets in, pain syndrome decreases.
Gonadotropin-releasing hormone agonists - Diferelin, Zoladex, Buserelin. The drugs cause a decrease in ovarian function, leading to amenorrhea.

Symptomatic treatment

As an additional method of treatment, sedative, anti-inflammatory, analgesic, immunostimulating drugs are prescribed.

IN Lately, more and more more women seek to find out as much as possible about endometriosis, and this is not surprising, because if earlier this disease appeared mainly in women from 30 to 55 years old, now young twenty-year-old girls are also becoming its victims.

The widespread spread of the disease leads to two of the most dire consequences. This is the possibility of infertility, or the possibility of the formation of cancer cells on the genital organs. And this, not to mention the unpleasant symptoms, such as:

Severe pain in the lower abdomen before and after menstruation.
Tearfulness and elevated level irritability.
Bleeding outside the period of menstruation.
Pain during intercourse.
Discomfort when emptying the bladder. (This will happen if endometrial cells have grown into the bladder.)

And the difficulty lies in the fact that just in the early stages of the disease, these symptoms are difficult to detect.

Pain in the lower abdomen.

To avoid the disease, or at least its strong consequences, you need to follow the basic rules of hygiene, especially during menstruation and regularly visit a doctor.

This is important, because in the early stages, the disease is almost not dangerous, but if the disease is neglected, then you can hardly get off with the removal of the entire reproductive system, which entails enormous stress for the body and a difficult, long recovery.

Degrees of disease

Endometriosis 1 degree:

is not so dangerous and is characterized by a shallow germination of the endometrium on the surface of the organs. In the first stage of the disease, the symptoms almost never appear, but the amount of blood during menstruation greatly increases. It will be very easy to get rid of the disease during this period, but as already mentioned, it is very difficult to identify it yourself, so a regular trip to the doctor will serve you here. He will not refer you for an ultrasound, because to detect a problem using visual measures on early stage impossible. But if he suspects that you have endometriosis, he will offer to take a Pap test or histological examination. Histolopography will help the doctor determine the location of the foci of infection. The disease at this stage is treated mainly hormonal drugs, or some other medicines.

Endometriosis 2 degrees:

something more serious. The epithelial cells that have begun to germinate deepen or simply increase in volume. Very rarely, in the second stage of the disease, endometrial formations begin to appear in new places, but at this stage of the disease, pain may begin in those places where the endometrium has grown most firmly. If endometriosis is spreading too quickly, the doctor may resort to surgery, although much more often, stage 2 endometriosis can be cured simply by taking the right medications.

Endometriosis 3 degrees:

accompanied by an increase in the area of the disease. The endometrium sprouts in new places, while already germinated cells continue to grow, and, accordingly, the pain along with them. In addition to the uterus, in which the endometrium grows to the serous layer, the peritoneum, fallopian tubes become infected, cysts form on the ovaries and numerous adhesions. In this case, an operation is necessary, otherwise the disease will quickly move into the fourth, most serious degree.

Endometriosis 4 degrees:

completely affects the reproductive and excretory system and the pelvic area, and also, the disease at this stage leads, sometimes, to the fusion of organs. Most often this occurs with the rectum and vagina. A disease in the 4th stage of development - can even threaten with death. In this case, it is impossible to restore the reproductive system, and it will be very difficult to move away from heavy operations.

Video: Endometriosis. Program with Dr. Nona

What will be the treatment depends on the stage of endometriosis and the age of the patient. As already mentioned, this is a terrible and very dangerous disease, which is better not to run.

Conservative treatment will be applied if the disease goes away without pronounced symptoms, and also if the woman has not yet given birth or is simply very young.

Women who have reached the age of 40 are likely to go through major surgery, in case of a serious stage of the disease with complete removal uterus.

In addition to the fact that the treatment itself is difficult, it is also expensive, especially in the case of neglect of the disease, so do not hesitate to follow all the above rules.

The diagnosis of endometriosis caused me a serious state of panic. All sorts of horrors came into my head - from imminent death before the development of cancer. Medical Encyclopedia calmed the shattered nervous system: the prognosis is favorable when seeking professional help when the first symptomatic indicators appear - with endometriosis, which is at the 1st degree of development.

The growth of tissue structures of the endometrium in the region of the ovaries, oviducts and other internal organs is called endometriosis. Abnormal deviation is one of the root causes of spontaneous abortion. Research activities and therapy of the disease are carried out in gynecology, conservative direction or surgical intervention.

Specialists subdivide the abnormal deviation into phased stages of progression.

1st degree

At the first stage, the endometrium grows shallowly on the surface of the organs. clinical picture practically no, suspicion is caused by an increase in the volume of outgoing blood at the time of menstruation.

2 degrees

sprouted cell structures increase in volume or gradually deepen into the tissues. In cases of exclusion, the formation of anomalous zones in new areas is recorded. The stage is characterized by the first unpleasant sensations- at the points of germination of the endometrium.

3 degrees

There is a spread of pathology, an increase in cells and acute pain. IN central authority reproductive endometrium is introduced to the serous surface, further damage affects the peritoneum, oviducts, with the formation of neoplasms on the ovaries and adhesive processes.

4 degrees

The disease captures the pelvic area, leads to the fusion of individual organs - the intestines and vagina. The condition is life-threatening for the patient.

Why is endometriosis dangerous?

The prevalence of abnormal deviation leads to infertility and the synthesis of atypical cells in the tissues of the genitals.

Treatment options for the disease

Therapy is carried out taking into account additional diseases, age, number of conceptions and births, the complexity of the course and the location of the pathology. Treatment includes the use medications or surgery.

Symptoms and signs by which one can judge the disease

Main clinical manifestations illnesses are separate uncomfortable sensations.

pelvic pain

It is registered in 25% of patients, characterized by a focal location or a general spillage throughout the lower abdomen. Pain can be constantly present or form a couple of days before the onset of menstruation. The deviation is caused by parallel inflammation in areas where the endometrium has grown.

Dysmenorrhea or painful periods

Symptoms appear in 60% of patients. Severe excruciating pain is present for three days from the countdown of the cycle and occurs when blood enters the voids of the cysts. As a result, there is an increase in pressure in it and subsequent spasm of the blood lines of the uterus.

Pain during intercourse

Unpleasant sensations occur when the foci of pathology are located in the vagina, the region of the uterine ligament (near the sacrum) and the uterine-intestinal gap and on the side of the rectovaginal obstruction.

Pain during emptying of the bladder and bowels

They arise for the same reasons as pain during intimate contacts.

Menorrhagia or prolonged and heavy menstruation

Registered in 15% of patients with diagnosed endometriosis. Symptomatic manifestations occur with parallel diseases in the organs located in the small pelvis - with fibroids, polycystic ovaries.

Development of posthemorrhagic anemia

The anemic condition is formed on the basis of prolonged and massive blood loss. Patients complain of a state of general malaise, rapid onset of fatigue, constant lethargy, and occasional dizziness.

Diagnosis of endometriosis

Diagnostic measures begin with the collection of anamnestic data - the woman's complaints, obvious symptomatic manifestations, the nature of discomfort and pain syndrome. The patient undergoes a gynecological examination, rectal examination.

Ultrasound diagnostics allows you to determine the location of pathological foci, to conduct dynamic monitoring of the prescribed therapy and its results. CT reveals the level of damage to nearby organs, laparoscopic examination allows you to visually assess the foci of endometriosis.

Treatment

Drug therapy is indicated for women:

in the absence of clear clinical signs illness;
at a young age or premenopausal;
in order to preserve and restore reproductive function.

The course of treatment includes the following medications:

Hormonal drugs - necessary to increase the amount of estrogen produced. Medicines show high efficiency in the initial stages of the development of endometriosis.
Progestogens are allowed for use - hormones necessary for the regulatory work of the reproductive department. The course of therapy varies from six months to eight months. Therapy is performed at any stage of endometriosis, adverse reactions use may be the development of a depressive state and the appearance of spotting spotting between periods.
Antigonadotropic substances - are responsible for suppressing the production of gonadotropins. The duration of treatment is at least six months, with an excessive amount of androgenic hormones, their treatment is prohibited. Side effects from reception are represented by enhanced functionality sweat glands, sudden changes in body weight, an increase in the fat content of the dermis, intensive growth of body hair.
Antispasmodics and painkillers - allow you to suppress pain.

Surgical intervention is performed at the second and third stages of endometriosis, in the absence of positive dynamics from drug therapy. According to health indicators, it can be carried out:

hysterectomy - excision of the body of the uterus;
adnexectomy - removal of the oviducts and ovaries.

Both surgical interventions shown to patients over 45 years of age.

When endometrioid heterotopias are removed, the probability of recurrence of the disease varies from 15 to 40% - the anomaly requires repeated surgical intervention.

Prevention

There are no specific measures to prevent the development of endometriosis. All women are advised to periodically visit a gynecologist, in order to timely diagnose the pathology. Special attention patients after a medical abortion should pay attention to their health.

Female infertility as the main complication of endometriosis

The problem is shaped by cystic formations, which are filled with old blood from the previous cycle. Anomaly provokes the development of infertility. The percentage of probability of natural conception after the course of therapy and recovery is in the range from 15 to 55% - during the first year.

Endometriosis negatively affects the process of bearing a child - the disease reduces the chances of a full-fledged pregnancy, and is often the primary source of spontaneous abortion.