The causes of endometriosis. Endometriosis Causes, symptoms, modern diagnostics, effective treatment of the disease Endometriosis of the uterus causes treatment

One of the most common gynecological problems affecting women of childbearing age is endometriosis. The incidence of the disease, according to various sources, is up to 50%. Especially often the disease is detected in women aged 40 - 44 years, as well as in women suffering from infertility.

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Features of the onset and course of endometriosis

Endometriosis is a polyetiological dyshormonal disease characterized by the fact that endometrial cells, normally lining the internal uterine cavity, begin to grow in other places, sometimes even outside the pelvis. Endometrial cells enter along with the blood flow under the influence of provoking negative factors.

Under the influence of hormones on the receptors of the overgrown endometrium, small bleeding constantly occurs in it, akin to menstrual bleeding, which lead to inflammation of those organs in which the focus of endometriosis is located and cause such complications as:

• infertility;
• an increase in the size of the affected organ;
• pain.

Repeated childbirth reduces the risk of endometriosis, and after menopause it is rare. Currently, this disease began to occur in adolescent girls, there were even cases when endometriosis was diagnosed in virgins. Endometriosis after menopause practically does not occur.

The true frequency of the onset of the disease cannot be identified, since it is characterized by a long asymptomatic course and very often the diagnosis of endometriosis is made, being already at the stage that forces a woman to consult a doctor about tormenting her pain in the small pelvis.

About a third of cases of pathology pass without treatment after the onset of menopause.

Endometriosis symptoms: what a woman feels

Symptoms of the disease will depend on the location of the foci and the severity of the course. Treatment of endometriosis is necessary, since many of its forms affect the conception and bearing of a child, as well as give a number of unpleasant complications.

Endometriosis can be asymptomatic, but sometimes patients with this diagnosis complain of the following symptoms:

• pain in the pelvic area;
• soreness of menstruation;
• pain during sex;
• painful bowel movements;
• painful urination;
• profuse menstruation;
• posthemorrhagic anemia;
• infertility.

Reasons for education

It is difficult to answer from what endometriosis occurs, since its exact causes have not yet been established. Some scientists believe that the cause of the development of pathology may be such a feature as retrograde menstruation. Also, the etiological factors of this extremely unpleasant ailment are considered to be states of immunosuppression, hereditary predisposition, abnormal structure of the female genitourinary system and pelvic organs.

Any surgical intervention in this area deserves special attention. This includes, in particular, cauterization of erosion, removal of neoplasms, abortion and childbirth by caesarean section.

Scientists, studying the manifestation of systemic pathology in gynecology, believe that endometriosis is associated with a violation of hormonal and immune processes in the body.

As for practicing specialists, in their opinion, the causes of endometriosis lie in the following:

• retrograde menstruation, in which rejected endometrial cells are thrown into the abdominal cavity and then transported to the abdominal region and adjacent tissues;
• characterized by an excessive release of the hormones FG and LH together with a decrease in progesterone levels and an increase in prolactin;
• a genetic predisposition in which endometriosis is transmitted from mother to daughter;
• violation of the immune system, when the protective functions of the body are unable to destroy endometrial cells outside the uterine cavity;
• endometrial metaplasia, which means the transformation of another tissue into it for reasons of unknown origin.

If endometriosis is found, the causes of its occurrence may be different, but the factors that provoked it are as follows:

• frequent inflammation of the genitourinary system;
• incorrectly placed intrauterine device;
• a history of numerous artificial terminations of pregnancy;
• surgical interventions in the pelvic organs;
• moxibustion and cryodestruction of cervical erosion;
• iron-deficiency anemia;
• obesity;
• unfavorable environmental conditions, work in hazardous production.

Sometimes a woman may have postpartum endometriosis, its causes are caesarean section or complicated labor.

Endometriosis classification and severity

Gynecological practice divides endometriosis according to the place of its manifestation into: genital and extragenital.

• Genital endometriosis subdivided into: external and internal endometriosis, which is also called adenomyosis.
• it is customary to divide into peritoneal and extraperitoneal.

As for the severity of this disease, it is pleasant to divide it into 4 degrees, depending on the area of \u200b\u200bthe lesion, time and severity of the course.

• 1st degree - characterized by one small superficial lesion.
• 2nd degree - during the diagnosis, several deep foci of its occurrence are found.
• Grade 3 - several deep foci of growth of the endometrium in combination with small ovarian cysts and small adhesions in the abdominal cavity.
• 4 degree - many deep focal lesions, extensive cysts, adhesions of internal organs.

Symptoms and treatment of a disease will certainly depend on its severity. The doctor may prescribe hormonal treatments or surgery.The most common endometriosis of the uterus and ovaries.

Genital external endometriosis and its symptoms

Genital external endometriosis is characterized by overgrowth of the endometrium on the peritoneum and pelvic organs. Over time, these growths take the form of nodules, tumors and lesions. Most often, the following are affected: ovaries, fallopian tubes, cervix, posterior space, vaginal mucosa. Symptoms of the disease will depend on the form of dislocation and severity:

Ovarian endometriosis

It occurs when, for some reason, the cells of the abdominal cavity, which are called macrophages, cease to function. The task of macrophages is to destroy endometrial particles. When they are inactive, the endometrium from the uterine cavity is introduced into the ovary, causing first a small lesion on its surface, and then cysts filled with thick menstrual blood.

Focal endometriosis on the surface of the ovary regularly produces minor bleeding that causes inflammation. And the presence of endometriotic cysts causes the risk of developing an oncological process in them.

Ovarian endometriosis can be suspected when groin pain occurs before menstruation begins, combined with soreness and bloating.

Endometriosis of the cervix and retrocervical endometriosis

It occurs when endometrial cells get from the uterine cavity to its cervix and into the cervical canal. For a very long time, this type of disease is asymptomatic, only after a while a woman may begin to worry about minor spotting that appears from the genital tract shortly before the onset of the next menstruation, the soreness of its course and pain during intimacy.

However, endometriosis of the cervix is \u200b\u200beasily detected by a gynecologist at the time. Its lesions look like dark blue eyes on the pale pink surface of the neck.

Endometriosis of the fallopian tubes

Most often, this form of endometriosis occurs in combination with focal lesions of the uterus and ovaries. In this case, one or both fallopian tubes are affected. The clinical picture is similar to that of endometriosis of the ovary or other reproductive organs.

Posterior cervical endometriosis

In this form, the posterior cervical space is affected. Signs of endometriosis in this place is characterized by intensifying before the monthly aching pains in the lower abdomen, which at the beginning of the next menstruation become pulsating and paroxysmal and can be given to the sacrum and rectum. Pain during intercourse is not uncommon.

With the progression of the disease, endometrial tissue grows into the sacro-uterine ligaments, into the rectum and into the posterior wall of the bladder and causes their disorders. For example, dysuric disorders during menstruation and hydronephrosis with damage to the bladder, pain during bowel movements and blood in the stool when the rectum is affected. Fortunately, such lesions are rare.

Endometriosis of the vagina, perineum and vaginal part of the cervix

The vagina and perineum are affected by endometriosis a second time, after the occurrence of its focus in the cervical canal. The main symptoms are recurrent vaginal pains, which intensify during sexual intercourse and on critical days.

Endometriosis of the vagina is often combined with endometriosis of the part of the cervix protruding into the vagina, which is not characterized by painful sensations. It is revealed on a gynecological examination and may look like an endometriosis polyp.

Small forms of genital endometriosis

These are small small local foci of proliferation of endometriotic tissue on the peritoneum, round and sacral uterine ligaments, post-uterine space, rectal recess.

These forms of endometriosis are characterized by the development of infertility, pain, and they are not observed. Small forms are revealed on diagnostic laparoscopy.

When diagnosed with external genital endometriosis, symptoms and treatment will depend on an accurate diagnosis of its location.

Endometriosis of the uterus and its symptoms

Endometriosis of the uterus or adenomyosis is characterized by the proliferation of the endometrium from its inner layer into the myometrium (the muscular layer of the uterus) and the peritoneum enveloping the uterus.

With a mild severity of the disease, its symptoms are absent, and signs of endometriosis are diagnosed on ultrasound.

With moderate and severe severity of the disease, menstrual disorders appear. Before and after the critical days, spotting may appear. Uterine bleeding may occur in the middle of the cycle. The menses themselves when they become abundant, clots appear in them. Sometimes severe bleeding opens with endometriosis, which can lead to emergency removal of the uterus. In addition, internal endometriosis of the uterus is characterized by: soreness of menstruation, shortening of the cycle, severe premenstrual syndrome, pain during intimacy. This disease is often the cause of infertility.

Often, along with this ailment, hyperplasia occurs, which is a general violation of the growth and development of endometrial tissue. Endometriosis and hyperplasia are often diagnosed together.

Sometimes endometriosis of the body of the uterus is combined with mastopathy. Both conditions require immediate treatment as they are benign tumors, but there is still a risk of becoming malignant.

Extragenital endometriosis

These forms of endometriosis are relatively rare. Its diagnosis is no more than 8% of the total diagnosis of this ailment. It develops in those organs that are located next to the affected genitals. Endometrial cells penetrate to them through the blood or by invading endometrial tissue.

• Intestinal endometriosis is characterized by aching pain in the abdominal cavity, worsening during critical days;
• Pulmonary endometriosis, characterized by shortness of breath and hemoptysis;
• Endometriosis of the diaphragm and pleura is dangerous due to the accumulation of air or blood in the pleural region;
• Endometriosis of the bladder and urinary tract is manifested by painful and frequent urination;
• Endometriosis of the scar and umbilicus, characterized by the appearance of spotting from them during menstruation.

Complications of pathology

A disease such as endometriosis can cause a number of complications:

• the formation of cysts;
• adhesions of the small pelvis;
• infertility;
• neurological disorders;
• cancerous tumors;
• anemia.
  

Also, women suffering from endometriosis note constant weakness, chronic fatigue and disorders of the psycho-emotional state. In order to avoid dangerous consequences, it is necessary to regularly undergo preventive examinations and timely treat this condition.

Endometriosis as a cause of infertility

Pregnancy is quite acceptable in this pathology, but not in all forms. Endometriosis of the uterus and pregnancy, for example, are completely incompatible concepts, since the presence of endometriotic foci both inside and outside the uterus is characterized by 100% infertility:

• the embryo will not be able to attach to the wall of the uterus with an altered endometrial structure;
• the adhesion process developing in this form of endometriosis in the pelvic organs will not allow the egg released from the ovary to enter the fallopian tube for fertilization.

Endometriosis and pregnancy are possible only with adequate treatment. The choice of a clinic where to treat endometriosis is yours, but the first visit due to symptoms that disturb you may be to a paid antenatal clinic. It is important not to start the process, otherwise chronic endometriosis is fraught with endocrine dysfunction and patency of the fallopian tubes, which interfere with fertilization.

There is no unambiguous answer to the question of whether it is possible to become pregnant with endometriosis, but an untreated disease and pregnancy is not a very successful combination, since even if conception occurs with active endometriotic foci, then there is a very high risk of miscarriage at different times with even greater changes in hormonal levels and, accordingly , with an increase in the severity of the course of the disease.

As for artificial insemination and, in particular, the combination of endometriosis and IVF, the IVF protocol is not started when the foci of endometriosis are not muffled, since the probability of its positive result is negligible.

I would like to answer positively to the question of whether pregnancy will occur after endometriosis, but it all depends on the severity of damage to the internal reproductive organs. In this matter, laparoscopic surgery will help. With laparoscopy, the doctor will not only be able to make sure that there are no foci, but also dissect the adhesions formed by the disease, expand, if necessary, the fallopian tubes, and make incisions on the ovaries.

Therefore, you need to be interested not in how to get pregnant with endometriosis, but how to cure it as soon as possible for early conception, successful gestation and easy childbirth.

Diagnosis of endometriosis

The symptoms of endometriosis are very often disguised as symptoms of other diseases, and not necessarily gynecological, therefore, for the correct diagnosis, a thorough and serious study of the patient's body is important. Diagnosis of endometriosis is needed not only to make a diagnosis, but also to fully identify all pathological foci, which is necessary for effective and effective treatment.

The following methods can be used to study pathology:

• endoscopic (hysteroscopy and laparoscopy);
• radiological;
• ultrasonic;
• laboratory.

Ultrasound is the primary method for diagnosing endometriosis

If endometriosis is suspected, the doctor directs the patient for an ultrasound scan. This method is painless, non-traumatic and absolutely harmless to patients. In addition, ultrasound diagnostics are accurate, inexpensive, and have no contraindications. The technique allows you to identify all changes in the structure of the mucous and muscular layer of the uterus.

Endometriosis is diagnosed. The procedure is performed on the 25th day of the monthly cycle, when structural changes are pronounced. If the disease is already in the body, then the monitor of the ultrasound machine will clearly show the increased size of the uterus characteristic of endometriosis and the different density of the muscle layer in its areas. Also, the gynecologist will see the absence or presence of a capsule in the inner layer.

In case of suspicions of endometriosis based on the patient's complaints, ultrasound will be the first of the studies prescribed by the doctor to draw up a further scheme for the diagnosis and treatment of endometriosis.

X-ray for endometriosis

To assess the severity and area of \u200b\u200bthe lesion in endometriosis of the uterus and fallopian tubes, X-ray diagnostics of endometriosis - hysterosalpingography is meant. A contrast agent is injected into the cavity of the uterus and fallopian tubes, allowing you to see the lesions of endometriosis, possible adhesions and neoplasms on the reproductive organs on an X-ray. Hysterosalpingography is performed on the 7th day of the cycle.

This method of diagnosing endometriosis is less traumatic than endoscopic methods, it is performed without the use of anesthesia, but for women with hypersensitivity to contrast media, the hysterosalpingography procedure will be painful.

The advantages of hysterosalpingography are that it allows the examination to be performed without surgery. Contraindications: sensitivity to iodine-containing drugs, the presence of severe infectious processes, liver and kidney pathology.

Hysteroscopy for endometriosis of the uterus

Diagnosis of endometriosis of the uterus can be carried out using such an endoscopic method as hysteroscopy, in which a special optical device, a hysteroscope, is inserted into the internal cavity of the uterus through the dilated cervix.

This method is important for:

• identification of all diffuse forms of endometriosis of the uterus;
• detection of endometriosis of the mouth of the fallopian tubes;
• classification of the degree and stage of endometriosis;
• assessing the spread of endometriosis.

An important nuance, hysteroscopy cannot detect abnormalities in the muscular layer of the uterus (with myometrium).

For hysteroscopy, local anesthesia is allowed.

Diagnostic laparoscopy for endometriosis

The procedure is assigned to identify all possible foci overgrowth of endometriotic tissue in the abdominal cavity.

Laparoscopy is a gentle operation performed without opening the abdominal cavity, but under general endotracheal anesthesia, so the method is not suitable for all patients.

• Procedure progress... Through small incisions, under the supervision of a doctor, a tube is inserted through which carbon dioxide enters, creating the required volume in the abdominal cavity. Further, studies are carried out with a new generation device - a laparoscope, which allows displaying images of internal organs on a monitor. Thus, by gradually examining the organs, a specialist can accurately identify all foci of endometriosis inside the body.
• Additional features... Usually, this procedure is accompanied by operative laparoscopy. A specialist, having discovered endometriosis, eliminates it with a special microinstrument, by removing “eyes”, cysts and other neoplasms (with the external form of this disease). It also removes overgrown endometrial tissue.
• Pregnancy after laparoscopy. After successful diagnosis and treatment, pregnancy with endometriosis is quite possible. Small incisions in the abdominal cavity, as well as careful and thorough laparoscopic cleaning of endometriotic growths, do not cause any harm to fragile reproductive organs. Moreover, for many women diagnosed with endometriosis, laparoscopy is the only chance to become a mother.

Laboratory diagnostics of endometriosis complements endoscopic examination methods

Diagnostic laparoscopy and hysteroscopy involve biopsy of material from internal organs affected by endometriosis. The resulting tissue sample is sent to a special laboratory for histological examination. This analysis involves the study of a biopsy sample under a microscope to identify changes characteristic of endometriosis and malignant forms of formations.

Gynecology is a field of medicine that studies the sexual and reproductive health of the fair sex, and also helps women during the period of gestation and childbirth. Reception of a gynecologist is an obligatory part of every woman's life.

Endometriosis treatment

The choice of treatment method is influenced by various factors, such as the patient's age, the number of pregnancies, the number of abortions, the number and nature of surgical interventions. It is especially important to accurately determine the stage and place of localization of the endometrioid focus.

The most effective and safe methods of treating endometriosis involve an integrated approach, which includes, in particular, the radical removal of pathological areas. It is important to remember that when treating a pathology, a gynecologist should pay attention not only to eliminating its manifestations, but also to concomitant diseases, as well as neuropsychiatric manifestations in the patient.

The complex method of treatment includes the above-mentioned laparoscopy, in order to remove the pathological focus. In parallel, the woman is prescribed hormone therapy, means of strengthening the immune system, anticancer measures, and, if necessary, pain relievers.

At the Diana Medical Center, the treatment of endometriosis is comprehensively approached, which allows a woman to be saved not only from the pathology itself, but also from its unpleasant consequences.

The main symptoms are:

Endometriosis is a gynecological non-neoplastic disease, accompanied by the growth of the inner lining of the uterus (endometrium) outside its cavity. Simply put, the tissues that are in the uterus of healthy women grow in other organs with endometriosis. Endometriosis, the symptoms of which women experience in this case, develops for uncertain reasons, although there is some reason for the isolation of immune, hormonal, hereditary and some other factors.

general description

So, in order to better understand what is at stake when considering this disease, it is necessary to dwell on what, in fact, the endometrium is, and also to delve a little into the features of the organs of the woman's reproductive system.

In women, the small pelvis contains the uterus - a muscular organ connected on both sides to the fallopian tubes that open to the abdominal cavity. The uterus is covered by three main layers, this is the inner layer endometrium,middle (muscle) layer myometrium,and perimetry- the outer serous thin membrane of the organ, which acts as a continuation for the peritoneal sheets from the bladder.

The layer of interest to us, the endometrium, includes two more layers, this is the functional layer and the basal layer. The functional layer includes a layer of cells, which in their own structure resemble cylinders, which, in fact, determines their name - this is a columnar epithelium. Between such cells are glandular cells - due to them, the required mucus is produced, and there are also a large number of terminal branches belonging to small spiral arteries.

Throughout the entire menstrual cycle, the functional layer is subject to constant changes due to the effects of female sex hormones. When menstruation occurs, it is rejected and, finally, excreted. Further, where there was a rejection of the functional layer in the uterus, the process of cell division begins already in the basal layer. As a result, new cells are formed that replace the rejected layer and form a new layer.

Experts note that in terms of prevalence, endometriosis ranks third among gynecological diseases, following uterine fibroids and inflammatory processes affecting the genitals of women. Most often, endometriosis is diagnosed in women of the reproductive age group, mainly between the ages of 40 and 44. According to various data, in this category, the frequency of endometriosis on average is about 12%. In infertile women, endometriosis is diagnosed more often - they account for 30-40%, while multiparous women are faced with this disease somewhat less often - about 27%.

Remarkably, adolescent girls can also develop this condition. For example, it is known that about 50% of patients in this group who underwent surgery due to pain in the pelvic region were diagnosed with endometriosis. The premenopausal period also does not exclude the possibility of developing this disease for women - here its frequency is on average about 2-5%. We add that after menopause, women similar to the listed age groups may also develop endometriosis, which, however, occurs somewhat less frequently.

At the same time, the true indicators of the frequency of the disease in question cannot be determined, this is due to the difficulties associated with its diagnosis, as well as the fact that in some cases, endometriosis proceeds without symptoms at all. On average, about 70% of cases of patients seeking medical help due to pain in the pelvic area ends with the diagnosis of endometriosis.

These data, with the proper approach of readers to them, are a weighty argument in favor of regular preventive visits to a doctor such as a gynecologist. This is especially true for those women who experience certain embarrassment associated with the appointment of this specialist, as well as those women who completely ignore such recommendations and generally do not visit a gynecologist.

Endometriosis: causes

The disease we are considering is polyetiological, which, in turn, indicates the presence of many different probable causes that cause it. At the same time, as has already been highlighted, the true cause of endometriosis has not yet been determined. Let's dwell on some of the options that are currently considered as the main ones.

• Retrograde menstruation. Or, as it is called, "reverse" menstruation. This phenomenon determines the following process: a certain amount of menstrual blood secreted during menstruation is directed into the abdominal cavity through the fallopian tubes. Menstruation according to this "scenario" is not uncommon, moreover, it is often found in healthy women. The only difference from patients with endometriosis is that in healthy women, the immune system restrains the endometrium, preventing it from growing in the area in which it appears, that is, in the abdominal cavity.
• Heredity. This factor is relevant in many diseases that a person has to deal with, and endometriosis can also be considered as a disease associated with this factor. Accordingly, it is believed that the risk of developing the disease in question increases if the closest relatives have it.
• Immune system disorders. This cause is also considered a putative factor in the development of endometriosis. If the immune system is weakened, then being in the abdominal cavity with the already considered variant of "reverse" menstruation, the endometrial cells not only do not break down, but also attach to the tissues and organs located here, thereby forming foci of endometriosis.
• Gynecological surgery. Any kind of surgical intervention, and this is curettage (scraping), abortion, cesarean section, cauterization of erosion, etc. - all this is usually considered as significant predisposing factors to the development of endometriosis.
• Hormonal changes. This factor is also believed to contribute to the development of endometriosis. The fact is that the endometrium is quite sensitive to the effects of female sex hormones, the foci of endometriosis react to them in a similar way. The proliferation of such foci, for example, is facilitated by female sex hormones, estrogens.
• Endometrial metaplasia. This factor means such a transformation in which one tissue is transformed into another. There is a theory according to which the endometrium, once outside the uterus, can transform into another tissue in a similar way. Meanwhile, the causes of metaplasia are currently unclear, moreover, any assumptions about it generate a lot of controversy among researchers.

In addition to the factors listed, there are several other factors, and they are also not excluded when considering the connection with endometriosis. In particular, these include:

• iron deficiency in the body;
• environmental impact;
• urinary tract infections, as well as STDs;
• dysfunctions of the liver organ;
• obesity;
• use of an intrauterine device, etc.

Endometriosis: forms and types

The classification of endometriosis is made in gynecology in accordance with the area of \u200b\u200blocalization of its foci. In particular, there are genitaland extragenitalendometriosis. Genital endometriosis can be internal (this is adenomyosis) or external, extragenital, in turn, can be extraperitoneal or peritoneal.

Internal genital endometriosis means the proliferation of endometrial foci in the area of \u200b\u200bthe muscular uterine layer, namely, in the cervix and in the uterine canal.

As for extragenital endometriosis, it mainly develops in the environment of the kidneys, bladder, intestines, lungs, in the area of \u200b\u200bsome postoperative scars.

Extragenital peritoneal endometriosis primarily affects the fallopian tubes, ovaries, and pelvic peritoneum.

Localization of extraperitoneal endometriosis is concentrated on the part of the external genital organs. The main forms of this variant of the disease are endometriosis of the vaginal part of the cervix, endometriosis of the vagina, posterior endometriosis, endometriosis of the rectovaginal septum.

Endometriosis can occur in the so-called "small" forms or in severe forms. In the latter version, the localization of foci may correspond to a mixed form, which is why endometriosis is sometimes not subject to a clear classification. In addition, according to the observations of specialists, severe forms of endometriosis develop as a result of neglect of therapeutic and preventive measures at the stages necessary for this.

Based on the depth of the lesion by the foci, the corresponding stages of endometriosis are distinguished. In particular, these are the minimal stage, the mild stage, the moderate stage and the severe stage. The severe stage, as it is easy to assume, is the most painful for the patients, and also the most difficult in terms of the implementation of measures aimed at treating endometriosis. With internal endometriosis, the lesion according to the specific stages is as follows:

• Stage 1 - the mucous membrane is affected up to the myometrium layer (up to the middle, muscle layer, as mentioned earlier);
• Stage 2 - the layer of the myometrium is affected to the middle;
• Stage 3 - the lesion reaches the serous (peritoneal) cover of the uterus;
• Stage 4 - here the parietal peritoneum is affected.

Thus, it is possible to distinguish a group of organs of the abdominal cavity and small pelvis (namely, they are most often affected by foci), which will determine the types of endometriosis:

• Endometriosis of the body of the uterus (aka adenomyosis);
• Ovarian endometriosis;
• Endometriosis of the peritoneum (also known as peritoneal endometriosis);
• Vaginal endometriosis;
• Endometriosis of the cervix;
• Rectovaginal endometriosis;
• Endometriosis of the bladder;
• Endometriosis affecting other organs (for this item, the disease is much less common): the diaphragm, the pleura of the lungs, the lungs themselves, intestines, eyes, stomach, skin, etc.

Endometriosis of the body of the uterus: symptoms

Endometriosis of the body of the uterus, or, as we previously designated, adenomyosis, is one of the main forms of endometriosis, in which the myometrium is affected by foci of endometrioid tissue. The symptoms of this form of the disease are as follows:

• Painful periods.This symptom also has its own medical definition - aldismenorrhea. The intensity of pain sensations of the severity of pain, in general, does not correspond. The appearance of pain is due to the fact that fluid begins to accumulate in the tissues, which occurs due to the actual adhesion process affecting the uterine cavity, accumulation of menstrual blood in the foci, and the inflammatory process.
• Cycle disturbances. This symptom is quite typical for adenomyosis, although, however, not only for him - many gynecological diseases and disorders in the body are accompanied, as you know, by similar "failures". With adenomyosis, cycle disorders are mainly reduced to bleeding. The appearance of brownish or bloody discharge is a rather important symptom for this case, they appear 1-2 days before the onset of menstruation and last similarly, 1-2 days after it. An important signal is also a change in the nature of menstrual flow. So, if before menstruation proceeded normally, then with adenomyosis, they can become, for example, excessively abundant. This is also accompanied by the often severe exhaustion of the patient.
• Dark color of menstrual flow. A characteristic feature of the manifestation of endometriosis during menstruation, there are also blood clots.
• Prolonged menstrual flow. Often menstruation with endometriosis lasts longer, exceeding the average duration.
• Infertility. Infertility is due to two main reasons, namely the fact that there is no, as such, the possibility of implantation of the ovum and its further bearing due to the prevalence of the process, and also by the fact that the adhesion process is developed in a pronounced form, which is accompanied by damage to the uterine cavity. In both cases, the result is the same - all this leads to infertility. At the same time, this is not the final verdict for the disease, because in at least 20% of cases, in practice, pregnancy is recorded among patients even with a severe form of the disease in question.
• Miscarriage of pregnancy,that is, in this case we are talking about spontaneous abortion / miscarriage. The reasons for this outcome are associated with the general picture of changes, against which infertility develops.
• Endocrine Disorders.Basically, this symptom is relevant for extragenital endometriosis, although it may also be present during adenomyosis. It manifests itself in particular hypothalamic-pituitary insufficiency of the ovarian system. Due to hormonal imbalance, bloody discharge can appear in women between periods, which occurs quite often with endometriosis.

In most cases, the disease progresses. If untreated for six months, about 47% of patients experience a worsening of their condition, while spontaneous improvement occurs in about 30%. Remarkably, during pregnancy, patients experience some regression of the disease, and even a significant improvement in their general condition. The fact is that pregnancy is a condition in which a decidual reaction begins to develop in the formed foci, as a result of which they begin to decrease.

Decidualization consists in such changes in the endometrium during pregnancy, in which a special type of endometrial cell layer is formed - the decidual tissue. During pregnancy, decidual changes occur quite intensively: the cells accumulate fat and glycogen, the size of these cells increases. At the same time, the growth of blood vessels in the endometrium is subject to enhancement.

As for the role of the specified decidual tissue, its role is not fully defined. Meanwhile, it is generally accepted that due to this tissue, control is exercised over the introduction into the wall of the uterus of the ovum, where it acts as a kind of layer, first between the trophoblast, and then - the wall of the uterus and the placenta. We also add that the decidual response acts as an integral stage of implantation.

Ovarian endometriosis: symptoms

Ovaries with endometriosis can be affected by the introduction of endometrial cells into them through the lumen of the fallopian tube, which occurs with the flow of lymph and blood. The causes of ovarian endometriosis at the moment are also not completely clear, foci of endometriosis can be located both outside on the ovary and directly in it. Symptoms of ovarian endometriosis in each case can manifest themselves in different ways, it depends on the size of the lesions and on the specific area of \u200b\u200btheir localization. Let's highlight the general symptoms:

• Lower abdominal pain.Such pain is not necessarily associated with a specific period of the menstrual cycle, that is, it can appear at any time. Constant pain in the lower abdomen can be caused by inflammation of the peritoneum due to irritation due to the formation of endometriotic foci.
• Pain in the lower abdomen during physical exertion, during sexual intercourse.
• Increased pain in the period before menstruation, especially severe pain on its first day.
• The spread of pain to the groin or lumbar region, to the rectum.

Endometriosis of the peritoneum: symptoms

Endometriosis of the peritoneum (peritoneal endometriosis) is characterized by the fact that in its development a significant role is played by the interaction of endometrial elements with peritoneal mesothelial cells. The development of this form of the disease can be facilitated by the previously considered "reverse" reflux of menstrual blood, which is caused by certain disturbances in the functioning of the immune and endocrine systems.

Peritoneal endometriosis can be of two types. So, the first type is characterized by a limited scale of damage - only the peritoneum is affected. The second type, respectively, is characterized by the fact that the defeat of endometrioid foci occurs not only within the peritoneum, but also behind them, that is, the uterus, ovaries and fallopian tubes are affected.

With small forms of endometriosis lesions, any clinical symptoms may be absent for a long time - the disease proceeds in a latent form. At the same time, infertility in such a course of the disease, even in a small form, often exceeds 90%. If the foci of endometriosis have spread beyond the peritoneum and have taken root in the rectum and its muscle layer, also affecting the perrectal tissue, then this course is accompanied by the appearance of pelvic pain, painful intercourse (which is more pronounced on the eve of the onset of menstruation, as well as after it) ...

Endometriosis of the vagina and perineum: symptoms

Basically, the perineum and vagina are affected by endometriosis as a result of germination from the side of the retrocervical focus, somewhat less often this occurs due to the appearance of endometrial foci in the area of \u200b\u200bthe site affected during childbirth.

The leading complaint for this form of the disease is pain that occurs both in the vagina itself and in the depth of the pelvis, and the severity of pain in this case varies from moderate to quite pronounced, often painful, exhausting. An increase in pain is noted during sexual intercourse, as well as a week before and after menstruation. Severe pain appears in particular if the anterior perineum is involved in the process, as well as the external sphincter of the rectum.

Also, there are certain kinds of difficulties in the act of defecation, which is accompanied by excruciating soreness in those periods during which there is an exacerbation of endometriosis. By the nature of the manifestation, the pain is pulsating and burning (analogy with an abscess). When menstruation occurs, patients find swelling, nodules or cystic type of formation on palpation.

After the completion of menstruation, the detected formations either decrease in size or completely disappear, after which scars remain in their place, they are painful, and have areas of brownish pigmentation. If in this case the diagnosis is made erroneously and unreasonably (sphincteritis, rectitis) on the basis of a lesion of the external sphincter of the rectum, and thermal procedures are prescribed (including warm sitz baths), then the pain only intensifies.

Vaginal pain can also be combined with local itching. Some patients find brownish and bloody discharge emanating from the vagina both spontaneously and during sexual intercourse. Such discharge appears in an almost standard period for endometriosis for this symptom - a few days before menstruation and within several days after it.

Endometriosis of the cervix: symptoms

This form of the disease is also quite common, and the reason for this is the location of the affected area - the cervix most often "gets hit" during various manipulations in gynecology (abortion, curettage, etc.).

Some of the symptoms of endometriosis of the cervix, in general, can be called common with other areas of damage in this disease. These include:

• smearing brownish discharge that appears before menstruation;
• pain and discomfort during intercourse;
• the appearance of brownish discharge during sexual intercourse (this symptom mainly occurs in the second half of the cycle).

As for other pain sensations (in the lower abdomen, for example), they are not so characteristic of the overall clinical picture in this form of the disease.

Rectovaginal endometriosis: symptoms

Rectovaginal endometriosis can be deep (or internal), which is accompanied by the development of pathological foci in the uterus characteristic of endometriosis, as well as external, which is accompanied by damage to the fallopian tubes, wide uterine and intestinal ligaments, ovaries, Douglas space and peritoneum.

Symptoms of this form of the disease are similar to other forms: there are also painful sensations that occur during sexual intercourse, as well as pain in the lower abdomen before and after menstruation.

Bladder endometriosis: symptoms

Some time ago, in this form, endometriosis was considered to be a rare disease, any information about this disease in the medical literature flashed in a rather meager amount. Meanwhile, now cases of this disease are diagnosed more often, and it is more likely that the past lack of familiarization of urologists and gynecologists with it is to blame, and not the rarity of its occurrence. A role in this is also played by the fact that often specialists in attempts to establish such a diagnosis as endometriosis of the bladder adhere to the direction of another pathology - cyclic hematuria, which in any case is incorrect, moreover, the last indicated diagnosis is rarely relevant for patients with whom it was delivered.

The bladder with endometriosis can be affected in different ways. So, for example, it is possible for the contents of the ovarian endometrioid cysts to enter on its surface, as well as the ingress of menstrual blood (according to the "scenario" of retrograde reflux), which includes viable endometrial particles, or the proliferation of the endometrium from the isthmus and the anterior uterine wall to the bladder. An important role is played by the isthmus, which is left with endometriosis during supravaginal amputation of the uterus, as well as a sparing surgical effect on the uterus during certain manipulations. Caesarean section plays a role. The variant of hematogenous ingress of endometrial elements into the wall of the urinary bladder is acceptable.

Features of the clinical picture of endometriosis in this case are due to the peculiarities of its genesis. So, the foci of endometriosis, formed during the implantation of endometrial particles, on the surface of the urinary bladder organ, may not manifest themselves for a long time, in other words, there are no symptoms. The detection of foci occurs by chance, for example, in the process of celiac disease in case of actual diseases of certain organs of the pelvis, as well as in the region of the lower abdominal cavity. Naturally, the detection of pathology is allowed by those specialists who are familiar with it.

With the spread of endometriosis to the posterior wall of the bladder from the stump of the uterus or from the isthmus, it leads to the occurrence of rather severe dysuric phenomena in patients. If we are talking about such a pathology as congenital endometriosis of the bladder, in which the location of the lesions is concentrated on the side of the ureteral orifices, then the picture of the disease can also be quite severe.

Most often, the symptoms of bladder endometriosis include complaints of a feeling of heaviness that occurs in the depths of the pelvis and lower abdomen. It intensifies before menstruation, as well as after it. At the same time, urination in patients becomes more frequent, in some cases it is accompanied by pain. The severity of pain sensations can vary, respectively, they can be both moderate and strong enough, up to the loss of normal working capacity during such a period. During urological examinations and repeated urine examinations, the reasons explaining the suffering of the patients are not found, which is why the diagnosis of cystalgia is established. The therapy used to address the manifestations of symptoms determines the lack of sufficient effectiveness. With thermal treatments, the pain increases. At the same time, experts do not attach due importance to the relationship determined between the menstrual cycle and complaints.

Gradually, painful urination is supplemented during menstruation with hematuria (blood in the urine), the severity of its manifestation may vary. At this stage of the progression of the disease, a diagnosis such as recurrent hemorrhagic cystitis can be established. Therapy for the manifestations of actual symptoms is still ineffective.

The disease soon becomes chronic. According to some reports, it takes about 3-5 years from the moment such a symptom as painful urination appears before the onset of hematuria. Remarkably, many patients have experienced some relief from painful urination since the onset of hematuria. In most cases, the listed symptoms lead to a fear in patients that they may have a tumor in the bladder.

We add that blood in the urine with endometriosis of the bladder, according to some observations, is a symptom that occurs in this disease in 25% of patients. If we are talking about extensive endometriosis, in which there is a seizure of the bladder neck by the lesion, then a symptom such as the problem of urinary retention (incontinence) can also make itself felt.

Endometriosis and pregnancy

If we consider this disease in combination with infertility, then it is impossible to state unequivocally on the equality between them. In other words, pregnancy is not impossible with endometriosis. Another thing is that pregnancy with endometriosis significantly reduces the chances of pregnancy. In practice, there are cases of conception with this disease, but it is important to understand that the percentage of successful conception in this case is lower, and, of course, that with endometriosis there is a certain risk for the fetus, which consists in spontaneous miscarriage. If you still succeed in conceiving a child, then it is imperative that you be observed by a doctor, strictly following the recommendations from his side.

As for the causal mechanism in the "endometriosis - infertility" scheme, there is still no clear clarity. Meanwhile, there are certain assumptions about the factors that provoke infertility in endometriosis:

• Immunological and endocrine disorders, topical in parallel with endometriosis. These factors adversely affect ovulation, fertilization and subsequent implantation of an egg into the uterus.
• Mechanical disorders causing obstruction of the fallopian tubes; pathology of ovarian anatomy; adhesions that make it difficult for the egg to be released.
• Processes accompanying local inflammation.
• Luteinized follicle syndrome.
• Frequent early miscarriages.
• Pathology of the transport function on the part of the fallopian tubes, caused by an increase in prostglandins against the background of endometriosis.

In its own way, interesting and, at the same time, important is such a factor as unfavorable conditions for the future fetus in the body (womb). More precisely, the essence of this is as follows: the body independently decides whether a woman can bear (and then give birth) a healthy baby right now.

At the same time, new studies show that most women with endometriosis, regardless of the nature of the menstrual cycle (even if normal and regular), there is no true ovulation as such, that is, we are talking about anovulation. We add that without ovulation, pregnancy is, in principle, impossible.

Data from some sources indicate that after treatment and organ-preserving surgical interventions, pregnancy occurs on average in 15-56% of cases - such a significant gap in indicators is due to the peculiarities of the pathological process and the severity of the course of the disease. Basically, gynecologists note that after treatment in the right direction, pregnancy occurs in six months or a year. Accordingly, the expectation of pregnancy can drag on from 6 to 14 months.

At the same time (although rarely), in practice, such cases are not excluded in which the successful treatment of endometriosis does not end with the onset of a long-awaited pregnancy after six months or more. In this case, you will need to undergo an additional examination, which will allow you to identify other factors involved in the problem of infertility.

Complications of endometriosis

If the treatment of endometriosis is ignored as a necessity, or if it is initially implemented illiterately, then later you can face a number of complications:

• infertility;
• development of adhesions in the abdominal cavity and in the small pelvis;
• the development of post-hemorrhagic anemia in patients against the background of abundant chronic blood loss accompanying menstruation;
• neurological disorders caused by compression of the nerve trunks;
• the formation of endometrioid ovarian cysts;
• transformation of endometrioid tissues into a malignant tumor formation.

Diagnosis

In order to establish a diagnosis of endomketriosis, it is necessary to obtain results from certain studies, these, in particular, include:

• Ultrasound of the pelvic area using a special vaginal probe;
• hysterosalpingography - a method in which a contrast agent is used, due to which it is possible to assess how common the process of foci formation turned out to be, and also to understand how much the patency of the fallopian tubes has suffered from this, which is especially important for the patient's actual infertility;
• hysteroscopy - this method makes it possible to examine the features of the surface of the uterus, endometrioid passages and the orifices of the fallopian tubes (on the pale pink mucous membrane, they look like dark red dots);
• laparoscopy is a microsurgical effect that makes it possible to diagnose any form of the disease, and with the simultaneous possibility of treatment during it;
• a blood test to identify a marker of endometriosis;

In general, the need for a particular variant of the study is determined by the attending physician, depending on the characteristics of the pathological process, the diagnostic scheme may vary.

Treatment

Treatment of endometriosis is carried out in two main directions, and this is the surgical removal of foci in the areas of endometriosis (or the removal of organs with them completely), as well as drug treatment, focused on ensuring hormonal correction of the activity characteristic of the endometrium.

Surgical treatment often has no alternatives due to the fact that the patient's condition is often rapidly deteriorating and there is a threat to subsequent infertility. In many cases, the pain accompanying endometriosis becomes practically unbearable, in addition to this, the pain is accompanied by the rapid growth of foci, which causes an unfavorable prognosis.

Surgical intervention can be performed in different ways, it is determined on the basis of the location of the foci, the possibility of access to them due to one or another technique of the required impact. If we are talking about endometriosis of the vagina, cervix or perineum, then the preferred option is endoscopy (excision of foci and their cauterization is carried out either through the vaginal cavity or outside). If the foci are located in the uterine cavity, then such an option as the removal of the uterus (the question of whether or not to remove the appendages is separately raised) or hysteroscopic surgery, which provides access through the vagina to the affected organ of the uterus, can be considered.

If endometriotic foci are located in the area of \u200b\u200bthe fallopian tubes, ovaries or peritoneum, then laparoscopy can be performed - several small holes are made in the abdomen in certain areas for subsequent access to the affected areas.

As for drug treatment, it is focused on suppressing the growth / reproduction of endometrial cells. The following groups of drugs are mainly used (only the attending physician can make a decision on their appointment!):

• oral contraceptives of combined action (Marvelon, Femoden, Diane-35, etc.);
• drugs representing the group of antigonadotropins (gestrinone, danazol, etc.);
• drugs representing a group of progestins (depostat, duphaston, etc.);
• drugs of the agonist group (decapeptyl-depot, zoladex, etc.);
• antiestrogens (tamoxifen, etc.).

Information on the indicated groups of drugs is provided solely for general information! Self-medication with them is unacceptable, the use is possible only on the basis of the testimony of the attending gynecologist!

Endometriosis: prevention measures

Prevention of endometriosis is an equally relevant issue both for those women who have suffered this disease and recovered from it, and for those women who have come across this ailment only through certain information sources. We highlight the following recommendations for prevention:

• regular visits to the attending gynecologist, at least once every 6 months;
• sexual abstinence during menstruation;
• timely treatment of gynecological diseases;
• the fight against excess weight (exercise, diet, etc.);
• avoiding stressful situations as such, as much as possible;
• elimination of abortion, selection of optimal solutions for contraception.

Endometriosis: some facts about this disease

Some women ignore this disease, believing that it will go away by itself, some believe that it is only "their problem", some even believe that it will not affect them in any way. Is it so? Let's take a look at some of the established facts related to endometriosis.

• Endometriosis is a disease of active and business women

A number of studies in this area and their results, in particular, indicate that endometriosis is more often diagnosed in women in large cities, as well as in women whose professional activities are associated with increased mental stress. Basically, here we are talking about socially successful business women, as well as about women whose activities are complemented by a systematic change in climatic conditions due to business trips, etc. Here we are talking about the desire for self-realization while postponing motherhood for later. Those women whose sex life is "overly active" are also at increased risk, especially when it comes to combination with frequent change of sexual partners (which, as you know, is not a great rarity). It is quite possible that in addition to treating endometriosis, you will have to take care of some restructuring of consciousness, which is also an important part in this matter.

• Endometriosis negatively affects the sexual partners of women with this disease

Relatively recently it became known that the problem of endometriosis is not only a purely female problem, but also the problem of a woman's sexual partner. There are two well-founded statements on this score:

Semen contains certain molecules (such as estradiol, prostaglandins, etc.), due to which the endometrium has a stimulating effect. Semen during intercourse is in the uterine cavity or in the abdominal cavity through the posterior and anterior vaginal fornices. Prostaglandins increase cell proliferation, and also lead to the suppression of apoptosis (that is, such a protective mechanism that acts as part of the development of endometriosis), while inducing the production of certain enzymes, due to which endometriosis develops with greater intensity. Accordingly, we can summarize that when sperm enters the body of a patient with endometriosis, it acts as a factor supporting the development of this disease.

Endometriosis negatively affects the quality of semen. It has also been proven that hypoxia acts as one of the options for triggering mechanisms for endometriosis. In other words, women with endometriosis are always in a state of oxidative stress, in which cells are damaged as a result of oxidation. At the same time, there is an accumulation of free oxygen radicals in their body, they, as it became known, are characterized by a toxic effect on spermatozoa - in particular, cell membranes are subject to damage, incl. and DNA, apoptosis (cell death) is also triggered. That is, the processes that “control” the disease in women have a negative effect on the general condition of the sperm. Accordingly, in case of infertility, it is extremely important to start treatment, thereby eliminating the negative impact for both partners, leading to such a result.

• Endometriosis and IVF

In particular, on this point, patients are interested in whether the IVF procedure will be effective for endometriosis. There are also certain facts on this score:

Common forms of the disease negatively affect the ovarian reserve, reducing the number of eggs obtained during stimulation, why this happens is still unclear;

Endometriosis itself acts as a basis for placing patients in the appropriate risk group regarding the possibility of developing an ectopic pregnancy in them after the embryo transfer has been performed;

Internal endometriosis (i.e. adenomyosis) contributes to a reduction in the possibility of successful embryo implantation within the framework of the implementation of PBT programs in the same way as with the usual (natural) method of conception.

Let us summarize that the only correct decision in the treatment of endometriosis is laparoscopy (surgical intervention) with the addition of conservative therapy in the form of certain drugs.

Joseph Addison

With exercise and abstinence, most people can do without medicine.

Which doctor to contact

If you suspect a disease such as "Endometriosis", you should consult a doctor:

Endometriosis is the appearance of cells in the inner layer of the uterus (endometrium) in atypical places: on the peritoneum, ovaries, fallopian tubes, the wall and cervix of the uterus, 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 it is, why and how to treat it - often remains unanswered. But what if a woman with endometriosis is planning a pregnancy - is it necessary to do something in this case?

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

What is it: causes of occurrence

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

1. One of the theories points to the process of retrograde menstruation, when part of the menstrual tissue enters the abdominal cavity, grows into it and grows.
2. Genetic theory puts forward the point of view 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 that explains 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 subsequently develop into endometriosis, or that part of this tissue, under certain conditions, does not lose the ability to reproduce.

The likelihood of the disease increases with:

• frequent inflammation of the genitals;
• tumors ();
• difficult childbirth;
• operations on the uterus;
• abortion;
• drinking alcohol;
• smoking;
• excessive "love" for products containing caffeine;
• disorders in the work of the organs of the endocrine system (thyroid gland, adrenal glands, hypothalamus,
• pituitary gland, female reproductive glands);
• reduced immunity.

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

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

Is it possible to get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of becoming pregnant, but it cannot harm the development of the fetus. If a woman with endometriosis does conceive 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, be sure to discuss with your gynecologist the possibility and risks of pregnancy in your particular case.

Endometriosis symptoms

The symptomatology of this disease is so diverse that it can sometimes mislead even experienced specialists. Endometriosis of the uterus can be accompanied by both pronounced symptoms and their absence at all.

However, certain symptoms should definitely alert a woman:

1. Pain of varying intensity, up to acute. They can be localized, given to the groin, anus, leg. Pain either occurs in the first days of menstruation, and disappears with the end of it, or does not leave the woman throughout the entire cycle, but at the end of menstruation, they weaken.
2. Smearing dark spotting from the genital tract 2-5 days before and after menstruation, especially if these same menstruation is quite abundant and prolonged;
3. Uterine bleeding during the intermenstrual period (metrorrhagia);
4. Spotting discharge can also be during sexual intercourse.

Menstruation with endometriosis becomes profuse, 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,
• frequent and so on.

Unfortunately, in some cases, the symptoms of endometriosis are very mild or nonexistent. For this reason, you should visit the gynecologist's office once every six months. Only timely diagnosis can prevent 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, therefore, endometriosis of the uterine body can have four degrees of distribution:

• 1 degree. There are one or more small foci of endometriosis.
• 2nd degree. There are several small foci of endometriosis, which penetrate into the thickness of the organs affected by them.
• 3 degree. There are many superficial foci and several deep foci of endometriosis or several cysts on the ovaries ("chocolate" cysts - the name comes from the characteristic dark brown color of the cysts given to the cysts by disintegrating blood).
• 4 degree. Diagnosed with multiple and deep foci of endometriosis, multiple, large cysts on the ovaries, adhesions between the pelvic organs.

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

Diagnostics

In the effective treatment of endometriosis, the most important point is timely and correct diagnosis. You can determine the presence of endometriotic foci using:

• x-ray contrast methods (hysterosalpingography)
• endoscopic examinations (for example, hysteroscopy),

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

Prevention

The main activities aimed at preventing 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 abortion and other surgical interventions on the uterus to eliminate possible consequences;
• timely and complete cure of acute and chronic pathology of the genitals;
• taking oral hormonal contraceptives.

Complications

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

Most likely consequences:

• adhesion process in the small pelvis;
• impaired fertility;
• anemia due to profuse bleeding;
• endometrioid cysts;
• malignancy.

How to treat endometriosis

Methods for the treatment of endometriosis have been improved for many years and are currently divided into:

• surgical;
• medicinal;
• combined.

Medicinal methods of therapy include the use of various groups of drugs:

• combined estrogen-gestagenic drugs;
• gestagens, antigonadotropic drugs;
• agonists of gonadotropic releasing hormones.

The earlier a woman is diagnosed, the more likely she is to use medication alone.

Conservative therapy

Conservative treatment is indicated for the asymptomatic course of endometriosis of the uterus, at a young age, in the permenopausal period, with adenomyosis, endometriosis and infertility, when it is necessary to restore fertility.

The medication route of treatment includes a fairly traditional therapy:

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

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

• progesterone preparations;
• danazol;
• gestrinone (Nemestran);
• gonadotropin-releasing hormone (GnRH) agonists;
• monophasic combined oral contraceptives.

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

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

• (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, studies are underway in the world on the possibility of using immunomodulators for the treatment of endometriosis, especially for the treatment of associated infertility.

Surgical treatment of endometriosis

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

Surgical methods for the treatment of endometriosis consist in the removal of endometriotic formations (most often - cysts) from the ovaries or other lesions. Modern surgery gives preference to sparing operations - laparoscopy.

After removal of the foci of the disease, physiotherapeutic and drug treatment is shown to consolidate the result and restore the cycle. Severe endometriosis is treated by removing the uterus.

The results of treatment depend on the volume of surgery, on the usefulness of hormone therapy. The rehabilitation period in most cases is favorable: fertility is restored, pain during menstruation is significantly reduced. After treatment, dynamic observation by a gynecologist is recommended: gynecological examination, ultrasound control (once every 3 months), control of the CA-125 marker in the blood.

Endometriosis prognosis

This disease often recurs. For example, the rate of recurrence of endometriosis after surgery to remove lesions during the first year is 20%, that is, 1 in 5 women operated on during the first year after surgery will again face the same problems as before the surgery.

Hormonal correction has a good effect, but the problem with this method of treatment lies in the disruption of the process of natural maturation of the endometrium of the uterus, and therefore in the impossibility of natural conception of a child. With the onset of pregnancy, as a rule, for the entire period of pregnancy, the symptoms of endometriosis disappear. With the onset of menopause, endometriosis also disappears.

Many women have probably heard about such a disease as endometriosis. What it is, however, is not known to all the fair sex. Although almost everyone probably knows that this is a common gynecological pathology. It is also no secret that quite often endometriosis of the uterus occurs in women suffering from infertility.

Endometriosis of the uterus - what is it?

The essence of the disease lies in the pathological proliferation of the endometrium. The endometrium, in simple terms, is the mucous membrane of the inner uterus. The endometrium is necessary for a woman to attach a fertilized egg to the uterus and for the development of the fetus.

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

The prevalence of the disease

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

The reasons for the development of the disease in a woman

For the onset of the disease, two main factors are required: the presence of endometrial cells, congenital or due to reflux with menstrual flow, in places not intended for this, and hormonal disorders, accompanied by increased secretion of estrogen by the ovaries.

At the moment, there are several versions explaining the reasons for the spread of particles of endometrial tissue and, as a result, the spread of foci of the disease in a woman's body. Among them, the following are distinguished:

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

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

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

The embryonic theory states that the rudiments of the embryonic tissue of the genitourinary system may not be transformed and are able to remain in other organs in small quantities, developing pathological activity under the influence of unfavorable factors.

A hereditary predisposition can also affect the likelihood of developing the disease.

The following factors significantly increase the likelihood of developing pathological foci of proliferation of the endometrium:

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

Endometriosis, symptoms and treatment

The symptomatic picture may be unexpressed, blurred, correspond to signs of other diseases and dysfunctions. In some women, the disease proceeds without visible symptoms. There are no specific signs inherent only to this disease, however, one can suspect an overgrowth of the endometrium in the uterine membrane and reproductive organs by the following manifestations:

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

If the tissues of the endometrium are located outside the reproductive organs of a woman, then, depending on the site of localization, clinical symptoms such as nosebleeds, the presence of blood in saliva, urine, sputum, feces, tears, discharge of blood from the navel, etc.

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

Symptoms and treatment in women after 40

The onset of the disease in women over 40 is most often associated with impaired immunity. The most common symptoms during menopause are:

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

Analysis of symptoms and treatment in women over 40 years old should be carried out by a specialist, self-medication in this case is dangerous. Not all methods of treatment suitable for young patients are suitable for women over 40. Most often, conservative treatment is used, taking hormonal and pain relievers.

Disease classification

In most cases, the disease is classified according to its location. The most common pathology associated with the body of the uterus (in about 90% of cases). This type of disease is called internal genital. The rest of the types, in which, for example, damage to the ovaries or peritoneum is observed, are called external. However, the internal type of the disease is often combined with the external one.

Endometriosis of the uterus - symptoms, prescribed treatment

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

Treatment begins with the appointment of a course of hormonal drugs. In the absence of effectiveness, they resort to surgical treatment (surgical manipulations to cauterize or remove foci of growth of the endometrium). With pronounced indications and a threat to health, advanced stages may require prompt removal of the uterus or part of it.

Endometriosis of the cervix

Experts associate the increase in the number of cases of endometrial proliferation in the cervix with procedures for surgical treatment of cervical erosion. If moxibustion or other manipulation was carried out in the premenstrual period, there is a possibility of implantation of endometrial cells during their transportation with menstrual flow.

A typical symptom in this localization is intermenstrual spotting; painful periods are possible.

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

Ovarian endometriosis - symptoms and treatment

The defeat of ovarian tissue with endometrioid cysts is one of the most common forms of the disease. In such a case, the reproductive function of the body is disrupted: ovarian cysts create obstacles to the ovulation process.

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

When the diagnosis is confirmed, surgical treatment is prescribed by the method of laparoscopy. During treatment, part of the altered tissues and the cyst itself are removed. If the endometrium affects the ovaries in a significant amount, then they resort to removing the ovary.

Disease localized in the peritoneum

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

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

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

Causes and symptoms of proliferation of the endometrium in the vaginal area

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

The clinical picture of the disease consists of painful sensations and bloody discharge during intercourse, localization of pain in the vagina during menstruation.

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

Medication is predominantly used, in particular, hormonal drugs are prescribed. In the absence of effectiveness from the course of medications, a surgical method of treatment is used, which consists in manipulating the excision and cauterization of the lesions.

Rectovaginal form

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

This type of disease is characterized by a pronounced pain syndrome, especially during bowel movements, as well as bloody inclusions in the feces on the days of menstruation. Diagnostics is carried out by rectal examination, surgical treatment.

Features of the pathological process in the bladder area

The defeat of the walls of the bladder by the endometrium is quite rare. Among the reasons for the development of this form of the disease, there is a retrograde reflux of blood with endometrial cells during menstruation, the germination of the endometrium through the wall of the uterus, the spread of cells by endometrioid cysts of other organs.

There is often a situation when the disease is asymptomatic and is diagnosed only when performing a surgical operation of the abdominal region for other indications. However, with the proliferation of the endometrium on the posterior wall of the bladder or at the mouth of the ureters, difficulties, pain during urination, increased urge, a feeling of heaviness, especially in the premenstrual period, are possible.

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

Complications and prevention

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

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

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

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

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

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

Content

In modern gynecology, endometriosis is one of the most common pathologies in women. The disease is not well understood, which causes certain difficulties in its diagnosis and subsequent treatment.

Endometriosis is the proliferation of the lining of the uterus outside of it. The cells of the inner layer of the uterine mucosa, which is called the endometrium, for unknown reasons are thrown into neighboring tissues and take root in an environment unusual for them, forming foci of endometriosis.

Factors and reasons for the appearance

Endometriosis is a hormone-dependent benign disease that rarely degenerates into oncology.

The causes of endometriosis.

• Periods. The disease affects mainly women of reproductive age. It is believed that the reflux of endometrial cells from the mucous membrane appears during menstruation.
• Hormonal imbalance. It has been proven that most women suffering from pathology have a high level of follicle-stimulating and luteinizing hormone, as well as prolactin, which is not observed in healthy women. While progesterone is present in fairly low amounts. The consequences of hormonal imbalance are manifested in an increase in androgens.
• Hereditary predisposition. The likelihood of developing endometriosis is higher if the family already has cases of pathology.

Scientists have identified genetic markers that determine the predisposition of women to endometriosis.

• Immune system disorders. With adequate functioning of the immune system, mucosal cells do not appear and do not take root outside the inner layer of the uterus. A failure in the immune system leads to the abandonment and further growth of endometrial cells in tissues unusual for them.
• Metaplasia that occurs in the endometrium. There is a hypothesis that endometrial cells outside the lining of the uterus can transform into another tissue.

The causes of endometriosis are still a mystery to scientists.

There are certain factors that may explain why endometriosis occurs.

Among the factors that determine the occurrence of endometriosis are:

• mechanical damage to the uterine mucosa, which appears due to abortion, curettage and surgical interventions;
• adverse effects of ecology and the external environment;
• violation of hemoglobin production;
• excess weight;
• concomitant inflammatory processes of the genital area.

The reasons for the onset of pathology are individual in nature.

Forms and degrees

Casting and sprouting of the endometrium can be observed in different tissues in women.

Depending on the area of \u200b\u200boccurrence of the pathology, various forms are distinguished.

• Genital. With this form, pathological foci appear in the myometrium, ovaries, tubes, genitals, on the cervix, in the vagina and peritoneum.
• Extragenital. The lesions appear in the intestines, bladder, lungs.
• Combined. This variety is characterized by a combination of genital and extragenital forms.

The most common form of endometriosis is genital, and the consequences of the occurrence of pathological foci are manifested most often in the occurrence of adenomyosis of the uterus, which cannot be said about other types.

Adenomyosis is also called internal, or endometriosis of the uterus.

Adenomyosis can be roughly divided into stages depending on the depth of its progression:

• superficial lesion;
• defeat to the middle of the muscle layer;
• damage to the serous membrane;
• damage to the peritoneum with the appearance of fistulas.

Clinical presentation and symptoms

There are numerous symptoms that vary in women of different ages. The causes of different symptoms are the forms and stages of endometriosis, as well as concomitant diseases of women.

At the initial stage of the disease, its manifestations are practically absent due to the insignificant spread of the pathological process, which cannot be said about the later stages.

As endometriosis progresses, characteristic symptoms appear.

• Pains of varying intensity. The occurrence of this symptom is typical for all types of endometriosis. Soreness appears in the lower abdomen and spine and increases sharply during menstruation. The consequences of the disease also become unpleasant sensations during sexual intercourse and defecation.
• Changes in the nature of menstruation. Pathology is characterized by the occurrence of smearing brown discharge before and after menstruation, which does not happen normally. The menstrual discharge becomes more abundant and lasts longer than usual. In the middle of the cycle, breakthrough bleeding often appears that is not associated with menstruation.

Consequences of regular blood loss often expressed in the occurrence of anemia.

• Infertility. This symptom often appears in the genital form of endometriosis. The causes of infertility can be called changes that occur in the endometrium. The consequence is its inability to implant the ovum. Another cause of infertility in endometriosis is an extensive adhesion process, which often accompanies pathology.

• Intoxication. With an ailment in women, weakness, nausea, and low-grade fever often appear.
• Specific symptoms. For example, intestinal endometriosis is characterized by the occurrence of its increased peristalsis.

Some womendo not pay attention to the occurrence of unusual signs during menstruation. Normally, menstruation is not a cause of disability.

Diagnostic methods

The consequences of endometriosis are certain disorders on the part of various organs. However, endometriosis often appears unnoticed by the woman herself. Its occurrence is associated with many reasons that are not always possible to determine.

Diagnostic methods for the study of endometriosis.

• Gynecological examination. The doctor, by palpation, can diagnose the increased size of the organ and appendages, as well as the occurrence of pain and limitation of the mobility of the organ, which is a consequence of adhesions.
• Colposcopy. The method is used when a retrocervical type of the disease occurs.
• Ultrasound of the pelvic organs using a vaginal probe. It should be noted that this study is the main one in the diagnosis. During the procedure, you can clearly visualize changes in the ovaries and myometrium.

• Hysterosalpingography. The method is used when infertility occurs, as it diagnoses the patency of the tubes.
• Hysteroscopy. This study helps to identify adenomyosis with a hysteroscope.
• Laparoscopy. The procedure allows you to diagnose any form and type of endometriosis, which cannot be achieved using other methods.

Laparoscopy can be called the most informative method. During its implementation, both diagnostics and adequate treatment can be carried out, which cannot be said about other methods.

• Blood test for the CA-125 marker. This study is complementary due to the fact that its results are rather difficult to interpret.
• Consultation of narrow specialists. The consequences of extragenital endometriosis can be disruption of the functioning of many organs, for example, the bladder or intestines. In such cases, consultation with a narrow specialist is very important for the diagnosis.

The scope of diagnostic methods depends on the woman's history. Sometimes a simple examination in a chair and an ultrasound scan is sufficient to confirm the diagnosis.

Treatment

Treatment of endometriosis is challenging due to the variety of disease types.

Treatment can be roughly divided into large groups:

• conservative or medication;
• surgical or operative;
• complex or combined.

Conservative therapy is based on taking medications:

• combined oral contraceptives that reduce estradiol production and have an antiandrogenic effect;
• derivatives of norsteroids that suppress the production of estrogens and reduce the manifestations of pathology;
• prolonged MPA, promoting anovulation;
• androgen derivatives that inhibit the progression of the disease;

The use of drugs this group is contraindicated in the occurrence of girtusism due to the fact that the drug increases testosterone levels.

• agonists of gonadotropin-releasing hormone, leading to the effect of artificial menopause;
• anti-inflammatory therapy that significantly reduces pain and other consequences of endometriosis;
• physiotherapy, vitamin therapy and herbal medicine, which help to activate the body's defenses.

Many women wonder what to expect from conservative therapy. Drug treatment can eliminate some of the causes and consequences of the disease, stop its progression and reduce the volume of pathological foci.

However, in some cases, the use of surgical methods is justified.

There are certain indications for surgery:

• retrocervical variety;
• concomitant endometrial hyperplasia or ovarian cyst, as well as fibroids;
• lack of effect of drug therapy;
• suspicion of oncology;
• dysfunction of other organs.

Often, surgery is the only way to cure the consequences of endometriosis due to the fact that the use of drugs is accompanied by pronounced side effects.

Types of surgical intervention.

• Laparoscopy. The method involves a microsurgical operation. The procedure for eliminating foci of endometriosis is carried out using electrocoagulation and a laser, which cauterize or excise pathological areas, which cannot be said about other methods.
• Laparotomy. This is a traditional type of intervention, the consequences of which are a difficult recovery period. For this reason, modern gynecology rarely uses such an operation.
• Radical surgical intervention. Some forms and features of the progression of the disease cause amputation of the uterus. This is an extreme measure, used mainly in women before and after menopause.

The most effective is complex therapy, including medical and surgical methods. The emergence of a positive effect is also influenced by means of physiotherapy, acupuncture, hirudotherapy and herbal medicine.

The emergence of positive dynamics depends on the chosen methods of treatment, as well as on the characteristics of the woman's history. As an effect of the treatment, the restoration of reproductive function and a decrease in the signs of the disease can be expected.

Complications

Many women have no idea what to expect in the absence of adequate therapy. In fact, this can lead to serious complications:

• infertility;
• anemia;
• adhesions;
• ovarian cysts;
• neurological disorders;
• malignant tumor.

Endometriosis often causes various consequences for a woman's health. To avoid negative consequences, it is advisable to undergo a timely examination by a gynecologist and treat the disease when it occurs.

Prevention and prevention

Prevention is necessary both for patients who have already encountered the disease and for healthy women.

Special care should be taken when:

• changing the duration of the cycle;
• obesity;
• using a spiral;
• reproductive age;
• hormonal disorders.

To prevent the onset of an illness, you must:

• regularly visit a gynecologist and undergo a full examination;
• timely treat gynecological and inflammatory diseases;
• avoid obesity and stress;
• do physical education;
• refrain from intimate life on critical days;
• planning pregnancy and avoiding abortion;
• live a healthy life.

Endometriosis refers to those pathologies that are easier to prevent than cure. Women who have been diagnosed accordingly should be especially careful to avoid the consequences of this serious illness.