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

This is one of the most mysterious female diseases. Despite the fact that this diagnosis is made quite often, the question - what kind of disease is it, why and how to treat it, often remains unanswered. 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

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

1. One theory points to the process of retrograde menstruation, when part of the menstrual tissue enters the abdominal cavity, grows into it and increases.
2. Genetic theory puts forward the point of view that the genes of some families contain the beginnings of endometriosis and, thus, members of these families are predisposed 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 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 genital organs;
• tumors ();
• difficult childbirth;
• operations on the uterus;
• abortions;
• drinking alcohol;
• smoking;
• excessive "love" for products containing caffeine;
• disturbances in the functioning of the organs of the endocrine system (thyroid gland, adrenal glands, hypothalamus,
• pituitary gland, female gonads);
• reduced immunity.

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

Therefore, regularly undergo a 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.

Can you get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of getting 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.

Symptoms of endometriosis

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

However, certain symptoms should definitely alert a woman:

1. Pain of varying intensity, up to acute. They can be localized, given to the inguinal region, anus, leg. Pain either occurs in the first days of menstruation, and disappears with its end, 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 very menstruation is quite plentiful and prolonged;
3. Uterine bleeding in the intermenstrual period (metrorrhagia);
4. Spotting discharge can also be during sexual contact.

Menstruation with endometriosis becomes abundant, with clots, which leads to the development of chronic posthemorrhagic anemia:

• brittle nails,
• dyspnea,
• weakness, drowsiness
• dizziness,
• pallor of the skin and mucous membranes,
• frequent, etc.

Unfortunately, in some cases, the symptoms of endometriosis are very mild or absent. For this reason, you should visit the gynecologist's office every six months. Only timely diagnosis can protect against the development of undesirable consequences of endometriosis.

Endometriosis 1, 2 and 3 degrees

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

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

There is no linear relationship between the degree of spread of endometriosis and the severity of the symptoms of the disease. Often, advanced endometriosis is less painful than mild endometriosis, which has only a couple of small lesions.

Diagnostics

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

• radiopaque methods (hysterosalpingography)
• endoscopic examinations (for example, hysteroscopy),

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

Prevention

The main measures aimed at the prevention of endometriosis are:

• specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) in order to exclude endometriosis;
• observation of patients who have undergone 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 can be asymptomatic and does 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:

• adhesive process in the small pelvis;
• fertility disorder;
• anemia due to heavy 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;
• medical;
• combined.

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

• combined estrogen-gestagen preparations;
• gestagens, antigonadotropic drugs;
• gonadotropic releasing hormone agonists.

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

Conservative therapy

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

The drug treatment path includes a fairly traditional therapy:

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

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

• progesterone 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 tolerability of drugs and the performance of functional diagnostic tests.

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

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

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

Surgical treatment of endometriosis

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

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

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

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

Prognosis for endometriosis

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

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

Update: October 2018

The uterus is a hollow organ, which is represented by three layers: the inner one, lining its cavity, is the endometrium or mucous membrane, the middle, thickest one is the myometrium or muscle layer, and the outer one is the peritoneum, enveloping the uterus or serous membrane. The endometrium, in turn, is divided into 2 layers: functional, which is rejected during menstrual bleeding, and basal (growth), which gives rise to a new growth of the functional layer.

Uterine endometriosis, or adenomyosis, is a hormone-dependent disease characterized by the spread of inclusions, very similar in structure to endometrial cells, outside the uterine mucosa. Accordingly, all monthly changes inherent in the functional layer of the endometrium will also occur in endometrioid heterotopias (foci), which causes the clinical picture, symptoms of endometriosis of the uterus. Treatment of this disease can be both conservative and surgical.

The prevalence of endometriosis is 40 - 70%, such a wide range is due to the asymptomatic course of the disease, so adenomyosis is detected incidentally when a woman contacts a doctor with other problems, usually for infertility (see all).

Types and degrees of adenomyosis of the uterus

There are 3 forms of uterine endometriosis:

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

According to the depth of involvement in the pathological process of the uterine wall, four degrees are distinguished:

• 1 degree - germination of endometrioid foci to a shallow depth, no further than the muscle layer;
• 2 degree - involvement in the process of half the thickness of the myometrium;
• Grade 3 - the disease spreads to the entire muscle wall;
• Grade 4 - adjacent organs and the peritoneum that covers them are involved in the process, while fistulas are formed in the uterus with access to the small pelvis.

Causes of uterine endometriosis

The exact cause of endometriosis has not been established. There are several theories of the development of this disease, but each separately does not fully explain the mechanism of the disease, but only complements others:

• implantation theory. Throwing endometrial cells into other organs during menstruation, operations, and other things, where they take root and form foci of endometriosis.
• The theory of embryonic origin. Endometrial lesions arise from the remnants of the germinal material from which the genitals are formed.
• metaplastic theory. Foci of endometriosis are formed from the mesothelium of the peritoneum, which has undergone metaplasia.

Predisposing factors for adenomyosis of the uterus:

Clinical picture of endometriosis

About half of women with uterine endometriosis have no symptoms. Adenomyosis with asymptomatic course is an incidental finding on ultrasound of the pelvic organs. But this applies only to those patients who have endometriosis of the uterus of the 1st degree.

A pathognomic sign of adenomyosis is. Smearing discharge is characteristic 2 to 3 days before menstruation and for several days after it. Metrorrhagia (acyclic bleeding) is possible, which usually occurs in the middle of the menstrual cycle. Sometimes it can be so pronounced that the doctor has to urgently carry out surgical intervention, up to the removal of the uterus.

Menstruation with endometriosis becomes abundant, with clots, which leads to the development of chronic posthemorrhagic anemia:

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

Also, with endometriosis, there is a shortening of the menstrual cycle. About 50% of patients develop severe premenstrual syndrome.

In addition, a symptom of endometriosis is algomenorrhea or dysmenorrhea. Menstruation becomes very painful, the pain has a paroxysmal character.

Pain appears before menstruation, increases during them and persists for several days after the end of menstrual bleeding.

Pain syndrome is associated with infiltration of uterine tissues with fluid, accumulation of blood in endometrioid foci, as well as adhesive disease of the small pelvis, which inevitably accompanies endometriosis.

Localization of pain depends on the location of endometrioid heterotopias. For example, if the angle of the uterus is involved in the pathological process, pain will occur in the corresponding inguinal region, if the isthmus is affected, the pain radiates to the rectum, lower back and vagina (see). Adenomyosis also causes pain during intercourse (dyspareunia).

Endometriosis of the uterus causes the development of infertility, which is associated with two factors.

• Firstly, egg implantation and gestation becomes impossible in an altered uterus.
• Secondly, the adhesive process in the pelvis prevents the penetration of the egg into the fallopian tube.

Diagnosis of endometriosis

Diagnosis of adenomyosis begins with a thorough history and complaints, then a gynecological examination is performed, during which an enlarged (up to 6-8 weeks) uterus is determined, especially on the eve of menstruation, spherical in shape. Its mobility may be limited by pelvic adhesions. With the nodular form of adenomyosis, individual nodes are determined, the uterus has an uneven, bumpy surface. Additional methods include:

• pelvic ultrasound

Echo signs of adenomyosis: an increase in the anteroposterior size, the appearance of a zone of increased echogenicity in the muscle layer, the presence of anechoic inclusions with a diameter of 2–6 mm or cavities with liquid containing small impurities. The nodular form of adenomyosis is characterized by the presence of 2–6 mm diameter inclusions in the form of a circle or oval and fuzzy contours of the node. The focal form of adenomyosis is characterized by the detection of saccular formations 2–15 mm in size.

• Hysteroscopy

The main hysteroscopic sign of the disease is the detection of holes in the endometrioid passages in the form of burgundy dots, while the uterine mucosa retains a pale pink color. Additional signs of diffuse adenomyosis include an enlarged uterine cavity and a “jagged” contour of the basal mucosal layer.

• Metrosalpingography

Metrosalpingography is carried out in the first phase of the menstrual cycle immediately after the end of menstruation. On the radiograph, it is noticeable that the contrast agent is located outside the boundaries of the outlines of the uterine cavity, and its dimensions are increased.

• Magnetic resonance imaging

Allows you to diagnose adenomyosis in 90% of cases, but is rarely used due to the high cost of the study.

• Markers of endometriosis

An increase in the levels of cancer protein-125 (CA-125) and placental protein-14 (PP-14) in the blood indirectly indicates endometriosis. It should be noted that an increase in CA-125 is observed not only in endometriosis, but also in malignant ovarian tumors, uterine fibroids, inflammatory diseases, and during short-term pregnancy. In patients suffering from adenomyosis, an increased content of CA-125 is observed throughout the second phase of the menstrual cycle and during menstruation.

• Colposcopy - examination of the cervix with a special device.

Treatment of endometriosis

Treatment of endometriosis can be either conservative or surgical. With conservative therapy, hormonal and non-hormonal drugs are prescribed. Conservative therapy should be comprehensive, and include, in addition to prescribing hormonal drugs, a special diet high in calories and limited in spices, salt and pepper, outdoor walks, exercise therapy, limiting physical and mental stress. The choice of treatment method in each case is individual and depends on many factors (the age of the patient, the desire to preserve childbearing function, the severity of the disease, the presence / absence of concomitant pathology, etc.). In addition, with such a disease, the following drugs are indicated:

• sedatives,
• immune system is corrected
• relief of pain syndrome (see)
• drugs are prescribed to normalize the functions of the liver and pancreas.

Hormonal drugs for the treatment of uterine endometriosis

• Estrogen-gestagenic preparations

Oral estrogen-progestin contraceptives suppress the release of gonadotropin-releasing factor and the synthesis of FSH and LH, inhibit the production of hormones in the ovaries and proliferative processes in the endometrium. Under their influence, the processes in the endometrium and endometrioid growths associated with a change in the phases of the menstrual cycle stop, and with prolonged use, endometrial involution occurs, resulting in sclerosis and overgrowth of endometrioid foci. Oral contraceptives are prescribed continuously for a period of 6 to 12 months.

• Progestogens

Progestogens have antiestrogenic and antiprogesterone actions due to their binding in target cells to estrogen and progesterone receptors. Duphaston, Norkolut, Premolut are recommended to take 5-10 mg from the 5th to the 25th day of the menstrual cycle or from the 16th to the 25th day, the duration of treatment is 6-12 months. Medroxyprogesterone acetate is prescribed at 30-50 mg per day orally or 150 mg every 2 weeks intramuscularly.

• Antiprogestins

Gestrinone, a new derivative of 19-nortestosterone, has antiestrogenic, antiandrogenic and progestinomimetic effects and causes atrophy of the glandular endometrium. Assigned to 2.5 - 5.0 mg twice a week. The appointment of mifepristone (dose 100-200 mg / day) for six months also leads to atrophic changes in the endometrium and artificial menopause.

• Antiestrogens

Tamoxifen blocks estrogen receptors in target tissues and suppresses the production of prostaglandins (a source of pain). The course of treatment is 6 months at a dose of 10 mg twice a day.

• Gonadotropin inhibitors

Danazol blocks the release of gonadotropins (FSH and LH), inhibits the secretion of sex hormones in the ovaries. It is prescribed at a dosage of 200 mg 2 times a week with a gradual increase in dose to 800 mg / day until amenorrhea occurs. Against the background of treatment with danazol, the pain syndrome is stopped, spotting spotting and pain during intercourse disappear.

• Gonadotropin-releasing hormone agonists

The use of synthetic gonadotropin-releasing hormone agonists (zoladex, buserilin, nafarelin) causes the development of drug-induced amenorrhea. For example, Zoladex is injected subcutaneously into the anterior abdominal wall at a dosage of 3.6 mg once every 4 weeks. The course of treatment is 6 months.

Indications for surgical treatment of adenomyosis:

• adenomyosis in combination with endometrial hyperplasia;
• nodular form of adenomyosis;
• combination of uterine endometriosis with fibroids;
• endometriosis 3 and 4 degrees;
• the presence of endometrioid ovarian cysts or widespread retrocervical endometriosis;
• lack of therapeutic effect from hormonal treatment, lasting 3 or more months;
• contraindications to the appointment of hormonal drugs (thromboembolism, severe varicose veins of the lower extremities, thrombophlebitis, liver disease, migraine, a tendency to depression, endocrine disorders, arterial hypertension, etc.).

Can uterine endometriosis be cured?

Endometriosis of the uterus is a relapsing chronic disease. Relapses after conservative therapy or organ-preserving operations during the year occur in 20% of cases, after 5 years of disease development, the number of relapses increases to 75%. With combined treatment (conservative and surgical organ-preserving intervention), a longer effect is observed, but exacerbations are still inevitable. The most optimistic prognosis for adenomyosis is in premenopausal women, as disease activity subsides with physiological decline in ovarian function (see).

Is it possible to get pregnant with endometriosis of the uterus and give birth to a healthy baby?

Endometriosis of the body of the uterus is the 2nd cause of infertility in women, after chronic salpingitis, salpingo-oophoritis. In addition, part of the chronically recurrent inflammatory processes in the ovaries may also be caused by internal endometriosis, and not by infectious diseases. Therefore, the connection between infertility and endometriosis in women of childbearing age becomes obvious, which is confirmed in every 2-3 cases of infertility.

Since the mechanisms of the appearance of infertility in endometriosis in different patients are different, respectively, the tactics of therapy and the prognosis will differ. In women with internal endometriosis, the causes of infertility may include:

• Adhesive process in the small pelvis, disrupting the transport function and motor activity of the fallopian tubes
• Infertility in uterine endometriosis is caused by pathological changes in the hormonal background, as a result of which the egg does not mature and exit the follicle.
• Inflammatory processes in the muscular layer of the uterus can provoke increased contractile activity of the myometrium and lead to spontaneous abortion in the early stages.
• With autoimmune processes in a woman's body, it is possible to reduce the activity of spermatozoa in the uterine cavity, or the impossibility of implanting a fertilized egg.
• against the background of endometriosis, adhesive process - make it difficult to have a full-fledged regular sex life.

Usually infertility in this pathology is caused simultaneously by several reasons. Restoring a woman's ability to conceive and bear a child should be a complex treatment. It is very important that the duration of the disease does not exceed 3 years, then the chances of a successful pregnancy increase.

What is the likelihood of a woman with endometriosis having a healthy baby? Modern medicine today has a fairly extensive material in the field of observations of the course of pregnancy, childbirth and the period after the birth of a child in women with this disease. And the main facts of these studies point to the following:

• In the presence of endometriosis in a pregnant woman, the risk of the threat of termination of pregnancy is quite high, especially in the short term. Modern methods of therapy are carried out according to standard schemes and are able to stabilize the condition of the woman and the fetus.
• It is very important to diagnose and adequately treat endometriosis in time, since the risk of developing persistent infertility increases with age (according to various sources, in 40-80% of cases).
• Abortion or miscarriage contribute to the exacerbation of endometriosis, worsening the prognosis and accelerating the development of the pathological process. Women should, if possible, try to maintain the resulting pregnancy against the background of adenomyosis. In the case of spontaneous or artificial termination of pregnancy, the patient needs complex anti-relapse treatment - immunomodulators, hormonal drugs, etc.
• In most cases, childbirth in women with adenomyosis is uneventful, but in the postpartum period there is a high risk of uterine bleeding or recurrence of uterine endometriosis.

Article outline

One of the most common and at the same time unusual gynecological diseases is uterine endometriosis. The disease itself can be characterized as a non-localized growth of the endometrium. What does this mean? Arising for the first time in the endometrium lining the uterus, the pathological focus can spread not only to nearby tissues, but also to distant areas.

Ways of spread - through the circulatory and lymphatic systems (which makes the disease look like cancer). But without changes at the cellular level (which is typical for benign neoplasms). Pathological foci are called heterotopias, they are prone to cyclic changes. Like normal areas of the uterine endometrium, they can increase in size and be rejected in accordance with the menstrual cycle. A pathological focus located in a non-standard place may bleed slightly (which is typical for menstruation).

The prevalence of this disease is quite high, in the structure of gynecological pathologies it occupies the 3rd place. It is characterized by late detection, since there are no symptoms for a long time. Like many gynecological diseases, endometriosis can be detected during gynecological examinations, but if we are talking about an extragenital form (a pathological process outside the uterus, for example, distant localization in the lungs), then its detection may not be associated with gynecology.

Below we will explain in detail the concept of endometriosis of the uterus in an accessible language, find out what it is, what causes, signs, symptoms and treatment are inherent in the disease.

The concept of endometriosis

Endometriosis is a gynecological disease with an unexplained etiology. It occurs at any age, from the moment of puberty, ending with menopause. There are practically no cases of the onset of the disease in girls before the onset of menstruation. At the same time, there are data on the regression of the pathological process in women after the complete attenuation of the reproductive function and the hormonal activity of the body associated with it. In postmenopausal women, this disease is absent.

The beginning of the pathological process is associated with the structural features of the uterus. Its walls form 3 layers, the uterine cavity is lined from the inside by the endometrial. It, in turn, is divided into functional (external), internal and basal. During normal functioning of the body, the functional layer is constantly rejected and excreted during menstruation. And then, at the beginning of the cycle, it is updated due to the cells of the underlying basal layer (natural proliferation). What causes part of the functional layer to move to nearby or distant tissues and organs has not yet been fully elucidated. The mechanism of development is not fully understood, which in a certain way complicates the treatment.

With endometriosis affecting the organs of the reproductive system, complications are possible in the form of infertility, cysts, and menstrual irregularities. The prognosis in the early stages is quite favorable, with an uncomplicated course, a complete recovery is possible. But at the same time, the disease is prone to relapses, which makes the need for regular preventive examination by a gynecologist relevant and mandatory.

Statistics

In gynecology, endometriosis is considered the third most common, which makes the problem of its study, timely detection, treatment and prevention quite relevant. Some statistics say about 10% of all gynecological diseases.

There is an opinion that endometriosis is more common, just the symptoms of the disease are often absent, and it can be detected after several years of latent course.

According to age groups, the structure of this pathology is as follows:

• up to 5% in menopausal women;
• up to 10% in girls in puberty;
• the remaining cases occur in women of reproductive age, most often from 25 to 40 years.

The most common is the genital form of the disease, the rarest cases occur in the extragenital form with distant lesions (urinary system, intestines and even lungs) - only 6-8%. According to statistics, most often the pathology is found in combination with fibroids, and the main complication is infertility. Considering that the majority of patients are of reproductive age, the lack of regular examinations becomes a rather urgent problem in gynecology. Since pathological foci are sometimes discovered by chance, and the disease can be asymptomatic, diagnosis is often difficult. Therefore, it is important for women to know as much as possible about pathology. Reliable information about the features of its course will help to detect the first signs of pathology in yourself and contact a specialist in time.

Classification

There are two main classification systems for endometriosis. One system is based on the localization of the pathological focus, the second - on the degree of damage. Both systems are used to describe the clinical picture. When describing localization, it stands out:

• genital form;
• extragenital form;
• combined.

The first group includes pathologies of the uterus itself, which are of different types:

• diffuse endometriosis: heterotopias appear on the entire surface of the mucosa, while cavities form in the myometrium;
• nodular adenomyosis: endometroid foci are located locally, form nodes that do not have a capsule;
• focal endometriosis: the pathological process is fixed exclusively in certain areas of the uterine wall.

There are also these types of endometriosis:

• peritoneal endometriosis: the ovaries, fallopian tubes and pelvic peritoneum are involved in the pathological process;
• extraperitoneal endometriosis: the main localization is the lower parts of the reproductive system, lesions are observed on the vaginal segment of the cervix, rectovaginal septum, vagina, the external one is quite often found with lesions of the genital organs;
• : affects the muscular layer of the uterine body, while the organ increases to the size corresponding to the gestational age of 5-6 weeks.

It should be understood that such a variety of heterotopia locations complicates the diagnosis. With a visual gynecological examination, it is far from always possible to detect problem areas and identify all pathological foci.

Degrees of endometriosis

In the classification according to the volume of the lesion, 4 degrees are distinguished:

• endometriosis of the 1st degree: the growth of heterotopias is limited to the muscle layer, they can be characterized as superficial and single;
• endometriosis of the 2nd degree: up to half the thickness of the muscle layer is included in the pathological process, deeper heterotopias are found in the myometrium, their number increases;
• endometriosis of the 3rd degree: extends to the entire thickness of the muscle wall, up to the serous membrane. Complicated by ovarian cysts (on both or one, single or multiple), single adhesions can form on the peritoneum;
• endometriosis of the 4th degree: the volume of the pathology increases significantly and goes beyond the uterus, affecting the peritoneum, fistulas can form, their passages lead to the small pelvis. Complemented by bilateral polycystic ovaries (large cysts). The endometrium grows into the peritoneum with the formation of adhesions, the pathological process covers the rectum and vagina.

Each stage passes into the next, the third and last are especially dangerous. Grade 3 is difficult to treat, but the fourth is treated the worst, because the volume of the lesion is quite large, and there is no clear localization. In this case, it is difficult to remove heterotopias surgically.

The reasons

The causes of endometriosis are still not fully understood, the disease is considered polyetiological, there is no consensus among specialists on this issue. Existing theories, each separately, cannot fully explain why pathology appears. Therefore, when describing this disease, all existing theories and causes are considered.

The mechanism of spread associated with menstruation is more understood. He does not fully explain why the disease occurs, but it becomes clear how heterotopias are far from the uterus.

The relationship with other gynecological diseases has been identified, but sometimes it is not entirely clear what is the cause and what is the effect. For example, endometriosis and infertility are certainly linked. But problems with conception can be considered as a symptom (with polycystic ovaries of a different etiology) or as the root cause (if this is the result of an abortion, and abortions are considered risk factors and are called one of the identified causes of pathology). And also as one of the options for the negative consequences of the disease. Consider what theories of the occurrence of the disease are recognized by medicine at the moment.

Theories of disease progression

Foci of endometriosis can occur in the following situations.

• Retrograde menstruation (this theory is also called implantation). The mechanism of development is associated with retrograde processes during menstruation. What it is? It is assumed that part of the endometrial cells, which, together with menstruation, should be removed from the body, are "thrown" into neighboring organs (a retrograde way of penetration of part of the menstrual blood outside the uterus). This is how heterotopias are formed, which begin to behave like a normal section of the endometrium lining the uterus. That is, they go through the stage of normal proliferation, then they are rejected, causing small bleeding like menstruation. Proponents of this theory pay attention to the fact that the disease is not detected before puberty, and in postmenopausal women in the early stages it is prone to self-regression.
• hormonal theory. In the examined patients, a similar pattern of hormonal imbalance is found. They have a low level of progesterone, and an excess of estrogen, FSH (follicle-stimulating hormone), prolactin and LH (luteinizing hormone). There is also dysfunction of the adrenal cortex, which plays an important role in the humoral regulation of reproductive function.
• Immune disorders. The main function of the immune system is the destruction of all atypical foci, any tissue that has gone beyond its normal localization is usually destroyed. The appearance, continued existence and development of heterotopias is considered a sign of a violation of the immune response to "foreign" cells of the uterine endometrium.
• hereditary predisposition. New approaches to the study of endometriosis have made it possible to identify a specific hereditary marker. It indicates a hereditary predisposition and is detected in women in whose family history this disease is detected in several generations.
• metaplastic theory. It is based on the assumption of the possibility of degeneration of certain types of tissues into endometrial. In particular, there is a version about the ability of peritoneal mesothelium to metaplasia.
• embryonic theory. It is assumed that some violations in the development of the fetus can lead to the appearance of endometriosis. This conclusion was made on the basis of observations. Cases of a combination of this pathology with malformations of the genital organs in girls aged 10-12 years have been recorded.

All of the above theories cannot fully explain the mechanism of endometriosis, especially since there are still risk factors that provoke the disease.

Risk factors

The risk factors for the onset of the disease include most of the standard causes for gynecological diseases:

• violation of the cycle of different etiologies;
• any injury to the uterus: as a result of abortion, curettage, the use of intrauterine devices, complicated childbirth, surgical interventions, etc.;
• inflammatory processes of various etiologies, including infectious and viral diseases of the reproductive system;
• stenosis of the cervical canal;
• late onset of sexual activity and childbirth in the late reproductive period;
• diseases of the reproductive system associated with hormonal disorders. In gynecology, there are hormone-dependent diseases, their occurrence is most often caused by a change in the balance of estrogen - progesterone;
• diseases associated with changes in hormonal levels (diabetes mellitus, obesity, thyroid pathology, autoimmune diseases);
• propensity to allergies, reduced immunity.

In addition, risk factors include physical inactivity or excessive physical activity, stress, prolonged use of hormonal contraceptives, liver disease, poor ecology, iron deficiency, and low living standards. Such an extensive list indicates a lack of a clear understanding of the main causes of the onset and development of endometriosis, which greatly complicates further treatment.

Methods of determination

The examination should be comprehensive, because there are certain difficulties in visualizing the pathological process. It is especially important to conduct a differential diagnosis, since during the examination, endometriosis can give a similar picture with other gynecological diseases. For timely detection and accurate determination of the type and stage of pathology, it is required:

• at the appointment, collect an anamnesis (including data on hereditary diseases);
• conduct a gynecological examination: with endometriosis, it is not always possible to determine the pathology on the mirrors, and the visual picture is fuzzy and similar to other pathological conditions;
• prescribe tests: preferably for genetic markers, to identify concomitant infections - a smear;
• hysteroscopy for endometriosis: can be used both for examination and for taking material for histological examination (biopsy);
• colposcopy: allows you to more accurately visualize the picture;
• Ultrasound: helps to see the dynamics of a common pathological process;
• laparoscopy: more accurately visualizes the picture, allows you to determine the number of heterotopias, their condition, size, localization;
• CT and MRI: allows you to identify the relationship of lesions with other organs, are considered the most informative methods with an accuracy of assessing diagnostic results up to 98%;
• hysterosalpingography: an x-ray method for examining the uterine body and tubes, less effective than the previous method (83%).

If endometriosis is suspected, you should immediately contact a specialized specialist for a full comprehensive examination. Some methods (analysis for markers, colposcopy) can be done as part of a physical examination, which helps to identify the disease at an early stage. The cause for concern and an unscheduled visit to the gynecologist will be the symptoms characteristic of this pathology.

Symptoms and signs

Symptoms of endometriosis in women may not appear for a long time, in the initial stages, a latent course and the absence of visible changes in the endometrium are characteristic, which makes diagnosis difficult. However, there are certain symptoms that are characteristic of this particular disease.

• Pain: any pain is the basis for an immediate visit to the gynecologist. Almost 25% of patients report diffuse or localized pelvic pain. Also, pain can appear and intensify: during urination, defecation and sexual intercourse (contact pain);
• Dysmenorrhea: this pain syndrome during menstruation is indicated separately, as it occurs in most patients (up to 60%);
• Menorrhagia: a change in the cycle with lengthening of menstruation and more heavy bleeding, occurs in 10-15% of patients;
• Posthemorrhagic anemia: chronic blood loss leads to the appearance of symptoms characteristic of anemia (fatigue, pallor, weakness, drowsiness, dizziness);
• Infertility and the threat of miscarriage: pathological processes can lead to spontaneous abortion, but the main difficulties are associated with the inability to conceive (according to some reports, up to 40% of women with this pathology have difficulty conceiving);

As signs can be considered: intoxication, problems with urination and defecation, shortening of the cycle or its irregular nature.

Possible complications and consequences

Complications of endometriosis include the formation of many cysts (polycystic), adhesions, which become the main cause of infertility. In this case, problems with conception are not considered as a symptom, but as a complication. Statistics show that almost 50% of patients are able to become pregnant during the first year after treatment, the rest have problems with conception even after remission and complete cure.

Also, the consequences of endometriosis can be neurological disorders that occurred as a result of compression of the nerve trunks, and symptoms characteristic of anemia. Malignant degeneration is extremely rare, this disease is not or is a background disease. The atypical arrangement of uterine endometrial cells and the way they spread do not affect the very structure of the cells. On the contrary, heterotopias manifest themselves as typical endometrial cells, which indicates their normal function and the absence of signs of degeneration.

How to treat

The treatment of endometriosis is aimed both at eliminating the pathological focus and at the maximum possible restoration of the normal functions of the woman's body, especially the reproductive system. This approach is associated with the peculiarity of the disease (complications in the form of polycystic disease, infertility, etc.).

How to treat pathology is determined by the doctor after studying the clinical picture, taking an anamnesis and conducting differential diagnosis. If the examination revealed concomitant diseases (for example, infectious and viral diseases of the genitourinary system or hormone-dependent pathologies of the reproductive system), the scheme is drawn up taking into account these facts.

Methods of treatment are determined in accordance with the volume and localization of the pathological focus. As well as the prevalence in the body, the age of the patient, the presence of a history of childbirth and other factors. Since women of childbearing age are in the main risk group, tactics are required that can preserve reproductive function (which is sometimes quite difficult). In the process of treatment, both conservative and surgical methods are used.

Conservative therapy

How are they treated with therapeutic methods? The main drugs are hormonal drugs. These include:

• COOK. The use of drugs in this group (combined oral contraceptives) is associated with their ability to suppress hormones such as LH, FSH, GnRH. Thus, suppression of the processes of proliferation and production of estradiol is achieved. COC is a fairly effective remedy, as it allows you to slow down the natural processes of the menstrual cycle, which are repeated in areas with heterotopias;
• to suppress gonadotropins, prolonged MPA are prescribed;
• androgen derivatives help to increase testosterone levels and reduce the amount of estradiol produced;
• drugs containing aGnRH help block ovarian function and estrogen production;
• derivatives of norsteroids are prescribed in the form of an intrauterine therapeutic spiral.

Contraceptives with different mechanisms of action are given a leading position. Therapy of endometriosis becomes effective, as atypical endometrial tissue is amenable to their effects. Rather, it ceases to respond to the normal natural hormonal background, which provides cyclic processes of maturation of this tissue. The remaining drugs are prescribed as symptomatic. Removal of pain syndrome, restoration of a normal blood formula, disturbed as a result of anemia, improvement of immunity - all characteristic symptoms can be stopped if the correct one is prescribed.

Surgical intervention

Removal of endometriosis by surgical methods is prescribed for:

• ineffectiveness of conservative treatment;
• some types of underlying disease;
• complications in the form of cysts, bleeding, fibroids;
• functional disorders in other organs;
• the appearance of the first signs of atypical degeneration (the threat of oncology).

The operation can be performed laparoscopically or laparotomically. In the first case, the lesion is cauterized with a laser or with the help of electrocoagulation, ablation or embolization. They are recommended for a small volume of the pathological focus.

If the lesion is large, then more radical methods of surgical intervention are used:

• hysterectomy and adnexectomy are chosen if necessary to cope with a large amount of pathology;
• removal of the uterus is used most often in patients over 40.

Surgical methods cope well with the disease, but whenever possible, doctors choose minimally invasive and organ-preserving methods for removing affected areas.

Alternative medicine

Is it possible to cure pathology with folk remedies? When choosing alternative medicine methods, it should be remembered that they will only be auxiliary means. This means that, firstly, they should not be used without the consent of the attending physician. Secondly, that they are not a substitute for basic treatments. Even if the disease was detected in the early stages, it does not pose a clear threat, and the doctor chose the tactics of dispensary observation (regression of the pathological process is possible).

To get rid of endometriosis with the help of folk remedies can be prescribed:

• homeopathy: all preparations should be selected by an experienced homeopathic doctor, taking into account the current clinical picture. Basically, funds are chosen that can reduce the activity of certain hormones. That is, homeopathic preparations can serve as a substitute for COCs or other hormonal agents, for example, with intolerance or with increased side effects as a result of long-term use. They can also relieve acute symptoms (stop bleeding, pain, remove the effects of anemia);
• douching: definitely should not be used without consulting a doctor, as in some conditions it can worsen the current clinical picture. If the topical application of herbs is indicated for a particular patient, then a boron uterus, eucalyptus, and herbal preparations are usually used. But this method has much more contraindications than indications;
• herbal medicine: herbs are selected that are sources of phytoestrogens, or are able to block the production of certain hormones that provoke pathological processes;
• candles with propolis: this product of the vital activity of bees has long gained popularity in the treatment of pathologies of the female reproductive system. It is usually mixed with honey and applied both topically and internally. Reviews indicate that this method helps to relieve symptoms well and can serve as an excellent addition to the main treatment.

The most effective suppositories can be both vaginal and rectal, they are selected by a doctor and are able to relieve the main symptoms of the disease.

other methods

As an addition to the main treatment, alternative medicine techniques can be used. Well proven:

1. physiotherapy: electrophoresis with honey and zinc, radon baths, magnetotherapy in some pathological conditions are quite capable of improving the clinical picture. Physiotherapy is prescribed by a doctor, taking into account the mechanism of their action and the effect on the patient's body;
2. acupuncture: acupuncture can stimulate the protective functions of the body;
3. hirudotherapy: leech saliva improves immunity, “starts” recovery processes, reduces pain and has anti-inflammatory properties;
4. Dietary supplements for endometriosis should be taken only as prescribed by a doctor and in combination with the main means of treatment. Dietary supplements usually try to correct the hormonal background, saturate the body with vitamins, improve immunity, and relieve the effects of anemia.

endometriosis and sex

Is it possible to have sex? There are no absolute contraindications for restrictions, usually intimate life is conducted in the usual rhythm. The exception will be restrictions related to:

• with increased bleeding;
• if sexual intercourse brings painful sensations (often women with contact pain themselves refuse or significantly reduce the number of sexual acts);
• in the postoperative period, when rest is required until healing.

Preventive measures

Prevention is:

• in regular visits to the gynecologist and attentive attitude to their health;
• taking oral contraceptives (as prescribed by a doctor);
• concern for the safety of sexual relations (and, if necessary, in the timely treatment of consequences);
• maintaining a normal hormonal background (treatment of diseases of the thyroid gland, adrenal glands, obesity, diabetes mellitus);
• balanced nutrition, maintaining the immune system in the normal range, prevention of beriberi, etc.

That is, all preventive measures are aimed at eliminating risk factors and causes of the disease.

Do's and Don'ts

Contraindications are directly related to the current clinical picture of endometriosis. For example, when detecting cysts and polyps, overheating is not recommended. This means that prolonged exposure to the sun, trips to the sauna and solarium are undesirable. Restrictions may also be associated with the incompatibility of some drugs with alternative methods of treatment, douching and the use of other vaginal remedies (suppositories, tampons). It is clear that all restrictions mainly depend on the prevalence and aggressiveness of the pathological process.

The possibility of pregnancy and bearing a healthy fetus

Pregnancy can occur both in the presence of endometriosis (can be detected only in the management of a pregnant patient), and after treatment. Since infertility is considered as a cause of pathology and as its complication, conception can become a major problem.

One of the complications may be the threat of miscarriage or spontaneous abortion in the absence of adequate treatment and a large amount of pathology. In the early stages, the cessation of menstruation due to pregnancy can lead to regression, but in the future, the pathological process can be activated again.

The disease usually does not affect the health of the unborn child, unless it is a hereditary factor that can be passed on to the daughter from the mother.

Can it be cured permanently

Whether the disease is treated usually worries all patients.

In the initial stages, the pathology lends itself well to therapeutic methods. With the elimination of all possible provoking factors, it is curable. But women of reproductive age remain at risk of relapse.

Therefore, the doctor decides how to treat the disease, but the woman should be observed in the future as a dispensary patient with the risk of resuming the pathological process. With the attenuation of the hormonal (and, as a result, reproductive function), as a rule, complete regression occurs and the disease does not return in the future.

Can it pass on its own

Practice shows that such cases are not rare. They may be associated with changes in hormonal levels, pregnancy or postmenopausal. Sometimes regression occurs for no apparent reason, what caused it is impossible to say for sure. But at the same time, you should not count on such an outcome.

When a disease is detected, it is necessary to begin complex treatment. In this case, you should not self-medicate and use folk remedies without medical advice. The argument “helped someone” will be little consolation in the further development and spread of the pathological process. To treat a disease or leave a woman for some time at a dispensary is decided only by a specialized specialist based on the clinical picture, a complete examination and anamnesis of a particular patient.

Can it turn into cancer

Despite the fact that endometrial cells can behave like malignant tumors by their method of propagation, the risk of their degeneration into atypical tumors is small. Much more dangerous in this regard can be concomitant diseases or provoking factors. In this case, it is difficult to answer what caused the oncology.

But the opinion of experts is almost unanimous on this issue: the disease does not belong to precancerous or background ones, therefore, the risk of transition to oncology is minimal.

Prices for treatment

The cost of treatment will depend on several factors:

• the level and status of the clinic, its location: usually, in more prestigious medical institutions, examination and surgery are more expensive than in clinics of the "middle" level, and on the periphery, treatment is cheaper than in large cities;
• the volume of medical procedures: the more methods for examination are used, the more expensive the diagnosis, as a result, therapeutic treatment is usually cheaper than surgery;
• the price depends on the method of its implementation: with endometriosis, the tactics of surgical intervention may be different. The cost of endoscopic coagulation will depend on the volume of pathology (from 30 to 50 thousand rubles), removal of the uterus, of course, will cost more.

The cost of conservative therapy will be affected by the number of prescribed drugs. The patient may be offered analog drugs as an alternative.

Since the main drugs are contraceptives, they do not require large material costs, but do not forget that we are usually talking about a stable intake for six months to 9 months (rarely a year).

Endometriosis can cause painful periods, persistent pelvic pain, infertility, and other symptoms. Symptoms of endometriosis can range from mild to severe.

Treatment options include mainly pain medication, hormonal treatments, and surgery.

It is worth explaining what it is in an accessible language and why it is dangerous, how the pathology develops, what methods have been developed for its detection and treatment is acceptable in various clinical situations.

What is endometriosis?

Photo of endometriosis

The endometrium is the tissue that lines the inner lining of the body of the uterus (mucosal layer).

Uterine endometriosis is a condition in which endometrial tissue is found outside the uterus. It is "trapped" in the pelvis and lower abdomen, and, less commonly, in other areas of the body.

The foci of the spread of the disease

Endometriosis is a hormonally dependent pathological condition, accompanied by the growth of the glandular lining of the uterus in the fallopian tubes, in the ovaries, bladder, in the thickness of the uterus, on the peritoneum, in the intestines and on some other organs (see photo above).

Endometriosis is a common gynecological pathology, ranked 3rd in frequency of occurrence after inflammation and uterine fibroids. Most often, endometriosis of the uterus is detected in women of reproductive age - from 25 to 40 years. Also, pathology can manifest itself in girls during the formation of menstrual function and in. It should be borne in mind that the difficulties in detecting pathology and the asymptomatic course of the disease allow us to conclude that the endometrioid process is more common.

Reasons for the development of endometriosis

In medicine, there is no single theory about the causes of endometriosis. There is, the most common of which is retrograde menstruation (means the reverse flow of menstrual blood). She explains the origin of endometriosis by the involvement of endometrial particles with menstrual blood into the fallopian tubes and abdominal cavity during retrograde menstruation.

When a number of conditions are combined, endometrioid cells are fixed on various organs and resume their ability to function cyclically. During menstruation, the presence of the endometrium, localized on uncharacteristic organs, provokes microbleeding and inflammation.

Thus, those women who have retrograde menstruation may develop endometriosis, but not in all situations. The likelihood of developing pathology increases due to the following features:

• hereditary predisposition;
• disorders in the immune system;
• surgical interventions;
• environmental factors (properties of the environment that affects your body).

Also, the progression of endometriosis is possible with surgical interventions on the uterus. For this reason, after any operation, it is important to be observed by a doctor for the timely diagnosis of possible pathologies.

There are also a number of other theories about the causes of endometriosis, the spectrum of which includes:

• theory of gene mutations;
• deviations in the interaction of receptor molecules with hormones;
• violations of the functionality of cellular enzymes;
• embryonic theory.

Risk Factors for Endometriosis

There are several main groups of women predisposed to the progression of endometriosis:

• women with shortening;
• women with impaired metabolism (obesity);
• using intrauterine contraceptives;
• age over 30-35 years;
• women with pathologically high levels of estrogen;
• women with pathologies that depress the immune system;
• undergone surgery on the uterus;
• smoking women.

Classification and degree of development of endometriosis

The exact answer to the question “what is uterine endometriosis” is determined by the localization and prevalence of the pathological process. For this reason, a classification of pathology according to location has been developed.

There are two main groups of the disease - extragenital and genital.

In the case of the genital form of the pathology, the areas of heterotopia are located on the genitals, and in the case of the extragenital form, they are located outside the reproductive organs. The genital form of the disease is divided into several conditions:

• peritoneal form of endometriosis - involvement in the pathological process of the pelvic peritoneum, ovaries and fallopian tubes;
• extraperitoneal form of endometriosis - ectopic foci are localized in the lower part of the woman's reproductive system (cervix, vagina, external genitalia);
• the internal form of endometriosis (uterine endometriosis or adenomyosis) can develop in the myometrium.

In the absence of proper treatment, the pathological process is mixed.

In the case of extragenital localization, the foci of the location of the endometrium include the intestines, lungs, kidneys, and postoperative scars.

Based on the prevalence and depth of the pathological focus, 4 main degrees of development of endometriosis are distinguished:

• First: single foci are localized on the surface.
• Second: a greater number of deep foci.
• Third: multiple deep foci, the presence of endometrioid, adhesive process.
• Fourth: a large number of deep foci of pathology, large endometrioid cysts, severe, the endometrium grows into the thickness of the rectum and vagina.

In addition, the following degrees of internal endometriosis are distinguished according to the degree of involvement in the pathological process of the muscular layer of the uterus:

• First: the beginning of the defeat of the myometrium.
• Second: the foci of pathology grow into half of the layer of the myometrium.
• Third: the defeat of the entire thickness of the muscle layer of the organ.
• Fourth: damage to the walls of the organ, the spread of the pathological process to the tissues of the peritoneum.

Endometrial lesions differ in shape and size: they can be medium-sized, rounded or shapeless and common up to several centimeters in diameter.

Most often, they are characterized by a dark cherry color and delimitation from adjacent tissues with whitish scars. As a result of cyclic maturation, endometrioid lesions are more visible just before the onset of menstruation.

Clinical symptoms of endometriosis

The clinic of the condition can be varied, depending on the localization of the pathological process and its severity. Timely detection of the disease is possible with regular visits to the gynecologist for the purpose of preventive examination.

Allocate a range of symptoms that characterize the progression of endometriosis:

• Pain in the pelvic area. The pain syndrome can be both diffuse and localized. The pain may be constant or aggravated by menstruation. Soreness is most often provoked by the inflammatory process that accompanies endometriosis.
• Dysmenorrhea. Menstrual disorders.
• Dyspareunia, or painful intercourse.
• Pain during urination and defecation.
• Menorrhagia is an increase in the amount and duration of menstrual bleeding.
• Posthemorrhagic. The condition is provoked by the chronic nature of blood loss. It manifests itself in the form of increasing weakness, jaundice or pallor of the skin, fatigue, drowsiness, dizziness.
• Infertility. It develops in 25-40% of patients with endometriosis. In this case, we are talking about a low probability of pregnancy, and not about its complete impossibility.

Possible complications of endometriosis

Due to hemorrhages and scarring in endometriosis, adhesions are provoked in the organs of the abdominal cavity and small pelvis. Quite often, as a result of pathology, cysts form on the ovaries, which are filled with menstrual blood. Both adhesions and endometrioid cysts can cause infertility.

Also, with endometriosis, compression of the nerve trunks can be observed, which leads to the development of neurological symptoms. Due to significant blood loss, such manifestations are provoked as:

• anemization;
• irritability;
• constant weakness.

Foci of endometriosis in some cases undergo malignancy (malignancy).

Diagnosis of endometriosis of the uterus

When endometriosis is detected, it is important to exclude other gynecological pathologies that occur with similar symptoms. Diagnostic search includes the following activities:

• Collection of anamnesis. It is important to take into account not only the clinical symptoms and complaints of the patient, but also a family history, that is, cases of pathology among family members. It is also necessary to clarify whether gynecological operations were performed.
• Gynecological examination. It can be vaginal, rectovaginal, in the mirrors. The most informative is its holding a few days before the onset of menstruation.
• Colposcopy and hysterosalpingoscopy. They are carried out in order to clarify the localization and parameters of the lesion, as well as to obtain a biopsy.
• Ultrasound procedure. It is necessary to clarify the location of the foci of pathology and the dynamics of the state in the course of therapy.
• Spiral computed tomography or magnetic resonance imaging. These methods allow us to clarify the nature and localization of endometriotic lesions.
• Laparoscopy. The method allows you to visually assess the number, maturity, activity of endometriotic lesions.
• Hysterosalpingography is an X-ray examination of the uterus and fallopian tubes.
• Hysteroscopy is an endoscopic examination of the uterus to detect.
• Laboratory studies: detection of tumor markers CEA, CA-125, CA 19-9 and RO test. These indicators in the case of endometriosis increase significantly. Also, laboratory diagnostics is carried out in order to detect anemia in patients with endometriosis.

Some diagnostic techniques are worth considering in more detail.

Hysterosalpingography

This technique is important for detecting internal endometriosis (adenomyosis or endometriosis of the uterus). The study is carried out with a water-soluble contrast agent on the 5th, 6th or 7th day of the cycle. X-ray shows the presence of contour shadows.

Tomography

Computed tomography can provide information about the boundaries of the pathological process. Magnetic resonance imaging is more informative in endometriosis.

Ultrasound procedure

ultrasound picture of illness

This technique allows you to characterize the pathology according to clear criteria. Endometrioid origin is characterized by the presence of a dense capsule, hyperechoic contents.

In the case of adenomyosis, the study can reveal areas with increased echogenicity, irregularity and serration of the border areas of the endometrium and myometrium, round inclusions about 5 mm in diameter. Nodal variants of adenomyosis are accompanied by the formation of cavities with liquid with a diameter of about 30 mm.

Hysteroscopy

This technique allows you to accurately identify endometrioid passages, the roughness of the relief of the walls of the uterus in the form of crypts or ridges. In 1997 V.G. Breusenko et al developed a hysteroscopic classification of the prevalence of the endometrioid process:

• The first stage: unchanged relief of the walls of the uterus, endometrioid passages are found in the form of “eyes” of a blue tint or bleeding foci. The wall of the uterus is characterized by unchanged density.
• The second stage: uneven relief of the uterine wall in the form of ridges or loose muscle tissue. Endometrioid passages are revealed. The uterine cavity is poorly stretched. The wall has a higher density.
• Third stage: the inner surface of the uterus includes many bulges of various sizes that do not have clear boundaries. Sometimes endometrioid passages are noted on the upper part of the bulges. The uterine wall is very dense.

Differential Diagnosis

Differential diagnosis is necessary to distinguish between endometrioid cysts and ovarian tumors. The final diagnosis is based on history and ultrasound. With endometriosis of the ovaries, there may be no pain, and with an oncological process, non-localized pain may appear.

In the oncological process and in endometriosis, an increase in the level of CA-125 is noted. Therefore, an increase in the concentration of this substance does not confirm only one diagnosis. In some cases, the final diagnosis is possible only during laparoscopic surgery.

In the case of rectovaginal localization of endometrioid lesions, a differential diagnosis with metastases of chorionic carcinoma is required. For the final diagnosis in this case, a correct history taking and a study of the concentration of hCG are required (signs of pregnancy are also determined).

The tubo-ovarian inflammatory process in the form of an abscess is difficult to diagnose due to the erased clinic of inflammation (for example, chlamydial etiology) and the difficulty of distinguishing the process from a benign tumor or cyst of endometrioid origin.

If the formations on the ovary do not regress within two months, surgical intervention is prescribed. Often, the final diagnosis is made after surgery and biopsy examination.

Also, in the case of endometriosis, differential diagnosis with a hyperplastic process of the endometrium may be required. With the retrovaginal nature of the lesion and endometriosis of the ligamentous apparatus of the uterus, it is imperative to exclude malignant neoplasms in the organs of the digestive system.

Treatment of endometriosis of the uterus

The tactics of therapeutic correction is determined by the following parameters:

• age;
• number of pregnancies;
• the number of births;
• the prevalence of the pathological process;
• the location of the foci;
• clinic intensity;
• accompanying illnesses.

There are such methods of treatment of endometriosis:

• Medical.
• Surgical - laparoscopy with the elimination of endometrial lesions or radical removal of the uterus and ovaries.
• Combined.

The goals of therapeutic correction of endometriosis are not only the elimination of symptoms, but also the prevention of adverse processes in the form of adhesions, cysts and other pathologies.

Non-surgical treatment of uterine endometriosis with drugs

Conservative treatment (non-surgical) of the disease is carried out if endometriosis is asymptomatic, the patient is at a young age or at the age of premenopause, and there is also a need to preserve reproductive functions.

The basis of conservative treatment is hormonal therapy with such groups of medicines:

• Combined estrogen-progestogen preparations. These include Nonovlon, Silest, Marvelon. These medicines contain small doses of gestagens, inhibit the synthesis of estrogens and the ovulatory process. They are prescribed in the initial stages of endometriosis, since combined drugs have no effect in the case of widespread endometriosis, the presence of cysts. Possible side effects in case of application: nausea and vomiting, pain in the mammary glands, spotting in the intermenstrual period.
• Gestagens. These include Dufaston, Nemestran, Utrozhestan, Norkoput. Perhaps the appointment at all stages of the endometrioid process. Treatment with these drugs is carried out over a period of six months to 8 months. Possible side effects: intermenstrual spotting, depression, soreness in the mammary glands.
• Antigonadotropic drugs. These include Danol, Danogen, Danazol. The mechanism of action is to suppress the synthesis of gonadotropic hormones in the hypothalamic-pituitary system. A continuous course is prescribed lasting from six months to 8 months. Do not apply in case of hyperandrogenism. The following side effects are possible: hot flashes, sweating, fluctuations in body weight, roughness of the voice, increased oiliness of the skin, increased hairiness.
• Gonadotropic releasing hormone agonists. These include Goserepin, Triptorelin and some other drugs. The advantages of taking medications from this group include the possibility of short-term use and the absence of pronounced side effects. These drugs suppress the ovulatory process, reduce the concentration of estrogen, which together suppresses the prevalence of endometrioid lesions.
• Auxiliary medicines: immunostimulating drugs, antispasmodic, analgesic, anti-inflammatory drugs.

A specific scheme of drug correction of the endometrioid process is prescribed by the attending physician, based on the characteristics of the clinical situation. Therapy of the condition should be comprehensive, it is important to strictly follow medical recommendations for the maximum effectiveness of the chosen tactics for the treatment of endometriosis.

A detailed table on how to treat endometriosis of the uterus with medication, including drugs, their mechanism of action, dosages and side effects:

Medicines	Main mechanisms of action	Dosage and regimen	Possible side effects
Gonadotropin-releasing hormone agonists, prolonged, deposited forms	Blocking the production of gonadotropic hormones	Injection form of administration, once every 28 days, 4 to 6 times	Vegetative-vascular symptoms, in physiological conditions characteristic of menopause, a decrease in bone density
Antigonadotropic drugs: danazol, gestrinone	Gonadotropin blocking, endometrial atrophy	Danazol: 600-800 mg per day for six months, Gestrinone: 2.5 mg 2 times a week for six months	Androgen-dependent dermatopathy, dyslipidemia, high blood pressure, weight gain
Progesterone analogs: dydrogesterone	Decreased proliferation intensity, decidualization	10–20 mg per day from days 5 to 25 of the menstrual cycle or continuously for six months	Not found
Synthetic progestogens: norethisterone	Decreased proliferation intensity, decidualization, atrophic changes in the endometrium	5 mg daily for six months	Weight gain, hyperlipidemia, fluid retention
Combined monophasic, estrogen-progestin drugs	Decreased intensity of endometrial proliferation and ovulatory peak of gonadotropic hormones	Continuous use for 6-9 months	Hypercoagulation, fluid retention

Surgical treatment of endometriosis

With an average and severe degree of development of the endometrioid process, organ-preserving operations on the uterus are indicated. At the same time, fragments of heterotopias in organs, endometrioid cysts are removed, adhesions are dissected.

Video, how to perform surgery on the uterus with endometriosis:

The operation is prescribed if conservative treatment does not bring the desired effect, there are contraindications to taking drugs, there are foci more than 3 cm in diameter, the function of the organs of the excretory system and intestines is impaired. Quite often operational measures are combined with conservative ones. Surgical intervention is implemented through laparotomy or laparoscopy.

A radical operation, that is, removal of the appendages and extirpation of the uterus itself, can be prescribed if the patient is over 40 years old, the pathological process progresses, and there is no effect from less radical correction methods.

In some cases, endometriosis is prone to recurrent course, which may lead to repeated surgical intervention. It is important to undergo preventive examinations with a specialist at least once every six months for the earliest detection of pathology and the effectiveness of conservative correction measures.

The criteria for the effectiveness of the treatment of pathology are:

• good health;
• absence of pain and other subjective complaints;
• the absence of cases of recurrence of the process for five years after a full therapeutic course.

If a woman is of reproductive age, then the effectiveness of therapy is determined by the preservation of childbearing function. In most patients, even surgical correction does not cause complications in the form of infertility due to the use of modern laparoscopic methods.

In the case of radical operations, the resumption of the pathological process does not occur.

Treatment of symptoms at home

Complementary and alternative therapies may include acupuncture, chiropractic, and herbal medicine, but there is no evidence that these are effective.

• According to many reviews found on the forums, it helps some to cope with the disease.
• Avoiding caffeine may help reduce pain, as caffeine may worsen symptoms.
• Exercise, such as walking, can reduce pain and slow the progression of the condition by lowering estrogen levels.

It is important to monitor symptoms because of the long-term complications of endometriosis. Severe pain or unexpected bleeding should be reported to the doctor.

Although there is currently no cure for endometriosis, most women can relieve symptoms and still have children.

Measures to prevent endometriosis

The sooner a woman visits a gynecologist when the initial signs of a pathological process appear, the greater the likelihood of recovery and the lower the likelihood of an operation.

Self-medication or neglect of therapy only worsens the condition: with new menstruation, the appearance of new endometrioid foci, the formation of cysts, the progression of the formation of adhesions and scars, and the patency of the fallopian tubes decrease.

The main preventive measures for the endometrioid process include:

• Examination of patients with complaints of dysmenorrhea. Women of any age with the appearance of symptoms of dysmenorrhea are examined for a tendency to develop the endometrioid process.
• Observation of women who underwent gynecological operations for the timely detection of pathological foci. Any surgical intervention in the area of ​​the organs of the reproductive system can provoke the progression of endometriosis, therefore, after the operation, it is necessary to regularly observe a specialist.
• Timely diagnosis and treatment of acute, chronic inflammatory processes of the reproductive system. Inflammatory diseases can also lead to the development of the endometrioid process, so it is important to treat pathologies in time and not neglect the prescribed methods of therapy.
/ article author

Higher education (Cardiology). Cardiologist, therapist, functional diagnostics doctor. I am well versed in the diagnosis and treatment of diseases of the respiratory system, gastrointestinal tract and cardiovascular system. Graduated from the academy (full-time), has a lot of work experience behind her.

Specialty: Cardiologist, Therapist, Doctor of Functional Diagnostics.

Content

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

Forms of endometriosis

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

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

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

Stages of endometriosis

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

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

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

Cause of the disease

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

1. Implantation of endometrial cells outside the uterine cavity due to their throwing outside the organ during menstruation.
2. Hormonal disorders in the body.
3. hereditary predisposition.
4. Immunity disorders, when the body's defense system does not recognize the abnormal arrangement of endometrial cells and does not destroy them.
5. Malformation of the genital organs even in the prenatal period.
6. Damage to the mucous membrane of the uterus during medical procedures - diagnostic curettage, abortion.
7. Inflammatory and infectious diseases of the genitourinary system.
8. Incorrectly selected contraceptives, prolonged use of an intrauterine device, etc.

signs

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

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

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

Diagnostics

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

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

How to treat endometriosis

If a woman has been diagnosed with this disease, she needs to know that this disease cannot be completely cured, but the right course of therapy will help to level the consequences of the disease and live a full life. Find out what treatments are available for endometriosis.

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

Alternative treatment

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

1. 2 tbsp. l. dried herbs, pour 0.5 liters of vodka, leave for 2 weeks in a dark place. Take tincture three times a day before meals, 30 drops, slightly diluting it with water.
2. 2 tbsp. l. dry chopped herbs add to 1 tbsp. purified vegetable oil. Infuse the remedy also for 2 weeks, then strain the resulting infusion. Insert a tampon soaked in this medicine into the vagina at night.

Why is endometriosis dangerous?

This disease cannot be left to chance, because it is fraught with many serious consequences. Thus, it has been established that endometriosis and infertility are interrelated conditions, therefore, a woman planning a pregnancy must definitely treat this disease in order to realize her reproductive function. An endometrioid cyst on the ovary can lead to loss of the epididymis. If endometriosis occurs together with uterine fibroids, then this combination often threatens with irreversible consequences, entailing the removal of the organ.

Prevention

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

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