Endometriosis. Causes, symptoms, modern diagnostics, effective treatment of the disease. Symptoms of endometriosis in women, diagnosis and treatment

Content

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

Endometriosis is the growth of the lining of the uterus outside of it. 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 develops into cancer.

Causes of endometriosis.

• Period. The disease mainly affects women of reproductive age. There is an opinion 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 high levels of follicle-stimulating and luteinizing hormone, as well as prolactin, which is not observed in healthy women. While progesterone is present in fairly low quantities. The consequences of hormonal imbalance are manifested in an increase in androgens.
• Hereditary predisposition. The likelihood of developing endometriosis is higher if there are already cases of the pathology in the family.

Scientists have identified genetic markers that determine a woman's susceptibility to endometriosis.

• Disturbances in the functioning of the immune system. With adequate functioning of the immune system, mucosal cells do not appear and take root outside the inner layer of the uterus. A failure in the immune system leads to the casting and further growth of endometrial cells in tissues that are unusual for them.
• Metaplasia arising in the endometrium. There is a hypothesis that endometrial cells outside the uterine lining can turn into other tissue.

The causes of endometriosis still pose a certain mystery to scientists.

There are certain factors that may explain why endometriosis occurs.

Among the factors determining the occurrence of endometriosis are:

• mechanical damage to the uterine mucosa that occurs due to abortion, curettage and surgical interventions;
• adverse effects of ecology and the external environment;
• disruption of hemoglobin production;
• overweight;
• concomitant inflammatory processes of the genital area.

The reasons behind the occurrence of pathology are individual in nature.

Forms and degrees

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

Depending on the area of ​​origin of the pathology, various forms are distinguished.

• Genital. In this form, pathological foci appear in the myometrium, ovaries, tubes, genitals, on the cervix, vagina and peritoneum.
• Extragenital. Lesions appear in the intestines, bladder, and 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 most often manifest themselves in the occurrence of uterine adenomyosis, which cannot be said about other varieties.

Adenomyosis is also called internal or endometriosis of the uterus.

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

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

Clinical picture and symptoms

There are numerous symptoms that vary among 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.

• Pain of varying degrees of intensity. The occurrence of this symptom is characteristic of all types of endometriosis. Pain appears in the lower abdomen and spine and increases sharply during menstruation. The consequences of the disease also include discomfort during sexual intercourse and bowel movements.
• Changes in the nature of menstruation. The pathology is characterized by the appearance of spotting brown discharge before and after menstruation, which does not happen normally. Discharge during menstruation becomes heavier and lasts longer than usual. In the middle of the cycle, breakthrough bleeding that is not associated with menstruation often appears.

Consequences of regular blood loss often result in anemia.

• Infertility. This symptom often appears with 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 fertilized egg. Another cause of infertility with endometriosis is an extensive adhesive process, which often accompanies the pathology.

• Intoxication. When the disease occurs, women often experience weakness, nausea, and low-grade fever.
• Specific symptoms. For example, intestinal endometriosis is characterized by the occurrence of increased peristalsis.

Some women do not pay attention to the occurrence of unusual symptoms during menstruation. Normally, menstruation is not a cause of disability.

Diagnostic methods

The consequences of endometriosis are certain disorders of various organs. However, endometriosis often appears unnoticed by the woman herself. Its occurrence is associated with many reasons that cannot always be determined.

Diagnostic methods for studying endometriosis.

• Gynecological examination. By palpation, the doctor can diagnose increased sizes of the organ and appendages, as well as the occurrence of pain and limited mobility of the organ, which is a consequence of adhesions.
• Colposcopy. The method is used when a retrocervical type of disease occurs.
• Ultrasound of the pelvic organs using a vaginal sensor. It should be noted that this study is fundamental in diagnosis. When performing the procedure, you can clearly visualize changes in the ovaries and myometrium.

• Hysterosalpingography. The method is used in cases of infertility, as it diagnoses tubal patency.
• Hysteroscopy. This test helps identify adenomyosis using a hysteroscope.
• Laparoscopy. The procedure allows you to diagnose any form and variety of endometriosis, which cannot be achieved using other methods.

Laparoscopy can be called the most informative method. During its implementation, it is possible to carry out both diagnosis and adequate treatment, which cannot be said about other methods.

• Blood test for marker CA-125. This study is ancillary because the results are 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 specialist is very important to make a diagnosis.

The scope of diagnostic methods depends on the woman’s medical history. Sometimes a simple examination on a chair and an ultrasound are enough to confirm the diagnosis.

Treatment

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

Treatment can be divided into large groups:

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

Conservative therapy is based on taking medications:

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

Use of drugs this group is contraindicated in cases of hirtusism due to the fact that the medicine increases testosterone levels.

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

Many women are interested in 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 cancer;
• 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 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 does not often use such an operation.
• Radical surgical intervention. Some forms and features of the progression of the disease cause uterine amputation. This is a last resort measure, used mainly in women before and after menopause.

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

The emergence of positive dynamics depends on the chosen treatment methods, as well as on the characteristics of the woman’s medical history. As an effect of the treatment, restoration of reproductive function and reduction of 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;
• spikes;
• 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.

Particular care should be taken when:

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

To prevent the occurrence of the disease, you must:

• regularly visit a gynecologist and undergo a full examination;
• promptly treat gynecological and inflammatory diseases;
• avoid obesity and stress;
• do physical education;
• abstain from intimate life during menstrual periods;
• plan pregnancy and prevent abortions;
• lead a healthy lifestyle.

Endometriosis is one of those pathologies that is easier to prevent than to treat. Women who have been diagnosed should be especially careful to avoid the consequences of this serious disease.

Endometriosis is a disease in which tissue grows outside the uterine cavity, with properties similar to uterine tissue. The incidence of the disease ranges from 7 to 50% in women of childbearing age.

A special case of the disease is adenomyosis (location of endometrial tissue in the thickness of the muscle layer)

Symptoms and signs

The main symptoms include

• complaints of pain, a feeling of heaviness in the lower abdomen;
• intermenstrual discharge is often brown and spotting;
• Long-term endometriosis may be accompanied by manifestations from the central nervous system, such as decreased performance, drowsiness, deterioration of attention, and irritability.

Endometrial cells extend beyond the uterus, where they can settle and grow on the peritoneum, fallopian tubes, ovaries and neighboring organs: rectum, bladder, intestines, and other organs. It is extremely rare (when they enter the bloodstream) that these cells settle in the lungs, larynx, kidneys and other organs distant from the uterus.

The peculiarity of endometriosis is that, regardless of where the endometrial cells settle, they function similarly to those in the uterus, that is, every month, according to the phases of the menstrual cycle, they grow, loosen, and bleed on the days of menstruation (for example, with endometriosis of the urinary system, bloody spots appear discharge with urine, with endometriosis of the rectum - discharge of blood from the anus, etc.).

Every month, a few days before and during menstruation, a woman experiences abdominal pain of varying severity - from discomfort to the need to lie down, take painkillers, and even complete loss of ability to work. These pains can spread to the rectum, sacrum, buttocks, legs, back, etc.

In the latter case, there is often pain during sexual intercourse up to complete impossibility. Depending on the location and extent of its spread, endometriosis may be accompanied by headaches and dizziness.

There are cases of asymptomatic progression even with severe damage to one or another organ.

When endometriosis affects any part of the reproductive system (uterus, fallopian tubes, ovaries, pelvic peritoneum), infertility can occur.

Examinations for suspected endometriosis

A number of procedures are performed to make a diagnosis.

History taking

A doctor can suspect a disease based on the patient’s list of her complaints and symptoms.

Will indicate endometriosis

• menstrual irregularities (painful and heavy menstruation, chocolate-colored discharge before menstruation),
• pain that worsens before menstruation,
• as well as the presence of infertility
• involvement in the process of internal organs located next to the uterus and ovaries (bladder, rectum).
• Patients with endometriosis-affected rectum often note that pain before menstruation radiates to the sacrum and anus, accompanied by constipation, blood in the stool, and painful bowel movements. During sexual intercourse, such patients also experience pain and pain radiating to the rectal area. If endometriosis has infiltrated the bladder wall, then patients report painful urination, and urine tests periodically reveal traces of blood (a small amount of protein and blood cells).

Gynecological examination

During a mandatory vaginal examination by a gynecologist, characteristic signs for endometriosis are determined:

• spherical shape of the uterus,
• enlarged ovaries due to endometrioid cysts,
• limited mobility of the uterus and appendages with severe adhesions,
• seals behind the uterus in the form of spikes, painful on palpation - this is a sign of damage to the uterosacral ligaments by endometriosis.

Colposcopy

Colposcopy, or examination of the cervix using a microscope, allows you to see the presence of endometriosis on the cervix.

Ultrasound examination of the pelvic organs

MRI and CT are radiological research methods.

They highlight healthy body tissues and those affected by endometriosis more clearly than ultrasound. Using CT and MRI, it is possible to make a differential diagnosis between uterine fibroids, a malignant tumor and a nodular or infiltrative form of endometriosis, as well as assess the degree of involvement of the bladder, uterosacral ligaments behind the uterus and the rectum.
The sensitivity and accuracy of MRI diagnostics is 95%, so this method should always be prescribed to make a diagnosis in unclear cases.

Hysteroscopy examines the inside of the uterus using a microscopic camera, usually performed under intravenous anesthesia in a hospital.

The doctor usually prescribes hysteroscopy in cases where there are menstrual irregularities and the pathology of the endometrium is described by ultrasound - growth of the endometrium, the presence of polyps, nodes that deform the uterine cavity, suspicion of a malignant disease. In these cases, the diagnosis is clarified by visual examination of the uterine cavity and endometrium, and as a result of histological examination of an endometrial biopsy from the uterus, a malignant disease can be excluded.

Hysteroscopy to clarify the pathology of the endometrium is also indicated for all patients with infertility.

This is the most accurate method of diagnosing endometriosis and clarifying the stage and extent of the process.

Laparoscopy involves puncturing the abdominal wall to insert a special instrument equipped with a video camera - a laparoscope. You can examine the uterus, ovaries, ligamentous apparatus of the uterus, bladder and rectum, assess the severity of the adhesive process, and conduct a study of the patency of the fallopian tubes. When the diagnosis of external genital endometriosis is confirmed, diagnostic laparoscopy moves into the therapeutic stage (surgical treatment of endometriosis).

Tests for endometriosis

Laboratory diagnosis of endometriosis: it has been established that with endometriosis, the concentration of tumor markers in the blood of patients increases -

• CA-125, CEA (carcinoembryonic antigen)

An increase in CEA in the blood is observed with endometriosis, as well as with malignant tumors of the uterus, ovaries, and vulva.

CA-125 is specific for ovarian adenocarcinoma; for endometriosis, its specificity is 97%, sensitivity is only 27%.

In a nutshell, it’s worth deciphering “specificity” and “sensitivity.” That is, in simple terms, only 27 patients out of 100 will have this tumor marker in their blood above normal. The remaining 73 sick people will not be sensed by the method. But for those whose tumor marker is elevated, 97% (almost 100%!) will be confirmed to have a specific disease.

Important! Due to the low sensitivity of the markers, the determination of tumor markers in the blood is only an auxiliary method for diagnosing endometriosis.

Treatment methods

Endometriosis is a chronic and recurrent disease, therefore, patients with an established diagnosis of endometriosis should be monitored by a gynecologist for life. The priority is comprehensive treatment of the disease: surgical removal of endometriosis foci, followed by drug therapy and prevention of repeated surgical procedures.

Symptomatic

involves the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the intensity of pain. They are recommended to be used for no more than 3 months. due to the large number of side effects on the stomach and intestines. It is assumed that the doctor prescribes NSAIDs temporarily, for the period of exacerbation or until the main drug or surgical treatment begins to work.

Hormonal treatment

Many patients are frightened by the very principle of taking hormones. Women are concerned about fears of weight gain and facial hair growth, which was characteristic of the use of the first hormonal drugs invented decades ago. Nowadays, most medications are free of these side effects. Others remain: fluid retention in the body, engorgement of the mammary glands, decreased libido, the appearance of acne, increased thrombotic activity of the blood, depressed and changeable mood, headaches, intermenstrual bleeding, vaginal dryness, vaginitis, etc.

Meanwhile, hormonal therapy for endometriosis plays a key role and cannot be done without it, because initially endometriosis develops precisely because of hormonal imbalance. In areas of heterotopia, endometrioid tissue grows under the influence of excess estrogen levels and a decrease in the sensitivity of focal cells to gestagens. Treatment of endometriosis can be carried out using various groups of drugs with a similar mechanism of action: they all reduce the amount of estrogens in the blood of patients, and some of them increase the sensitivity of endometrial cells to gestagens. Groups used in treatment:

• gestagens as a first line drug. This is a large group of drugs (4 generations), the action of which is aimed at suppressing the growth of the endometrium. The drugs are available in different forms - for oral administration (for example, Visanne, Norkolut, Duphaston), as injections (Depo-Provera), as an intrauterine device with hormone release (Mirena).
• combined (estrogen + gestagen containing) oral contraceptives (for example, Silhouette, Janine, Qlaira) also inhibit the growth of the endometrium,
• Gonadotropin-releasing hormone agonists (GnRH) - act on hormones at the level of the brain, pituitary gland and hypothalamus. Examples - Buserelin, Lucrin-depot, Zoladex,
• antigonadotropins with androgenic action - Danazol, Gestrinone,
• group of aromatase inhibitors (inhibitors of estrogen synthesis in peripheral tissues) - Anastrozole, Letrozole,
• combination of drugs with each other and with surgical treatment.

Surgery

Surgical treatment can be radical (implies removal of the uterus and appendages) only in severe cases of the disease and in the case when the woman has already completed her reproductive age and is not interested in pregnancy. In all other cases, surgical treatment will be organ-preserving if possible.

Based on surgical access, surgical treatment is divided into laparoscopic and abdominal (abdominal).

Laparoscopy in the treatment of endometriosis

Laparoscopy is the preferred surgical approach (the “gold standard”) for the treatment of endometriosis of any severity. Advantages of laparoscopic approach:

• minimal tissue trauma,
• the period of postoperative rehabilitation is reduced,
• lower percentage of formation of postoperative adhesions,
• better visualization of affected tissues due to the optical magnification of the endoscope camera, hence more painstaking and skillful work of the surgeon.

When performing laparoscopy, it is possible to remove endometrioid cysts and nodes, cauterize or excise foci of endometriosis on the pelvic peritoneum, separate adhesions, restore the patency of the fallopian tubes and normal pelvic anatomy, and introduce an anti-adhesion gel barrier. It is even possible to remove the uterus and appendages using surgical laparoscopy if the surgeons have the appropriate qualifications.

Abdominal (abdominal) access with an incision into all layers of the abdominal wall is still necessary in cases of extensive organ damage and the need to excise endometriosis nodes from the walls of the rectum and bladder. Here, abdominal surgery is safer for the patient and the doctor.

In patients with severe pain, menstrual dysfunction, in the absence of effect from laparoscopic organ-sparing surgery, but wishing to preserve the uterus, cases of ablation of the uterosacral nerve (LUNA operation) are also used. At the same time, the effect of reducing pain from denervation is described as insignificant.

Surgical treatment is indicated for patients with identified cystic forms of endometriosis, with intractable chronic pelvic pain syndrome, with infertility, with nodular forms of the disease, when adjacent pelvic organs are involved in the process with impaired function and pain.

The goal of surgical treatment is to remove all foci of endometriosis, while observing the principle of organ preservation whenever possible. Removal of disease foci is the main factor in reducing pain in the postoperative period in patients. Also during the operation, adhesions are separated and the normal anatomy of the pelvic organs is restored.

Treatment of endometriosis after surgery

After the surgical stage, drug treatment should be individualized depending on the severity of endometriosis, the patient’s age, interest in pregnancy, the presence of concomitant diseases, etc.

If the patient had no complaints, and only during a planned operation to remove an ovarian cyst, its endometrioid nature was revealed, then in the postoperative period it will be enough to prescribe a COC of a certain composition (containing dienogest) with subsequent monitoring by a gynecologist over time.

If the patient at the clinic has severe pain and bleeding, and the operation reveals a severe degree of the disease, then the gynecologist will prescribe hormonal therapy for her for a long time and using one or more drugs. Thus, a combination of gonadotropin-releasing hormone agonists with gestagens, or the pure use of gestagens, would be reasonable.

Important! All medications must be prescribed by a doctor individually for each specific patient! For a woman who is not interested in pregnancy, the doctor will advise choosing, for example, an intrauterine hormonal device as a drug containing a progestogen. For a patient planning to enter an IVF program after treatment, a completely different drug is available.

What to consider when choosing a hormonal drug:

• stage and prevalence of endometriosis,
• patient's age,
• plans for the implementation of fertile function,
• tolerance to hormonal drugs,
• the presence of concomitant diseases,
• patient's budget options.

Hormonal treatment is usually prescribed for 3 months, then its effectiveness is assessed. If the result is satisfactory, treatment continues for up to 6-9 months, with subsequent observation by a doctor and the appointment of maintenance and preventive therapy. If treatment is ineffective, either the treatment regimen is changed or surgical treatment is prescribed if it has not been used before.

In the postoperative and rehabilitation period, patients may benefit from physiotherapeutic treatment methods - magnetic and electromagnetic fields of low frequency, balneotherapy, hydrotherapy (coniferous, general radon and iodine-bromine baths). And, conversely, you should be aware of the factors that negatively affect the body and cause the progression of the disease. Contraindicated for use in patients with endometriosis:

• healing mud,
• paraffin, heated sand,
• bath and sauna,
• hydrogen sulfide, turpentine, sodium chloride, sulfide baths,
• Excessive sunbathing is not recommended.

When surgery is not required

Surgery can be avoided if the patient does not have cystic or severe common forms of endometriosis.

For example, a patient with menstrual dysfunction at the age of 50 years consulted a doctor; the examination revealed a slight enlargement and heterogeneity of the uterine walls; no abnormalities were described in the appendages and pelvis. The patient underwent hysteroscopy with an endometrial biopsy, a malignant disease of the uterus was excluded, and the walls of the uterus and endometrium were visually examined with a hysteroscope camera. It has been established that there is internal endometriosis of the uterus (adenomyosis). The patient is prescribed hormonal therapy for 6 months with a drug from the group of gestagens with an assessment of the effect after 3 and 6 months.

Another example: a 35-year-old patient, interested in pregnancy, consulted a doctor. Three years ago, she had already undergone laparoscopy for endometrioid cysts of both ovaries and resection of the ovaries; now, according to ultrasound, a picture of adenomyosis and small cystic inclusions on the operated ovary (no more than 2 cm), presumably endometrioid, are described. Regarding infertility, the patient is being seen by a reproductive specialist and is preparing for an IVF protocol. Now, before IVF, she needs to have an endometrial biopsy. A reproductive specialist does not recommend repeated excision of ovarian tissue to avoid preserving the supply of eggs. Before IVF, to suppress the activity of endometriosis, together with a reproductologist, treatment was prescribed using drugs from the group of gonadotropin agonists without repeated surgery.

Forecast

Endometriosis is a recurrent disease; the process does not recur only in patients who have undergone radical surgery to remove the uterus and appendages. The prognosis is more favorable for women who received treatment before menopause: after hormonal therapy, a smooth transition to menopause usually occurs, estrogen levels continue to decrease physiologically and no relapses occur.

At reproductive young age, the relapse rate is up to 20% per year, and after 5 years - up to 74%. Therefore, it is important to be observed by a gynecologist without interruptions and to complete courses of hormonal therapy. It is also important to choose a competent attending physician who takes into account the characteristics of the patient’s case and, together with her, sees the goals of treatment:

• removal of endometriosis foci,
• fight against infertility,
• reducing the risk of re-operation and relapse of the disease,
• prevention of disease progression and spread to neighboring organs,
• reducing pain and improving quality of life.

Endometriosis- one of the most mysterious women's diseases. Despite the fact that this diagnosis is given to women quite often (statistics show that up to 30% of women of reproductive age suffer from endometriosis in one form or another), the question - what kind of disease is this, why and how to treat it, often remains without answer. But what if a woman with endometriosis is planning a pregnancy - is anything necessary to be done in this case?

What is endometriosis? Causes of endometriosis

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

Why these cells appear in the wrong places is a mystery to which doctors do not have a clear answer. There are several theories about the appearance of endometriosis. In general, the picture looks like this. The inside of the uterine cavity is lined with a mucous membrane called the endometrium (metra - uterus; endo - inside). This mucous membrane consists of two layers - basal and functional. The functional layer is shed every month during menstruation, unless pregnancy occurs. Over the next month, the endometrium grows again due to the proliferation of cells in the basal layer, under the influence of ovarian hormones. The ovaries directly produce hormones that influence the development of the endometrium, in particular estrogens and progesterone. Estrogens (hormones of the first half of the menstrual cycle) promote the growth of the endometrium and the maturation of the egg. After ovulation, the amount of estrogen decreases, the ovaries begin to secrete progesterone, which suppresses the growth of the endometrium and promotes the development of glands in it, preparing it for the implantation of a fertilized egg. If pregnancy does not occur, then the level of estrogen and progesterone drops, the endometrium is rejected by the uterus, which is externally manifested by menstruation. Discharge during menstruation is a mixture of blood and fragments of the rejected endometrium.

For the formation of endometriosis, at least two factors are necessary: ​​hormonal imbalance and impaired immunity.

Hormonal imbalance

Endometriosis does not develop in a woman’s body unless she has a malfunction of the hormonal system. Regulation of the female reproductive system is ensured with the participation of many hormones produced by the glands of the brain (hypothalamus, pituitary gland) and ovaries. Moreover, the function of the ovaries is controlled by pituitary hormones, and the function of the pituitary gland, in turn, is controlled by the hormones of the hypothalamus. If a malfunction occurs in the functioning of the system at any level of regulation (hypothalamus-pituitary-ovaries), then the ratio of estrogen and progesterone in the body is disrupted in favor of estrogens. This leads to suppression of ovulation and proliferation of the endometrium, which is then shed in patches, causing bleeding. Individual cells of the immature endometrium are thrown into atypical places, forming areas of endometriosis.

Immunity disorders

Another cause of endometriosis is immune disorders. The human immune system is designed in such a way that it protects the body from any “unusual” proteins, destroying “foreign” proteins of infections, foreign bodies or tumor cells. In the same way, it destroys cells that are uncharacteristic for a particular tissue, in particular, endometrial cells that have entered other tissues. In almost all women, during menstruation, discharge not only comes out (through the vagina), but is partially thrown through the tubes into the abdominal cavity, the wall of the uterus, the ovaries, and also into the blood and spread throughout the body. Normally, menstrual fluid that enters the abdominal cavity is quickly destroyed by special protective cells of the abdominal cavity. Endometriosis occurs when the immune system ceases to recognize endometrial cells in other tissues, allowing them to multiply unhindered anywhere.

Risk factors

The following factors may contribute to the development of endometriosis:
early onset of menstruation;
family predisposition - often mothers suffering from endometriosis, daughters also face this problem;
endometriosis most often affects thin, tall women with red hair;
various disruptions in the body's immune system.
After the endometrial cells take root in a new place, they continue to exist according to the laws of the menstrual cycle as they did while in the uterine cavity - in the first half of the cycle they actively multiply and grow, and when menstruation arrives, they are rejected into the abdominal cavity, leading to the formation of new foci of endometriosis. Lesions of endometriosis come in different shapes, sizes and colors. Most often these are small compactions that are scattered throughout the peritoneum. Sometimes these lesions merge, especially often behind the uterus on its ligaments, forming a lesion several centimeters in size (this condition is called retrocervical endometriosis). If endometrial tissue enters the ovary, benign endometriotic cysts can form in it. Endometriosis of the uterine body (adenomyosis) occurs when endometrial cells invade the muscular layer of the uterus. In rare cases, foci of endometriosis can be found in a variety of organs and tissues of the body. So, there is endometriosis of the kidneys, ureters, bladder, lungs, and intestines. This occurs because fragments of endometrial tissue are carried throughout the body by the lymphatic or circulatory system, and can also enter wounds during surgery. For example, endometriosis occurs in the scar after cesarean section, as well as in the scar after dissection of the perineal skin during childbirth.
During pregnancy, menopause and menopause, foci of endometriosis undergo a reverse process, which leads to an improvement in the woman’s condition.

Symptoms of endometriosis. How does endometriosis manifest?

In rare cases, a woman does not even suspect that she has endometriosis, since it can occur without showing itself at all. But much more often, this disease seriously affects a woman’s well-being. One of the main signs of the disease is pain in the lower abdomen associated with the menstrual cycle. They subside at the beginning of the menstrual cycle, increase towards its end, becoming especially strong during menstruation. The pain is most often bilateral, sometimes accompanied by a feeling of pressure in the rectum and can radiate to the back and leg. Discomfort and pain can also occur during sexual intercourse, as well as during bowel movements. Sometimes the pain is so severe that sexual life becomes impossible. The cause of the pain lies in irritation of the nerve endings of the peritoneum by the “menstruating” endometriotic foci. This leads to the formation of adhesions (connective tissue cords), the formation of an adhesive process in the abdominal cavity, which in turn leads to constipation up to intestinal obstruction with frequent, painful urination. Almost all women with genital endometriosis complain of pain during sexual intercourse. Another sign of this disease is prolonged menstruation, dark spotting before and after menstruation, and bleeding between periods. The cycle becomes irregular or shortened. Menstruation becomes profuse, clotted and painful. The woman constantly suffers from blood loss, which leads to anemia. Cervical endometriosis manifests itself as bloody discharge after sexual intercourse.

Often this insidious disease also affects the emotional state of a woman: constant pain, disturbances in the sexual sphere, difficulties with conception, lead to irritability, imbalance, and depression.

Diagnosis of endometriosis

A doctor can suggest a diagnosis of endometriosis during a routine gynecological examination: for example, he can see its focus on the cervix or feel painful lumps in the vagina. The doctor also pays attention to pain, its connection with menstruation and sex life. To confirm or clarify the diagnosis, pelvic ultrasound, magnetic resonance imaging, colposcopy, hysteroscopy and laparoscopy are used.

Pelvic ultrasound cannot determine the presence of foci of endometriosis in the peritoneum. But using this method you can detect an endometrioid ovarian cyst, although in some cases such cysts may be similar to other ovarian formations, for example corpus luteum. Also, using ultrasound, you can determine the accumulation of endometriotic tissue in the retrouterine space with retrocervical endometriosis.
Magnetic resonance imaging is a more informative research method. Ovarian endometriosis using this method is diagnosed with 96% accuracy.
Colposcopy(examination of the vagina and cervix using a microscope) allows you to clarify the location and form of damage to the cervix and vaginal tissue by endometriosis.
Hysteroscopy(examination of the uterine cavity using a special hysteroscope device) helps in diagnosing adenomyosis.
Determination of tumor markers. To diagnose endometriosis, they resort to determining tumor markers in the blood. A tumor marker is any protein substance that appears in a cancer patient and correlates with the presence of a tumor, the degree of its spread and regression. The level of CA125 increases in the blood of women suffering from endometriosis. However, this test is not specific for endometriosis, since the concentration of CA125 in the blood can be increased in other diseases (ovarian cancer, pregnancy, inflammatory diseases of the appendages). In general, CA125 determination is used to assess the effectiveness of conservative treatment of endometriosis.
Laparoscopy is the "gold standard" for diagnosing endometriosis. This is a gentle surgical operation that allows you to examine the abdominal cavity under magnification (using a special device - a laparoscope) through small holes in the abdominal wall. In fact, only with this method can you see foci of endometriosis and take a biopsy (pieces of tissue) from them to confirm the diagnosis. Without laparoscopy, the diagnosis of endometriosis can only be assumed.

Treatment of endometriosis

It should immediately be noted that endometriosis treatment– this is a long process. Conservative, surgical and complex methods can be used. When choosing a treatment method, the specialist takes into account the patient’s age, the severity of the disease, and whether the woman is planning a pregnancy.

Conservative treatment is prescribed mainly for diffuse forms of the disease. First of all, these are hormonal drugs that suppress the activity of estrogen. It is estrogens that are the “culprits” of uncontrolled growth of the endometrium, and then its long-term rejection, during which endometrial cells enter other organs and tissues.

The effect can be at any level of hormonal regulation. These may be drugs that inhibit the secretion of pituitary hormones, without which the ovaries cease to function and artificial menopause occurs, which can be maintained as long as necessary to achieve a therapeutic effect. Naturally, such treatment is accompanied by side effects that resemble natural menopause (hot flashes, emotional lability, decreased bone mass). Excess estrogen is also corrected by prescribing hormonal contraceptives. It is preferable to use monophasic: lindinet, midiana, dimia, silhouette, janine, claira. In this case, the same level of hormones is achieved throughout the entire cycle, which does not allow the endometrium to develop as in the natural cycle. Foci of endometriosis lose their activity. Hormonal imbalances can also be corrected by administering pure progesterone (balancing excess estrogen).

Iron deficiency anemia must be treated with iron supplements and a special diet. Immunomodulating, analgesic and hemostatic drugs are also prescribed. It is almost impossible to eliminate endometriotic lesions, but treatment can cope with pain and normalize the menstrual cycle, which increases a woman’s chances of becoming pregnant.

In some cases, for example, when adhesions form due to endometriosis, it is necessary to resort to surgical treatment. Most often, laparoscopy is used, which makes it possible to remove foci of affected tissue and adhesions in the least traumatic way.

When treating endometriosis, conservative and surgical treatment is often combined. Unfortunately, it is rarely possible to completely get rid of this disease; treatment only allows you to stop the disease, which gives a temporary head start for pregnancy.

In addition, many doctors believe that the effectiveness of surgical treatment for a combination of infertility and mild forms of endometriosis has not been proven. On average, 90% of women with mild to moderate endometriosis become pregnant without surgery within 5 years. This is comparable to the pregnancy rate in healthy women during the same time period (93%).

If a woman is not planning a pregnancy, she is prescribed oral contraceptives immediately after surgery to prevent relapses of endometriosis.

Planning pregnancy with endometriosis

Endometriosis is often associated with infertility. It is believed that endometriosis can disrupt the maturation of the egg and the process of its release (ovulation), which leads to the impossibility of fertilization and implantation of the fertilized egg. With a long course of endometriosis, the risk of developing infertility increases due to the adhesive process in the genitals. Particularly dangerous in this regard are adhesions in the fallopian tubes and ovaries, which create an obstacle to the advancement of the egg, making it impossible for it to meet the sperm and conceive.

However, endometriosis is not a “guarantee” of absolute infertility. There are proven facts of accidental detection of this disease in women who have never had problems conceiving. Also, after treatment for endometriosis, many women manage to get pregnant.

After conservative treatment, it is recommended to plan pregnancy no earlier than three months after treatment, so that the expectant mother’s body can fully recover.

After surgery, on the contrary, it is necessary to plan pregnancy immediately (unless a combined course is prescribed - a combination of surgical and hormonal treatment). Many doctors advise that before undergoing surgical treatment of endometriosis, make sure that infertility is not caused by other disorders. If there are several possible causes of infertility, it is recommended to first eliminate all other problems and only then undergo surgery for endometriosis. This is due to the fact that the effect of the operation does not last long; the chances of conception increase only in the first 6-12 months after the operation.

The course of pregnancy with endometriosis

Although this disease makes it difficult to get pregnant, it is still possible, even without treatment. During pregnancy, endometriosis, as a rule, is not treated, and this is done after the baby is born. The only exception is when an expectant mother is diagnosed with an endometrioid ovarian cyst: if there is a danger of its rupture or torsion, then an operation is planned, which is usually performed at 16–20 weeks of pregnancy (this is the period that is safest for the fetus).

The combination of pregnancy and endometriosis requires special attention from doctors. Pregnancy often has to be supported with the help of hormones to prevent miscarriage. The threat of miscarriage can arise in the first and second trimesters due to a lack of the female sex hormone progesterone in the body - estrogens suppress the secretion of progesterone. And progesterone is necessary during this period mainly for the proper development of pregnancy and suppression of contraction of the uterine muscles. After 12 weeks of pregnancy, when the placenta is finally formed, the likelihood of miscarriage decreases. Endometriosis itself no longer threatens the fetus - it does not affect its development in any way.

Prevention of endometriosis

Preventive measures include: gynecological examinations at least once a year; treatment of acute and chronic diseases of the reproductive system, menstrual disorders; normalization of lifestyle and nutrition; combating chronic stress; use of hormonal contraception; pregnancy planning.

Gynecological diseases of various types occur in women of all ages due to the influence of a large number of factors. One of the pathological processes in the fair sex is endometriosis. Symptoms and treatment in women will be discussed within this article.

Endometriosis is a common disease and is characterized by an altered state of endometrial cells. They grow beyond the proper layer. The disease affects people of reproductive age and involves many changes in the body. During the process, inflammation of the surrounding tissue occurs, which causes the main symptoms of endometriosis. Symptoms and treatment for this disease in women depend on the location of the damaging and stimulating factors. The disease can develop outside the reproductive system, but within the framework of the article, it is the genital disease that is considered.

Classification of ailments:
This factor can be classified into several types and groups.

• External disease – refers to the pelvic peritoneum and ovaries.
• An internal disease involves the ingrowth of the endometrium into neighboring tissues.

Within the development of the second disease, the uterus grows and a significant change in its shape to the state of a ball or circle. The lion's share of morbidity cases may be due to fibroids, since this condition develops according to a similar development mechanism.

Stages and forms of the disease:
If we consider the classification signs according to the depth of tissue damage, there are 4 stages of the disease.

1. The lesions are superficial and single in nature.
2. Deeper lesions are present.
3. Multiple formations are observed.
4. An incredible number of deep lesions are present.

Prevalence of the disease:
As already mentioned, the disease can affect women of reproductive age, but the exact prevalence parameters are unknown. Many women believe that the disease is a normal part of the menstrual cycle, so they are in no hurry to consult a specialist.

If the body is healthy, then within each menstrual cycle, the lack of fertilization of the female cell suggests rejection of the surface endometrial tissue. Sometimes menstrual blood is thrown into the abdominal cavity through the fallopian tubes, where endometrial cells are grafted and grow. This process marks the beginning of the external type of disease.

Among the main symptoms of the disease, several areas can be distinguished.

• Significant pain in the pelvic area. Typically, these phenomena are cyclical in nature and appear most acutely during menstruation. Sometimes these sensations can be permanent.
• Menstrual bleeding noticeably increases and lengthens.
• During sexual intercourse, minor or significant pain also occurs.
• When a person empties his bowels or bladder, this process is also accompanied by pain.

In general, the symptoms are varied, which can confuse even experienced specialists. Sometimes there may be no signs, which makes diagnosis and timely treatment difficult. In all forms, identical manifestations occur, but the degrees of their severity are different. If there are no symptoms, one of the manifestations of the disease is infertility. Signs of intoxication may also appear - chills, increased levels of leukocytes, and so on. Experts do not recommend mastering self-diagnosis; the best solution would be to contact a specialist.

Is it possible to get pregnant with endometriosis?

The probability of conceiving a child is always present, but with this disease, since it causes infertility, it is small. Even if conception is possible, the presence of this disease in a woman’s body can cause some complications for the development of the fetus and for the health of the expectant mother. Therefore, it is not recommended to become pregnant until endometriosis, the symptoms and treatment of which in women has been completely completed.

These concepts are different from each other, but women tend to confuse the terminology. Unlike endometritis, the disease in question is a more severe pathological process. But endometritis is also intended to cause risks and threats to women’s health. The only similarity between the diseases is that in both cases there is a possibility of developing infertility. But with proper medical intervention, endometritis can disappear forever.

What is endometritis

Endometritis is an inflammatory disease that causes damage to the internal uterine layer - the mucous membrane and endometrium. Sometimes the muscle layer is involved in the inflammation process. There are acute, chronic and combined forms of manifestation. The layer may become covered with a coating of pus, during which the functionality of the reproductive system decreases.

Symptoms of endometritis

Various interventions take an active part in inflammatory processes - cesarean section, curettage, abortion. All these factors contribute to a decrease in the body’s defenses and aggravation of the overall situation. Sick people feel significant weakness and a general state of malaise. They may have a fever and pain in the lower abdomen. In practice, there were many cases with rapid heartbeat and increased ESR.

Treatment with herbs and special compounds, based on expert opinion, is designed to help solve a wide range of problems.

• Elimination of the reason why the disease arose and manifested itself.
• Individual intolerance is the only contraindication to treatment.
• Absence side effects and serious complications after treatment measures taken.
• In addition to treating the disease, the body’s health is observed.
• An important advantage of this treatment method is its affordability.

Selected herbal mixtures offered in pharmacies, applied strictly according to the indicated dosage, are used for douching and internal drinking. There are also alternative folk remedies used in combination as an effective addition to therapy.

Proper use of techniques will allow you to achieve excellent therapeutic results.

Visanne is a hormonal drug that has a complex effect and ensures rapid recovery. Based on patient reviews, it allows you to solve many problems.

• Fighting the cause of the disease.
• Suppression of acute symptoms of the disease.
• Improving female reproductive functions.

But the use assumes the existence of contraindications in the form of pregnancy, lactation and individual intolerance to the drug substances.

Have you observed endometriosis symptoms and treatment in women? Leave your opinion or review for everyone on the forum!

Due to the difficulties in identifying symptoms and treating endometriosis, it still remains somewhat of a “mystery” for modern science.

Some statistics:

• 15–50% of all women have heterotopia.
• It is not possible to establish the exact incidence rate, since it is estimated that in 15–20% of women it is asymptomatic.
• Endometriosis is mainly diagnosed during childbearing age – 25–40 years.
• It is also detected in approximately every tenth girl during the establishment of the menstrual cycle and in 2–5% of women in menopause.
• It is extremely rare that endometrioid heterotopias are first diagnosed before menarche or during the postmenopausal period.
• There are cases of chronic endometriosis.
• In the vast majority of cases (more than 95%), endometriosis occurs in the genital area.

Endometrioid heterotopias have the property of infiltrative growth into almost any surrounding tissue. But they rarely become malignant, so this disease has a benign course.

Origin theories:

CLASSIFICATION

By location:

• Genital. Heterotopias are localized within the female reproductive system.
• Extragenital. Endometriotic growths are found outside the female genital organs: in the structures of the gastrointestinal tract, urinary or respiratory systems, in the thickness of the skin or postoperative scars, etc.

Genital endometriosis is divided into internal (in the uterus and the initial parts of the fallopian tubes) and external. Read on to learn about the symptoms and treatment of uterine endometriosis.

The combined form (when both genital and extragenital localization is detected) is diagnosed less frequently.

By the number of detected foci:

• With a mild degree of the disease, up to five foci with a diameter of more than 0.5–1 cm or the presence of a “small” form are detected (foci with a diameter of up to 0.5 cm, detected only during an endoscopic examination).
• The average degree is characterized by the presence of 6–15 such foci.
• In severe cases, 16 to 30 focal localizations of the disease are diagnosed.
• With widespread endometriosis (fourth degree), 30 or more such lesions are detected.

There is also a classification of degrees of severity based on a scoring method for calculating the degree of depth and total area of ​​identified heterotopias.

There are also stages of damage to certain organs (uterus, ovaries, etc.) according to the clinical and anatomical classification.

Stages of internal endometriosis:

• The pathological process is limited to the submucosal layer of the uterus.
• The spread of the disease to approximately the middle of the muscle layer.
• Endometrioid growths affect the entire thickness of the muscle layer down to the serous membrane.
• In addition to all the membranes of the uterus, endometriosis affects the surrounding peritoneum and adjacent internal organs.

SYMPTOMS OF ENDOMETRIOSIS

Manifestations of the disease depend on the location and stage of the pathological process. Some women may remain asymptomatic for many years.

Endometrioid heterotopias usually (but not always!) retain their cyclic functionality. Therefore, it is most often typical to increase the severity of the manifestations of the disease on the eve of the expected menstruation and during it.

The most common symptoms:

• Pain in the pelvic area. They usually have a connection with the menstrual cycle. There is a nagging pain in the lower abdomen and back, the intensity of which increases on the eve of menstruation and during it.
• Menstrual irregularities. Scanty bleeding appears a few days before the expected menstruation, as well as after it. Sometimes - even in the middle of the cycle. The amount of blood lost during menstruation increases.
• Dyspareunia is pain and discomfort during sexual intercourse.
• Pain localized in the area of ​​the bladder and rectum (often with retrocervical heterotopia). Intensifies with defecation and urination.
• Infertility – primary or secondary.
• Various autonomic disorders: headaches, mood lability, sleep disorders, sweating, etc.

Pain of varying severity occurs in almost all patients. Pain is caused by irritation of pain receptors in tissues on which heterotopias grow, as well as the frequent occurrence of adhesions.

With extragenital localization, symptoms characteristic of damage to a particular organ appear. For example, chest pain can occur with damage to the respiratory system. When the urinary system organs are involved in the pathological process, lower back pain, hematuria, urethral obstruction, etc. may appear.

DIAGNOSTICS

A complex of diagnostic methods is usually used, since endometriosis is often “masked” as other somatic diseases.

To identify the disease, the following is carried out:

• Careful collection of medical history and complaints of the patient. For example, some women consider painful and/or long periods to be “normal.”
• General and gynecological examination. Particularly informative on the eve of menstruation.
• Transvaginal ultrasound examination of the pelvic organs is performed in the luteal phase of the cycle. A diffuse spherical enlargement of the uterus is detected; small cystic cavities or nodules without clear contours are found in its walls. During the examination, pain often occurs.
• Colposcopy. Allows you to identify heterotopias on the cervix, vaginal wall or vulva.
• Hysterosalpingography. Along with an increase in the area of ​​the uterine cavity, deformation and jagged edges, as well as “contour shadows” are determined.
• Magnetic resonance imaging (MRI).
• Endoscopic methods: hysteroscopy, diagnostic laparoscopy. They are the “gold standard” for diagnosing endometriosis. In this case, a tissue biopsy is also performed, followed by histological examination.
• Determination of tumor markers: CA-125, REA, CA-19-9.
• Hormonal and general clinical studies.

Additional studies of the abdominal organs, respiratory, urinary and other systems are prescribed if extragenital localization of the disease is suspected.

TREATMENT OF ENDOMETRIOSIS IN WOMEN

The radical method of treatment is still surgical - surgical removal of all heterotopias. However, despite the achievements of modern surgery, it is not always possible to remove all lesions and prevent recurrence of the disease. Therefore, a clear preference in the treatment of endometriosis in women is given to a combined approach - a combination of surgical and conservative treatment.

Treatment goals:

• Suppression of the activity of endometriotic growths.
• Their maximum removal and restoration of the normal anatomy of the pelvic organs.
• Relief of pain syndrome.
• Infertility treatment.
• Correction of the consequences and complications of the disease: adhesive disease, psychoneurological disorders, anemia, etc.
• Prevention of disease relapse.

Principles of surgical treatment:

• The methods and scope of surgical intervention directly depend on the location and extent of the pathological process.
• Whenever possible, organ-preserving operations are performed.
• Maximum removal of (ideally all) endometrioid heterotopias.
• Surgical techniques: resection, electrocoagulation, laser vaporization. Often used in combination.
• Hormonal treatment is necessarily prescribed for about six months after the operation. In some cases, such treatment is carried out three to four months before.

Principles of conservative therapy:

• Hormonal treatment is carried out in most cases with progesterone preparations (progestins). Combined oral contraceptives, levonorgestrel-containing uterine system (for adenomyosis), antigonadotropins and GnRH agonists are also used. The choice of drug is made taking into account all possible indications and contraindications.
• To eliminate pain, in addition to hormonal drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) are used.
• Neurological disorders are treated with sedatives. Neurotropic drugs are prescribed by a neuropsychiatrist.
• Symptomatic treatment. For example, iron supplements for detected anemia.
• Physiotherapy.

COMPLICATIONS

PREVENTION

Preventive measures are aimed primarily at the early detection of this pathology. Considering that the disease can occur for a long time without pronounced symptoms, attention should be paid to changes in the nature and rhythm of menstruation, especially in young girls.

Intrauterine interventions should be avoided whenever possible, e.g. For this purpose, reliable methods of contraception are recommended: COCs, which should be selected by a doctor.

PROGNOSIS FOR RECOVERY

The earlier the disease is detected and adequate treatment is started, the greater the chances of a complete and successful cure.

Endometriosis has a tendency to recur. According to statistics, after complex treatment, a relapse of this pathology occurs in every fifth patient.

The disease most often recurs with retrocervical localization of the pathological process (in approximately half of the patients).

The onset of pregnancy and the transition to menopause are considered favorable prognostic signs, since during these periods the symptoms of endometriosis significantly decrease or even disappear.

Found a mistake? Select it and press Ctrl + Enter