Diffuse endometriosis of the uterus of the 2nd degree. Focal endometriosis (adenomyosis): causes, symptoms, diagnosis and treatment. Additional methods for diagnosing uterine endometriosis

Endometriosis of the uterus has another name - adenomyosis. This is a disease in which endometrial tissue (the inner layer of the uterus) grows outside its cavity, where this tissue should be normal. Based on this, characteristic clinical manifestations of the disease develop. Gradually, the process is steadily progressing, which further aggravates the condition of the woman. Therefore, the further prognosis depends on how timely the diagnosis is carried out and treatment is started. This is especially true when you consider that some women can become disabled on the background of this pathology. The development of disability (limitation of opportunities) is due to the fact that a persistent pain syndrome is formed, and nearby organs are involved in the process. All this dictates the need for early diagnosis and treatment of this pathological process.

Reasons for the development of the disease

Internal endometriosis of the body of the uterus develops for unknown reasons, which are still not fully understood. Therefore, various etiopathogenetic theories are proposed that try to explain the origin of this disease. The following reasons are currently accepted:

implantation theory;
metaplastic theory;
retrograde casting theory;
immunological theory;
combined theory.

But none of these theories explain the specific causes of endometriosis, so they remain only at the hypothesis stage. Moreover, if one theory explains one process, then it finds a contradiction in another. In this regard, the so-called modern concept of the development of endometriosis dominates in modern gynecology. It is a combined reflection of all existing theories in relation to this type of disease.

What does she look like? According to this concept, during menstruation, menstrual blood does flow to the peritoneum. However, the pathological process does not always develop. The reasons for its development are that there must be certain violations of the immune system and favorable conditions for the implantation of endometrial tissue on a particular organ. Thus, endometriosis develops if there are predisposing and contributing factors.

Classification

Endometriosis of the body of the uterus can be classified based on various features. One of the classifications involves the division of this disease according to severity. There are mild, moderate and severe degrees. The main criteria underlying this division are:

severity of pain syndrome;
the prevalence of endometriotic lesions;
general condition of the patient;
violation of the ovarian-menstrual cycle;
development of infertility.

Another classification takes into account the causes of the development of this pathological process, namely the background processes, that is, concomitant pathology. Perhaps she determined the development of endometriosis of the body of the uterus. The reasons that probably became the background for the development of this pathology are also subject to treatment in the process of complex therapy of this disease.

Clinical picture

Symptoms of uterine endometriosis can vary in severity. They include the following manifestations:

pain;
violations of the ovarian-menstrual cycle;
involvement in the pathological process of adjacent organs;
violation of reproductive function;
various neurovegetative manifestations.

Let's talk about each of them in more detail. With regard to reproductive function, a separate section has been written - adenomyosis and infertility.

Pain is usually associated with the onset of menstruation. At this time they appear, and then gradually increase. Therefore, with the progression of the disease, pain can accompany the entire menstruation, and also persist for several days after it. These pains lead to severe asthenization of the patient. This means that she becomes irritable, nervous. As a result, this condition negatively affects the social adaptation of women. A reasonable question arises - is it possible to cope with this? Yes, you can, if the diagnosis of the disease is timely, and the treatment is correct and adequate.

If the pathological process progresses against the background of the absence of treatment, then endometriosis leads to damage to nearby organs. This means that the bladder and rectum are involved. As a result, this is clinically manifested by a violation of the act of urination, an admixture of blood in the urine or feces (its appearance is associated with the menstrual cycle), constipation and other manifestations.

Symptoms of an ovarian-menstrual cycle disorder can be as follows:

intermenstrual spotting;
heavy menstruation;
long delays in menstruation (hypomenstrual syndrome - oligo- or opsomenorrhea, depending on the duration of the delay).

Neurovegetative symptoms include:

increased irritability;
nervousness;
hot flashes and palpitations;
headache and dizziness;
frequent mood swings, etc.

As a result, all of the above symptoms over time lead to the fact that the general condition of the woman is sharply disturbed. She cannot live and work normally, she is assigned a disability group.

Diagnostics

Symptoms of endometriosis of the uterus are not pathognomonic (specific), therefore, without the use of additional research methods, it is very problematic to determine a specific diagnosis. Therefore, the following methods are used:

hysteroscopy - examination of the uterine cavity using endoscopic equipment;
ultrasound examination - with a certain degree of probability it suggests this disease (ultrasound signs of the disease are well detected on the eve of menstruation, so it is carried out a few days before the expected menstruation);
histological examination.

It should be noted that it is extremely difficult to determine the diagnostic signs in this disease. Therefore, it is very important to conduct a comprehensive assessment of all the symptoms that are detected at the stage of an objective examination and at the stage of a diagnostic search using additional examination methods.

Treatment

The body of the uterus needs to be timely and correct. This will allow you to influence the consequences of this disease. It has already been considered how dangerous adenomyosis is. Therefore, it is quite obvious that it is necessary to treat!

Treatment of endometriosis of the body of the uterus is divided into two main types:

conservative;
surgical treatment.

Conservative therapy is carried out in a complex. It involves the use of the following pharmacological preparations:

hormonal (there are different classes of hormonal drugs that are used for this disease);
immunocorrective (their appointment is carried out taking into account the identified violations in the immune status);
painkillers (preference is given to drugs from the group of non-steroidal anti-inflammatory drugs, since the balance of prostaglandins is disturbed, which leads to pain);
psychotropic, which are prescribed taking into account disorders in the nervous system.

Hormone therapy is carried out on the basis of whether a woman wants to have children later. If the answer to this question is yes, then you can use:

combined oral contraceptives;
pure gestagens.

If a woman does not plan more pregnancy, then you can also apply:

antiestrogen;
analogues of gonadoliberin;
antigonadotropins.

These three groups of drugs can lead to a state of artificial menopause, so it is desirable to use them in older women. Given the possibility of estrogen-deficient conditions, they are treated intermittently (3 months of admission combined with 3 months of break, etc.).

Surgical treatment is carried out according to strict indications, when conservative therapy is most likely doomed to success. Features of the operation is the observance of measures to prevent the spread of endometrioid cells in the peritoneum. This will prevent the recurrence of the disease. It is desirable to give preference to such operations that allow you to save the uterus as an organ. Radical operations are performed if the anatomy is disturbed and a pronounced adhesive process has developed, which has led to damage to neighboring organs.

After treatment, the woman should be under the supervision of an obstetrician-gynecologist. This will allow timely detection of recurrence of the disease. This situation is an indication for hormone therapy.

Fertile function against the background of adenomyosis

Violation of the reproductive (fertile) function, that is, the ability to give birth to children, is an integral clinical sign of this disease. The mechanism of development of infertility is associated with the following pathogenetic factors:

a violation in the balance of prostaglandins, which does not allow a fertilized egg to implant normally;
the development of anovulation, that is, the maturation of the egg is disturbed or does not occur at all, and the process of its release from the dominant follicle may also suffer;
immunological disorders that lead to immune mechanisms of infertility;
a pronounced adhesive process that disrupts the patency of the fallopian tubes.

Thus, infertility against the background of endometriosis is a complex problem. Can it be cured? Of course, if treatment is started in a timely manner, taking into account all possible pathogenetic factors. Therefore, in order to treat this condition, it is necessary to know the immune and hormonal status of the patient. After that, appropriate treatment is prescribed. Hormonal treatment is carried out in several stages:

correction of identified violations;
stimulation of ovulation;
support for the second phase of the menstrual cycle.

In conclusion, it should be noted that endometriosis of the uterine body is a serious disease that requires timely diagnosis and treatment. With a belated detection of a pathological process, it is possible to develop irreversible processes in the internal organs, which can lead to a woman's disability. Therefore, further prognosis depends on the timeliness of treatment.

Endometriosis of the body of the uterus, what it is, excites many women. A disease when endometrial cells grow outside the uterine layer and affect the muscular layer of the organ.

This is an insidious pathology, because it is difficult to diagnose, it occurs either without any special changes in the body, or the symptoms are similar to other gynecological diseases. The main complication of endometriosis is female infertility.

Pregnancy either does not occur at all or ends in premature termination - miscarriage.

Types and severity of the disease

Endometriosis of the uterus, medically known as adenomyosis.
Depending on the location and degree of damage, the disease is divided into three types:

Genital - the most common disease. It is divided into internal and external endometriosis.
Extragenital - observed outside the genitals: intestines, lungs, stitches after surgery.
Mixed - combines the previous types of pathology.

If you prescribe the wrong treatment, the disease can develop into a chronic form, then there is a sharp exacerbation of the symptoms of the disease.

Such endometriosis cannot be cured, the treatment consists in slowing down the growth of the pathology and relieving pain and other symptoms of the disease.

Endometriosis of the uterus is also divided into three forms:

Diffuse - cell germination is observed throughout the uterus, treatment is very problematic. Therefore, this form of pathology is considered the most dangerous.
Focal, when certain parts of the mucous membrane of the uterus are affected - the posterior or anterior walls.
The nodular form of endometriosis is characterized by the appearance of foci of germination with compaction, which causes the appearance of nodes. Such nodules lead to an increase in the size of the uterus.

Depending on the depth of penetration of endometrial tissues, there are four degrees of severity of the disease:

At the first degree, pathological foci grow to a shallow depth, without going beyond the muscle layer.
Second degree - half of the myometrium is affected.
Third degree - the endometrium affects all the walls of the uterus, to the serous cover.
At the fourth degree, the growth penetrates into the abdominal cavity. Such damage to organs leads to the appearance of fistulas in the uterus and other organs of the small pelvis.

Treatment should be timely in order to get rid of the disease at an early stage, in order to avoid more serious problems. This is especially true for girls who are planning a pregnancy.

After all, getting rid of such a disease is difficult, and sometimes completely impossible.

Causes of the disease

This disease is not fully understood, there are many theories of the development of pathological processes.

But there are a number of factors that provoke endometriosis of the uterine body:

During menstruation, endometrial cells can get outside the uterus, where they begin to grow, affecting other organs: the ovaries, fallopian tubes, and the abdominal cavity.
Hormonal disorder in the body. Studies have shown that high levels of estrogen, and low levels of progesterone in the blood, provoke the development of the disease.
genetic inheritance. There are many cases that endometriosis of the body of the uterus is transmitted through the female line. These girls are at risk.
Violation of the functioning of the immune system. High immunity protects the body from the growth of pathological tissues outside the normal location. With immune disorders, endometrial cells that fall outside the uterus are not destroyed, but begin to function.

There are a number of reasons that provoke the disease:

Mechanical damage to the uterus - regular abortions, gynecological curettage, other manipulations in which the mucous membrane is damaged, then the endometrial cells penetrate deep and begin to multiply.
Gynecological interventions - cauterization of erosion provokes the entry of cells into the vagina, which leads to the development of endometriosis. With a cesarean section, pathological tissues can enter the abdominal cavity, where they continue to function.
Infectious diseases that are sexually transmitted contribute to the development of the disease.
Inflammatory processes or chronic diseases of the genital organs cause endometriosis of the uterine body.
Incorrect use of hormonal drugs.
The use of an intrauterine device causes pathology in many women. In the place where the spiral is in contact with the mucous membrane, an inflammatory process may occur. Tissues lose their elasticity, during menstruation, cells can penetrate outside the uterus.
An important role is played by the environment, ecology, constant stressful situations, physical activity.

The most common symptom of gynecological diseases is menstrual irregularities. Menstruation with endometriosis can be regular, but with profuse bleeding or with uneven intensity and duration.

More often, patients complain of prolonged discharge, which is not amenable to conservative treatment. Abundant blood loss with clots can lead to anemia.

Also an important symptom is regular pain in the lower abdomen. A woman feels pain during sexual contact, urination.

When viewed on a gynecological chair, it is difficult to determine this disease. The doctor may feel an increase in the uterus. To make an accurate diagnosis, modern research and laboratory tests are necessary.

Internal endometriosis of the body of the uterus is often combined with hyperplasia, and therefore requires additional research.

If there are no pronounced symptoms, the patient is prescribed hormonal treatment. It is aimed at eliminating the imbalance in the hormonal background. All medications, their dosage and duration of administration, should be discussed with your doctor.

In a severe form of the disease, all reproductive organs can be removed. But this takes into account the age of the woman, whether pregnancy is planned, the general condition of the patient.

The method of surgical intervention should be determined by the doctor, taking into account the individuality of the body of each patient. The most common and effective method of treatment is laparoscopy.

The main signs of endometriosis are the absence of pregnancy or miscarriage of a child.

With endometriosis, the functioning of reproductive functions is disrupted, caused by:

Ovarian damage.
The formation of adhesions in the pelvic area.
Violations in the area of the uterine wall.

Proper treatment will relieve the pathology, the long-awaited pregnancy will come in six months. But pregnancy will not get rid of the disease forever, so such women need to regularly visit a gynecologist.

When planning a pregnancy, it is important to undergo drug therapy in order to avoid complications in the future.

The degree of risk depends on the shape and location of pathological cells. To avoid premature birth, such women need to be constantly under the supervision of doctors. This will help prevent complications and endure a healthy baby.

After childbirth, it is necessary to continue the treatment of the disease, because pregnancy will not relieve the pathology.

It is better to diagnose the disease in a specialized clinic, which is equipped with modern research methods. Treatment should be prescribed by a qualified specialist, after examining the patient.

To identify the disease in the early stages, it is necessary to visit the gynecologist regularly, once every six months.

Diffuse endometriosis is a pathological proliferation of endometrial tissues with their germination into the myometrium. This disease is associated with hormonal disorders in the body of a woman and is often combined with other gynecological problems.

Diffuse endometriosis of the uterus is one of the causes of infertility, and the prognosis of the state of the reproductive system of a woman will depend on the form of the disease and the stage at which it was detected.

The most common form of internal endometriosis is diffuse, it can also be of the nodular type, which is characterized by the appearance of nodular formations on the surface of the uterus. These neoplasms are able to spread to surrounding tissues. Treatment of this type of disease is only surgical, otherwise extensive damage occurs not only to the uterus, but also to other organs of the small pelvis and abdominal cavity.

Diffuse endometriosis of the body of the uterus occurs in 3 stages:

On the first tissue, the endometrium is affected up to 10 mm deep. Symptoms are absent or mild. Rarely, women report increased bleeding during menstruation and additional discomfort.
On the second endometrial cells germinate to the middle of the myometrium. Pain appears, aggravated during menstruation, tissue swelling occurs. Possible consequences in the form of uterine prolapse and persistent pain. There is bleeding between cycles.
On the third endometrium begins to affect the fallopian tubes, vagina, cervix. The symptomatology amplifies, other pathologies join.

The reasons

The diffuse form of endometriosis of the uterus occurs due to endocrine and hormonal disorders. Excess estrogen production will be a key factor in tissue proliferation. During menstruation, exfoliation and rejection of the endometrium occurs, but in the case of a hormonal imbalance, this process is disrupted, and not all cells are removed.

This leads to the fact that part of them penetrates through the vessels into the myometrium, continuing to grow there. The diffuse form of the pathology is characterized by a uniform thickening of the tissues, and the endometrium can reach 5 cm. Having penetrated into the myometrium, the tissues continue to function, which leads to discomfort and internal hemorrhages.

Diagnostics

During a gynecological examination, the doctor sees an increase in the volume of the uterus. In the case of the nodular form, the formations are palpable on palpation. The diagnosis is confirmed by echographic signs: an increase in the uterus in the anteroposterior direction, rounded echogenic inclusions up to 6 mm, increased echogenicity in the myometrium.

For the greatest information content, an ultrasound examination is performed on the 23-25th day of the menstrual cycle.

Treatment

Treatment of the diffuse form of endometriosis will be prescribed in the presence of pain. In the case of an asymptomatic course, drug therapy and surgery can become catalysts for the transition of the disease to the active phase.

With diffuse endometriosis, a set of preventive procedures is prescribed:

improvement of the immune system;
restoration of hormonal balance;
removal of inflammatory foci;
elimination of concomitant gynecological and systemic diseases.

Such events can provoke an artificial menopause, during which the growth and spread of the endometrium stops. After treatment, the menstrual cycle normalizes, and at the same time, the reproductive function returns to normal.

The main problem in the treatment of the diffuse form of endometriosis of the mark body is the inability to completely get rid of it even with several surgical operations. In this case, the woman undergoes courses of hormonal therapy, followed by the appointment of surgical removal of tissues. This is especially true of the diffuse-nodular form of endometriosis with the formation of a large number of polyps.

As hormone therapy, the doctor prescribes drugs of the following groups:

antigonadotropins - Danogen, Danoval;
antigestagens - Nemestran;
synthetic estrogen-gestagens - Microgynog, Ovidon, Anovlar;
antiestrogens - Tamoxifen, Toremifene;
androgens are testosterone preparations.

Conservative treatment is a long process, but otherwise it is necessary to resort to surgical treatment. The operation involves cauterization of pathological foci, and in advanced cases, the body of the uterus is removed.

There are several options for cauterization of the endometrium:

electrical;
laser;
high frequency waves.

Every intervention has risks. After the operation, internal bleeding may occur, and then the procedure will need to be repeated. Less often, tissue infection occurs, which happens against the background of a hidden focus in the body, which is detected only during the operation. There is also a possibility of adhesive processes, as evidenced by pain after the elimination of the underlying disease.

For the treatment of diffuse endometriosis, the use of organ-preserving endoscopic techniques is effective: ablation, cryoablation, interstitial laser-induced thermotherapy.

In case of internal bleeding and posthemorrhagic anemia, the doctor prescribes iron preparations: Ferroplex, Fenyuls.

Comprehensive treatment is complemented by physiotherapy procedures. These are medicinal electrophoresis with sodium thiosulfate, vaginal enemas, therapeutic baths.

Forecast and prevention

Diffuse endometriosis refers to recurrent pathologies. The frequency of recurrence of the disease in the first year is about 5-20%, within 5 years - 40% for mild form and 75% for advanced. A favorable prognosis for drug therapy is noted in premenopausal women. After radical removal of foci of diffuse endometriosis, the disease does not return.

Prevention of the diffuse form of endometriosis consists in regular visits to the gynecologist and the diagnosis of pathologies at the initial stage.

Endometriosis is in the TOP-3 in terms of frequency of occurrence among gynecological pathologies, yielding to inflammatory diseases and uterine myoma.

In the vast majority of cases, it is detected in women of childbearing age at the age of 25-45 years, less often in adolescent girls, very rarely in patients during menopause. Most often detected in nulliparous women aged 30-40 years.

This pathology is difficult to diagnose, can be asymptomatic for a long time, so it is assumed that in fact it occurs much more often. In recent decades, there has been a trend towards "rejuvenation" of endometriosis.

Let's figure out what it is - endometriosis of the uterus in women - an explanation in plain language is presented in our article.

What is this disease

What does uterine endometriosis mean? Endometriosis is a hormonally dependent systemic disease. caused by the growth of the glandular layer of the endometrium outside the uterine cavity. The course is long and recurrent.

The mucous membrane of the uterine cavity (endometrium) consists of a cylindrical epithelium and a connective tissue basal layer.

In the thickness of the endometrium is a dense capillary network and tubular glands. In a healthy woman, such tissue is located only in the uterine cavity.

For unknown reasons, fragments of glandular tissue, structurally and functionally similar to the endometrium, can be found on the surface or in the thickness of the walls of organs, where they do not normally exist. Such formations are called heterotopic.

Sites of heterotopia can be located in the muscular layer of the uterus, fallopian tubes, in the ovaries, on the walls of the bladder, intestines, on the peritoneum and other organs of the small pelvis.

This tissue is subject to the same cyclic changes as the normal endometrium.. During menstruation, heterotopic areas of the endometrium bleed, this condition is accompanied by pain.

With each cycle, the size of the pathological formation increases., as the pathology progresses, other organs of the small pelvis may also be involved.

Reasons for development

The disease is understudied, there is still no consensus on the causes and mechanisms of its development. Among the risk factors for the development of this disease are:

Actually The most common causative factors are hormonal disorders and disorders of immune defense, in particular, immunodeficiency states.

Prerequisites for the development and progression of pathology arise with an excess of estrogen and, as well as metabolic disorders of progesterone, hormones that regulate the normal course of menstrual cycles.

Live healthy! Endometriosis:

What is dangerous: consequences and complications if not treated

Is endometriosis dangerous for life and what does it lead to? very difficult, often patients develop secondary infertility.

Against the background of this disease, the formation of endometrioid is possible.

In advanced cases, they form adhesions in the pelvis and/or abdomen which can lead to or fallopian tubes.

In many patients due to heavy menstrual bleeding sustainable.

Depending on the location of the focus of pathology and its size, the course of the disease may be accompanied by symptoms of neurological disorders resulting from mechanical effects on the nerve roots and nerve endings.

In the absence of treatment, it is possible for the pathological tissue to grow through the wall of the uterus and its further spread to the pelvic organs.

Pathological endometrium is a benign formation, however, there is a possibility of tissue degeneration into a malignant tumor, which occurs in about 12% of cases.

The presence of progressive endometriosis refers to the factors of increased risk of developing cancer in other organs that are not directly related to the lesion.

Classification of species and code according to ICD-10

Endometriosis code according to ICD-10 - No. 80.

Forms: diffuse, nodular and focal

Depending on the location of pathological foci the disease is divided into genital and extragenital forms.

The genital form is lesions of the internal genital organs, to extragenital - all cases of lesions of other organs.

With multiple lesions, the form of the disease can be classified as combined. Endometriosis of the uterus is one of the varieties of the genital form of the disease.

Uterine lesions can be external, when the tubes, cervix and internal are involved in the pathological process.

It affects the body of the uterus, pathological foci are embedded in the muscle layer (myometrium). This type of disease is known as adenomyosis.

According to the nature of pathological foci distinguish between nodular, diffuse and mixed forms.

With diffuse lesions, pathologically altered tissues are located relatively evenly in the myometrium, without forming structures with clearly defined boundaries.

With a nodular form, the foci are clearly defined. With a mixed form, signs of both types of lesions are found in the myometrium.

1, 2, 3 and 4 degrees

According to the severity of the lesion, 1, 2, 3 and 4 stages of uterine endometriosis in women are distinguished:

I degree(initial stage). The lesions are single, superficial;
II degree. A few lesions that penetrate into the tissue of the affected organ;
III degree. Multiple areas of pathological endometrium are found, lesions penetrate through the wall of hollow organs almost through and through;
IV degree- multiple lesions sprout the serous membrane. The pathological process spreads to other organs.

Diagnostics

How to diagnose endometriosis of the body of the uterus, what tests are taken and examinations are carried out when making a diagnosis? non-specific and resemble manifestations of other gynecological diseases.

During a routine examination, the doctor may find an increase in the uterus, with a nodular form of the disease, large nodes are palpated.

An examination with a transvaginal ultrasound probe is a standard examination procedure for gynecological diseases.

Asymmetry of the thickness of the walls of the uterus, an increase in the size of the organ, diffuse and nodular pathological formations in the thickness of the myometrium are revealed.

Colposcopic examination allows you to identify lesions that have spread to the cervix.

Hysterosalpingography, radiopaque examination The uterus makes it possible to assess the patency of the tubes and the prevalence of lesions. It is carried out on the 5-7th day of the cycle.

Early stages of endometriosis can be detected by laparoscopy.

With insufficient information content of the main studies, the patient MRI or CT may be ordered. During the study, the exact localization and size of the lesions are revealed.

Conducted if necessary histological examination.

Blood analysis sometimes reveals an increase in ESR. The hormonal background differs from the normal one, the patients have an increased level of luteinizing and follicle-stimulating hormones, prolactin, with a simultaneous decrease in the level of progesterone.

The most characteristic symptom of pathology is increase in the content of a specific marker CA-125.

Is it possible to identify yourself and how to determine

Endometriosis is one of the most insidious gynecological diseases that may be asymptomatic for a long time.

The latent disease is often detected by chance, during an examination for infertility. Symptoms of pathology resemble manifestations of other gynecological diseases.

The intensity varies from vague discomfort to unbearable pain. Some patients may experience fainting, nausea, or vomiting.

Depending on the location of the lesion and the severity of the disease pain of varying intensity can occur during defecation and intimacy.

Endometriosis changes the menstrual cycle. Bleeding becomes more abundant and prolonged, the cycle is often reduced.

A few days before the onset of menstruation or a few days after, many patients have spotting brown discharge.

This condition is poorly amenable to drug treatment, in severe cases leads to the development of posthemorrhagic iron deficiency anemia.

Hormonal imbalance and so-called eruptive uterine bleeding, quite characteristic of the diffuse form of the disease, exacerbate the situation.

In some cases, symptoms of general intoxication may develop: fever, general weakness, fatigue, etc.

When to See a Doctor

Ideally, preventive examinations by specialized specialists are recommended for healthy people to take place annually.

In practice, a visit to the doctor is often postponed indefinitely and the patient is at the reception when it becomes completely unbearable to endure.

The reason for going to the doctor are any changes in the menstrual cycle and the course of menstruation, manifestations of soreness, discomfort and any other symptoms that are not typical for normal menstruation.

It is better to be overly vigilant than to waste precious time.

Treatment

Endometriosis is difficult, in most cases it is not possible to achieve a complete recovery of the patient.

Can endometriosis go away on its own? Cases of spontaneous healing after childbirth are described, but the likelihood of such a development of events is assessed as low.

After the extinction of the reproductive function, the manifestations of the pathology disappear due to a change in the hormonal status of the woman.

A comprehensive program for the treatment of uterine endometriosis is developed individually, based on the patient's examination data. In addition to the form, localization and severity of the lesion, the doctor takes into account the age of the patient and her desire to have children in the future.

At the initial detection of the disease, conservative treatment is prescribed. The course of conservative therapy includes:

non-steroidal anti-inflammatory drugs;
hormonal agents;
sedatives;
immunomodulators;
vitamin-microelement complexes.

Additionally appoint physiotherapy course.

In advanced cases, in the absence of the effect of conservative treatment, the presence of contraindications to the use of medications for the patient combined or surgical treatment is prescribed.

Surgical treatment can be radical or organ-preserving.. The advantage is given to laparoscopic surgical interventions, in which local removal of foci of pathological endometrium is performed.

With a high risk of degeneration of a neoplasm into a malignant one, a steady absence of the effect of conservative treatment, with a particularly aggressive course of the pathological process and in severely neglected cases, the uterus is extirpated.

After such an operation, a woman will not be able to have children., therefore, the technique is used for, in exceptional cases - at a younger age.

The success of treatment is determined by the preservation or restoration of fertility. The criteria for recovery are absence of subjective complaints and clinical symptoms of recurrence within 5 years.

"Doctor I ..." - Endometriosis stage 4, laparoscopic surgery

Lifestyle with this female disease in gynecology

Prevention and treatment of any disease always includes a number of general recommendations for the promotion of health in general.

So, how to live with endometriosis, what can and cannot be done with this diagnosis?

Diet and diet

There are no specific dietary restrictions, it is enough to adhere to the general recommendations for a healthy diet. Food should be complete and varied.

It is recommended to enrich it with fruits, vegetables, whole grains, seeds and some types of nuts are useful. It is not necessary to restrict meat consumption, but it is better to replace part of the meat products with sea fish.

Bath, sauna, beach

Is it possible to visit the bath with endometriosis, go to the sauna or sunbathe? Thermal treatments are believed to contribute to the progression of endometriosis. However, the presence of a diagnosis is not an absolute contraindication.

If visiting a sauna, bath or bath leads to a deterioration in well-being, then it is better to refrain from them. This question should be asked to your gynecologist, who monitors the dynamics of the course of the disease, and follow his recommendations.

Is it possible to sunbathe with endometriosis, largely depends on the characteristics of a particular clinical case. If the doctor recommends to refrain from sunbathing, it is worth neglecting his recommendations.

Sports and physical activity

An active lifestyle has never harmed, provided that the loads are feasible, and training does not cause a deterioration in well-being.

Physical exercise helps to reduce the level of estrogen in the blood. When choosing your preferred sport, it is advisable to consult a doctor.

Is it possible to have sex

When the diagnosis is established, doctors strongly recommend refrain from intimacy during menstruation.

If sexual intercourse is accompanied by painful sensations, it is worth talking with a partner and changing the style of intimate communication.

Contraceptive methods

One of the treatments for endometriosis is hormone therapy.. For therapeutic purposes, patients are prescribed oral contraceptives.

Is it possible to put a spiral with endometriosis? The intrauterine device is attributed to the factors provoking the development of this disease. Therefore, the decision on the possible installation of a therapeutic IUD is made on an individual basis, taking into account the characteristics of the clinical case.

Contraindications

They can impede the outflow of blood, which increases pain and provokes further progression of the disease.

Prevention

Since the causes and mechanisms of the development of pathology have not been elucidated, primary prevention measures are reduced to early diagnosis and treatment of the disease.

Endometriosis is not a death sentence. With timely detection and treatment, the disease can be successfully controlled, it will hardly affect the quality of life in all its manifestations.

Endometriosis is a disease in which there is an increase in the number of cells of the intrauterine lining layer (endometrium), as a result of which it grows and extends beyond the uterus, and in some cases beyond the reproductive system. Fragments of the endometrium are found in the digestive system, ovaries and other places.

Often, endometriosis is accompanied by various gynecological inflammatory processes, as well as uterine fibroids. As a rule, the course of the disease is rapid, but only in 5% of cases, tissue growth is converted into a malignant tumor.

Classification

According to the place of formation, endometriosis is divided into 3 types:

Genital. Occurs in 92 - 95% of cases. It is divided into internal - the muscular body of the uterus (adenomyosis) and external endometriosis - the disease affects the vagina, ovaries, cervix, perineum, retrocervical tissue, sacro-uterine ligaments, fallopian tubes, recto-uterine cavity of the peritoneum.
Extragenital. It develops in the organs of the excretory system, intestines, lungs and other organs, as well as in postoperative sutures;
Mixed. Combines both types.

Often occurs in a chronic form. The disease is characterized by alternating temporary exacerbations and remissions. There is no cure for chronic endometriosis. The principles of treatment are based on symptomatic therapy and slowing down the development of the disease.

Endometriosis of the uterus, in turn, has 3 forms:

diffuse - is formed when the endometrioid tissue expands over the entire area of \u200b\u200bthe mucosa. As a result, cavities are formed in the myometrium;
nodular - there are local endometrioid foci with non-capsular nodes;
focal - separate small sections of the walls undergo growth.

There are 4 degrees of depth of penetration of the endometrium:

1 degree - endometrioid foci grow shallow (within the muscle layer);
Grade 2 - half of the myometrium is affected;
3 degree - the endometrium penetrates the entire thickness of the muscular uterine wall;
Grade 4 - growth affects the adjacent organs and the peritoneum covering them, in the uterus there is the formation of fistula passages that go into the small pelvis.

Video fragment of maparoscopic surgery for the nodular form of endometriosis of the uterine body

The reasons

There are quite a few factors that potentially affect the onset of the disease, but the exact causes have not yet been established. The most likely ones are:

hormonal disruptions;
menses;
endometrial metaplasia (biotransformation of one type of tissue into another);
stenosis of the cervical canal;
disorders of the immune system;
genetic inheritance.

Possible reasons also include previous operations of the pelvic organs (this also includes cauterization of cervical erosion and caesarean section), iron deficiency anemia, a history of abortions, difficult or late first births, the presence of inflammatory processes, an intrauterine device, obesity, physical inactivity, stressful situations, bad environment, etc.

Symptoms

A common occurrence is the absence of any symptoms. However, you should consult a doctor if any of the following symptoms appear.

The main symptom is menstrual irregularities. Spotting and painful sensations begin 2-3 days before menstruation and last several days after it ends.
Often in the middle of the cycle, uterine bleeding of varying intensity is observed. Menstruation is characterized by profusion and the presence of clots, which can result in chronic post-hemorrhagic anemia.

In half of sick women, premenstrual syndrome occurs, while the duration of menstruation is shortened. Menstruation is accompanied by paroxysmal pain. Pulling painful sensations in the lower abdomen are also manifested during sexual intercourse.

Diagnostics

Since there are a number of gynecological diseases that are similar in symptoms to endometriosis, a set of certain procedures is carried out to confirm the diagnosis. These include the following:

Treatment

It is carried out through hormonal, symptomatic and surgical methods.

For hormonal therapy, the following drugs are prescribed:

oral contraceptives (combined single-phase), such as Regulon, Janine, Diane-35, Logest. The course of treatment is 7–9 months;
prolonged form of medroxyprogesterone (for example, Depo-Provera). The medicine is applied intramuscularly once every 2.5-3 months. The duration of treatment lasts from six months to 9 months;
drugs that are gonadotropin-releasing hormone agonists (Zoladex, Buserelin). Used for six months;
derivatives of norsteroids (for example, levonorgestrel). Based on this drug, some intrauterine devices are produced, the main advantage of which is the local hormonal effect;
androgens and their derivatives (Gestrinone, Danazol). Apply no more than 4-6 months.

Symptomatic treatment includes the use of antispasmodics (no-shpa, drotaverine), anti-inflammatory drugs (ibuprofen), sedatives (tinctures of valerian, motherwort) and enzyme preparations (chymotrypsin, lidase). A prerequisite is the saturation of the body with vitamins.

These methods are highly effective, however, in some cases, surgical intervention is unavoidable:

when detecting retrocervical endometriosis;
with suspicion of the presence of oncology;
with the simultaneous diagnosis of fibroids and endometriosis, accompanied by uterine bleeding;
when an endometrioid cyst is found in the ovary and with the development of complications leading to the occurrence of pelvioperitonitis;
in case of low efficiency of hormonal treatment;
in violation of the functioning of nearby organs.

Laparoscopy (microsurgical operation) is used as the main surgical manipulation. It is carried out by means of a laser or electrocoagulation. In this case, the foci of endometriosis are cauterized or completely removed. In advanced cases, a laparotomy is prescribed (an incision in the anterior abdominal wall).

The maximum result in the treatment is given by complex therapy, including hormonal and surgical methods.

To get rid of the disease, folk remedies are often used (the use of tinctures from medicinal herbs) and physiotherapy procedures (acupuncture, magnetotherapy, radon baths, hirudotherapy, electrophoresis with zinc and iodine).

Forecast

Endometriosis of the uterus is characterized by a chronic course, accompanied by periodic exacerbations, the frequency of which increases over the years. If the disease is started, the consequences can be irreversible. The main complications with an unfavorable prognosis of endomyosis are the formation of cysts in the ovaries, the formation of adhesions in the pelvis and abdominal cavity, posthemorrhagic anemia, and problems in the field of neurology. The worst option is the degeneration of endometrioid tissues into an oncological neoplasm.

If the disease is diagnosed in time and therapeutic therapy is started immediately, the prognosis of the course of the disease is favorable.

Endometriosis of the uterus is the cause of female infertility in every third case (endometriosis and pregnancy). However, in the presence of this disease, pregnancy is not only real, but highly recommended. This is due to prolonged anovulation, lack of menstruation, and the beneficial effects of progesterone during pregnancy.

However, the presence of endometriosis in a woman can cause a miscarriage. For such patients, preparation for pregnancy is recommended, as well as the adoption of preventive measures in connection with the possible development of fetoplacental insufficiency.

Endometriosis and uterine fibroids

The combination of these two diseases is a fairly common phenomenon. Symptoms are similar to those of endometriosis. However, in this case, the manifestations are more pronounced. Most often, the only treatment option for this pathology is surgery. A few years ago, this method of treatment deprived women of the chances of becoming pregnant and fully bearing a child, but current medicine makes it possible not only to preserve the uterus, but also not to lose its ability to fully function.

Sometimes treatment is limited to the appointment of hormonal drugs, which can reduce the size of fibroids. However, further surgery is still recommended. The use of folk remedies in this case is ineffective.

Endometriosis of the uterus is the cause of female infertility in every third case. However, in the presence of this disease, pregnancy is not only real, but highly recommended. This is due to prolonged anovulation, lack of menstruation, and the beneficial effects of progesterone during pregnancy.

However, the presence of endometriosis in a woman can cause a miscarriage. For such patients, pregravid preparation is recommended, as well as the adoption of preventive measures in connection with the possible development of fetoplacental insufficiency.