Endometriosis of the body of the uterus - what is it in an accessible language and what you need to know about this pathology. Internal endometriosis: what is this disease and methods of treatment

The importance and functionality of the uterus in the process of conception and childbearing is well known. However, there are a number of diseases that limit its capabilities. One of them is adenomyosis. About what it is - internal endometriosis - how to recognize and cure it, whether it is possible to bear a healthy child with such a disease, we will talk in the article.

Normally, the inside of the uterus is lined with a mucous layer known medically as the endometrium. Its function is to create the most favorable conditions for:

implantation of a fertilized egg in the uterus
her anchorage there,
supplying the fetus with nutrients and oxygen during pregnancy.

Therefore, the ability of a lady to become pregnant and bear a healthy child directly depends on the state of the mucous membrane of this most important genital organ. But sometimes the endometrium grows into the muscles of the uterus, and also grows in its neck and canal. This pathology of the body of the uterus is called internal genital endometriosis (adenomyosis).

There are four stages of the disease. The least dangerous is the 1st degree of internal genital endometriosis, a characteristic feature of which is the germination of the endometrium to a shallow depth. If the disease is not detected in time and appropriate measures are not taken, internal endometriosis will pass into the 2nd, more serious degree.

At this stage, neoplasms increase in size, cover a large area and grow in new places. Pains begin to bother.

The third stage of the disease is characterized by:

ingrowth of the endometrium into the serous layer,
infection of the fallopian tubes and peritoneum,
the occurrence of cysts on the ovaries,
the formation of a large number of adhesions.

With the fourth degree of internal endometriosis, the pelvic area, excretory and reproductive systems are completely affected. There are frequent cases of fusion of organs.

Echo-signs of internal endometriosis

As you know, the disease is easier, easier and cheaper to prevent than to treat it later. This is especially true for diseases of the genital organs. After all, here we are often talking not only about your health, but also about the possibility of getting pregnant and bearing a healthy baby. Therefore, even if nothing bothers you, it is necessary, first of all, to undergo regular preventive examinations.

Well, if there are pains, disruptions in the menstrual cycle and other unpleasant things, it is impossible to postpone a trip to the gynecologist in any case. The main symptoms of the presence of internal endometriosis include the following ailments:

pain in the lower abdomen,
irregular menstrual cycle,
painful heavy periods,
bleeding during the intermenstrual period.

But since similar symptoms are also characteristic of some other diseases, the gynecologist will definitely send you for an ultrasound examination. Based on its results, it is impossible to establish an accurate diagnosis, however, certain echo-signs will make it possible with a high degree of probability to assume the presence of internal endometriosis.

Internal endometriosis of the uterus: treatment

Treatment of internal genital endometriosis of the uterus involves the use of one of two methods:

conservative (with the help of drugs);
surgical (operating).

Sometimes a combined method of liberation from the disease is used. Drug therapy is not limited to taking pills. The doctor also prescribes:

a high-calorie diet with a limited content of salt and spices in dishes,
prolonged exposure to fresh air,
limiting not only physical, but also mental stress.

The method of treatment depends on the degree of the disease, the age and general condition of the patient and is prescribed individually.

According to statistics, the risk of getting endometriosis is lower in women who smoke and in those who take hormonal contraceptives.

Internal endometriosis and pregnancy

Endometriosis ranks second on the list of causes of infertility. If it is internal endometriosis, the inability to get pregnant can be caused either by the development of adhesive processes, or by changes in the hormonal background that does not allow the egg to mature and leave the follicle.

Endometriosis on ultrasound is found in many women of reproductive age and raises serious concerns about their women's health. Endometriosis is a disease in which the cells of the inner layer of the uterine wall grow outside of this layer. The main method used to diagnose the disease is transvaginal ultrasound, which shows what changes occur in the uterine membranes.

Often, signs of endometriosis are found in women during a preventive examination, since the pathology is often asymptomatic. In some cases, the diagnosis of endometriosis using ultrasound is difficult. Such patients are shown to conduct additional laboratory, radiological and endoscopic studies.

Varieties of endometriosis

Genital endometriosis can be internal, affecting the body of the uterus, and external, in which the disease spreads to the ovaries, fallopian tubes, vagina, cervix, and peritoneum.

Internal endometriosis is of three degrees. With the first of them, the upper layers of the myometrium are affected by 2-3 mm. At the next stage, the uterine wall is affected up to half its thickness. The third degree of the disease is characterized by complete damage to the myometrium (to the serous membrane). With endometriosis, it will be informative only in the second and third stages of the disease.

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Signs of the disease and its detection

One of the important questions that should be clarified before the procedure is: when is the best time to do an ultrasound? The most suitable are 23-25 days of the cycle. This is due to the peculiarities of physiological processes occurring in different phases of the menstrual cycle.

In phase I (1-11 days), there is a reduced echogenicity and homogeneity of the endometrium, the line of closure of the anterior and posterior layers of the uterine mucosa is clearly visualized. This condition does not allow diagnosing endometriosis with high accuracy. During the period of ovulation (12-15 days), the echogenicity of the endometrium increases, but this process is uneven, so false signs of endometritis or other pathological conditions can be detected.

And only in the II, secretory phase of the cycle (16-28 days), the echogenicity of the endometrium becomes maximum, and the line of closure of the mucous membranes is erased. This creates the most suitable conditions for identifying various pathologies of the endometrial layer of the uterus, since during this period their severity becomes maximum.

If you are interested in which day of the cycle to undergo an ultrasound scan, then plan the study for the second half of the menstrual cycle.

Signs of endometriosis on ultrasound

On ultrasound with endometriosis, the following changes can be detected:

increased echogenicity of the myometrium;
echogenic inclusions up to 5 mm, located in the thickness of the walls of the uterus (in some cases, they merge with each other, forming cavities);
an increase in the anterior-posterior size of the uterus, due to which it acquires a rounded shape;
uneven thickness of the uterine walls, endometrial hyperplasia;
bending of the uterus (in 15% of patients);
the presence of signs of chronic endometritis on ultrasound;
vasodilation (they look like they are affected by varicose veins);
deformation of the bladder due to uterine pressure;
the presence of various neoplasms (endometrial polyp, nodules, etc.).

The more of these symptoms were detected in the patient during the study, the more accurate the diagnosis is considered.

One of the most important manifestations of the disease is the presence of small endometrial nodes in the walls of the uterus. They can have both regular and irregular shapes.

There is no clearly defined boundary between them and neighboring tissues. At the same time, the echogenicity of the node is much higher than that of the myometrium.

Cystic cavities may be present inside the endometrial node, which are visible on ultrasound as inclusions with low echogenicity.

Endometriosis is a serious gynecological disease that is asymptomatic in the early stages. Pathology is characterized by the growth of the mucous layer of the uterus (endometrium), while the lesions spread throughout the abdominal cavity, interfering with the normal functioning of vital organs and systems. With early diagnosis and timely treatment, it is possible to prevent the development of severe complications and preserve female reproductive functions.

First of all, the patient should be alerted to prolonged and painful menstruation, spotting between cycles, pain during sex. These are the first signs that may indicate the presence of endometriosis. With these symptoms, a woman needs to urgently consult a gynecologist. It is important to undergo a comprehensive examination in a timely manner using the necessary diagnostic methods.

Ultrasound examination is prescribed in the first place, but whether it is possible to see endometriosis on the monitor is a moot point. In the early stages of pathology, there are practically no structural changes in the reproductive organs. Therefore, an accurate diagnosis can only be made after a complete examination. If you suspect the development of pathology, when to do an ultrasound, the doctor should determine, since changes in the endometrium during the cycle affect the results of the examination.

Ultrasound is one of the primary methods for diagnosing endometriosis, allowing you to confirm the preliminary diagnosis, which was made on the basis of an examination by a gynecologist. Ultrasound diagnostics gives a complete picture of the state of the pelvic organs, and also allows early detection of pathological processes in the muscular and mucous membrane of the uterus.

An ultrasound examination is prescribed by a doctor if the patient has symptoms such as:

pain in the lower abdomen and lower back, which tend to increase during menstruation;

the presence of spotting between periods;

increase in the period of menstruation and the amount of discharge;

prolonged absence of pregnancy.

Carrying out ultrasound diagnostics

Ultrasound diagnosis in case of suspected development of the disease is carried out in two ways: transabdominal and transvaginal. The first involves conducting a study directly through the anterior abdominal wall, the second - the introduction of a special sensor into the vagina. To conduct an ultrasound diagnosis of endometriosis, the transvaginal method does not require any preliminary preparations. A transabdominal examination is usually performed with a full bladder, so 2 hours before the procedure, you need to drink about a liter of water and do not go to the toilet.

On which day of the cycle it is better to do an ultrasound scan for endometriosis - the doctor should determine. Pathology develops in the inner layer of the uterus (endometrium), which is rejected during menstruation and excreted with menstruation from the female body. Immediately after menstruation, the thickness of the endometrium is only 2-5 mm, in the middle of the cycle it increases to 9-13 mm, and in the second half it thickens to 20 mm. It is recommended to do a scan no earlier than a week after the end of menstruation. But since every day the endometrium thickens and becomes thicker, only the attending physician can determine when to do an ultrasound in your case.

Many gynecologists agree that the diagnosis of endometriosis of the uterus will have more reliable results in the second half of the menstrual cycle (by day it is 14-20 days). It is at this time that the echogenicity of pathological foci increases, which simplifies their detection.

results

Can ultrasound show endometriosis? When conducting a diagnosis, the doctor examines the following parameters:

the size of the reproductive organ;

outer contour of the uterus;

punctate structure of internal tissues;

echogenicity of the muscular layer of the uterus and its cavity;

changes in the cervix and fallopian tubes;

the condition of the appendages;

the presence of nodular seals.

Roughness and fuzziness of the contour of the uterus indicates the presence of a pathological process. In a healthy woman, the normal parameters of the uterus are as follows:

length - 7 cm;
width - 6 cm;
thickness - 42 mm.

Deviations from these parameters indicate the presence of a pathological process. With endometriosis, uneven thickening of the uterine walls is clearly visible. How pathological foci look, and the changed structure of the uterus, see the photo.

Normally, the echogenicity of the endometrium has a uniform, uniform character, and the uterine cavity should have a uniform structure and smooth edges. Detection of hyperechoic structures on ultrasound indicates the presence of endometriosis. The presence of the disease can also be indicated by changes in the structure of the cervical canal and the cervix itself, which normally has a length of 4 cm and a homogeneous echostructure. On ultrasound, you can see all the deviations from the norm.

With the help of ultrasound examination, the localization of pathological foci is determined. The most common form is ovarian endometriosis. Ultrasound can detect polyps and cysts of endometrioid origin, determine their structure and size. This is important in cases where differential diagnosis is carried out. Due to the structural similarity of endometrioid neoplasms with luteal and hemorrhagic cysts, it is often difficult to make an accurate diagnosis.

It should be noted that despite the high efficiency of the ultrasound diagnostic method, endometriosis can not always be detected on ultrasound, especially if there are small foci located in the deep layers of the muscle tissue of the organ. Therefore, the results of an ultrasound examination are not an absolute confirmation of the absence of pathology.

To clarify the diagnosis, a woman must undergo a comprehensive examination using instrumental and laboratory diagnostics. Patients diagnosed with endometriosis during treatment should be systematically examined for ultrasound, this allows us to evaluate the effectiveness of the therapy. In order to prevent each woman is recommended to regularly visit the antenatal clinic.

To diagnose various diseases in women in gynecology, ultrasound examination, including transvaginal, is often used. Endometriosis on ultrasound is visualized as tissue that has grown beyond the inner limits of the uterus. Pathological foci can be located in the ovaries, tubes, partly in the abdominal cavity, upper part of the neck, in rare cases - in the rectum.

An examination is prescribed for any suspicion of abnormal growth of endometrial cells, which the doctor notices during a routine examination. However, in the first and second stages, ultrasound is almost never used. At these phases of the development of the disease, the foci are single, weakly expressed, they cannot be visualized, and a clear localization cannot be determined.

The only informative study is MRI of the pelvic organs, which makes it possible to detect even single growths of endometrial tissue beyond the uterine cavity.

With extensive tissue growth, the uzist doctor can determine the exact location and structure of the pathological focus. In this case, the diagnosis of endometriosis on ultrasound allows you to make the correct diagnosis.

More often, the study is carried out transvaginally, and conventional ultrasound of the pelvic organs is resorted to only when endometrial cells grow into the rectum and organs adjacent to the uterus.

Ultrasound with suspicion of this pathology is assigned one of the first as part of the examination. Endometriosis is a hormone-dependent disease, so polyps and cysts can develop in parallel with it. Timely diagnosis by ultrasound allows you to identify these formations and begin treatment.

The main stage of preparation for ultrasound is the filling of the bladder. This is necessary for maximum diagnostic information. A few hours before the manipulation, a woman should drink at least 0.5 liters of liquid. You cannot empty your bladder before the procedure.

On what day of the cycle is it better to do an ultrasound

Ultrasound for endometriosis is optimally done on the 12-15th day (from the beginning of menstruation) of the cycle with its duration of about 30 days. That is, already on the 5-7th day after the end of menstruation, the study will provide the most accurate information about the location and structure of endometriosis foci.

Visualization of endometriosis foci on ultrasound and the information content of the entire study are directly related to the period of menstruation. Starting from the moment of ovulation, that is, from the middle of the cycle, the lining of the uterus swells under the action of hormones necessary for conception. Areas of overgrown endometrium look like clear foci of a darker shade. Also during this period, you can see cysts, polyps, fibroids in the initial phase of growth.

echocardiography of endometriosis

To determine the type of pathology, an early appointment of ultrasound is extremely important. There is also a pathology of the internal type. In addition, the disease is divided into focal, nodular and diffuse forms. The latter is diagnosed with an internal variant. The diffuse type is indicated by such signs of endometriosis on ultrasound:

thickens the tissue lining the inner walls of the uterus, often the back;
the body of the uterus has an oval or rounded shape;
uterine myometrium is characterized by increased echogenicity, has a fuzzy uneven contour;
it is possible to visualize various inclusions up to 0.05 mm in diameter - polyps, myoma, foci of endometriosis, calcium deposits, malignant tumors in the initial stage of growth.

In the nodular form of pathology during the examination, the following changes will be visible:

violation of the structure of the uterine walls;
interstitial (within the uterine cavity) endometrioid node.

It is possible to detect neoplasms similar to cysts, with a maximum diameter of 3 cm, without clear contours.

Focal endometriosis is determined by the following features:

increased echogenicity of certain areas of the myometrium in the absence of even clear contours;
cystic formations up to 1.6 cm in diameter;
uneven thickening of the walls of the uterus.

In general, the pathology is indicated by the following results: any nodular structures, fuzzy uneven contours of the endometrium, incorrect symmetry of the uterine walls.

The most difficult to diagnose are nodular and focal types of endometriosis. Symptoms and echoes of these diseases are rarely diagnosed separately, more often they accompany uterine myoma and some other pathologies.

Ultrasound results

It is not possible to see endometriosis on ultrasound right away. If the disease is at the initial stage of development, repeated examinations are prescribed - once a month on the 5-7th day of the menstrual cycle.

Additionally, the doctor can determine by ultrasound:

changes in tubes and neck;
the condition of the appendages;
the structure of internal tissues - nodular inclusions, heterogeneity, thickening;
echogenicity of the myometrium and the body of the uterus, its size;
any neoplasms and nodular seals.

The presence of pathological processes is evidenced primarily by changes in the size of the uterus. Normally, its length is 7 cm, width - 6 cm, and thickness - up to 42 mm. The contours must be clear, uniform, without foreign inclusions. If the thickness of the endometrium is higher than normal, they talk about the beginning of the development of endometriosis.

The detection of hyperechoic inclusions indicates pathological tissue growth. This is also indicated by a violation of the structure of the cervix and cervical canal.

Additionally, the internal view of the uterus, the localization of all pathological foci is visualized. Today, women are most often diagnosed with endometriosis of the ovaries. During the differential diagnosis, cysts and polyps are found.

Ultrasound is also used to monitor the effectiveness of therapy, especially when conducting conservative treatment. In this case, it is better to do an examination every three months to assess the degree of tissue growth.

Treatment and prevention

Depending on the stage of development of the disease, one or more foci are visualized on ultrasound. In the 3rd-4th degree, cysts are additionally formed on the ovaries, there may be adhesions.

In advanced cases, in addition to transvaginal ultrasound, a pelvic ultrasound is prescribed to identify endometrioid lesions in the intestine, less often in lung tissues.

Conservative treatment - installation of releasing intrauterine systems, taking hormonal drugs. In the combined course, estrogen-gestagenic, antigonadotropic drugs are used. As a symptomatic therapy, anti-inflammatory, desensitizing, painkillers are prescribed.

If this treatment does not bring positive results within 6–9 months, stenosis of the lumen of the ureters or intestines is observed, the woman is diagnosed with individual intolerance to hormonal drugs or there are contraindications for admission, surgical removal of endometriotic lesions is used.

The cyst is removed during laparoscopy, laparotomy, or with direct access through the vagina.

In modern surgery, it is most often used, which involves a low-traumatic invasive access to growths through small incisions.

Prevention of the disease consists in the timely examination of the cervix and uterus, the choice of modern hormonal methods of contraception, strict control over the cycle, minimizing abortion and curettage, as well as uterine injuries.

Women's health requires constant monitoring. consider spotting, acyclic menstrual bleeding, inability to become pregnant or bear a child. In advanced cases, when lesions are present in the muscular layers of the uterus and in neighboring organs, menstruation can be scarce, the adhesive process begins.

All these clinical manifestations are indications for the study. Based on its results, conservative methods of treatment are applied or a decision is made to remove the formation surgically. If endometriosis was detected during the gestational period, hormonal or surgical therapy is resorted to only after childbirth.

Endometriosis has almost the same symptoms as other gynecological diseases, therefore, without an examination and only by a disturbing symptom, it is impossible to clearly say that a woman has this disease. For example, pain in the pelvic area, during sexual intercourse, the inability to conceive a child are also associated with other pathological conditions.

Endometriosis may not manifest itself too clearly, then it is even more dangerous.

Indications

When to do an ultrasound for endometriosis? The answer, it would seem, is obvious: as soon as there is a suspicion of endometriosis, there are its symptoms. These include:

painful menstruation,
daub before menstruation, after them,
fertility problems, infertility,
less often - pain during intimacy.

It is worth giving some explanation on the symptoms. Women who are concerned about endometriosis also suffer from infertility - up to 40% of patients.

Soreness in the pelvic region occurs in almost 25% of patients, while the pain can be localized either in a separate area or throughout the pelvic region.

During intercourse, there may be not so much soreness as a feeling of discomfort. Women do not always even pay attention to this, considering it a kind of norm or attributing it to the cause of fatigue or unwillingness to initially have sex.

You need to additionally pay attention to other symptoms that should be of concern. Reasons to consider an ultrasound:

prolonged, profuse menstruation,
the usual discharge is darker, up to,
painful urination,
soreness during menstruation (also called dysmenorrhea) - in the first three days of a new cycle, 40-60% experience this,
cycle failures,
post-hemorrhagic anemia due to a large loss of blood during periodic secretions - weakness, pallor or yellowing of codi, severe fatigue and dizziness attacks are noted,
excessive emotionality,
increase in body temperature.

The earlier the diagnosis is made and endometriosis is detected at the initial stage, the better for the patient. But the "cunning" of the pathology lies in the fact that sometimes its course is asymptomatic, or it can be difficult to identify the signs, since they are weak and not so disturbing. Because of this, it turns out that the disease is diagnosed at a late stage.

In order to detect a pathological condition in time, doctors recommend coming for an ultrasound scan once or twice a year.

Timing for Research

What day to do an ultrasound if you suspect endometriosis? The most accurate results can be obtained if you come to a specialist in the second half, on days 25-28 (if the cycle is approximately 30 days). Diagnosis during this period is relevant because by this time the areas with anomalies are growing, and the cysts and nodules of the endometrioid tissue are increasing.

Structural changes in the endometrium

In order to understand why ultrasound should be prescribed specifically for the second half, it is worth studying how the state of the endometrium changes in different periods.

Conventionally, they are divided by 2.

From the 5th to the 7th day - early proliferation. Echoes are low, and the endometrium has a homogeneous structure. Thickness (normal) is 3-7 mm.
8th-10th day – medium proliferation. The endometrium does not differ much from the previous period. Normal thickness is 7-10 mm.
From the 11th to the 14th days - low echo signs, and the mucosa begins to grow. Thickness - 8-15 mm.

early secretory - from the 15th to the 18th day, when the growth of the endometrium stops a little, echogenicity increases towards the center, thickness - 11-17 is normal,
middle secretory - 19th-23rd days - echogenicity is increased, the mucous membrane thickens, heterogeneity of the structure, normal thickness is fourteen mm,
late secretion occurs on the 24th-27th days of menstruation. cycle, when the data is identical to the previous one, but with a smaller thickness. Endometrium - mouth 11 to 17 mm.

During menstrual bleeding, there are hyperechoic areas, and the endometrial tissue itself reaches extremely thin indicators. The thickness returns to its original values.

In order to get an accurate picture and follow the pathology in dynamics, it is necessary to conduct an ultrasound scan more than one cycle. It is advisable to repeat the examination the next month, approximately on the same day.

The question of whether endometriosis is visible on ultrasound can be answered: yes, but this will require good equipment and sufficient qualifications of a specialist. Since certain echoes allow to make a diagnosis.

What will the ultrasound show?

If endometriosis has affected the uterus, then the ultrasound will show:

endometrial tissue is fuzzy and uneven,
there are nodal structures,
asymmetry of the uterine walls.

Endometriosis of the ovaries on ultrasound can be detected according to:

you can see the neoplasm, which has a rounded shape, is located on the side or behind the uterus,
tissues are heterogeneous, probably with a fine punctate structure,
focal inclusions of different varieties, shapes and sizes.

Signs of endometriosis on ultrasound vary. The indicators vary depending on the types.

Disease types

External - the lesion occurs in the vagina, ovaries, tubes, part of the peritoneum.
Internal - damage to the upper cervical segment, the body of the organ.

Endometriosis happens:

nodal,
focal,
diffuse (more often it is a form of an internal type of pathology).

Diffuse endometriosis appears on ultrasound as follows:

uterus - the shape of a circle or oval,
the tissues that make up the posterior uterine wall are thickened,
echogenicity of the body of the myometrium is increased,
inclusions are noticeable on the organ - up to 0.05 mm - these are calcium deposits, formations of various genesis, cancerous,
the endometrium has a fuzzy, uneven contour.

On ultrasound with a nodular form of endometriosis, you can see:

structural metamorphoses in the uterine wall, often round or oval,
cystic areas, the diameter of which is up to 30 mm,
structures without concrete contours,
endometriosis node of the interstitial type, that is, growing without going beyond the organ.

With focal endometriosis, ultrasound shows:

one of the sections of the muscular uterine wall - with increased echogenicity, does not have a smooth, clear contour,
an in-depth study will show cystic neoplasms - from two to sixteen mm in size,
walls of the uterus of different thicknesses.

Diagnosis of pathology (nodal / focal) is more difficult. After all, their signs are similar to each other, but separately they are infrequent. Often they develop with uterine fibroids, type lesions.

Diagnostic methods

The following ultrasound methods are available:

vaginally or transrectally,
the study is performed through the abdominal cavity, while there is absolutely no pain.

Is it possible to see endometriosis on ultrasound and make a 100% diagnosis immediately after the examination? It is impossible to give such guarantees. The doctor may refer you for additional examinations for clarification. For example, laparoscopy, biopsy.

Once again, it is worth recalling the need for regular examinations. This will help to see not only endometriosis on the ultrasound machine, but also other possible pathologies. Also, ultrasound examination must be regular in women who have had miscarriages, abortions, childbirth or during pregnancy.