Echosigns of endometriosis treatment. Video: Endometriosis of the uterus treatment. Fertile function against the background of adenomyosis
What is uterine endometriosis? This is a very common disease, so it is useful for every woman to know about it. Endometriosis (adenomyosis) is characterized by the growth of the lining of the uterus beyond its normal location. In this case, endometrial cells grow between the fibers of the muscular layer (myometrium) of the uterus. The danger of endometriosis is that its development can lead to female infertility.
Development process and types of disease
Separate areas are affected, the pathological process often covers the anterior and posterior walls of the uterus. With the nodular type of the disease, seals in the form of nodules form in the places of germination.
Internal endometriosis of the body of the uterus can have a diffuse appearance, characterized by a uniform germination of the endometrium throughout the internal region of the reproductive organ and the defeat of all muscle layers. Such adenomyosis is very difficult to cure. Any type of adenomyosis is accompanied by an increase in the size of the uterus.
The development of the disease leads to malfunctions in the functioning of the uterus, to a violation of the process of hormone production. Overgrown endometrioid cells cause hemorrhages in the area of the affected area, which is the cause of the development of inflammatory processes. With a disease, the inner layer of the mucous membrane becomes loose, so it is difficult for the embryo to gain a foothold on it. As a result of these processes, infertility can occur.
Conditions for the occurrence and symptoms of adenomyosis
The disease in the early stages often proceeds without external manifestations, the following symptoms can serve:
- various menstrual irregularities;
- the appearance of pain in the pelvic area;
- pain that begins 2-3 days before the onset of menstruation;
- change in the size and shape of the uterus.
Under normal conditions, the cyclic development of the endometrium occurs, it thickens at the beginning and is rejected at the end of the cycle. Moreover, growth (unlike adenomyosis) occurs only inside the uterine cavity, without affecting the muscle layer.
The following reasons can lead to the development of endometriosis:
- physical overload and stress;
- surgical operations performed in the uterine cavity;
- abuse of sunbathing;
- hereditary predisposition;
- hormonal disorders;
- retrograde menstruation, accompanied by the reflux of blood cells and endometrium into the region of the ovaries and fallopian tubes;
- immune disorders.
These phenomena cause damage to the membrane that protects the muscle layer, and contribute to the engraftment and growth of endometrial cells.
Methods of diagnosis and treatment
A gynecologist diagnoses a disease based on the results of a survey and examination of the patient, as well as using data obtained during laboratory tests and diagnostic studies. The doctor may prescribe studies such as hysteroscopy, transvaginal ultrasound, MRI, biopsy.
The examination helps not only to identify the signs of the disease, but also to determine the stage of its progression. In the initial stage, the endometrium grows into the muscle layer to a depth of 1 cm. In stage 2, painful sensations appear and the depth of germination is half the thickness of the walls of the uterus. At stage 3, the pathological process affects the entire depth of the uterine body and can pass to the ovaries and tubes.
Treatment of pathology can be conservative, surgical or combined.
If there are no pronounced symptoms, then hormone therapy can be used using estrogen-progestin drugs (for example, Anovlar) and agents that have an antigonadotropic (suppressing the production of gonadotropic hormones) effect. The duration of treatment and dosage of drugs are determined by the doctor. With conservative treatment, physiotherapy can be used. Medications stop the growth of the endometrium and help cleanse muscle tissue.
To eliminate infertility, small lesions in the body of the uterus can be removed through conservative plastic surgery. After surgery, the likelihood of pregnancy increases dramatically. Pregnancy, which helps to restore the hormonal balance in the body, can naturally lead to the elimination of endometriosis. With a high degree of development of internal endometriosis of a diffuse or nodular form, extirpation (removal) of the uterus may be required.
Prevention of the disease consists in the elimination of stressful situations and excessive loads, the timely treatment of hormonal disorders and foci of inflammation. To preserve the integrity of the membrane that protects the muscle layer, it is necessary to prevent abortion (using contraceptives) and treat trauma to the birth canal. Regular visits to a gynecologist will help to detect and stop the development of endometriosis in time.
The female reproductive system is very complex, and sometimes it is even too easy to disable it, but it can be much more difficult to restore it. One of the most common diseases in women today is endometriosis. It occurs, perhaps, even too often.
Unfortunately, it is difficult to give more accurate information, since the disease is often asymptomatic. Previously, this disease occurred mainly in women aged 30-50 years. Unfortunately, today it has become much younger, more and more patients with endometriosis are 20-25 years old.
How the disease progresses
Endometriosis is a serious disease associated with disorders in the inner layer of the uterus - the endometrium. With endometriosis, endometrial cells begin to grow outside the uterus. The disease is very dangerous, including because it is quite difficult to diagnose. On the one hand, it is not uncommon for it to be asymptomatic, on the other hand, those symptoms that may still appear are characteristic of a number of gynecological diseases. Therefore, it is very important to undergo a complete examination at the first signs of endometriosis.
In this regard, I would like to emphasize the importance of regular preventive examinations by a gynecologist, which, unfortunately, many women neglect.
Types of endometriosis. Adenomyosis
Depending on the localization of the pathological tissue and the degree of damage, endometriosis is divided into several types. Yes, allocate genital endometriosis , that is, affecting the organs of the reproductive system, and extragenital , that is, affecting neighboring organs: the bladder, intestines, kidneys, peritoneal walls, and so on.
Genital endometriosis is divided into external, developing in the vagina, vaginal-rectal wall, fallopian tubes and ovaries, and internal endometriosis of the uterus, or adenomyosis.
Let's talk about the last type in more detail. Adenomyosis is, in fact, endometriosis of the body of the uterus. Under normal conditions, the endometrium develops cyclically: first it thickens, preparing for the implantation of the egg, then, at the end of the cycle, it is rejected and comes out along with the menstrual blood. At the same time, the endometrium grows only in the uterine cavity, and its muscular layer is under the reliable protection of a special membrane.
However, in some cases, the growth of the uterine mucosa changes, increases, and also finds weak spots in the protective membrane and grows into the muscular layer of the uterus. As a result, firstly, excess mucous tissues are not completely removed from the uterus, and secondly, muscle tissues are affected. Doctors distinguish 4 different stages of this disease: endometriosis of the uterus of 1 or 2 degrees means that the endometrium has grown to about the middle of the myometrium. Grade 3 indicates that there is germination to the serous cover, but grade 4 means that the peritoneum is already affected.
Adenomyosis also differs according to the type of development. Perhaps the most difficult and unpleasant option is diffuse endometriosis of the uterus. With diffuse adenomyosis, the germination of the endometrium occurs evenly throughout the uterus, layer by layer. Treating this condition is very difficult.
However, focal adenomyosis still occurs more often, when only certain parts of the uterus are affected: the anterior or posterior wall. Another variant of endometriosis of the uterine body is nodular. It has a lot in common with focal, however, in this case, the muscle tissue begins to defend itself, to resist the "invasion". As a result, a seal, a small nodule, is formed around the foci of germination. This, in turn, leads to an increase in the size of the uterus. However, in terms of future treatment, there is simply no big difference between the second and third types.
Reasons for the development of the disease
Unfortunately, doctors and scientists still cannot say with certainty what exactly leads to the development of adenomyosis. There are several theories, none of which, in other matters, has been proven.
So, some scientists argue that the cause of the development of endometriosis is retrograde menstruation : a phenomenon in which part of the menstrual blood goes deeper into the uterus, into the fallopian tubes and sometimes into the abdominal cavity. Menstrual blood always contains particles of the endometrium. As a result, these cells can attach themselves to very unusual places for themselves.
Various factors can also lead to the development of uterine endometriosis. procedures and interventions into her cavity. Miscarriages, abortions, curettage, removal of polyps, any operations that can break the integrity of the membrane, including laparoscopy and caesarean section. Of course, after the operation, the membrane recovers quite quickly, however, scar tissue appears at the site of damage, which is much less effectively able to resist the germination of the endometrium.
Undoubtedly, the development of the disease is influenced by hormones , so that any failures in this area, disruption of the glands, can also cause endometriosis. According to research results, women are at risk, often facing stressful situations, as well as undergoing constant.
Some scholars note the effect hereditary factor . According to their research, if a case of endometriosis has already been encountered in the family, then the woman's risk of encountering this disease also increases.
At the moment, there is even information that doctors are developing a special DNA text that will allow early detection of a woman's genetic predisposition to endometriosis. This will allow women at genetic risk to focus on preventive measures.
Symptoms and Diagnosis
Diagnosis of endometriosis of the uterus, unfortunately, is extremely complicated by a whole range of reasons. Firstly, in a number of cases, the disease is completely asymptomatic until the moment when serious complications begin. Secondly, most of the symptoms characteristic of endometriosis can signal many other diseases.
To make an accurate diagnosis, it is necessary to conduct a number of studies, including a routine gynecological examination with mirrors, ultrasound, colposcopy and laparoscopy.
Ideally, every woman should know the signs of endometriosis of the body of the uterus in order to be able to consult a doctor in a timely manner. Most of the symptoms are somehow related to the menstrual cycle.
So, one of the most striking and common symptoms is painful menstruation. The pain begins to bother women 1-2 days before the onset of menstruation and reaches its greatest strength, as a rule, by the 3rd day of discharge.
The causes of pain during menstruation can be very different. In particular, it can be caused by an excess of prostaglandins, which cause muscle contraction. When the concentration of these substances in the tissues of the uterus is not uniform, pain occurs. Also, pain can be the result of contact of the affected areas of the uterus with other organs and tissues.
Pain can haunt a woman not only during menstruation, but also in the middle of the cycle. The cause may be inflammation that occurs against the background of pathological processes.
A symptom of adenomyosis is a violation of the menstrual cycle. Especially often this symptom occurs in cases where the disease itself is of a hormonal nature. Perhaps a change in the duration of menstruation or, more often, a change in the nature of the discharge. Often, periods become much more abundant.
If the lesion extends to the cervix or vagina, then the woman may experience acute pain during intercourse. Scanty spotting after sex is also possible.
Not infrequently, with adenomyosis, an increase in the size of the uterus and a change in its shape are observed. Of course, on her own, a woman will not be able to determine the size of her uterus. But it is clearly visible on ultrasound.
What is dangerous endometriosis of the uterine body
The consequences of endometriosis of the uterus can be extremely unpleasant and even dangerous. First of all, this disease often leads to infertility. The nature of this phenomenon is not fully understood, however, in 60% of cases, women with endometriosis experience difficulty conceiving and bearing children .
According to some versions, conception is complicated precisely by violations of the uterine mucosa. That is, a fertilized egg simply cannot be fixed. In addition, the overgrown endometrium can block the entrance to the fallopian tubes, which also interferes with conception. Last but not least is the hormonal background. In some cases, endometriosis does not ovulate at all.
The formation of nodules on the body of the uterus is fraught with a change in its shape. In some cases, a fixed bend of the uterus is formed. And it also prevents conception.
Fortunately, in most cases, infertility can be cured after the disease itself is eliminated. Although sometimes, when the uterine lesion reaches a critical point, and other methods of treatment do not help, the woman's uterus is removed.
If pregnancy does occur, then it will be extremely difficult to maintain it. Early miscarriage in women with adenomyosis occurs many times more often than in healthy women. This means that a woman with endometriosis throughout her pregnancy will have to carefully monitor herself, avoid physical and emotional stress.
However, infertility is not the only danger of adenomyosis. Heavy periods can cause another serious disorder - anemia . Together with blood, a woman loses iron each time. However, during normal menstruation, no more than 80 ml of blood is lost; with adenomyosis, this amount can increase several times. At the same time, the supply of iron from the outside remains the same.
But iron is responsible in our body, primarily for the transfer of oxygen from the lungs to other organs. As a result of a lack of hemoglobin, less oxygen enters the organs, oxygen starvation begins. The woman begins to feel weakness, fatigue, constant malaise.
In some cases, endometriosis can cause development of uterine fibroids . It has to do with defense mechanisms. In a more dangerous scenario, we can talk about the degeneration of pathological endometrial cells into cancer cells. In this case, the removal of the uterus is likely to be avoided.
Treatment and prevention
From the foregoing, it becomes clear how important timely and qualified treatment of uterine endometriosis is. If you suspect that you have adenomyosis for any reason, do not delay a visit to the doctor.
There are three fairly effective methods of treatment: conservative (medication), organ-preserving surgery in combination with medication, and radical surgery. Which method is chosen in which case depends on the specific situation.
Before prescribing treatment, the doctor must conduct all the necessary studies. Only on their basis, depending on the degree of damage to the organ, the form of the disease, the age and general physical condition of the woman, and also taking into account her plans for the future, in particular, in relation to childbearing.
As a rule, doctors try to get by with conservative methods. Medicines remove menstruation from a woman for up to six months. During this time, excess overgrown endometriosis tissue is excreted from the body. And the growth of the endometrium stops. Muscle tissue during this time is also cleared.
Naturally, the treatment is carried out with the help of hormonal agents. As a rule, these are 2 or 3 phase contraceptives. Many women worry about the need for long-term use of hormonal pills. In this regard, the development of more effective and safer means is constantly underway. Now it is very important that, firstly, the doctor who treats you is aware of all the latest developments. Secondly, it is necessary that throughout the course of taking the drugs your condition is constantly monitored.
If conservative methods do not help or if the degree of damage is too high, a uterine cleaning may be prescribed. Of course, curettage can only be discussed in the case of focal or nodular adenomyosis. In the case of diffuse lesions of the uterus, the area of the lesion is too large to make sense of scraping it. In such a situation, one has to rely only on drug treatment of endometriosis.
In addition to surgery, in this case, the use of hormonal drugs is also expected. In some cases, medications are prescribed in the preoperative period. This allows you to prepare the body for a stressful situation, as well as restore reproductive functions.
In exceptional cases, when neither the first nor the second methods help, surgery may be required to remove the uterus. Doctors do their best to avoid this, and not only out of a desire to preserve the ability to bear children, but also because the whole life of a woman directly depends on the hormonal background, and the removal of the uterus and ovaries greatly changes it, and therefore changes the life of a woman.
Unfortunately, it is quite difficult to talk about the full prevention of this disease, because the causes of the appearance of endometriosis are still a mystery in most cases. However, something can still be done.
First, try to avoid stressful situations. And in any case, excessive loads do not have a positive effect on a woman's health. Secondly, try to take care of your health. Abortions, curettage, miscarriages and, of course, various inflammatory processes and diseases lead to damage to the protective membrane, and scars at the sites of damage can later become those weak points through which endometriosis “breaks through”.
Perhaps this is all that can be done in terms of preventing endometriosis. The rest of the measures relate to ways of early detection of this disease. In no case should you neglect regular preventive examinations by a gynecologist. This will help to track unwanted processes in time and stop them in time.
Folk methods of treatment
Let's return to the issue of women's fears regarding hormonal drugs. Unfortunately, many patients reject doctors' prescriptions and try to get by with folk remedies in the treatment of endometriosis of the uterine body.
It can be various homeopathy, and some kind of semi-magical rituals, and various diets. Of course, some of these remedies, such as beetroot juice or properly selected homeopathic remedies, can lead to a general improvement of the body and maybe even remove the external symptoms of endometriosis, but this does not mean a cure at all.
Adenomyosis will again go into an asymptomatic stage, the woman will decide that she is completely cured and will forget about her illness. The same will continue to progress. In the future, it will be much more difficult to cure a neglected disease.
So it is better not to get carried away with folk methods of treating endometriosis of the body of the uterus. It's best to just talk to your doctor about the details of the treatment, find out what side effects are possible, when you can expect the result, and whether other drugs can be selected. This will help you understand the mechanism of the drug and understand how necessary it is at all.
Endometriosis of the body of the uterus is a serious and dangerous disease that must be treated in a timely manner. Monitor your well-being, condition and do not forget to visit a antenatal clinic every six months. Otherwise, the disease can lead to infertility and removal of the uterus. And this is the hardest blow for any woman.
Of course, modern medicine allows you to cope even with fairly severe forms of the disease, but this is not a reason to let everything take its course.
Informative video: a specialist talks about the methods of treating endometriosis
Answers
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 a 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 a neoplasm that spreads from the tissues of the uterus. The lining of the uterus is called the endometrium. It consists of endometrioid cells and has special receptors. These receptors exist only in the uterine mucosa, however, with the development of pathology, they spread to other organs and begin to function there. In other words, such a pathology is a benign tumor and can be another name for the endometrium.
There can be many reasons that provoke diseases, however, in the list of the most likely:
- Disturbances in the immune system;
- genetic inheritance;
- Hormonal disbalance.
Doctors also warn about the risk group, which includes women:
- Having undergone numerous abortions;
- With insufficient iron content in the body;
- With an installed intrauterine device that can move;
- With chronic inflammatory diseases of the pelvic organs (adnexitis).
Kinds
Depending on the localization of the pathological process in medicine, several types of the disease are distinguished:
- Genital (endometrium is transferred and grows in the tissues of the ovaries, fallopian tubes, cervix and other genital organs);
- Extragenital (a process that affects organs that are not related to the reproductive system);
- Mixed form (combines both previous forms).
If endometriosis is located in the body of the uterus, then it is often called internal or. Its development has 4 degrees.
- 1 degree. The uterine mucosa is affected down to the outer layer of muscular smooth tissue (myometrium).
- 2 degree. The myometrial layer is also involved in the process up to the middle.
- 3 degree. Endometriosis extends deep into the serous cover.
- 4 degree. Endometrial cells pass to the parietal peritoneum.
The nature of education allows you to subdivide the process into focal endometriosis and diffuse. With diffuse, there is a uniform thickening of the walls of the uterus, and with focal, the neoplasm is localized in a certain area.
Clinical picture
This pathology is quite rare. In addition, signs may be completely absent for a long time, without causing any trouble to the woman. Among the most common manifestations of a doctor are:
- Drowsiness and weakness;
- Severe pain in the first few days of the menstrual cycle;
- Pain in the lower abdomen;
- Violation of the menstrual cycle;
- Nausea;
- Attacks of vomiting.
More on the topic: Uterine prolapse exercises
Doctors say that prolonged heavy menstrual flow with pain is not the norm. Any of the above symptoms should serve as a signal that a woman needs qualified medical help.
Diagnostics
Quite often, endometriosis of the body of the uterus, according to the clinical picture, can be mistaken for myoma, therefore, many studies are prescribed to make an accurate diagnosis. Among the main ones:
- Blood test (with endometriosis, the CA-125 marker has an increased rate);
- Ultrasound of the pelvic organs (it can be used to objectively assess the condition of the uterus and its appendages);
- Laparoscopy (a minimally invasive surgical method that uses special equipment with illumination and a mini camera);
- Hysterosalpingography (gives information about the stage of the disease).
The list of analyzes in each case may vary. For some patients, it will be enough to undergo an examination and ultrasound, while others will need to go through all the procedures to make a diagnosis.
Pregnancy
In most cases, the disease causes obstruction of the fallopian tubes. For this reason, pregnancy occurs very rarely. If this happens, there is a high risk to the fetus.
Women who have undergone treatment are able to become pregnant in 50% of cases. However, it is not worth waiting for this event in the first few months after the course of therapy. It takes 6-14 months to restore health and reproductive function. It is after complete rehabilitation that successful fertilization can occur.
Effects
Lack of timely treatment can adversely affect the health of the patient. Among the most frequent complications are:
- cancerous tumors;
- Infertility;
- neurological disorders;
- Endometrial ovarian cyst.
Treatment
After the doctor examines the echo signs, he can prescribe an individual treatment for the disease, which can be conservative and surgical.
If the disease is in the initial stages of development, then conservative therapy is often used. It includes a course of taking hormonal drugs:
- Progestogens;
- Antigonadotropins;
- Gonadotropin-releasing hormone agonists.
These medicines are aimed at eliminating the main cause of the disease. However, along with this, additional drugs are used that stop the symptoms. The patient is prescribed:
- Anti-inflammatory therapy (NSAIDs);
- Sedatives (to prevent neurological manifestations);
- Analgesics (to relieve pain);
- Iron-containing preparations (for recovery after blood loss);
- Vitamins A and C (restoring the antioxidant system);
- Immunomodulators (to restore the immune status);
- Physiotherapy procedures.
Surgical treatment is used only in cases where other methods of exposure have not given the expected result. Doctors insist on surgery and in cases where there is a chronic failure of neighboring organs or the endometrium is complicated by fibroids and uterine bleeding.
