Drugs for the treatment of endometriosis. All about chronic endometriosis and its treatment. How long is endometriosis treated and is it possible to speed up the process

Complete non-consequent therapy of the disease can be attributed to rare cases. One of the forms into which an active disease flows is chronic endometriosis. The difference between classic and chronic disease is huge. How to treat the chronic form of the disease, read further in the article.

Symptoms of the development of chronic endometriosis

Endometriosis is a disease in which the cells of the endometrium (the inner layer of the uterus) move to neighboring organs where they should not be. The signs of the disease are associated with the location of these pathological growths: in the wall of the uterus - with profuse bleeding during menstruation, in the fallopian tubes - with infertility, in the ovaries - with cysts, in the bladder - with painful urination, in the rectum - with pain in the perineum. The foci of this disease are subject to hormonal cyclic changes, and characteristic complaints increase before and during menstruation.

Chronic forms of endometriosis often behave calmly. The course of their "life" worries a woman a little. Occasionally they cause premenstrual bleeding, rarely pain characteristic of the disease. But this does not mean that the disease is harmless. She slowly and steadily develops functional infertility. The fact is that endometrial cells are almost inactive, but the body continues to react to them, and envelops them with adhesions, epithelial plugs, and forms cysts. These formations, depending on the location, may prevent fertilization, or the fixation of the fetus on the walls of the uterus.

The symptoms of the disease largely depend on the distribution and location of endometriosis, as well as the duration of its course and the presence of other concomitant diseases.

The main and most common symptom of chronic endometriosis is the appearance of pain that occurs or sharply increases before menstruation. With a long-term and severe process, pain is often permanent.

There may also be bloody discharge during menstruation, dark in color with clots. After menstruation, a rather long period of spotting spotting is possible. As a rule, this is a sign of intrauterine endometriosis.

It is also noted, most regrettably, the presence of infertility. The causes of infertility in this situation are the absence of ovulation, defective changes in the endometrium during the entire menstrual cycle, as well as adhesions in the fallopian tubes and pelvis. Also, very often infertility is caused by a violation of the attachment of a fertilized egg to the wall of the uterus.

It is worth noting that only a good doctor is able to accurately recognize endometriosis and prescribe the correct and effective treatment.

The problem of women's diseases becomes more and more diverse every year. One of the most unpleasant in terms of symptoms and consequences can be considered the problem of endometriosis. Today it has been proven that the disease can have a type of development similar to oncological diseases. It grows, affects the pelvic organs and practically metastasizes to other organs of the body. If endometriosis is not stopped, a woman can completely lose her reproductive function, lose part or most of her reproductive apparatus.

If the treatment is not correct, the disease can acquire a chronic form, it can lead to the removal of internal organs, it can put the patient to bed.

Varieties of chronic endometriosis

As for the possible variants of the disease, there are a lot of varieties. First, endometriosis is divided into internal and external.

Internal endometriosis is a lesion of endometrial cells of the myometrium - the tissues of the uterus. Internal endometriosis is the most common in terms of prevalence.

External endometriosis is a lesion by endometrial cells of the cervix, vagina, fallopian tubes, ovaries, peritoneal walls, intestines, bladder, inguinal lymph nodes and other organs of the pelvic floor. External endometriosis is not common, but it also occurs.

In addition, the disease endometriosis differs depending on the type of distribution. It can be diffuse - endometrial cells are distributed evenly throughout the tissues of the organ, there are no characteristic foci of inflammation. Or it may have a nodular shape. In this case, nodules from endometrial cells form on the walls and in the walls of organs, which are focal manifestations of the disease.

Depending on the affected organ, individual problems and symptoms arise. It is worth noting that external endometriosis is most often the result of a neglected form of internal endometriosis. Therefore, it is so important to start timely treatment.

Specialists highlight

extragenital (outside the reproductive system - navel, intestines, etc.)
and genital (within the genital organs - uterus, ovaries) endometriosis.

There are two types of genital endometriosis:

outer
and internal.

With external genital endometriosis, a tissue resembling the endometrium is located outside the uterine cavity on the organs and peritoneum of the small pelvis, forming various nodules, tumors, lesions, or other foci of growth.

As a rule, the foci of the disease are located on the ovaries, fallopian tubes, in the area behind the uterine space, on the ligaments that support the uterus, on the cervix and the mucous membrane of the vaginal walls. And when the foci of endometriosis are located in the thickness of the walls of the uterus, this is already internal endometriosis or adenomyosis.

Stages of chronic endometriosis

At the first stage of development, endometriosis, as a rule, is not so terrible, although it all depends on the lesion. In this case, it is characterized by the appearance of single surface manifestations. Depending on the location of the lesion, it may or may not hurt. It may not be possible to diagnose it with the help of visual measures - a colposcope, ultrasound at this stage. But the pap test and histological examination can give results.

At the second stage, explicit expressions of the disease begin. The location of the disease expands or the nodules simply increase. In other words, endometriosis begins to grow deeper into the affected tissues, but does not yet spread territorially. Although with rapid development, the disease can very quickly bypass this stage, and immediately go to the third stage.

In the third stage of the disease, the problem grows not only in the uterus, but also begins to manifest itself in the form of cysts on the ovaries, adhesions in the fallopian tubes and on the peritoneum. The fact is that secretions inside the peritoneum can cause enormous damage to the body, even death, so the body defends itself and seals the threatening fluid into adhesions and cysts for the time being. The removal of these formations is most often necessary, and very often ineffective, because this is only a result, and not a cause in itself.

The fourth stage of endometriosis is expressed by the total infection of the reproductive system, pelvic area, excretory system.

Of course, the treatment depends on the stage of endometriosis and its area of influence. Therefore, it is so important to catch the disease in the early stages.

Degrees of chronic endometriosis and their signs

The specified disease is usually classified into degrees depending on the spread and depth of the lesion:

degree. There are one or more superficial lesions.

degree. One or more deep foci can be identified.

degree. A large number of deep foci of endometriosis, minor cysts on one or both ovaries, there are thin adhesions of the peritoneum.

degree. There are multiple deep foci, large cysts on both ovaries, dense adhesions of organs, germination of the vagina or rectum is possible.

Currently, experts call on patients who have been diagnosed with this, since modern medicine allows you to get pregnant with internal endometriosis of the 1st, 2nd degree, and even often with endometriosis of the 4th degree. To do this, you just need to contact a good specialist in a timely manner, who will correctly determine the degree of endometriosis and select the optimal treatment.

Features of the treatment of chronic endometriosis

The incidence of endometriosis has been increasing annually in recent years. And traditional medicine treats all sick people with the help of hormonal drugs and surgical methods. Homeopathy is also popular.

Medical treatment is aimed at combating comorbidities. Most often these are antibiotics, desensitizing drugs, vitamins, drugs to increase the supporting function of the body.

In addition, they offer to take a course of sedative therapy, which always has a good effect on the female apparatus.

The role of physiotherapy is very great. In particular, such a woman is prescribed high-quality sanatorium treatment. Baths, irrigation of the uterus, douching, herbal medicine and mineral waters, under the supervision of a physician, can do wonders for a woman's body.

In addition, a woman with chronic endometriosis is recommended to take COCs, especially if she is going to give birth. Very often, after several years of taking, a woman manages to get pregnant, and after childbirth, if they went well, endometriosis completely fades and leaves the body. Hormonal shake-up during pregnancy completely eliminates its activity.

The main thing to remember is that any disease can be dealt with. And chronic endometriosis in this regard is no exception.

Drug therapy for chronic endometriosis

The drug method of treating the disease involves the use of hormonal drugs that normalize the functioning of the ovaries and prevent the further formation of foci of endometriosis. For treatment, hormonal preparations are used, similar in composition to hormonal contraceptives, preparations of the danazol group, preparations of the decapeptyl group. Courses of treatment last for several months or longer. In addition, the treatment also involves non-hormonal analgesics aimed at reducing pain. Steroid hormones may also be used.

Until the late 1970s, most doctors prescribed long-term use of combined contraceptive pills. At the same time, after cessation of treatment, pregnancy occurred in 40-50% of cases.

Long-acting gestagens (Medroxyprogesterone acetate 100-200 mg per month intramuscularly) in the treatment of endometriosis inhibit the hypothalamic-pituitary function. This causes amenorrhea. Against the background, weight gain and depression often appear, as well as prolonged amenorrhea after treatment.

Gestrinone preratate, a derivative of 19-nortestosterone, is also used. This drug for the treatment of endometriosis has an antigonadotropic effect and is prescribed 2.5 mg on the 1st and 4th day of menstruation, and then 2.5 mg 2 times a week for 6 months.

Unfortunately, the treatment of the disease is associated with the frequent occurrence of various side effects. Weight gain, fluid retention, weakness, breast shrinkage, acne, deepening of the voice, facial hair growth, atrophic vaginitis, hot flushes, muscle spasms, and emotional lability are common.

Today, the best way to treat chronic endometriosis is the use of gonadotropin-releasing hormone (GTRH) agonists, in which "medical oophorectomy" occurs.

Triptorelin - often begins from the 1st to the 5th day of the menstrual cycle: the contents of a syringe with 3.75 mg of the drug, after pre-mixing with the attached suspension agent (7 ml), are injected subcutaneously into the anterior abdominal wall or intramuscularly every 28 days for up to 6 months depending on indications. The drug is slowly released from the microcapsules into the blood. This allows you to maintain its constant presence in the blood plasma, the therapeutic concentration is maintained for 4 weeks. It is known that improvement in well-being is noted in most patients by the end of the 1st month of treatment. In 56% of women, remission persists for 7-37 months after the last injection of the drug.

In addition, there are other methods of treating chronic endometriosis - Goserelin intradermally 1 time per month, 3.6 mg, as a subcutaneous depot 1 time per month in the biodegradable polymer Uozelerin, preparations for irrigation of the nasal mucosa in a daily regimen at a daily dose of 900 mcg of Buselerin or 400-500 micrograms of Nafarelin.

All the methods discussed above have many side effects, and, in addition, have a large number of contraindications. In addition, when using them, a positive result is not always noted, and the cost of therapy is quite high. Therefore, it is often necessary to resort to surgical intervention for the treatment of endometriosis.

Homeopathy in the treatment of endometriosis

Today, many patients with this disease resort to the help of homeopathic doctors. Indeed, endometriosis homeopathy can give a very good effect. It is the preparations individually selected by a homeopath that are able to restore hormonal metabolism. For the selection of homeopathic treatment, electropuncture diagnostics is carried out, which allows you to choose the right treatment and natural homeopathic diseases that will help you cope with the trouble. With such treatment, as practice shows, complaints disappear within six months, as well as permanent manifestations of the disease, such as ovarian cysts, mastopathy, nodes and cysts of the thyroid gland.

Homeopathic treatment works very well on the very cause of the disease, it is harmless and quite affordable. Professional homeopathy is hundreds of times stronger than herbal medicine. Of course, the choice of the type of treatment always remains with the patient. Traditional medicine should not be discounted either, as it also helps to fight this disease quite well. But homeopathy also has excellent possibilities for the treatment of such patients. In addition, it is practically harmless and has no side effects. By the way, this area of medicine is currently being actively explored, new methods of treating endometriosis using homeopathic remedies are emerging. This suggests that homeopathy has a pretty big future here!

Causes of chronic endometriosis

Many women, having learned about such a disease, for a very long time cannot understand the cause and essence of this disease. We will try to explain as clearly and simply as possible all the data currently available on the nature and cause of the development of the disease.

The disease is characterized by the fact that the endometrium (the mucous layer of the uterus) is found not only in the uterine cavity, but also in other places. The exact cause of endometriosis is still unknown. In the presence of chronic endometriosis, the endometrium, which is rejected at the end of the menstrual cycle, enters the fallopian tubes along with the blood, takes root there and begins to grow. It can also be carried with blood throughout the body, sprouting in the most unexpected places.

The disease can be formed in the presence of malfunctions in the immune system. In a normal state, the immune system destroys all cells foreign to a particular organ. With a diagnosis of endometriosis, this does not happen, as a result of which endometrial cells that accidentally get into another organ take root there and begin to function like a normal endometrium in the uterus.

Why this happens is still unclear. But it has already been established that heredity and stress play a role here. In addition, hormonal disorders, thyroid diseases, various intrauterine manipulations, inflammatory diseases of the genital organs, excess weight, as well as alcohol abuse, caffeine, and smoking will help to recognize endometriosis.

To date, there are many assumptions about the cause of the development of chronic endometriosis. They suggest the possible occurrence of endometriosis due to a genetic hereditary predisposition.

Causes of chronic endometriosis

The prerequisites for the development of chronic endometriosis are also considered to be in the endometrium itself, which is able to develop on other tissues outside the uterine cavity. Also, some authors are of the opinion about an anomaly in the embryonic period of a woman, which leads to the presence of areas of endometrial tissue in other organs.

However, the mediated role in the occurrence of symptoms of endometriosis of the following factors is known for certain, which can help every woman to understand the possible causes of this pathology:

hormonal imbalance and, as a result, menstrual irregularities;

disorders in the immune system.

The reasons why chronic endometriosis develops are not so complicated. This is, first of all, undertreated endometriosis caused by abortion, or caesarean section. It is also possible its development due to postpartum intervention in the integrity of the uterus, or diseases such as cervical erosion or ulcerative inflammation. In general, any violation of the integrity of the uterine mucosa in women who have had endometriosis can cause the development of a chronic type of the disease.

I would like to note that in any case, this process is almost always accompanied by some additional pathology of the reproductive system. Very often these are anomalies and underdevelopment of the genital organs, inflammatory diseases of the genital organs, etc. Also, the causes of the development of chronic endometriosis of the body of the uterus (myometrium) are abortions, diagnostic curettage of the uterus, pathological births and abortions, complicated by inflammatory processes, and other intrauterine interventions.

Chronic endometriosis is a disease that often leads to female infertility. The cause of the disease is a violation of the integrity of the endometrial layer in the uterus. Symptoms are latent, mild, which greatly complicates timely diagnosis. The clinical picture of endometriosis depends on the stage of development, and the type of disease. The main one is concomitant diseases, often in a chronic form, complicated by medical abortions, sexually transmitted diseases and weak immunity.

Chronic endometriosis of the uterus is a disease that is characterized by the pathological placement of endometrial cells outside the uterine cavity, in neighboring organs. Cells can migrate to the walls of the uterus, fallopian tubes, bladder, rectum, or egg. The endometrium is one of the three layers of the uterine cavity, to which the egg is attached after its successful fertilization. If there was no conception, the endometrial cells die off and come out with menstruation. Chronic endometriosis what it is - the disease is an inflammatory process on the endometrial layer, caused by a violation of sterility in the uterine cavity, due to the development of pathogenic microflora.

Endometriosis of the uterus has a similar etiology with oncological neoplasms. Formed as a small inflammatory focus, endometriosis gradually grows in the form of metastases, touching the internal organs of the genitourinary system. Without timely treatment, the disease can lead to complications, up to complete infertility.

Causes of endometriosis

The endometrium consists of two layers - basal and functional. The main purpose of the functional layer is to ensure the attachment of the amniotic egg upon successful fertilization of the egg, and to generate mucus that lines the walls of the uterine cavity. Contact with the mucous membrane of the uterus with a virus and pathogenic microbes causes inflammation of the functional layer of the endometrium. Why is the sterility of the mucous membrane violated:

Medical termination of pregnancy with curettage of the uterine cavity
douching procedure
Carrying out hysteroscopy - the introduction of a hysetroscope into the uterine cavity to study the state of the uterine pharynx
Careless hysterosalpinography, a diagnostic procedure for examining the fallopian tubes
Sexual intercourse during menstruation
Violation of hygiene and antiseptic standards during caesarean section
Neglect of personal hygiene during menstruation, especially when using tampons
Sexually transmitted diseases
Penetration into the uterine cavity of pathogenic microflora due to infectious diseases in the intestines and organs of the genitourinary system
immune system dysfunction
Hormonal disbalance

Types of endometriosis

Chronic endometriosis has two forms - external and external. With the external form of the disease, endometrial cells grow into the cervix, ovaries, rectum and other neighboring organs. This type of disease is extremely rare. The internal form of endometriosis is characterized by the penetration of the endometrium into the soft tissues of the uterus, provoking their inflammation.

Pathological location of endometrial cells can be diffuse or nodular. With diffuse endometriosis, cells fill the uterine cavity with an even layer, there are no separate inflammatory foci. The knotty type of the disease is characterized by the formation of inflammatory nodes from endometrial cells.

Chronic endometriosis can be genital and extragenital, depending on which organs are affected. The genital type of the disease is characterized by an inflammatory process on the internal organs of the reproductive system. With extragenital endometriosis, soft tissues of organs that are not part of the reproductive system become inflamed - in the organs of the gastrointestinal tract.

Symptomatic picture

Symptoms of chronic endometriosis begin to appear a few weeks after the onset of the inflammatory process. Symptoms of the disease depend on the cause of the inflammatory process and the type of pathogenic bacteria. General clinical picture:

Mild pain, aching character in the lower abdomen during menstruation. The pain syndrome can be quite strong.
Increase in body temperature up to 38
Vaginal discharge, the type of which depends on the underlying disease. If endometriosis was triggered by infection with gonorrhea, the discharge will be purulent
Prolonged periods that last a week or more
Problems conceiving a child, inability to bear a fetus (pregnancies end in miscarriages)
Bloody discharge with dense clots, outside of menstruation. As a rule, such discharge occurs immediately after menstruation, or during menstruation.

Symptoms of chronic endometriosis may not appear for a long period of time, and a woman can find out about the disease at a routine gynecological examination.

Symptoms of exacerbation of endometriosis:

poor appetite
General weakness and apathy
Increase in body temperature 38.5 - 39 degrees
Drawing pain in lower abdomen. Pain can be severe, radiate to the lumbar and sacral region
Purulent discharge from the vagina with an unpleasant odor
Bleeding from the uterus. This symptom is extremely rare.

With these symptoms, a visit to the doctor should be urgent. Delay in the diagnosis of the disease complicates and delays the process of treating chronic endometriosis.

Therapy for endometriosis

It is necessary to treat the disease in a complex way, using hormonal and restorative therapy. In cases of a strong inflammatory process, which is accompanied by the formation of adhesions, a surgical operation is performed. Medicines for the treatment of endometriosis are prescribed on an individual basis, and are aimed at treating the disease - the root cause. Mandatory intake of vitamin complexes, antibiotics and desensitizing drugs (antihistamines).

Treatment of chronic endometriosis continues after taking antibiotics. The recovery period is required to normalize the general condition and restore the functions of the organs of the genitourinary system. A woman needs to undergo rehabilitation in a sanatorium - taking mineral waters, special baths, a course of herbal medicine and douching are effective means that help restore reproductive health.

Women who have not yet given birth, or plan to become a mother again in the future, are prescribed hormonal contraceptives. In most cases, after pregnancy and childbirth, endometriosis goes away on its own, this is due to a radical change in hormonal levels.

Most hormonal drugs that are successfully used in the treatment of endometriosis can cause a number of side effects:

Weight gain
Depression
Amenorrhea (prolonged absence of menstruation)
Swelling of the limbs
General weakness of the body
Acne
Increased facial hair

Alternative Treatments

Homeopathy and traditional medicine have a positive effect when taken regularly. Before treating chronic endometriosis using non-traditional remedies, you should consult with your doctor. Before prescribing a homeopathic remedy, it is necessary to undergo electropuncture diagnostics. All kinds of traditional medicine can be used solely as an additional measure to the main, drug treatment. Their task is to relieve symptoms and alleviate the general condition.

Symptoms and treatment of chronic endometriosis depend on the stage of development. The sooner you see a doctor, when the first symptoms appear, the faster and easier the recovery period will be.

Forecast for the future

Timely cured endometriosis does not present any difficulties for the successful conception and bearing of a child. Women who develop the disease during pregnancy should be constantly monitored by the attending physician; in case of complications, treatment is carried out in a hospital setting.

The threat of infertility, or the inability to bear a child, exists in the case of an advanced stage of the disease, when endometrial cells have damaged the cervix, ovaries and other organs of the genitourinary system. In this case, a woman is tormented by frequent abdominal pain, menstrual cycle failure, general poor health.

Chronic endometriosis develops as a result of a violation of the integrity of the inner lining of the uterus. This pathology is the main factor in the development of female infertility, with this form of the course, the symptoms are usually mild.

The disease occurs more often in the reproductive age after 35-40 years. By this time, most women have a number of concomitant diseases in a chronic form, accompanied by a weakened immune system. Also among the reasons for the growth of the endometrium are frequent abortions, curettage, STDs.

Pathology is characterized by the progressive growth of endometrial cells that extend beyond the uterine cavity. They can migrate not only to the tubes, ovaries, cervix, bladder, but also to the rectum, stomach walls. The inflammatory process inside the genital organ leads to the fact that the cells grow.

Normally, it fluctuates between 0.5–5 mm. The minimum indicator is noted closer to the beginning of menstruation, if fertilization does not occur, the maximum - at the time of ovulation. This is due to the fact that a fertilized egg is attached to the mucosa.

In the chronic stage of endometriosis, many women have problems with conception, since the overgrown layer is not able to accept the egg, it cannot attach due to a violation of its integrity.

Reasons for development

A number of reasons contribute to the development of endometriosis, however, it has not been fully clarified what provokes the uncontrolled pathological growth of cells of the uterine mucosa. Basic prerequisites:

curettage and surgical abortion;
frequent douching;
inaccurate hysteroscopy;
intimacy on critical days;
infectious diseases of the genitourinary system and intestines;
immune disorders;
hormonal imbalance.

More than a third of all cases of the chronic form of pathology are observed in women over 40 years of age with a history of abortion, curettage, and infectious diseases of the genital organs.

Symptoms

The development of the chronic form of the disease is preceded by an acute phase, characterized by vivid clinical manifestations. In the absence of treatment and the presence of adverse factors, the symptoms disappear, but the growth of the endometrium continues.

The manifestations are as follows:

the presence of acyclic menstrual bleeding in the lower back and abdomen;
discomfort and the release of a small amount of blood during intercourse or after it;
failure of the cycle of menstruation;
discharge of various colors and consistency caused by infectious diseases;
infertility, miscarriage, miscarriages in anamnesis.

Depending on the form of endometriosis, symptoms can vary. If the pathology is caused by gonorrhea, purulent discharge with an unpleasant odor will periodically appear. With an exacerbation of the chronic form of the disease, an increase in temperature up to 39 degrees, apathy, weakness, bleeding, and a decrease in appetite are possible.

How to treat

Chronic endometriosis can be cured using complex therapy, including restorative and hormonal drugs. Surgical methods are rarely used: if the growth of the endometrium progresses, adhesions occur in the tubes, and frequent bleeding is observed.

Any treatment is preceded by the diagnosis of a chronic process, which is aimed at finding out the root cause of the disease. If an inflammatory focus is detected, appropriate anti-inflammatory and antibacterial drugs are prescribed.

Taking hormonal drugs helps to stabilize the cycle, normalize the level of estrogen and progesterone, and stop bleeding.

Surgical treatments

Treatment of chronic endometriosis with surgical intervention is justified in the case when a woman often has bleeding, the effectiveness of hormonal therapy is not effective. is prescribed for retrocervical localization of endometrioid foci, cyst formation, adenomyosis (damage to the uterus by overgrown endometrium).

4 types of surgery are used:

laparotomy;
access to endometriosis foci through the vagina;
combined methods.

The most sparing is considered laparoscopy. This minimally invasive technique allows small incisions to be made with minimal blood loss. In addition, the risk of tissue infection is reduced.

Complex treatment

Conservative therapy includes the use of the following drugs:

Hormonal drugs (COCs), containing progesterone and estrogen, which reduce the activity of endometrial growth.
Gestagens. They contain synthetic analogues of the hormone progesterone, reduce the activity of estrogen on the tissues of the mucous membranes of the uterus.
Gonadotropin-releasing hormone antagonists. Necessary to reduce ovarian hyperfunction, act directly on the pituitary and hypothalamus.
Gonadotropic hormone inhibitors. They reduce the production of their own estrogen, block ovarian function, stop the growth of endometrial cells.

Depending on the severity of the drugs can be used in combination. In the initial phase of the pathology, only oral contraceptives are often prescribed. If 3-6 months have passed after treatment, but the growth of the endometrium continues, the question arises of surgical intervention.

Folk methods

Used in complex treatment. To stop the foci of the disease, reduce the activity of the ovaries, normalize the hormonal background, the menstrual cycle, apply:

plantain;
propolis;
boron uterus;
clay;
aloe juice.

On the basis of natural ingredients, decoctions, alcohol tinctures are prepared. They are also used as an impregnation for tampons, components of homemade vaginal suppositories.

Complications

One of the most common consequences of untreated chronic endometriosis is infertility. Also, pregnancy pathologies often occur - spontaneous miscarriage, placental abruption, fetal development arrest.

The disease leads not only to infertility. If the cause of endometriosis is a malfunction of the ovaries, weight may increase, excessive vegetation on the body may appear, and the skin condition suffers. Also, the growth of cells of the mucous layer of the uterus leads to the appearance of polyps, cysts, adhesions in the tubes.

Since endometriosis, especially in the chronic form, rarely manifests itself as a vivid clinical picture, it is necessary to observe preventive measures. These include the use of modern methods of contraception, minimizing abortions and diagnostic curettage, boosting immunity, monitoring hormonal status, and regular gynecological examinations.

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

This is one of the most mysterious female diseases. Despite the fact that this diagnosis is made quite often, the question - what kind of disease is it, why and how to treat it, often remains unanswered. But what if a woman with endometriosis is planning a pregnancy - is it necessary to do something in this case?

Statistics show that up to 30% of women of reproductive age suffer from endometriosis in one form or another.

What is it: causes

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

One theory points to the process of retrograde menstruation, when part of the menstrual tissue enters the abdominal cavity, grows into it and increases.
Genetic theory puts forward the point of view that the genes of some families contain the beginnings of endometriosis and, thus, members of these families are predisposed to endometriosis.
There is also a theory that explains the occurrence of endometriosis by the fact that tissue affected by endometriosis spreads to other parts of the body through the lymphatic system.
Others believe that remnants of tissue from the phase when the woman was in its infancy may subsequently develop into endometriosis, or that part of this tissue, under certain conditions, does not lose the ability to reproduce.

The likelihood of the disease increases with:

frequent inflammation of the genital organs;
tumors ();
difficult childbirth;
operations on the uterus;
abortions;
drinking alcohol;
smoking;
excessive "love" for products containing caffeine;
disturbances in the functioning of the organs of the endocrine system (thyroid gland, adrenal glands, hypothalamus,
pituitary gland, female gonads);
reduced immunity.

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

Therefore, regularly undergo a preventive examination by a gynecologist. This is especially important for those who have had any operations on the uterus (abortion, caesarean section, cauterization of cervical erosion, etc.). Timely diagnosis is the key to successful treatment without consequences.

Can you get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of getting pregnant, but it cannot harm the development of the fetus. If a woman with endometriosis does conceive a child, there is every reason to believe that the symptoms of the disease will become much weaker during the entire period of pregnancy.

If you have endometriosis, before you start trying to conceive a child, be sure to discuss with your gynecologist the possibility and risks of pregnancy in your particular case.

Symptoms of endometriosis

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

However, certain symptoms should definitely alert a woman:

Pain of varying intensity, up to acute. They can be localized, given to the inguinal region, anus, leg. Pain either occurs in the first days of menstruation, and disappears with its end, or does not leave the woman throughout the entire cycle, but at the end of menstruation they weaken.
Smearing dark spotting from the genital tract 2-5 days before and after menstruation, especially if these very menstruation is quite plentiful and prolonged;
Uterine bleeding in the intermenstrual period (metrorrhagia);
Spotting discharge can also be during sexual contact.

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

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

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

Endometriosis 1, 2 and 3 degrees

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

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

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

Diagnostics

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

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

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

Prevention

The main measures aimed at the prevention of endometriosis are:

specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) in order to exclude endometriosis;
observation of patients who have undergone abortion and other surgical interventions on the uterus to eliminate possible consequences;
timely and complete cure of acute and chronic pathology of the genitals;
taking oral hormonal contraceptives.

Complications

Endometriosis of the uterus can be asymptomatic and does not affect a woman's quality of life. On the other hand, endometriosis not diagnosed in time and the lack of adequate treatment can lead to complications.

Most likely consequences:

adhesive process in the small pelvis;
fertility disorder;
anemia due to heavy bleeding;
endometrioid cysts;
malignancy.

How to treat endometriosis

Methods for the treatment of endometriosis have been improved for many years and are currently divided into:

surgical;
medical;
combined.

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

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

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

Conservative therapy

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

The drug treatment path includes a fairly traditional therapy:

hormonal;
anti-inflammatory;
desensitizing;
symptomatic.

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

progesterone preparations;
danazol;
gestrinone (Nemestran);
gonadotropin-releasing hormone (GnRH) agonists;
monophasic combined oral contraceptives.

The duration of hormone therapy courses and the intervals between them are determined by the results of treatment and the general condition of the patient, taking into account the tolerability of drugs and the performance of functional diagnostic tests.

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

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

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

Surgical treatment of endometriosis

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

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

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

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

Prognosis for endometriosis

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

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

Chronic endometriosis can be called a very insidious gynecological disease that can affect women of any age.

It should be recognized that cases of a complete cure for this disease are not so common, which means that the pathology often flows into a chronic form. The chronic course is characterized by periodic remissions and exacerbations, and it becomes almost impossible to completely cure the disease, so therapy is often aimed only at eliminating its clinical manifestations and inhibiting the pathological process.

In most cases, chronic among women the age category of 30-40 years, but sometimes the disease is found in young girls and in women during menopause.

Disease classification

Endometriosis is classified by location pathological foci. Yes, single it out genital and extragenital forms. In turn, genital endometriosis is divided into (affecting the body of the uterus) and (affecting other organs: ovaries, cervix, vagina, etc.).

There are other classifications of the disease, according to one of which, endometriosis is divided into acute and chronic.

Causes of chronic endometriosis development

It is not so difficult to identify the causes that contribute to the development of chronic endometriosis.

untreated endometriosis.
after surgical interventions in the uterus, including abortion and caesarean section;
in various diseases such as erosion or ulcerative inflammation.

In general, we can say that any violation of the uterine mucosa of a woman who has undergone endometriosis can provoke the development of chronic pathology.

It is worth saying that the main ones in women have not yet been identified. There are several versions on this score, but preference is given to implantation theory. It is based on the mechanism of retrograde reflux of menstrual blood with particles of the endometrium into the abdominal cavity, where its cells take root and grow in other organs. With reduced immunity, the body's defenses are not able to recognize and destroy foreign cells in time. Another possible reason for this phenomenon could be hormonal disbalance.

Based on the foregoing, we can distinguish the so-called risk group which includes women:

having bad habits and leading a generally unhealthy lifestyle;
living in places with poor ecology;
having a hereditary predisposition to this disease;
who have metabolic disorders;
suffering from diseases of the endocrine system;
who had various surgical interventions that violate the integrity of the uterus (abortions, curettage, operations);
having congenital anomalies in the structure of the organs of the reproductive system.

Clinical manifestations

Symptoms chronic endometriosis depends to a greater extent on localization of lesions. Very often, the disease in a chronic form proceeds relatively calmly and practically does not cause concern to a woman. Rarely, the following may occur pathological manifestations:

premenstrual bleeding;
pelvic pain;
menstrual irregularities;
pain during sexual contact;
infertility.

Aggravation usually occurs before the onset of menstruation, as well as during them.

Complications

The most common complication of chronic endometriosis is functional infertility. The thing is that endometrioid cells practically lose their activity, but the body's reaction to them continues: they are enveloped in adhesions and epithelial plugs, cysts are formed. All these formations prevent fertilization and the introduction of the embryo into the walls of the uterus.

If conception does occur, with chronic endometriosis, the risk of miscarriage and complications during childbirth.

Diagnostic methods

Diagnosing chronic endometriosis is not always easy, due to the lack of pronounced clinical manifestations. At the discretion of the attending physician, may be carried out the following studies:

gynecological examination of the patient with the use of mirrors;
colposcopy;
, including with the use of a special vaginal sensor;
hysteroscopy;
colonoscopy;
computed tomography of the pelvic organs;
taking swabs from the vagina and cervix;
blood test for the detection of tumor markers.

However, the most informative diagnostic method can be, which refers to endoscopic techniques. If necessary, this procedure allows you to conduct a biopsy of lesions for further study of the material obtained.

Treatment of chronic endometriosis

The treatment of chronic endometriosis should always be approached complex otherwise the problem will not be solved. After a thorough examination of the patient and identification of the localization of the pathological process, the doctor may prescribe:

aimed at eliminating any concomitant diseases. Most often, antibiotics, non-steroidal anti-inflammatory drugs, etc. are used in this case;
sedative treatment, which always has a beneficial effect on the female apparatus;
physiotherapeutic procedures (electrophoresis, magnetotherapy, baths, etc.);
, in which oral contraceptives can be used, especially suitable for women who want to have children in the future. There are cases when, after a successful birth, chronic endometriosis completely disappears due to a hormonal shake-up.

If or in case of ineffectiveness of the above measures, surgical operation method, in which pathological foci, adhesions and cysts are removed using a laser or exposure to electric current.

Folk methods of treatment

Non-traditional methods for chronic endometriosis can also be very useful, but any of them can be used only with the approval of the attending physician and in combination with traditional treatment.

Few people know that you can restore the hormonal background and strengthen the immune system with the help of proper diet, and this, in turn, will contribute to the inhibition of the pathological process.
- In order to increase the body's defenses, it is necessary to consume a sufficient amount of vegetable and animal proteins.
- Also, the body can not do without vitamins and minerals, which are part of fresh vegetables and fruits.
- Carbohydrates are also necessary, but not easily digestible, contained in sweets and rich pastries, but complex, which are part of black bread, cereals, bran and some vegetables.
In order for products to bring maximum benefit to the body, it is best to cook them for a couple, but you can bake or stew.
Diet also important - to ensure proper metabolism, food should be taken in small portions several times a day.
In addition, traditional healers advise women suffering from chronic endometriosis to resort to other methods. One of them is hirudotherapy(treatment with leeches), the action of which is aimed at relieving inflammation and improving blood circulation. Also, it may be worth paying attention to procedures such as acupuncture, acupressure, moxibustion.
Particularly popular in the treatment of many gynecological diseases, including endometriosis, received phytotherapy which is based on the action of various medicinal herbs and plants. Many of them are able to remove and alleviate the condition of a woman, for example, the upland uterus, yarrow, wormwood, celandine, horsetail and many others. Infusions and decoctions are prepared from these plants, which are then used for medicinal baths, douching and ingestion.

Prevention measures

Despite the complexity and insidiousness of such a disease as chronic endometriosis, it is still possible to avoid its relapses and exacerbations if adhere to the following rules:

eat right and get rid of bad habits;
choose the best method of contraception for yourself in order to avoid unwanted pregnancies and abortions;
keep the immune system at a high level;
monitor your own hormonal balance;
undergo preventive examinations at the gynecologist twice a year.

The main thing to remember is that with a competent approach can cope with almost any disease, including chronic ones.