What is uterine endometriosis? Diffuse endometriosis of the body of the uterus. Clinical ultrasound signs of uterine endometriosis

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

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

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

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

What is this disease

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

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

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

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

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

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

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

Reasons for development

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

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

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

Live healthy! Endometriosis:

What is dangerous: consequences and complications if not treated

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

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

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

In many patients due to heavy menstrual bleeding sustainable.

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

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

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

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

Classification of species and code according to ICD-10

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

Forms: diffuse, nodular and focal

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

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

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

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

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

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

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

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

1, 2, 3 and 4 degrees

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

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

Diagnostics

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

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

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

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

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

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

Early stages of endometriosis can be detected by laparoscopy.

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

Conducted if necessary histological examination.

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

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

Is it possible to identify yourself and how to determine

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

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

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

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

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

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

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

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

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

When to See a Doctor

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

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

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

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

Treatment

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

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

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

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

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

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

Additionally appoint physiotherapy course.

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

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

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

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

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

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

Lifestyle with this female disease in gynecology

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

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

Diet and diet

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

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

Bath, sauna, beach

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

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

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

Sports and physical activity

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

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

Is it possible to have sex

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

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

Contraceptive methods

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

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

Contraindications

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

Prevention

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

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

Endometriosis ranks third among gynecological diseases after inflammation and fibroids. It is mainly diagnosed in women of reproductive age, sometimes in adolescents, very rarely in the postmenopausal period.

Endometriosis of the body of the uterus is a hormonally dependent disease associated with the growth of the epithelium outside the organ. The endometrium (mucosa of the uterine cavity) consists of a connective basal layer and a cylindrical epithelium. In the thickness of the endometrium are tubular glands, a dense network of capillaries.

If the woman is healthy, the tissues are localized in the uterine cavity. Under the influence of certain factors, fragments of glandular cells are found in the thickness of organs, where they should not be. Such growths are called heterotopia.

Sites can occur in the fallopian tubes, the muscular layer of the uterus, ovaries, bladder, peritoneum, intestines, and other organs. This tissue experiences the same cyclical changes as the endometrium. That is, during menstruation, heterotopic areas bleed, increasing pathological formations. With each cycle, more and more pelvic organs are involved.

Causes of internal endometriosis of the body of the uterus

Disease endometriosis

Pathology is little studied, there is no consensus on the mechanisms of its development. Risk factors for endometriosis:

reproductive age;
inability to conceive and give birth;
earlier abortions, other manipulations on the uterine cavity;
prolonged use of the intrauterine device;
disruption of the menstrual cycle;
anomalies in the structure of the genital organs;
obesity;
chronic inflammatory processes;
genetic predisposition.

Provoking factors are immune and hormonal failures. A prerequisite for the progression of endometriosis is an excess of estrogen and prolactin, a violation of progesterone metabolism. These hormones regulate the normal course of the menstrual cycle.

Signs of internal endometriosis of the body of the uterus

The disease is very insidious, as it is asymptomatic for a long time. The latent course is often discovered by chance when a woman goes to the doctor about infertility.

Symptoms of endometriosis resemble those of other gynecological diseases. It:

pain in the lumbar region, lower abdomen, appearing during menstruation;
fainting, nausea, vomiting - signal a common process;
pain during intimacy, defecation - depend on the location of the focus and the severity of the disease;
failures of the menstrual cycle, menstruation becomes long and plentiful, the cycle is reduced;
brownish discharge that appears a few days before menstruation;
breakthrough uterine bleeding, hormonal imbalance - characteristic of the diffuse form;
signs of general intoxication (temperature, fatigue, weakness).

The reason for contacting a gynecologist is any changes in the menstrual cycle and the nature of menstruation, the appearance of pain, discomfort and other signs that are not characteristic of normal menstruation. It is better to diagnose the pathology in the early stages, when it is amenable to medical correction.

There is pain in proximity

Sonographic signs of adenomyosis of the uterine body

Symptoms of endometriosis are easily confused with other gynecological diseases. An accurate diagnosis can only be made by a doctor during a personal examination and instrumental diagnostics.

The most common method for detecting endometriosis is ultrasound. Echo signs against the background of general symptoms help to clarify the disease:

thickening of the walls of the uterus;
round anechoic inclusions 0.2-0.6 cm in size;
an increase in the overall size of the uterus to a spherical shape;
possible detection of cysts in the affected area.

Adenomyosis nodes are different from fibroids. They lack clear contours and a capsule. Vaginal examination is more informative in the second phase of the cycle (23-25 days).

The defeat of the disease

Treatment of endometriosis of the body of the uterus

The disease is difficult to treat. In many cases, full recovery does not occur. The situations of self-treatment of endometriosis after childbirth are described. But this rarely happens. Most often, endometriosis disappears after menopause, when the hormonal background changes.

A comprehensive treatment program is developed based on the results of the examination. In addition to localization, severity, form of pathology, the doctor takes into account the age of the woman, her desire to conceive a child.

If the disease is detected at an early stage, conservative treatment is indicated. The course of drug therapy includes:

hormonal drugs;
NSAIDs;
sedative medications;
immunomodulators;
vitamins and minerals.

Additionally, methods of physiotherapy are shown. In severe cases, with the ineffectiveness of drug therapy, the presence of contraindications to certain drugs, the patient is prescribed surgical treatment.

The operation can be radical or organ-preserving. The gold standard is the laparoscopy technique, in which the elimination of endometrial foci is performed.

Operation process

With an aggressive course, a high risk of degeneration into a cancerous tumor, the presence of life-threatening complications, hysterectomy is recommended. After such an intervention, a woman cannot have children, so the technique is applicable at the age of 40 and older.

The success of therapy is determined by the restoration or preservation of reproductive function. If there are no symptoms of relapse for 5 years, the woman is considered cured.

Forms of the disease

Depending on the location of the foci, endometriosis is genital and extragenital. The first form includes lesions of the genital organs, the second - of other organs. With multiple foci, a mixed form of the disease is diagnosed.

Endometriosis of the body of the uterus is a genital variety. Lesions are external with the involvement of the cervix and tubes. With internal adenomyosis, the body of the uterus is affected, the foci are introduced into the muscle layer of the organ. By nature, adenomyosis is focal, diffuse, nodular, mixed.

Forms of adenomyosis

Diffuse endometriosis of the body of the uterus

It differs in the specifics of the process. Endometrial cells penetrate into the muscle layer of the organ and gradually affect it completely.

The disease brings serious inconvenience, but in the early stages there are no symptoms. Usually the patient feels pain in the pelvic area, heavy bleeding, discomfort during sex, lack of pregnancy.

The development of pathology is affected by the state of the endocrine system, the presence of inflammatory processes, and previous gynecological interventions.

You can get reliable information about the disease with the help of endoscopic examination. Palpation, characteristic symptoms, ultrasound can suspect a pathology, but without an internal examination of the uterus, there can be no certainty.

The negative aspect of the treatment of diffuse adenomyosis is the impossibility of performing an organ-preserving operation. In the early stages, it is possible to stop the disease by prescribing hormones. Such treatment introduces the patient into an artificial menopause, the abnormal growth of the endometrium stops. In the later stages, removal of the uterus is indicated.

Focal endometriosis of the uterine body

With this form, local foci in the muscle tissue are observed. Pathology is fraught with frequent pelvic pain, prolonged menstruation, brownish intermenstrual bleeding, inability to conceive.

The risk group for focal endometriosis includes women of reproductive age, whose relatives also suffered from this disease.

Conservative, operative and combined measures are used to combat the disease. The focal form is completely corrected by hormonal preparations at stage 1. When the dimensions exceed 2.5-3 cm, minimally invasive techniques are indicated (laparoscopy, hysteroscopy). The destruction of formations is carried out by excision with a laser or electrocoagulation.

With early diagnosis, the woman often recovers completely and restores her reproductive function.

nodal

Knots formed

In this form, nodes filled with connective and glandular tissue are formed at the site of penetration of the endometrium. The nodular form is not as common as the others. But it is the most dangerous.

Often, nodular adenomyosis is combined with uterine myoma, which presents certain difficulties in making a diagnosis. The main signs are formations in the muscular layer of the uterus of different sizes.

In the first stages, adenomyosis does not manifest itself in any way, does not affect the quality of life and reproductive function. With the development of the disease, the symptoms become pronounced.

An early degree can be easily corrected with oral contraceptives. The most gentle method of surgical intervention is laparoscopy. It is used only with a small size of the nodes, and if the process has not affected the serous layer of the uterus.

Degrees of development

Pathology depends on the depth of the lesion of the uterus. There are 4 stages of the disease.

From Normal to Defeat

Endometriosis of the body of the uterus 1 degree

Not characterized by any changes in health status. There are no pronounced symptoms, the disease is diagnosed during a routine examination by a gynecologist by chance.

Women almost never go to the doctor with suspicions of grade 1 adenomyosis. The menstrual cycle may slightly increase, but menstruation is not plentiful, the shape of the uterus and size does not change.

Endometriosis of the uterine body of the 2nd degree

Endometrial cells penetrate into deeper muscle layers. The first symptoms appear: aching pain, heaviness in the lower abdomen. With the progression of the disease, attacks of nausea, vomiting, frequent headaches, and a rise in body temperature develop.

At stage 2, brown discharge may appear between periods. Surgical treatment is not yet required, conservative methods are sufficient.

2 degree

3 degree

The myometrium is affected to the serous layer. On examination, there are significant changes in the surface and structure of the uterus, some areas are enlarged, the formations do not have clear boundaries and contours. There is a significant thickening of the walls of the uterus.

At this stage, there are abundant and long periods, heavy bleeding between them.

4 degree

The growth of the endometrium goes beyond the uterus, penetration into the ovaries, tubes, and bladder occurs.

A woman experiences regular pain in her head, may faint. Shortly before and during menstruation, severe pain appears, a feeling of heaviness in the lower abdomen. The only treatment at this stage is surgical removal of the uterus.

Infertility may develop

Consequences of endometriosis of the body of the uterus

What does the lack of treatment of pathology lead to? Against its background, many women develop secondary infertility. In advanced cases, cysts appear in the ovaries, adhesions in the abdominal cavity or small pelvis. Subsequently, they lead to obstruction of the fallopian tubes or intestines.

Severe anemia develops against the background of heavy bleeding. Depending on the localization of the foci, neurological disorders are possible. They arise due to mechanical compression of the nerve endings.

In the absence of therapy, the pelvic organs are affected. There is a possibility of malignant degeneration (approximately 12%).

Progressive endometriosis is a risk factor for the development of cancerous tumors in other places not associated with the lesion.

Start your treatment

In their practice, gynecologists have to deal with various diseases of the female genital area. And often they diagnose endometriosis of the body of the uterus. And women, having heard such a name, do not always understand what it is. Therefore, it is especially important for patients to be aware of the origins, characteristics and symptoms of endometriosis, as well as to know what methods of its treatment are available.

General information

The uterus is the central organ of the genital tract. It provides menstrual function and, most importantly, gives a woman the opportunity to bear and give birth to a child. This is a hollow organ, the wall of which consists of several layers: internal or mucous (endometrium), middle or muscular (myometrium) and external or serous (parametria). The first undergoes cyclical changes throughout the reproductive period.

Under the influence of ovarian hormones in the endometrium, processes called the uterine cycle occur. It starts with the end of menstruation. The first phase - proliferative - takes place under the dominance of estradiol. The mucous membrane is restored by building up a functional layer of basal cells. This process goes on throughout the first phase of the cycle, and after ovulation, another restructuring is observed in the endometrium. Progesterone stimulates its secretory transformation, that is, it promotes the development of glands that produce mucus. In the second phase, the endometrium becomes loose and juicy, preparing to receive a fertilized egg. But in the absence of conception, it is again rejected, passing into the phase of natural desquamation.

Causes and mechanisms

Speaking in an accessible language, endometriosis is a disease in which the cells of the uterine mucosa penetrate into places that are unusual for them, and continue to function there under the influence of ovarian hormones. Normally, this should not be, of course, but deviations can appear for various reasons. There are many hypotheses explaining the development of endometriosis of the body of the uterus, and each of them affects only one mechanism. Therefore, it is believed that the disease has a multifactorial nature. Its origin is associated with the following conditions:

Anomalies of embryogenesis.
Operational interventions.
Hormonal disorders.
Inflammatory diseases.
Immune disorders.
genetic predisposition.

Researchers attach great importance to the theory of implantation drift, according to which endometrial cells penetrate into the wall of the organ during retrograde reflux of menstrual blood. This is facilitated by an increase in intrauterine pressure during adhesions, stenosis or atresia of the cervical canal. Cell dissemination is very often observed with damage to the mucous membrane: during surgical interventions (caesarean section, abortion, pathological childbirth, diagnostic curettage, removal of polyps and fibroids), inflammation (endometritis) or prolonged use of uterine contraceptives (spirals).

Endometriosis necessarily occurs against the background of hormonal and immune disorders in a woman's body. Therefore, you need to pay attention to other factors that are quite common in modern life:

Endocrine diseases (obesity, diabetes, hypothyroidism).
Menstrual dysfunction.
Allergic reactions.
Excessive insolation.
Emotional stress.
Physical exercise.
Environmental pollution.
Bad habits.
Inactivity (hypodynamia).

Many of these aspects are familiar to women, so you need to be very careful about your own health, avoiding adverse external influences. So you can reduce the risk of many diseases, including endometriosis of the uterus.

Endometrial cells can invade the uterine wall for a variety of reasons. And the list of factors contributing to the disease is quite wide.

Classification

According to the generally accepted classification, uterine damage is internal endometriosis, or, as it is also called, adenomyosis. Based on the prevalence of mucosal cells, there are several forms of the disease:

Diffuse - endometrioid foci are evenly scattered over the entire surface.
Focal - only certain areas are affected.
Nodular - group clusters of cells are formed.

According to the nature of the histological relationship, adenomyosis can be glandular, cystic, or fibrous. The foci of the latter have minimal or no functional activity. It should be said that the diffuse form of glandular endometriosis is most often observed. And if we take into account the depth of damage to the uterine wall, then several stages should be distinguished:

I - penetrates into the basal layer of the mucous membrane.
II - invasion into the myometrium (up to the middle of its thickness).
III - extends up to the serous membrane.
IV - affects the parietal peritoneum.

Often there is a combination of adenomyosis with external forms of the disease (foci in the ovaries, tubes, vagina and peritoneum). In addition, various gynecological and extragenital diseases can accompany uterine endometriosis.

Clinical picture

The symptoms of this disease are very diverse. In some cases, the pathology does not manifest itself at all, so it can be detected only with an additional examination. But this happens most often if endometriosis of the uterine body of the 1st degree is diagnosed. And with a more extensive and deep lesion, the symptoms will be quite bright. Basically, pathology manifests itself with the following signs:

Prolonged and heavy periods (hypermenstrual syndrome).
Intermenstrual bleeding (menorrhagia).
Pain in the lower abdomen, radiating to the sacrum (appear at the beginning of menstruation).
Discomfort during intercourse (dyspareunia).
Problems with conceiving a child (infertility).

The central place among the clinical signs of endometriosis in the body of the uterus is algomenorrhea. In addition to the pain syndrome that occurs on the eve of menstruation, women are concerned about general disorders such as irritability, nausea, and migraine paroxysms. And in connection with abundant secretions, signs of anemia appear:

General weakness.
Dizziness.
Dyspnea.
Pallor.
Hair breakage.
Change in taste.

Infertility is associated not so much with pathological foci in the thickness of the uterine wall, but with concomitant hormonal disorders (anovulation, corpus luteum insufficiency), as well as adhesions in the fallopian tubes and abdominal cavity. Diffuse endometriosis of the uterus can also be suspected during a gynecological examination: the organ will be enlarged, dense, limited mobility and sensitive to palpation (especially on the eve and with the onset of menstruation). With a nodular form, the uterus often has a bumpy surface.

Adenomyosis can be combined with other diseases of the gynecological sphere: ovarian cysts, fibroids, endometrial hyperplasia. But more serious associations are also possible, for example, with a malignant process (carcinoma). Therefore, the role of differential diagnosis of endometriosis should not be underestimated.

Endometrioid foci located in the uterus give a rather vivid clinical picture. But many of the symptoms are nonspecific and require differentiation from other diseases.

Additional diagnostics

Since clinical signs can only suggest a disease, additional methods play a key role in the diagnosis. With internal endometriosis, the following studies are shown:

Complete blood count (erythrocytes, hemoglobin, ESR, color index, hematocrit).
Biochemical blood test (hormonal spectrum, specific markers, indicators of inflammation).
Ultrasound of the pelvis.
Hysteroscopy.
Colposcopy.
Metrosalpingography.
Tomography.
Laparoscopy.

Ultrasound examination conducted by a vaginal sensor makes it possible to diagnose pathology in 90% of cases. Echo-signs of endometriosis will include foci of increased acoustic density in the myometrium, not surrounded by a capsule, an increase in the size of the uterus in the anteroposterior plane. The focal process is characterized by the formation of cystic cavities with liquid contents and small impurities. Hysteroscopically, the disease is verified by small bluish foci and passages from which blood flows. The mucous membrane will have uneven contours.

Treatment

Therapeutic correction for endometriosis affecting the body of the uterus should be comprehensive. For each patient, the doctor draws up an individual program, which takes into account the age factor, the prevalence of pathology, the presence of concomitant conditions and the desire to maintain reproductive function. Based on this, conservative and surgical measures are used.

Conservative therapy

The use of conservative methods is based on the suppression of the further growth of endometriotic lesions, the restoration of regulatory balance and immunological processes in the body, and the elimination of symptoms of the disease. For this, drugs are used. And the main group of medicines are hormonal drugs:

Progestins and gestagens (Primalut, Dufaston, Gestrinon).
Estrogen-gestagens (Janine, Marvelon).
Antiestrogens (Tamoxen, Nolvadex).
Gonadotropin inhibitors (Danoval).
Gonadotropin-releasing factor agonists (Zoladex, Buserelin).

Which of the drugs to use in a particular case, the doctor will tell. He also sets the dosage and course of administration. In addition to these drugs, the complex of drug treatment includes non-steroidal anti-inflammatory, immunotropic and sedatives.

The basis of drug therapy for endometriosis is hormonal drugs. They allow you to reduce the size of the foci and suppress their development.

Operational correction

Indications for surgical treatment are combinations of the disease with endometrial hyperplasia or fibromyoma, nodular and common forms of pathology, ineffectiveness of hormone therapy for 3 months, or the presence of contraindications to it in a woman. In order to eliminate endometrioid foci, organ-preserving or radical interventions can be used. The first consists in resection or cryoablation of the mucous layer of the uterus. To dissect adhesions in the pelvis, laparoscopy is also performed. But these methods will become effective only with superficial and small foci. If they are located diffusely and deeply, then the only remedy will be the removal of the uterus (hysterectomy).

When the uterus is affected by endometriosis, it creates serious problems associated with menstrual irregularities and the inability to become pregnant. But with early detection of the disease and its full treatment, surgical intervention can be avoided and the reproductive ability of a woman can be successfully restored.

Endometrioid disease of the body of the uterus progresses gradually: the stages of the pathological process are manifested by typical symptoms, worsening the condition of the woman. For effective treatment, it is important to identify grade 1 endometriosis in time, in which it is possible to completely get rid of menstrual problems. The form of the disease directly determines the risk of infertility, so the initial stages of adenomyosis will not prevent a woman from performing a childbearing function. Diffuse endometriosis can be treated with drugs, especially when symptoms are minimal and the risk of complications is minimal.

Diagnosis of initial adenomyosis

Internal endometriosis 1 degree is difficult to identify. The reasons for the late diagnosis of pathology can be the following factors:

lack of clear manifestations of endometrioid disease;
no violations of menstruation;
pain in the lower abdomen before menstruation happens, but the woman associates this problem with the arrival of critical days;
changes in the uterus are minimal, so the ultrasound doctor may not see typical signs;
no problems with conception: if contraceptives are not used, then pregnancy occurs.

Usually, grade 1 adenomyosis is an incidental diagnostic finding that occurs during surgery for cystic ovarian tumors or during the removal of uterine fibroids. Sometimes a doctor can identify the disease during a diagnostic laparoscopy performed to find the cause of the pain syndrome. Or with hysteroscopy for the removal of a polyp of the body of the uterus.

At stage 1 of endometrioid disease, 2 variants of the disease are possible:

diffuse form of adenomyosis, in which multiple small endometrioid foci do not penetrate deeper than the submucosal layer of the uterus;
the nodular form of the disease, when there are 1-2 endometrioid nodules in the endometrium that do not reach the muscle layer.

The main type of diagnosis for endometriosis of the body of the uterus is an ultrasound scan, performed twice - before menstruation and after the end of critical days. Suspicious ultrasound signs are:

unevenness of the inner layer of the body of the uterus;
asymmetric change in the size of the uterus, when one of the walls of the organ is larger than the other;
detection of areas of increased and decreased echogenicity;
detection of small liquid cavities;
change in vascular blood flow in the alleged pathological areas of the uterine body.

It is necessary to confirm the ultrasound diagnosis using the following research methods:

blood test for oncomarker Ca-125;
diagnostic hysteroscopy with endometrial biopsy.

However, it should be understood that with grade 1 endometriosis, a situation may arise when no research method will provide a guaranteed confirmation of the diagnosis. In this case, the doctor will prescribe preventive treatment. With the proven detection of initial adenomyosis, one should follow the recommendations of a specialist in the treatment of endometrioid disease.

Treatment of pathology

Hormone therapy for grade 1 adenomyosis provides excellent results. Using the recommendations of a doctor, you can not only prevent the development of complicated forms of the disease, but also create optimal conditions for the desired conception. If a woman does not need pregnancy, then the treatment is aimed at normalizing the menstrual cycle and creating reliable contraceptive protection.

The following drugs are commonly used:

Jeanine;
Silhouette;
Yarina;
Bysanne.

In cases where a woman wants to become pregnant, the following drugs are used:

Duphaston;
Utrozhestan.

With grade 1 endometriosis, it is extremely rare that there is a need to use strong drugs with a long-term effect, but according to indications, the doctor may recommend:

Buserelin-Depot injections;
introduction of the Mirena hormonal coil.

Any treatment is carried out under the supervision of a doctor and with the obligatory ultrasound examination at the appointed time. Criteria for a positive result of therapy:

painless and regular menstruation;
no progression of endometriosis;
desired pregnancy.

Surgical treatment for the initial degree of diffuse or nodular endometriosis is not used.

Conception and bearing with adenomyosis 1 degree

Endometrioid disease can cause complications that are possible in any months of pregnancy. You should be aware of the following problems:

frozen pregnancy;
spontaneous abortion in the early stages;
threat of interruption in 1-2 trimesters;
violations of blood flow in the placenta;
incorrect placenta previa;
premature birth;
uterine bleeding immediately after childbirth.

Effective prevention of complications will be the strict implementation of the doctor's recommendations at all stages of the reproductive process. Dufaston must be taken for a long time, starting long before conception and ending at 20 weeks. Then the doctor will advise using Utrozhestan suppositories up to 34 weeks. It is necessary to comply with the recommended dosage and regimen of the use of medicines in order to fulfill the dream of having a baby without any problems.

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 often 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 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, but 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 with regard 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 rather 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 preparations, 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

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