How to treat abdominal endometriosis. Extragenital endometriosis: types, symptoms, treatment. Symptoms of endometriosis of the pelvic peritoneum

Endometriosis is a disease in which cells of the uterine lining are found outside of it. This is an estrogen-dependent pathology that occurs in reproductive age and persists until menopause. Progressive endometriosis is manifested by pelvic pain, dyspareunia, menstrual irregularities and leads to infertility.

Endometriosis of the abdominal cavity and pelvic peritoneum is one of the frequent localizations of the pathological process. With this form of the disease, pain syndrome comes to the fore. Surgical treatment - removal of heterotopias, dissection of adhesions, restoration of fertility. Medical therapy is ineffective.

In the article we will tell you how endometriosis of the abdominal cavity manifests itself and what treatment regimens exist.

Classification: what is endometriosis

In the International Classification of Diseases, endometriosis of the pelvic peritoneum is coded N80.3. If the abdominal cavity and anterior abdominal wall are affected, code N80.8 is set - another endometriosis. This form of pathology is often combined with heterotopias of other localization: in the uterus and appendages, intestines and bladder. Often, the defeat of the abdominal wall goes along with endometriosis of the postoperative scar and navel.

According to the international classification, the defeat of the pelvic peritoneum refers to external genital endometriosis. With this form of pathology, the pelvic organs are affected - everything except the uterus. When heterotopias are detected on the anterior wall of the abdomen and in the abdominal cavity, they speak of extragenital endometriosis - the process goes beyond the reproductive organs.

Reasons for the development of the disease

The appearance of endometriotic foci is associated with various factors. In case of damage to the peritoneum and the anterior wall of the abdomen, the following points should be taken into account:

Usually, heterotopias penetrate the sheets of the peritoneum from other foci. The examination reveals endometriosis of the ovaries, fallopian tubes, retrocervical space, etc.;
Less commonly, heterotopias first appear on the peritoneum or outside the pelvis. This happens after operations - for example, a caesarean section.

Foci of distribution of endometrioid heterotopias.

The exact causes of the development of the disease are unknown. Scientists pay attention to several factors:

genetic predisposition. Endometriosis is a pathology that develops with unfavorable heredity and the implementation of risk factors;
Hyperestrogenism. Excessive production of estrogen provokes tissue growth and leads to uncontrolled cell division. There are foci of endometriosis, sensitive to the level of hormones;
Immunological disorders. Failure of T- and B-lymphocytes prevents apoptosis - programmed cell death. Tissues grow uncontrollably, pathological foci appear;
The metaplastic theory explains the emergence of foci from the remnants of Müllerian tissue during the period of embryonic development. It is assumed that peritoneal cells are transformed into endometrial cells;
The implant theory says that endometriosis develops when blood is retrograde from the uterus during menstruation. In this case, organs located nearby are first affected - the fallopian tubes, ovaries, pelvic peritoneum. Further heterotopias by lymphogenous and hematogenous way pass into other organs.

According to the implantation theory, the cause of endometriosis is the retrograde reflux of blood from the uterus during menstruation.

Risk factors:

Absence of pregnancy and childbirth. If a woman is not pregnant and is not breastfeeding, follicles mature in the ovaries every month and ovulation occurs. Every month, the endometrium grows in the uterus, preparing for possible implantation. The more often ovulation occurs, the higher the risk of developing the disease;
Abortions and spontaneous miscarriages with curettage of the uterine cavity, as well as other instrumental interventions. During the operation, the endometrium is damaged, conditions arise for the development of endometrial foci. From the uterus, heterotopias pass to the organs of the pelvis and abdominal cavity;
Operations on the uterus. Any intervention with the opening of the uterine cavity can lead to the spread of endometrial cells outside of it. Often the disease occurs after a caesarean section.

Endometrial lesions on the peritoneum develop over many years. It is impossible to detect them without special examination methods. For many years, the disease may remain asymptomatic. Typically, endometriosis of this localization is detected 7-10 years after the implementation of risk factors.

On a note

Endometriosis always appears during the reproductive years while a woman's ovaries are functioning. At menopause, the production of sex hormones stops, and heterotopias usually regress.

Leading symptoms of endometriosis of the abdominal cavity and pelvic peritoneum

Superficial endometriosis is characterized by a shallow location of foci. Heterotopias capture the sheets of the peritoneum, the serous cover of the internal organs, the walls of the pelvis and abdominal cavity. They do not penetrate deeper than 5 mm. This form of pathology usually remains asymptomatic or manifests itself with minimal signs.

Deep infiltrative endometriosis is accompanied by invasion of heterotopia into the peritoneum. Altered cells penetrate to a depth of 5 mm or more, leading to the development of fibrosis and muscle hyperplasia. Such a disease does not remain asymptomatic for long, and characteristic signs appear:

Pain syndrome. The pain is localized in the lower abdomen, in the projection of the sacrum and coccyx, lower back, radiates to the perineum. It occurs a few days before menstruation and intensifies during menstruation. With a significant spread of the process, the pain becomes very strong, almost unbearable. Many women are forced to take analgesics every month;

With deep endometriosis of the abdominal cavity, a woman experiences severe pain in the lower abdomen.

Dyspareunia. Discomfort and pain during intercourse are characteristic of external endometriosis. Unpleasant sensations occur when the parietal peritoneum and ligaments of the pelvis are affected. With severe pain, libido decreases, sexual life stops.

The menstrual cycle against the background of external endometriosis can remain stable. Menses are moderate, of medium duration. Abundant menstruation is characteristic of concomitant adenomyosis - with damage to the uterus. There are pulling pains in the lower abdomen and lower back during menstruation.

It's important to know

The severity of the pain syndrome is not always associated with the prevalence of the process. With multiple, but superficial lesions, the pain may be tolerable. On the contrary, a few deep heterotopias give severe pain and disrupt the usual course of life.

Consequences of pathology: what will happen if not treated

Endometriosis is a steadily progressive chronic pathology. In women of reproductive age, the disease does not go away on its own. Only when entering menopause, when hormone production stops, spontaneous regression of foci is possible. At other times, without treatment, progressive endometriosis leads to the development of complications:

Chronic pain syndrome. The deeper the heterotopias penetrate into the tissues, the stronger the pain and the more difficult it is to cope with it with medications;
endometrioid carcinoma. Against the background of pathology, the risk of developing cancer increases. The likelihood of malignant transformation increases with age;
Ascites. The accumulation of fluid in the abdominal cavity occurs rarely, but reaches significant values - up to 10 liters. Endometrioid carcinoma also leads to ascites;
Hydronephrosis. Foci in the pelvic cavity often pass to the urinary tract. They interfere with the outflow of urine and lead to enlargement of the kidneys - hydronephrosis. In the future, renal failure develops;

Left untreated, abdominal endometriosis can lead to hydronephrosis.

Psycho-emotional disorders. Constant pain, problems in the sexual sphere, infertility - all this can cause depression.

Endometriosis is a socially significant disease. Progressive pathology significantly disrupts the usual course of life and becomes a source of constant discomfort. Only with timely therapy can slow down the development of the disease and reduce the risk of complications.

Endometriosis and pregnancy: how the disease affects the conception of a child

Endometrioid heterotopias are foci of chronic inflammation. They lead to the appearance of adhesions - coarse fibrous strands that block the lumen of the fallopian tubes, envelop the ovaries, and stretch the ligaments of the pelvis. Adhesions increase pain and cause infertility. The egg cannot meet the sperm and conception does not occur.

Infertility in endometriosis of the pelvic peritoneum and abdominal cavity may be associated with concomitant ovarian damage. With the formation of a cyst, the ovarian reserve decreases, the quality of the eggs deteriorates, and the conception of a child becomes impossible. The risk of infertility is higher with a long course of the disease and in women over 35 years of age.

External and extragenital endometriosis usually does not affect the course of an existing pregnancy. If there is no concomitant pathology of the uterus, the fetus develops without complications. Childbirth goes on time, the birth of a child through the natural birth canal is possible.

It's important to know

Cesarean section for endometriosis of the peritoneum leads to the spread of lesions in the pelvic organs and the progression of the disease.

With endometriosis of the peritoneum, assisted delivery in the form of a caesarean section is not recommended, since such surgery can lead to further spread of the pathology.

Examination scheme: key aspects of diagnosis

Gynecological examination for endometriosis of the pelvic peritoneum and abdominal cavity is uninformative. In the mirrors, the foci are not visible, they are not palpable on palpation. The diagnosis is made on the basis of instrumental methods:

Ultrasound procedure. Superficial lesions are not visible on ultrasound. A doctor can detect only deep forms of endometriosis - and only on high-precision equipment. With the help of ultrasound, it is possible to identify concomitant pathology - a change in the uterus and appendages;
Magnetic resonance imaging. On MRI, superficial foci are not always visible and are determined only with a significant spread of the process. Deep forms in the form of point structures or hemorrhagic cysts are determined on the ligaments, serous cover and sheets of the peritoneum. On MRI, adhesions are clearly visible - rough cords with a signal of low or medium intensity;
Diagnostic laparoscopy. During the operation, you can see foci, adhesions, assess their prevalence and take a biopsy.

The photo shows an ultrasound image for endometriosis of the abdominal wall. A hypoechoic formation with areas of internal blood flow is determined:

MRI shows a focus of medium intensity with small hyperintense inclusions:

Tactics of treatment for endometriosis

Conservative therapy for endometriosis of the peritoneum and abdominal cavity is ineffective. Medications are prescribed only in two situations:

Hormonal preparations are used to suppress the growth of the remaining heterotopias after surgical treatment. Gonadotropic hormone agonists and gestagens are prescribed for 3-6 months;
Non-hormonal drugs are needed to reduce pain. Non-steroidal anti-inflammatory drugs are prescribed during menstruation for 5-7 days.

Folk remedies in the treatment of endometriosis of the abdominal cavity and pelvic peritoneum are used only in combination with hormonal agents and after the operation. Herbs do not affect the course of the disease and do not lead to regression of foci. They only improve the general condition of a woman and contribute to the normalization of hormonal levels.

Surgical treatment is the main method for endometriosis of such localization. During laparoscopy, the doctor conducts an audit of the pelvic and abdominal organs. It coagulates individual pinpoint foci, excised hemorrhagic cysts and significantly altered tissues. During the operation, adhesions can be excised, associated cysts in the ovaries can be removed.

The success of treatment directly depends on the complete removal of endometriotic lesions. But even with the excision of all visible heterotopias, a recurrence cannot be ruled out. Elements smaller than 2 mm may not be noticed during laparoscopy, and it is technically difficult to remove all altered tissues. Therefore, to suppress the remaining foci, hormonal drugs are prescribed after surgery - but they do not guarantee a complete cure. The disease may return if risk factors are present.

In an accessible and understandable language about endometriosis: a specialist says

The growth of tissue outside the uterus of a benign nature is called. In this case, the endometrium, that is, the lining of the uterus, is attached to other organs and begins to function actively. This disease is in third place in the list of all diseases of the fair sex and more often affects women in reproductive age.

The reasons

To date, the root causes of endometriosis in the female half have not been fully determined, but there are common factors that can provoke this disease.

The main reasons for the development of pathology:

Hormonal failure in the body of a woman;
Decrease in the protective function of the body, since with immunity normally the body is able to fight cells growing beyond the uterine cavity;
“Reverse” menstruation, that is, when a woman’s regular discharge does not come out all, but some enters the abdominal cavity, where the endometrium attaches to other organs and begins to actively function there;
hereditary factor;
Surgical intervention in the uterine cavity or inflammatory processes;
Pathologies associated with abnormal structure of the genital organs;
Obesity;
Decrease in the level of hemoglobin in the blood;
Use of an intrauterine device for a long time.

Most often, endometriosis affects the female half up to 40 years old, as well as girls who have early "critical days" and are accompanied by copious discharge for more than seven days.

Symptoms

Most often, the disease passes without obvious manifestations, that is, a woman, as a rule, does not bother anything. But there are a number of symptoms by which pathology can be recognized.

Symptoms of endometriosis:

Altered vaginal discharge between "critical days" (they may be accompanied by an unpleasant odor, be in the form of pus during inflammation, and also have a brown or red color).
Pain in the lower abdomen, regardless of the "menstruation".
Discomfort and intimacy, as well as during sports.
that have nothing to do with menstruation.
The presence of blood in the urine or feces during menstruation (this occurs when the disease and the rectum).

At the same time, the manifestations of the disease directly depend on the degree of growth of the endometrium outside the uterus, the larger the area of the lesion, the stronger the woman will have various manifestations. Also, endometriosis and infertility are interrelated concepts. 90% of women with the disease have problems conceiving, even when there are no obvious manifestations of the disease.

Forms of the disease

Endometriosis can come in three different forms:

Genital (develops inside the genitals).

This form of the disease occurs most often, but it may not have pronounced symptoms. In this case, the endometrium affects the ovaries, fallopian tubes, cervix and cervical canal.

(endometrium grows outside the internal genital organs).

Here, not only the organs of the peritoneum are affected, but also the pulmonary region and the genitourinary system. If there are internal scars on some organ after surgical operations, then the endometrium is actively attached to them. In rare cases, the disease can affect the organs of vision. In this case, blood may come out of the eyes.

Mixed (development of the disease both inside and outside the internal genital organs).

Also, endometriosis has several stages. At the 1st and 2nd stages, there may not be manifestations, but if left untreated, then the disease acquires. First, small areas are affected, and then the foci of the disease begin to grow. It is also a seemingly benign and harmless disease, if left untreated, of a malignant nature.

Also, foci of endometriosis in the abdominal cavity lead, first of all, to infertility, constant pain in the pelvic region, and also to the adhesive process, if there are scars after a cesarean section or other surgical intervention in this area.

Complications

If treatment is not carried out or the therapy is incorrect, then this can provoke a number of complications. The initial stage of the disease, when only the mucosa is affected, passes into the second, affecting the layers of the myometrium to the middle. Subsequently, the pathology grows to the peritoneal lining of the uterus (3rd form) and affects the entire abdominal cavity (4th stage).

If treatment is not started in a timely manner, then this leads to various consequences.

Possible complications of endometriosis:

The patency of the fallopian tubes is disrupted, which significantly reduces the reproductive function of a woman;
The onset of pregnancy, but ectopic;
Miscarriage;
Adhesions in the pelvis and abdominal cavity;
Anemia due to severe and persistent blood loss;
Education ;
Malignant neoplasms.

Also, the growth of endometriosis affects other organs, which can lead to neurological disorders. And in the case of anemia, a woman feels constant weakness, she is tormented by migraine, heart palpitations and shortness of breath.

Is it possible to conceive with endometriosis?

In general, - rarely compatible concepts. Since the disease itself entails that a woman simply cannot conceive a baby. And even if pregnancy occurs, which is extremely rare, it can end in a miscarriage. But it also cannot be definitely said that endometriosis and infertility are completely incompatible concepts. Pregnancy can occur, although in rare cases. Along with this, not only endometriosis leads to the inability of a woman to conceive a baby, this problem has other root causes.

So, endometriosis negatively affects ovulation, can lead to obstruction of the fallopian tubes or adhesions, which in turn makes it difficult for the egg to be released. In addition, a woman with a normal and regular menstrual cycle, but with the presence of a disease, may not ovulate at all. And accordingly, such a woman has no chance of becoming pregnant.

Proper treatment of endometriosis in more than 50% of cases leads to pregnancy within six months or 12 months.

If the therapy was on time and pregnancy came after, then it is this condition that will contribute to the fact that a woman can finally recover from endometriosis. This is because during the period of bearing a baby and feeding him with breast milk, menstruation stops, and the hormonal background changes somewhat. The area affected by endometriosis completely heals during this time and after 10-15 months there are no relapses. At the same time, of course, care must be taken to avoid, if possible, those factors that can provoke the disease.

Diagnostics

This disease is not diagnosed by symptoms, as they are similar to other pathologies in the pelvic region of a woman. To do this, a number of surveys are assigned.

The definition of the disease is carried out by the following methods:

(the vaginal sensor allows you to determine many changes in this area);
Hysteroscopy (helps to examine the surface of the uterus and determine the patency of the fallopian tubes);
Hysterosalpingography (especially relevant for infertility, since it is possible to determine the depth and degree of damage to endometriosis foci);
Laparoscopy (an excellent method of diagnosis, as well as therapy, because during the procedure it is possible to remove foci of pathology and not affect other organs and systems);
General blood test (with the help of a marker, an ailment is determined).

These laboratory tests are prescribed by a specialist after a visual examination and determination of the location of the disease.

Treatment

Treatment may be in the form of surgery or drug therapy. Both of these methods are often used in combination. If the therapy is conservative, then it is aimed at blocking the pathological process of cell proliferation.

Thus, endometriosis of the pelvic peritoneum is treated with oral contraceptives, during which the hormonal levels are corrected. Anti-inflammatory and analgesic drugs are also prescribed, as well as vitamins and immunomodulators, which increase the protective functions of the whole organism. It is possible to use local preparations in the form. But it should be understood that such therapy is designed for a long period, up to six months. But some women may have allergic manifestations to both tablet preparations and suppositories, so conservative therapy in this case is not possible.

As a rule, surgical treatment is carried out after conservative therapy has not brought positive results for six months. In most cases, it is carried out. This method allows you to save the internal genital organs of a woman. It is performed under general anesthesia for half an hour. The recovery process is fast. But if the degree of endometriosis is high and severe, then the woman is recommended to remove the uterus. This often occurs in more advanced forms.

Regarding traditional medicine, it has proven itself well, that is, treatment with leeches. This herbal medicine leads to the restoration of hormonal balance, blood thinning and restoration of the circulatory system. But it should be understood that all this will not lead to the destruction and elimination of endometrial foci, since so far no folk remedy has been able to cope with them.

Prevention

Prevention is especially relevant for women who have already had this disease, as well as for those who have only heard about it.

Preventive measures are as follows:

Avoid sexual intercourse during menstruation;
Engage in timely treatment of any gynecological diseases;
Watch your weight and stick to proper nutrition;
Avoid depression and stress, which can lead to various pathologies in the body;
Avoid interventions in the genital organs, including abortion, which can provoke uterine injuries and the development of various diseases;
Contraceptives should be selected only after consultation with a specialist.

It should be understood that nulliparous women after 30 years are at risk. Frequent climate change is also dangerous, which has a negative effect on the woman's body and on the hormonal background. Therefore, according to statistics, it is the representatives of the weaker sex, whose activities are associated with mental stress, that are susceptible to this disease. As a rule, such women put motherhood on the back burner, as they are busy building a career, and this accordingly reduces their chances of getting pregnant and bearing a baby normally.

Also at risk are women who change sexual partners too often and their sex life is “too active”.

And if the therapy of endometriosis did not bring positive results, then the woman is recommended in vitro fertilization. But it does not always give a positive result. Therefore, at the first symptoms or suspicions of a disease, it is important to undergo appropriate treatment.

The development of endometriosis of the abdominal cavity in a person is said if the endometrium of the uterus begins to spread into the peritoneum of the small pelvis. Endometriosis cells are constantly exposed to female hormones, causing them to bleed. And if there is no outflow of blood, then it forms numerous cysts, pathological plaques, nodes, and so on.

The disease develops as a result of some medical manipulations, injuries.
Endometriosis is characterized by damage to the abdominal cavity.
Perhaps a latent course of the lesion of the abdominal disease.
It is detected during laparoscopic diagnostics.
The best treatment for abdominal endometriosis is surgery.
Conservative treatment lasts more than six months.
Some women may develop relapses of the pathology.

What is peritoneal endometriosis

Endometriosis is a disease characterized by the appearance of endometrial tissue outside the uterine mucosa. The endometrium is the inner lining of the uterus. Consists of functional and basal layer. The functional layer is shed monthly during menstruation, and then it is restored from the basal layer. Discharge during menstruation contains blood and remnants of the endometrium. These secretions are mainly excreted externally, and only a small part of them spreads through the fallopian tubes into the abdominal cavity. If a woman is healthy, all cells are destroyed by leukocytes.

Sometimes some fragments of the endometrium are able to implant into tissues and organs. Here they grow, after which foci of endometriosis appear. Most often this process is observed in the peritoneum. Due to the activity of female hormones, pathological foci gradually increase.

Distinguish:

endometriosis of the abdominal pelvic organs;
damage to the ligaments of the uterus, ovarian tubes, extrauterine space;
internal endometrial lesion of the body of the uterus;
endometriosis lesions of the bladder, lungs and other organs.

All foci of the disease are small seals of different colors, dispersed throughout the abdominal cavity. With the confluence of pathological foci, tissue infiltration develops.

Causes of the growth of the uterine epithelium

The causes of pathological growth of the endometrium include:

reflux of menstrual blood along with endometriosis cells into the abdominal cavity;
degeneration of peritoneal cells;
adverse effects of female sex hormones on embryocytes;
surgical interventions;
transition of endometrial cells with blood and lymph flow;
disorders of the immune system.

Symptoms of endometriosis of the pelvic peritoneum

Peritoneal endometriosis can occur in the following forms:

damage exclusively to the peritoneum in the pelvic area;
disease of the uterus, ovaries, intestines and other organs.

The small form of the disease does not manifest itself clinically and is detected during clinical diagnosis. If the focus affects the deep layers of the abdominal cavity, then before and after menstruation, the following signs are found:

severe pulling pain in the lower abdomen;
discomfort in the abdomen after intimate contact and during physical exertion;
urination disorders;
adhesive process in the peritoneum and, as a result, damage to the uterus;
ovulation disorders;
infertility.

Diagnostics

Endometriosis is detected during laparoscopy. The doctor observes:

whitish vesicles;
cysts with black content;
endometriosis foci of different colors;
spots and tubercles, painted in brown.

Treatment of abdominal endometriosis

For the treatment of abdominal endometriosis, surgical therapy, drug treatment and the experience of traditional medicine are used.

Medical treatment

It is assigned for the purpose of:

relapse prevention;
prevention of the formation of adhesions;
elimination of pain;
anemia treatment;
relief of mental disorders.

Duration of drug therapy - from 2 months. up to six months or more. Patients are prescribed such drugs.

Estrogen-gestagenic - Microgynon, Ovidon, Diana, Rigevidon. The main side effect of this treatment is a high risk of blood clots.
Pain-relieving progestins. The most common drug is Duphaston. May increase weight and cause edema.
Gonadotropin-releasing hormone agonists. Cause the cessation of menstruation.
Androgens - Testosterone and Sustanon.
Anabolics
Antiestrogens - Toremifene and Tamoxifen.
Immunomodulatory drugs - Thymogen and Cycloferon.
Non-steroidal anti-inflammatory drugs.
Antispasmodics.
Tranquilizers - to eliminate neurological disorders.

With the development of anemia, iron preparations are used - Ferroplex or Fenyuls.

Surgery

It is the most efficient. Advantages of the operation:

low trauma;
preservation of reproductive function;
the doctor can accurately assess the condition of the internal organs;
the patient can leave the inpatient department the next day;
scars from surgery heal quickly.

It is possible to carry out coagulation with a laser, removal of the affected areas of the body with the help of an electric knife, ultrasound.

The experience of traditional medicine

Upland uterus is often used to treat endometriosis of the abdominal cavity. The broth is prepared as follows: 1 tbsp. herbs are poured with 2 cups of boiling water, placed in a water bath for 15 minutes. For one day you need to prepare 0.5 liters of infusion. You need to drink in small portions 1 hour before meals.

Together with the upland uterus, you need to use a decoction of the cinquefoil. It should be taken half an hour after a meal.

Possible Complications

The main complication of endometriosis lesions of the abdominal cavity is infertility. Up to half of the patients have some difficulty in conceiving a child.

Patients with this pathology are much more likely to develop ovarian cancer. The incidence of ovarian cancer is insignificant.

Pregnancy and pathology

Abdominal disease can damage the ovary and sperm. But even in these cases, doctors recommend patients not to postpone the birth of a child. The chances of a successful pregnancy with endometriosis decrease every year.

Prevention

To prevent the development of the disease, it is necessary:

choose the best ways to prevent pregnancy;
normalize hormonal levels;
refuse sexual activity during menstruation;
fight overweight;
regularly perform diagnostic laparoscopy.

Medical interest in endometriosis has grown over the past two decades. And there was something to show it from! Gynecologists began to massively diagnose the disease. Any seal immediately arouses suspicion and concern - what is its nature, whether there are malignant cells in it. Endometriosis nodules, after a detailed study, ceased to raise such questions, but no one managed to fully understand the mystery of the female ailment. There are theories and concepts, but they are all controversial.

However, the disease is not as young as it seems. Descriptions of its symptoms are found in Egyptian manuscripts dated as far back as 1855 BC. Later, Hippocrates devoted his research to her. Several millennia have changed, and there is still no clarity, despite the fact that modern science has technical capabilities at the highest level.

Ancient scientists, of course, did not have at their disposal the equipment and tools that are available to modern doctors. As a result of long-term research and observation, it was found that the nodules consist of pieces of endometrial tissue. Their source is located in the uterine cavity, the inner shell of which is covered with a layer of endometrium. During menstruation, it is periodically rejected.

The process of the menstrual cycle is controlled by the pituitary gland, which gives the female body the necessary commands. First, it stimulates the maturation of the egg. Then it promotes its advancement to the uterus. If fertilization has occurred, then the next step is to attach the fetal egg in the uterine cavity to the nutrient soil of the endometrium. If not, then it is removed from it. Menstruation is just the endometrial tissue, which, along with blood, exits through the vagina.

All this happens with the participation of several hormones produced in the female body. The action of each of them is aimed at achieving a specific goal. Their level in different periods of the cycle either rises or falls, in response to the changes taking place with the woman.

Why is the endometrium outside the uterus?

If medicine could answer this question, then perhaps the topic of endometriosis would be closed. Proponents of hormonal and metaplastic theories put forward a variety of assumptions about the occurrence of foci of endometrial tissues outside the uterine cavity. Until now, they still remain only hypotheses.

Abdominal endometriosis - foci of inflammation outside the uterine cavity

Whatever the reasons for the development of pathology, scientists have no disagreements about their prerequisites. They are unanimous in their opinion that endometriosis is provoked and aggravated by:

Disruptions in the hormonal system, weakened immunity;
Retrograde menstruation, in which menstrual blood moves in an unusual opposite direction and enters the peritoneum;
Abortions, caesarean sections, diagnostic curettage of the uterus;
Other interventions in the uterus - operations, cauterization of erosions, installation of intrauterine devices;
Sexual intercourse during menstruation;
hereditary predisposition;
Inflammatory processes in the genitourinary system;
Anomalies in the structure of the genital organs.

What are the forms of endometriosis?

There are three groups of forms of endometriosis:

Genital. Foci of endometriosis with it develop inside the genital organs;
Extragenital, in which endometrial tissues are found outside the genitals;
Combined, combining the two previous ones.

In the extragenital form, endometriosis spreads far beyond the uterus. His attacks are the intestines, lungs, urinary system. If there are postoperative scars, then they also serve as an object of fixation for endometriosis. In some cases, the organs of vision are affected, and then such a characteristic phenomenon as the release of blood through the eyes is observed.

The genital form is more common. When leaving the uterine cavity, endometrial tissues settle on its outer wall, move to the fallopian tubes and reach the ovaries. A frequent occurrence is the defeat of endometriosis of the walls of the peritoneum. The external genital organs, the cervix and its cervical canal also suffer.

The longer endometriosis is not treated, the more it forms foci. Gradually, from the 1st and 2nd stages, when relatively small areas are affected, endometriosis develops into a chronic disease with a 3-4 degree of development.

Endometriosis of the pelvic peritoneum

Endometrial nodules can grow in size (and quite quickly) and affect one organ after another. The process resembles metastasis, which is characteristic of oncological diseases. But endometriosis forms benign formations, and its transformation into a malignant form is relatively rare.

The internal organs located in the pelvic cavity are in close proximity to the walls of the peritoneum. Over time, foci of endometriosis are formed, including on them. In such cases, peritoneal endometriosis is diagnosed, which in medicine is called peritoneal.

The similarity of the symptoms of this type of disease with the signs of the inflammatory process is so great that the wrong diagnosis is often made. Treatment in this case is antibiotics and does not bring a positive result. A new round of examination begins, which takes some time. And you can’t hesitate, because the endometrial tissues grow deeper and deeper into the affected organs, not excluding the peritoneum.

Symptoms indicating endometriosis

The first thing that causes suspicion of endometriosis is changes in vaginal discharge. In inflammatory processes, they are purulent, with an unpleasant odor. In the case of endometriosis, they disturb a woman in the intervals between menstruation. Their color is brown, turning into reddish. Menstrual bleeding at the same time becomes too plentiful and also painful.

Pain accompanies not only menstruation, but also appears on other days of the cycle. They give down the abdomen, and their strength is so great that the woman is forced to take painkillers. Together with bleeding, this leads to significant blood loss. Anemia develops. The woman complains of weakness, dizziness. Her appearance is unhealthy, her skin becomes pale.

Pain syndrome is also observed during sexual intimacy, but to a lesser extent. If endometriosis affects the rectum, then blood is released during bowel movements, and the process itself causes pain. With endometriosis of the abdominal cavity, a woman experiences discomfort when examined by a gynecologist. Sometimes during it it is possible to feel the seals, indicating the presence of the disease.

How is endometriosis diagnosed?

Based on her symptoms, a woman cannot determine that she has endometriosis. The gynecologist will not do this either until the results of the examination are in front of him. To do this, use one of the methods: ultrasound, hysterosalpingography (HSG) or laparoscopy. Usually conduct a study of organs in the pelvic region. If during it the foci of endometriosis cannot be detected, then the study area is expanded.

Ultrasound, due to its prevalence, is available in most medical institutions. The form of the report is a graphic image, which is obtained after a transvaginal examination. The presence of endometriosis on it is reflected in the form of circles and ellipses.

The complex of equipment for HSG includes a fluoroscope, an X-ray tube and a monitor that receives an image. After the introduction of a contrast agent, an x-ray is taken and its description is made.

The most accurate data is obtained during laparoscopy. The technique is reliable and gives comprehensive results. It is used for both diagnosis and treatment of endometriosis. Moreover, the operation is often done without removing the patient from anesthesia after the suspicions of endometriosis are confirmed.

How is the treatment carried out

It takes a long time to get rid of endometriosis, even if surgical intervention is used for this. After removing the foci of the disease with a laser or electrocoagulation, it is necessary to take hormonal drugs for half a year and more. They are designed to restore hormonal balance and thus stop the formation of new endometrial lesions.

When peritoneal endometriosis is diagnosed, adhesions can be eliminated during surgical treatment. They form in the fallopian tubes and ovaries, thereby preventing natural conception.

Drug therapy in some cases is possible without surgery, but it is effective only in the early stages. It is based on taking hormonal drugs that change the ratio of hormones in the body and at the same time have a contraceptive effect. Therefore, it is impossible to get pregnant during the treatment period, but as soon as it ends, doctors strongly recommend conceiving a child. Thus, two problems are solved at once: it is possible to avoid a recurrence of the disease and give birth to a healthy baby.

What are the benefits of laparoscopy

By agreeing to the operation, a woman can count on the fact that all her genital organs will be preserved. This possibility is provided by laparoscopy, a minimally invasive and gentle method used to treat endometriosis. It will not be possible to do without anesthesia, but it is quite possible to reduce the time spent under it to half an hour and get rid of huge sutures and postoperative scars. Only three small puncture wounds remain on the body, which heal quickly and are almost invisible over time.

The recovery process is much faster. The mere fact that on the day of the operation or, in extreme cases, the next day, the woman leaves the hospital speaks for itself. It is also important that during laparoscopy, the chances of damage to other organs located in close proximity to the peritoneum are minimized. It is not always possible to avoid this during open abdominal operations.

Since endometrioid nodules are capable of degenerating into oncological neoplasms, it is advisable to send the removed areas for histological examination. With laparoscopy, there is such an opportunity, except in cases where thermal exposure is applied.

The experience of traditional medicine

Since endometriosis was known to ancient physicians, then, accordingly, there must be some methods that have come down to us from those times. Unfortunately, for a long time the disease was considered to be the possession of the devil in a woman, hysteria. The reason was the behavior of the woman during the attacks. She was forced to writhe from unbearable pain, which perplexed those around her.

From the heritage of doctors and healers, which has come down to our days, leeches, acupuncture, and medicinal herbs are successfully used.

Herbal medicine to a greater extent has an analgesic and hemostatic effect and does not lead to the disappearance of endometrial foci. But hirudotherapy is considered a fairly effective technique, and has become widespread. It is approved by the Ministry of Health of the Russian Federation and since the end of the last century has experienced another surge in its use. Leeches bite at biologically active points and inject their saliva. The enzymes contained in it contribute to blood thinning, restoring hormonal balance, and improving blood circulation.

One of the ways of traditional medicine is treatment with leeches.

Despite all the positive properties of folk remedies, it is not recommended to use them without consulting a gynecologist.

Relationship between endometriosis and pregnancy

Endometriosis and pregnancy can be at opposite poles, or they can be friendly. Hostility between them arises on the basis of infertility, which leads to endometriosis. In exceptional cases, a woman manages to conceive a child with endometriosis. If she does not know that she is sick, then the diagnosis is established after childbirth or during curettage, which was required after a frozen or ectopic pregnancy. Often these pregnancies end in miscarriage.

At the same time, pregnancy that occurs after the treatment of endometriosis contributes to the final recovery. This happens because menstruation stops, the hormonal background changes. The foci of endometriosis are destroyed on their own and after at least 10-12 months the disease does not recur. After this period, which covers the period of gestation and feeding of the child, there may not be a relapse. Of course, for this it is necessary to take care of excluding the causes that led to the development of endometriosis.

The spread of the endometrium of the uterus beyond this organ can occur both in the reproductive system and in the intestines, in the bladder, in the pelvic peritoneum, in the lungs and even in the eyes. Endometrial cells in any part of the female body are subject to the cyclic action of female hormones and bleed during menstruation.

If there is no exit of blood from damaged vessels, it accumulates, forming cysts, nodes, plaques and other formations. This disease is very common among women of reproductive age who have gynecological problems. Among those patients who are being treated for and undergoing a detailed examination (in particular, laparoscopy), up to 44% have a similar diagnosis.

Extragenital endometriosis, which includes damage to the peritoneum of the small pelvis, is from 6 to 8% of all recorded cases of the disease. Regardless of the localization, endometriosis is not a local, but a general disease that causes disturbances in the work of the endocrine and nervous system in a woman.

The atypical distribution of endometrial cells is based on their movement through the blood and lymph flow to other organs and tissues.

This is facilitated by medical manipulations inside the uterus:

Diagnostic curettage;

C-section;

Manual examination of her cavity after childbirth.

Among other factors in the development of the disease, experts call injuries to the inner surface of the abdominal cavity, combined with reduced immunity. It can be inflammation, mechanical damage, surgery. In addition, genetic predisposition plays an important role.

There is an assumption that endometrial cells during menstruation, for some reason, are not excreted through the cervical canal, but are thrown into the abdominal cavity through the fallopian tubes. Normally, this situation is stopped by immune cells (macrophages), but if there are problems with the endocrine system, this protection may not work. Peritoneal cells (mesotheliocytes) begin to interact with endometrial cells, forming foci of the disease.

Clinical picture of peritoneal endometriosis

There are two forms of peritoneal endometriosis:

Heterotopia is diagnosed exclusively in the peritoneum of the small pelvis;

In addition to the peritoneum, endometriosis affects the uterus, ovaries, fallopian tubes, and intestines.

The severity of the disease depends on the following factors:

The area of foci of peritoneal endometriosis (from extensive to minimal);

The presence of adhesions, their severity (from single to complete obliteration);

The depth of the peritoneal lesion (1-3 cm).

A small form of the disease does not manifest itself for a long time, it proceeds latently.

With the spread of foci of the disease into the deeper layers of fiber before and after menstruation, the following symptoms appear:

Exhausting pain in the lower abdomen of a pulling or aching character;

Discomfort during sexual contact and during physical exertion;

Violation of the functioning of the abdominal organs - problems with urination, defecation, bending of the uterus due to adhesions in the peritoneum;

Absence of normal ovulation due to the adhesive process, and, as a result, infertility.

Diagnosis of peritoneal endometriosis

Most often, endometriosis of the abdominal cavity is detected during laparoscopy.

Morphological manifestations of peritoneal endometriosis:

Vesicles of a whitish hue without pigment;

Hemorrhagic vesicles - small cysts filled with thick tar-like contents;

Superficial and deep foci of the endometrium (heterotopia) of blue, purple, black;

Knots, tubercles, spots, painted in yellow-brown color.

The only radical remedy that allows you to get rid of foci of endometriosis is laparoscopy.

This procedure has many positive properties:

She is less traumatic;

A woman does not lose the ability to bear children;

During laparoscopy, the doctor has the opportunity to objectively assess the condition of the internal organs;

The very next day, in the absence of complications, you can leave the hospital;

Traces of the operation heal quickly, they are 3 small punctures in the anterior wall of the peritoneum.

During laparoscopy, the doctor grabs the endometriosis focus with a clamp and cuts it off with special scissors. The defects of the peritoneum remaining after this heal quickly. To prevent the disease from spreading further, the tissues excised during laparoscopy are removed through the operating channel in a special container.

In addition to surgery, it is possible to carry out cryodestruction, laser coagulation, excision of nodes with an electric knife, argon coagulator, and an ultrasonic scalpel.

In addition to removing the foci of the disease, the goal of specialists involved in the treatment of endometriosis is:

Prevention of recurrence of the disease;

Protection against complications, consequences of adhesive disease;

Therapy of pain syndrome;

Treatment of posthemorrhagic anemia;

Relief of psychoneurological manifestations.

Hormone therapy lasts from 2 months to six months.

It includes the following groups of drugs:

Estrogen-gestagens - Microgynon, Diane-35, Ovidon, Rigevidon, Anovlar, a side effect is an increased risk of thrombosis;

Progestins that effectively relieve pain - Norkolut, Depostat, Duphaston, Orgametril, a side effect - weight gain, swelling of the limbs, tension in the mammary glands, breakthrough uterine bleeding;

Gonadotropin-releasing hormone agonists that cause temporary amenorrhea - Suprefect-depot, Zoladex, Decapeptyl-depot, side effect - hot flashes similar to menopausal syndrome;

Androgens - Testosterone, Sustanon-250;

Anabolic steroids - Retabolil, Methylandrostenediol;

Antiestrogens - Tamoxifen, Toremifene.

These drugs require strict control of contraindications and side effects.

Other groups of drugs for symptomatic treatment:

Immunomodulators - Levamisole, Cycloferon, Timogen;

Antioxidants - ascorbic acid, vitamin E, pycnogenol;

NSAIDs for pain relief and treatment of inflammatory processes - Brufen, Indomethacin;

Antispasmodics - Analgin, No-shpa;

Tranquilizers to eliminate neurological manifestations - seduxen, Elenium, Phenazepam, Rudotel, Tazepam;

Iron preparations for the treatment of hemorrhagic anemia (Ferroplex, Fenyuls).

With the exact selection of drugs and the implementation of the doctor's recommendations, peritoneal endometriosis is effectively treated.

Prognosis of the development of the disease

Relapses occur in 20% of women of reproductive age with a similar diagnosis. In premenopause, the prognosis is more favorable because the production of estrogen by the ovaries gradually decreases. After radical surgery, peritoneal endometriosis does not recur, the ability to bear children is restored.

Education: Diploma "Obstetrics and Gynecology" received at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.