What causes endometriosis in women. The theory of benign metastasis. Hormonal treatment of uterine endometriosis

Signs of endometriosis occur in women with pathological growth of tissue lining the inner cavity of the uterus. The endometrium passes to other organs, the abdominal wall, intestinal tissues.

Common symptoms that occur in a woman are manifested in the form of heavy menstruation, spotting in the middle of the cycle, pain in the lower abdomen.

No doctor can name the exact causes of the pathology. However, among the likely factors that cause signs of endometriosis in a woman are the following:

• Retrograde menses. At the onset of menstruation, the discharge does not completely go out through the genital tract, but is partially thrown into the abdominal cavity through the fallopian tubes. This phenomenon is not uncommon in completely healthy women. However, with good immunity, endometrioid tissue cells are rejected and are not able to take root in an atypical place.
• genetic factor. The disease can be inherited through the female line. If mother, grandmother, aunts had a problem, there is nothing to be surprised at.
• Weak immune defense of the body. Normally, endometrioid tissue cells are destroyed and excreted from the body. Poor immunity can cause the growth of the endometrium outside the uterine cavity.
• Hormonal imbalance. Endometrial tissue cells are sensitive to the effects of female sex hormones - estrogen and progesterone. An increase in the concentration, for example, of estrogen, in the body can cause the appearance of endometrioid lesions.
• Surgical intervention., curettage can injure the tissue lining the uterine cavity, resulting in endometriosis.

Other causes of endometriosis:

• genital infections;
• the use of contraceptives in the form of an IUD (intrauterine device);
• excess body weight;
• bad ecology;
• insufficient amount of iron in the body;
• problems with the liver.

Signs of endometriosis in women

All the symptoms that cause endometriosis can be conditionally divided into groups:

• Pain syndrome.
• Cycle problems.
• Inability to conceive a child.
• Psycho-emotional problems.
• Other nonspecific manifestations.

Pain syndrome

Women with endometriosis may experience the following symptoms:

• depending on the days of the menstrual cycle.
• Pain syndrome that occurs due to sexual intercourse.
• Pain not associated with either the first or the second.

The nature of the pain can also be different, and its intensity is directly dependent on the following reasons:

• the location of the lesions (the most severe pain occurs if endometriosis has affected the cervix);
• the extent of endometriosis lesions (when lesions occur in the abdominal cavity, affect the bladder);
• the formation of adhesions in the pelvic organs;
• the duration of the disease;
• high or low pain threshold in a woman.

Cycle problems

Almost always accompanies endometrioid pathology.

A woman may observe the following symptoms:

• a few days before the expected date of menstruation, accompanied by a strong pain effect;

On the video about the signs of endometriosis and its treatment:

Impossibility of conception

Infertility is diagnosed in most women who are faced with the problem of endometriosis.

The following reasons interfere with natural conception:

• hormonal imbalance in the body, which leads to the absence of a mature egg;
• adhesions in the fallopian tubes due to the inflammatory process;
• the impossibility of implantation of a fertilized egg due to a violation of the normal properties of the endometrium.

Psycho-emotional problems

Infertility, a constant feeling of pain, hormonal failure, cycle disturbance, frequent and heavy periods - all this seriously affects the psycho-emotional state of the patient.

As a result, the following manifestations are possible:

• imbalance;
• excessive irritability;
• insomnia;
• anxiety;
• depressive mood.

Other non-specific manifestations

In addition to the specific symptoms of endometriosis listed above, women can also be diagnosed with general signs, which include:

• poor general health;
• constant weakness and fatigue;
• frequent headaches;
• reduced performance.

Carrying out diagnostics

If you find signs of endometriosis, deterioration of health, a woman needs to make a visit to the doctor.

A physical examination will be carried out in the gynecological office, then the following procedures will be prescribed (which ones, the attending doctor decides):

• Ultrasound of the pelvic organs - conventional or transvaginal.
• Laparoscopy - is used both for examination in case of suspected endometriosis, and for the treatment of this pathology.

Is not always easy. The fact is that pain in the lower abdomen and other symptoms often merge with, which is a common occurrence in a number of women.

Treatment Methods

The goal of treatment is the elimination of endometrioid lesions, pain syndrome and the fight against infertility. The choice of methods of therapy is influenced by the symptoms of the disease, the desire of a woman to become a mother or lack of it, planning a pregnancy now or the possibility of postponing this issue until a later time.

Can be assigned to:

• hormone therapy;
• anti-inflammatory drugs.

In the most difficult cases, surgical treatment is indicated.

Duphaston

One of the commonly prescribed drugs is. This is a hormonal agent, which is based on progestogen or synthetic progesterone.

The action of Duphaston is aimed at eliminating pathological endometrial foci, while the drug does not affect ovulation and the menstrual cycle. The dosage is prescribed by the doctor.

Prevention measures

The sooner a woman visits a gynecologist when she feels unwell, the greater the likelihood of a complete cure in the future. Self-treatment or waiting tactics are not acceptable, since in this case the disease further develops, which is fraught with the formation of adhesive processes, new lesions and an increase in their area.

Basic preventive measures:

• immediate medical attention for painful or abnormal periods;
• timely treatment of genital infections and inflammatory diseases;
• examination by a doctor after artificial termination of pregnancy or other surgical interventions;
• observance of intimate hygiene;
• use of hormonal contraception.

Endometriosis is a disease that affects the pelvic organs of a woman. This is a pathological growth of the internal tissue of the uterus. Treatment is medical or surgical. But the best therapy is still active prevention, which means being attentive to your health and visiting a doctor in a timely manner.

Endometriosis is a pathology in which there is the appearance of tissue that normally forms only the mucous membrane of the uterus, outside of this organ. Such an abnormally located endometrium penetrates the surrounding organs, destroying them. Through the blood and lymphatic vessels, endometrioid cells spread throughout the body and can enter any organ, for example, in the fatty tissue of the anterior abdominal wall, postoperative scars, the mucous membrane of the eye, and the navel. Endometriosis is not a tumor in the traditional sense of the word, because the cells in this disease do not undergo degeneration. In addition, its symptoms are closely related to the menstrual cycle.

This disease most often develops in young women 20-40 years old. It is detected in 40% of women suffering. It is difficult to establish the true frequency of the spread of pathology in the population, since this disease can develop even in adolescence and not manifest itself for a long time.

Classification

Depending on the localization (location) of the foci, extragenital and genital (affecting the genitals) endometriosis are distinguished.

Forms of genital endometriosis:

• internal, affecting the body of the uterus, the isthmus (the place of transition to the cervix), isthmic parts of the fallopian tubes (the place where the tubes open into the uterine cavity);
• external, affecting the external genital organs, the vaginal part of the cervix, the vagina, the space behind the cervix, the ovaries, the fallopian tubes, the peritoneum.

Extragenital endometriosis affects other organs and systems - lungs, intestines, navel, scars after surgery, conjunctiva.

Causes and mechanisms of development

Currently, the causes of endometriosis are not fully established. Scientists have put forward several theories for the development of this disease, but none of them fully explains its origin.

Theories of the development of pathology

1. The implant theory is one of the earliest. She claims that endometrial cells enter the abdominal cavity through the fallopian tubes when pressure inside the uterus increases. In this case, the cells should have an increased ability for adhesion (sticking) and implantation (implantation) to the surface of the peritoneum. A necessary factor is a violation of the immune system and hormonal regulation.
2. The theory of endometrial origin suggests that endometrial cells enter the thickness of the uterine wall during abortions, diagnostic intrauterine procedures, operations, that is, any manipulations that violate the integrity of the mucous membrane. Once in the thickness of the muscles, endometrial cells begin to grow, forming foci of adenomyosis. The same theory explains the appearance of foci in distant organs by the entry of endometrial cells through the blood vessels during surgical interventions on the uterus.
3. embryonic theory. According to her, endometriosis develops from the rudiments that were formed in utero as a result of abnormal development of the genitourinary system. The development of endometriosis in young girls, often combined with anomalies of the genitourinary system, confirms the validity of this statement.
4. The metaplastic theory states that, under certain conditions, cells of other tissues can turn into endometrial ones. It is believed that cells of the lymphatic vessels, kidneys, peritoneum, and pleura can undergo such degeneration.

Predisposing factors

In the pathogenesis of endometriosis, hormonal and immune abnormalities are of great importance.

In patients, the secretion of progesterone is disturbed, its binding changes. There is an increased level of estrogen, which stimulates the growth of the endometrium. Quite often, such patients have an increased level of prolactin, there is a violation of the function of the adrenal cortex.

Characterized by an imbalance of growth and cell death. Increased secretion of endothelial growth factor causes the development of blood vessels and the growth of foci of endometriosis. At the same time, the activity of killer cells is suppressed, apoptosis (genetically programmed cell death) is inhibited.

Clinical picture

Symptoms of endometriosis may not appear for a long time. However, signs of the disease gradually develop, which depend on the location of the foci.

The main symptom of adenomyosis (endometriosis of the body of the uterus) is painful menstruation. They become abundant and long lasting. A very characteristic symptom is the appearance of smearing brown discharge before and after menstrual bleeding. If the foci of adenomyosis are large, they can manifest as intermenstrual bleeding - metrorrhagia.

Constant blood loss causes chronic iron deficiency anemia, accompanied by pallor of the skin and mucous membranes, weakness, shortness of breath on exertion, brittle hair, and dystrophic changes.

The pain develops gradually over several years. It intensifies in the first days of menstruation, and after its termination completely disappears. The pain may radiate (spread) to the groin, rectum, or vagina.

Endometriosis of the cervix is ​​accompanied by spotting before menstruation or during intercourse. With the defeat of the cervical canal, pulling pains in the lower abdomen may appear.

With endometriosis of the vagina and perineum, the main complaint is pain that worsens during intercourse, as well as on the eve and in the first days of menstruation. They are localized in the vagina and can be very strong.

The defeat of the perineum and rectum is accompanied by pain during defecation.

Retrocervical endometriosis is accompanied by signs of compression of the nerve plexuses and rectum. Patients complain of aching pain in the small pelvis, aggravated before menstruation, radiating to the lower back, thighs. Often there is constipation, there is an admixture of mucus and blood in the feces.

Endometriosis of the ovaries is accompanied by aching pain in the lower abdomen before menstruation. It can be aggravated by physical activity or sexual contact. High risk of infertility.

Infertility is one of the characteristic manifestations of genital endometriosis. It occurs due to a decrease in the number of follicles in the ovaries, between the pelvic organs, a violation of the structure and function of the endometrium of the uterus due to recurrent bleeding, hormonal disorders.

Diagnostics

On examination, signs of endometriosis can be detected in the form of foci on the surface of the cervix and vaginal mucosa.

A two-handed gynecological examination is most informative before the onset of menstruation. Depending on the localization of the foci, an increase and soreness of the uterus, nodes in the thickness of the vaginal wall or behind it, restriction of the mobility of the uterus and ovaries can be determined.

Diagnosis of endometriosis is based mainly on instrumental methods, which include (ultrasound), laparoscopy, magnetic resonance imaging. With their help, you can clarify the location of endometrioid foci, their shape, degree of growth, and other important characteristics. Laparoscopy for endometriosis can be not only diagnostic, but also a therapeutic procedure.

The diagnosis is confirmed by histological examination - analysis of samples of the obtained tissue under a microscope.

Today we will talk about:

endometriosis is a disease of the female reproductive system of a hormone-dependent type. This disease is characterized by the growth of the endometrium - the mucous membrane of the uterus - in other parts of the female body. According to experts, endometriosis of the uterus is a widespread gynecological disease, ranking third in terms of prevalence after various inflammations of the female genital organs. As a rule, this disease affects the body of women in reproductive age. The peak incidence of endometriosis occurs after the age of forty. However, this disease today also manifests itself in girls who are in adolescence. Another feature of endometriosis is that in women who have had several births, the disease manifests itself less frequently than in nulliparous patients. The disease can also occur in women after a menstrual break.

To date, experts have made several assumptions regarding the causes of endometriosis. Today there is a so-called theory of retrograde menstruation. According to this theory, the blood secreted during menstruation and containing parts of the endometrium quite often ends up in the fallopian tubes and the abdominal cavity. This is the so-called phenomenon of retrograde menstruation. When cells enter these organs, they can be cauterized. After that, the cells of the uterine mucosa begin to function as their purpose requires: they prepare for the implantation of the embryo. If conception does not occur, then the main part of the mucous membrane comes out during menstruation. But from other organs, the exit of the endometrium is impossible. Consequently, a small hemorrhage occurs in the organs, causing inflammation. In view of this, women with retrograde periods are at risk. To find out if retrograde menstruation is taking place, it is enough to undergo an examination and consultation with a gynecologist.

However, endometriosis of the uterus affects far from every woman with a similar feature of menstruation. It is generally accepted that the main characteristics that significantly increase the predisposition to this disease are the following. Firstly, this is a certain structure of the fallopian tubes, which is easy to identify during the examination. Secondly, the presence of a hereditary factor plays an important role. Thirdly, the appearance of endometriosis contributes to the violation of the functions of the immune system of the woman's body.

They started talking about the genetic factor after the research of scientists from Ireland. It has been proven that in women whose close relatives suffer from endometriosis, the likelihood of its manifestation increases five times. In view of this, during examination and consultation, specialists will definitely find out if there were any cases of this disease among the patient's relatives.

However, other factors mentioned also increase the likelihood of the disease. So, with violations in the work of the immune system, which maintains the normal state of tissues in the body, a similar pathology may occur. If the immune system is normal, then it can have a destructive effect on deviations in the functioning of the body, which include the growth of the endometrium outside the uterine lining. When the immune system fails, other systems also fail. To detect the development of the disease as early as possible will allow regular preventive examinations.

To date, one of the most common causes of endometriosis are surgical interventions ever performed in the uterus. These are abortion, caesarean section, cauterization of erosion and other procedures. In view of this, after such operations, it is necessary to undergo examinations with a doctor with a clear regularity.

Classification of endometriosis

Symptoms of endometriosis

The second unpleasant symptom of this disease is the impossibility of conception. manifests itself in 25-40% of affected women. To date, all the causes of infertility in endometriosis have not been fully elucidated. Obviously, there are changes in the fallopian tubes, ovaries, which provoked endometriosis, and pregnancy does not eventually occur. The second reason for the impossibility of conception with this disease is a malfunction of the immune system. Endometriosis can similarly affect the regularity of ovulation, and then pregnancy will not occur due to disturbances in the ovulation process that accompany this disease. Another symptom of endometriosis is menorrhagia. However, this symptom of the disease is less common than the main symptoms.

Diagnosis of endometriosis

Further, in the process of making a diagnosis, the following methods are used: a gynecological examination is performed using a mirror, ultrasound examination of organs in the small pelvis, rectovaginal, rectal examination, colposcopy, laparoscopy, hysteroscopy. It is the last two procedures that are the most commonly used methods for the diagnosis of endometriosis of the uterus. They should only be performed in a clinical setting. Pelvic pain, which lasts for more than six months, is the main indication for the use of laparoscopy and hysteroscopy.

Most patients with this disease have an increase in the uterus, usually moderate. Also, in a certain part of the patients (in about 15-20% of cases), fixed and non-fixed bending of the uterus is determined. In the process of diagnosis, in some patients, the presence of nodules in the posterior fornix is ​​determined, provoking the onset of pain. To assess whether there are similar phenomena in the rectovaginal septum, a rectovaginal examination is performed. During a study aimed at examining the fallopian tubes and ovaries, the specialist determines whether these organs are enlarged, whether they are motionless, and whether pain occurs. During colposcopy and hysteroscopy, the specialist receives the material used for the biopsy. It is biopsy and histology that are considered an effective addition to endoscopic examination methods and contribute to determining the correct method of therapy.

Treatment of endometriosis

There are currently several effective treatments for endometriosis. So, depending on the above points, experts suggest the use of a conservative medical method for the treatment of endometriosis, as well as surgical methods. During the operation, an organ-preserving method (laparoscopy and laparotomy) can be used, with the help of which only the foci of the disease are removed and the organs are preserved. In some cases, a radical method is shown in which the uterus and ovaries are removed. A combination of these methods of treatment is also used.

So, conservative therapy is used if the disease is asymptomatic, in the permenopausal period, with infertility, adenomyosis, endometriosis to restore fertility. For this, the patient is prescribed a course of hormonal, anti-inflammatory, desensitizing and symptomatic agents. However, hormone therapy is considered the main component of such treatment. It is important to consider that only a long course of drug treatment guarantees the effect of such therapy. During treatment, regular monitoring by the treating specialist is indicated.

Prevention of endometriosis

Women who notice a reduction, a metabolic failure and, accordingly, a sharp weight gain, should pay special attention to preventive measures. Also, examinations and consultations with a doctor should be regularly carried out by those women who use intrauterine contraceptives, those who are already thirty years old, and also regularly smokers. Especially for: - http: // site

Causes, symptoms and how women's diseases develop are studied by gynecology. Endometriosis, according to experts, is the most mysterious pathology in gynecology. This is a disease that affects the genitals, if we speak in simple Russian, then the essence of this disease is as follows: the endometrium lining the uterus grows strongly and makes its way outside the uterus. The frequency of this pathology is 15% of other gynecological problems.

general information

The disease is considered hormonally dependent, the endometrium, for some reason, begins to grow rapidly in places where this is not usually observed. According to doctors, this is the trouble of the 21st century, endometriosis is in second place after uterine fibroids. In most cases, the disease is detected in women after 45 years of age, this is due to the end of the reproductive period. However, there are cases when endometriosis occurs in young girls.

The disease is very difficult to diagnose, and it is almost impossible to detect in the early stages. Approximately 80% of patients who complained of discomfort in the pelvic area are diagnosed with endometriosis. This fact says only one thing, you need to visit a gynecologist as often as possible as a preventive measure to identify the disease.

The reasons

There are actually a lot of reasons for the occurrence of this disease, while until now, this pathology has not been fully studied by medicine. We can only state the main causes of the disease:

Classification

Gynecology classifies this disease according to its place of distribution. So several places of localization were established:

1. genital type. The disease affects the muscular part of the uterus, as well as its canal.
2. Extragenital. Growth occurs in the bladder, kidneys and even the intestines.
3. Peritoneal. Here, the ovaries, the abdominal cavity and the uterine tubes are usually affected.

The extragenital type of the disease usually occurs on the genitals from the outside. The disease has several forms, it can be either mild or severe (if the woman has not been treated on time). Also, the disease has four stages, depending on the depth of the lesion.

Symptoms

The symptoms of this disease are quite diverse, so sometimes even experienced professionals are misled. This gynecological disease is so insidious that the symptoms may not appear, or vice versa, they will annoy the woman too actively.

The activity of manifestations depends on a large number of factors, for example, on the type, mental state of the patient, the degree of cell growth, as well as on concomitant ailments.
At all stages, the symptoms will be the same, only of varying severity, here are the most basic ones:

Often, patients confuse the symptoms of adenomyosis with uterine fibroids, especially if they have had or have one. Other girls do not pay much attention to the symptoms at all, thinking that this is normal.

Remember women that menstruation should not lead to large blood loss and disability.

If such symptoms occur, you need a good consultation with a doctor, you do not need to self-medicate, this can lead to irreparable consequences.

How does endometriosis affect pregnancy?

It is worth noting that adenomyosis does not lead to chronic infertility, this pathology only prevents the conception of a child. There have been cases when girls became pregnant with a diagnosis of endometriosis. But this is rare and such a pathology can harm the unborn child. If it suddenly happened that you managed to get pregnant with this ailment, you will have to constantly, be under the supervision of a doctor and strictly follow all his advice.

Scientific research has not helped doctors understand why adenomyosis causes infertility. Experts were divided in opinion and put forward several points of view on this matter.

The causes of infertility can be:

1. Mechanical damage to the uterine tubes.
2. Malformed ovaries.
3. There is an adhesive process in the body.
4. endocrine disorders.
5. Weakened immunity.
6. early abortions.
7. Inflammatory processes in the uterus.

In addition, such female problems as infertility and miscarriage are often due to the wrong lifestyle and lack of ovulation, without which it is simply impossible to get pregnant. Stimulants in this situation are not helpers, since they are not able to give the desired result. According to the Ministry of Health, the frequency of a long-awaited pregnancy after perfect therapy ranges from 18 to 50% of those suffering from adenomyosis.

Patients say that after therapy, they can conceive a child after 12 months of intensive use of drugs.

Of course, there are cases in which the treatment must be repeated, in such a situation you should not worry, it is better to pull yourself together and undergo another treatment. Never give up, remember that modern medicine can work miracles and such a disease is within its power, it only takes a little effort.

How is it diagnosed

Recognizing endometriosis of the uterus on a routine examination by a gynecologist is very difficult. The doctor will be able to make the correct diagnosis only after he sees the patient's tests. Usually, before and after the cycle, the appendages are enlarged in size. Also, if the disease affected the ovaries, during a gynecological examination, the girl will be hurt.

Here are the main diagnostic methods:

1. Ultrasound of the pelvic organs. This method of diagnosis is by far the most popular. With the help of ultrasound, other pathologies can be seen.
2. Hysteroscopy. A way to identify the problem, which allows you to view the entire surface of the vagina.
3. Hysterosalpingography. In this method, a special contrast agent is used, which helps to see exactly to millimeters the spread of the disease.
4. Laparoscopy. This is a very effective diagnostic method, which not only helps to identify the focus, but also to carry out treatment.
5. Complete blood count and analysis for CA-125. This method makes it possible to evaluate the effectiveness of therapy and, if necessary, prescribe another treatment.

The number of diagnostic examinations is determined exclusively by the attending physician. Everything will depend on the degree of neglect of the disease, and whether there are concomitant pathologies.

Treatment

There are several types of treatment: conservative, combined, and also surgical. The conservative type is based on long-term therapy with hormonal drugs. Usually, doctors with such a pathology prescribe: Janine, Regulon and Diana. Treatment can last from six months to a year. To support immunity, patients are prescribed additional treatment in the form of anti-inflammatory drugs, such as ibuprofen, analgin and aspirin.

The solution to the problem by surgery is used when hormone therapy does not help.

Surgery is required when observed.