Endometriosis of the uterus - treatment, symptoms, causes. What is endometriosis? Symptoms, treatment of gynecological pathology The possibility of pregnancy and bearing a healthy fetus

Endometrioid disease (endometriosis) is a pathological benign process of growth of endometrial-like tissue outside the cavity.

Endometriosis of the uterus or adenomyosis is the germination and reproduction of endometrial-like tissue in various parts of the muscular layer of the uterine wall.

In adenomyosis, endometrioid "implants", similar to the glandular and stromal components of the basal mucosal layer, are introduced into the myometrium at different depths, causing deformation and inflammation of the surrounding tissues.

Endometriosis of the body of the uterus - what is it?

Endometriosis of the body of the uterus, adenomyosis, internal endometriosis, endometriosis of the uterus - all this is the same disease.

Recently, endometriosis of the body of the uterus is considered as a special, independent variant of endometrioid disease.

Endometriosis of the uterus: ICD-10 code

N80.0 Endometriosis of uterus (adenomyosis)

Causes of the disease

There is still no single point of view on the causes of endometriosis of the uterus. Since the end of the twentieth century, a significant role has been assigned to genetic factors, i.e. congenital predisposition to the development of the disease.

The key link and trigger mechanism of adenomyosis today is considered mechanical damage to the transition zone of the myometrium(Junctional Zone, JZ).

The transitional zone (JZ) or subendometrial myometrium is the border layer of myometrium located directly under the uterine mucosa. Normally, the JZ thickness in women of childbearing age does not exceed 2-8 mm.

It has been proven that during abortions, especially those performed with the help of curettage (curettage), when taking a biopsy of the endometrium or other gynecological, surgical manipulations, the border between the endo- and myometrium can be destroyed. This makes it easier for endometrial components to enter and survive in the new environment.

However, further formation and progressive growth of endometrioid foci in the muscular layer of the uterus is possible only against the background of a weakening of immune control and a violation of the hormonal status of a woman. Endometriosis of the uterus is a complex, multifactorial pathological process.

• Genetic predisposition ("familial" form of endometriosis).
• Curettage of the uterus.
• Prolonged use of a contraceptive intrauterine device (IUD).
• Inflammatory processes of the mucous membrane of the uterus.
• Violation of immunity: local and / or general.
• Local hormonal imbalance: increased regional estrogen synthesis (local hyperestrogenism), reduced sensitivity to progesterone in the focus of endometriosis.
• Adverse environmental and social factors.
• chronic stress.

There are several types (forms) of adenomyosis:

• Diffuse (up to 80% of cases).
• Diffuse-nodular (approximately 10%).
• Focal (up to 7%).
• (until 3%).

With the formation of endometrial cavities in the myomertium, they speak of cystic endometriosis.

According to the modern classification (L. V. Adamyan), internal diffuse endometriosis, depending on the depth of the lesion, is divided into 4 degrees (stages):

• Ι degree (stage) of adenomyosis - the pathological process is limited to the submucosa and transition zone.
• ΙΙ degree (stage) - the process extends to the myometrium, but does not reach the outer (serous) membrane of the uterus.
• ΙΙΙ degree (stage) - the entire myometrium is involved in the disease process, up to the serous membrane of the uterus.
• ΙV degree (stage) - the pathological process goes beyond the uterus, affecting other organs and tissues.

The combination of adenomyosis with external genital endometriosis is observed in 70% of cases.

What is dangerous endometriosis of the uterus:

• Decreased quality of life and work capacity.
• Development of severe, life-threatening secondary anemia.
• Infertility.
• Malignancy (malignancy).

The ability of endometrioid foci to "filter" (infiltrate) into the surrounding tissues, the tendency of their growth in distant organs, the absence of a connective tissue capsule around the pathological areas - all this brings endometriosis of the uterus closer to the tumor process.

The disease is distinguished from a true tumor by the absence of pronounced cellular atypia and the dependence of the clinical manifestations of the disease on menstrual function. Wherein the possibility of malignant degeneration of endometriosis is undeniable.

• Pain in the pelvic area and lower back. In most cases, the intensity of pain is associated with the menstrual cycle: during the period of menstruation, it is maximum.

Unlike sometimes occurring (periodic) "monthly" pain, pain with endometriosis of the uterus during menstruation always occurs and is observed regularly for 6 or more months in a row.

The nature of the pain:

- pulling, stabbing, cutting ... variable; in the lower abdomen, in the lower back;

— constant: from mild to moderate to intense.

- increases on the eve of menstruation;

- pain during menstruation may resemble a picture of an acute abdomen, accompanied by bloating, flatulence.

• Painful menstruation (algomenorrhea).
• Painful intercourse (dyspareunia).
• Scanty, chocolate-brown bloody discharge from uterus a few days before and after menstruation.
• Prolonged heavy menstruation, up to cyclic uterine bleeding (hyperpolymenorrhea) with the occurrence of secondary anemia.
• Miscarriages in early pregnancy.
• Infertility (primary and/or secondary).
• PMS: nervousness, headaches, fever, sleep disturbance, vegetative-vascular disorders.

One of the frequent signs of the disease and the only reason for the patient to see a doctor is infertility. Miscarriage (spontaneous abortion, miscarriage) often precedes the development of typical (pain, "chocolate daub", heavy periods) clinical symptoms of endometriosis.

Pain, although a frequent, but subjective sign of the disease - each woman evaluates the intensity and / or significance of the pain syndrome in different ways.

Sometimes the first sign by which adenomyosis can be suspected is heavy and prolonged periods(hyperpolymenorrhea).

Diagnosis of endometriosis of the uterus

With a bimanual gynecological examination, a clinical sign of adenomyosis may be an increase in the size of the uterus, especially pronounced on the eve of menstruation.

A spherical uterus is a sign of diffuse adenomyosis.
A tuberous uterus is a sign of the nodular form of adenomyosis.

Small forms of adenomyosis (endometrioid lesions

Complaints of the patient and a routine gynecological examination can only suggest the presence of uterine endometriosis. Instrumental studies are needed to make an accurate diagnosis.

Sonography (ultrasound) remains the most accessible and fairly informative method for diagnosing adenomyosis today.

When conducting ultrasound using a vaginal sensor in the second half of the menstrual cycle, uterine endometriosis is detected
in 90-95% of cases

Optimal timing of ultrasound if adenomyosis is suspected:
- in the second phase of the menstrual cycle, preferably on the eve of menstruation.
- control ultrasound is performed immediately after the end of menstruation.

Clinical ultrasound signs of uterine endometriosis:

Adenomyosis Ι degree(small forms of endometriosis):

• Anechogenic tubular zones, up to 1.0 cm in size, located from the endometrium to the myometrium.
• Small, up to 0.2 cm, hypo- and anechogenic oval-shaped structures in the basal layer of the endometrium.
• Unevenness, serration, indentation of the basal layer of the endometrium; other endometrial defects.
• Small (up to 0.3 cm) areas of increased echogenicity in the transition zone of the myometrium.
• The thickness of the wall of the uterus: normal, close to normal.

Adenomyosis ΙΙ degree:

• In the subendometrial layer of the myometrium, there are zones of increased heterogeneous echogenicity of various sizes with the content of rounded anechoic inclusions, 0.2-0.5 cm in diameter.
• The thickness of the uterine wall slightly exceeds the upper limit of normal.
• The walls of the uterus are thickened unevenly, with a difference of up to 0.4 cm or more in relation to each other.

Adenomyosis ΙΙΙ degree:

• The uterus is enlarged.
• The walls of the uterus are thickened unevenly.
• In the myometrium: a zone of increased heterogeneous echogenicity, occupying more than half the thickness of the uterine wall. Bands of increased and medium echogenicity.
• In areas of increased echogenicity, there are many anechoic inclusions and cavities of various shapes, 2.0–4.0 cm in diameter.
• A significant decrease in the thickness of the endometrium.

Nodular, focal adenomyosis:

• In the wall of the uterus, a rounded zone of increased echogenicity with small (0.2-0.4 cm) anechoic inclusions or cavities is determined.
• M-echo deformity (with submucosal location of endometrioid nodes).
• The change in the size of the uterus and the thickness of the uterine wall depends on the size and number of nodular formations.

Additional methods for diagnosing uterine endometriosis

CT, hysterosalpingoscopy (-graphy) and laparoscopy are not methods of choice for the diagnosis of adeomyosis. These studies are carried out on an individual basis.

MRI is the most accurate method for diagnosing endometrioid disease. But in the case of adenomyosis, the significance of MRI is comparable to a transvaginal ultrasound performed on the eve of menstruation.

MRI is prescribed according to individual indications, to exclude / confirm the combination of adenomyosis with various forms of external genital and / or extragenital endometriosis, other types of benign and / or malignant proliferative diseases. With the help of MRI, it determines the exact localization of endometriotic lesions.

This is a study of the rate of blood flow in the uterus.
Endometrioid heterotopias are avascular formations, they do not reveal growth zones of new vessels. The resistance index in the foci of endometriosis increases with the severity of the pathological process.

Allows you to visualize the signs of adenomyosis, to make a targeted biopsy of suspicious areas.

• The uterine cavity is deformed.
• On the pale pink mucosa, dark red crypts are visible - the mouths of endometrioid "moves" of various sizes. They may ooze dark red blood.

Separate diagnostic curettage of the endometrium with further histological examination of the removed tissue to determine the endometriosis of the uterus does not have great diagnostic value (after all, endometrioid foci are located in the thickness of the myometrium). Curettage under the control of hysteroscopy is done to identify / exclude the combination of adenomyosis with cancer of the uterine body,. This is important for choosing the right tactics for further treatment.

Histological verification of adenomyosis is carried out after hysteroresectoscopy. During a minimally invasive endoscopic operation performed by vaginal access, endometrial tissue is taken along with a portion of the myometrium. Then the removed tissue is examined under a microscope (histological examination) and an accurate diagnosis is made.

The "gold standard" for diagnosing external forms of endometriosis
at stage 4 of adenomyosis, laparoscopy remains. This therapeutic and diagnostic operation is carried out by introducing endoscopic equipment into the abdominal cavity through punctures of the abdominal wall.

How to treat endometriosis of the uterus

The treatment of adenomyosis remains a complex and ambiguous problem, purely individual for each patient, for each specific case of the disease.

Hormonal treatment of uterine endometriosis

Speaking about the effectiveness of hormonal treatment, you need to know that none of the drug therapy regimens leads to a complete cure and does not eliminate the possibility of recurrence of endometriosis.

The effect of hormonal treatment is temporary - after discontinuation of drugs, the disease may gradually return.

In cases of asymptomatic course of uterine endometriosis, ultrasound signs of the disease are not an indication for hormone therapy.

With asymptomatic adenomyosis of 1-2 degrees, “waiting tactics” is advisable, i.e. the patient does not receive hormonal treatment, but is under close dynamic observation. According to the indications, restorative and physiotherapy, immunocorrection, antioxidant and anti-inflammatory therapy can be prescribed (see below).

Goals of hormone therapy:

• Reducing the size of endometriosis foci.
• Reducing the severity of symptoms of the disease.
• Reducing the risk of surgical and / or repeated surgical intervention.
• Fight against hyperestrogenism, stabilization of hormonal levels.
• Prevention of progression and recurrence of the disease.
• Preservation of fertility (childbearing function).

Drug therapy of endometriosis of the uterus is primarily focused on patients interested in a future pregnancy.

Hormone therapy is based on the significant role of endocrine factors in the development of endometrioid disease. It is carried out in the absence of contraindications and side effects. Initially, treatment is prescribed for 3 months. Then evaluate its effectiveness and, if successful, extend it for 6-9 months. In case of an unsatisfactory result, a replacement of the drug or surgical treatment is indicated.

1. Oral progestogens.
Monotherapy with progesterone-like drugs is considered quite effective with adenomyosis. Progestogens are prescribed continuously, in sufficiently high doses for 3-6 months or more. The frequency of side effects they have is significantly lower than that of A-GnRH (see below).

Pills for endometriosis of the uterus

2. COC - combined oral contraceptives.
They are used to reduce pain (pelvic pain relief) associated with uterine endometriosis in women who are not interested in pregnancy. With dysmenorrhea (hyperpolymenorrhea), COCs are prescribed continuously. The effectiveness of these drugs in the treatment of endometriosis is low. More often they are prescribed as maintenance postoperative therapy, to prevent the recurrence of the disease.
The drug of choice for the treatment of endometriosis is considered a remedy.

COC preparations are contraindicated in women with adenomyosis suffering from migraine.

1. Gonadotropin-releasing hormone (A-GnRH) agonists
/doctor's consultation required/

Treatment with A-GnRH drugs is considered the "gold standard" of drug therapy for endometriosis.

A-GnRH is used to treat severe forms of uterine endometriosis. Against the background of taking these drugs, menstruation stops in women (a "medicated pseudomenopause" occurs). After discontinuation of the drug, the menstrual cycle is restored independently. The frequency of recurrence of endometriosis 5 years after the end of the course of A-GnRH reaches approximately 50%.

Long-term (more than 6 months) A-GnRH therapy is possible, but always under the guise of "return" hormone replacement therapy (HRT) with estrogen and progesterone. This method of treatment of endometriosis is considered efficient enough.

2. Parenteral progestogens.

• Depot medroxyprogesterone acetate (Depo-Provera) - injected under the skin at 104 mg every 12 weeks.

The effectiveness of parenteral progestogens is comparable to A-GnRH. But the long-term use of both is undesirable due to the negative impact on bone mineral density (risk of osteoporosis).

A significant disadvantage of progestogen treatment is breakthrough bleeding (dysfunctional uterine bleeding that occurs in response to progesterone stimulation of the endometrium). Therefore, it is more expedient to inject therapeutic agents directly into the uterus, in the form of an IUD.

3. Hormonal intrauterine device LNG-IUD Mirena:
A levonorgestrel-releasing intrauterine system is recommended for the treatment of adenomyosis in women uninterested in pregnancy.
High performance Mirena proven by the agency of the Ministry of Health and Social. USFDA services.
Duration of application is 5 years.

4. Antigonadotropins for the treatment of endometriosis:

• Gestrinone (Nemestran)
• Danazol (Danol, Danoval)

These drugs are currently rarely used due to frequent side effects due to androgenic influence (acne, seborrhea, male pattern hair growth, weight gain, voice change, reduction of mammary glands, etc.)

Article plan

One of the most common and at the same time unusual gynecological diseases is uterine endometriosis. The disease itself can be characterized as a non-localized growth of the endometrium. What does this mean? Arising for the first time in the endometrium lining the uterus, the pathological focus can spread not only to nearby tissues, but also to distant areas.

Ways of spread - through the circulatory and lymphatic systems (which makes the disease look like cancer). But without changes at the cellular level (which is typical for benign neoplasms). Pathological foci are called heterotopias, they are prone to cyclic changes. Like normal areas of the uterine endometrium, they can increase in size and be rejected in accordance with the menstrual cycle. A pathological focus located in a non-standard place may bleed slightly (which is typical for menstruation).

The prevalence of this disease is quite high, in the structure of gynecological pathologies it occupies the 3rd place. It is characterized by late detection, since there are no symptoms for a long time. Like many gynecological diseases, endometriosis can be detected during gynecological examinations, but if we are talking about an extragenital form (a pathological process outside the uterus, for example, distant localization in the lungs), then its detection may not be associated with gynecology.

Below we will explain in detail the concept of endometriosis of the uterus in an accessible language, find out what it is, what causes, signs, symptoms and treatment are inherent in the disease.

The concept of endometriosis

Endometriosis is a gynecological disease with an unexplained etiology. It occurs at any age, from the moment of puberty, ending with menopause. There are practically no cases of the onset of the disease in girls before the onset of menstruation. At the same time, there are data on the regression of the pathological process in women after the complete attenuation of the reproductive function and the hormonal activity of the body associated with it. In postmenopausal women, this disease is absent.

The beginning of the pathological process is associated with the structural features of the uterus. Its walls form 3 layers, the uterine cavity is lined from the inside by the endometrial. It, in turn, is divided into functional (external), internal and basal. During normal functioning of the body, the functional layer is constantly rejected and excreted during menstruation. And then, at the beginning of the cycle, it is updated due to the cells of the underlying basal layer (natural proliferation). What causes part of the functional layer to move to nearby or distant tissues and organs has not yet been fully elucidated. The mechanism of development is not fully understood, which in a certain way complicates the treatment.

With endometriosis affecting the organs of the reproductive system, complications are possible in the form of infertility, cysts, and menstrual irregularities. The prognosis in the early stages is quite favorable, with an uncomplicated course, a complete recovery is possible. But at the same time, the disease is prone to relapses, which makes the need for regular preventive examination by a gynecologist relevant and mandatory.

Statistics

In gynecology, endometriosis is considered the third most common, which makes the problem of its study, timely detection, treatment and prevention quite relevant. Some statistics say about 10% of all gynecological diseases.

There is an opinion that endometriosis is more common, just the symptoms of the disease are often absent, and it can be detected after several years of latent course.

According to age groups, the structure of this pathology is as follows:

• up to 5% in menopausal women;
• up to 10% in girls in puberty;
• the remaining cases occur in women of reproductive age, most often from 25 to 40 years.

The most common is the genital form of the disease, the rarest cases occur in the extragenital form with distant lesions (urinary system, intestines and even lungs) - only 6-8%. According to statistics, most often the pathology is found in combination with fibroids, and the main complication is infertility. Considering that the majority of patients are of reproductive age, the lack of regular examinations becomes a rather urgent problem in gynecology. Since pathological foci are sometimes discovered by chance, and the disease can be asymptomatic, diagnosis is often difficult. Therefore, it is important for women to know as much as possible about pathology. Reliable information about the features of its course will help to detect the first signs of pathology in yourself and contact a specialist in time.

Classification

There are two main classification systems for endometriosis. One system is based on the localization of the pathological focus, the second - on the degree of damage. Both systems are used to describe the clinical picture. When describing localization, it stands out:

• genital form;
• extragenital form;
• combined.

The first group includes pathologies of the uterus itself, which are of different types:

• diffuse endometriosis: heterotopias appear on the entire surface of the mucosa, while cavities form in the myometrium;
• nodular adenomyosis: endometroid foci are located locally, form nodes that do not have a capsule;
• focal endometriosis: the pathological process is fixed exclusively in certain areas of the uterine wall.

There are also these types of endometriosis:

• peritoneal endometriosis: the ovaries, fallopian tubes and pelvic peritoneum are involved in the pathological process;
• extraperitoneal endometriosis: the main localization is the lower parts of the reproductive system, lesions are observed on the vaginal segment of the cervix, rectovaginal septum, vagina, the external one is quite often found with lesions of the genital organs;
• : affects the muscular layer of the uterine body, while the organ increases to the size corresponding to the gestational age of 5-6 weeks.

It should be understood that such a variety of heterotopia locations complicates the diagnosis. With a visual gynecological examination, it is far from always possible to detect problem areas and identify all pathological foci.

Degrees of endometriosis

In the classification according to the volume of the lesion, 4 degrees are distinguished:

• endometriosis of the 1st degree: the growth of heterotopias is limited to the muscle layer, they can be characterized as superficial and single;
• endometriosis of the 2nd degree: up to half the thickness of the muscle layer is included in the pathological process, deeper heterotopias are found in the myometrium, their number increases;
• endometriosis of the 3rd degree: extends to the entire thickness of the muscle wall, up to the serous membrane. Complicated by ovarian cysts (on both or one, single or multiple), single adhesions can form on the peritoneum;
• endometriosis of the 4th degree: the volume of the pathology increases significantly and goes beyond the uterus, affecting the peritoneum, fistulas can form, their passages lead to the small pelvis. Complemented by bilateral polycystic ovaries (large cysts). The endometrium grows into the peritoneum with the formation of adhesions, the pathological process covers the rectum and vagina.

Each stage passes into the next, the third and last are especially dangerous. Grade 3 is difficult to treat, but the fourth is treated the worst, because the volume of the lesion is quite large, and there is no clear localization. In this case, it is difficult to remove heterotopias surgically.

The reasons

The causes of endometriosis are still not fully understood, the disease is considered polyetiological, there is no consensus among specialists on this issue. Existing theories, each separately, cannot fully explain why pathology appears. Therefore, when describing this disease, all existing theories and causes are considered.

The mechanism of spread associated with menstruation is more understood. He does not fully explain why the disease occurs, but it becomes clear how heterotopias are far from the uterus.

The relationship with other gynecological diseases has been identified, but sometimes it is not entirely clear what is the cause and what is the effect. For example, endometriosis and infertility are certainly linked. But problems with conception can be considered as a symptom (with polycystic ovaries of a different etiology) or as the root cause (if this is the result of an abortion, and abortions are considered risk factors and are called one of the identified causes of pathology). And also as one of the options for the negative consequences of the disease. Consider what theories of the occurrence of the disease are recognized by medicine at the moment.

Theories of disease progression

Foci of endometriosis can occur in the following situations.

• Retrograde menstruation (this theory is also called implantation). The mechanism of development is associated with retrograde processes during menstruation. What it is? It is assumed that part of the endometrial cells, which, together with menstruation, should be removed from the body, are "thrown" into neighboring organs (a retrograde way of penetration of part of the menstrual blood outside the uterus). This is how heterotopias are formed, which begin to behave like a normal section of the endometrium lining the uterus. That is, they go through the stage of normal proliferation, then they are rejected, causing small bleeding like menstruation. Proponents of this theory pay attention to the fact that the disease is not detected before puberty, and in postmenopausal women in the early stages it is prone to self-regression.
• hormonal theory. In the examined patients, a similar pattern of hormonal imbalance is found. They have a low level of progesterone, and an excess of estrogen, FSH (follicle-stimulating hormone), prolactin and LH (luteinizing hormone). There is also dysfunction of the adrenal cortex, which plays an important role in the humoral regulation of reproductive function.
• Immune disorders. The main function of the immune system is the destruction of all atypical foci, any tissue that has gone beyond its normal localization is usually destroyed. The appearance, continued existence and development of heterotopias is considered a sign of a violation of the immune response to "foreign" cells of the uterine endometrium.
• hereditary predisposition. New approaches to the study of endometriosis have made it possible to identify a specific hereditary marker. It indicates a hereditary predisposition and is detected in women in whose family history this disease is detected in several generations.
• metaplastic theory. It is based on the assumption of the possibility of degeneration of certain types of tissues into endometrial. In particular, there is a version about the ability of peritoneal mesothelium to metaplasia.
• embryonic theory. It is assumed that some violations in the development of the fetus can lead to the appearance of endometriosis. This conclusion was made on the basis of observations. Cases of a combination of this pathology with malformations of the genital organs in girls aged 10-12 years have been recorded.

All of the above theories cannot fully explain the mechanism of endometriosis, especially since there are still risk factors that provoke the disease.

Risk factors

The risk factors for the onset of the disease include most of the standard causes for gynecological diseases:

• violation of the cycle of different etiologies;
• any injury to the uterus: as a result of abortion, curettage, the use of intrauterine devices, complicated childbirth, surgical interventions, etc.;
• inflammatory processes of various etiologies, including infectious and viral diseases of the reproductive system;
• stenosis of the cervical canal;
• late onset of sexual activity and childbirth in the late reproductive period;
• diseases of the reproductive system associated with hormonal disorders. In gynecology, there are hormone-dependent diseases, their occurrence is most often caused by a change in the balance of estrogen - progesterone;
• diseases associated with changes in hormonal levels (diabetes mellitus, obesity, thyroid pathology, autoimmune diseases);
• propensity to allergies, reduced immunity.

In addition, risk factors include physical inactivity or excessive physical activity, stress, prolonged use of hormonal contraceptives, liver disease, poor ecology, iron deficiency, and low living standards. Such an extensive list indicates a lack of a clear understanding of the main causes of the onset and development of endometriosis, which greatly complicates further treatment.

Methods of determination

The examination should be comprehensive, because there are certain difficulties in visualizing the pathological process. It is especially important to conduct a differential diagnosis, since during the examination, endometriosis can give a similar picture with other gynecological diseases. For timely detection and accurate determination of the type and stage of pathology, it is required:

• at the appointment, collect an anamnesis (including data on hereditary diseases);
• conduct a gynecological examination: with endometriosis, it is not always possible to determine the pathology on the mirrors, and the visual picture is fuzzy and similar to other pathological conditions;
• prescribe tests: preferably for genetic markers, to identify concomitant infections - a smear;
• hysteroscopy for endometriosis: can be used both for examination and for taking material for histological examination (biopsy);
• colposcopy: allows you to more accurately visualize the picture;
• Ultrasound: helps to see the dynamics of a common pathological process;
• laparoscopy: more accurately visualizes the picture, allows you to determine the number of heterotopias, their condition, size, localization;
• CT and MRI: allows you to identify the relationship of lesions with other organs, are considered the most informative methods with an accuracy of assessing diagnostic results up to 98%;
• hysterosalpingography: an x-ray method for examining the uterine body and tubes, less effective than the previous method (83%).

If endometriosis is suspected, you should immediately contact a specialized specialist for a full comprehensive examination. Some methods (analysis for markers, colposcopy) can be done as part of a physical examination, which helps to identify the disease at an early stage. The cause for concern and an unscheduled visit to the gynecologist will be the symptoms characteristic of this pathology.

Symptoms and signs

Symptoms of endometriosis in women may not appear for a long time, in the initial stages, a latent course and the absence of visible changes in the endometrium are characteristic, which makes diagnosis difficult. However, there are certain symptoms that are characteristic of this particular disease.

• Pain: any pain is the basis for an immediate visit to the gynecologist. Almost 25% of patients report diffuse or localized pelvic pain. Also, pain can appear and intensify: during urination, defecation and sexual intercourse (contact pain);
• Dysmenorrhea: this pain syndrome during menstruation is indicated separately, as it occurs in most patients (up to 60%);
• Menorrhagia: a change in the cycle with lengthening of menstruation and more heavy bleeding, occurs in 10-15% of patients;
• Posthemorrhagic anemia: chronic blood loss leads to the appearance of symptoms characteristic of anemia (fatigue, pallor, weakness, drowsiness, dizziness);
• Infertility and the threat of miscarriage: pathological processes can lead to spontaneous abortion, but the main difficulties are associated with the inability to conceive (according to some reports, up to 40% of women with this pathology have difficulty conceiving);

As signs can be considered: intoxication, problems with urination and defecation, shortening of the cycle or its irregular nature.

Possible complications and consequences

Complications of endometriosis include the formation of many cysts (polycystic), adhesions, which become the main cause of infertility. In this case, problems with conception are not considered as a symptom, but as a complication. Statistics show that almost 50% of patients are able to become pregnant during the first year after treatment, the rest have problems with conception even after remission and complete cure.

Also, the consequences of endometriosis can be neurological disorders that occurred as a result of compression of the nerve trunks, and symptoms characteristic of anemia. Malignant degeneration is extremely rare, this disease is not or is a background disease. The atypical arrangement of uterine endometrial cells and the way they spread do not affect the very structure of the cells. On the contrary, heterotopias manifest themselves as typical endometrial cells, which indicates their normal function and the absence of signs of degeneration.

How to treat

The treatment of endometriosis is aimed both at eliminating the pathological focus and at the maximum possible restoration of the normal functions of the woman's body, especially the reproductive system. This approach is associated with the peculiarity of the disease (complications in the form of polycystic disease, infertility, etc.).

How to treat pathology is determined by the doctor after studying the clinical picture, taking an anamnesis and conducting differential diagnosis. If the examination revealed concomitant diseases (for example, infectious and viral diseases of the genitourinary system or hormone-dependent pathologies of the reproductive system), the scheme is drawn up taking into account these facts.

Methods of treatment are determined in accordance with the volume and localization of the pathological focus. As well as the prevalence in the body, the age of the patient, the presence of a history of childbirth and other factors. Since women of childbearing age are in the main risk group, tactics are required that can preserve reproductive function (which is sometimes quite difficult). In the process of treatment, both conservative and surgical methods are used.

Conservative therapy

How are they treated with therapeutic methods? The main drugs are hormonal drugs. These include:

• COOK. The use of drugs in this group (combined oral contraceptives) is associated with their ability to suppress hormones such as LH, FSH, GnRH. Thus, suppression of the processes of proliferation and production of estradiol is achieved. COC is a fairly effective remedy, as it allows you to slow down the natural processes of the menstrual cycle, which are repeated in areas with heterotopias;
• to suppress gonadotropins, prolonged MPA are prescribed;
• androgen derivatives help to increase testosterone levels and reduce the amount of estradiol produced;
• drugs containing aGnRH help block ovarian function and estrogen production;
• derivatives of norsteroids are prescribed in the form of an intrauterine therapeutic spiral.

Contraceptives with different mechanisms of action are given a leading position. Therapy of endometriosis becomes effective, as atypical endometrial tissue is amenable to their effects. Rather, it ceases to respond to the normal natural hormonal background, which provides cyclic processes of maturation of this tissue. The remaining drugs are prescribed as symptomatic. Removal of pain syndrome, restoration of a normal blood formula, disturbed as a result of anemia, improvement of immunity - all characteristic symptoms can be stopped if the correct one is prescribed.

Surgical intervention

Removal of endometriosis by surgical methods is prescribed for:

• ineffectiveness of conservative treatment;
• some types of underlying disease;
• complications in the form of cysts, bleeding, fibroids;
• functional disorders in other organs;
• the appearance of the first signs of atypical degeneration (the threat of oncology).

The operation can be performed laparoscopically or laparotomically. In the first case, the lesion is cauterized with a laser or with the help of electrocoagulation, ablation or embolization. They are recommended for a small volume of the pathological focus.

If the lesion is large, then more radical methods of surgical intervention are used:

• hysterectomy and adnexectomy are chosen if necessary to cope with a large amount of pathology;
• removal of the uterus is used most often in patients over 40.

Surgical methods cope well with the disease, but whenever possible, doctors choose minimally invasive and organ-preserving methods for removing affected areas.

Alternative medicine

Is it possible to cure pathology with folk remedies? When choosing alternative medicine methods, it should be remembered that they will only be auxiliary means. This means that, firstly, they should not be used without the consent of the attending physician. Secondly, that they are not a substitute for basic treatments. Even if the disease was detected in the early stages, it does not pose a clear threat, and the doctor chose the tactics of dispensary observation (regression of the pathological process is possible).

To get rid of endometriosis with the help of folk remedies can be prescribed:

• homeopathy: all preparations should be selected by an experienced homeopathic doctor, taking into account the current clinical picture. Basically, funds are chosen that can reduce the activity of certain hormones. That is, homeopathic preparations can serve as a substitute for COCs or other hormonal agents, for example, with intolerance or with increased side effects as a result of long-term use. They can also relieve acute symptoms (stop bleeding, pain, remove the effects of anemia);
• douching: definitely should not be used without consulting a doctor, as in some conditions it can worsen the current clinical picture. If the topical application of herbs is indicated for a particular patient, then a boron uterus, eucalyptus, and herbal preparations are usually used. But this method has much more contraindications than indications;
• herbal medicine: herbs are selected that are sources of phytoestrogens, or are able to block the production of certain hormones that provoke pathological processes;
• candles with propolis: this product of the vital activity of bees has long gained popularity in the treatment of pathologies of the female reproductive system. It is usually mixed with honey and applied both topically and internally. Reviews indicate that this method helps to relieve symptoms well and can serve as an excellent addition to the main treatment.

The most effective suppositories can be both vaginal and rectal, they are selected by a doctor and are able to relieve the main symptoms of the disease.

other methods

As an addition to the main treatment, alternative medicine techniques can be used. Well proven:

1. physiotherapy: electrophoresis with honey and zinc, radon baths, magnetotherapy in some pathological conditions are quite capable of improving the clinical picture. Physiotherapy is prescribed by a doctor, taking into account the mechanism of their action and the effect on the patient's body;
2. acupuncture: acupuncture can stimulate the protective functions of the body;
3. hirudotherapy: leech saliva improves immunity, “starts” recovery processes, reduces pain and has anti-inflammatory properties;
4. Dietary supplements for endometriosis should be taken only as prescribed by a doctor and in combination with the main means of treatment. Dietary supplements usually try to correct the hormonal background, saturate the body with vitamins, improve immunity, and relieve the effects of anemia.

endometriosis and sex

Is it possible to have sex? There are no absolute contraindications for restrictions, usually intimate life is conducted in the usual rhythm. The exception will be restrictions related to:

• with increased bleeding;
• if sexual intercourse brings painful sensations (often women with contact pain themselves refuse or significantly reduce the number of sexual acts);
• in the postoperative period, when rest is required until healing.

Preventive measures

Prevention is:

• in regular visits to the gynecologist and attentive attitude to their health;
• taking oral contraceptives (as prescribed by a doctor);
• concern for the safety of sexual relations (and, if necessary, in the timely treatment of consequences);
• maintaining a normal hormonal background (treatment of diseases of the thyroid gland, adrenal glands, obesity, diabetes mellitus);
• balanced nutrition, maintaining the immune system in the normal range, prevention of beriberi, etc.

That is, all preventive measures are aimed at eliminating risk factors and causes of the disease.

Do's and Don'ts

Contraindications are directly related to the current clinical picture of endometriosis. For example, when detecting cysts and polyps, overheating is not recommended. This means that prolonged exposure to the sun, trips to the sauna and solarium are undesirable. Restrictions may also be associated with the incompatibility of some drugs with alternative methods of treatment, douching and the use of other vaginal remedies (suppositories, tampons). It is clear that all restrictions mainly depend on the prevalence and aggressiveness of the pathological process.

The possibility of pregnancy and bearing a healthy fetus

Pregnancy can occur both in the presence of endometriosis (can be detected only in the management of a pregnant patient), and after treatment. Since infertility is considered as a cause of pathology and as its complication, conception can become a major problem.

One of the complications may be the threat of miscarriage or spontaneous abortion in the absence of adequate treatment and a large amount of pathology. In the early stages, the cessation of menstruation due to pregnancy can lead to regression, but in the future, the pathological process can be activated again.

The disease usually does not affect the health of the unborn child, unless it is a hereditary factor that can be passed on to the daughter from the mother.

Can it be cured permanently

Whether the disease is treated usually worries all patients.

In the initial stages, the pathology lends itself well to therapeutic methods. With the elimination of all possible provoking factors, it is curable. But women of reproductive age remain at risk of relapse.

Therefore, the doctor decides how to treat the disease, but the woman should be observed in the future as a dispensary patient with the risk of resuming the pathological process. With the attenuation of the hormonal (and, as a result, reproductive function), as a rule, complete regression occurs and the disease does not return in the future.

Can it pass on its own

Practice shows that such cases are not rare. They may be associated with changes in hormonal levels, pregnancy or postmenopausal. Sometimes regression occurs for no apparent reason, what caused it is impossible to say for sure. But at the same time, you should not count on such an outcome.

When a disease is detected, it is necessary to begin complex treatment. In this case, you should not self-medicate and use folk remedies without medical advice. The argument “helped someone” will be little consolation in the further development and spread of the pathological process. To treat a disease or leave a woman for some time at a dispensary is decided only by a specialized specialist based on the clinical picture, a complete examination and anamnesis of a particular patient.

Can it turn into cancer

Despite the fact that endometrial cells can behave like malignant tumors by their method of propagation, the risk of their degeneration into atypical tumors is small. Much more dangerous in this regard can be concomitant diseases or provoking factors. In this case, it is difficult to answer what caused the oncology.

But the opinion of experts is almost unanimous on this issue: the disease does not belong to precancerous or background ones, therefore, the risk of transition to oncology is minimal.

Prices for treatment

The cost of treatment will depend on several factors:

• the level and status of the clinic, its location: usually, in more prestigious medical institutions, examination and surgery are more expensive than in clinics of the "middle" level, and on the periphery, treatment is cheaper than in large cities;
• the volume of medical procedures: the more methods for examination are used, the more expensive the diagnosis, as a result, therapeutic treatment is usually cheaper than surgery;
• the price depends on the method of its implementation: with endometriosis, the tactics of surgical intervention may be different. The cost of endoscopic coagulation will depend on the volume of pathology (from 30 to 50 thousand rubles), removal of the uterus, of course, will cost more.

The cost of conservative therapy will be affected by the number of prescribed drugs. The patient may be offered analog drugs as an alternative.

Since the main drugs are contraceptives, they do not require large material costs, but do not forget that we are usually talking about a stable intake for six months to 9 months (rarely a year).

These are hormone-dependent pathological growths of the glandular tissue of the uterus (endometrium) outside it: in the ovaries, in the fallopian tubes, in the thickness of the uterus, in the bladder, on the peritoneum, in the rectum and other organs. Clinical manifestations depend on the localization of the process. Common symptoms are pelvic pain, enlargement of endometrioid nodes, spotting from external areas before and during menstruation. Diagnosis includes a gynecological examination, ultrasound, hysteroscopy. Treatment - hormone therapy, surgical removal of gerotopia, in severe cases, hysterectomy is required.

ICD-10

N80

General information

Endometriosis is a pathological benign growth of tissue that is morphologically and functionally similar to the endometrium (the lining of the uterus). It is observed both in various parts of the reproductive system and outside it (on the abdominal wall, bladder mucosa, intestines, pelvic peritoneum, lungs, kidneys, and other organs). Fragments of the endometrium (heterotopia), growing in other organs, undergo the same cyclical changes as the endometrium in the uterus, in accordance with the phases of the menstrual cycle. These changes in the endometrium are manifested by pain, an increase in the volume of the affected organ, monthly bleeding from heterotopias, menstrual dysfunction, and discharge from the mammary glands. Genital endometriosis can cause ovarian cysts, menstrual irregularities, and infertility.

Endometriosis is the third most common gynecological disease, after inflammation and uterine fibroids. Endometriosis in most cases occurs in women in the reproductive period, that is, at the age of 25-40 years (about 27%), occurs in 10% of girls during the formation of menstrual function and in 2-5% of women in menopausal age. Difficulties in diagnosis, and in some cases the asymptomatic course of endometriosis, suggest that the disease is much more common.

Causes of endometriosis

Among experts there is no consensus on the causes of endometriosis. Most of them lean towards the theory of retrograde menstruation (or implantation theory). According to this theory, in some women, menstrual blood with particles of the endometrium enters the abdominal cavity and fallopian tubes - the so-called retrograde menstruation. Under certain conditions, the endometrium is attached to the tissues of various organs and continues to function cyclically. In the absence of pregnancy, the endometrium is shed from the uterus during menstruation, while microhemorrhage occurs in other organs, causing an inflammatory process.

Other theories of the development of endometriosis, which are not widely used, consider gene mutations, abnormalities in the function of cellular enzymes, and hormone receptor responses as its causes.

Risk factors

Women who have such a feature as retrograde menstruation are predisposed to the development of endometriosis, but not in all cases. Factors that increase the risk of endometriosis include:

• Heredity. The role of hereditary predisposition to the development of endometriosis and its transmission from mother to daughter is very high.
• Surgical interventions on the uterus: surgical termination of pregnancy, cauterization of erosions, caesarean section, etc.
• Immunosuppression.
• Metabolic disorders, obesity, overweight.
• Use of intrauterine contraceptives.
• Age after 30-35 years.
• Elevated estrogen levels.
• Smoking.

Pathomorphology

Endometrioid lesions can vary in size and shape, from rounded lesions a few millimeters in size to shapeless growths of several centimeters in diameter. Usually they have a dark cherry color and are separated from the surrounding tissues by whitish connective tissue scars. Foci of endometriosis become more noticeable on the eve of menstruation due to their cyclic maturation. Spreading to the internal organs and peritoneum, areas of endometriosis can grow deep into the tissues or be located superficially.

• Development of posthemorrhagic anemia

Occurs due to significant chronic blood loss during menstruation. It is characterized by increasing weakness, pallor or yellowness of the skin and mucous membranes, drowsiness, fatigue, dizziness.

• Infertility.

In patients with endometriosis is 25-40%. So far, gynecology cannot accurately answer the question of the mechanism for the development of infertility in endometriosis. Among the most likely causes of infertility are changes in the ovaries and tubes due to endometriosis, a violation of general and local immunity, and a concomitant violation of ovulation.

With endometriosis, one should not talk about the absolute impossibility of pregnancy, but about its low probability. Endometriosis drastically reduces the chances of bearing a child and can provoke a spontaneous miscarriage, so the management of pregnancy with endometriosis should be carried out with constant medical supervision. The chance of pregnancy after endometriosis treatment ranges from 15 to 56% in the first 6-14 months.

Complications

Hemorrhages and cicatricial changes in endometriosis cause the development of adhesions in the pelvis and abdominal organs. Another common complication of endometriosis is the formation of endometrioid ovarian cysts filled with old menstrual blood (“chocolate” cysts). Both of these complications can cause infertility. Compression of the nerve trunks can lead to various neurological disorders. Significant blood loss during menstruation causes anemia, weakness, irritability and tearfulness. In some cases, malignant degeneration of endometriosis foci occurs.

Diagnostics

When diagnosing endometriosis, it is necessary to exclude other diseases of the genital organs that occur with similar symptoms. If endometriosis is suspected, it is necessary to collect complaints and anamnesis, in which pain, information about past diseases of the genital organs, operations, and the presence of gynecological pathology in relatives are indicative. Further examination of a woman with suspected endometriosis may include:

• gynecological examination (vaginal, rectovaginal, in mirrors) is most informative on the eve of menstruation;
• colposcopy and hysterosalpingoscopy to clarify the location and form of the lesion, obtaining a tissue biopsy;
• ultrasound examination of the pelvic organs, abdominal cavity to clarify the localization and dynamic picture in the treatment of endometriosis;
• spiral computed tomography or magnetic resonance to clarify the nature, localization of endometriosis, its relationship with other organs, etc. The accuracy of the results of these methods for endometriosis is 96%;
• laparoscopy, which allows you to visually examine the foci of endometriosis, assess their number, degree of maturity, activity;
• hysterosalpingography (X-ray images of the fallopian tubes and uterus) and hysteroscopy (endoscopic examination of the uterine cavity), which allow diagnosing adenomyosis with an accuracy of 83%;
• study of tumor markers CA-125, CEA and CA 19-9 and RO-test, the indicators of which in the blood in endometriosis increase several times.

Treatment of endometriosis

When choosing a method of treating endometriosis, they are guided by such indicators as the age of the patient, the number of pregnancies and childbirth, the prevalence of the process, its localization, the severity of manifestations, the presence of concomitant pathologies, the need for pregnancy. Methods of treatment of endometriosis are divided into medical, surgical (laparoscopic with removal of foci of endometriosis and preservation of the organ or radical - removal of the uterus and oophorectomy) and combined.

Conservative treatment

Treatment of endometriosis aims not only to eliminate the active manifestations of the disease, but also its consequences (adhesive and cystic formations, neuropsychiatric manifestations, etc.). Indications for conservative treatment of endometriosis are its asymptomatic course, the young age of the patient, premenopause, the need to preserve or restore childbearing function. Leading in the drug treatment of endometriosis is hormone therapy with the following groups of drugs:

• combined estrogen-gestagen preparations.

These drugs, containing small doses of progestogens, suppress estrogen production and ovulation. Shown at the initial stage of endometriosis, because they are not effective in the prevalence of the endometrioid process, ovarian cysts. Side effects are expressed by nausea, vomiting, intermenstrual bleeding, soreness of the mammary glands.

• gestagens (norethisterone, progesterone, gestrinone, dydrogesterone).

Shown at any stage of endometriosis, continuously - from 6 to 8 months. Reception of gestagens may be accompanied by intermenstrual spotting, depression, soreness of the mammary glands.

• antigonadotropic drugs (danazol, etc.)

Suppress the production of gonadotropins in the hypothalamus-pituitary system. Apply continuously for 6-8 months. Contraindicated in hyperandrogenism in women (excess of androgenic hormones). Side effects are sweating, hot flashes, changes in weight, coarsening of the voice, increased oily skin, increased intensity of hair growth.

• agonists of gonadotropic releasing hormones (triptorelin, goserelin, etc.)

The advantage of this group of drugs in the treatment of endometriosis is the possibility of using drugs once a month and the absence of serious side effects. Releasing hormone agonists cause suppression of the ovulation process and estrogen content, leading to suppression of the spread of endometriosis foci. In addition to hormonal drugs in the treatment of endometriosis, immunostimulants, symptomatic therapy are used: antispasmodics, analgesics, anti-inflammatory drugs.

Surgical tactics

Organ-preserving surgical treatment with removal of heterotopias is indicated for moderate and severe stages of the course of endometriosis. Treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, dissection of adhesions. It is carried out in the absence of the expected effect of drug therapy, the presence of contraindications or intolerance to drugs, the presence of lesions with a diameter of more than 3 cm, dysfunction of the intestines, bladder, ureters, kidneys. In practice, it is often combined with drug treatment of endometriosis. It is performed laparoscopically or laparotomically.

Radical surgical treatment of endometriosis (hysterectomy and adnexectomy) is performed for patients over the age of 40 with active progression of the disease and the ineffectiveness of conservative surgical measures. Unfortunately, radical measures in the treatment of endometriosis are required in 12% of patients. Operations are performed laparoscopically or laparotomically.

Forecast

Endometriosis tends to recur, in some cases, forcing to resort to repeated surgical intervention. Relapses of endometriosis occur in 15-40% of patients and depend on the prevalence of the process in the body, its severity, localization, radicalness of the first operation.

Endometriosis is a formidable disease for the female body, and only its early detection and persistent treatment leads to complete relief from the disease. The criteria for the cure of endometriosis are satisfactory health, the absence of pain and other subjective complaints, the absence of relapses within 5 years after completing the full course of treatment.

In childbearing age, the success of the treatment of endometriosis is determined by the restoration or preservation of childbearing function. With the current level of surgical gynecology, the widespread use of sparing laparoscopic techniques, such results are achieved in 60% of patients with endometriosis aged 20 to 36 years. In patients with endometriosis after radical surgery, the disease does not recur.

Prevention

The earlier, when the first symptoms of endometriosis appear, a woman comes to a gynecologist's consultation, the more likely a complete cure and no need for surgical intervention. Attempts at self-treatment or expectant management in the case of endometriosis are absolutely not justified: with each subsequent menstruation, new foci of endometriosis appear in the organs, cysts form, cicatricial and adhesive processes progress, and the patency of the fallopian tubes decreases.

The main measures aimed at the prevention of endometriosis are:

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

With regard to endometriosis, like many other gynecological diseases, a strict rule applies: the best treatment for the disease is its active prevention. Attention to one's health, the regularity of medical examinations, timely treatment of gynecological pathology make it possible to catch endometriosis in the very initial stage or completely avoid its occurrence.

The uterus is a hollow organ connected through the cervical canal to the vaginal cavity and through the fallopian tubes to the abdominal cavity and ovaries.

The innermost layer of the uterus is the endometrium. You can get an idea of ​​its appearance at each menstruation, when it is rejected and removed almost entirely from the uterine cavity.

Why is the endometrium removed from the uterine cavity at the beginning of each menstrual cycle?

The answer to this question is simple - it's all about that. That it is the endometrium that is that “fertile soil” that, having fallen on which, a fertilized egg can continue its development and give rise to a new life. Therefore, every time when fertilization did not occur during the menstrual cycle, the mucous layer of the uterus is rejected and a new one gradually forms - already during the next cycle.

With endometriosis, for unknown reasons, the endometrium of the uterus is in areas where it should not be (the muscular membrane of the uterus, ovaries, on the abdominal mucosa, in the vagina). Moreover, in the foci of the pathological spread of the endometrium (they are also called ectopic foci or heterotopias), as in the uterus, all stages of endometrial maturation (proliferation of endometrial cells, secretion and rejection) occur.

The growth of the endometrium is regulated by the hormonal system, namely, the sex hormones of the ovaries and hypothalamus. Therefore, these hormones equally affect both the basal layer of the normal endometrium of the uterus and ectopic foci, regulating their growth and development phases.

Risk factors and possible causes of endometriosis

Risk factors in the development of endometriosis:

• Abortions at different stages of pregnancy
• Diagnostic curettage of the uterine cavity
• Operations on the pelvic organs

Endometriosis of the body of the uterus

Symptoms of endometriosis of the body of the uterus (adenomyosis)

• Painful menses. The most intense pains are in the first days of menstruation, when there is an active contraction of the muscular membrane of the uterus and rejection of the endometrium, including in ectopic foci.
• Profuse menstrual flow with bloody discharge. Menstrual flow with endometriosis is characterized by a dark color, but there is also a significant part of the blood clots in the discharge.
• Longer menstrual flow. The duration of menstrual flow in many women suffering from endomniosis exceeds the average.
• The appearance of dark brown discharge 2-5 days before menstruation. Also, after the end of menstruation, dark brown discharge may go away for another 2-5 days. These secretions depart in the pre- and postmenstrual period from endometrioid foci, which can enter the uterine cavity when the myometrium contracts.
• Bloody discharge during the intermenstrual period. This symptom is quite common. It may indicate a hormonal imbalance.

Stages of endometriosis of the body of the uterus (adenomyosis)

Diagnosis of endometriosis of the body of the uterus

• Allows the gynecologist to determine the likelihood of a particular gynecological disease. Inspection in the mirrors allows you to examine the vaginal cavity and the outer part of the cervix.
• Ultrasound of the pelvic organs- this study reveals almost all forms of endometriosis in 90% of cases. However, in some cases, a more detailed instrumental examination is required. Ultrasound for the diagnosis of endometriosis is best done on the 23-25th day of the menstrual cycle.
• X-ray examination of the genital tract using contrast (hysterosalpingography) . Before this diagnosis, it is recommended to carry out curettage of the uterine cavity. The X-ray image is preceded by filling the uterine cavity with a special radiopaque substance.
• Hysteroscopy- This is an examination of the uterine cavity using a special apparatus - a hysteroscope. This device displays visual information on the monitor screen and allows you to directly examine the uterine cavity, as well as perform minimally invasive operations using special manipulators.

Endometriosis of the cervix

Symptoms of cervical endometriosis

• Dark spotting discharge from the genital tract on the eve of menstruation
• Pain for this form of endometriosis is not as characteristic as for other types of heterotopia.
• Brown discharge during genital intercourse, more often observed in the second half of the menstrual cycle.
• Discomfort and even pain during genital intercourse.

Diagnosis of endometriosis of the cervix

• Gynecological examination. When viewed in the mirrors, as a rule, foci of endometriosis of the cervix are detected.
• Cervicoscopy- this instrumental study allows you to examine the cervical canal and identify heterotopias in it.
• Separate scraping- allows you to identify endometrioid secretions in the resulting biomaterial.

All diagnostic measures for endometriosis of the cervix should be carried out in the second half of the menstrual cycle - on the 23-25th day of the cycle.

Endometriosis of the vagina and perineum

Symptoms of endometriosis of the vagina and perineum

• Severe pain that worsens shortly before menstruation
• Pain during genital or anal intercourse
• Brownish spotting that occurs more often in the second half of the menstrual cycle
• During genital intercourse, brownish discharge from the vagina may be observed.

Diagnosis of endometriosis of the vagina and perineum

• Gynecological examination. Inspection of the vaginal cavity in the mirrors and sampling from the foci of endometriosis of the contents allows you to accurately diagnose in most cases.
• Ultrasound of the pelvic organs- allows you to clarify the prevalence and size of endometrioid lesions.

ovarian endometriosis

Symptoms of ovarian endometriosis

• Soreness in the lower abdomen may or may not be related to the menstrual cycle. Persistent pain can occur as a result of inflammation of the peritoneum, irritated by endometriosis lesions.
• In some cases, there is an increase in pain in the lower abdomen during physical exertion or during sexual contact.
• An increase in soreness can occur as menstruation approaches, with a peak on the first day of menstruation.
• Pain can be given to the lumbar or inguinal region, as well as to the rectal region.

Diagnosis of ovarian endometriosis

• Ultrasound of the pelvic organs is the most informative of non-invasive diagnostic methods.
• Diagnostic laparoscopy gives the most accurate data on the localization, size of endometrioid lesions. Also, this method can be used for surgical treatment.

Fallopian tube endometriosis

Symptoms of endometriosis of the fallopian tubes

• Pain in the lower abdomen
• Soreness may increase a few days before menstruation
• Acute pain during exercise may indicate the formation of peritoneal adhesions.
• Soreness during intercourse, increasing with the approach of menstruation.

Diagnosis of endometriosis of the fallopian tubes

• Ultrasound of the pelvic organs allows you to determine the size of the focus and its approximate localization.
• Laparoscopic diagnostics allows you to make a direct examination of the surface of the fallopian tube and most reliably identify the localization of endometriosis.

Treatment of endometriosis

Surgery

Medical treatment

• Combined oral contraceptives (femoden, anovlar, ovidon, marvelon, rigevidon, diane-35)
• Preparations from the group of progestins (duphaston, norkolut, depostat)
• Drugs from the group of antigonadotropins (danazol, gestrinone)
• Representatives of gonadotropin-releasing hormone agonist preparations (zoladex, decapeptyl-depot, suprefect-depot)
• Drugs - antiestrogens (toremifene, tamoxifen)

As mentioned above, only your gynecologist can determine the treatment regimen and control the effect against the background of the ongoing treatment. Therefore, self-treatment for endometriosis with hormonal drugs is contraindicated due to the many side effects of these drugs and the need to monitor the effectiveness of the treatment.

Prevention of endometriosis

• It is necessary to avoid abortions, not to strive for childbirth through a Caesarean section, think a thousand times before agreeing to curettage and other procedures in the uterine cavity, and refrain from using intrauterine contraceptives.
• It is necessary to monitor the regularity of the menstrual cycle - its violation is the main symptom of hormonal changes.
• Immunity should be maintained at a high level - therefore, sports, rational nutrition and a competent distribution of work and rest regimen must be determined and observed for you.

Endometriosis and pregnancy

In some cases, the pain syndrome in endometriosis is so pronounced that the only way to get rid of this disease is to remove the uterus.

But what to do if natural conception against the background of endometriosis does not occur within 6 months?

Checking the patency of the fallopian tubes- this requires hysterosalpingography, diagnostic laparoscopy

Determination of the presence of ovulation(Ultrasound of the ovaries in the middle of the menstrual cycle, measurement of basal temperature and study of hormonal levels)

Diagnosis of the condition of the uterus(ultrasound of the pelvic organs, hysteroscopy, hysterography)
If during these studies the cause of infertility was identified, then the gynecologist will prescribe the necessary treatment:
In case of obstruction of the fallopian tubes - excision of the flocks of the abdominal cavity, removal of endometriotic foci that can mechanically compress the fallopian tubes.

With a disturbed hormonal background, ovulation is stimulated with hormonal drugs.
With endometriosis of the uterus, it is possible to perform an operation to remove the foci of endometriosis.

If pregnancy has not occurred within 6 months after the treatment, then the possibility of in vitro fertilization should be considered.

If conception has come, then we are doubly happy for you. From now on, regular premenstrual pain will disappear and there is every chance of having a healthy baby. The fact is that under the influence of hormonal changes occurring in the body of a woman during pregnancy, the activity of endometrioid foci drops to a minimum.

Prognosis for endometriosis

What are the complications and consequences of endometriosis?

Endometriosis can affect both the genitals ( with genitalia) and other body tissues ( with extragenital form) - intestines, lungs, liver and so on.

The consequences of the disease are determined by:

• the affected organ;
• the severity of the growth of endometrial tissue;
• timeliness and adequacy of the treatment.

• violation of the menstrual cycle;
• the formation of adhesions in the pelvis;
• the formation of endometrioid cysts;
• neurological disorders;
• rupture of the affected organ;
• violation of childbirth;
• malignancy ( transformation into a malignant tumor);
• infertility.

Formation of adhesions in the pelvis
The appearance of endometrial cells in organs in which they are not usually found leads to the development of an inflammatory process characterized by the migration of a large number of leukocytes ( cells of the immune system that provide protection to the body) to the site of inflammation. They surround "foreign" cells, trying to prevent their further spread throughout the body. As the disease progresses, special cells may appear in the focus of inflammation - fibroblasts, which produce a large amount of fibrin protein and collagen fibers. Of these, adhesions are subsequently formed, which are growths of the connective ( cicatricial) tissue. Growing adhesions can block the lumen of the fallopian tubes and uterus, with endometriosis of the intestine, squeezing of its loops and disruption of the passage of feces can occur. There may be "gluing" between the various organs of the small pelvis and abdominal cavity, which leads to a violation of their function.

Formation of endometrial cysts
If pathological growths of endometrial cells are located on the surface of the affected organ ( ovaries, uterus or other) then during menstruation, they are rejected, as a result of which they enter the abdominal cavity or are excreted through the vagina with menstrual blood. If the focus of endometrial tissue is located in the depths of the organ ( that is, it is surrounded on all sides by normal tissue), the rejected cells of the endometrium cannot stand out, as a result of which they remain in the resulting cavity ( along with a certain amount of blood flowing from damaged vessels), that is, a cyst is formed.

Such a pathological process will be repeated every month, when the woman begins her period, as a result of which the size of the cyst and the volume of blood contained in it will gradually increase. The cyst will gradually compress the surrounding tissues, leading to dysfunction of the organ. When the size of the cyst reaches a critical size, its wall may rupture and the contents will leak out. Sometimes this is manifested by profuse bleeding, which is observed during the next menstruation. If the contents of the ruptured cyst enter the abdominal cavity, peritonitis develops ( inflammation of the peritoneum - a thin membrane surrounding the internal organs of the abdominal cavity and small fold).

Neurological disorders
The growth of endometrioid cells in various tissues can lead to compression of the nerve structures passing in this area. As a result, intestinal motility may be disturbed, which will be manifested by constipation or frequent diarrhea, bloating, and so on. Dysregulation of the bladder can lead to frequent urination or urinary incontinence.

Rupture of the affected organ
The germination of endometrial cells in the walls of various organs violates their integrity and strength. The rupture of the wall of the large intestine can occur with an increase in the load on them, which is observed with constipation, intestinal obstruction, the use of rough and poorly processed food. The ingress of feces into the abdominal cavity can lead to the development of fecal peritonitis, requiring urgent surgery. Rupture of the uterine wall can occur at various stages of pregnancy ( depending on the degree of damage to the myometrium - the muscular layer of the uterus) and without urgent surgical intervention can lead to the death of the fetus and mother.

Birth disruption
During childbirth, the myometrium begins to contract, helping to push the fetus out of the uterine cavity. The germination of the endometrium in the tissue of the muscular layer of the uterus significantly disrupts the contractility of the organ, as a result of which there may be a weakness in labor ( that is, the uterus cannot contract with sufficient force to ensure the birth of a child). In addition, the load on the muscle fibers of the organ during labor pains increases several times, which, with endometriosis, can lead to uterine rupture.

Intestinal obstruction
Violation of the passage of feces can develop as a result of a pronounced proliferation of endometrial tissue in the intestinal cavity. In this case, a mechanical overlap of its lumen and the development of intestinal obstruction occur. Another cause of this complication may be the formation of adhesions in the abdominal cavity. As they grow, they squeeze the intestinal loops from the outside, as a result of which the passage of feces is also disturbed.

malignancy
One of the theories for the development of endometriosis is considered to be a tumor degeneration of ordinary cells of the organ. If we consider endometriosis from this point of view, then it refers to benign tumors, since the growing cells of the endometrium do not destroy, but rather push back the cells of normal tissues. However, sometimes malignant degeneration of endometrioid cells into cancerous ones can occur. In this case, the rate of development of the pathological process accelerates, cancer cells begin to destroy neighboring tissues and organs, and metastases appear - distant tumor foci that are formed as a result of the migration of cancer cells with blood and lymph flow.

Infertility
The most common complication of endometriosis is infertility, which is observed in more than 60% of women suffering from this disease. The cause of infertility can be adhesive processes, endometrioid cysts in the ovaries, as well as the development of inflammatory reactions in the uterine mucosa, which prevents the attachment of a fertilized egg and the onset of pregnancy.

It is worth noting that the onset of pregnancy at any stage of endometriosis stops the progression of the disease. This is due to the suppression of the secretion of female sex hormones ( estrogen), which are responsible for proliferation ( overgrowth) endometrial tissue. The longer a woman has endometriosis, the less likely she is to become pregnant.

Can you have sex with endometriosis?

Sex life with endometriosis is affected by:

• form of the disease. The most dangerous in this regard is endometriosis of the uterus and external genital organs. In this case, the proliferation of endometrial cells ( mucous membrane of the uterus) leads to functional disorders in the affected organ, and can also cause a number of complications. Endometriosis of other organs ( e.g. lungs) usually does not affect a woman's sex life.
• The severity of the disease. With endometriosis, endometrial cells appear in various organs. The larger the focus of endometriosis, the more the surrounding tissues are compressed and the more the function of the affected organ suffers.

• Bleeding. With endometriosis of the cervix or vagina, the affected tissue may be permeated with a large number of endometriotic lesions. During intercourse, their mechanical damage may occur, resulting in bleeding. The intensity of blood loss varies depending on the severity of the endometrioid process and the affected organ.
• Get sick. Acute stabbing pains are usually observed in endometriosis of the body and cervix, vagina, intestines. An inflammatory process develops around the endometrial cells, which is accompanied by increased sensitivity of the tissue of the affected organ. During sexual intercourse, the overgrown tissue of the endometrium is squeezed, which causes the onset of pain. Its intensity varies from mild to unbearable ( what can cause sexual intercourse). Another cause of pain may be vaginal dryness, often observed in the treatment of endometriosis with hormonal drugs, as well as the development of adhesions in the pelvis.

In milder cases, it is recommended to reduce the frequency of having sex in the first half of the menstrual cycle if possible. This is due to the fact that during this period, under the influence of female sex hormones ( estrogen) there is an increase in the endometrium in the uterus and in the foci of endometriosis, which may be accompanied by a deterioration in the condition of the woman and the development of more severe complications.

Can you sunbathe with endometriosis?

Endometriosis is the overgrowth of endometrial cells ( mucous membrane of the uterus) organs where they are not normally found. Under the influence of female sex hormones ( estrogen) there is increased growth of the endometrium ( both in the uterus and in the foci of endometriosis), as a result of which it compresses the surrounding tissues, leading to a violation of their functions.

Sunbathing with endometriosis can cause:

• Faster progression of the disease. Exposure to ultraviolet rays or simply high temperatures accelerates metabolic processes throughout the body, including in the foci of endometriosis. This is followed by accelerated division ( breeding) endometrial cells, which worsens the course of the disease. In addition, exposure to high temperatures can lead to the appearance of new foci of endometriosis in previously unaffected organs and tissues.
• Development of cancer. Endometriosis is essentially a benign tumor. Since cell division in the foci of endometriosis occurs very intensively ( especially in the first half of the menstrual cycle), with a high degree of probability, a mutation may occur in them, the result of which will be a malignant degeneration of the tumor and the development of cancer. Under normal conditions, this does not happen, since the woman's immune system quickly finds mutated ( tumor) cells and destroys them. However, when exposed to ultraviolet radiation, the rate and number of mutations increase several times, while simultaneously increasing the risk of developing a malignant tumor.

• live in countries with a hot climate;
• sunbathing during the hot part of the day from about 10-11 am to 4-5 pm);
• sunbathe for more than 30 minutes continuously;
• visit a bath and / or sauna;
• visit the solarium.

Can you get pregnant with endometriosis?

For pregnancy to occur, conception must occur that is, the fusion of female and male germ cells). The female sex cell ( egg) matures in the ovaries, after which it is secreted into the fallopian tubes, where it remains for several days. To fertilize it, the spermatozoon ( male sex cell) must pass through the cervix, uterine cavity and enter the fallopian tube. After the fusion of the egg and sperm, a new cell is formed - the zygote, which enters the uterine cavity and attaches to the endometrium ( mucous membrane of the uterus). Thus, the development of the fetus in the female body begins.

Endometriosis is characterized by the appearance of endometrial cells ( mucous membrane of the uterus) in various organs and tissues, where it is not normally found. Almost any tissue or organ can be affected ( uterus and ovaries, pelvic organs, thoracic and abdominal cavity and so on). The growing tissue of the endometrium compresses the affected organ, damaging it. In addition, endometrial cells outside the uterine mucosa are perceived as "foreign", as a result of which an inflammatory process develops in the affected organs, characterized by dilation of blood vessels and tissue edema.

If endometriosis affects the pelvic organs ( uterus and fallopian tubes, ovaries), developing complications can disrupt the process of conception at various levels, leading to infertility.

The cause of infertility in endometriosis can be:

• violation of the patency of the fallopian tubes;
• the formation of adhesions;
• change in the endometrium;
• endometrioid ovarian cysts.

Violation of the patency of the fallopian tubes
During the first phase of the menstrual cycle ( in the first 14 days after the next menstruation) there is an increased growth of endometrial tissue under the action of female sex hormones ( estrogen). Such changes affect not only the uterine mucosa, but also endometrial cells in the foci of endometriosis. If at the same time the fallopian tubes are affected, then their lumen may be completely blocked, as a result of which the spermatozoa will not be able to reach the egg and conception will become impossible.

Adhesion formation
Another cause of infertility may be the formation of adhesions in the pelvis. In response to the appearance of endometrial cells in various tissues, an inflammatory process develops. Special cells migrate to the focus of inflammation - fibroblasts, which are involved in the formation of fibrin ( blood plasma protein) and collagen fibers. Of these two components, adhesions are formed - connective tissue strands that can squeeze the fallopian tubes from the outside, disrupting their patency.

Endometrial change
If endometriosis affects the muscular layer of the uterus, fallopian tubes or cervix, then the developing inflammatory changes prevent the normal attachment of the zygote.

Endometrial ovarian cysts
A cyst is a closed cavity filled with fluid ( usually bloody). During menstruation, normal endometrial tissue is shed in the uterine cavity, as a result of which a small amount of blood flows out of the damaged vessels. In the foci of endometriosis, the same phenomena are observed, however, blood can remain in the affected organ itself, resulting in the formation of a cyst.

As the disease progresses, the cyst may enlarge and new cysts may appear, significantly reducing the amount of functional ovarian tissue. In addition, the process of normal maturation of the egg and its release into the fallopian tubes becomes impossible, as a result of which infertility develops.

Is IVF effective for endometriosis?

Endometriosis is characterized by abnormal growth of endometrial cells ( mucous membrane of the uterus) organs where they are not normally found. A number of factors lead to infertility in this disease, which must be taken into account and studied before IVF.

Endometriosis is characterized by:

• Violation of the patency of the fallopian tubes. With the growth of the endometrium in the fallopian tubes, their lumen overlaps, resulting in spermatozoa ( male sex cells) cannot reach the egg ( female sex cell) and fertilize it. Even if this process occurs, the likelihood that a fertilized egg will enter the uterine cavity and attach to its wall is also significantly reduced.
• Adhesive disease. In the organs affected by endometriosis, an inflammatory process develops, characterized by swelling of the tissues and the release of the liquid part of the blood from the vascular bed. Also, the development of inflammation is facilitated by bleeding, often observed in lesions of the pelvic organs ( ovaries, uterine wall, intestines, bladder). As the disease progresses, fibrin plaque is deposited on the walls of the organs ( specific plasma protein), which leads to the formation of adhesions, "gluing" the organs together. Adhesions can compress the ovaries or fallopian tubes, which disrupts the development and fertilization of the egg.
• Immune system disorders. Endometriosis is characterized by changes in the immune protective) systems of the female body. With extensive damage to the uterine wall, inflammatory changes in the mucous membrane of the organ can be observed, which can also be the cause of infertility.
• The formation of cysts in the ovaries. The endometrioid ovarian cyst is a cavity filled with blood, which is formed as a result of repeated bleeding observed in the foci of endometriosis during each menstruation. Since the blood has nowhere to be released, it accumulates in the tissues of the ovaries, leading to a violation of their function ( first of all, to disruption of the process of maturation of the egg).

Fertilized eggs are placed in a special incubator for 3-5 days, after which the transfer is carried out 2 ( in some cases - 4) embryos into the uterine cavity. This procedure is painless and takes only a few minutes. If the process of their attachment occurs normally, pregnancy will occur.

Indications for IVF for endometriosis are determined by:

• The prevalence of the disease. If the cause of infertility was a violation of the fertilization process ( with adhesive disease, ovarian cysts or obstruction of the fallopian tubes), IVF allows you to get pregnant in almost 90% of cases. In the presence of inflammatory changes in the uterine cavity and a violation of the hormonal background of a woman, the effectiveness of the method is significantly reduced.
• The effectiveness of previous treatment. If there are not many endometriotic foci and they have not caused serious functional and anatomical disorders in the uterus, fallopian tubes and ovaries, drug treatment of endometriosis is first provided. After that, the woman is advised to try to conceive naturally within a year. If she fails, IVF is assigned.
• The age of the woman. If a woman is younger than 35 years, before IVF it is recommended to carry out the treatment described above and adhere to expectant management for 1 year. If the patient's age is over 35 years, IVF is performed as early as possible ( after performing all the necessary studies and a short course of treatment with hormonal drugs).

Is there a special diet for endometriosis?

Endometriosis is a pathological condition in which endometrial cells ( mucous membrane that lines the uterine cavity) appear in other tissues and organs ( where they do not normally occur). The central link of this disease is the growth of endometrial tissue outside the uterine cavity. This is due to an increase in the concentration of female sex hormones ( estrogen) in the first half of the menstrual cycle. During the next menstruation, the endometrium is rejected, as a result of which a certain amount of blood flows out of the damaged vessels.

Clinical manifestations of endometriosis are due to:

• Location and size of endometriosis foci. This disease can affect almost any organ of the human body. The growing tissue of the endometrium puts pressure on the normal cells of the affected organ, which, as the disease progresses, leads to a violation of its function, the development of inflammatory processes and the appearance of pain of varying intensity.
• The amount of blood loss. During normal menstruation, a woman loses no more than 100 ml of blood. However, with endometriosis, bleeding develops in all foci of the disease, which in severe cases can lead to massive blood loss and severe anemia.

Is it possible to cure endometriosis with folk remedies?

Used to treat endometriosis:

• Herbal collection. Contains elderberry, chamomile and nettle flowers, as well as raspberry, mint and sage leaves. The collection has anti-inflammatory, antimicrobial and weak analgesic effect. To prepare the collection, you need to take 20 grams of each ingredient, chop and pour 2 liters of boiling water. Insist in a dark place for 4 - 5 hours, then strain and take 1 glass ( 200 ml) 4 times a day 30 minutes before meals. The course of treatment is 10 - 14 days.
• Plantain infusion. It has anti-inflammatory and antimicrobial action. Helps stop bleeding and activates regenerative processes in damaged tissues. To prepare an infusion, 50 mg of crushed plantain leaves must be poured with 1 liter of boiling water and infused for 1 hour. The infusion must be carefully filtered, then add another 500 ml of warm boiled water. Take orally 2-3 tablespoons 4 times a day, half an hour before meals. The duration of treatment is 10 days.
• A decoction of a boron uterus. It has anti-inflammatory and antimicrobial effects, contributes to the normalization of the menstrual cycle, and also reduces the risk of endometriosis degeneration into a malignant tumor. To prepare a decoction, 2 tablespoons of boron uterus grass should be poured with 1 liter of hot water and boiled in a water bath for 20 minutes. Strain thoroughly and take 100 ml ( half a glass) 3 times a day before meals.
• Infusion of celandine. It has antimicrobial and analgesic action. To prepare the infusion, 2 tablespoons of chopped celandine grass should be poured with 500 milliliters of boiling water and infused in a dark place for 3 hours. Then carefully strain and take 50 ml 4 times a day before meals.
• Beet juice. Helps to normalize hemoglobin levels and restore mucous membranes after bleeding. Freshly squeezed beetroot juice should be taken 50-100 ml 3 times a day before meals.
• A decoction of the bark of viburnum. Viburnum bark has an astringent and hemostatic effect, and also increases the tone of the muscular layer of the uterus, helping to stop bleeding as soon as possible. To prepare a decoction, 100 grams of chopped bark must be poured with 2 liters of boiling water and boiled in a water bath for 30 minutes. After that, cool at room temperature, strain and take 2 tablespoons 4 times a day before meals.
• Decoction of barberry root. This plant enhances uterine contraction, helping to stop bleeding. To prepare a decoction, 1 tablespoon of chopped barberry roots must be poured with 1 liter of hot water, brought to a boil and boiled for 20 minutes. After that, cool at room temperature, strain and take 50 ml 3 times a day before meals.

How to treat endometriosis with hormonal drugs?

The endometrium is a mucous membrane of the uterus, consisting of two layers - functional and basal. The functional layer under the influence of various sex hormones undergoes certain changes depending on the phase of the menstrual cycle, while the basal layer ensures its regeneration ( recovery) after menstruation.

Depending on the day of the menstrual cycle, there are:

• proliferation phase. This phase begins immediately after the end of the next menstruation, lasts about 12-14 days and is characterized by the growth of the functional layer of the endometrium, which occurs under the influence of estrogens ( female sex hormones). Estrogens are secreted by the cells of the follicle ( maturing egg) in the ovaries.
• secretion phase. Lasts about 14 days. During this phase, estrogen production and rate of endometrial proliferation) decreases, and the hormone progesterone secreted by the corpus luteum of the ovaries "prepares" the endometrium for the implantation of a fertilized egg ( the number of glands increases, the endometrium begins to produce various enzymes). If pregnancy does not occur, the functional layer of the endometrium is gradually shed.
• phase of menstruation. During menstruation, rejection and removal of the functional layer of the endometrium occurs, and under the influence of a newly increasing concentration of estrogen, a new phase of proliferation begins.

The action of hormonal drugs in endometriosis is aimed at blocking the proliferation of the endometrium at various levels, which significantly reduces the clinical manifestations of the disease.

Treatment regimens for endometriosis with hormonal drugs

The process can be genital and cover the pelvic organs (fallopian tubes, ovaries, ligamentous apparatus) or/and extragenital, involving the organs of the abdominal cavity, bladder, lung tissue. The disease occurs in 10-15% of women aged 25-44 years.

Causes of endometriosis

The causes of the disease are still not exactly established. A certain role is played by heredity. According to many experts, endometriosis is a gynecological manifestation of a systemic pathology resulting from dysregulation of immune and hormonal processes.

Risk factors for the development of endometriosis are complicated childbirth and childbirth over the age of 30, caesarean section, abortion, and diathermocoagulation of the cervix, which is often used to treat erosions. If this intervention is performed on the eve of menstruation, then there is a high probability of the introduction of endometrial cells into the wound surface with the subsequent development of endometrioid growths in the thickness of the cervix and the pelvic cavity.

Symptoms of endometriosis

Typical clinical symptoms are painful menstruation, pelvic pain, pre- and postmenstrual spotting, and uterine bleeding. Pain during defecation and during sexual intercourse are less common. When neighboring organs (rectum, bladder) are involved in the pathological process, constipation, frequent urination, hematuria, etc. can be observed. A characteristic sign of endometriosis of the cervix is ​​bloody discharge from the genital tract in the intermenstrual period. With endometriosis of the vagina, bloody discharge from the genital tract can be noted before and after menstruation, and with the germination of the vaginal wall, pain occurs in the vagina during menstruation, during sexual intercourse.

Abnormally located endometrial tissues and the developed adhesive process can significantly impair the function of the affected organs (intestinal obstruction, infertility (in 20-25% of cases).

However, endometriosis can be almost asymptomatic, and a woman may not be aware of her disease. That is why it is so important to regularly undergo preventive examinations by a gynecologist, including ultrasound diagnostics and various tests.

In addition, the diagnosis of endometriosis is complicated by the fact that there are a number of other pathologies of the pelvic organs that have a similar clinical picture. Therefore, at the slightest suspicion of endometriosis, it is recommended to undergo a full range of diagnostic procedures, which includes a clinical and gynecological examination, ultrasound diagnostics of endometrioid cysts and adenomyosis, hysterosalpingography, laparoscopy and hysteroscopy.

Complications

A severe complication of endometriosis is infertility, which occurs in more than 60% of patients. According to medical statistics, endometriosis is determined in every second case of female infertility. When squeezing the nerve trunks, various neurological disorders can occur.

Frequent bleeding can lead to anemia (anemia), which can lead to increased fatigue, pallor of the skin, shortness of breath, palpitations, as well as dizziness, tinnitus, discomfort in the heart area, and severe general weakness.

The most formidable complication of endometriosis is malignancy - the degeneration of endometrioid tissue into a malignant tumor.

What can a doctor do?

It is possible to speak with confidence about the diagnosis only on the basis of the results of an additional study. According to indications, ultrasound, laparoscopy, hysteroscopy / hysterosalpingography, biopsy (examination of tissues of pathological areas) are performed.

The main goals of treatment: pain reduction, suppression of the activity of the process, restoration of reproductive function.

The choice of method / method of correction depends on the severity of the symptoms, severity, the age of the woman and her plans for pregnancy.

Most often, drug (hormonal, immune) therapy is carried out, aimed at suppressing the activity of the ovaries, slowing the growth of endometrioid tissue; A combination of medical and surgical treatment is also used.

For drug treatment, various hormonal preparations are used, when used for the duration of treatment, menstrual function is turned off. This contributes to the regression of endometriosis foci of various localization. The duration of taking drugs and their choice is individual and depends on the form and stage of the disease, the age of the patient, the need for infertility treatment, the effectiveness of therapy and other factors.

Currently, gestagens are widely used: norethisterone (primolyut-nor), medroxyprogesterone acetate (prover, depo-prover), dydrogesterone (dufaston), linestrenol (orgametril), etc .; estrogen-progestin preparations (single-phase oral contraceptives) in a continuous and, sometimes, in a cyclic mode, (danol, danoval), gestrinone and gonadotropin-releasing hormone agonists (zoladex, decapeptyl-depot, etc.).

The last group of drugs gives the best results in the treatment of the disease. When used for more than 2 weeks, they stop the production of estrogens (female sex hormones). This leads to a decrease in the activity of endometrioid foci and their regression. In most women, bleeding stops after 2 months from the start of treatment. However, some of them may experience vaginal bleeding within 3-5 days after the start of treatment, or spotting for 10-14 days. Usually, a decrease in the manifestations of endometriosis is noted within 4-8 weeks from the start of treatment.

Surgical treatments for endometriosis are used for nodular forms of endometriosis of the uterine body, with a combination of endometriosis with, with endometrioid ovarian cysts and in other cases. After the operation, hormonal preparations are prescribed for a period of 6 months. In some cases, preoperative hormonal treatment is also carried out. Of great importance is the use of laparoscopy in infertility and the presence of "small" forms of endometriosis. Produce electrocoagulation of foci of endometriosis, followed by the appointment of hormone therapy.

In addition to hormonal and surgical treatment after surgery, restorative treatment is carried out. It is necessary to prevent the occurrence of adhesions, prevent and correct possible complications of long-term hormone therapy. They use electrophoresis and zinc, drugs that affect the function of the gastrointestinal tract, liver and pancreas (festal, pancreatin, methyluracil, etc.), diet therapy, vitamins. The complex therapy includes sedatives, painkillers, antiallergic drugs.

What can you do?

Early seeking medical help, timely treatment and implementation of medical recommendations make the prognosis favorable, the probability of pregnancy increases to 40-70%.

The earlier the disease is diagnosed, the greater the likelihood of successful treatment. Therefore, the most important thing is regular visits to the gynecologist and preventive examinations.