Endometriosis. Causes, symptoms, modern diagnosis, effective treatment of the disease. Reasons and mechanisms. Who is most at risk for developing endometriosis?

To understand the essence of the disease, it is necessary to understand the key medical terms.

Let's consider the most basic ones.

endometriosis- one of the common diseases in gynecology, in which endometrial cells grow in the thickness of the uterus or even go beyond the reproductive system.

endometrium- the mucous membrane that lines the walls of the uterus. The rejection of the endometrium regularly every month during menstruation is considered the norm.

Myometrium- muscular tissue of the uterus.

Causes of pathology

Scientists do not name the exact reasons contributing to the development of such a pathology, but among them there are:

hormonal background, or rather its violation. In the event of a malfunction in the endocrine system, estrogens - female sex hormones in the ovaries are formed much more than normal. The endometrium in the first half of the menstrual cycle fills the thickness of the uterus, and when it is rejected, it causes severe bleeding.
weakening of the immune system. With reduced immunity, the body does not effectively fight the reproduction of endometrial cells.
frequent abortions, curettage, surgical interventions. Various operations damage the integrity of the membrane. And, despite its recovery, scar tissue contributes to the germination of endometrial cells.
menses. Prolonged heavy menstruation, early puberty can also cause the development of the disease. Discharge during menstruation contains not only blood, but also particles of the endometrium. With heavy bleeding, the discharge not only finds an exit through the vagina, but also enters the abdominal cavity. Normally, these cells are destroyed, and in pathology they are able to be fixed in the tissues of various organs.
stress, environmental impact, food quality. Stressful situations, toxins and excessive physical exertion on the body lead to hormonal disorders.
hereditary factor. At risk are girls whose mothers, grandmothers or sisters suffered from a similar ailment, or in case of an anomaly in the structure of the genital organs. Pulling pain in the lower abdomen in girls may appear 2-3 years before the onset of the first menstruation.

How to recognize endometriosis

The first signs that should alert a woman are deviations from the regular menstrual cycle, pain during menstruation and during sexual contact.

2-3 days before and after menstruation, spotting with blood may appear. Often bleeding occurs in the middle of the cycle. Menstruation becomes more abundant and painful.

If the patient is already at an advanced stage, endometrial cells can affect the bladder, rectum and, as a result, cause pain during urination and defecation. After menstruation, the pain syndrome usually subsides, but this is not a reason to postpone a visit to the doctor. If you notice at least one of the signs, be sure to get tested.

Forms of endometriosis

Endometriosis of the body of the uterus is divided into diffuse, focal and nodular form.

The diffuse form of endometriosis is characterized by a uniform compaction of the walls of the uterus, affecting each layer. The most difficult in terms of therapy is diffuse endometriosis of the body of the uterus. However, the most common form is focal, in which either the anterior or posterior wall of the uterus is affected. In the thickness of the myometrium, one can also find small or large nodules that do not have definite boundaries. In this case, there is a nodular form of endometriosis of the uterus. Due to these neoplasms, the uterus increases in size. But for the appointment of a course of treatment, there is practically no difference between the focal and nodular form of the lesion.

With a diffuse form, pathological processes can cover different depths of the walls of the uterus. In this connection, the following degrees of distribution are distinguished:

first degree - shallow lesions of the myometrium;
second degree - the depth of the lesion reaches the middle of the myometrium;
third degree - the uterine wall is completely affected, pathological changes.

affect the fallopian tubes, ovaries, adjacent organs.

How is uterine endometriosis diagnosed?

Diagnosis of the disease is complicated by a number of reasons.

First, asymptomatic, you can skip the initial stage.
Secondly, the symptoms of the disease may be similar to other gynecological pathologies.

A comprehensive examination is necessary to make an accurate diagnosis. It consists of an examination by a gynecologist, ultrasound of the pelvic organs and the abdominal cavity, colposcopy and laparoscopy.

The development of the disease occurs gradually, each time worsening the woman's well-being. By identifying endometriosis of the uterine body of the 1st degree, you can permanently get rid of the disturbing symptoms and eliminate the problem. Unfortunately, this is extremely rare, and happens for the following reasons:

obvious signs of the disease do not bother the patient;
a woman equates pain during critical days with periodic women's days and does not consider it as a pathology;
when undergoing an ultrasound scan, the doctor may not notice the changes, because they are extremely insignificant;
no problems with conception.

The most reliable results will show ultrasound and laparoscopy. So, to make a diagnosis, the doctor pays attention to the echo signs characteristic of internal endometriosis:

"Round uterus", that is, increased in size;
thickening of the walls of the uterus
the presence of open uterine cysts.

Treatment

As a treatment, hormone therapy is used to stop the growth of the endometrium for a while.

Treatment is selected based on the severity of the disease, the age of the woman and her plans related to pregnancy planning. After all, while menstruation and active hormonal work of the ovaries take place, the disease can return again and again. It is possible to guarantee complete relief from the problem only after the onset of menopause. For surgical intervention, the most sparing method at the moment is used.

All about endometriosis from Elena Malysheva, video

Consequences of endometriosis

In the absence of proper treatment, the consequences of endometriosis of the body of the uterus are very dangerous.

First of all, endometriosis can lead to problems with conception or provoke difficulties in bearing a child. Pregnancy does not occur as a result of adhesions formed and dysfunction of the egg. Adhesions are the result of a continuous inflammatory process that blocks the patency of the fallopian tubes.
In another case, the process of fertilization is hampered by the presence of endometrioid lesions on the ovaries. The process of maturation of the egg is disrupted. Foci of endometriosis can affect the quality of eggs, as well as prevent the attachment of a fertilized egg. With a hormonal imbalance, ovulation may not occur at all.
The possibility of pregnancy in women with a similar diagnosis remains. However, it will be extremely difficult to carry a child safely. At times, the risk of developing an ectopic pregnancy or miscarriage increases.

In most cases, endometriosis is treatable and the problem of infertility is eliminated. Only in the most advanced cases, when all methods of treatment have been tried, the uterus has to be removed.
Every woman should monitor the regularity of her menstrual cycle and undergo routine examinations.

For the first time, signs of endometriosis of the body of the uterus were described in the middle of the nineteenth century. But to this day, scientists are debating why this disease develops - the final reason has not yet been established today.

The disease can also have a congenital form, transmitted from mother to daughter by inheritance.

How does endometriosis of the body of the uterus develop in a woman?

Without immune and endocrine disorders, this disease, as a rule, does not develop. In the case when the hormonal background is disturbed, the ovaries secrete too much estrogens - female sex hormones. Then, during the first half of the menstrual cycle, the endometrium begins to grow, which is subsequently rejected with very heavy bleeding.

Then the endometrial cells are ejected through the gaping blood vessels into the myometrium (the muscular layer of the uterus) and begin to multiply in it. This process is facilitated by disturbances in the functioning of the immune system. What happens with endometriosis in the body of the uterus

Endometriosis of the body of the uterus is focal and diffuse. In the case of diffuse endometriosis of the uterine body, a uniform thickening of the walls up to 4–5 centimeters occurs, with focal endometriosis, small and large nodes appear in the thickness of the myometrium without definite boundaries.

In some cases, endometrioid cysts are detected in the thickness of the muscle, which are filled with bloody contents. Often, foci of endometriosis are located in the fundus of the uterus, in the area where her body connects to the fallopian tubes.

Pathological processes that are diffuse in nature can spread to different depths of the myometrium:

the first degree - the myometrium is superficially affected;
second degree - in the myometrium, the process has spread to the middle;
third degree - the entire myometrium to the serous membrane is affected.

In most patients with a diffuse form of the disease of the second or third degree and a nodular form, muscle tissue grows around the foci of endometriosis - the so-called adenomyosis.

In the muscular walls of the uterus, endometrial foci rarely begin to secrete a secret that is characteristic of the 2nd phase of the monthly cycle (exposure to progesterone). These cells show a more sensitive reaction to an increase in the amount of estrogen during the first half of the monthly cycle, increasing in size from one cycle to another.

In the tissues that surround the foci of endometriosis, swelling, hemorrhage and proliferation of connective tissue occur, which has a negative effect on the course of pregnancy.

The main signs of endometriosis of the body of the uterus

The first sign of this disease is profuse and extremely painful menstrual bleeding, as well as intermenstrual bleeding, which can also be very significant. In some cases, endometriosis of the body of the uterus is congenital. In such a case, pain in a girl in the lower abdomen may appear about two to three years before the onset of the first menstruation. And the first menstruation is often accompanied by heavy bleeding. It is possible to suspect the presence of congenital endometriosis if the mother has this disease or if the girl's genital organs develop abnormally (for example, if the uterus is abnormally structured).

How is endometriosis of the body of the uterus diagnosed in a woman?

In the presence of significant changes that are diffuse in nature, during a gynecological examination, an increase in the volume of the uterus is often detected. The presence of a focal form with large nodes can also be determined during the examination - the gynecologist during a vaginal examination palpates the nodes located in the uterus.

If there are manifestations of endometriosis (bleeding, pain), and nothing is detected during the examination, then changes can be determined during an ultrasound examination (ultrasound) using a vaginal probe. In rare cases, ultrasound detects the presence of inactive endometriosis, which does not manifest itself in any way and is a so-called incidental finding. However, in some cases, to diagnose this pathology, it is necessary to carry out such research methods as radiography, hysteroscopy, magnetic resonance and computed tomography.

Endometriosis of the uterus: treatment

Only active forms of the disease, which manifest themselves in severe bleeding and pain, are subject to treatment. It is believed that the therapy of inactive endometriosis only contributes to its further spread. Women like this just need to be watched.

Endometriosis of the uterus treatment includes hormonal correction (suppression of estrogen production), therapy of inflammatory areas around the foci of endometriosis, and restoration of immunity.

In addition, women who suffer from endometriosis often have metabolic and endocrine ailments (obesity, diabetes, and others). They are also identified and treated.

In the case when conservative therapy is ineffective, an operation is performed, during which foci of endometriosis are cauterized. In the presence of severe adenomyosis or in the case of a combination of this disease with fibroids, it is recommended to perform supravaginal amputation of the uterine body. Such operations are more often performed on women in the post-menopausal period.

The hereditary predisposition to women in the family is being investigated, and the disease can also occur after operations. Significantly contribute to the appearance of adenomyosis dysfunction of the thyroid gland, female gonads. The work of these and other endocrine glands ensures the balance of the main female hormones. And the occurrence of endometriosis is preceded by an excess of endometrial cells, or the inability to remove from the body the amount of endometrium that has been produced.

What are the symptoms of endometriosis

severe pain, weakening by the end of menstruation;
weakness and drowsiness;
menstrual irregularities;
nausea, vomiting, abdominal pain.

Adenomyosis monthly causes small hemorrhages in the period between menstruation, this causes inflammation of the lower abdomen. Endometriosis increases the risk of developing inflammatory bowel disease. A large-scale study was conducted by Danish scientists who studied the medical records of 37,000 women. In the past, the diagnosis of an intestinal disease precluded a diagnosis of a gynecological one. However, Dr. Tyne Jess and colleagues have shown a predisposing role for endometriosis in the development of inflammatory bowel disease. The principle of the influence of endometriosis is unclear. However, having received new data, doctors will more quickly diagnose the body and further treatment.

Treatment of endometriosis of the body of the uterus

Successfully treated with hormonal drugs. In more severe cases, there is the possibility of successful surgical intervention.

The purpose of drug treatment is to artificially interrupt menstruation for up to six months. In addition, mineral and vitamin complexes that strengthen the immune system are used.

In such a situation, the body independently includes a mechanism to fight endometrial cells in the uterine tissues. Of course, if there are severe pains among the symptoms, then a special course of painkillers is prescribed.

The prevalence of endometriosis is significant, the incidence of endometriosis in young women is increasing. These conditions dictate the need to remember about measures to prevent the disease. By the way, the prevention of endometriosis must be carried out not only for women who have had this disease.

The decisive role is played by the education of physical culture in girls, not only the culture of hygiene, the culture of communication, etc. It is dangerous to prohibit sports during menstruation and encourage bed rest. It is important for girls to do gymnastics, acrobatics, figure skating during menstruation. So in girls, pieces of the endometrium are displaced and exit with menstrual blood through the fallopian tubes.

Prevention.

Lack of exercise explains the occurrence of endometriosis in young women. During the period of menstruation, sports loads are necessary, but their intensity can be limited - you can refuse to lift weights, sharp jumps, and pose upside down. Exercise reduces estrogen production, which directly prevents endometriosis.

Other preventive measures:

Visit the gynecologist every six months;
Choose a healthy diet and control your body weight;
Sexual abstinence during menstruation;
Rejection of abortion;
Avoid stressful situations.

Endometriosis seemed to be a mysterious disease for a long time. The pathogenesis of this disease has been haunting the minds of scientists and doctors all over the world for several centuries. However, to date, enough discoveries have been made in the field of gynecology. Now every woman has the opportunity to understand her body and its diseases, the main thing is to know about precautionary measures.

Video: Endometriosis of the uterus treatment

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Disease of the uterus, in which the growth of the endometrium begins, is called "focal endometriosis." It can be external (applies to the vagina) or internal (affects the uterine area). The disease is benign, but requires immediate treatment.

What is adenomyosis?

Focal endometriosis (adenomyosis) of the uterus is a pathology in which the endometrium grows. And as a result of changes that occur monthly, cysts are formed that are filled with fluid.

Adenomyosis occurs as a result of hormonal fluctuations in the female body. Before puberty, the development of the disease is not possible. The number of lesions decreases during menopause, when menstruation stops. Due to this, the endometrium does not undergo monthly changes.

Damage types

There are three main types of adenomyosis:

diffuse. In this case, blind pockets form on the surface of the endometrium, penetrate into the inner layers of the uterus. Very often, as a result of this, fistulas are formed - channels lined with epithelial tissue.
nodal. The glandular epithelium penetrates into the muscular layer of the uterus, as a result of which nodules of various sizes form on the surface of the organ.
Mixed. It is a combination of diffuse and nodular type. On the inner layer of the uterus, nodes and blind pockets are formed at the same time.

stages

Gradually, the endometrium grows deeper and deeper into the inner layers of the uterus. Depending on the degree of ingrowth, several stages of the disease are distinguished:

in the first stage, endometrial foci penetrate to the beginning of the muscle layer;
in the case of the second stage, the endometrium grows into half of the muscle layer;
Stage 3 - the lesion has spread to the serous membrane, which covers the uterus from the side of the peritoneum;
Stage 4 - Adenomyosis affects the peritoneum.

If qualified treatment is not carried out, it is possible that one stage of the disease will develop into another.

Causes

Endometriosis of the uterus is a disease that is affected by hormonal levels in the body. Pathology can appear as a result of immune disorders, as well as due to a violation of the integrity of the connective tissue that separates the endometrium and myometrium. It is this tissue that prevents the germination of the endometrium inside the uterine wall. Connective tissue can be damaged during abortion, curettage, due to the use of a spiral.

There are other factors associated with the activity of the reproductive system that can lead to adenomyosis:

the onset of menstruation before 11 years of age or after 17;
deprivation of virginity at a rather late age - after 25 years;
the use of oral contraceptives containing hormones;
obesity, as a result of which the level of estrogen in the body increases;
hormone therapy aimed at eliminating any gynecological disease.

And a decrease in immunity can occur due to living in poor environmental conditions - polluted air, poor-quality drinking water, etc. Allergic diseases can also lead to dysfunction of the immune system. Chronic diseases, as well as lack / excess of physical activity, have a negative effect on the body.

Adenomyosis can also appear due to poor heredity. If a mother or grandmother had such a pathology, the risk of developing it increases by 50%. There is also congenital adenomyosis, which arose due to violations during fetal development.

The main symptoms of pathology

In most cases, the focal form is not accompanied by any symptoms. However, the following manifestations of the disease are possible:

Menstrual disorders. Menstruation lasts a long time - more than a week, accompanied by severe pain in the lower abdomen. The discharge is quite plentiful, may contain blood clots. In the period between periods, a spotting discharge of a brownish color may appear.
Pain that appears 2-3 days before the onset of menstruation and disappears after a few days. The severity of discomfort depends on where the adenomyosis foci are located, as well as on the degree of the disease. The most severe pains appear if the isthmus is affected. In this case, discomfort appears not only in the lower abdomen, but also in the perineum. Also often there are pains during sex, which are especially pronounced before the onset of menstruation.
infertility. Women are unable to conceive because of adhesions in the fallopian tubes. Because of them, a fertilized egg cannot enter the uterine cavity. And if the structure of the endometrium is broken, the implantation of the egg in the uterus is also difficult. And even if conception occurs, due to the presence of an inflammatory process in the body, spontaneous miscarriage can occur.
Iron-deficiency anemia. It is caused by excessive menstruation. This pathology is accompanied by increased weakness, decreased ability to work, drowsiness, dizziness and fainting. The skin turns pale, immunity decreases, therefore, the frequency of colds increases.
neuroses. Caused by heavy periods, lack of pregnancy, loss of strength, etc.

The severity of symptoms depends on the degree of pathology. As a rule, the disease of the 1st stage is asymptomatic. Pathology of 2 and 3 degrees can also be asymptomatic or with minor signs. Severe symptoms appear at stage 4 of the disease, which is due to the presence of adhesive processes.

How is adenomyosis diagnosed?

During the examination, the doctor determines how the shape and size of the organ has changed. With a diffuse type of pathology, the uterus acquires a spherical shape and increases in size, as at 8-10 weeks of pregnancy. The knotty type of adenomyosis is characterized by tuberosity of the organ and the formation of tumor-like nodules on its surface. If the disease is accompanied by the formation of fibroids, the size of the uterus corresponds to the parameters of the neoplasm. In this case, the body does not decrease after menstruation.

Colposcopy is also used for diagnosis. This is a test in which the doctor examines the cervix through the vagina. In the process of this, a special magnifying device is used - a colposcope. During the procedure, a small area of the affected tissue may be taken for histological examination. The analysis gives an idea of the qualitative and quantitative composition of tissues, allows you to detect atypical cells.

An examination of all organs is required - lungs, heart, gastrointestinal tract, etc. This is necessary so that the doctor can choose the right medicines. After all, drugs have contraindications and side effects, so they are not suitable for all patients.

Treatment

The first three stages of adenomyosis can be treated with medication, but surgery is sometimes required. But the 4th degree of the disease is eliminated only surgically.

Surgical treatments

A hysterectomy is used to remove adenomyosis. It is vaginal and abdominal. In the first case, the operation is performed through the vagina, and in the second case, through an incision in the abdomen. Vaginal hysterectomy is more common because it is less painless and the body recovers faster.

In order for the operation to be successful, laparoscopy is simultaneously performed - a laparoscope equipped with an optical element is inserted. Data from the camera is transferred to the screen, so the doctor can see all the organs during the operation. In this case, the operation can be complete (removal of the uterus and ovaries), as well as partial (excision of only foci of adenomyosis).

Hormonal treatment and vitamin therapy

Therapy for adenomyosis includes taking hormonal drugs. Namely:

Oral contraceptives. After taking them, the production of FSH and LH decreases. Hormones help reduce the size of the ovaries.
Antiprogestins. The effect of their intake is antiestrogenic and androgenic. The drugs of this group inhibit the growth of follicles, so the level of estrogen in the body decreases.
Antiestrogens. Medicines of this group suppress the synthesis of prostaglandins necessary for the normal development of follicles.

At the discretion of the doctor, other hormonal drugs may be prescribed. It depends on the severity of the disease. To increase immunity, vitamin complexes are prescribed - Multitabs, Aevit and others.

Physiotherapy

With focal endometriosis, physiotherapy procedures are performed. Very useful is the effect of low-frequency current on the body, hydrotherapy, climatotherapy and others.

Combined treatment

Good results are obtained by a combination of medical and surgical treatment. For example, before the operation, the patient undergoes a course of hormone therapy. Due to this, the size of the foci of endometriosis decreases, so the operation is easier.

Folk remedies

The use of folk remedies is also very effective in eliminating the symptoms of adenomyosis. However, their use is possible only in the initial stages of the development of the disease. The following traditional medicines are used:

Infusion of boron uterus. Take 1 tbsp. dried plant and pour 500 ml of boiling water. Insist for an hour. Then take 2-3 times a day, 50 ml.
A decoction of the cinquefoil. Cut 50 g of fresh grass, which is poured with a liter of water. Bring to a boil and leave to cool. Then the broth is filtered and taken half a glass 2 times a day.

Treatment of adenomyosis should be carried out under the supervision of a specialist. Otherwise, the disease can lead to anemia, infertility, and even degenerate into oncology.

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Endometriosis is a neoplasm that spreads from the tissues of the uterus. The lining of the uterus is called the endometrium. It consists of endometrioid cells and has special receptors. These receptors exist only in the uterine mucosa, however, with the development of pathology, they spread to other organs and begin to function there. In other words, such a pathology is a benign tumor and may have another name for the endometrium.

There can be many causes that provoke diseases, but the list of the most likely ones includes:

Disturbances in the immune system;
genetic inheritance;
Hormonal disbalance.

Doctors also warn about the risk group, which includes women:

Having undergone numerous abortions;
With insufficient iron content in the body;
With an installed intrauterine device that can move;
With chronic inflammatory diseases of the pelvic organs (adnexitis).

Kinds

Depending on the localization of the pathological process in medicine, several types of the disease are distinguished:

Genital (endometrium is transferred and grows in the tissues of the ovaries, fallopian tubes, cervix and other genital organs);
Extragenital (a process that affects organs that are not related to the reproductive system);
Mixed form (combines both previous forms).

If endometriosis is located in the body of the uterus, then it is often called internal or. Its development has 4 degrees.

1 degree. The uterine mucosa is affected down to the outer layer of muscular smooth tissue (myometrium).
2 degree. The myometrial layer is also involved in the process up to the middle.
3 degree. Endometriosis extends deep into the serous cover.
4 degree. Endometrial cells pass to the parietal peritoneum.

The nature of education allows you to subdivide the process into focal endometriosis and diffuse. With diffuse, there is a uniform thickening of the walls of the uterus, and with focal, the neoplasm is localized in a certain area.

Clinical picture

This pathology is quite rare. In addition, signs may be completely absent for a long time, without causing any trouble to the woman. Among the most common manifestations of a doctor are:

Drowsiness and weakness;
Severe pain in the first few days of the menstrual cycle;
Pain in the lower abdomen;
Violation of the menstrual cycle;
Nausea;
Attacks of vomiting.

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Doctors say that prolonged heavy menstrual flow with pain is not the norm. Any of the above symptoms should serve as a signal that a woman needs qualified medical help.

Diagnostics

Quite often, endometriosis of the body of the uterus, according to the clinical picture, can be mistaken for myoma, therefore, many studies are prescribed to make an accurate diagnosis. Among the main ones:

Blood test (with endometriosis, the CA-125 marker has an increased rate);
Ultrasound of the pelvic organs (it can be used to objectively assess the condition of the uterus and its appendages);
Laparoscopy (a minimally invasive surgical method that uses special equipment with illumination and a mini camera);
Hysterosalpingography (gives information about the stage of the disease).

The list of analyzes in each case may vary. For some patients, it will be enough to undergo an examination and ultrasound, while others will need to go through all the procedures to make a diagnosis.

Pregnancy

In most cases, the disease causes obstruction of the fallopian tubes. For this reason, pregnancy occurs very rarely. If this happens, there is a high risk to the fetus.

Women who have undergone treatment are able to become pregnant in 50% of cases. However, it is not worth waiting for this event in the first few months after the course of therapy. It takes 6-14 months to restore health and reproductive function. It is after complete rehabilitation that successful fertilization can occur.

Effects

Lack of timely treatment can adversely affect the health of the patient. Among the most frequent complications are:

cancerous tumors;
Infertility;
neurological disorders;
Endometrial ovarian cyst.

Treatment

After the doctor examines the echo signs, he can prescribe an individual treatment for the disease, which can be conservative and surgical.

If the disease is in the initial stages of development, then conservative therapy is often used. It includes a course of taking hormonal drugs:

Progestogens;
Antigonadotropins;
Gonadotropin-releasing hormone agonists.

These medicines are aimed at eliminating the main cause of the disease. However, along with this, additional drugs are used that stop the symptoms. The patient is prescribed:

Anti-inflammatory therapy (NSAIDs);
Sedatives (to prevent neurological manifestations);
Analgesics (to relieve pain);
Iron-containing preparations (for recovery after blood loss);
Vitamins A and C (restoring the antioxidant system);
Immunomodulators (to restore the immune status);
Physiotherapy procedures.

Surgical treatment is used only in cases where other methods of exposure have not given the expected result. Doctors insist on surgery and in cases where there is a chronic failure of neighboring organs or the endometrium is complicated by fibroids and uterine bleeding.