Chronic endometriosis symptoms. What is chronic endometriosis? Treatment of chronic endometriosis

Many anomalies of the reproductive system often have no symptoms in mild stages, and are difficult to diagnose during examination by a gynecologist. Among such diseases, doctors identify chronic endometriosis. We will try to talk about what this pathology is, what its causes and symptoms are, and how dangerous endometriosis is for conception.

Endometriosis is a pathology of the development of the endometrium, in which cells of the uterine tissue grow in nearby cavities, interfering with the normal functioning of the reproductive system. Researchers have not found out the cause, but according to numerous theories, the appearance of endometriosis is associated with an increase in hormones and menstrual discharge. There are several types of pathology:

Genital endometriosis - uterine tissue grows into the myometrium, the size of the organ increases. This type includes pathology of the ovaries and pelvic peritoneum. In the genital form, uterine fibroids are often diagnosed, since these types of pathology have a similar development mechanism.
External endometriosis, or as it is also called extragenital, is the growth of uterine tissue in the pelvic area, usually in the navel and intestines.

They are divided according to the type of growth:

Diffuse endometriosis is characterized by the absence of growth centers, the cells spread evenly.
Nodular endometriosis, on the contrary, is characterized by the presence of many nodes consisting of epithelial cells.

Treatment of endometriosis

In order to become pregnant, the doctor must examine the condition of the tissues, collect blood for hormones and prescribe subsequent treatment. If you notice the signs of the disease in time, you can avoid surgical intervention. After treatment, relapse of the disease often occurs.

It should be remembered that the first sign of the return of the disease is the presence of local pain during menstruation, the appearance of bleeding, and the inability to conceive. If you observe these symptoms, you should immediately consult a doctor.

Drug treatment

Drug therapy is usually based on hormonal drugs, since tissue growth is directly dependent on hormones. This pathology usually occurs with a short-term or long-term increase in hormone levels. Commonly prescribed medications include:

Utrozhestan. The drug contains a plant analogue of progesterone; in combination with excipients, it is able to restore the elasticity of the uterine tissue, improve the condition of nerve fibers and their regeneration, and helps improve cell metabolic processes. For endometriosis, the drug promotes the attachment and further development of the fertilized egg and prevents tissue proliferation.
Longidaza. The drug is prescribed to adults as part of complex therapy for the treatment and prevention of diseases accompanied by connective tissue hyperplasia, adhesions in the pelvis, and inflammatory diseases of the genital organs, incl. tubo-peritoneal infertility, intrauterine synechiae, chronic endometriosis.
Terzhinan. Used to eliminate the inflammatory process in the uterus. The medicine has antimicrobial, anti-inflammatory, antiprotozoal, antifungal effects; ensures the integrity of the vaginal mucosa and constant pH.

Treatment of inflamed tissue is carried out comprehensively, and in addition to hormone therapy, anti-inflammatory drugs, painkillers, enzyme and sedative medications, as well as various vitamins (group B, ascorbic acid) are used. Medicines are prescribed only by a doctor.

Surgery

In more advanced cases, it is often necessary to resort to surgical methods. Surgery is aimed at removing endometrial cells from other organs. To eliminate foci of the disease, the following methods are used:

Laparoscopy. A method of surgical diagnosis and subsequent correction of the cavity under study, often carried out after drug treatment. This is the most effective and least traumatic way to remove affected areas of organs. After laparoscopy, prophylactic medications are also prescribed.
Laparotomy. A similar type of endometriosis removal, but instead of 4 punctures in the abdominal wall, a complete incision of the abdominal wall occurs.
Surgery for endometriosis is performed intravaginally, in the case of the genital form of the disease, in the absence of lesions in the ovaries.

Surgery to remove endometriosis should be carried out after a complete diagnosis by an experienced doctor.

Additional treatments

Sometimes, in preparation for surgery, the doctor prescribes not only medications but also physical procedures. As part of the treatment, the doctor may prescribe ultraviolet and laser irradiation, magnetic therapy, electrophoresis, baths with iodine, bromine and radon. To quickly restore the endometrium, the doctor may recommend playing sports, yoga, and avoiding heat baths.

Living with endometriosis

Existing with the existing pathology, if it does not progress, is not dangerous for the body, unless the woman is planning a child. For example, endometriosis and sex are quite compatible if the disease is extragenital in nature, in other cases, if there are lesions in the cervix, unpleasant sensations may appear after sexual intercourse.

Sports and endometriosis can also coexist, if you do not put strong pressure on the pelvic organs and abs. Exercise for endometriosis plays a role in alleviating the symptoms of the disease and helps improve metabolic processes in cells. Yoga for endometriosis will help improve the general condition of the body and reduce pressure on the endometrium, but you should not choose positions that increase blood circulation in the pelvis.

Visiting the bathhouse and other thermal procedures for endometriosis is unfortunately prohibited. This is due to the fact that heat affects the acceleration of endometrial cell division. Hypothermia of the pelvic organs is also unacceptable.

If necessary, you can go for a massage, but during the procedure it is prohibited to exert a strong mechanical effect on the pelvic organs.

Bottom line

Endometriosis is a disease in which endometrial cells grow in other organs; it occurs in 1-5% of women with endometrial pathologies. The degrees, forms of growth, types of disease and symptoms of manifestation are quite diverse. Depending on the degree of the disease, the doctor prescribes medication, physiotherapy or surgical treatment. One of the main drugs for the treatment of endometriosis is Utrozhestan, but self-medication in case of elevated hormone levels can worsen the situation.

It is possible to live with endometriosis, but to conceive, even at the initial stage of growth, it is recommended to undergo treatment from an experienced doctor. Be healthy!

Content

Drugs for the treatment of endometriosis include several groups of drugs used to stop the progression of the disease. and is a leader among gynecological pathologies in women of reproductive age. This disease is in third place in terms of prevalence after erosion and fibroids, according to statistical data.

General Treatment Approaches

Treatment of endometriosis of the uterine body is a difficult task, since the disease is chronic. Effective treatment is based on integrated approaches. For each patient, an individual pathology treatment regimen is selected, which depends on:

woman's reproductive plans;
age;
degree and form of the disease;
location of endometriotic lesions;
duration of endometriosis.

Treatment may be:

conservative;
surgical;
complex.

Indications for conservative treatment are as follows:

absence of symptoms of endometrial proliferation;
desire to have children in the future;
restoration of fertility in case of infertility.

Conservative treatment is based on taking effective medications:

hormonal medications;
anti-inflammatory drugs;
sedative medications;
multivitamin complexes.

The basis of effective therapy is , which affects the progression of endometrial growth, stabilizes and reduces the size of endometriosis foci, and reduces its symptoms.

A chronic and recurrent disease such as adenomyosis must be treated differently in each individual case. Internal endometriosis is a chronic hormone-dependent disease that is completely impossible to cure. However, doctors treat the disease due to the serious complications it can cause.

Selection of effective means of conservative treatment depends primarily on the degree, form and symptoms of the pathology.

If the symptoms are severe and severe, painkillers with an anti-inflammatory effect must be prescribed. If the patient is stressed, the doctor may recommend taking effective sedatives.

There are certain cases when endometrial growth cannot be effectively treated without surgery.

Indications for surgery for endometriosis:

the presence of endometrial hyperplasia or myomatous nodes;
diffuse, nodular form of adenomyosis;
ovarian cysts due to proliferation of the endometrium;
lack of effectiveness of the treatment;
development of purulent inflammation;
infertility due to adhesions;
progression of chronic endometriosis on the postoperative scar of the uterine body;
contraindications to drug treatment.

Surgical treatment can be done using radical and organ-preserving operations.

In modern gynecology, organ-preserving operations such as laparoscopy or laparotomy are recommended. During surgical treatment, pathological lesions are cauterized while preserving the integrity of unaffected tissues and reproductive function.

In especially severe cases, radical treatment is used, which may involve removal of the uterine body with or without the ovaries.

The most effective is complex treatment, which involves both endometriosis and surgical methods.

Drugs for endometriosis

Many patients ask the gynecologist how the uterus is medicated and what drugs are used for treatment. Drug treatment of uterine endometriosis depends on the prevalence of the pathology, the severity of manifestations and the woman’s reproductive plans.

Drugs for endometriosis are prescribed for the following purposes:

decreased production of certain sex hormones, such as estrogens;
elimination of uterine bleeding;
elimination of pain and other manifestations;
preparation and rehabilitation that accompany surgical treatment.

Tablets and other means by which the disease can be treated are recommended to be taken for a strictly limited amount of time. This is due to the fact that any medicine and drug treatment has side effects. The gynecologist takes this into account when prescribing any medications.

If you treat uterine endometriosis with medication, you should take medications from different groups. The patient is prescribed hormonal medications, vitamin preparations, and anti-inflammatory tablets. In some cases, you can use folk remedies.

Several groups of drugs are used for endometriosis.

Gonadotropin-releasing hormone agonists. These medications reduce estrogen production. Usually medications such as Diferelin, Zoladex or Buserelin are prescribed. These products are produced and used in the form of injections, not tablets. Drugs of the medicinal group introduce the body into a state of artificial menopause. Menstruation stops due to the lack of estrogen and endometrial growth. The lesions gradually regress. Treatment with medications is recommended for six months. Long-term use of the medication threatens the development of symptoms of menopause.
Inhibitors of gonadotropic hormones, antigestagens. The drugs suppress the production of LH, progesterone, and FSH. The gynecologist prescribes drugs such as Danazol, Mifepristone. These medications also have significant side effects. If you take these medications, which come in the form of capsules and tablets, you may experience acne and unwanted body hair.
Gestagens. Uterine pathology can be treated with progesterone tablets. The drug normalizes the duration of the cycle by lengthening the second phase. Medicines in this group include Duphaston, Utrozhestan, Norkolut. Some medications come in both tablet and injection forms. The appropriateness of products that are gestagens is constantly disputed. Some scientists believe that drugs to treat endometriosis may contribute to the progression of the uterine disease.
COOK. Medicines classified as combined oral contraceptives contain gestagens and estrogens. The drugs simulate the normal production of hormones by the female body, which causes stabilization of the growth of the uterine mucosa. It is recommended to treat with medications for three to six months. The following drugs are used in treatment: Janine, Jess, Diane-35, Yarina, Klaira.

During treatment, the patient does not have periods. These tablets should be used to treat a disease that progresses at the initial stage. In addition to hormonal drugs, other groups of drugs are used:

anti-inflammatory tablets, injections and suppositories;
immunostimulating and immunomodulating medications;
hemostatic drugs.

During drug treatment, you must strictly follow the recommendations of the gynecologist and not self-medicate. The effectiveness of drug treatment with various tablets and drugs in the aspect of infertility becomes higher if it is started at the initial stage.

Combined oral contraceptives

In young women in the phase of active reproductive potential, contraceptives are widely used to treat endometriosis and adenomyosis. As a rule, such therapy is combined with surgery. To do this, a woman uses medications a month before and 3 months after. If surgery is not indicated, oral contraceptives are prescribed for 6-9 months.

The principle of action of contraceptives for endometriosis is the same for all drugs. Selection is carried out depending on the severity of the disease. For endometriosis, low-dose COCs are mainly used. Also, these drugs have antiandrogenic properties - they minimize the influence of male sex hormones on the woman’s body, thereby reducing the greasiness of hair and skin, and reducing the number of acne. These medications do not cause weight gain.

The following drugs are used:

ethinyl estradiol in combination with gestodene (Gineleya; Lindinet; Logest; Milvane; Minulet; Mirelle; Femoden);
ethinyl estradiol with desogestrel (Marvelon, Tri-Mercy, Mercilon, Regulon, Novinet);
ethinyl estradiol and dienogest (Janine, Silhouette, Zhenetten, Femis-Messy).

The regimen for taking the drugs is the same: they start taking pills on the fifth day of the cycle, stop on the 25th day and take a seven-day break. In addition, the drugs are used continuously without a seven-day interval. In the latter option, menstruation does not occur.

Janine with endometriosis

Janine is the most common oral contraceptive prescribed to women with endometriosis.

The patient takes Janine and the endometriosis gradually regresses. It has been proven that if you take Janine, you can improve the well-being of women in approximately 90% of cases.

Janine is a modern low-dose treatment that includes dienogest and ethinyl estradiol. Janine is quickly absorbed and has a therapeutic effect. If you drink Janine, pregnancy is impossible during the treatment period. This effect is due to inhibition of the production of certain hormones, which ensures anovulation and a decrease in estrogen concentrations. In addition, the contractility of the tubes also decreases, making it difficult for the physiological advancement of the egg.

Doctors recommend taking Janine to inhibit the growth of lesions and block enzymes that are responsible for the production of mediators of inflammation and pain. Over time, the volume of the lesions decreases, the pain decreases, and the woman notes an improvement in her general condition.

If you drink Janine, you can improve the condition of your hair and skin, which is especially important for patients with hirsutism and acne. This effect is possible due to the antiandrogenic effect of Janine. That is why Janine is advised to drink for concomitant problems caused by excess androgens.

It has been proven that if you take Janine, endometriosis in the early stages can be successfully treated.

Janine and other low-dose contraceptives are taken for the following conditions and situations:

endometriosis at an early stage;
preparation before surgery;
postoperative therapy to prevent relapses.

Janine and other contraceptives should be taken for several months (6-9) to achieve the desired effect. You should take Janine only after a detailed examination, and during therapy, monitor your blood counts and perform a pelvic ultrasound.

Before taking Janine and other contraceptives, you need to pay attention to the following side effects that may occur if you take the drug:

thromboembolic complications;
migraine;
emotional instability;
intolerance to certain foods;
temporary visual impairment;
changes in stool;
allergy;
slight bleeding;
soreness of the mammary glands.

If you take Janine, following the prescribed dosage, the likelihood of developing adverse reactions is negligible. However, it is not advisable to drink Janine if the patient smokes, since nicotine increases blood clotting along with the medicine.

Janine and other COCs for the treatment of endometriosis may be contraindicated. In general, taking or drinking COCs if you have endometriosis is not recommended in the following cases:

history of thromboembolic pathologies;
diabetes;
hypertension;
benign tumors of a hormone-dependent nature;
liver diseases;
migraine.

Before taking Janine, you should consider the compatibility of drugs. Drinking Janine is not recommended while taking tetracycline antibiotics, carbamazepine, or barbiturates.

Hormonal drugs for endometriosis have an adverse effect on many organs, and in the presence of concomitant pathology, these side effects are most pronounced. At the same time, the following medications are prescribed:

hepatoprotectors (Essentiale, Karsil);
enzymes (Creon, Festal, Pancreatin);
means for protecting the mucous membrane of the stomach and duodenum (sea buckthorn oil, Methyluracil, Phosphalugel, Gastal).

Gestagens

The treatment regimen for endometriosis may consist of gestagens. These drugs are natural or synthetic analogues of progesterone, the hormone of the second phase of the cycle, which is produced by the corpus luteum of the ovary. The hormone is synthesized at the site of a burst follicle, that is, after ovulation, which is not always observed with endometriosis due to hormonal imbalance. Due to this, a lack of progesterone is formed, which, in turn, negatively affects the condition of the endometrium.

Progesterone preparations for endometriosis prevent excessive growth of the endometrium in conditions of excess estrogen. Also, drugs for endometriosis reduce pain and improve overall well-being.

Drugs in this group include:

Duphaston, which is used for the treatment of endometriosis at 10-20 mg per day from the fifth to the twenty-fifth day of the cycle, observing a seven-day break or continuously;
Norethisterone, the dosage regimen of which is the same as Duphaston, but the dosage is 5 mg per day;
levonorgestrel in the form of an intrauterine device, such as Mirena;
Utrozhestan 100 mg 2 times a day from 16 to 25 days of the cycle for 6-9 months;
Visanne is taken 1 tablet daily for a year.

Among the group of gestagens, it is used most often, since the drug has shown its high effectiveness in treating the disease. However, the side effects of gestagens in the first months of use are especially pronounced when taking Visanne. Endometriotic lesions atrophy, the number of vessels decreases, which leads to a decrease in the trophism of pathological formations.

The main side effects of the drugs are:

nausea, diarrhea, or constipation;
jaundice and abdominal pain;
discomfort in the mammary glands;
skin rash;
headache, depression.

Adverse events when taking progesterone drugs are very rarely reported. In general, these drugs are well tolerated for endometriosis. If you follow the dosage regimen from the 5th day of the cycle, ovulation is suppressed.

To taking progesterone drugs for endometriosis often resorted to when combined oral contraceptives are poorly tolerated.

Contraindications:

pregnancy;
infectious diseases of the reproductive tract;
cervical dysplasia;
acute liver disease;
oncological processes;
fibroids and uterine anomalies (for the spiral);
diabetes mellitus (with caution when prescribing tablets).

As a rule, it is used for nodular forms and mild cases; Visanne is considered the drug of choice for severe varieties and diffuse forms.

GnRH agonists and antigonadotropics

Moderate to severe endometriosis can be treated with medications that block hormone production.

Pituitary gonadotropin-releasing factor analogues are widely used to treat this chronic disease. The essence of the mechanism of action of these drugs is that the drugs block the production of pituitary hormones that stimulate the ovaries. As a result, the synthesis of FSH and LH stops. Estrogen production is suppressed to an extremely low level corresponding to menopause.

The following drugs are used:

Buserelin in the form of a spray is used continuously for 4-6 months from the second day of the cycle, three instillations into each nostril daily;
Buserelin depot is used in the form of injections, which are administered intramuscularly once a month for six months;
Zoladex in the form of subcutaneous capsules;
Danazol, which is a drug from the antigonadotropin group, has a weak anabolic effect, suppresses endometrial growth and ovulation by blocking the synthesis of sex hormones in women. After discontinuation, ovulation returns after 1.5-2 months. Use 400 mg per day for six months.

GnRH analogues and antigonadotropins are most often difficult to tolerate by patients, as they cause a number of side effects:

nervousness;
memory and sleep disturbances;
tides;
blurred vision;
nausea;
palpitations, increased blood pressure;
decreased libido;
vaginal dryness;
phenomena of osteoporosis.

Use with caution:

diabetes;
arterial hypertension;
depressive states.

The drugs are used before to stabilize the growth of lesions. After surgery, the use of drugs from this group is continued to prevent relapse.

Reproductive function is restored several months after stopping the medication.

The main goal of drug therapy for endometriosis is is the suppression of estrogen production by the ovaries.

The drugs lead to a temporary state of pseudomenopause, then ovarian function is restored. The effectiveness of hormones in the treatment of endometriosis is determined only during their administration; after discontinuation, the disease returns. Therefore, in terms of pregnancy planning, active planning is recommended immediately after stopping the drugs. The use of IVF after drug therapy aimed at stopping the progression of the disease is highly effective.

The duration of taking the drugs is 6-9 months.

The withdrawal of hormonal drugs is carried out gradually to avoid withdrawal syndrome in the form of bleeding and depression.

Immunomodulators and antioxidants

In order to correct the immune status of a woman suffering from endometriosis, immunomodulators and antioxidants are used.

Immunocorrection is carried out using:

Levamisole, which is used according to a regimen that includes a three-day intake and a four-day break;
Splenin is used as injections of 2 ml every other day, 20 injections in total;
Polyoxidonium 6 mg every other day - 5 injections, then 2 times a week. A total of 10 injections;
T-activin subcutaneously once a day at night at a dosage of 40 mcg/m² of body surface for 5-7 days, then once every 7-10 days;
Likopid - tablets under the tongue in a dosage of 10 mg 2 times a day - 10 days, then 10 mg every other day for 10 days;
Interferon-based suppositories(Viferon, Genferon, etc.) 500 thousand or 1 million units daily or every other day rectally for 3-6 months.

To suppress oxidative stress, which provokes the progression of endometriosis, antioxidants are used: vitamins A, E and C.

Anti-inflammatory drugs

The use of non-steroidal anti-inflammatory drugs is due to the need to suppress the production of prostaglandins, which initiate an inflammatory reaction in the area of endometriotic lesions. In addition, prostaglandins provide intense pain sensations. For relief of adenomyosis, it is preferable to use NSAIDs.

NSAIDs include Ibuprofen, Diclofenac, Indomethacin.

Nonsteroidal anti-inflammatory drugs for endometriosis It is preferable to use in the form of rectal suppositories.

The use of suppositories helps to quickly relieve symptoms due to the anatomical proximity of the organs and reduces the negative impact of the drugs on the woman’s body.

Use anti-inflammatory drugs 4-5 days before menstruation.

Uterine endometriosis must be treated regardless of its symptoms and severity. Without adequate treatment, the disease progresses rapidly, and there is a risk of various dangerous complications, including infertility. It is necessary to realize that endometriosis of the uterine body is a chronic pathology. To avoid relapses, it is recommended to regularly visit a gynecologist and undergo diagnostics, periodically take medications, and maintain a healthy lifestyle.

Chronic endometriosis is a dangerous disease in which endometrial cells grow outside the uterine cavity. They migrate to the bladder, rectum, fallopian tubes, eggs and other internal organs. The disease is an inflammatory process of the endometrium, the layer lining the inner cavity of the uterus. It is caused by a violation of the sterility of the organ cavity due to the development of pathogenic microflora in it, or taking certain types of medications.

Often the pathology is complicated by adhesions (formations of connective tissue), and can also develop simultaneously with uterine fibroids.

Reasons for the development of the disease

The exact causes of endometriosis have not been established. Several reasons for the growth of endometrial cells outside their proper location are being considered. The sterility of the uterine mucosa is impaired when:

Factors such as structural features of the fallopian tubes, gene mutations, abnormalities in the functions of cellular enzymes and reactions of hormone receptors increase the likelihood of developing endometriosis.

Characteristic signs

Signs of endometriosis may not appear for a long time. A woman learns about the pathology only during a routine gynecological examination. They depend on the type of pathogenic bacteria and the cause of the inflammatory process.

If you suspect chronic endometriosis, you should pay attention to the following symptoms:

Exacerbation of endometriosis always occurs before the onset of menstruation, as well as during it.

If you experience such symptoms, you should consult a doctor immediately.

Experts identify the following forms of pathology:

Diffuse. Characterized by uniform proliferation of cells in the myometrium.
Nodal. The lesions grow in the form of nodes.
Focal. Individual areas are affected.

Diagnostic methods

Examination methods are conventionally divided into 2 groups:

main;
auxiliary.

The main diagnostic methods include the collection and analysis of anamnesis. The doctor listens to the patient’s complaints and pays attention to the symptoms of the pathology. Finds out whether there were abortions, therapeutic and diagnostic curettages, or operations.

The doctor conducts a manual gynecological examination, prescribes laboratory and instrumental research methods:

Treatment of chronic endometriosis

The goal of treatment is not only to eliminate the active manifestations of the pathology, but also its consequences:

Depending on the severity of the disease and its nature, conservative, surgical and combined methods are used.

The disease cannot be cured quickly. Drug treatment is always long-term. It reduces the activity of the ovaries and stops cyclical processes in endometrial cells. The treatment regimen includes the following groups of drugs:

anti-inflammatory;
hormonal;
sedatives;
desensitizing;
means of symptomatic use (painkillers).

You can get a positive result with the use of drugs only at an early stage of the development of endometriosis and in the absence of symptoms of endometrial growth.

Surgical treatment of endometriosis is indicated for:

infertility;
long-term pain syndrome;
voluminous endometriotic foci;
presence of concomitant diseases;
the appearance of foci of endometriosis in the abdominal cavity.

Surgery is part of complex therapy.

Laparoscopy is considered a common method of surgical treatment. This is a minimally invasive and minimally traumatic technique. It is performed under both general and local anesthesia.

Removal of the uterus and appendages is carried out when the appendages and pelvic organs are affected. This happens more often during menopause.

Consequences

Chronic endometriosis in the absence of timely treatment can lead to serious consequences:

development of malignant neoplasms;
loss of performance due to pain;
infertility;
spontaneous abortion;
neurological disorders;
the formation of other pathologies;
formation of pathological processes (cysts).

Endometriosis cannot be ignored. The disease will not go away on its own. When the first symptoms indicating pathology appear, you should urgently visit a gynecologist.

When the uterus, ovaries, and appendages are removed, the hormonal balance will be disrupted. This will lead to accelerated aging of the woman’s body and poor health.

Prevention

sexual abstinence during menstruation;
excess weight loss;
prevention of stressful situations;
choosing the optimal methods of contraception and abandoning intrauterine devices;
exclusion of termination of pregnancy;
regular visits to the gynecologist;
rejection of bad habits;
strengthening immunity;
enhanced monitoring of health status after surgery on the pelvic organs.

If endometriosis is at the initial stage of development and does not interfere with conception, then pregnancy can permanently relieve the disease. Often after childbirth, a woman’s complete recovery is observed.

Chronic endometriosis is a disease that occurs most often in women of reproductive age. It is characterized by the growth of the endometrium beyond the uterine cavity.

The exact causes of the disease have not been established, which makes it difficult not only for treatment, but also for diagnosis.

What is chronic endometriosis? A pathology as a result of which endometrioid tissue cells move to other pelvic organs - the ovaries, fallopian tubes, intestinal or bladder walls.

Normally, the endometrium is located in the uterine cavity. Its function is to attach the embryo after conception. Once a month, in the absence of fertilization, endometrial cells exfoliate and come out along with menstrual flow.

Symptoms

chronic endometriosis largely depend on the localization of pathological endometrioid foci.

The most characteristic symptom is, which occurs or intensifies during menstruation. The reason is the hormonal dependence of the disease, since changes in the endometrium occur precisely under the influence of sex hormones - estrogen and progesterone.

Pain with endometriosis can occur in the perineum or rectum, which again depends on the location of the lesions.

Another sign of the disease is intermenstrual bleeding or very heavy periods.

When pathological cells of the ovarian endometrium are damaged, cysts are formed on them, which are called “chocolate cysts”. The reason is their contents - a thickened brown bloody liquid.

Types of disease

Chronic endometriosis can have two forms:

Outdoor. Characterized by the proliferation of endometrial cells on other pelvic organs - ovaries, bladder, rectum or cervix.
Internal. Ingrowth of pathological cells into the internal tissues of the uterus, which causes a severe inflammatory process.

Endometriosis is also classified as diffuse and nodular:

Diffuse is characterized by uniform filling of organ surfaces with endometrioid tissue.
With nodular endometriosis, individual foci appear in the form of inflammatory nodes from endometrioid tissue cells.

Chronic endometriosis: reasons for its development

Chronic endometriosis is an advanced form of the disease. The following factors can provoke its development:

curettage of the uterus for medical reasons;
sexual infections;
hormonal imbalance in the body;
decreased immunity;
sexual contact during menstruation;
use of sanitary tampons;
incorrect or frequent douching.

Consequences

The disease negatively affects the entire body, but especially the reproductive function of women.

The impossibility of conception is explained by the inflammatory process, the formation of adhesions and, as a consequence, obstruction of the fallopian tubes.

The cause of infertility can be immunological problems caused by endometriosis, which results in spontaneous termination of pregnancy in the early stages.

Is pregnancy possible?

It is believed that the chances of conceiving in the presence of the disease are negligible. However, there is an opinion that if conception occurs with endometriosis, it does not in any way affect the development of the embryo. And, moreover, with the onset of pregnancy, the manifestations of the disease may become weaker due to natural changes in hormonal levels.

In any case, before planning a child, you must undergo an examination and, if endometriosis is detected, consult with your doctor.

Watch the video about the symptoms, causes and treatment of endometriosis:

Diagnosis and treatment

Accurate diagnosis is difficult in chronic endometriosis. A gynecological examination alone is not enough, and therefore the following procedures are prescribed:

Ultrasound of the pelvic organs;
MRI or CT;
laparoscopy and biopsy.

As for therapy, everything is decided individually. In 30% of cases, a wait-and-see approach is used in the initial stages of the disease. If necessary, drug treatment is prescribed.

How to treat chronic endometriosis? Hormone therapy is effective. Drugs containing hormones suppress the activity of the ovaries, as a result the natural hormonal levels change and the development of endometriosis is blocked.

Treatment with medications is always long-term – from 3 months to a year.

Surgery is indicated when the disease progresses and there is no effect of drug therapy. During surgery it is possible:

cauterization and elimination of endometrioid lesions;
excision and removal of adhesions.

More severe forms of the disease in some cases require removal of the ovaries or uterus.

As for traditional methods of treatment for chronic endometriosis at home, they can be effective in the initial stages of the disease. In the chronic form, such treatment, and especially as an alternative to pills, is unreasonable.

Chronic endometriosis affects the uterus, other pelvic organs, and neighboring organs. The treatment is long, but it can give a positive result. It should be noted that the disease is prone to relapse, and therefore it is important not only to follow all the doctor’s recommendations, but also to visit him regularly after treatment.

The endometrium is the tissue that lines the walls of the uterus. This mucous velvety membrane has a thin structure with a pinkish tint. The endometrium consists of several layers.

The tissue structure includes:

outer surface epithelium;
internal glands, whose task is to produce an alkaline liquid necessary to moisturize the uterine cavity;
blood vessels;
tissue spaces.

The thickness of the membrane during the menstrual cycle fluctuates between 0.5/3-5 mm. It reaches its maximum numbers during pregnancy, and in the absence of conception, with the onset of menstruation, it is washed off from the walls of the uterus to the minimum levels.

When the endometrium appears outside the uterus, on the surface of the fallopian tubes, on the walls of the uterus on the outer back side, in the cavity between the uterus and the rectum, a diagnosis is made. This is a very serious gynecological disease that can affect women aged 25-45 years.

The disease is considered chronic because it is very difficult to achieve a complete cure; it is characterized by constant remissions and acute forms. The proposed treatment can only eliminate the clinical manifestations of the disease and slow down the pathological process.

Causes of the disease

The occurrence of endometriosis itself in women has not yet been fully studied. The leading theory is the implantation origin of the disease. Its essence is that endometrial particles enter the area outside the uterus along with menstrual blood. Here its particles take root and begin to grow. If a woman’s immunity is reduced, then the body cannot recognize and destroy these cells in time.

Another possible cause of endometriosis is hormonal imbalance, which also provokes the growth of the endometrium in the wrong places.

When the process of endometrial growth outside the uterus finds itself in favorable conditions, we can talk about a chronic form of endometriosis. The reasons are:

incomplete treatment of endometriosis;
surgical intervention in the uterine area, including abortions and;
erosive and ulcerative inflammation in the uterine area.

If we take into account the causes of the chronic form of the disease, we can highlight the following conditions and lifestyle that a woman may fall into:

presence of bad habits;
bad ecology;
hereditary predisposition to this disease;
metabolic disorder;
the presence of diseases of the endocrine system;
surgical interventions in the uterine cavity;
defects in the structure of the reproductive system.

Under these circumstances, every woman should pay special attention to her health. Regular examinations by a specialist and treatment, if necessary, will help avoid serious consequences of the disease.

Symptoms of the disease

Endometriosis causes pathological processes at the site of endometrial growth. Depending on the affected area, these may include periods, infertility, cysts, painful urination and perineal pain.

In the chronic form of the disease, the picture changes. The sensations are not so painful and practically do not bother the woman.

Symptoms depend on where endometriosis is located, how widespread it is, and how long the process lasts. Based on this, experts identify the following main symptoms of chronic endometriosis:

atypical pain that occurs and sharply intensifies before the onset of menstruation; if the process lasts for a long time, then such pain is observed constantly;
uncharacteristic spotting with dark clots during menstruation and the presence of spotting after it for a long time; all this indicates a form of endometriosis of an intrauterine nature;
diagnosing infertility, the cause of which will be the lack of ovulation, abnormal changes in the thickness of the endometrium during the menstrual cycle, adhesions in the tubes and pelvis, improper attachment of the fertilized egg to the wall of the uterus.

These serious symptoms of the disease can only be determined by a competent specialist. The outcome of the disease will depend on proper treatment.

Classification of the disease

Chronic endometriosis manifests itself in different ways. When diagnosing such a disease, a specialist can detect symptoms of its different forms. Depending on this, the treatment will be different.

Medicine today identifies the following forms of the disease:

internal, when endometrial cells affect the myometrium, or uterine tissue; this is the most common form;
, is a lesion of the cervix, fallopian tubes, vagina, ovaries, bladder, inguinal lymph nodes; this form is uncommon.

According to the degree of prevalence, the following are distinguished:

diffuse endometriosis, when the endometrium spreads evenly outside the uterus;
nodular form of the disease, when distinct nodules of cells form and form an inflammatory focus.

Individual symptoms of the disease may also be identified. In addition, the external form may be the result of a neglected internal one. Therefore, experts insist on timely treatment.

Stages of disease development

Endometriosis, becoming chronic, causes gradual pathological changes in a woman’s body.

Depending on the symptoms and consequences of the disease on the body, the following stages are distinguished:

At the first stage, the severity of the disease depends on the lesion. Isolated superficial manifestations are observed, and a feeling may be felt. Diagnosis can only be made by testing and histological examination; ultrasound and colposcopy will not give results.
The second stage is marked by the appearance of the first symptoms. You can detect nodules and mark the affected area.
At the third stage, the manifestation of the disease outside the uterine space is observed; adhesions and cysts may appear on the fallopian tubes, ovaries, and peritoneum. This will be the result of the disease, not its cause.
The fourth stage leads to infection of the entire reproductive system, excretory organs, and pelvic area.

The correct thing to do would be to start influencing the cause of the disease, that is, to start treatment at the first stage, before the disease comes out and becomes chronic.

Degrees of disease and clinical manifestations

Chronic endometriosis is studied in detail by specialists in order to be able to help patients with treatment. Analysis of cases of the disease in women allowed doctors to distinguish degrees of disease depending on local spread and how deeply the tissue was affected.

Today the following degrees of the disease are distinguished:

I – the presence of one or several small superficial lesions is observed;
II – one, and in some cases several deep lesions are determined;
III – there are many deep foci, small cysts on one/two ovaries, the peritoneum is subject to thin adhesions;
IV – numerous deep lesions are noted, both ovaries are affected by cysts, and invasion of the rectum or vagina may occur.

The higher the severity of the disease, the stronger its clinical manifestations will be. These include pelvic pain, premenstrual bleeding, pain during sexual intercourse, menstrual irregularities, and infertility.

There may also be an exacerbation of endometriosis, and then the clinical manifestations of the disease will intensify.

With timely diagnosis and proper treatment of endometriosis, an affected woman will be able to become pregnant and carry a child to term.

Diagnostics

Diagnosis of chronic endometriosis is not an easy procedure. This is explained by the absence of pronounced symptoms of the disease, which are most often similar to signs of pelvic inflammation.

Specialists have several methods for examining a patient:

examination by a gynecologist using special mirrors;
ultrasound examination using a vaginal probe;
colposcopy;
hysteroscopy;
MRI of the pelvic organs;
colonoscopy;
laparoscopy;
collection of smears from the vagina and cervix;
conducting a blood test for the presence of tumor markers.

Particular importance is given, which makes it possible to identify even very small foci in this disease. This method is necessarily complemented by clinical studies, which makes it possible to make an accurate diagnosis.

Not all patients are suitable for an MRI procedure, but if they are planning a pregnancy, the method will help to accurately determine the extent of the disease and begin treatment on time.

A modern method is one that combines diagnosis and simultaneous treatment of external forms of the disease.

What type of examination is necessary in each individual case is decided by the gynecologist.

Treatment and prevention

Treatment of chronic endometriosis should be comprehensive. Otherwise the problem will come back again. After a thorough examination has been carried out and the localization of the pathology has been detected, treatment is prescribed.

Modern medicine for this disease offers the following treatment:

Basic drug therapy. It includes a complex of antibiotics, non-steroidal anti-inflammatory drugs, antioxidants (vitamins E, A, C), immunocorrective drugs, etc.
A course of sedative treatment that has a beneficial effect on the female body.
Physiotherapy (magnetic therapy, electrophoresis, bromiodine balneotherapy, etc.).
Hormonal therapy (progestins, antigonadotropins, etc.).

Traditional methods and techniques can be added to the basic pharmacological treatment.

Proper nutrition comes first. It strengthens hormonal levels and immunity, the pathological process will slow down. The consumption of plant and animal proteins is recommended; fresh vegetables and fruits rich in vitamins and minerals; black bread, bran, cereals containing carbohydrates necessary for the body. It is better to steam or bake food.

One of them is hirudotherapy, which very well relieves inflammation and improves blood circulation.

Herbal medicine should not be ignored either. Many medicinal herbs and mixtures can alleviate the condition of a woman diagnosed with chronic endometriosis.

It is important to pay attention to disease prevention. To do this, it is enough to follow simple rules. These include proper nutrition and giving up bad habits, taking care of contraception, strengthening the immune system, and systematic examinations by a specialist.

Taking care of your own health is the duty of every woman.