Causes of uterine endometriosis in women. Endometriosis

Today we will talk about:

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

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

However, endometriosis of the uterus It does not affect every woman with a similar feature of menstruation. It is generally accepted that the main characteristics that significantly increase the susceptibility to this disease are the following. Firstly, this is a certain structure of the fallopian tubes, which is easy to identify during the examination. Secondly, the presence of a hereditary factor plays an important role. Thirdly, the appearance of endometriosis is facilitated by dysfunction of the woman’s immune system.

People started talking about the genetic factor after research by scientists from Ireland. It has been proven that in women whose close relatives have endometriosis, the likelihood of its manifestation increases five times. In view of this, during examination and consultation, specialists must find out whether there have been cases of this disease among the patient’s relatives.

However, other factors mentioned above also increase the likelihood of the disease. Thus, if there are disturbances in the functioning of the immune system, which maintains the normal state of tissues in the body, a similar pathology may occur. If the immune system is normal, then it can have a destructive effect on abnormalities in the functioning of the body, which include the growth of the endometrium outside the uterine lining. When the immune system malfunctions, other systems also malfunction. Regular preventive examinations will allow you to detect the development of the disease as early as possible.

Today, one of the most common causes of endometriosis is considered to be surgical interventions ever performed in the uterus. These are abortion, caesarean section, cauterization of erosion and other procedures. In view of this, after such operations you should undergo medical examinations with strict regularity.

Classification of endometriosis

Experts classify endometriosis according to the location of this pathology. Taking this factor into account, genital endometriosis, adenomyosis, external endometriosis, as well as peritoneal, extragenital and extraperitoneal endometriosis are distinguished. With internal genital endometriosis, the endometrium grows in the cervix and uterine canal. With extragenital endometriosis, cells of the uterine mucosa grow in the kidneys, bladder, intestines, lungs, and also in scars after operations. With peritoneal extragenital endometriosis, damage occurs to the ovaries, pelvic peritoneum, and fallopian tubes. In the extraperitoneal form of the disease, endometriosis grows in the external genitalia. There are “minor” and severe forms of the disease. In severe forms, the disease develops if the patient does not undergo appropriate treatment on time. Depending on how deep the affected areas are, four stages of the disease are distinguished: minimal, mild, moderate, severe. The last stage of endometriosis is the most difficult to cure.

Symptoms of endometriosis

It is important to consider that the symptoms of endometriosis can vary greatly. Their manifestations directly depend on the individual characteristics of the patient’s body. Very rarely, this disease is completely asymptomatic, therefore, it can only be diagnosed if you undergo regular examination by a doctor. However, as a rule, certain symptoms of this disease still occur. The main symptoms of endometriosis are pain. In most patients, pain manifests itself in various forms. Another common symptom of the disease is dysmenorrhea. This symptom manifests itself to its maximum on the first or third day. This symptom is associated with menstrual bleeding into the cyst and, accordingly, an increase in pressure in the cyst. Dysmenorrhea can also occur due to retrograde menstruation and irritation in the peritoneum. It can also manifest itself as a consequence of the active production of prostaglandins, causing vasospasm and strong contractions in the uterus. Painful sensations during menstruation also appear due to the contact of nearby organs with an endometrioid lesion. In addition to the described symptoms, endometriosis may cause dark brown discharge that persists for several days after menstruation.

A certain number of women complain of pelvic pain that is not related to the menstrual cycle. It occurs due to secondary inflammation in those organs that have been affected by endometriosis. Symptoms of endometriosis can also include painful sensations during sexual intercourse. Most often, such a symptom occurs in women with endometriosis-affected vagina, rectovaginal septum, and rectouterine space. There is also pain in the lower back, menstruation is irregular, but it is especially heavy.

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

Diagnosis of endometriosis

In the process of making a diagnosis, examination and all necessary procedures under the guidance of a doctor of a certain profile are very important. First of all, when making a diagnosis, you should undergo an initial examination by a gynecologist. Next, the doctor interviews the patient in detail to find out the nature of the pain, find out what gynecological diseases she has suffered before, and whether appropriate surgical interventions have ever been performed. The specialist should also find out information about gynecological diseases of the patient’s relatives.

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

The majority of patients with this disease have an enlarged uterus, usually moderate. Also, in a certain part of patients (approximately 15-20% of cases), fixed and non-fixed uterine bending is determined. During the diagnostic process, some patients are determined to have nodules in the posterior fornix, causing pain. To assess whether there are similar phenomena in the rectovaginal septum, a rectal and rectovaginal examination is performed. During a study aimed at examining the fallopian tubes and ovaries, the specialist determines whether these organs are enlarged, immobile, or painful. When performing colposcopy and hysteroscopy, the specialist receives material used for performing a biopsy. It is biopsy and histology that are considered an effective addition to endoscopic examination methods and help determine the correct method of therapy.

Treatment of endometriosis

When selecting an adequate treatment method, the specialist takes into account many factors, including the patient’s age, previous pregnancy, and the characteristics of the disease at this stage. The doctor must assess how severe the symptoms of endometriosis are, whether this disease is combined with other inflammatory processes, and whether work should be done to restore the woman’s reproductive function.

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

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

Prevention of endometriosis

To prevent endometriosis, it is imperative to undergo regular preventive examinations by a gynecologist. Women and girls suffering from excessive menstrual pain, which may be a symptom of endometriosis, should be especially careful about this rule. It is important to undergo preventive examinations after an abortion or other surgical intervention in the uterus. To prevent the occurrence of endometriosis, all inflammatory diseases of the genital organs, including chronic ones, should be promptly treated. Tests aimed at determining the level of hormones that directly affect the functioning of both the immune system and other systems in the body will also help prevent the disease.

Women who notice a reduction, metabolic failure and, accordingly, a sharp weight gain should pay special attention to preventive measures. Also, those women who use intrauterine contraceptives, those who are over thirty years old, and those who regularly smoke should undergo regular examinations and consultations with a doctor. Especially for: - http://site

Endometriosis is often found among gynecological pathologies, second only to inflammatory diseases and uterine fibroids.

In most cases, it is detected in women of childbearing age aged 25-45 years, less often in teenage girls, and very rarely in patients during menopause.

It is more often detected in nulliparous women aged 30-40 years. This disease is difficult to diagnose and can be asymptomatic for a long time, so it is assumed that in fact it occurs much more often.

In recent decades, there has been a trend toward “rejuvenation” of endometriosis.

Description of the disease

What does endometriosis of the uterus mean? Endometriosis is a hormonally dependent systemic disease, caused by the growth of the glandular layer of the endometrium outside the uterine cavity.

The course is long-term and recurrent. The mucous membrane of the uterine cavity (endometrium) consists of columnar epithelium and a connective tissue basal layer.

In the thickness of the endometrium there is a dense capillary network and tubular glands. In a healthy woman, such tissue is located only in the uterine cavity.

For unknown reasons, fragments of glandular tissue, structurally and functionally similar to the endometrium, can be found on the surface or in the thickness of the walls of organs, where they normally do not exist.

Such formations are called heterotopic.

Areas of heterotopia can be located in the muscular layer of the uterus, fallopian tubes, ovaries, on the walls of the bladder, intestines, peritoneum and other pelvic organs.

This tissue undergoes the same cyclical changes as normal endometrium.. During menstruation, heterotopic areas of the endometrium bleed, this condition is accompanied by pain.

With each cycle, the size of the pathological formation increases, as the pathology progresses, other pelvic organs may also become involved.

Reasons for development

The disease is poorly understood, there is no consensus on the causes and mechanisms of its development yet.

Among the risk factors for development:

childbearing age;
absence of pregnancy and childbirth;
abortions and other instrumental manipulations in the uterine cavity;
long-term use of an intrauterine device;
menstrual irregularities;
anomalies in the structure of the internal genital organs;
excess body weight;
frequent or chronic inflammatory diseases of the reproductive organs;
hereditary predisposition.

Provoking factors are hormonal disorders and immune defense disorders, such as immunodeficiency states.

Prerequisites for the development and progression of pathology arise with an excess of estrogen and disturbances in the metabolism of progesterone, hormones that regulate the normal course of menstrual cycles.

Why it’s dangerous: consequences and complications if left untreated

Is endometriosis life-threatening and what does it lead to? is very difficult; patients often develop secondary infertility.

Against the background of the disease, the formation of endometrioids is possible.

In advanced cases, adhesions in the pelvis and/or abdominal cavity which can lead to or fallopian tubes.

Many people develop persistent bleeding due to heavy menstrual bleeding.

Depending on the location of the pathology focus and its size, the course of the disease may be accompanied by symptoms of neurological disorders resulting from mechanical effects on nerve roots and nerve endings.

If left untreated, pathological tissue may grow through the wall of the uterus and further spread to the pelvic organs.

Pathological endometrium is a benign formation, but there is a possibility of tissue degeneration into a malignant tumor, which occurs in approximately 12% of cases.

Progressive endometriosis is one of the factors that increases the risk of developing cancer in other organs not directly related to the lesion.

Classification of species and code according to ICD-10

The ICD-10 code for endometriosis is No. 80.

Forms: diffuse, nodular and focal

Depending on the location of the lesions the disease is divided into genital and extragenital forms.

The genital form includes lesions of the internal genital organs, to extragenital – all cases of lesions of other organs.

With multiple lesions, the form of the disease can be combined. Endometriosis of the uterus is one of the varieties of the genital form of the disease. Lesions of the uterus can be external, when the process involves the tubes, cervix, and internal.

It affects the body of the uterus, the lesions are embedded in the muscle layer (myometrium).

This type of disease is known as adenomyosis. According to the nature of the lesions distinguish nodular, diffuse and mixed forms.

In diffuse lesions, the pathologically altered tissues are located in the myometrium relatively evenly, without forming structures with clearly defined boundaries.

In the nodular form, the foci are clearly defined. In the mixed form, signs of both types of lesions are found in the myometrium.

1, 2, 3 and 4 degrees

According to the severity of the lesion, stages 1, 2, 3 and 4 of uterine endometriosis in women are distinguished:

I degree(initial stage). The lesions are single, superficial;
II degree. A few lesions penetrating into the tissue of the affected organ;
III degree. Multiple areas of pathological endometrium are detected, lesions penetrate through the wall of hollow organs almost completely;
IV degree– multiple lesions invade the serosa. The pathology spreads to other organs.

Diagnostics

How to diagnose endometriosis of the uterine body, what tests and examinations are performed when making a diagnosis?

They are nonspecific and resemble manifestations of other gynecological diseases.

During a standard examination, the doctor may find enlargement of the uterus; in the nodular form, large nodes are palpated.

Examination with a transvaginal ultrasound probe is a standard examination procedure for gynecological diseases.

Asymmetry in the thickness of the walls of the uterus, an increase in the size of the organ, diffuse and nodular pathological formations in the thickness of the myometrium are revealed.

Colposcopic examination allows you to identify lesions that have spread to the cervix.

Hysterosalpingography, X-ray contrast examination of the uterus makes it possible to assess the patency of the tubes and the extent of lesions. It is carried out on days 5-7 of the cycle.

Early stages of endometriosis detected during laparoscopic examination.

If the basic research is insufficiently informative, the patient MRI or CT may be ordered.

The study reveals the exact location and size of the lesions. If necessary, carried out histological examination.

Blood analysis sometimes reveals an increase in ESR. The hormonal background differs from normal; patients show increased levels of luteinizing and follicle-stimulating hormones, prolactin with a simultaneous decrease in progesterone levels.

The most characteristic sign of pathology is increased content of the specific marker CA-125.

Is it possible to identify

Endometriosis is an insidious gynecological disease that may remain asymptomatic for a long time. A hidden disease is often discovered accidentally during an examination for infertility.

Symptoms of the pathology resemble manifestations of other gynecological diseases.

Endometriosis can also be indicated in the lower abdomen, manifesting itself during menstruation, or less often - constant, intensifying at the beginning of menstruation.

The intensity can range from vague discomfort to unbearable pain. Some patients may experience fainting, nausea or vomiting.

Depending on the location of the lesion and the severity of the disease pain of varying intensity can occur during bowel movements and intimacy.

With endometriosis, the menstrual cycle changes. Bleeding becomes more profuse and prolonged, and the cycle is often shortened.

A few days before the start of menstruation or a few days after, many patients experience spotting brown discharge.

This condition is difficult to treat with medication, and in severe cases leads to the development of posthemorrhagic iron deficiency anemia.

Hormonal imbalance and so-called burst uterine bleeding, quite characteristic of the diffuse form of the disease, aggravate the situation.

In some cases, symptoms of general intoxication may develop: increased body temperature, general weakness, fatigue, etc.

When to see a doctor

Healthy people are recommended to undergo preventive examinations by specialized specialists annually.

In practice, a visit to a doctor is often postponed indefinitely and the patient ends up at the appointment when it becomes completely unbearable to endure.

The basis for contacting a doctor will be any changes in the menstrual cycle and the course of menstruation, manifestations of pain, discomfort and any other symptoms that are not characteristic of normal menstruation.

It is better to be overly vigilant than to waste time.

Treatment

Endometriosis is difficult to treat, and in general it is not possible to achieve complete recovery.

Cases of spontaneous healing after childbirth have been described, but the likelihood of such a development is assessed as low.

After the decline of reproductive function, the manifestations of pathology disappear due to changes in the hormonal status of the woman. A comprehensive treatment program for uterine endometriosis is developed individually, based on the patient’s examination data.

In addition to the shape, location and severity of the lesion, the doctor takes into account the patient’s age and her ability to become pregnant in the future.

When the disease is first detected, conservative treatment is prescribed. The course of conservative therapy includes:

non-steroidal anti-inflammatory drugs;
hormonal agents;
sedatives;
immunomodulators;
vitamin-microelement complexes.

Additionally prescribed course of physiotherapeutic procedures.

In advanced cases, in the absence of effect from conservative treatment, contraindications to the use of medications for women combined or surgical treatment is prescribed.

Surgical treatment can be radical or organ-preserving. Preference is given to laparoscopic surgical interventions, which involve local removal of foci of pathological endometrium.

If there is a high risk of the tumor degenerating into a malignant one, there is a persistent lack of effect of conservative treatment, with a particularly aggressive course of the pathology and in severely advanced cases, hysterectomy is performed.

After such an operation, a woman will not be able to have children. Therefore, the technique is used in the treatment of women, in exceptional cases - at a younger age.

The success of treatment is determined by the preservation or restoration of fertility.

The criteria for recovery are absence of subjective complaints and clinical symptoms of relapse for 5 years.

“Doctor I...” - Stage 4 endometriosis, laparoscopic surgery:

Lifestyle

Prevention and treatment of any disease includes a number of general recommendations for promoting health.

Smokers need to get rid of an unhealthy habit, women with abnormal body weight need to get closer to physiologically justified indicators.

How to live with endometriosis, what can and cannot be done with this diagnosis?

Diet and nutrition

There are no specific dietary restrictions, it is enough to adhere to general recommendations for a healthy diet. Food should be complete and varied.

You can enrich it with fruits, vegetables; uncrushed cereals, seeds and some types of nuts are useful.

There is no need to limit your meat consumption, but It is better to replace some meat products with sea fish.

Bath, sauna, beach

Is it possible to visit the bathhouse if you have endometriosis, go to the sauna or take sunbathing?

Heat treatments are believed to contribute to the progression of endometriosis, however, the presence of a diagnosis is not an absolute contraindication.

If visiting a sauna, steam bath or bath leads to a deterioration in your health, then it is better to abstain from them.

This question should be asked to your gynecologist, who monitors the dynamics of the disease, and follow his recommendations. Is it possible to sunbathe with endometriosis?, largely depends on the specific clinical case. If a doctor recommends abstaining from sunbathing, you should ignore his recommendations.

Sports and physical activity

An active lifestyle has never been harmful, provided that the loads are feasible and training does not cause a deterioration in well-being.

Exercise reduces estrogen levels in the blood. When choosing a sport for yourself, it is advisable to consult a doctor.

Is it possible to have sex

Contraception methods

One of the methods of treating endometriosis is hormonal therapy.. Oral contraceptives are prescribed for therapeutic purposes.

Is it possible to insert an IUD for endometriosis? The intrauterine device is considered to be a factor that provokes the development of the disease. Therefore, the decision on the possible installation of a therapeutic IUD is made individually, taking into account the characteristics of the clinical case.

Contraindications

Women with diagnosed endometriosis are better off give up tampons. They can impede the flow of blood, which increases pain and provokes the progression of the disease.

Prevention

Since the causes and mechanisms of development of the disease are not clear, Primary prevention measures come down to early diagnosis and treatment of the disease.

Endometriosis is not a death sentence. With timely detection and treatment, the disease can be successfully kept under control; it will have almost no effect on the quality of life in all its manifestations.

The inside of the uterine cavity of a healthy woman consists of a unique tissue - the endometrium. Depending on the phase of a woman’s menstrual cycle, the endometrium changes: it gradually grows, and during menstruation it is rejected by the uterus and comes out.

But sometimes the endometrium begins to appear not only in the uterus, but also in the ovaries, bladder, rectum, scar after Caesarean section, and even in organs and tissues distant from the uterus. In this case, the work of these organs can be significantly disrupted.

How to treat endometriosis, why does this disease appear and what are its symptoms?

Endometriosis is a pathological hormone-dependent process in which there is a proliferation of glandular tissue of the uterus (namely, the endometrium) outside it, in other organs and tissues: ovaries, fallopian tubes, in the thickness of the uterus, bladder, peritoneal surface, in the rectum, etc. Fragments of the endometrium, growing in other organs, undergo the same cyclic 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 affected organ in volume, monthly bleeding from heterotopias, menstrual dysfunction, discharge from the mammary glands, and infertility.

Endometriosis is very common in the population. In terms of frequency of occurrence among gynecological pathologies, it is surpassed only by inflammatory diseases and uterine fibroids.

The vast majority of detected cases of endometriosis occur during the reproductive period. It is also diagnosed in approximately 10% of girls during the formation of menstrual function and in 2-5% of cases in women during menopause.

Causes of endometriosis

Unfortunately, scientists do not yet know the exact causes of endometriosis in women, despite numerous studies and experiments in this area. Usually it is weak immunity that “allows” the endometrium to settle where it is not needed. Doctors also trace the connection between this disease and such causes as pathological childbirth, repeated surgical abortions, Caesarean section, installation of spirals, cauterization of erosion, chronic inflammatory processes of the small pelvis.

However, most often gynecologists are inclined to believe that the cause of the disease is a genetic predisposition against the background of hormonal imbalance. After all, the disease manifests itself only during menstruation. With the onset of menopause or pregnancy, the painful process stops and sometimes disappears completely.

Many experts are inclined to the theory of retrograde menstruation (or implantation theory). According to this theory, some women experience reflux of menstrual blood with endometrial particles into the abdominal cavity and fallopian tubes. In some cases, endometrial cells, attaching to the tissues of various organs, continue to function cyclically. In the absence of pregnancy, the endometrium is rejected from the uterus during menstruation, while microhemorrhage occurs in other organs, accompanied by the development of an inflammatory process.

Predictive factors for endometriosis:

features in the structure of the fallopian tubes,
immunosuppression,
heredity.

The role of hereditary predisposition in the development of endometriosis is beyond doubt. Therefore, it is believed that the likelihood of transmitting this disease from mother to daughter is quite high.

Other theories of the development of endometriosis, which are not widespread, consider gene mutations, deviations in the functions of cellular enzymes, and failure of the reaction of receptors in relation to hormones as one of the possible causes.

Symptoms of endometriosis

The course of endometriosis can be varied. The onset is usually asymptomatic. That is why its presence can be detected in time only with regular medical examinations. However, there are reliable symptoms indicating the presence of endometriosis.

Pelvic pain. Accompanies endometriosis in 16-24% of patients. The pain can be clearly localized or diffuse throughout the pelvis, occur or intensify immediately before menstruation, or be present constantly. Often, pelvic pain is caused by inflammation that develops in organs affected by endometriosis.

Painful sexual intercourse (dyspareunia). Discomfort and pain during sexual intercourse are especially pronounced when foci of endometriosis are localized in the vagina, the wall of the rectovaginal septum, in the area of the uterosacral ligaments, and the utero-rectal space.

Pain when defecating or urinating.

Menorrhagia is heavy and prolonged menstruation. It is observed in 2-16% of patients with endometriosis. Often accompanies adenomyosis and concomitant diseases: uterine fibroids, polycystic ovary syndrome, etc.

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.

Classification of endometriosis

Based on localization, genital and extragenital forms of endometriosis are distinguished.

In the genital form of endometriosis there are:

peritoneal endometriosis - with damage to the ovaries, pelvic peritoneum and fallopian tubes;
extraperitoneal endometriosis, localized in the lower parts of the reproductive system - the external genitalia, vagina, vaginal segment of the cervix, rectovaginal septum, etc.;
internal endometriosis (adenomyosis), developing in the muscular layer of the uterus. With adenomyosis, the uterus becomes spherical in shape, increasing in size until 5-6 weeks of pregnancy.

The localization of endometriosis can also be mixed, as a rule, in the absence of timely detection and treatment of the disease.

In the extragenital form of endometriosis, foci of heterotopia appear in the intestines, lungs, kidneys, in the area of the umbilical ring and postoperative scars.

There are 4 degrees of endometriosis, which depend on the depth and distribution of focal growths of the endometrium:

I degree - foci of endometriosis are superficial and isolated;

II degree - foci of endometriosis are deeper, in greater numbers;

III degree - deep multiple foci of endometriosis, endometrioid cysts on one or both ovaries, individual adhesions on the peritoneum;

IV degree - multiple and deep foci of endomeriosis, bilateral large endometrioid cysts on the ovaries, dense adhesions, growth of the endometrium into the walls of the vagina and rectum. IV degree of endometriosis is characterized by the prevalence and severity of the lesion and is difficult to treat.

According to the degree of damage to the myometrium, there is a classification of uterine adenomyosis (internal endometriosis), the development of which is divided into four stages:

Stage I – initial growth of the myometrium;

Stage II – the spread of endometriosis foci to half the depth of the muscular layer of the uterus;

Stage III – germination of the entire thickness of the myometrium up to the serous membrane of the uterus;

Stage IV – germination of the walls of the uterus with the spread of foci of endometriosis to the peritoneum.

Endometriotic lesions can vary in size and shape: from round formations several millimeters in size to shapeless growths several centimeters in diameter. They usually have a dark cherry color and are separated from the surrounding tissue 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 tissue or be located superficially. Ovarian endometriosis is expressed in the appearance of cystic growths with dark red contents. Heterotopias are usually located in groups.

The degree of endometriosis is assessed in points, taking into account the diameter, depth of germination and localization of lesions. Endometriosis is often the cause of adhesions in the pelvis, limiting the mobility of the ovaries, fallopian tubes, and uterus, leading to menstrual irregularities and infertility.

What are the dangers of endometriosis?

Often, endometriosis can be asymptomatic, gradually leading to infertility. Numerous adhesions that form during endometriosis provoke obstruction of the fallopian tubes, as a result of which pregnancy becomes impossible. Statistics show that about half of infertility cases are the result of untreated endometriosis.

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

Endometriosis sharply reduces the chances of bearing a child and can provoke spontaneous miscarriage, so pregnancy management with endometriosis should be carried out with constant medical supervision. The probability of pregnancy after treatment for endometriosis ranges from 15 to 56% in the first 6-14 months.

Complications of endometriosis

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

Diagnosis of endometriosis

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, anamnesis, in which pain is indicative, information about previous diseases of the genital organs, operations, and the presence of gynecological pathology in relatives. Further examination of a woman suspected of having endometriosis may include:

gynecological examination (vaginal, rectovaginal, speculum) is most informative on the eve of menstruation;
colposcopy and hysterosalpingoscopy to clarify the location and shape of the lesion and obtain a tissue biopsy;
ultrasound examination of the pelvic organs and 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 foci of endometriosis, assess their number, degree of maturity, and activity;
hysterosalpingography (X-rays of the fallopian tubes and uterus), hysteroscopy (endoscopic examination of the uterine cavity), which allows diagnosing adenomyosis with an accuracy of 83%;
study of tumor markers CA 125, CEA and CA 19-9 and PO test, the levels of which in the blood increase several times during endometriosis.

Treatment of endometriosis

Therapeutic tactics depend on various factors: the woman’s age, her plans for pregnancy, location, prevalence of endometriosis, number of pregnancies, births, and the presence of other diseases of the pelvic organs.

Treatment methods for endometriosis are divided into medications, surgical (laparoscopic with removal of foci of endometriosis and preservation of the organ, or radical - removal of the ovaries and uterus) and combined.

Treatment of endometriosis aims not only to eliminate the active manifestations of the disease, but also its consequences (adhesions, cystic formations, neuropsychiatric manifestations, etc.).

Indications for conservative treatment of endometriosis are its asymptomatic course, the patient’s young age, premenopause, and the need to preserve or restore reproductive function. The leading method of drug treatment for endometriosis is hormone therapy with the following groups of drugs:

combined estrogen-gestagen drugs (Marvelon, Silest, Nonovlon, etc.). These drugs, containing small doses of gestagens, suppress the production of estrogen with ovulation. Indicated at the initial stage of endometriosis, because they are not effective in cases of widespread endometrioid process and ovarian cysts. Side effects include nausea, vomiting, intermenstrual bleeding, and tenderness of the mammary glands.

gestagens (norkolut, uterozhestan, nemestran, duphaston). Indicated at any stage of endometriosis, continuously - from 6 to 8 months. Taking gestagens may be accompanied by intermenstrual bleeding, depression, and soreness of the mammary glands.

antigonadotropic drugs (danazol, danogen, danol, etc.). Suppress the production of gonadotropins by the hypothalamic-pituitary system. Used continuously for 6-8 months. Contraindicated in case of intrinsic hyperandrogenism (excess of androgenic hormones). Side effects include sweating, hot flashes, weight gain, deepening of the voice, increased oiliness of the skin, increased intensity of hair growth.

agonists of gonadotropic releasing hormones (triptorelin, goserelin, etc.). The advantage of drugs in this group for the treatment of endometriosis is the possibility of using the drugs once a month, the absence of serious side effects. Releasing hormone agonists cause suppression of the ovulation process and estrogen levels, leading to suppression of the spread of endometriosis.

In addition to hormonal drugs, immunostimulants and symptomatic therapy are used in the treatment of endometriosis: antispasmodics, analgesics, anti-inflammatory drugs.

Organ-preserving surgical treatment with removal of heterotopias is indicated for moderate and severe stages of endometriosis. Treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, and dissecting adhesions. It is carried out in the absence of the expected effect of drug therapy, the presence of contraindications or intolerance to medications, 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 by laparoscopic or laparotomic approaches.

Radical surgical treatment of endometriosis (hysterectomy and removal of appendages) is performed for patients over the age of 40 with active progression of the disease and 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.

Endometriosis has a tendency to recur, which sometimes makes it necessary to resort to repeated surgery. Relapses of endometriosis occur in 15-40% of patients and depend on the prevalence of the process, its severity, localization, and the radical nature of the first operation.

During childbearing age, the success of endometriosis treatment is determined by the restoration or preservation of reproductive function. With the modern level of surgical gynecology and the widespread use of gentle 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.

Most often, medical and surgical methods are used in combination. Conservative treatment consists of prescribing hormonal drugs that suppress the activity of the ovaries, as well as drugs that strengthen the woman’s immune system.

Endometriotic ovarian cysts, as well as extensive endometriosis, if it is combined with uterine fibroids, must be operated on. Surgery is also performed if conservative treatment methods are ineffective, or if endometriosis progresses during treatment.

Prevention of endometriosis

A woman can often recognize the early manifestations of endometriosis on her own if she is sufficiently attentive to herself. The disease in the early stages may be indicated by disruptions in the menstrual cycle along with mood changes, nervousness, and headaches. If unpleasant symptoms occur, it is better not to wait for severe pain to occur, but to immediately seek medical help.

Attempts at self-treatment or wait-and-see tactics regarding 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 preventing endometriosis are:

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

The risk of developing endometriosis is higher in the following groups of women:

those who note a shortening of the menstrual cycle;
suffering from metabolic disorders, obesity, overweight;
using intrauterine contraceptives;
after the age of 30-35 years;
having elevated estrogen levels;
those suffering from immunosuppression;
having a hereditary predisposition;
who have undergone uterine surgery;
smoking women.

Endometriosis is an inflammatory process in which the cells of the epithelial layer lining the inner surface of the uterus grow beyond the organ. Doctors consider hormonal disorders to be the main cause of the pathology. In most women, endometriosis develops as a result of a lack or, conversely, increased synthesis of estrogen - the main female hormone that regulates the activity of the reproductive system, reproductive organs and is responsible for the appearance of skin, nails and hair.

To determine which hormone caused pathological changes in the epithelium, diagnostic curettage is performed. The resulting material is sent for histological examination, based on the results of which the woman is prescribed treatment. It is necessary to start therapy for this disease as early as possible, since complications of chronic endometriosis can be various gynecological diseases, breakthrough uterine bleeding and infertility. To do this, it is important to know the symptoms and signs of pathology.

Endometriosis does not have pronounced clinical symptoms, so it is impossible to diagnose the disease without a special examination. Even an examination on a chair using a gynecological speculum does not always allow one to determine the pathological growth of endometrial cells, so the symptoms of the disease must be treated very carefully. It is important to inform your doctor about all existing disorders, because endometriosis is characterized by a combination of four signs that appear in almost every woman with endometriosis.

Infertility

The diagnosis of infertility is made if pregnancy does not occur after a year of regular sexual activity without the use of contraceptive methods. The main reason for the lack of pregnancy with endometriosis is anatomical changes in the endometrium, which make it impossible for the attachment and preservation of a fertilized egg. Hormonal disruptions that cause pathological growth and changes in the structure of the endometrium affect the synthesis of hormones necessary for the development of pregnancy.

If the cells of the epithelial layer extend beyond the organ (to the ovaries, cervix, fallopian tubes, etc.), adhesions can form in the space of the fallopian tubes - compacted areas of connective tissue that connect two or more organs. The adhesive process causes obstruction of the fallopian tube - one of the causes of infertility in internal endometriosis.

Note! Chronic endometriosis negatively affects the state of the immune system and inhibits its activity. Even if pregnancy occurs, the probability of its termination or fetal death will be very high - more than 65%.

Pain syndrome

Pain with endometriosis can have a different nature, intensity and localization. Acute pain is usually cutting or stabbing, localized in the lower abdomen. Chronic pain can be dull and nagging. Their intensity is usually moderate, so most women do not pay attention to them, mistaking this sign for manifestations of premenstrual syndrome or the result of increased stress.

Chronic pain with endometriosis can increase when exposed to the following factors:

intimacy;
menstrual flow;
lifting weights.

Important! Pain in chronic endometriosis is easily relieved with painkillers, so many people ignore this symptom. A distinctive feature is a constant, chronic course, that is, the symptom weakens or disappears while the drug is in effect, after which the pain returns.

Bleeding

In almost all cases of endometriosis, regardless of its location, a woman is bothered by contact bleeding that appears after sexual intercourse. If the lesion affects the organs of the genitourinary system or parts of the intestines, drops of blood or blood streaks may be found in the urine or feces.

A slight discharge of blood with severe pain is observed several days before the onset of menstruation (about 4-5 days). The bleeding usually lasts 1-3 days, after which it goes away, and after 24-48 hours the woman begins menstruation.

Menstruation may be accompanied by the formation of dark scarlet or brown blood clots. Their size can reach several centimeters, and their appearance is somewhat reminiscent of raw liver. Clots themselves are not a symptom of endometriosis, as they can also occur with other pathologies (for example, endometrial hyperplasia), but in combination with other signs, pathological growth of epithelial cells can almost certainly be suspected.

Irregular menstrual cycle

Women with this disease always experience menstrual irregularities. These include:

constant cycle fluctuations;
absence of menstruation for several months in a row;
heavy and prolonged menstruation (menorrhagia).

In case of any cycle disruptions, women should immediately consult a doctor, since in the absence of timely treatment, the risk of serious consequences and complications will be very high. Untreated endometriosis can lead to the formation of benign tumors, infertility, and inflammatory processes.

Signs and symptoms of different types of endometriosis

Sign	Internal endometriosis	External form of pathology (vaginal walls and cervix are affected)	Cystic formations of the ovaries
Painful bleeding before the onset of menstruation	Yes	No	Yes
Cycle disruption	Yes	Yes	Yes
Drainage of blood during or after intimacy	Yes	Yes	Yes
Menorrhagia (heavy menstruation that lasts more than 7 days)	Yes	No	No
Pain in the lower abdomen during sexual intercourse or menstruation	Yes	Yes	No
Lack of pregnancy for 1 year without using contraception	Yes	Yes	In most cases

Video: Doctor Myasnikov about endometriosis

The role of psychological factor in diagnosis

Almost 80% of women with chronic forms of endometriosis have psychological problems. They are prone to depressive disorders, psychosis, their emotional state is disturbed, and there is a tendency to sudden mood swings. Some women may completely lose interest in events happening around them. They stop taking care of their appearance, reduce communication with friends and loved ones, and avoid appearing in public places.

A distinctive symptom of the pathology (subject to the presence of other clinical manifestations) is anxiety, causeless fear. In particularly severe cases, panic attacks may occur.

Important! Some women start taking sedatives to cope with emerging psychological problems. It is important to understand that such treatment will give short-term results, since the cause of the pathology will not go away.

How does the disease manifest in older women?

Some people mistakenly believe that endometriosis is a disease of women of reproductive age. Pathological growth of the endometrium beyond the epithelial layer can occur at any age, and in women over 45 years of age, the risk of developing the disease is several times higher, since after menopause the production of progesterone is blocked. Other factors that are often found in older women can also contribute to the occurrence of pathology. These include:

excess body weight;
diabetes;
disorders of the thyroid gland;
a large number of infectious diseases in history;
previous operations (regardless of the location of the pathological process).

Elderly women suffering from endometriosis often experience headaches, dizziness, and attacks of nausea. In severe cases, one-time vomiting is possible. The pain syndrome is usually of mild or moderate intensity, exacerbations are rare. The psychological state of a woman also differs from normal indicators: irritability, aggression towards others, and tearfulness appear.

Important! A distinctive sign of the disease during menopause is bleeding. They can be light (bleeding) or voluminous - in this case we are talking about bleeding. This clinical picture is typical for uterine endometriosis.

Ovarian endometriosis: signs

The consequence of endometriosis is the appearance of cystic formations. The main symptom of this pathology is pain, which is most often permanent and intensifies after intense exercise or intimacy. Menstruation with ovarian endometriosis is painful; the use of medications often does not bring significant relief.

Ovarian endometriosis can be distinguished from other forms of the disease by the characteristic shooting pain in the perineum, rectum and lumbar region. Pain syndrome occurs at any time of the day and does not depend on the woman’s physical activity. At night, when the muscles and ligaments are relaxed, the pain may be more intense.

Cervical endometriosis: clinical picture of the disease

Damage to the cervical part of the uterine body is the only form of endometriosis in which there is virtually no pain (in rare cases, pain may be mild). This is due to the fact that there are no nerve endings or pain receptors on the neck. Pathology can be suspected by uncharacteristic bleeding in the second half of the menstrual cycle. Bleeding can also be observed before the onset of menstruation - it usually lasts 2-3 days and does not cause discomfort, unlike internal endometriosis.

Video: Endometriosis - symptoms, treatment

Symptoms of internal endometriosis

On an ultrasound, the doctor detects nodular formations on the surface of the uterus, which indicate the development of pathology. During palpation of the uterus, severe pain appears. During the period between menstruation, the pain is localized mainly in the lower abdomen and is acute. The intensity of sensations increases during sexual contact and lifting heavy objects. If you examine a woman’s blood during this period, you can notice signs of anemia, which are associated with constant bleeding.

Symptoms of illness after cesarean section

Delivery by caesarean section is considered a simple operation (in terms of technique), but it is important that it is performed by a qualified surgeon. It is also worth checking with your doctor what kind of material will be used for suturing, since some types of surgical threads can cause itching, discomfort in the suture area and increase the risk of gynecological pathologies.

The proliferation of epithelial cells in the area of the suture and postoperative scar occurs in 20% of cases. You can suspect pathological changes in a woman’s body after a cesarean section based on the following symptoms:

poor healing of the scar surface;
discharge of brown liquid from the seam;
severe itching in the suture area;
palpating nodules under the sutures;
severe nagging pain in the lower abdomen.

If these signs are detected, the woman is advised to contact the antenatal clinic and see the doctor who managed the pregnancy. In some cases, hospitalization may be required to exclude suppuration and inflammation of the sutures, so pathological symptoms should not be ignored.

Diagnosis of the disease

Endometriosis is a disease that is difficult to diagnose due to a vague clinical picture, since the pathology has signs and symptoms characteristic of most gynecological diseases. Even during an examination, it is not always possible to determine the presence of pathology. The doctor will be able to suspect endometriosis during palpation of the vagina and rectum if nodules or cysts are detected.

Examination and palpation alone are usually not enough to diagnose the disease, so the doctor must prescribe additional procedures, for example, ultrasound of the pelvic organs. The examination can be performed abdominally (through the skin of the abdomen) or using a vaginal ultrasound probe, which is inserted into the vagina. Ultrasound is not a 100% informative method for diagnosing endometriosis, but with the help of this examination the presence of cystic cavities can be detected.

If there is any doubt, the woman will undergo laparoscopy. This operation is performed under local anesthesia or general anesthesia and can be used not only for diagnostic purposes, but also for the treatment of pathology. Laparoscopy rarely causes complications, but to prevent consequences, it is important to maintain sexual rest after the procedure (at least 2-4 weeks).

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

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

Classification

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

Forms of genital endometriosis:

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

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

Causes and mechanisms of development

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

Theories of pathology development

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

Predisposing factors

Hormonal and immune abnormalities are of great importance in the pathogenesis of endometriosis.

In patients, the secretion of progesterone is disrupted and its binding changes. There is an increased level of estrogens, which stimulate endometrial growth. Quite often, such patients have elevated prolactin levels and dysfunction of the adrenal cortex.

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

Clinical picture

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

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

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

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

Cervical endometriosis is accompanied by spotting before menstruation or during sexual intercourse. If the cervical canal is damaged, nagging pain in the lower abdomen may appear.

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

Damage to the perineum and rectum is accompanied by pain during defecation.

Retrocervical endometriosis is accompanied by signs of compression of the nerve plexuses and rectum. Patients complain of aching pain in the pelvis, intensifying before menstruation, radiating to the lower back and hips. Constipation often occurs, and an admixture of mucus and blood appears in the stool.

Ovarian endometriosis is accompanied by aching pain in the lower abdomen before menstruation. It may worsen with physical activity or sexual contact. There is a high risk of developing infertility.

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

Diagnostics

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

A two-manual gynecological examination is most informative before the onset of menstruation. Depending on the location of the lesions, enlargement and tenderness of the uterus, nodes in the thickness of the vaginal wall or behind it, and limited mobility of the uterus and ovaries may be detected.

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

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