Endometriosis of the uterus: what is it, why is it dangerous, symptoms, signs and treatment in an accessible language. Endometriosis: causes, forms, diagnosis, treatment of the disease in adults and children Endometriosis causes symptoms treatment

One of the pathologies of the female body included in the practice of gynecology is endometriosis, the symptoms and treatment of which can be determined and prescribed with full confidence only by a doctor. Endometriosis is characterized by a different manifestation and in the initial stages, the symptoms can be attributed to another disease.

When you need to contact a gynecologist, if his visit for a lady is not a permanent visit, as provided for every representative of the fair half once every six months. What symptoms clearly indicate endometriosis, the treatment of which requires a serious attitude of the patient and referral to an experienced specialist? Details in the article.

What is endometriosis?

Endometriosis is only a female disease associated with her reproductive function. In a woman of reproductive age, if there are no gynecological pathologies, menstruation occurs every month, which is mucus accumulated in the uterus during the preparation of the genital organs for conception.

If fertilization does not occur, the process of renewal of the uterine mucosa, the so-called endometrium, starts, and the expulsion of the corpus luteum, dead egg and exfoliated endometrium from the uterine cavity and ovarian cavity. At the exit from the vagina, it looks like a total blood mass interspersed with clots, mucus. This is a normal process for a healthy woman.

But for reasons not fully established, in some women, the exfoliated endometrium not only comes out, as expected, but is also thrown into the internal organs. (fallopian tubes, on the walls of the uterus, into the abdominal cavity and beyond), where it attaches to the mucous walls of these organs and begins to grow (this is endometriosis). In gynecology, wandering endometrial tissues are commonly referred to as endometrioid heterotopias.

The situation is complicated by the fact that this wandering endometrium continues to function in the same way as in the reproductive organs during the menstrual cycle. More precisely, the tissue is regenerated throughout the cycle and at the time of menstruation, particles of the old endometrium (heterotopies) exfoliate and rush further, joining in the same organ or, together with the flow of blood or plasma, travels through the body.

Foci of endometriosis are found in the cavity of the lungs, kidneys, heart, eyes, on the nasal mucosa. Such reproduction of the endometrium throughout the body makes it difficult to diagnose and treat endometriosis, because the symptoms that patients complain about do not always indicate a gynecological problem.

The complexity of the treatment of endometriosis is that the symptoms may not appear immediately, but after a long time, when conservative treatment can only eliminate somatic symptoms. And overgrown tissue with endometriosis has to be removed surgically.

Wikipedia gives the following definition of what endometriosis is - it is "a gynecological disease in which the cells of the endometrium (uterine inner layer) grow outside this layer", that is, the endometrium of the uterus, where it should be by the nature of the structure of the female genital organs. Endometrioid tissue, referring to Wikipedia, is endowed with hormone receptors, like the inner layer of the walls of the uterus, and therefore undergoes the same changes expressed in monthly bleeding.

Only bleeding in endometriosis from heterotopia enters the cavity of the affected organs, causing certain symptoms - pain, an increase in the size of organs, adhesions in the abdominal cavity, with damage to the reproductive organs - infertility. These are complications of endometriosis.

Bleeding in endometriosis provokes an inflammatory process in the surrounding tissues.

Having understood what endometriosis is, you need to clearly understand what symptoms accompany endometriosis, so as not to miss the moment when the treatment will be effective.

Attention: Do not forget that endometriosis is dangerous for infertility or the impossibility of carrying a pregnancy, because endometrioid nodules will interfere with the development of the embryo or placenta.

Different forms of endometriosis cause different symptoms

Before talking about the symptoms and treatment of endometriosis, it is necessary to consider the types of endometriosis by location and degree of growth.

There are two classifications of endometriosis in gynecology according to the place of formation of endometrioid nodes:

Genital endometriosis

The tissue grows only in the genitals of a woman. Endometrium can settle only inside the uterus (internal genital endometriosis) or go beyond it and rush into other reproductive organs - fallopian tubes, ovaries, vagina, abdominal pelvic cavity (external genital endometriosis).

If we approach the issue of classification of genital endometriosis in more detail, then in gynecology there are the following terms:

• The defeat of the endometrium of the ovaries, pelvic cavity, fallopian tubes is defined as peritoneal endometriosis.
• The defeat of the vagina, cervix, rectovaginal septum is defined as extraperitoneal endometriosis.
• Attachment of nodules directly to the walls of the uterus is called internal endometriosis or adenomyosis. A symptom of such localization of heterotopias is an increase in the size of the uterus until the gestational age of five or six weeks, although there was no fertilization. In this case, some ladies perceive the growth of the endometrium as a banal weight gain, although the situation is much more complicated.

Extragenital endometriosis

The endometrium with the flow of blood or lymph scatters throughout the body and they can be found in the most unexpected places that have nothing to do with the genitals. Endometriosis is formed in the gastrointestinal tract, urinary system, in the upper respiratory tract.

Quite often, gynecologists diagnose a mixed form of endometriosis, when there are pathological changes in the reproductive organs and in systems far from the sexual one.

Usually these are the advanced stages of endometriosis, when the woman simply ignored the symptoms of endometriosis and did not seek treatment, or the symptoms of endometriosis were hidden until a certain point and the lady felt great. Although during a preventive examination by a gynecologist, visual symptoms of endometriosis still appear, and if a gynecologist suspects a disease, the patient is prescribed an additional examination and the necessary treatment.

In addition to the classification of endometriosis by location, there is a gradation of pathology according to the degree of growth of endometrioid nodes:

A separate classification has intrauterine endometriosis (adenomyosis), because the degree of growth in the walls of the uterus have a different degree. Sometimes the treatment of endometriosis involves the complete removal of the uterus to avoid degeneration into malignant tumors.

Signs of endometriosis are clearly manifested in the premenstrual period, a few days before the onset of menstruation. Some ladies consider this the norm, because from adolescence they experience pain during menstruation and do not seek treatment. But the symptoms of pain in endometriosis are stronger and can be expressed in attacks that cannot be stopped even with strong analgesics.

Important: To remove the symptom of pain in endometriosis is possible only with special treatment, which is provided for endometriosis.

The main symptoms of endometriosis

There are different symptoms of endometriosis that patients report at the doctor's office. But they talk about them only at the moment when endometriosis is already in an advanced stage and serious treatment of endometriosis is required.

At the initial stage of endometriosis, there are no specific symptoms indicating this particular gynecological disease. Specific symptoms may appear only when endometriosis progresses to the second, third or fourth degree of endometriosis. What to look for:

Symptoms of endometriosis are presented in a single manifestation or in a complex. Depends on the localization of endometriosis and the degree of progression of gynecological pathology. The earlier the diagnosis is made, the more effective the treatment of endometriosis and the complete elimination of the problem is possible.

What triggers the development of endometriosis

Research into the causes leading to improper disposal of waste material of the menstrual cycle is still ongoing. There are several theories that cannot be recognized as the only true ones, but it is worth knowing about them:

1. One of the assumptions regarding the causes of endometriosis is the theory of retrograde menstruation. Most physicians tend to justify this justification. The bottom line is that at the moment of expulsion of exfoliated tissue, part of the endometrium rushes not into the vaginal cavity, but in the other direction, more precisely, into the cavity of the fallopian tubes or the abdominal cavity. Under favorable conditions, the endometrium is attached to the walls of organs and continues to exist cyclically. In the absence of pregnancy, under the influence of hormones, hemorrhage occurs, only not outward, as provided by nature, but in the same cavity where the exfoliated endometrium from the uterus fell under the prevailing conditions. Inflammation appears due to the presence of foreign tissue in the organ, particles of the endometrium with blood. The phenomenon of retrograde menstruation may be present in a woman, but certain conditions become the impetus for the development of endometriosis - heredity from the mother, the physiological structure of the fallopian tubes, depression, and decreased immunity.
2. The second theory is inclined to believe that the cause of the development of endometriosis is a gene mutation.. There is an assumption that in the genes of some people there are rudiments of endometriosis, which, under certain conditions, are activated and lead to serious female pathology. There is no practical evidence for this.
3. The third theory is based on the fact that during embryonic development, part of the endometrium from the uterus enters the body of the future girl and eventually manifests itself in the form of endometriosis.

Regardless of what exactly is the root cause of such a complex process leading to the disease, the factors that help trigger this mechanism are well established:

• Any inflammatory processes in the genital tract that have frequent episodes, but without proper treatment.
• Instrumental interventions in the female reproductive system, for example, turnover and other operations, treatment methods.
• Severe birth process requiring treatment.
• Tumors, malignant or benign, in the area of ​​the uterus or other reproductive organs, the treatment of which did not give a positive result.
• Anemia, the treatment of which requires a separate approach.
• Addiction to alcohol, tobacco.
• Hypothermia.
• Colds and viral diseases, the treatment of which has not been completed.
• Pathologies in the endocrine system, for example, dysfunction of the thyroid gland or other glandular organs responsible for the synthesis of hormones.
• Weakened immunity.
• Autoimmune diseases.

Important: Finding the exact cause of endometriosis is difficult, but you need to pay attention to the symptoms in order for the medical treatment of endometriosis to be effective.

The key to effective treatment of endometriosis is correct and timely diagnosis.

Gynecologists constantly urge women to check up twice a year so as not to miss the symptoms of a serious gynecological pathology. In the case of endometriosis, this is doubly true, because endometrial damage to various organs is considered one of the most serious and dangerous diseases of a woman, who do not always have vivid symptoms and can be treated due to a late visit to the doctor.

The following diagnostic procedures are required to confirm and treat endometriosis indicated by symptoms:

1. Examination by a gynecologist on an examination chair using special instruments. It is better to conduct such a study on the eve of menstruation.
2. Collection of biomaterial from the genital organs during colposcopy and hysterosalpingoscopy.
3. Ultrasound of the pelvic organs and abdominal cavity to clarify the place of attachment of the endometrium and the overall clinical picture to select a method for treating endometriosis.
4. Radiography of the fallopian tubes and uterus to determine endometriosis in the cavity of these organs and the degree of their reproduction.
5. Computer or magnetic resonance imaging of the whole body to detect endometriosis foci not only in the reproductive system, but also in other organs and tissues.
6. Laparoscopy to examine the focus of endometriosis and assess the prospects for treatment.
7. Special blood tests for markers of various types of tumors (malignant, benign). If there are foci of endometriosis in the body, then the indicators of these studies will be exceeded.

If the listed methods of research on endometriosis are not enough to make an accurate diagnosis, shape, size and localization of the endometrium, the gynecologist will suggest additional procedures.

Principles of treatment of endometriosis

The treatment of endometriosis is complex and complex, but the choice of technique depends on the specific condition of the patient, the symptoms of endometriosis, her age, the presence of children, the general physical form, the presence of a history of surgical interventions in the female genital organs, the neglect of the disease and the desired result.

There are the following ways to treat endometriosis:

• Medical- it is used for symptoms of the initial stage of endometriosis, when the foci are not widely localized or the nodules have not reached such sizes that they block the functions of the affected organs. If the goal of treatment for symptoms is to preserve the ability to become pregnant, doctors gradually prescribe different types of drugs that should stop the progressing process of endometriosis. The phase of ovulation can be blocked for a while so that menstruation does not occur, then the foci of endometriosis will not pour out blood in the wrong place and continue to multiply, the symptoms of endometriosis may disappear. Hormone therapy comes first in medical treatment. The production of the female hormone estrogen and the process of ovulation are suppressed. Treatment with hormonal drugs lasts from 3 to 8 months to exclude the casting of a new batch of endometrial tissue. There may be side effects from treatment. Together with hormones for endometriosis, analgesics, anti-inflammatory drugs, immunostimulants are prescribed to boost natural immunity and remove pain symptoms.

• Surgery it is assumed if medical treatment is not enough or foci of endometriosis reach a diameter of 3 cm and this is a serious threat to a woman. In surgical treatment, preference is given to laparoscopy, if it is necessary to preserve the woman's childbearing function. The surgeon locally removes the endometrioid nodes, which relieves inflammation and relieves pain symptoms with proper treatment. If endometriosis has reached grade IV, then complete removal of the uterus, overlapping of the fallopian tubes is required in order to save the woman's life and remove the source of the cyclic functioning of the endometrium in different parts of the body. This stops the menstrual cycle and the progression of endometriosis too.

Important: You should not treat endometriosis on your own, because only a doctor can choose a treatment regimen based on the clinical picture of a particular patient.

Endometriosis is a very serious gynecological disease that radically changes a woman's life if you do not see a doctor in a timely manner. Do not forget that the symptoms of endometriosis may be sluggish or completely absent until the onset of complications.

Finally

Endometriosis, the symptoms and treatment of which are discussed in detail in the article, may not disturb a woman if she monitors her health and takes preventive measures by visiting a gynecologist once every six months.

At the initial stage, the treatment of endometriosis is effective even with hormone therapy and the childbearing function does not suffer from this. Pregnancy passes calmly under the strict supervision of a gynecologist.

Endometrium is a very common pathology in gynecology: it owns 10% of all female diseases. The early stages of the disease are asymptomatic, and often they learn about the problem too late - when the adhesive process begins to develop in the uterus, accompanied by pain, cycle disturbance and general discomfort. Endometriosis is not a fatal disease, but it can significantly complicate the patient's life: if left untreated, ovarian cancer, problems with childbearing, and relapses may occur.

General description of the disease

Endometriosis is a disease that is quite common in gynecological practice. It is characterized by the growth of endometrial cells outside the inner layer of the uterus.

Reference! The endometrium is the inner mucosa that lines the muscular layer of the uterus. Consists of two layers: basal and functional. The structure and thickness of the basal layer is unchanged, while the functional layer, due to which menstruation occurs, is particularly sensitive and immediately responds to changes in the concentration of female hormones. Particles of the endometrium are washed out of the organ every month during bleeding, however, in some cases, pieces of the membrane stick to the inner walls of the organs (fallopian tubes, ovaries, bladder, intestines) and begin to grow, preventing the blood from freely escaping. It thickens and, accumulating, presses on the nerve endings, causing the patient severe pain, nausea and loss of strength.

The earlier opinion that endometriosis is a disease of mature women after 35 years turned out to be fundamentally wrong. The fact is that a few decades ago, the diagnosis of the disease could only be carried out during an open operation on the abdominal cavity, and such manipulations were done very rarely. Statistics say: in total, 176 million of the fair sex suffer from this disease on the planet, of which 117 million are women from 30 to 50 years old (peak - 40-44 years old), the rest are girls from 14 to 30.

What is the impetus for the onset of the disease is still not exactly clear. The disease can be detected in a woman without serious pathologies and hormonal disorders, but the risk is significantly higher in the group of women who:

• there is a predisposition to endometriosis (the disease was diagnosed in close female relatives);
• there are serious hormonal disorders;
• in the past there were difficult childbirth or caesarean section, abortion or other surgical interventions that affected the organs of the reproductive system;
• often there are cycle failures, delays in menstruation;
• there is a habit on their own, without going to a gynecologist and taking tests, to choose contraceptives for themselves, especially emergency contraception;
• there are infectious and inflammatory diseases of the pelvic organs in a chronic form;
• overweight, addiction to smoking and alcohol.

Classification

There are three forms of uterine endometriosis:

1. Diffuse adenomyosis or internal endometriosis of the uterus. Mucosal cells grow gradually into the submucosal uterine cavity, up to half the depth of the myometrium, changing its structure. It is easily diagnosed using ultrasound and hysteroscopy, as well as during an external examination on a gynecological chair.
2. Nodular adenomyosis. A more dangerous form that affects not only the quality of life, but also the ability to bear children. Main features: formation in the muscle layer of formations in the form of nodes, singly or in groups. Not to be confused with myomatous nodes, the presence inside is not capsules, but glandular and connective tissues. The lesion can also affect the pelvic organs.
3. Focal endometriosis. In this case, a number of organs suffer, in addition to the uterus: appendages, intestines, bladder. Developing, the disease does not affect the entire organ as a whole, but its individual sections. The number of foci increases gradually, they become deeper, the process is accompanied by the growth of cysts in the ovarian region, adhesions on the pelvic organs.

Reference! Adenomyosis is a disease resulting from an imbalance of progesterone and estrogen. An excess of the first substance causes a pathological proliferation of the inner surface of the uterine organ and, in terms of symptoms, the disease is similar to ordinary endometriosis, but there are still several differences. With adenomyosis, the overgrown layer of the uterus does not go beyond it, unlike endometriosis. In addition, in the first case, the disease does not make itself felt until the formation of internal cysts, and with adenomyosis - immediately.

Depth of injury:

• 1 degree.

Endometrial lesions are not deep, affecting only the upper muscle layer. A single ultrasound does not show signs of the disease, the menstrual cycle is normal, there are no problems with conception. The first symptom is abdominal pain before and during menstruation. For diagnosis, ultrasound should be done 2 times: before menstruation and the next day after it. It is cured completely by taking hormonal contraceptives orally and installing an intrauterine device.

• 2 degree.

It is characterized by the germination of cells deeper into the muscle layer. The first cysts are formed on the ovaries (4-5 cm in size), adhesions around the appendages and endometrial foci on the walls of the vagina and cervix. The pain manifests itself in each menstrual cycle, it is shortened, the volume of blood lost increases. In addition to combined oral contraceptives, the treatment regimen includes gestagens (tablets or injections).

Reference! Sometimes doctors recommend conceiving a child at this stage, since hormonal changes during pregnancy can cause endometrial foci to regress.

• 3 degree.

The disease covers the entire muscular wall and reaches the outer layer of the uterus. The number of cysts on the internal organs increases, adhesions between the intestines and appendages are clearly expressed. The foci affect the outer layer of the rectal wall and the cross-muscular ligaments. Blood loss increases during menstruation, a woman during this period feels tired and prone to loss of strength, severe pain, which causes nausea and vomiting. The concomitant diagnosis of anemia is often made. Depending on the age of the patient, she is prescribed either drug hormone therapy with the use of contraceptives and gestagens (at reproductive age), or surgical removal of endometrial foci.

• 4 degree.

The peritoneum and all neighboring organs (bladder, sigmoid and rectum) are already involved in the process. The resulting cysts exceed 6 cm in diameter, arranged in clusters. The patient feels constant pain and worsening of the general condition. Treatment is by surgery only.

Symptoms of endometriosis

The disease does not have a pronounced clinical symptomatology, therefore it is impossible to make a diagnosis without a special examination. However, the presence of four or more signs absolutely accurately indicates a pathology:

• Menstrual disorders, in which menstruation may go longer than usual or be absent for several months.
• Bloody discharge found in urine, feces or after intimacy.
• Prolonged pain syndrome (painful menstruation, pain during sexual intercourse, defecation or urination).
• Problems with conception.
• Abundant uterine bleeding and discharge between periods.
• Nausea, vomiting.
• Constipation, flatulence, bloating.

Complications

Complications include:

• Hormonal imbalance.
• Tubal obstruction.
• Infertility (a woman is diagnosed with infertility if, after a year of regular intercourse without the use of contraceptives, she has not become pregnant).
• miscarriages.
• endometrial cysts.
• Anemia.
• Weakened labor activity, leading to caesarean section, uterine bleeding and hemorrhagic shock.
• Perforation of the walls of the uterus or intestines.
• Intestinal obstruction.
• The occurrence of inflammatory processes in the kidneys, difficulty urinating.
• Peritonitis.
• The formation of malignant tumors.
• Damage to the nerve fibers of the sciatic nerve, lumbosacral and pelvic plexuses.
• neurotic disorders.

Diagnostics

Diagnosis requires an integrated approach:

1. Collection of complaints and anamnesis.
2. Gynecological examination.
3. A blood test for an increase in cancer protein (markers CA-125) and placental protein (PP-14).
4. Ultrasound examination of the pelvic organs.
5. Hysteroscopy.
6. Colposcopy.
7. Metrosalpingography.
8. Magnetic resonance imaging.

Treatment of endometriosis

Treatment can be conservative, surgical and combined. The doctor chooses an option depending on the age of the patient, a history of other diseases, the severity of the course, and a number of others.

Conservative treatment includes anti-inflammatory, hormonal and desensitizing therapy, in addition - a special diet, long walks in the fresh air, physiotherapy exercises. It is prescribed if the disease is asymptomatic, a woman is less than 30 years old, and in cases where it is necessary to restore the ability to conceive a child.

Indications for surgical treatment are: grade 3 and 4 endometriosis, numerous cysts, adenomyosis and endometrial hyperplasia in combination with fibroids, the inability to use hormonal drugs, the lack of effect from treatment 3 months after the start of the procedures.

Important! It is necessary to pay attention to the restoration of the body after operations on the pelvic organs - hirudotherapy, acupuncture, physiotherapy procedures.

Forecast and prevention of endometriosis

Measures to prevent endometriosis:

• Refuse to use tampons - they accumulate bacteria in themselves and disrupt the course of movement of endometrial cells.
• Do not have vaginal sex during your period.
• Limit physical activity on "critical days" (you can not do deep bends, squats).
• Go for a preventive examination by a gynecologist every six months.
• Do not take birth control pills without first consulting a specialist.
• Refrain from prolonged exposure to the scorching sun or in the solarium.

Food

Proper nutrition is important for two reasons: firstly, with the help of certain foods you can correct estrogen levels, and secondly, to support the immune system, which suppresses abnormal cell division.

What is needed:

• Foods rich in vitamins B (cereals, liver, wholemeal flour), C (sea buckthorn, dogwood, dog rose, blackcurrant), A and E (vegetable oil, fish, walnuts, dried apricots).
• Foods high in plant sterols (peas, apples, beans, fennel, parsley and celery).
• Fiber in large volumes (bran, greens, sweet fruits).
• Fatty acids (pumpkin seeds, fish oil).

Attention! Products containing phytoestrogens should be temporarily excluded or reduced to a minimum. These are pomegranates, carrots, spinach, corn, buckwheat and millet, coriander, dill, green tea and beer, whole grains and dairy products, eggs, beef and pork. You should eat in small portions, 4-5 times a day. Avoid fatty, spicy and fried foods, give up coffee and tea.

Conclusion

The earlier the pathology of the uterus is diagnosed, the more effective the treatment will be. Contacting a medical institution for help and following all medical recommendations will help you cope with endometriosis with minimal losses and feel the joy of motherhood in the future. Do not forget to undergo regular preventive examinations and monitor your health.

The changes characteristic of endometriosis are first mentioned in papyri dating back to 1600 BC. e. Since that time, science has stepped far forward, but even now many questions remain unanswered. What the disease looks like in the light of modern knowledge can be found on the basis of an analysis of the scientific papers presented in this article. But in order to understand what endometriosis is in women, it is necessary to understand what the endometrium is.

What is it

The endometrium is the inner lining of the body of the uterus, lining its entire cavity from the inside. It consists of cells with a high growth potential (epithelial), a kind of framework of connective tissue and blood vessels. This is a hormonally dependent tissue: it thickens in the last phases of the menstrual cycle, it is more abundantly supplied with blood, it becomes much richer in glands. This is necessary for the successful implantation of a fertilized egg. If fertilization does not take place, most of the endometrium (functional) falls off and is eliminated from the uterine cavity with menstrual bleeding. After that, the deeper layers begin to restore the lost surface layer.

In modern history, the disease was first described in the middle of the 18th century, and for more than 60 years there have been discussions about what it is and what nature it has - a tumor, hyperplasia, a consequence of the introduction of microorganisms, an immune disorder. Endometriosis of the uterus is a disease that has a chronic relapsing course and is manifested by growths outside the uterus of tissue that strongly resembles the endometrium in function and structure.

Symptoms

Traditionally, endometriosis is divided into extragenital and genital. Genital distinguish between external (perineum, vagina, cervix, fallopian tubes and ovaries, peritoneum, recto-uterine cavity) and internal (exclusively the body of the uterus). Symptoms can be divided into local and general manifestations.

local signs

Locally, the disease manifests itself in the form of foci of various sizes and shapes, made with a fine suspension or without it, easily detected by such an accessible and simple research method as ultrasound:

Diffuse form - small multiple formations 0.1 - 0.7 cm in size, filled with liquid.

Diffuse-nodular form - multiple nodular formations 1-4.5 cm in size, more often without fluid visualized inside, by means of ultrasound.

Nodular form - single, separately located nodes about 4 - 4.5 cm in size, often without liquid.

Endometrioid cysts are rounded formations filled with fluid, up to 12 cm in size.

Internal endometriosis (adenomyosis) is characterized by the appearance in the muscular layer of the uterine body of formations resembling the endometrium. More often it has a diffuse character (80% of cases) and the appearance of small cystic formations randomly located over the area of ​​the myometrium. The number of foci is different. With nodal forms, individual nodes of different sizes are found. Endometrioid cysts, as a rule, reach large sizes and deform the body of the uterus.

Endometriosis of the rectovaginal space is manifested, most often, by single nodes located directly under the cervix, and measuring up to 4.5 cm.

Endometrioid cysts are most often found in the ovaries. 80% have one ovary affected, 16% have both, and 4% have more than 2 cysts in both ovaries.

Endometriosis of the vagina, cervix, perineum in the vast majority of cases has a diffuse character, rarely manifests itself as a nodular form.

General signs

The general symptoms of the disease depend on the localization of the foci, their size and the stage of the process. Pain is the main symptom. In the initial stages of the disease, it is associated with the menstrual cycle: it has a pulling character, is localized in the lumbar region, in the lower abdomen, sharply aggravates immediately before the appearance of discharge. With genital endometriosis, pain occurs during sexual intercourse. With the germination of endometrioid tissue in the surrounding organs, the nature of the pain changes: it becomes constant, sharp, stabbing, gives into the vagina, rectum.

Internal endometriosis (adenomyosis), in addition to pain, is manifested by spotting outside of menstrual bleeding. Allocations are scanty, have a dark "chocolate" color. Menses themselves are plentiful, have a long duration, and with the progression of the disease I acquire the character of menorrhagia - constant, incessant discharge. What kind of discharge is observed, however, does not always indicate the severity of the disease: the endometriotic areas themselves are able to secrete blood, therefore, if there is, for example, a nodular shape and a large size of the focus, there may be abundant discharge in the early stages of the disease.

Causes

Despite the long history of studying endometriosis, it cannot be said that the disease is understood and all the factors that cause it are known. Of the many theories explaining the cause of the occurrence of ectopic foci of growth of endometrioid takinis, the Sampson theory, developed in 1927, has found the greatest application. According to her, the elements of the functional layer of the endometrium rejected during menstrual bleeding pass, due to retrograde blood flow, not only through the cervical canal into the vagina, but also into the abdominal cavity through the fallopian tubes (fallopian tubes). Further, the components of the endometrium are fixed on the inner surface of the peritoneum and their germination occurs. The whole process is completed with the vascularization of a new focus - the formation of the vessels feeding it and combining them with the general blood flow.

Partially, this theory is confirmed by the existence of a certain relationship between the frequency of endometriosis and the structure of the fallopian tubes: in women with a diagnosed disease, the vast majority have a direct location of the intrauterine part of the fallopian tubes. This structure, theoretically, facilitates retrograde blood reflux. The disadvantage of this assumption is that the disease also occurs in women with a tortuous course of the tubes. Moreover, there is no data to reliably say how much the "curvature" of the fallopian tubes affects the likelihood of blood entering the abdominal cavity.

However, retrograde menstruation occurs in 80-90% of women, but only 10% of them are diagnosed with the disease. That is, not only the fact of blood reflux into the abdominal cavity is important, but also the process of fixation itself.

The rejected, functional part of the endometrium has the ability to produce substances (metalloproteinases, or MMPs) that facilitate its "sticking" to tissues. If these enzymes are synthesized in large quantities, the likelihood of fixing fragments of endometrioid tissue increases. The same happens if the substances that inhibit the activity of MMPs have a reduced activity. Helps to increase the activity of the body's own MPP inflammatory response

However, these circumstances are not enough to explain why in some cases the disease develops, while in others it does not. Indeed, having an unnatural localization for them (in the abdominal cavity), foci of endometrioid takinis should have been attacked by components of the immune system, primarily lymphocytes and macrophages. But that doesn't happen. The reason lies in the ability of endometriosis foci to synthesize a number of substances that neutralize the immune response. The suppression of the phagocytic activity of macrophages occurs due to the synthesis of special substances by the ectopic endometrium (located in the wrong place) - prostaglandins E2. At the same time, there is an increased synthesis of enzymes that inactivate T-lymphocytes and lead to their death. However, this theory is not enough to fully explain why in some cases the disease develops and in others not, since the immune response in patients is not always reduced.

Another theory for the development of endometriosis is hormonal. In healthy women, the peritoneal fluid (fluid inside the abdominal cavity) contains high concentrations of the hormone progesterone, which is normally a factor that prevents endometrial cell proliferation, implantation, and survival. In women with endometriosis, a significant decrease in the concentration of this hormone is found in the peritoneal fluid. Evidence of the validity of the theory can be the fact that the disease is often accompanied by unbursting follicle syndrome, a condition in which the level of progesterone in the peritoneal fluid is significantly reduced.

Another cause of endometriosis can be focal transformations of organ membrane cells into cells similar to the endometrial epithelium (metaplistic theory) due to the activation of a number of genes (WNT7A, PAX8). sheaths of the airways.

The genetic theory unites all theories of the origin of the disease, indicating that the causes of increased MPP activity, metaplasia, and hormonal disorders lie behind genetic disorders.

What is dangerous

The course of endometriosis, as a rule, leads to serious violations of psychological well-being, sexual health disorders, a pronounced decrease in the quality of life, and later on to social maladaptation of a woman. Psychological disorders are not the only thing that endometriosis is dangerous for. The consequences of a long-term illness in the form of uterine deformity end in infertility that cannot be treated. In addition, if endometriosis is not treated, over time, its foci will grow into nearby organs, which leads to dysfunction of the latter and the appearance of new symptoms.

Endometriosis is one of the most common diseases, which today occurs in almost every third woman. The disease is characterized by the spread of endometrial cells (the lining of the uterus) outside the uterus to nearby organs. In the process of the development of the disease, cells begin to appear in the internal organs, develop and cause various complications, including tumor-like formations. This disease can lead to a number of serious negative consequences, such as infertility, cancer or fibroids.

Most often, endometriosis occurs in women aged 30 to 45 years, but recently there has been a persistent trend in the occurrence of the disease in younger women. There are characteristic symptoms of endometriosis, which allow you to accurately diagnose the disease and distinguish it from other similar diseases. Let us consider in more detail what this disease is, why it appears and what kind of concomitant clinical picture it has.

How endometriosis appears and develops

During each menstrual cycle, along with spotting, maturation and rejection of the endometrium (the outer layer of the epithelium of the uterine mucosa) occurs. This phenomenon in women is considered the norm. However, due to various reasons, endometrial cells can spread throughout the body.

Through the fallopian tubes, endometrial tissue enters the peritoneal cavity, settles on neighboring organs, or sinks into the inner layers of the uterus, while functioning normally. With each new menstrual cycle, the inflammatory focus of the location of the endometrium begins to increase in volume, swell and bleed heavily.

In this case, the exudate, which is formed by the endometrium, has no way out. That is why women have symptoms such as severe pain and discomfort.

All this leads to the formation of various pathologies that adversely affect the health of a woman. In this case, the question arises: what is the danger of endometriosis? The response to irritation in the abdominal cavity is the occurrence of numerous adhesions in the fallopian tubes. If endometrial cells affect the ovary, then cysts can form, which are the cause of cystosis (polycystic). The existence of such pathologies disrupts the functioning of the reproductive system in women, and there may be a threat of infertility.

Why does endometriosis appear?

To date, there is no definite cause of this disease. However, the causes of endometriosis can be classified according to a number of factors that play a role in the onset of the disease:

1. The phenomenon of retrograde menstruation (reverse menstruation). This process is characterized by the fact that a small amount of blood that comes out during menstruation enters the abdominal cavity through the fallopian tubes. Retrograde menstruation exists in all healthy women, but the immune system in most cases blocks the process of endometrial growth.
2. One of the most common causes of endometriosis is a disorder of the immune system. This reason is directly related to the previous one. Endometrial cells that enter the abdominal cavity are no longer blocked by the immune system, so the disease develops.
3. hereditary predisposition to the disease. It is conditionally believed that women have a significantly increased risk of developing endometriosis of the uterus or cervix if her relatives had a similar disease.
4. All kinds of surgical interventions on the pelvic organs or genitals also increase the risk of developing the disease. Such interventions include numerous abortions and curettage of the uterine cavity during them, caesarean section, and so on.
5. Hormonal disorders. It should be taken into account the fact that endometrial cells are very sensitive to a decrease or increase in the level of hormones in the blood. So, a sharp increase in the amount of estrogen can lead to an increase in foci of inflammatory processes.
6. Less common causes of the disease are the remnants of the Müllerian duct (the precursor of the urogenital system during prenatal development) or general inflammatory processes in the body.

Where can endometriosis occur?

There are several variants of the dislocation of this disease. As a rule, the disease can develop in the pelvic organs (in this case we are talking about genital endometriosis) or in the abdominal cavity (internal endometriosis).

• Endometriosis of the uterus. It is characterized by the formation of a layer of endometrium in the middle layer of the muscular epithelium of the uterus (myometrium). The main symptoms of the disease in this case are severe pain in the lower abdomen and spotting brown or brown-red after menstruation.
• Endometriosis of the ovaries.
• Endometriosis of the cervix. It is the second most common (after the uterus itself) site of localization of the focus of the disease. It arises due to the following reasons: the cervical region is covered with a cylindrical epithelium, while the endometrium is a squamous epithelium. In the process of distribution of the latter, a conflict of tissue types is formed, which is why the disease is formed. There is also retrocervical endometriosis of the cervix, which is characterized by the formation of inflammatory foci on the posterior surface of this organ.
• Vaginal endometriosis.
• Rectovaginal endometriosis. It is characterized by the fact that endometrial cells enter the rectum and cause disease in it.
• Very rarely, internal endometriosis is observed, in which the disease is localized in various internal organs. However, the disease can appear in the pleural cavity, on the diaphragm, in the stomach, intestines, skin, eyes, etc.

Separately, it is worth noting another feature of the development of the disease. When talking about the location of the disease, both internal and external endometriosis can be implied. Both forms originate within the female reproductive system. The internal form occurs in the area of ​​the vagina, rectum, cervix, ovaries, etc. Internal endometriosis of the uterus is characterized by the occurrence of lesions only in the uterine cavity (adenomyosis) and fallopian tubes.

Symptoms and clinical picture

The manifestation of the disease depends entirely on what form it has and where the inflammatory process is localized. In most cases, the symptoms can be very diverse and largely depend on the individual characteristics of the organism. In rare cases, the disease may not manifest itself at all and its timely determination is possible only thanks to a routine medical examination. However, the disease has its own characteristic signs and symptoms.

First of all, external genital endometriosis should be considered. As a rule, the disease is accompanied by symptoms that are completely different from the symptoms of a gynecological disease. The following clinical picture is observed:

• Women experience pain in the area of ​​​​the foci of the disease. But since the disease can be located in completely different places (intestines, lungs, stomach), certain difficulties may arise in the diagnosis. However, there is a clear relationship between the menstrual cycle and periods of exacerbation of the disease.
• With the approach of the menstrual cycle, the pain begins to intensify due to the progressive growth of the endometrium, and after it the pain gradually fades away.
• In most cases, signs of endometriosis in the extragenital form are generally absent and appear only when an adhesive or cystic process occurs. This disease later develops into chronic endometriosis, which has been present in women for many years.

The most common signs that characterize endometriosis of the uterine body are:

• Severe pain syndrome, which manifests itself in 45-60% of all patients.
• Dysmenorrhea, which is especially pronounced 2-3 days before the onset of menstruation and reaches a peak at 2-3 days.
• Endometriosis of the body of the uterus is accompanied by pelvic pain, which is not associated with menstruation. In most cases, such signs indicate the presence of a secondary inflammatory process.
• Severe pain during intercourse.
• Infertility.
• Menorrhagia and other comorbidities.

There are 4 degrees of severity of the disease, and most often in women, endometriosis of 1 and 2 degrees is determined. The clinical picture of the stages is as follows:

• Endometriosis of the 1st degree is accompanied by single superficial foci of the disease.
• Endometriosis 2 degrees there are deeper foci of tissue damage.
• Endometriosis 3 and 4 degrees is accompanied by the formation of numerous cysts and adhesions of the peritoneum.

Definition of endometriosis using diagnostic methods

Diagnosis of endometriosis in some cases can present significant problems, especially with extragenital localization of the endometrium. As a rule, the following diagnostic actions are carried out to determine the disease:

1. Gynecological examination using mirrors;
2. General blood analysis;
3. Endoscopic examination of the uterine cavity (hysteroscopy);
4. Laparoscopy of the cervix and abdominal cavity;
5. Magnetic resonance imaging (MRI);
6. Ultrasound examination (ultrasound).

Diagnosis of endometriosis is very important for determining the disease and. That is why it is necessary to consult a gynecologist in a timely manner if the first symptoms of endometriosis occur in the early stages.

Endometriosis is an inflammatory process in which cells of the epithelial layer lining the inner surface of the uterus grow outside 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, an 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, according to the results of which the woman is prescribed treatment. It is necessary to start therapy for this disease as early as possible, since various gynecological diseases, breakthrough uterine bleeding and infertility can be a complication of chronic endometriosis. To do this, it is important to know the symptoms and signs of pathology.

Endometriosis does not have severe clinical symptoms, so it is impossible to diagnose the disease without a special examination. Even an examination on a chair with a gynecological speculum does not always allow you to determine the pathological growth of endometrial cells, so the symptoms of the disease must be treated very carefully. It is important to tell 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 intercourse without the use of contraceptive methods. The main reason for the lack of pregnancy in endometriosis is the anatomical changes in the endometrium, in which it becomes impossible to attach and maintain 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 go beyond the organ (into 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 fading will be very high - more than 65%.

Pain syndrome

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

Chronic pain in endometriosis can be aggravated by the following factors:

• intimacy;
• menstrual flow;
• weight lifting.

Important! Pain in chronic endometriosis is easily stopped by painkillers, so many people ignore this symptom. The hallmark is a constant, chronic course, that is, the symptom weakens or disappears while the drug is in effect, after which the soreness returns.

Bleeding

In almost all cases of endometriosis, regardless of its location, a woman is concerned about contact spotting that appears after sexual intimacy. If the lesion has affected the organs of the genitourinary system or the intestines, drops of blood or blood streaks may be found in the urine or feces.

An insignificant discharge of blood with a pronounced pain syndrome is noted a few days before the onset of menstruation (approximately 4-5 days). Blood smearing usually lasts 1-3 days, after which it disappears, 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 a raw liver. By themselves, clots 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 have menstrual irregularities. These include:

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

In case of any cycle failures, 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

Video: Dr. Myasnikov about endometriosis

The role of the 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 the events taking place around. They cease to monitor their appearance, reduce communication with friends and loved ones, avoid appearing in public places.

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

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

How does the disease manifest itself in older women?

Some 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 progesterone production is blocked after menopause. Other factors that are often found in older women can also contribute to the occurrence of pathology. These include:

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

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

Important! A hallmark of the disease during menopause are spotting. They can be mild (blood smearing) or voluminous - in this case we are talking about bleeding. This clinical picture is typical for endometriosis of the uterus.

Endometriosis of the ovaries: signs

The result of endometriosis is the appearance of cystic formations. The main symptom in this pathology will be pain, which is most often permanent and intensifies after intense exercise or intimacy. Menstruation with endometriosis of the ovaries is painful, the use of drugs often does not bring significant relief.

It is possible to distinguish ovarian endometriosis from other forms of the disease by the characteristic shooting pain in the perineum, rectum and lumbar region. There is a pain syndrome at any time of the day and does not depend on the physical activity of the woman. At night, when the muscles and ligaments are relaxed, the pain may be more intense.

Endometriosis of the cervix: the clinical picture of the disease

The defeat of the cervical part of the uterine body is the only form of endometriosis in which there is practically no pain (in rare cases, the pain can be slightly pronounced). This is due to the fact that there are no nerve endings and pain receptors on the neck. Pathology can be suspected by uncharacteristic spotting in the second half of the menstrual cycle. Blood smearing 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 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. In the period between menstruation, the pain is localized mainly in the lower abdomen, has an acute character. The intensity of sensations increases during sexual contact and lifting heavy objects. If during this period to examine the blood of a woman, you can notice signs of anemia, which are associated with constant bleeding.

Symptoms of the disease after caesarean 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 the doctor what kind of material will be used for suturing, as some types of surgical threads can cause itching, discomfort in the suture area and increase the risk of gynecological pathologies.

Growth of epithelial cells in the area of ​​the suture and postoperative scar occurs in 20% of cases. Pathological changes in the body of a woman after a cesarean section can be suspected by the following symptoms:

• poor healing of the scar surface;
• release of brown liquid from the seam;
• severe itching in the area of ​​suturing;
• palpation of nodules under the seams;
• severe pulling pain in the lower abdomen.

If these signs are found, a woman is advised to contact the antenatal clinic to the doctor who conducted 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 refers to diseases that are difficult to diagnose due to a blurred clinical picture, since the pathology has signs and symptoms that are characteristic of most gynecological diseases. Even during the examination, it is not always possible to determine the presence of pathology. A doctor can suspect endometriosis during palpation of the vagina and rectum if nodules or cysts are found.

As a rule, one examination and palpation is not enough to diagnose the disease, so the doctor will definitely 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 that 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 in doubt, the woman will undergo a laparoscopy. This operation is performed under local anesthesia or general anesthesia and can be used not only for the purpose of diagnosis, but also for the treatment of pathology. Laparoscopy rarely causes complications, but to prevent the consequences, it is important to observe sexual rest after the procedure (at least 2-4 weeks).