Internal endometriosis: what is this disease and methods of treatment. Endometriosis of the body of the uterus - what is it in an accessible language and what you need to know about this pathology

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

Let's consider the most basic ones.

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

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

Myometrium- muscular tissue of the uterus.

Causes of pathology

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

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

How to recognize endometriosis

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

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

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

Forms of endometriosis

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

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

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

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

affect the fallopian tubes, ovaries, adjacent organs.

How is uterine endometriosis diagnosed?

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

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

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

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

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

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

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

Treatment

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

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

All about endometriosis from Elena Malysheva, video

Consequences of endometriosis

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

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

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

Under the concept of endometriosis, there is a pathology in which you can see the appearance of the endometrium in places that are not characteristic of it - that is, outside the uterine cavity.
There are several varieties of this disease.

Extragenital endometriosis is the appearance of areas of the endometrium in any organs, with the exception of the reproductive system. It can be the liver, lungs, kidneys, bladder.

The second variety is genital endometriosis. In this condition, endometrial screening occurs within the organs of the reproductive system - endometriosis of the vagina, tubes, ovaries. There are two options here: internal and external.
Endometriosis is a common disease of the female reproductive system. In almost one hundred percent of cases, it leads to infertility. Most of the cases of pathology is genital endometriosis.

What is meant by internal endometriosis?

Internal endometriosis of the body of the uterus or adenomyosis is a variant of genital endometriosis. At the same time, sections of the mucous membrane are found in the thickness of the muscular membrane - in the myometrium.

According to the prevalence of screenings and their location, three types of pathology are distinguished:
Diffuse form - when pieces of the endometrium are found in all areas and layers of the muscular membrane;

Focal form - the endometrium in the muscles is located in separate foci;
Knotty shape - the endometrium grows, forming nodes.
Externally, the wall of the uterus thickens, becomes tuberous. In pathological foci, cystic cavities with blood inside are often found.

According to the degree of damage to the muscular membrane, four types of internal endometriosis of the uterus are distinguished:

1. Internal endometriosis of the 1st degree - only the submucosal layer is affected, the myometrium is not affected;
2. Internal endometriosis of the 2nd degree is characterized by damage to the myometrium to the middle;
3. The third degree is full thickness damage to the myometrium;
4. The fourth degree is observed when the endometrium exits the body of the uterus and the fallopian tubes and adjacent organs are already damaged.

This video shows what endometriosis looks like.

The reasons for its appearance

The exact cause of adenomyosis and other types of internal and external endometriosis is unknown. Several theories have been put forward that may partially explain the appearance of screenings of the uterine mucosa to other organs.
implant mechanism. Proponents of this theory believe that the introduction of pieces of the endometrium into the abdominal cavity occurs as a result of the return of menstrual blood through the fallopian tubes.

Traumatic mechanism. Such a theory is based on the fact that during traumatic gynecological manipulations, the destruction of the endometrium occurs and its parts can enter other organs with the blood and lymph flow.

Another theory suggests an embryonic origin for adenomyosis. According to this theory, endometriosis occurs as a result of abnormal embryonic development and displacement of certain areas of the embryonic tissue.

The theory of metaplasia allows the development of the disease due to the degeneration of one type of tissue into another - for example, connective tissue into the endometrium.
Each of the theories has its own advantages and disadvantages. Predisposing factors for the development of the disease are hormonal imbalance and a decrease in the body's immune status.

Symptoms

The main clinical symptom is a violation of menstrual function by the type of algomenorrhea. The volume of blood released during menstruation increases significantly, with a severe degree, uterine bleeding is possible. A characteristic sign of internal endometriosis is smearing dark brown discharge before and after menstruation.

Due to profuse blood loss, the patients suffer from a severe form of iron deficiency anemia. Internal endometriosis of the body of the uterus is characterized by severe pain. The pain is most intense on the first day of menstruation. Based on the irradiation of pain, it is possible to approximately determine the internal localization of endometriosis:

• If pain is felt in the groin, this means that the corners of the uterus are affected;
• The appearance of pain in the rectal area indicates damage to the isthmus of the uterus.

After the end of menstruation, the pain stops.

Diagnostic methods

The diagnosis of internal endometriosis of the uterus is made on the basis of patient interview data, gynecological examination and instrumental research methods.
The survey allows you to identify symptoms typical of the disease, their relationship with menstruation.

A gynecological examination will be most informative if it is carried out immediately before menstruation.

What can be found with a two-handed examination:

• The size of the uterus may be normal - if there is a first or second degree of the disease. With a more severe degree, the uterus increases and corresponds to the size of a six-week pregnancy;
• If the isthmus of the uterus is affected, then on examination it will be enlarged, of a dense consistency, painful.

Of the instrumental diagnostic methods, ultrasound is the most accurate. It is carried out using a special transvaginal sensor.

What do the echo signs of internal endometriosis look like:

• Increase in the size of the uterus from the anterior to the posterior wall;
• Different thickness of the myometrium in different areas;
• A typical sign, called honeycomb - myometrium has a cellular structure with alternating dense areas and small cysts;
• With a nodular form, it is possible to detect areas with increased echogenic density in the thickness of a healthy myometrium - endometrioid nodes;
• The focal form is characterized by areas with low density - cystic changes.

It is used in diagnostics and X-ray examination - hysterography. An enlarged uterus will be visible on the radiograph, its internal contours are deformed. If contrast is used, it can be seen flowing into the cavity in the myometrium.
Another highly informative diagnostic method is hysteroscopy. This manipulation is carried out using endoscopic equipment. The doctor can examine the uterine cavity and detect pathological changes.

With the help of MRI, minimal changes in the thickness of the myometrium can be detected and a diagnosis can be made at an early stage.

Treatment Methods

Endometriosis needs to be treated comprehensively. Both conservative and surgical treatment is used. With internal endometriosis of the uterus, treatment begins with the correction of hormonal and immune disorders. If such therapy does not give a sufficient effect, surgical treatment is prescribed.

Hormone therapy is required for severe menstrual irregularities - intense pain, heavy menstruation and uterine bleeding.

Treatment with hormones has two main goals:

1. Cessation of ovulation;
2. Reducing the amount of estrogen.

For this purpose, various hormonal agents are used - they are selected individually for each patient.

Surgical intervention is preferable to carry out a modern endoscopic technique. In this case, laser ablation of the endometrium is performed. This method reduces blood loss and reduces the frequency of recurrence of the disease.

Progestogens

These drugs lead to a decrease in the amount of estrogen and an increase in progesterone levels. As a result, endometrial atrophy and a decrease in the severity of endometriosis are observed.

Duphaston The active substance of this drug is dydrogesterone. The advantage of the drug is that it does not have the side effects inherent in other synthetic progesterones. Duphaston is not a derivative of testosterone, it does not have androgenic properties.

When taken orally, Dufaston selectively acts only on the endometrium. There are two ways to treat endometriosis:
From 5 to 25 days of the cycle;
Continuously on a tablet 3 times a day.

Of the side effects noted headache, soreness in the mammary glands. Contraindicated in case of individual intolerance.

Combined estrogen-progestogen agents

Helps reduce the intensity of pain and uterine bleeding.

Marvelon- a preparation for oral contraception containing estradiol and desogestrel. Its action is based on the cessation of ovulation. Estradiol simultaneously contributes to the regulation of the menstrual cycle.

With endometriosis, it is prescribed according to the standard scheme - 21 days of taking the pills and a seven-day break. Side effects may include an increase in blood clotting.

Gonadotropin releasing hormone agonist

These drugs suppress the secretion of gonadotropic hormones by the pituitary gland. As a result, temporary anovulation and endometrial atrophy are observed.

Buserelin depot- when taken for two weeks, there is a complete cessation of the synthesis of gonadotropic hormones. As a result, ovulation stops, the level of estrogen drops to a minimum. Endometrial atrophy occurs.
For the treatment of adenomyosis, one dose is prescribed every four weeks. To achieve a stable remission of the disease, treatment should continue for at least six months.
ethnoscience

Such treatment must be agreed with the attending physician. Using only traditional medicine in the treatment of adenomyosis is not only useless, but also unsafe for a woman. Home treatment can only be an addition to the main one.
Herbs such as boron uterus and red brush are used for oral administration. Decoctions of these herbs are taken orally for a month. The use of various douches is not recommended, as they can cause an inflammatory process and aggravate the condition.

Endometriosis is not completely curable. The disease is characterized by the occurrence of relapses. On average, the first relapses appear five years after the treatment. In postmenopause, adenomyosis disappears on its own, as physiological atrophy of the endometrium sets in.

Video about the disease

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

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

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

Internal endometriosis

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

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

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

Endometriosis of the uterus in the structure of endometriosis.
Adenomyosis in the classification of endometriosis

Endometriosis of the uterus: ICD-10 code

N80.0 Endometriosis of uterus (adenomyosis)

Causes of the disease

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

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

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

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

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

The mechanism of development of endometriosis of the uterus
Pathological circle of adenomyosis Risk factors for uterine endometriosis

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

There are several types (forms) of adenomyosis:

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

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

Types of adenomyosis

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

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

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

Stages of adenomyosis

What is dangerous endometriosis of the uterus:

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

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

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

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

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

The nature of the pain:

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

— constant: from mild to moderate to intense.

- increases on the eve of menstruation;

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

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

Clinical symptoms of uterine endometriosis

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

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

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

Signs of internal endometriosis

Diagnosis of endometriosis of the uterus

1. Gynecological examination

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

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

Small forms of adenomyosis (endometrioid lesions

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

2. Transvaginal ultrasound

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

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

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

Clinical ultrasound signs of uterine endometriosis:

Adenomyosis Ι degree(small forms of endometriosis):

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

Adenomyosis ΙΙ degree:

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

Adenomyosis ΙΙΙ degree:

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

Nodular, focal adenomyosis:

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

Ultrasound cannot reliably distinguish fibroids from the nodular form of uterine endometriosis.

Additional methods for diagnosing uterine endometriosis

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

1. Magnetic resonance imaging

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

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

2.CFM - color Doppler mapping.

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

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

Hysteroscopic signs of uterine endometriosis:

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

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

Instrumental diagnosis of uterine endometriosis 4. Surgical hysteroscopy and histology.

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

5.Laparoscopy.

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

How to treat endometriosis of the uterus

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

Treatment of internal endometriosis

Hormonal treatment of uterine endometriosis

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

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

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

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

Goals of hormone therapy:

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

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

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

Hormonal preparations of the first stage for endometriosis of the uterus

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

Pills for endometriosis of the uterus

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

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

Hormonal preparations of the second stage for endometriosis of the uterus

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

Name A-GnRH	Reception scheme (a course of treatment up to 6 months)	Possible side effects
Goserelin (Zoladex)	3.6 mg subcutaneously 1 time in 28 days	Hot flashes, sweating, vaginal dryness, headache, mood lability, osteoporosis, negative effects on the cardiovascular system, liver.
Leuprorelin (Lyukrin depot)	3.75 mg each intramuscularly 1 time in 28 days	Same
Buserelin	3.75 mg each intramuscularly 1 time in 28 days. Or 150 mcg each squirting in every nostril 3 times a day.	Same
Triptorelin (Diferelin, Decapeptyl depot)	3.75 mg each intramuscularly 1 time in 28 days.	Same

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

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

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

2. Parenteral progestogens.

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

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

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

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

4. Antigonadotropins for the treatment of endometriosis:

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

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

Ultrasound of the pelvic organs - uterus and ovaries

Sonography of the uterus

The uterus is pear-shaped. It distinguishes the neck, body and bottom. The uterus can be deviated from the median plane or rotated along the longitudinal axis.

Dimensions of the body of the uterus (mm) in women of reproductive age, depending on previous pregnancies and childbirth:

group of patients width

not having pregnancies 45 ± 3 34 ± 1 46 ± 4

who had pregnancy but did not give birth 51 ± 3 37 ± 1 50 ± 5

parous 58 ± 3 40 ± 2 54 ± 6

Biometrics of the uterus includes the determination of three dimensions of the body of the uterus: length, anterior-posterior size and width. If necessary, measure the length of the cervix.

The size of the uterus in women of reproductive age is in a fairly wide range and depends on previous pregnancies and childbirth. In addition, a change in the size of the uterus depending on the phase of the menstrual cycle was revealed.

In clinical practice, it is generally accepted that the upper limit of normal values ​​for the size of the body of the uterus in women of reproductive age is. length - 70; width - 60; anterior-posterior size - 42 mm. However, excess of these dimensions should not automatically be considered pathological. In this case, fibroids, internal endometriosis, malformations, pregnancy, or erroneous inclusion in the measurement of ovarian tissue should be excluded.

An ultrasound examination of the endometrium evaluates its thickness, structure and compliance with the phase of the menstrual cycle.

Measurement of the thickness of the M-echo should be carried out with a longitudinal scan of the uterus with simultaneous visualization of the cervical canal. The maximum value of the anterior-posterior size of the M-echo is taken as the thickness of the endometrium.

The thickness and structure of the endometrium undergoes significant changes throughout the menstrual cycle (the duration of the cycle is conventionally taken - 28 days).

During the first two days of menstruation (the stage of desquamation of the bleeding phase), the M-echo is visualized as a heterogeneous structure of reduced echogenicity, slightly increased sound conductivity, 0.5-0.9 cm thick. A clear layering of the structure of the endometrium during this period is not observed.

On the 3rd-4th day of menstruation (the stage of regeneration of the bleeding phase), the M-echo is presented as a formation of increased echogenicity, with a small thickness of 0.3-0.5 cm.

On the 5th-7th day of the menstrual cycle (an early stage of the proliferation phase), there is some thickening of the M-echo up to 0.6-0.9 cm, a decrease in echogenicity and an increase in its sound conductivity. During this period, along the periphery of the M-echo, the appearance of an echo-negative rim about 0.1 cm thick is observed.

On the 8-10th day of the menstrual cycle (the middle stage of the proliferation phase), a clear hyperechoic structure in the center of the endometrium with a thickness of about 0.1 cm begins to be determined for the first time, which persists almost until the end of the menstrual cycle. Directly above and below this formation, zones of average echogenicity and sound conduction are revealed with a thickness of about 0.3 cm. All these structures are surrounded by a thin (0.1 cm) echo-negative rim. The thickness of the endometrium during this period, including the echo-negative rim, is 0.8-1.0 cm.

On the 11-14th day of the menstrual cycle (the late stage of the proliferation phase), the echographic picture is similar to the previous one, however, between the zone of average echogenicity and the echo-negative rim, a thin echo-positive structure appears, about 0.1 cm thick. The thickness of the entire endometrium in this phase of the menstrual cycle is 0, 9 - 1.3 cm.

During all subsequent stages of the secretion phase, the M-echo has a similar structure, only a slight thickening is noted.

So, on the 15-18th day of the menstrual cycle (early stage of the secretion phase), the thickness of the endometrium is 1.0-1.6 cm, and on the 19-23rd day of the menstrual cycle (the middle stage of the secretion phase), it reaches maximum values ​​of 1.0-2 .1 cm. On days 24-27 (late stage of the secretion phase), the thickness of the endometrium decreases to 1.0 - 1.8 cm.

The identification of individual structures of the endometrium is currently not clear enough. It can be assumed that at the stage of desquamation of the bleeding phase, the appearance of M-echo in the form of a heterogeneous structure is due to some expansion of the uterine cavity, the presence of blood and fragments of the endometrium in it.

Dynamics of changes in the structure and thickness (cm) of the endometrium during the menstrual cycle:

cycle days thickness

bleeding phase 1 - 2 (desquamation stage) 0.5 - 0.9

3 - 4 (regeneration stage) 0.3 - 0.5

proliferation phase 5 - 7 (early stage) 0.6 - 0.9

8 - 10 (middle stage) 0.8 - 1.0

11 - 14 (late stage) 0.9 - 1.3

secretion phase 15 - 18 (early stage) 1.0 - 1.6

19 - 23 (middle stage) 1.0 - 2

24 - 27 (late stage) 1.0 - 1.8

In the stage of regeneration of the bleeding phase, the M-echo is represented only by the walls of the uterine cavity.

The echo-negative rim, which appears on the 5th - 7th day of the menstrual cycle (the early stage of the proliferation phase), usually persists until the end of the menstrual cycle. So, probably, the transitional part of the myometrium into the basal layer and the area of ​​the functional layer of the endometrium adjacent to it are visualized.

From the 8th to 10th day of the menstrual cycle, a hyperechoic structure appears in the center of the endometrium. She, as it were, divides it into two mirror equal parts. This acoustic phenomenon occurs as a result of contact between the surfaces of the layers of the anterior and posterior walls of the endometrium.

On the 11-14th day of the menstrual cycle, a thin echo-positive structure appears between the zone of average echogenicity and the echo-negative rim. So the spongy part of the functional layer of the endometrium, adjacent to the basal layer, can be visualized.

It should be noted that in some cases, throughout the entire menstrual cycle, the functional layer of the endometrium on the echogram may not be visualized as layered, but have a rather homogeneous structure. Apparently, this is due to the individual features of the structure of the endometrium and the quality of the resulting image.

Particular attention in the study of the endometrium in postmenopausal women should be given to the measurement of its thickness. An increase in the M-echo thickness of more than 5 mm is considered pathological.

In approximately 10% of cases, a small amount of fluid is found in the uterine cavity, the volume of which is 1 ml. This is due to stenosis of the cervical canal.

Sonographic examination of the ovaries

Usually, the ovaries are detected quite easily, however, in cases where the search is difficult for any reason, it is necessary to find their landmark - the internal iliac vein.

In reproductive age, the echographic dimensions of the ovaries are on average 30 mm long, 25 mm wide, and 15 mm thick. The volume of the ovary normally does not exceed 8 cm3.

However, depending on the phase of the menstrual cycle, their size may vary. The largest sizes of the ovaries are observed in women in the age group from 30 to 49 years.

In the early follicular phase, 10 to 20 primordial follicles begin to develop. Most of them soon undergo atretic changes. On average, 5 follicles reach the Graafian vesicle stage. From 8 to 12 days, it is possible to identify the dominant follicle, which exceeds 15 mm during this period. The development of the remaining follicles during this period stops.

The dominant follicle continues to increase by an average of 2-3 mm per day and by the time of ovulation, its diameter reaches 18-24 mm.

In postmenopause, due to the extinction of the reproductive function, the size of the ovaries decreases.

In connection with the gradual extinction of the hormonal function of the ovaries, the presence of single small follicles during the first five years of postmenopause should not be regarded as a pathological process.

After 5 years of menopause, follicles are not detected, and their persistence should cause some concern.

When forming a conclusion, it is necessary to indicate the position and size of the uterus, describe the structure of the myometrium, the thickness and structure of the M-echo; the location and size of the ovaries, their structure and the size of the dominant follicle.

Norms of endometrial thickness

1 - 2 day of the cycle - 0.5 - 0.9 cm

3 - 4 day of the cycle - 0.3 - 0.5 cm

5 - 7 day of the cycle - 0.6 - 0.9 cm

8 - 10 day of the cycle - 0.8 - 1.0 cm

11 - 14 day of the cycle - 0.9 - 1.3 cm

endometriosis

I was aspirated, endometrial polyps were removed, and after that I was examined for ultrasound. Histological analysis showed an endometrial character, and the ultrasound result is as follows:

The body of the uterus is spherical, cellular, of normal size. At the bottom of the uterus there is a subserous myomatous node d = 2.5 cm. The thickness of the endometrium is 1.2 cm. In the cervical canal, pronounced multiple endometrioid foci are determined. The right ovary is 3.0x2.8 cm, the left one is 3.0x3.0 cm with cystic inclusions. The analysis was made before menstruation on the 31st day of the cycle. Explain to me, please, what is a cellular uterus and do I have a chance to get pregnant with such tests?

The spherical shape of the uterus and the cellular structure of the myometrium (the muscular layer of the uterus) are signs of internal endometriosis of the uterine body (adenomyosis). Sometimes with this disease, pregnancy occurs on its own, sometimes it is the cause of infertility, then it must be treated. The main manifestations of adenomyosis are abundant painful menstruation, spotting between periods. Subserous uterine fibroids will not interfere with pregnancy, although it will increase during pregnancy, which will require constant monitoring.

My doctor prescribed me a sedative collection and vitamins aevi t for two months. Is such treatment adequate for breast fibroadenosis?

2. My mother, who was 52 years old, had her uterus and appendages removed (due to endometriosis), and now endometriosis of the cervical stump was found, which is accompanied by pain, and sometimes dark discharge (although there have been no periods for a long time).

a) Tell me what should be done for non-surgical treatment?

b) Is dufaston suitable for treatment?

1. If we are talking about fibroadenoma, then this is a nodular form of mastopathy, and it requires removal.

If you have ordinary mastopathy with a predominance of the fibrous component, then you have been prescribed the correct treatment.

2. Duphaston can help. It is better to try a stronger drug Norkolut in continuous mode. Or even stronger ones: danazol, gestrinone. But! These drugs are effective only when the ovaries are preserved, since the mechanism of their therapeutic action is to suppress ovulation. And if the ovaries are removed (specify), then hormone therapy cannot help. Only operation.

1. With endometriosis of the stump of the cervix, is it possible to do without surgery in the presence of one ovary (removed: appendages, uterus, one ovary)?

2. If possible, what drugs should be used for treatment?

1. The choice of treatment method depends on the complaints. If they continue to bother you, removal of the stump is indicated. If not, the very fact of endometriosis is not an indication for surgery.

2. Drugs must be prescribed by the attending physician. The preparations are "hard", cause manifestations of the climacteric syndrome.

I am 46 years old, on February 19 this year I had an operation: Laparotomy. Panhysterectomy. The operation was performed urgently according to the results of ultrasound: myoma node infarction with malnutrition.

Diagnosis: Ademiosis. Endometriosis of the sacro-uterine ligaments. Chr. endometritis Chr. bilateral adnexitis. Endometrial polyp.

Histological examination: Glandular cystic hyperplasia, Uterine fibromyoma with areas

ademiosis. Ovary - sclerosis and hyamentosis of the walls of blood vessels and corpus luteum, follicular cysts,

corpus luteum cysts. Tube - sclerosis of the wall. Neck - Naboth cysts.

According to the results of histology, I was prescribed Norkolut for 3 months under the scheme.

Almost immediately after the operation, I had hot flashes (an hour or more).

With any physical and emotional stress, severe sweating. After the shower comes relief, but not for long. I drank Remens for a month, I don’t feel any improvement.

Two weeks, as there were pains in the rectum. Can endometriosis develop again?

Pains are similar, as to operational. Appointment scheduled in a month. Do not spend more than 5 minutes at the reception.

Tell me how to alleviate my condition, reduce hot flashes, avoid complications such as osteoporosis, etc. What is the purpose of a hormonal drug?

Can hot flashes pass on their own? If not, then advise what can be taken with the least side effect. Can I go to a resort in half a year and take mud on my lower back? When can I start abdominal strengthening exercises? The incision was made along the white line. What can be physical activity?

95% of the strength of the suture of the anterior abdominal wall is restored 3 months after the operation. Weak loads can be started now.

Pain in the rectum can be a manifestation of retrocervical endometriosis. It is diagnosed during a routine examination and ultrasound. Also, after panhysterectomy, endometriotic lesions on the peritoneum of the small pelvis could remain, giving complaints characteristic of endometriosis, as before the operation.

Norkolut has been prescribed for you so that endometriosis does not progress. But it doesn't seem to help. It would be ideal to do a control laparoscopy and coagulation of endometriosis foci on the peritoneum. But in any case, given the removed ovaries, endometriosis will not progress, on the contrary, it will gradually pass. But hot flashes and other signs of hormonal deficiency (osteoporosis, etc.) will increase. You are not contraindicated in taking hormone replacement therapy, since the doses and drugs that are contained in modern drugs will not affect the course of endometriosis, and your health will be restored. After checking the condition of the mammary glands (mammography), blood biochemistry (lipids) and blood coagulation, it is possible to prescribe continuous hormone replacement therapy with drugs such as Kliogest, Livial.

In January, the ovary was removed laparoscopically due to an endometrioid cyst, extensive external endometriosis of the 3rd degree was found. Different doctors recommend different hormonal therapy, some Nemestran, others Danoval. I have yet to give birth and I do not know which drug to choose.

With endometriosis 3 tbsp. the main method of treatment is laparoscopic coagulation of endometrioid lesions. After that, hormone therapy is prescribed, which turns off ovulation for a while so that endometriosis does not progress. Taking into account the fact that you are interested in restoring ovulation, more "soft drugs" are more preferable for you: danol (danazol, danoval), gestrinone (nemestran). Drugs such as zoladex, decapeptyl are more effective, but they inhibit the ovulatory function of the ovaries more strongly. The choice of the drug should be up to the attending physician who operated on you, knows about the prevalence of the process.

I am 29 years old. After the second birth, for 3 years, on the first day of menstruation, the temperature rises to 37.5 - 37.8, severe pain, cycle disturbances - delays of up to 10 days. Ultrasound showed: adenomyosis of the uterine body (nodular form), ovarian endometriosis, retrocervical endometriosis, uterus size 77-48-52, endometrium 11 mm. The smear contains a large number of leukocytes. Negative for chlamydia. The diagnosis of the attending physician coincided with the diagnosis of ultrasound plus chronic endometritis. For the treatment of adenomyosis and endometriosis, hormonal preparations were recommended, but with the permission of a mammologist, because. just before that, I had been operated on for breast fibroadenoma. The mammologist explained that since I still have pronounced manifestations of diffuse mastopathy and taking into account my heredity (close female relatives have breast cancer at a young age), hormonal preparations are shown to me only as a last resort. I consulted with several more gynecologists, their recommendations were different: some believed that hormonal treatment was required, others that it was not. Moreover, different hormonal preparations were prescribed: microgenon, norkolut, duphaston, depo-prover. As a result, my doctor and I decided to treat only endometritis. After the course of treatment, the temperature during menstruation became less - 37.2 and the leukocytes in the smear returned to normal. This was the case for 5 months after treatment. On the sixth month, the temperature again on the first day of menstruation rose to 37.8 and in the smear - again leukocytosis. Repeated ultrasound (one year after the first) showed that the size of the uterus and endometrium remained the same, but there were more endometriotic foci. After another 2 months, a 6 cm cyst of the right ovary was discovered. Hormone therapy was again prescribed for me, and if it does not disappear in a month, then an operation. And I was offered to remove the entire right ovary. Please tell me,

1) Should I decide on hormone therapy and which drug is more suitable for me (prolactin and progesterone are normal, but estradiol is not determined in our city). Do I still need some research and do I have time for this, or hormone therapy should be started immediately.

2) Are there any types of operations that allow you to remove a cyst without an ovary, which ones?

3) Are there other treatments for endometriosis and adenomyosis other than hormone therapy? Including surgery?

1. Those drugs that you have listed are all drugs of the same group (gestagens). And they are absolutely not contraindicated in mastopathy, even if relatives had malignant tumors. Caution requires the use of estradiol, and gestagens, on the contrary, are indicated for mastopathy.

On the other hand, with such progressive endometriosis, gestagens are too mild a method of treatment. It is advisable to start with an operation, remove the ovarian cyst, cauterize the endometrioid lesions, and in the postoperative period prescribe hormonal treatment to reduce the lesions in the uterus and retrocervical endometriosis (the temperature during menstruation is most likely from it). And these are hormonal drugs of other groups: nemestran, gestrinone, danazol, zoladex. They give more side effects, but are more effective against endometriosis.

2. Laparoscopic surgery. Technically, it is sometimes difficult to excise a cyst, it depends on the qualifications of the surgeon and is decided during the operation itself.

3. See item 1. But uterine endometriosis can only be surgically cured by removing the uterus.

Please tell us about a new drug for the treatment of endometriosis - "DUFASTON", because. I don't have any information about it. Q: What are the new treatments for endometriosis?

Endometriosis is a hormone-dependent disease associated with an absolute or relative increase in estrogen levels. "Dufaston" is an analogue of progesterone, a hormone of the second phase of the menstrual cycle, which balances the action of estrogens. With its deficiency or with an excessively elevated level of estrogen, endometriosis develops. "Dufaston" makes up for the lack of its own progesterone, and thereby suppresses endometriosis. There are other analogues of progesterone, but "Dufaston" is by far one of the best representatives of this group of drugs. For the treatment of endometriosis, drugs are used that turn off ovarian function, creating, as it were, an artificial menopause (menopause), which also contributes to the regression of endometriosis foci. After the abolition of these drugs in women of reproductive age (up to 40 years), ovarian function is restored, in women of advanced age, it can turn off completely. Effective surgical treatment of endometriosis. At the same time, its foci are removed from the surface of the fallopian tubes, peritoneum, in the case of endometriotic ovarian cysts, part or all of the ovary is removed along with the cyst, in severe forms of endometriosis of the uterus, the organ is removed.

Please tell me what are the obvious symptoms of endometriosis. My friend was diagnosed with this, but she only has pain in the lumbar region, a regular monthly cycle, the only thing is that a rash began to appear on her face on the day the menstruation began and immediately it disappears in a few hours. Are these symptoms sufficient for a diagnosis of endometriosis?

No, the symptoms you listed are not criteria for endometriosis. This diagnosis is finally made after a histological (under a microscope) examination of a tissue sample obtained promptly. Presumable symptoms of endometriosis are severe pain that increases or appears before menstruation and disappears on its first day, spotting before and / or after menstruation, pain during intercourse, during bowel movements, infertility of an unknown cause - these are such complaints. Some forms of endometriosis, for example, retrocervical, endometriosis of the uterine body, endometrioid ovarian cysts, can be diagnosed using ultrasound, some with a two-handed examination. With endometriosis, there is always ovulation, the cycle is regular, the temperature is two-phase, the egg matures.

Ultrasound of 31.07.2000 shows a longitudinal section of the uterus - in dynamics, a more homogeneous and "dense" structure of the uterus is observed, which confirms the conclusion of ENDOMETRIOSIS. in the uterine cavity a small amount of liquid inclusion. On ultrasound from 09.02.2001 ENDOMETRIAL POLYP. Nodular uterine fibroids up to 7 weeks.

Question: Is surgery required to remove it, what is not clear?

Question: What is the medicine OXYPROHYSTERONE CAPROnate?

A second ultrasound is done after menstruation (if any). If the polyp remains, then it must be removed with curettage (preferably hysteroscopic).

The issue of removing fibroids is decided depending on complaints (you do not write a word about what worries your mother, and this is the most important thing), the growth rate of the node, its location. Remove submucosal nodes (growing into the uterine cavity), rapidly growing, not amenable to hormone treatment, causing complaints of pain, spotting.

Oxyprogesterone capronate is a preparation of progesterone, a female sex hormone, the lack of which in the body can lead to the development of endometriosis and uterine fibroids. But it is not always effective in these situations. There are more modern, effective drugs, but they are much more expensive, they are not available everywhere, and they cause more adverse reactions. They cannot be appointed in absentia. But according to the description, the fibroid is small, it is enough to follow it (if it does not disturb subjectively) and not to use potent agents. There is not enough data for the diagnosis of endometriosis: the size of the uterus, endometrium is not indicated, there are no complaints. By the way, there is no size of the fibroid node (on ultrasound, the dimensions are measured in centimeters, not in weeks).

A lot depends on the age of the mother, the nature of the menstrual cycle. and most importantly, complaints.

I am 48 years old. In 1999 I was diagnosed with endometriosis. After diagnostic curettage, treatment with DANAVAL was prescribed for 6 months. There were no periods, of course. After this period, an ultrasound scan was done and the conclusion was made - atrophy of endometriosis. Joy knew no bounds. However, a year later, menstruation came again, were plentiful for 8 days. They did another ultrasound. Conclusion - the picture corresponds to internal endometriosis, multiple cysts of endocevicos, synechiae (septum) in the uterine cavity. Endometrium 1.0 cm. I can’t vouch for the spelling, because it’s written incomprehensibly. Scraping again. Diagnosis - adenomyosis with hemorrhoids. After 20 days, bleeding again. Urgently appoint DANAVAL 400 ml. in a day. Bleeding does not stop, on the contrary, it increases. I'm going to an appointment - Danoval was canceled and they are prescribed GPC 17, 4 ampoules each. For 2 weeks, all discharge disappears, then reappears. I'm in a panic. What should I do - am I really not cured and this will continue indefinitely?

Unfortunately, the symptoms of endometriosis rarely disappear forever with treatment. They usually reappear after discontinuation of treatment. You need, after consulting with your doctor, or use a drug like "zoladex", which creates an artificial menopause (with all its unpleasant symptoms) for 6 months. As a rule, after the abolition of Zoladex, endometriosis does not recur, but it is impossible to promise; Or decide to remove the uterus. However, curettage against the background of endometriosis is not needed, they only increase its manifestations.

I am 39 years old. They had an operation to remove two tubes and an ovary, as well as a cyst on the ovary. The diagnosis is endometriosis. There is a small cystic formation in the chest, the thyroid gland is enlarged and there is also a seal in it. Treatment with Nemestranom was prescribed. What do you recommend. How effective is the treatment with this drug? What are his side effects? What else can be taken to reduce them? What is my treatment period?

Since pregnancy does not appear to be involved, the goal of treatment is to prevent the recurrence of endometriosis and the characteristic pain complaints. Nemestran is an effective remedy that leads to atrophy of both endometrial formations and the endometrium itself. You can read about side effects in the instructions for the drug (they are caused by a decrease in the level of female sex hormones in the body and an increase in male ones, they resemble signs of menopausal syndrome), they often occur when the dose is exceeded. The normal dose is 2.5 mg 2 times a week. Usually the duration of the course is about 6 months, but the attending physician should specifically decide. If, against the background of taking, menopausal complaints begin to torment, you can take homeopathic preparations: climactoplan, climadinone, remens. Normally, after menopause, endometriosis goes away on its own, so the therapeutic effect of Nemestran is to create an artificial menopause.

But the thyroid and mammary glands must be examined by specialists. The formations in them are in no way associated with endometriosis and will not disappear from its treatment.

In October, I had an operation (laparoscopy), they removed a dermoid cyst from the right ovary (about 7 cm in size, histology showed that this is a mature teratoma), a corpus luteum cyst from the left ovary, a paravarious cyst (I don’t know if I wrote the name correctly). During the operation, endometriosis of the peritoneum was found, the foci of which were coagulated. Before the operation, the uterus was shifted to the left, as I was told, due to a dermoid cyst, which was located on the right. After the operation, I underwent a course of physiotherapy, another one is to come. But the position of the uterus has not changed, it is still shifted to the left. The first day of menstruation is also still painful. Please tell me, is the first day of menstruation as painful (as before the operation)? And why did the uterus remain shifted to the left?

1. Painful menstruation can be caused by the fact that not all foci of endometriosis are coagulated. There could be small, invisible foci during the operation. Maybe there is still internal endometriosis (the body of the uterus), which cannot be removed by laparoscopy. Usually, after laparoscopic coagulation of endometriotic lesions, a course of hormone therapy is prescribed to prevent recurrence of the disease. Consult with the gynecologist who operated on you, maybe he will prescribe a suitable hormonal preparation for you. Painful periods may also be unrelated to endometriosis, and may be caused by chronic endometritis (inflammation of the lining of the uterus). This condition is treated with difficulty, here the main method is physiotherapy.

2. Displacement of the uterus is caused by the tension of adhesions resulting from chronic inflammation of the appendages, intestines (dysentery in childhood) or due to endometriosis. Adhesions cannot always be eliminated during menstruation, so they continue to hold the uterus. This circumstance should not bother you, it does not interfere with pregnancy and does not cause pain.

In the regional hospital, the diagnosis was made: endometriosis of the uterine body, PMS (severe course - dizziness, attacks of paroxysmal tachycardia). Depo-provera 200 mg IM 2 times a month for 6 months was prescribed. At the place of residence, doctors refused to carry out the recommended treatment. Contraindications: Gilbert's syndrome, chronic cholecystitis, chronic diseases of the gastrointestinal tract and kidneys. Frequent exacerbations. Is it possible to do without hormonal drugs? If not, how to be?

There is a preparation "Utrozhestan" containing natural progesterone. These are capsules inserted into the vagina. Therefore, the hormone does not pass through the liver, as when taken by mouth. It is effective in doses of 2-3 capsules per day, quite expensive. It is necessary to accept at the expressed complaints constantly, within 6 months. If you write how premenstrual syndrome is expressed in addition to dizziness, it may be possible to choose a non-hormonal treatment for it. But endometriosis of the body of the uterus, if it bothers you, and pregnancy is planned (?), you need to treat it with hormones.

Tell me, please, I’m 31 years old, I have fibroids and endometriosis, at first I took dufaston, but there was bleeding against it, now Buserelin is from the first day of the cycle, now it’s already the seventh day, menstruation is not plentiful. but does not stop, and on the seventh day a bright red discharge. Tell me, please, what other drugs can I have, of course I will consult with my doctor, but I would like to have complete information on this issue, maybe hormonal treatment will not help me at all.

Against the background of buserelin, menstruation should stop altogether. This drug creates, as it were, an artificial menopause, for a while, turning off the function of the ovaries, which creates the conditions for the reverse development of your diseases. A drug such as buserelin should be taken for at least 3 months in order to detect its effectiveness. However, the presence of heavy bleeding on the 7th day of the cycle is alarming, be sure to consult a doctor. Curettage may be needed, or an aspiration biopsy if possible. Non-hormonal treatment of your diseases is an operation.

After hysteroscopy, the result was obtained - a polyp of the c / c, endometrial polyposis, endometriosis along all the passages of the walls, glandular hyperplasia with foci of weak adenomatosis, adenomyosis. (Sorry if there are medical errors). Now they are reviewing the glasses in the MGOD. I have 3 questions

1. If the diagnosis is confirmed, what are the chances of a cure?

2. What do you know about treatment with Zolotex?

3. Do you know the results of treatment with VISION drugs (Detox, Antiox, Lifepack, Women's Complex.). Are they not dangerous, because they did not pass clinical trials, being dietary supplements?

The diseases listed by you are quite serious, especially when they are combined, formidable complications are possible. So treatment must be taken seriously. Zoladex is a drug that is used to treat these conditions. Its action is based on the suppression of ovarian function, which causes an artificial menopause. In this case, these diseases regress (reduce or disappear). If you are near menopausal age, then after stopping the drug, menstruation may not be restored. A side effect of Zoladex are manifestations of menopausal syndrome. However, in this situation, it is an alternative to surgical treatment. In such a situation, I do not recommend relying on dietary supplements.

Can the contraceptive drug Regulon be used to treat symptoms of focal endometriosis? Is it normal to have a longer period and brown discharge before and after it? Can Regulon be used for cystic-fibrous mastopathy? How can endometritis be distinguished from focal endometriosis if there are no abnormalities according to the results of ultrasound?

Hormonal contraceptives suppress ovarian function, while there is a regression of such hormonally active diseases as endometriosis, fibrocystic mastopathy. Indeed, endometriosis of the body of the uterus and endometritis have similar symptoms. On ultrasound, endometriosis is more clearly visible 2-3 days before the onset of menstruation. However, this is only an indirect method. A more accurate diagnosis can be made with hysteroscopy.

The doctor made an ultrasound diagnosis: endometriosis. (Repeated ultrasound in another place confirmed this diagnosis). The gynecologist does not confirm this diagnosis. I am 40 years old. I have been using Marvelon for the last 3 years. There are no complaints. Do I need to do something now?

If you have no other manifestations of the disease other than ultrasound data (heavy menstruation causing anemia, endometrial hyperplasia, severe pain on the eve of menstruation, pain and discomfort during sexual intercourse ...), then therapy is not required. In addition, oral contraceptives suppress ovarian function, which leads to endometrial atrophy. And this is just one of the methods of treatment of endometriosis. If there are symptoms of a disease that threaten your health and reduce your quality of life, you should discuss treatment with your doctor.

I am 28 years old, married at 26. Two years ago, I had a resection of both ovaries for endometrial cysts. After that, I took Danol for half a year, and then I tried to get pregnant, but to no avail. The results of ultrasound in April 2000 on the 10th day of the cycle: the uterus is located in the midline. saddle-shaped, the cavity is not expanded, not deformed, the length of the neck is 30 mm of the usual structure, there is no free fluid in the small pelvis; endometrium 7 mm, the contour is not deformed, the structure corresponds to the phase of proliferation; the size of the left ovary is 23x15mm, in the structure of the "old" corpus luteum D=13mm, the right one is 24x19mm of the usual structure.

Questions: 1. In October 1999, I had an ultrasound scan, but the uterus was normal, what does "saddle" mean and what does it threaten?

2. Is it possible to determine by the results of ultrasound whether ovulation has occurred or not?

3. What is the proliferation phase and is it possible that I don't have endometriosis?

4. In what phase of the cycle is it better to carry out metrosalpingography, can it have any negative consequences.

5. Do I have any hope of getting pregnant and what measures should I take?

1. "Saddle uterus" - a form that is an intermediate option between a normal uterus and a bicornuate uterus. This feature does not affect the reproductive function.

2. An ultrasound examination can detect indirect signs of ovulation: the presence of a dominant follicle, fluid in the retrouterine space, corpus luteum.

3. Proliferation phase is the 1st phase of the menstrual cycle. According to the ultrasound you described, there is no endometriosis.

4. Hysterosalpingography is performed on the 7th-8th day of the menstrual cycle, in the absence of an inflammatory process.

5. You need to see a doctor for further examination.

Endometriosis disease, what it is, methods of treatment.

Endometriosis is a disease in which endometrial-like tissue grows outside of its normal location. In the occurrence of endometriosis, mechanical trauma to the genital organs, for example, during an abortion, may play some role. diagnostic curettage of the uterine mucosa, caesarean section, etc. as a result, conditions are created for the implantation of the endometrium in different parts of the reproductive system. The main signs of endometriosis are progressive pain before and during menstruation, menstrual irregularities, and infertility. Treatment of the patient is carried out depending on the age of the patient, localization and extent of the spread of the pathological process. Perhaps hormonal, surgical, symptomatic and physiotherapeutic treatment.

I have been diagnosed with endometriosis of the uterus. How to treat it, how serious is it and what are the consequences? I have been taking Mercilon for the second year on the recommendation of a doctor.

Endometriosis is a hormone-dependent disease that is manifested by the penetration of tissue similar to the mucous membrane of the uterine body into the uterine muscle. At the same time, during menstruation, foci of endometriosis also menstruate, which leads to the development of inflammation. Symptoms of adenomyosis (endometriosis of the uterus) are heavy and painful menstruation, bleeding, spotting before and after menstruation. Endometriosis is often associated with infertility and miscarriage. Oral contraceptives contribute to the regression of endometriosis foci.

Last December, I underwent laparoscopic surgery to remove an endometrial cyst. After the operation, a diagnosis was made - endometriosis of the endometrium and uterine fibroids. My nodules are small - 2 nodes of 2.5 cm each. The doctors insisted on hormone therapy, without explaining why and how it could affect my body. Now I have been using the drug "Nemestran" for two months. I don't know what is the use of it, but the negative effect is manifested. There were pains in the chest, the cycle of menstruation went astray and very often bloody discharge. Please tell us about the effect of this drug on the treatment of endometriosis and how taking this drug may affect future pregnancy. how to stop using this drug.

Nemestran is a drug for the treatment of endometriosis, including complicated by infertility. It is a synthetic analogue of the female sex hormone progesterone, the absolute or relative deficiency of which leads to the development of this disease. When Nemestrana is used, symptoms similar to menopausal syndrome develop. However, all manifestations disappear after discontinuation of the drug. The drug is contraindicated for use during pregnancy. However, it is used to treat infertility caused by endometriosis.

Tell me, please, what are the external manifestations of external endometriosis of the ovaries (is there a temperature, pain, etc. on which organs does endometriosis still occur?

Endometriosis of the ovaries most often manifests itself in the form of endometrioid cysts, which are soldered to the surrounding tissues and have a chocolate-colored content. Clinical manifestations of ovarian endometriosis are infertility and pain. The pain is usually permanent, worse on the eve and during menstruation, radiating to the lumbar region and rectum. A sharp increase in pain is sometimes accompanied by vomiting. The adhesive process in the pelvis causes constipation. bloating, etc. and may be an additional cause of infertility. Localization of endometriosis can be different: - genital (uterus, ovaries, tubes, cervix, uterine ligaments, etc.) - extragenital (bladder, intestines, kidneys, lungs, conjunctiva, postoperative scars, etc.)

I have ovarian endometriosis, only Nemestran is prescribed, but my friend says that Nemestran "plants" the liver, and that you need to drink Essentiale along with it. Is it so? Why didn't my doctor tell me about it?

The drug "Nemestran" is contraindicated in liver diseases. If you do not suffer from diseases of the hepato-biliary system, then for the preventive purpose it is possible to take the drug "Essentiale forte" in parallel.

For 3 months I treated endometriosis with nonmestranom. After the course of treatment, I had such a problem: before menstruation, the chest hurts and swells, the lower part of the chest is compacted and aches a little when pressed. The gynecologist said that this is mastopathy, which has developed due to the intake of Nemestrane. I heard that mastopathy can go away on its own, especially since the "hit" on hormones lasted only 3 months. Is it really true? Or is it better to consult a mammologist? If yes, is there a mammologist at your institute? Or can be you will advise me any treatment? Just not hormonal.

Symptoms which you describe are characteristic of a mastodynia. This is a dishormonal disease of the mammary glands, which may be associated with taking Nemestrane. Painful compaction in the lower part of the chest is alarming, so it is better to consult a specialist.

According to the results of ultrasound, two endometrial cysts were found in my right ovary (1.5 cm and 1.6 cm), a teratoma 5.0 x 3.5 x 4.6 cm, consisting of a dense component of dia. 3.6 cm and liquid fat in the left ovary, as well as endometrial polyp dia. 0.7 along the anterior wall of the uterus. Is non-surgical treatment possible? How is a teratoma different from a cyst?

There can be no two opinions: non-operative treatment is impossible. In your case, an operation using endoscopic methods (laparoscopy, hysteroscopy) is possible. Teratoma is a tumor consisting of germinal tissues. Most often it is benign, but only a histological examination can give an accurate answer. A cyst is a hollow formation with contents. Endometrioid cysts are a manifestation of ovarian endometriosis. Endometriosis does not respond well to conservative treatment, although it can regress slightly under the influence of hormonal drugs.

I am 33 years old. In 1992, I had an operation for endometriosis. Removed the left ovary and resection of the right. 5 years after the first operation, resection again - a corpus luteum cyst. And now, 3 years later. I have a fibroid in the uterus 15 mm. ovarian cyst 30-40 mm and a cyst in the chest. Can this be dealt with without surgery? And what should be done for this? If I remove both the uterus and ovaries, what does it threaten me with?

Usually, such problems develop against the background of the "disorganized" work of the neurohumoral and hormonal systems, therefore, either neuroendocrinologists or gynecologists-endocrinologists are involved in the treatment of patients. The main task of doctors in such situations is to try to normalize neuro-hormonal relationships in a variety of ways - from physiotherapy to hormone therapy, rather than surgical removal of the affected organ (the problem is not removed, but begins to manifest itself in other organs and systems). What to do in your case can be said only after a detailed examination.

44 years old. Diagnosis: adenomyosis, cyst of the left ovary, paraovarian cyst, cystic changes in the right ovary. Possible treatments? Can laparoscopy be applied? If yes, where?

We do not advise you to consult "on the phone" - a set of diagnoses is quite serious. Apparently, in this case we are talking about the choice between hormonal and surgical treatment, and maybe their combination. Without seeing the patient, without knowing the history of the disease, it is even impossible to say whether laparoscopic treatment is possible and whether it is necessary.

/ Continuation/ Surgery is scheduled, but, as I was told, rehabilitation is within 2 months. Therefore, I would like to consult about laparoscopy and, of course, not by phone. Please help me find out the phone numbers of organizations where such operations are performed.

Both with "normal" and laparoscopic operations, the volumes are the same, but with laparoscopy, access to the operation site is made not through an incision in the abdominal wall, but through a puncture, so such an operation is easier to tolerate. For example, an extract after a "normal" operation goes on 10-14 days, and after laparoscopy - on 5-8. Laparoscopic operations are longer, they have a whole list of female contraindications, for example, adhesions. Rehabilitation after laparoscopic surgery is just as necessary as after a conventional one, because. tissue healing occurs at the same time. Laparoscopic equipment in Moscow is available in many research centers and hospitals, both commercial and urban. These are the 1st City Clinical Hospital, the 15th City Hospital, the 7th City Clinical Hospital, the Center for Mother and Child on Oparin Street 4, the MONIIAG on Chernyshevsky Street, the Department of Medical Institutes. Prices and conditions are different everywhere, so we advise you to "arm yourself" with a directory and call as many places as possible.

I had a laparoscopy: they “blew out” the pipes, removed adhesions, discovered external endometriosis - they burned it. Doctors say that now I can get pregnant, but first I need to treat endometriosis (Nemestran was prescribed). Please answer why I cannot get pregnant right away, and what can happen if I suddenly become pregnant without treating endometriosis?

Unfortunately, against the background of endometriosis, pregnancy occurs very rarely - the disease is characterized by infertility. Pregnancy is one of the best "medicines" against endometriosis, against its background, it undergoes a reverse development.

I am 23 years old. My husband and I have been trying to conceive for a year now. The doctor suspects endometriosis. Recommends laparoscopy and sperm preparation for intrauterine insemination. You could not advise what to do or make first of all and whether there can be complications after a laparoscopy and what.

Infertility testing is multi-stage. You have probably taken swabs for special infections and microflora, measured basal temperature for at least 3 months, did a semen analysis, ultrasound of the pelvic organs, etc. Laparoscopy with checking the patency of the pipes and, if necessary, surgical treatment (dissection of adhesions, etc.) is one of the stages (far from the first) of the examination. She gives a lot of information, especially with small forms of endometriosis. Laparoscopy is an operation and complications can be, as with any operation: an allergic reaction to painkillers, infections, complications, development of adhesions.

Collapse

Adenomyosis or internal endometriosis affects a woman's reproductive function. It interferes with conception and childbearing. Up to 15% of women of childbearing age suffer from this condition.

What is this disease?

Internal endometriosis of the uterus is a consequence of endometriosis, when the endometrium grows outside the uterine cavity. The disease is hormonally dependent, that is, it progresses with a violation of the hormonal background.

Important! Adenomyosis is in third place among all diseases of the female reproductive system. Women who have not yet given birth are more prone to the disease. The risk of developing adenomyosis decreases with the onset of menopause.

What is uterine endometriosis? This is the growth of endometrial tissue in the muscular layer of the uterus, in the neck and canal. Due to the introduction of the endometrium into the muscle layer, degeneration of the muscular tissue of the uterus occurs. As a result of pathological changes, inflammation appears, and then the organ ceases to function normally.

Endometrial cells continue to function and grow, penetrating even into other organs. This leads to the following consequences:

• inflammatory processes;
• scarring and adhesions;
• disruption of the organ into which the endometrium has penetrated.

Cells can grow into the myometrium at different depths, up to the serous membrane of the uterus.

Degrees of adenomyosis

Depending on how deeply the endometrium has penetrated into the thickness of the uterus, there are 4 degrees of the disease:

1. First degree. The thickness of penetration deep into the uterine mucosa is less than 1 cm. This is the least dangerous degree.
2. Second degree. The endometrium grows to the middle of the uterine wall. There are initial signs of the disease in the form of painful sensations.
3. Third degree. The cells grow deep into the myometrium by more than half. Focal nodular neoplasms appear, they can cover the entire surface of the organ. At this stage, the serous layer of the uterus is affected and a large number of adhesions are formed.
4. Fourth degree. The heaviest. The endometrium grows beyond the muscular layer of the uterus and passes to neighboring organs. Sometimes organ fusion is diagnosed.

Types of adenomyosis

According to the type of development, internal endometriosis of the body of the uterus can manifest itself in several forms: diffuse, nodular and mixed. Of these, the most severe is the diffuse form of adenomyosis, since almost all layers of the uterus are affected.

The diffuse-nodular form is also called mixed. It includes signs of other forms.

diffuse form

The diffuse form of endometriosis is characterized by the fact that the endometrium covers the entire surface of the uterus and penetrates deep into the muscle tissue layer by layer.

Diffuse endometriosis of the body of the uterusdangerous because the endometrium can penetrate to any depth, up to the formation of fistulas.

Diffuse adenomyosis of the uterus goes through 4 stages. First, the endometrium affects the myometrium, then other layers of the uterus with a transition to neighboring organs.

Nodal shape

The nodular form of uterine adenomyosis is characterized by the formation of nodes in the muscular layer of the uterus. Node characteristics:

• a large number of;
• they are dense, filled with blood or brown liquid;
• connective tissue actively grows around them.

Nodular adenomyosis of the uterus leads to an increase in the size of the organ. During the diagnosis, the disease is often confused with fibroids, the difference is only in the origin of the nodes. In adenomyosis, they are made up of glandular tissue rather than muscle.

Causes of adenomyosis

Until the end, the exact cause of the onset of the disease could not be studied. It is safe to say that the following factors contribute to the development of adenomyosis:

• Retrograde menstruation is a condition where menstrual blood enters the uterus, tubes, and nearby organs. The endometrium attaches itself to unwanted places.
• Surgical interventions, including curettage, abortion, removal of polyps. All these operations can disrupt the integrity of the mucosa and contribute to the formation of scars, in place of which the endometrium grows.
• Violation of the hormonal background.
• Heredity.
• Late onset of sexual activity or menstruation.
• Overweight, metabolic disorders.
• The use of contraceptive methods such as the intrauterine device.
• Infectious diseases of the genital organs.
• Disruption of the immune system.

The risk group includes women who are constantly exposed to stress, physical exertion, are fond of sunbathing in a solarium, have undergone surgery on the genitals.

The chance of adenomyosis increases to 33-85% in women with uterine fibroids.

Various factors can influence the development of the disease, for example, the level of air pollution or extragenital diseases such as hypertension or diseases of the gastrointestinal tract.

Symptoms

To a greater extent, all the signs are associated with the menstrual cycle. Menstrual disorders appear only in the second stage, and sometimes later, when the endometrium penetrates deep into the tissues of the uterus.

Main symptoms:

• heavy, prolonged and painful menstruation;
• pain in the lower abdomen before and after menstruation;
• irregular cycle;
• the appearance of spotting in the middle of the cycle.

The main echo signs of endometriosis of the uterine body of a diffuse form are visible on ultrasound:

• the uterus is increased in size up to 6 weeks of pregnancy and becomes spherical;
• walls of uneven structure, become thinner or thicker, deformed;
• cystic cavities up to 6 mm in diameter appear.

With nodular echo-signs of internal endometriosis, the following are:

• in the wall of the uterus there are rounded nodes or foci of different sizes;
• the presence of inclusions and cysts up to 6 mm in diameter;
• the walls of the uterus thicken;
• nodes under the basal layer, which lead to deformation of the inner layer.

Menstruation may be accompanied by autonomic disorders, such as headache, nausea, vomiting, and even loss of consciousness.

Diagnostics

Examination of the disease is complicated by the fact that signs of internal endometriosis appear when the disease progresses and there are complications. Symptoms are similar to other pathologies of the female reproductive system.

Endometriosis can be detected by the following methods:

• colposcopy;
• examination on a gynecological chair, a smear from the vagina;
• laparoscopy;
• transvaginal ultrasound;
• hysterosalpingography;
• hormone analysis.

Hysteroscopy provides reliable information. It is carried out on the 5th-6th day of the menstrual cycle. One of the most important indicators is the condition of the basal layer of the endometrium.

Consequences of the disease

With adenomyosis, heavy menstruation, as a result of which a woman loses a lot of blood. The state of health worsens significantly, weakness, dizziness, pallor of the skin are noted.

Other complications of internal endometriosis are:

• infertility;
• anemia;
• chronic inflammation of the organs of the reproductive system;
• external endometriosis, such as the rectum or bladder;
• fibroids or uterine cancer;
• the spread of the endometrium through the vessels, as a result of which various organs are affected, for example, the liver, kidneys, lungs.

Endometriosis in 50% of cases leads to infertility.

How to cure the disease?

Treatment of adenomyosis is carried out by two main methods:

• drug therapy;
• surgical intervention.

The method of treatment depends on the degree of the disease and the presence of complications.

Medical treatment

Symptoms of the disease after the start of treatment with medicines disappear within two months. Drug therapy is aimed at normalizing the hormonal background and strengthening the immune system.

Non-steroidal drugs are taken with the progression of the disease, when a woman has severe pain.

With heavy and prolonged menstruation, hormonal agents are required. After two weeks of hormone therapy, the menstrual cycle is getting better. Reception of hormones is extended for up to six months. Combined hormonal preparations are prescribed, for example, Diana, Lindinet, Utrozhestan, Duphaston, Buserelin.

Also used such medicines:

• anti-inflammatory drugs;
• soothing;
• vitamin complexes, with B vitamins in the composition;
• immunomodulators.

Together with medications, you need to follow a high-calorie diet, attend physiotherapy exercises, limit physical activity and be outdoors more often.

Surgical treatments

There are two types of operations:

• with preservation of the reproductive organ, for example, laparoscopy or curettage;
• uterus removal.

In the first case, it will not be possible to remove all the foci of endometriosis, but the woman will be able to have children.

Curettage is effective only with a nodular form, with a diffuse form it is advisable to undergo a course of treatment with medications.

Any surgical intervention requires the use of hormonal drugs.

Folk remedies

As for folk remedies, they are ineffective. Symptoms may disappear for a while, but the disease itself will not go anywhere.

For douching, you will need a decoction of calendula, peony, yarrow, celandine, nettle, oak bark and mistletoe. Douche up to three times a day.

Adenomyosis is difficult to cure. Relapse occurs in 70% of cases. Combination therapy with the use of surgical and medical treatment gives the best effect.

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