What is endometriosis? Symptoms, treatment of gynecological pathology. Causes, symptoms and treatment of endometriosis Endometriosis active form

What is endometriosis? How to live with endometriosis? What can and should be done, and what is strictly prohibited?

How to live with endometriosis? What can and should be done, and what is strictly prohibited? A correspondent for Women's Health magazine addressed this question to Tina WEINTKAMI, a famous American professor, obstetrician-gynecologist, leading specialist at the Reproduction Center at Clark Memorial Hospital, Louisville, Kentucky, USA.

- How relevant is the problem of endometriosis at present?

This problem can certainly be called a pressing one. In the US, for example, about 15% of women suffer from endometriosis. And this figure is growing steadily every year. This is largely due to improved diagnostic methods.

- What is endometriosis?

The reason for the appearance and development of endometriosis is that endometrial tissue, or the inner lining of the uterus, which is normally shed during menstruation, for one reason or another goes beyond its limits and appears in those organs where it should not be. This is how endometriosis occurs in the ovaries, tubes, intestines and other organs. In this abnormal endometrium, the same cyclical changes occur as in the uterus, it swells and bleeds. But since this fluid cannot come out, it begins to compress the nerve endings, causing pain and the formation of adhesions. In addition, the uterine wall contains prostaglandins. When produced in too large quantities, they also increase pain.

- Why is this still happening?

There are many different theories about the occurrence of endometriosis. Viruses are thought to play a role. There are adherents of the genetic theory. In any case, there is always a hormonal imbalance. It is manifested by an increase in the level of female sex hormones estrogen.

- Is it possible to somehow predict the appearance of endometriosis? Are there any criteria for metriosis?

It is impossible to say for sure whether a woman will get endometriosis or not. In the USA, for example, there are doctors who are of the opinion that every woman has endometriosis, but not everyone has it. We can understand whether the patient belongs to the so-called risk group for endometriosis or not. These are women who have suffered abortions, difficult childbirth, and frequent inflammation of the appendages. At older ages, aggravating factors are obesity, diabetes, and hypertension.

- Can a woman help herself?

Undoubtedly. And often it is very effective. The patient herself can improve the quality of her life. Endometriosis is a serious problem, but it can be managed.

- What kind of life should such a woman lead?

An active lifestyle can greatly alleviate the condition. Avoid stress, spend more time in the fresh air. Healthy and long sleep is very important. On average, the body needs 8-9 hours per day to fully recover. Exercise lowers estrogen levels and may slow the growth of endometriosis.

It is better to start with simple exercises, as excessive exercise will only increase the pain. Don't neglect your regular morning exercises. It improves blood circulation, breathing and brings the body into a state of wakefulness. You can add static and dynamic exercises to it. Here is an example complex:

1 element - walking in place at a calm pace for 1 - 2 minutes. Element 2 - walking in a cross step and walking in a half-squat. Element 3 - from the knee-elbow position, lift your pelvis up as much as possible, standing on your toes and straightening your legs at the knees, while resting on your elbows. The exercise is performed 8 - 10 times. 4th element - in a sitting position, bring your legs together and spread them several times. 5th element - squat down from a standing position, simultaneously stretching your arms forward. Breathing should be uniform.

In conclusion, one of the most accessible types of aerobics is recommended as a general strengthening effect - running in place. The degree of load is monitored by pulse. When running, it should be equal to 180 minus your age in years. After 5 minutes, the pulse should not exceed 120 beats per minute, and after 10 minutes it should not exceed 100 beats. Running duration is 7-10 minutes.

For static exercises, “inverted” poses are suitable. For example, throwing your legs behind your head while lying on the floor. At the same time, blood flow to the brain increases and nutrition of the departments responsible for hormonal regulation improves. Such training, together with a positive attitude, helps overcome the disease.

- What diet should you follow if you have endometriosis? Are there any restrictions?

There are no special restrictions. The main thing is that the food is healthy and complete in all components.

Add fish to your diet. Fish is a natural anti-prostaglandin and can reduce pain. Fresh vegetables and fruits are also very welcome.

A woman’s daily diet should consist of 50% of them. Uncrushed cereals, nuts, and seeds are also useful. But it is better to limit caffeine consumption. Caffeine, found in coffee, tea, and carbonated drinks, increases pain in some women. For coffee lovers, decaffeinated coffee can be a good alternative.

- What to do if the pain still does not go away?

Many women with endometriosis find relief from moist heat or a heating pad and a warm drink. This will help relax the muscles in your lower abdomen. If heat doesn't help, you can try placing an ice pack on your lower abdomen. It is important to remember that there should be a layer of tissue between your body and the ice, and the ice is applied for 10 minutes with 15-minute breaks.

- What medications can help with endometriosis?

Medications such as aspirin and other anti-inflammatory drugs will help. Aspirin destroys excess prostaglandins and reduces muscle spasms. But the best painkillers are antiprostaglandins. They not only reduce pain, but also prevent its occurrence. The most effective of them are medipren and nuprin. These drugs help fight the cause of the disease.

I advise you not to use tampons or keep their use to a minimum. Tampons can make menstrual pain worse by preventing the natural flow of blood. Thus, an artificial barrier is created and, as a result, blood flows back into the pipes and abdominal cavity. The risk of endometriosis spreading in such a situation is very high.

- What effect does pregnancy have on the course of endometriosis?

During pregnancy, hormonal levels normalize, and the level of “harmful” estrogens decreases. However, after childbirth, endometriosis can again make itself known, so you should not let the disease take its course after the birth of a child.

- How long does it take to treat endometriosis?

The duration of treatment is very individual. It is assessed by the cessation of pain and the disappearance of endometriotic growths. On average, this occurs within 3 to 6 months of therapy.

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The pathology is gynecological and requires appropriate treatment from a gynecologist. Doctors can detect abnormal growth of the endometrium outside the body of the uterus, that is, on the genitals, the outer and inner surface of the cervix, ovaries, fallopian tubes, intestinal and bladder walls. The main cause of endometriosis is considered to be increased levels of estrogen in a woman’s body., prolonged and heavy menstrual bleeding and cycle shortening.

Cervical endometriosis is most often diagnosed by a gynecologist during routine preventive examinations of women, which confirms its significant importance in the healthcare system. It should be noted that this disease is diagnosed several times more often in nulliparous women of reproductive age.

After menopause, the risk of developing endometriosis decreases significantly and is only 2-3%.

Timely detection and elimination of pathology is of great importance, since there is a certain percentage of the risk of atypical cell degeneration and infertility. Any gynecologist specializes in endometriosis, including children's, which also diagnoses cases of endometrial growth outside the inner layer of the uterus.

Main symptoms of endometriosis

In some cases, endometriosis is asymptomatic and is discovered by a gynecologist by chance. However, the manifestation of this pathology can be quite characteristic, which precisely determines which doctor to go to for endometriosis. The symptoms inherent in this disease are as follows:

painful menstruation;

heavy bleeding;

spotting that persists before and after menstrual bleeding;

discomfort and pain during sexual intercourse;

problems with conception and infertility.

If such symptoms develop, every woman should make an appointment with a highly qualified gynecologist for timely diagnosis and successful elimination of the problem. People with endometriosis go to the doctor because self-medication and the use of traditional medicine recipes can aggravate the disease or provoke the development of another pathology.

Features of diagnosis for endometriosis

Doctors treating endometriosis make a preliminary diagnosis based on the information obtained during a visual examination using gynecological speculum and taking into account subjective symptoms. To clarify or confirm the diagnosis, the gynecologist prescribes the following examination methods:

Ultrasound using a vaginal probe;

cytological analysis of smears;

laparoscopy;

hysteroscopy;

Magnetic resonance examination of the pelvis.

By comparing the data from all the necessary examinations, the doctor accurately establishes the diagnosis and determines a conservative treatment plan using medications.

Yes, and even more than that, in about a third of women who do not receive any treatment, it goes away on its own. This is due to the work of the immune system, which can recognize the “unnecessary” endometrium and destroy it.

How is endometriosis treated?

Based on the above, endometriosis does not always need to be treated. In world gynecology there are three types of management of endometriosis:

Observation without treatment: this tactic is not suitable for everyone, but only if endometriosis was discovered by chance (for example, during an ultrasound or surgery for another reason), the foci of endometriosis are small and do not cause any inconvenience.

Treatment with medications: the most common treatment strategy. We will talk about it in more detail below.

Surgical treatment (surgery): usually prescribed if drug treatment has not helped or endometriosis has led to serious problems with the functioning of internal organs. Surgery may also be required if endometriosis develops.

What medications are used to treat endometriosis?

The main medications for endometriosis that gynecologists prescribe are hormonal and affect the level of the body's own hormones. We will talk about 4 groups of drugs that are most often used in the treatment of endometriosis:

Birth control pills (oral contraceptives, OK): Zhanin, Yarina

Medicines containing progesterone and its analogues: Utrozhestan, Duphaston, Visanne

• Gonadotropin analogues: Buserelin, Zoladex

Each of these groups of drugs affects the body differently.

Birth control pills (Zhanine, Yarina) and endometriosis

Your gynecologist can prescribe birth control pills (OC) for the treatment of endometriosis: Janine, Marvelon, Regulon and others. These medications contain varying doses of hormones, so be sure to consult your gynecologist before starting to take the medication.

Birth control pills help reduce pain associated with endometriosis shortly before and during your period. For successful treatment of endometriosis, it is necessary to take OCs for at least 6 months. If the effect is noticeable (pain disappears), then your gynecologist may advise you to take OK for another 3-6 months. As a result of this treatment, areas of endometriosis may noticeably decrease in size.

Utrozhestan, Duphaston and endometriosis

Preparations containing progesterone (female hormone) or its analogues, such as Utrozhestan, Duphaston, Depo-Provera, Visanne and some others, give a good effect in the treatment of endometriosis. These medications reduce the body's production of estrogen, which inhibits the growth of the endometrium (both in the uterus and in areas of endometriosis). It is better to prepare in advance for long-term treatment, since the course of taking these drugs can last for 6-9 months.

Danazol and endometriosis

Danazol is a synthetic hormone that, while taken, suppresses the production of female sex hormones, helping to reduce foci of endometriosis. For the therapeutic effect of Danazol to appear, it must be taken for at least 3-6 months.

This drug was previously widely used in the treatment of endometriosis, but in some countries doctors are beginning to abandon Danazol for several reasons. First of all, these are the side effects of Danazol, which include increased blood pressure, menstrual irregularities, weight gain, swelling and pain in the breasts, excess hair growth on the face and body, acne, hair loss and others. Secondly, new drugs have appeared in the arsenal of gynecologists that are as effective as Danazol, but without its side effects.

Buserelin, Goserelin (Zoladex) and endometriosis

Analogues of gonadotropin-releasing hormones, which include Buserelin, Goserelin (Zoladex), Sinarel and others, suppress ovarian function and reduce the level of female sex hormones in the blood. During treatment, you will not have periods, and you may also experience symptoms of menopause (hot flashes, mood swings), but this can be corrected by taking additional small doses of hormones.

The course of treatment for endometriosis with these drugs is no more than 6 months. After you stop taking the medication, the ovaries start working again, so you don’t have to worry that they will never “start” again.

There are many gynecological diagnoses that can unsettle a woman. Endometriosis is one of these insidious diseases. Find out useful information about the forms in which this disease manifests itself and at what symptoms you should suspect it. Information about traditional and folk methods of treating the disease may also be useful to you.

Forms of endometriosis

Today, this disease is a very common pathology in gynecology, which can lead to various complications if it is not treated in a timely manner. For this reason, a woman who monitors her health should be aware of endometriosis - what it is and how this disease manifests itself. This disease is a chronic growth of the endometrium - glandular mucous tissue that normally covers only the inner surface of the uterus - beyond the boundaries of this organ. In medical practice, there are different forms of the disease:

1. The extragenital form of the disease is diagnosed when endometrioid tissue grows on other organs located both in the abdominal cavity - intestines, urinary system, etc., and outside it - for example, on the lungs.
2. The combined form of the disease manifests itself if heterotopia - an atypical placement of endometrial tissue - is localized both on the genitals and other internal organs.
3. Genital endometriosis. With this form of the disease there are:

• internal endometriosis of the uterus (adenomyosis) - proliferation of nodular compactions in the muscular layer of the uterus, fallopian tubes, ovaries;
• external, or external endometriosis - retrocervical (retrocervical), damage to the vagina and peritoneum of the small pelvis.

Stages of endometriosis

The highest incidence of endometriosis disease occurs in the internal genital form of the disease – adenomyosis. Many women are diagnosed with this condition when they go to the doctor complaining of heavy, painful periods. What is adenomyosis, if you look in detail? This is a pathological process, which is characterized by the fact that foci of endometriosis arise in the myometrium - the muscular layer of the body and isthmus of the uterus.

Depending on the nature of the localization of endometrial cells, focal, diffuse or nodular adenomyosis is distinguished. In order to choose the right treatment regimen, when diagnosing, gynecologists pay special attention to the stage of the disease according to the following classification:

• I – the superficial layer of the endometrium grows into the basal layer to the borders of the myometrium;
• II – the muscular layer of the uterus is affected up to the middle of its thickness;
• III – the lesion extends to the serous layer;
• IV – endometriosis lesions spread to the peritoneum lining the abdominal walls.

Cause of the disease

It is a known fact that many diseases can be avoided if you eliminate the factors that provoke them from your life. Why can’t this disease be prevented in this way and get rid of the many troubles it causes? The fact is that medicine cannot clearly determine the causes of endometriosis in women. There are several theories why this disease occurs:

1. Implantation of endometrial cells outside the uterine cavity due to their throwing outside the organ during menstruation.
2. Hormonal disorders in the body.
3. Hereditary predisposition.
4. Disturbances in the functioning of the immune system, when the body's defense system does not recognize the abnormal arrangement of endometrial cells and does not destroy them.
5. Malformation of the genital organs during the prenatal period.
6. Damage to the uterine mucosa during medical procedures - diagnostic curettage, abortion.
7. Inflammatory and infectious diseases of the genitourinary system.
8. Incorrectly selected contraceptives, prolonged use of an intrauterine device, etc.

Signs

It is not easy to independently recognize this disease in the early stages, so it is very important not to miss periodic examinations with a gynecologist. A woman may suspect endometriosis if she begins to notice the following symptoms:

• increased pain in the lower abdomen and pelvic area during menstruation;
• increase in the amount of menstrual flow and duration of menstruation;
• increase in body temperature on critical days and immediately after them;
• bleeding or spotting between periods;
• pain during sexual intercourse;
• general weakness, dizziness.

You need to know that the indicated symptoms of endometriosis in women are characteristic not only of this, but also of other, even more dangerous gynecological diseases. For example, do you know what endometrial hyperplasia is? This disease is also characterized by the proliferation of endometrioid tissue due to hormonal imbalances in the body, manifested by changes in the nature of menstruation, but in the absence of proper treatment it can develop into oncology. It is possible to differentiate between these diseases, which are similar in symptoms, only after a complete examination.

Diagnostics

To confirm this disease in a patient, a gynecologist needs to combine instrumental and laboratory research methods. In rare cases, the diagnosis of endometriosis can be confirmed by colposcopy; much more informative results - accuracy of more than 90% - are obtained by transvaginal ultrasound. Using echo signs, you can determine whether the thickness of the mucous layer in the uterus is normal, and also notice other possible pathologies: hypoplasia, hypotrophy, endometrial dysplasia.

The diffuse and nodular form of endometriosis is well diagnosed during hysteroscopy - examination of the uterine cavity through the mouth of the cervical canal with a special device. Laparoscopy is also effective for making a diagnosis - a procedure during which not only the pelvic cavity is examined, but also cauterization of the foci of endometriosis is performed. The patient will also need to be tested for endometriosis - check her hormone levels, and also be examined to see if she has developed anemia.

How to treat endometriosis

If a woman has been diagnosed with this, she needs to know that this disease cannot be completely cured, but a properly selected course of therapy will help neutralize the consequences of the disease and live a full life. Find out what treatment methods are available for endometriosis.

1. Conservative drug therapy - a long course of hormone-containing drugs: Duphaston, Janine, etc.
2. Symptomatic treatment of manifestations of endometriosis by taking anti-inflammatory, analgesic tablets and suppositories, and medications for anemia.
3. Ablation is the process of destroying the mucous layer of the uterus using laser, radio, microwaves, cryodestruction and other methods.
4. Electrocoagulation is the cauterization of disease areas with electric current.
5. Physiotherapy – used in a comprehensive manner during hormonal or postoperative treatment of endometriosis, carried out using pulsed current methods, hydro-, laser-, magnetic therapy, and balneotherapy.
6. Surgical manipulations - often the removal of foci of mucosal proliferation is carried out through laparoscopic surgery, cryodestruction, and in severe cases, excision of the affected areas with a scalpel.

Traditional treatment

To get rid of the manifestations of this disease, patients often use available methods of alternative medicine. It is important to remember that such healing should not occur independently, but can only be used as an additional effect as part of complex therapy only after consultation with the attending physician. In practice, endometriosis is often treated with boron uterus. Here are some simple ways to use this medicinal plant:

1. 2 tbsp. l. dried herb, pour 0.5 liters of vodka, leave for 2 weeks in a dark place. Take the tincture three times a day before meals, 30 drops, diluting it slightly with water.
2. 2 tbsp. l. add dry chopped herbs to 1 tbsp. refined vegetable oil. Infuse the product for 2 weeks, then strain the resulting infusion. Insert a tampon soaked with this medicine into the vagina at night.

Why is endometriosis dangerous?

This disease cannot be left to chance, because it is fraught with many serious consequences. Thus, it has been established that endometriosis and infertility are interrelated conditions, so a woman planning a pregnancy must have this disease treated in order to realize her reproductive function. An endometrioid cyst on the ovary can lead to loss of the appendage. If endometriosis occurs together with uterine fibroids, then this combination often threatens with irreversible consequences, entailing removal of the organ.

Endometriosis is a disease whose incidence has increased in recent years. Doctors attribute this to a variety of hormonal imbalances in women. A high amount of estrogen in the body contributes to the suppression of ovulation and pathologically active growth of the endometrium inside the uterus, which is subsequently rejected, and its cells can migrate to other organs.

The most common form of the disease is internal genital endometriosis, when the proliferation of endometrioid cells is observed in the uterus. Usually the disease does not manifest itself in any way at the initial stage, and women find out about it only when they are planning a pregnancy or looking for the cause of existing infertility. Treatment of endometriosis can be conservative, in which the patient is prescribed hormones, or surgical - foci of endometrioid nodes are surgically removed. The surgical method is indicated for severe endometriosis.

Endometriosis in women

Endometriosis and pregnancy

Endometriosis and pregnancy – does one interfere with the other? Statistics say that half of women with this diagnosis are infertile. But if they are lucky enough to become pregnant, changes in hormonal levels during pregnancy and breastfeeding make it possible to ensure that the foci of endometriosis decrease. Unfortunately, this effect lasts only until the menstrual cycle returns, which often coincides with the end of feeding.

What to do if illness prevents you from getting pregnant? Treatment usually begins with hormone therapy. Some resort to treating endometriosis with folk remedies: beet juice, a special herbal mixture, and clay applications are used. But it is important to remember that the use of traditional medicine can significantly aggravate the disease, if only because it wastes a lot of time.

The most radical method of treatment is surgery. It allows you to remove large lesions, but after some time the patient may develop new growths of the endometrium. Therefore, if a woman decides to have surgery, she needs to plan her pregnancy as soon as possible, before the disease returns.

Endometriosis in nursing mothers

Despite the fact that the nature of endometriosis is not fully understood, doctors have learned to fight it.

It is known that the best way to get rid of it is to normalize your hormones. This can be achieved through childbirth and breastfeeding. A decrease in the amount of estrogen produced helps ensure that new foci of enlarged endometrium cease to form, and old ones become smaller. Symptoms of endometriosis in the form of severe or moderate constant pain go away. Moreover, there is a high probability that after breastfeeding ends and ovarian function is restored, the disease will not return again.

Endometriosis in nulliparous women

Symptoms of endometriosis are most often not pronounced, or they are confused with signs of other gynecological diseases. Therefore, the true diagnosis is not always established quickly. You can suspect the presence of endometriosis mainly by pain and prolonged painful menstruation. If a woman cannot get pregnant for a long time, this forces her to see a doctor and start being examined, since sometimes it is not possible to get pregnant precisely because of endometriosis.

Statistics show that after pregnancy and lactation, many women are completely cured of this disease. If it bothers you, and your health condition does not allow you to become a mother yet or you cannot get pregnant, women are offered hormonal treatment. It eliminates the signs of endometriosis and relieves the patient from chronic pain.

Does endometriosis occur in men?

The main cause of endometriosis, which all doctors agree on, is a hormonal disorder associated with increased secretion of estrogen. As a result, the endometrium grows more than expected, either in the uterine cavity or outside it.

Does endometriosis occur in men? After all, normally they do not have tissues similar to endometrioid, which means that the appearance of the disease is impossible. Actually this is not true.

It is extremely rare, but the disease can still develop in men. This occurs due to the fact that rudiments of embryonic tissue of the genitourinary system, characteristic of the female sex, may remain in the male body. During pregnancy, during the formation of the fetus, up to the 20th week, the cells of the genitourinary system continue to develop and acquire specificity for either the male or female reproductive system.

But sometimes the embryonic rudiments that form in women persist in men and can become a source of endometriosis. The likelihood of the disease increases even more if a man is treated with estrogen (for example, for prostate tumors). In this case, endometrium-like tissue can begin to grow very actively.

Endometriosis in children

Signs of endometriosis are typical primarily for women of fertile age from 20 to 45-47 years. But sometimes the disease occurs even in children. Scientists associate this with the theory of the embryonic origin of the disease, when areas of the endometrium are formed in the prenatal period. If a teenage girl begins menstruation, then the mechanism of endometriosis becomes the same as in women - pathological cells are captured by the bloodstream and spread throughout the genitals, abdominal cavity and other body systems.

Patients complain of painful, heavy menstruation. Pain with endometriosis is concentrated in the lower abdomen and can last for months, appearing and fading. If the symptoms of the disease greatly impair the quality of life of adolescents, they are prescribed treatment in the form of hormone therapy, oral contraceptives or surgery.

Symptoms of endometriosis are often non-specific and may be mistaken for signs of another disease. For this reason, the true incidence of endometriosis is not known for certain. How does the disease manifest itself?

• The main symptom is chronic, sometimes very intense pain. Mostly women complain of pain in the lower abdomen, sometimes it can intensify during sexual intercourse and bowel movements.
• Prolonged menstruation with noticeable blood loss is characteristic of internal endometriosis (in the uterine cavity).
• Due to severe and constantly recurring blood loss, anemia may develop.
• Primary or secondary infertility.
• Depending on where the endometrioid tissue is located, bleeding from the navel, bloody tears (blood from the eyes), blood from the sputum, and nosebleeds may occur.

Pain due to endometriosis

The main symptom that worries patients is pain with endometriosis. They accompany the patient’s life almost constantly, being localized in the lower abdomen, they can “give” to the groin and lower back. This pain is called chronic pelvic pain and can be associated with the presence of an ovarian cyst, irritation of the peritoneum (during an inflammatory process), spasm of blood vessels and muscles, or with adhesions due to endometriosis. Unpleasant sensations become stronger before menstruation, aggravated during sexual intercourse or going to the toilet.

Forms of endometriosis

Endometriosis of the uterine body

One form of the disease is adenomyosis, or internal genital endometriosis. In this case, the mucous layer (endometrium) grows into the muscular layer of the uterus, and can reach the outer serous membrane. The danger of adenomyosis is that it contributes to large menstrual blood loss and causes the development of anemia. In addition, the disease can be accompanied by severe pain and prevent pregnancy.

The symptoms and treatment of uterine endometriosis are well known to gynecologists, and therefore you should turn to them for medical help. First, patients are offered hormone treatment. For pronounced symptoms of uterine endometriosis, treatment consists of surgery, during which the lesions are removed using a scalpel, cauterization with a laser or electric current.

In severe cases, when the disease manifests itself with frequent and heavy bleeding, the patient is offered hysterectomy. Of course, for such a decision it is necessary to weigh the pros and cons, because organ deprivation leads to early menopause and premature aging of the female body.

Cervical endometriosis

Cervical endometriosis is a type of disease consisting of pathological growth of the endometrium in the cervix. It is believed that the increase in the number of cases of cervical endometriosis is directly related to the increased number of cervical manipulations used to treat erosion. If they are done before menstruation, there is a risk of introducing endometrioid cells into the wound, and then their subsequent spread into the thickness of the cervix.

A typical sign of the disease is intermenstrual bleeding. During menstruation, increased pain in the lower abdomen may occur. Treatment of cervical endometriosis is similar to that of other forms of the disease - the administration of hormones and removal of lesions using excision or cauterization.

Ovarian endometriosis is a common form of the disease that involves damage to the tissue of women's ovaries. Most often it manifests itself in the form of endometrioid cysts. Cysts have a negative impact on a woman’s fertile health, because they disrupt the functioning of the ovaries and interfere with normal ovulation. If ovarian endometriosis progresses, it can lead to depletion of the follicle reserve and infertility. In addition, cysts cause severe pain in the lower abdomen, especially worse during or after sexual intercourse.

With endometriosis, an ovarian cyst is easily detected on an ultrasound scan based on distinct signs that are visible to the doctor during the examination. To exclude the possibility that the cyst is still functional and not endometrioid, it is better to repeat the study over several cycles. When the diagnosis is preliminarily established, patients are offered surgical treatment in the form of laparoscopy.

Peritoneal endometriosis

In contrast to internal genital endometriosis, limited to the body of the uterus, there are other forms of the disease, which are called extragenital. They received this name for the localization of endometriotic lesions outside the woman’s genital organs. How can endometrial cells enter the abdominal cavity?

• With blood flow (retrograde reflux of menstrual blood).
• As a result of germination.

Damage to the peritoneum is called peritoneal endometriosis. It manifests itself as pelvic pain, discomfort during bowel movements, and painful menstruation. Abdominal endometriosis can be detected only through laparoscopy, which is also a method of treatment: during surgery, all accessible foci of growth are removed.

Vaginal endometriosis

Endometriosis of the cervix is ​​sometimes accompanied by the spread of the endometrium into the vagina. The cells enter the vaginal wall through wounds, and then germinate and spread further. This form of the disease is easy to detect due to the accessibility of the study area to a gynecological examination. Examination of the vaginal walls using mirrors and examination of the contents of the lesions allows an accurate diagnosis. Patients suffering from vaginal endometriosis complain of pain shortly before the onset of menstruation, painful sensations and spotting during sexual intercourse. This form of the disease is treated with surgery and hormonal therapy.

Rectovaginal endometriosis

The opposite of internal endometriosis is extragenital, located outside the genital organs. At the same time, there is a form of the disease that affects both the genital area and organs beyond it (mixed form). We are talking about endometriosis of the uterus and vagina, which is accompanied by the growth of endometrioid tissue into the rectum. This form of the disease causes women great physical suffering. Rectovaginal endometriosis can be diagnosed using a rectal examination. Suspicion of the disease should be caused by the patient's complaints of pain during bowel movements and blood in the stool during menstruation. Treatment of rectovaginal endometriosis is difficult, as complex surgical intervention is required.

Bladder endometriosis

Endometriosis of the uterus and other reproductive organs is quite common, but damage to the bladder is rare. How can endometrial cells end up in it?

• Retrograde reflux of menstrual blood.
• Germination from an adenomyotic lesion through the wall of the uterus.
• Entry of cells from endometrioid cysts onto the surface of the bladder.

Often, endometriosis of the bladder does not manifest itself in any way, and can only be discovered accidentally during operations on the abdominal and pelvic organs. If the growths affect the posterior wall of the bladder or the mouth of the ureters, patients complain of difficulty urinating. Typically, patients complain of a feeling of heaviness in the lower and deep abdomen, especially before menstruation. The act of urination may become more frequent and painful.

Often such patients are misdiagnosed with cystitis, but the treatment prescribed in accordance with the diagnosis does not bring relief. As the pathology progresses, the pain associated with endometriosis intensifies, and blood appears in the urine. To establish the true cause of the appearance of such symptoms, the doctor must pay attention to the relationship between pain and the menstrual cycle and prescribe cystoscopy, which can detect foci of endometriosis.

In medical practice, there are 4 degrees of endometriosis:

1. In the first degree, there are few foci, and they grow shallowly into the wall of the uterus (up to the muscle layer). Usually during this period there are no symptoms of the disease. The only sign is often heavy menstruation. If you consult a doctor at this stage, the disease can be treated with hormone therapy.
2. The second degree of endometriosis means that cell germination has reached the deeper layers of the uterus (up to the middle of the muscle layer). New foci of the disease do not appear, but old ones quickly increase in size. Due to the strong growth of the endometrium, the patient may experience pain. At this stage of endometriosis, treatment is carried out not only with hormones, but also with surgery, if the doctor considers it necessary.
3. The third degree of endometriosis corresponds to an increase in the area of ​​damage to the uterus (the entire muscular layer is affected up to the serous membrane). The pathological proliferation of cells continues at a rapid pace, as a result, the intensity of the woman’s pain increases. In addition to the uterus, other genital organs are also involved in the process. Many adhesions form in the small pelvis. Treatment of the third degree of the disease is predominantly surgical followed by hormone therapy.
4. The fourth degree of endometriosis is the most severe. It covers the entire pelvic area, including the gynecological organs and excretory system. Multiple adhesions often lead to fusion of organs with each other. Stage 4 endometriosis can only be effectively treated surgically.

Causes of endometriosis

Menstruation and endometriosis

The causes of endometriosis have not been fully established. It is obvious to researchers that the disease most often occurs against the background of hormonal disorders. One of the ways endometriosis spreads through the body is called retrograde menstruation. In this case, endometrial particles with the flow of menstrual blood do not move along the usual path towards the vagina, but enter the abdominal cavity through the fallopian tubes. There, fragments of endometrioid tissue are able to take root on the surface of other organs and function, obeying the hormonal female cycle. Bleeding areas form foci of endometriosis. The likelihood of further development of the disease increases with a decrease in immunity.

Hormonal disorders

Hormonal imbalance is the main cause of endometriosis. An increase in estrogen production leads to the fact that endometrial cells actively grow and multiply, and some of them spread through the bloodstream outside the uterus. Hormonal imbalance can be corrected with the help of special therapy. The main drug is progesterone, marketed under the name “duphaston” or “utrozhestan”. Duphaston for endometriosis compensates for the lack of its own progesterone, as a result of which the pathological growth of the endometrium is suppressed and the normal menstrual cycle is restored with the maturation of the dominant follicle and ovulation.

Often, one hormonal disorder leads to several diseases. For example, a frequent companion of endometriosis is fibroids, in which the muscular layer of the uterus grows under the influence of excess estrogen. However, in this case, therapy with progesterone (duphaston) is contraindicated, since it is believed that it provokes the development of fibroids.

Heredity

The cause of endometriosis can be heredity - up to 60% of patients note a familial nature of the disease. In some families, endometriosis is passed down from generation to generation for a long time, and affects all women. Often the disease is accompanied by endocrine and immune disorders, which can also be inherited. Hereditary predisposition means that the risk of passing the disorder from mother to daughter is very high, so to prevent endometriosis it is necessary to take care of its prevention.

Endometriosis can be caused by problems with the immune system. Normally functioning immunity, with the help of macrophages, destroys endometrial cells that have been rejected and gone beyond their normal location. In the event of a failure in the body's defense mechanism, the rejected cells are able to survive in atypical places, forming foci.

Therefore, the disease spreads to neighboring organs (endometriosis of the uterus, cervix and vagina, endometriosis of the ovary appears), and then passes beyond the reproductive system. As a result, endometriosis can affect the abdominal cavity, bladder, and grow into the intestines. In fact, its spread is similar to the development of a tumor, when pathological cells are also not destroyed by the body’s immune forces.

Metaplasia

Metaplasia is the benign replacement of one type of tissue with another that is not typical for a given location. Some scientists consider metaplasia one of the causes of endometriosis. The fact is that the endometrium and the inner surface of the abdominal cavity are embryonic “relatives”: they are formed from the same rudiment. During the process of intrauterine development in the unborn child, the rudiment is divided into the endometrium and the epithelial layer of the peritoneum. During separation, under the influence of many reasons, an error occurs, and in place of the epithelium, areas of the endometrium appear, in which endometriosis can subsequently develop.

Diagnosis of endometriosis

The following methods are used to diagnose endometriosis:

• Typically, the doctor begins by interviewing and studying the patient’s medical history. He is interested in the nature of the pain, whether it intensifies before the next menstruation or during and after defecation, the duration of the cycle and the nature of the discharge during and between menstruation, heredity for gynecological diseases, previous operations and illnesses.
• A manual gynecological examination is required to determine the size and position of the uterus, cervix and ovaries. Speculum examination allows you to see signs of endometriosis in the vagina and cervix.
• If the disease is suspected, X-ray diagnostic methods (HSG, CT, MRI) are prescribed, with the help of which it is possible to detect lesions not only in endometriosis of the uterine body, but also outside the reproductive system.
• Sometimes a blood test is used for the CA-125 marker - an increase in its level indicates the possible presence of endometriosis (it can also indicate the presence of cancer).
• One of the most reliable diagnostic methods is an endoscopic examination, in which a tube with a video camera is inserted through natural openings or laparoscopic incisions, and the doctor sees an image of the organs on the screen.

Another research method is ultrasound. It is used most often because it is minimally invasive (does not require punctures or incisions) and is quite inexpensive compared to endoscopy and MRI. Ultrasound examination has its disadvantages:

• It allows you to mainly see the disease in the uterine cavity and ovaries, while lesions in the abdominal cavity and intestines will go unnoticed.
• To increase reliability, the study should be carried out on certain days of the menstrual cycle (before the onset of menstruation, when the endometrium is saturated with blood and is better visualized).

On ultrasound, foci of endometriosis appear as areas with altered echostructure or compactions. If localized in the ovaries, the doctor will see endometrioid cysts.

Laparoscopy

The “gold standard” for diagnosing the disease is laparoscopy. With this operation, endometriosis is diagnosed most reliably and accurately. Like all invasive methods, laparoscopy has a significant drawback - it is a full-fledged surgical intervention under anesthesia, after which time is required for the body to recover.

At the same time, the study allows not only to diagnose endometriosis, but also to simultaneously treat it by surgically removing all available lesions. During the operation, the surgeon can diagnose and treat endometriosis of the uterus, detect and remove endometrioid ovarian cysts, and cauterize lesions in the abdominal cavity.

Biopsy

Endometriosis can be reliably diagnosed when suspicious cells are examined by a specialist morphologist under a microscope. To obtain these cells, you need to perform a biopsy - excision and collection of a piece of tissue. If the disease is localized in an accessible area where sampling can be done without surgery, it is done on an outpatient basis. When the disease has affected internal organs, surgery may be required.

Thus, for ovarian endometriosis, the surgeon obtains cell samples during surgery and transfers them for research. He then removes suspicious areas and removes the cyst. If you have endometriosis of the uterus, it is possible to perform a pipell biopsy, when the gynecologist takes tissue from the uterine cavity with a special tube. The Pipelle examination does not require anesthesia and is performed quickly and virtually painlessly. It is also carried out when there is a suspicion of fibroids, and the doctor needs information about the condition of the inner surface of the uterus. With endometriosis, fibroids are quite common, since both diseases are associated with hormonal disorders.

Endometriosis: treatment

How to treat endometriosis?

Today, two main methods are known: surgery and hormone therapy. Some doctors consider pregnancy and lactation as a method of treatment, which change the hormonal status of a woman and help reduce or even disappear the symptoms of the disease.

But it should be remembered that the improvement in this case is often temporary, and with the restoration of the menstrual cycle after pregnancy and lactation, endometriosis may return. In addition, not all patients have the desire and opportunity to give birth to a child in order to be cured. Therefore, modern medicine offers other methods of treating endometriosis:

• Hormone therapy consists of suppressing the secretion of estrogen, which affects the growth of the endometrium. For this purpose, contraceptives and drugs that replenish progesterone deficiency are used.
• Laparoscopic surgery is a radical method that allows you to remove most foci of endometriosis. The disadvantage of surgical intervention is that it can only be performed on patients who have no contraindications. After laparoscopy, hormone treatment is usually prescribed to prevent endometriosis from reoccurring.

Pain relief from endometriosis

With severe endometriosis, patients complain of severe pain. Depending on where the lesions are located, pain may appear in the lower abdomen, radiate to the lower back, and intensify during sexual intercourse and after using the toilet. Endometriosis is often accompanied by the formation of adhesions inside the abdominal cavity, which can hold organs together in an unnatural position. Because of this, as well as due to the stretching of the adhesions themselves, women experience pain from movements or changes in body position. Treatment of endometriosis with surgery is not always possible, but special medications and procedures will help relieve patients from pain:

• Nonsteroidal anti-inflammatory drugs that have an analgesic effect.
• Duphaston for endometriosis can have an analgesic effect due to inhibition of prostaglandin production.
• Gonadotropin-releasing hormone agonists, which block the production of estrogen by the ovaries.
• Massage.
• TENS – electrical stimulation of nerve endings near the site of pain to reduce it.

How to treat endometriosis with hormones? There are several areas of therapy:

• The use of analogues of the hormone produced by the hypothalamus (gonadotropin-releasing hormone) to immerse the woman’s body in a state of artificial menopause. In this case, foci of endometriosis atrophy in the absence of production of sex hormones.
• Antiprogestins also suppress menstrual function and ovarian estrogen secretion.
• Complex oral contraceptives (progestins and estrogen-progestogens) suppress ovulation and estrogen production. During the course of treatment, the drug is used without monthly breaks.
• Mirena intrauterine systems (spirals) act only in the uterine cavity and reduce the manifestations of endometriosis due to the release of small doses of progestogen.
• Duphaston for endometriosis compensates for the lack of progesterone, reduces estrogen production and acts on endometrial receptors, suppressing its growth.

Elimination of symptoms and treatment of endometriosis of the uterus and other reproductive organs can only be carried out as prescribed and under the supervision of a doctor. You cannot prescribe hormonal medications yourself, because they have serious side effects.

Endometriosis: surgery

In medicine, there are only two ways to treat endometriosis:

• Surgery.

The surgery performed to treat endometriosis is most often performed laparoscopically through small holes in the body. Filling the abdominal cavity with a special gas allows you to clearly see all organs. Using instruments inserted into the incisions, the surgeon cauterizes or excises the foci of the disease. If the patient has endometrioid cysts, they are emptied and removed.

In case of extragenital form and severe endometriosis, surgery is often the only way to improve a woman’s condition. Unfortunately, surgical treatment often brings only a temporary effect, and then endometriosis returns again. To prevent its development, patients are prescribed additional hormonal therapy after surgery.

Endometriosis: treatment with folk remedies

Women turn to treatment of endometriosis with folk remedies when they want to avoid hormonal therapy or surgery. Sometimes such methods bring some effect, but traditional treatment still gives the best results. Therefore, it is better to use folk remedies as an addition to the main therapy. What are the most popular methods of treating endometriosis with folk remedies?

• Phytotherapy.

Herbal infusions affect hormonal levels, helping to reduce estrogen levels in the blood. Herbal medicines also improve immunity and help reduce the inflammatory process in the pelvis.

• Hirudotherapy, or treatment with leeches.

The substance released by leeches during a bite helps relieve vasospasm and improve blood quality.

• Clay applications have an anti-inflammatory effect, improve cellular nutrition and metabolism.

Treatment with clay should be carried out with caution, since applications have a warming effect, and heat treatment for endometriosis is prohibited.

• Special physical exercises.

Their effect is to normalize pelvic circulation and reduce adhesions.

• Drinking beet juice eliminates hormonal imbalances.

It is also a good remedy for the prevention of anemia, which is very important for endometriosis of the uterus, accompanied by large blood loss during menstruation.

Infertility

Endometriosis and pregnancy are mutually exclusive concepts in the minds of most people. It is believed that it is almost impossible to get pregnant with endometriosis. How dangerous is the disease for women planning a child?

• Hormonal changes lead to ovulation disorders.
• The appearance of endometrial foci in the fallopian tubes contributes to their obstruction. Adhesive and inflammatory processes in the pelvic organs that accompany endometriosis can also lead to blockage of the lumen of the fallopian tubes or their deformation.
• Violation of the process of implantation of a fertilized egg prevents the development of pregnancy at a short term.
• With endometriosis, a cyst formed in the ovary disrupts the maturation process of dominant follicles and depletes the body's ovarian reserve.
• Foci of endometriosis release toxic substances that are dangerous to the embryo.

Problems during pregnancy

Up to 50% of cases of endometriosis are complicated by infertility, and if a woman still manages to become pregnant, complications and troubles may arise:

• In the very early stages of pregnancy, the fertilized egg runs the risk of not attaching to the wall of the uterus due to pathological growth of the endometrium. In addition, the functioning of endometriosis foci is accompanied by the release of toxic substances harmful to the development of the embryo.
• Impaired secretion of estrogen leads to the fact that in the 2-3 trimester the body does not have enough of its own progesterone, and this increases the likelihood of miscarriage.
• In the latter stages, in the presence of the uterine form of endometriosis, the risk of perforation of the uterine wall increases.
• The course of pregnancy can be complicated by fibroids - this is a benign formation that develops in the muscular layer of the uterus and can reach large sizes. Obviously, it is not useful for the development of the baby, because the myomatous node can occupy a large space inside the uterus. The node creates a problem and if the placenta is attached to it, there is a risk that the placenta may detach. In addition, fibroids increase the contractility of the uterus, and this can lead to spontaneous miscarriage.
• With endometriosis, fibroids are very common, because the cause of both diseases is similar - pathological cell division and proliferation.

Pathological birth

Despite the fact that endometriosis and pregnancy are hardly compatible concepts, sometimes women manage to conceive and carry a child. However, childbirth in the presence of the disease can be complicated by the following circumstances:

• Endometriosis doubles the risk of preterm labor.
• Attachment of the placenta dangerously close to the source of endometriosis can lead to premature detachment.
• Cervical endometriosis, especially when combined with once cured erosion, can lead to poor cervical dilatation during childbirth due to scarring and damage to the mucous membrane.
• The uterine form of endometriosis with cell growth into the thickness of the wall can lead to uterine rupture.
• Endometriosis of the cervix, uterus, or vagina can lead to heavy postpartum bleeding.
• If endometriosis occurs in the form of extragenital lesions, perforation and bleeding from the affected organ are possible.

Endometrioid cysts

One of the forms of endometriosis is ovarian, when the lesions are located in the ovarian tissue. Ovarian diseases are characterized by the formation of cysts - a thin-walled cavity with liquid contents. Their danger is that cysts interfere with the functioning of other organs, suppress ovulation, and can fester and break into the abdominal cavity.

With endometriosis, the cyst actively grows and causes pain to the woman. Its cavity is filled with clotted blood, which is why the formation is sometimes called a “chocolate cyst.” The walls of the cyst are sensitive to hormones, as they consist of the same cells as the lining of the uterus. For this reason, the disease can be treated with hormonal drugs. If there is no effect, a laparoscopic operation is performed, in which the cyst is emptied and removed along with the capsule.

Anemia

One of the complications accompanying this disease is anemia. It is associated with increased blood loss during and between periods. Anemia most often occurs with endometriosis of the uterus, when menstrual bleeding is especially heavy. It can be cured by eliminating the symptoms of the underlying disease.

For this purpose, hormonal therapy and surgical methods are used. Women who do not trust traditional medicine practice treatment of endometriosis with folk remedies. Despite the fact that sometimes you can achieve certain success in this way, remember: the elimination of symptoms and treatment should still be carried out by a gynecologist.

Peritonitis

Endometriosis under unfavorable circumstances can be complicated by peritonitis. Peritonitis is an inflammation of the peritoneum, accompanied by a serious condition of patients. It occurs when blood, urine or intestinal contents enter the abdominal cavity. This can happen when the pedicle of the endometrioid cyst is twisted, the endometrium grows through the walls of the uterus and destruction of surrounding tissues, damage to the walls of the bladder and intestines by foci of the disease. In this case, the typical pain associated with endometriosis intensifies, and the patient's condition quickly deteriorates.

Symptoms of endometriosis complicated by peritonitis are as follows:

• Acute abdominal pain that gets worse over time.
• Intoxication with nausea and vomiting.
• Temperature increase.
• Painful sensations when pressing on the anterior abdominal wall
• Tension of the abdominal muscles when pressing (stomach is hard as a board).

Neurological disorders

Neurological symptoms appear in patients with nerve damage from foci of endometriosis. This is facilitated by a large number of nerve plexuses in the genital area and organs of the reproductive system. The growth of lesions into nerve fibers leads to intense pain and decreased sensitivity in the pelvic area.

Neurological disorder in endometriosis may also be associated with chronic pelvic pain syndrome, which accompanies the disease. Pain is caused not only by the foci of the disease that affect the nerve endings, but also by multiple adhesions that accompany endometriosis.

It is difficult to remain optimistic and cheerful if something is constantly and severely painful. Therefore, patients are immersed in sad thoughts; nothing pleases them or interests them. When unpleasant sensations persist for a long time, depression gradually develops, and this is a separate disease, and not just a bad mood, as many people think. How to treat it, and how to reduce pain? The biochemical processes of chronic pain and depression occur in the same way, and this makes it possible to successfully use antidepressants in pain therapy.

Prevention of endometriosis

One way to prevent endometriosis is an annual examination by a gynecologist. In this case, during a manual examination, the doctor may suspect the presence of a disease in the body of the uterus and ovaries, peritoneum and intestines, and examination in the mirrors makes it possible to see foci of the disease located in the vagina and cervix. If the doctor suspects the presence of a disease, he refers the woman to additional tests - ultrasound, MRI, blood tests and laparoscopic diagnostics. An annual examination is also useful for identifying other diseases (for example, fibroids), because with endometriosis, fibroids are very common, which is associated with the same hormonal cause of these diseases.

Physical activity

It is known that endometriosis develops in women with disorders of the immune system. To strengthen the body’s defenses and prevent the development of the disease, you need to strengthen your immune system:

• To refuse from bad habits.
• Eat properly.
• Lead an active lifestyle with feasible physical activity.

In addition to strengthening the immune system, to prevent endometriosis, it is recommended to limit physical activity during menstruation. This is due to the fact that active movements can lead to the reflux of blood, and with it endometrial particles, into the abdominal cavity through the fallopian tubes.

Choice of contraceptive methods

The cause of endometriosis, according to most doctors, is hormonal imbalances combined with a malfunction in the immune system. Hormonal dysfunction is when the body produces excess estrogen, which causes the endometrium to grow. You can suppress the production of estrogen using complex oral contraceptives (COCs) - this is one of the ways to treat the disease. If a woman has a hereditary predisposition to endometriosis, prescribing COCs is a way to prevent the disease. We should not forget that endometrial cells can enter the surrounding tissue as a result of surgical intervention in the uterine cavity (for example, during an abortion). Taking COCs allows you to reliably protect yourself from unwanted pregnancy and harmful abortion procedures.

Preventing intrauterine intervention

One way to spread endometriosis is through surgery or any manipulation of the reproductive organs. During this intervention, endometrial cells enter neighboring tissues and can then begin to grow in them. Considering the fact that the disease develops in the presence of immune disorders, which are widespread in women, the risk of disease as a result of the operation is high. After all, endometrial cells outside the uterus, which are normally destroyed by macrophages, can actively develop in women with impaired immunity.

To avoid the spread of endometrioid tissue to others, you need to be careful with all intrauterine interventions. This is especially true for abortions. Abortion injures the walls of the uterus, the surface of the vagina and the cervix, and such microtraumas are an easy way for endometrial cells to enter surrounding tissues.

Endometriosis is a disease that affects a large number of women. The exact number of people suffering from the disease is unknown, but it is clear that it is the main cause of chronic pelvic pain. Endometriosis occurs in several forms. The extragenital form includes localization outside the reproductive system; the genital form affects the uterus with the cervix, vagina and ovaries. An unpleasant complication of the disease when the ovaries are involved in the process is a cyst.

With endometriosis, the cyst grows quickly, causes severe pain and can be complicated by rupture. In addition to this, a woman can be brought to the surgical table by the growth of the endometrium into the peritoneum and the walls of the intestines and bladder. Damage to the surface of organs can cause organ perforation and the development of peritonitis.

How to prevent the development of such serious complications? First of all, patients are prescribed hormonal treatment with contraceptives or other means that suppress estrogen production. Duphaston for endometriosis is one of the options for hormonal treatment aimed at replenishing progesterone deficiency and limiting endometrial growth. If hormonal therapy does not give the desired effect, surgical treatment is resorted to. Sometimes surgery may be the only way to reduce or completely get rid of the symptoms of the disease.