How to identify chronic endometriosis: basic treatment methods. Treatment methods for chronic endometriosis - symptoms of pathology

Chronic endometriosis develops due to a violation of the integrity of the inner lining of the uterus. This pathology is the main factor in the development of female infertility; with this form of progression, the symptoms are usually mild.

The disease occurs more often in reproductive age after 35–40 years. By this time, most women have a number of chronic concomitant diseases, accompanied by weakened immunity. Also among the reasons for the growth of the endometrium are frequent abortions, curettage, and STDs.

The pathology is characterized by the progressive growth of endometrial cells extending beyond the uterine cavity. They can migrate not only to the tubes, ovaries, cervix, bladder, but also to the rectum and stomach walls. The inflammatory process inside the reproductive organ causes the cells to grow.

Normally it ranges from 0.5–5 mm. The minimum indicator is observed closer to the beginning of menstruation, if fertilization does not occur, the maximum - at the time of ovulation. This is due to the fact that a fertilized egg is attached to the mucosa.

In the chronic stage of endometriosis, many women have problems conceiving, since the overgrown layer is not able to accept the egg, it cannot attach due to a violation of its integrity.

Reasons for development

A number of reasons contribute to the development of endometriosis, but it is not completely clear what provokes the uncontrolled pathological proliferation of cells in the uterine mucosa. Basic prerequisites:

• curettage and surgical abortions;
• frequent douching;
• inaccurate hysteroscopy;
• intimacy during menstrual periods;
• infectious diseases of the genitourinary system and intestines;
• immune disorders;
• hormonal imbalance.

More than a third of all cases of chronic pathology are observed in women over 40 years of age with a history of abortion, curettage, and infectious diseases of the genital organs.

Symptoms

The development of the chronic form of the disease is preceded by an acute phase, characterized by vivid clinical manifestations. In the absence of treatment and the presence of unfavorable factors, the symptoms disappear, but the growth of the endometrium continues.

The manifestations are as follows:

• the presence of acyclic menstrual bleeding in the lower back and abdomen;
• discomfort and the release of a small amount of blood during or after sexual intercourse;
• failure of the menstrual cycle;
• discharge of different colors and consistency caused by infectious diseases;
• infertility, miscarriage, history of miscarriages.

Depending on the form of endometriosis, symptoms may vary. If the pathology is caused by gonorrhea, purulent discharge with an unpleasant odor will periodically appear. With an exacerbation of the chronic form of the disease, an increase in temperature to 39 degrees, apathy, weakness, bleeding, and loss of appetite are possible.

How to treat

Chronic endometriosis can be cured using complex therapy, including restorative and hormonal drugs. Surgical methods are rarely used: if the growth of the endometrium progresses, adhesions occur in the tubes, and frequent bleeding is observed.

Any treatment is preceded by a diagnosis of the chronic process, which is aimed at identifying the root cause of the disease. If an inflammatory focus is identified, appropriate anti-inflammatory and antibacterial drugs are prescribed.

Taking hormonal medications helps stabilize the cycle, normalize the levels of estrogen and progesterone, and stop bleeding.

Surgical methods of treatment

Treatment of chronic endometriosis with surgical intervention is justified in cases where a woman frequently experiences bleeding and hormonal therapy is not effective. is prescribed for retrocervical localization of endometriotic lesions, cyst formation, adenomyosis (damage to the uterus by overgrown endometrium).

There are 4 types of surgical interventions:

• laparotomy;
• access to foci of endometriosis through the vagina;
• combined techniques.

Laparoscopy is considered the most gentle. This minimally invasive technique allows small incisions to be made with minimal blood loss. In addition, the risk of tissue infection is reduced.

Complex treatment

Conservative therapy includes the use of the following drugs:

1. Hormonal drugs (COCs) containing progesterone and estrogen, which reduce the activity of endometrial proliferation.
2. Gestagens. They contain synthetic analogues of the hormone progesterone, which reduce the activity of estrogen on the tissues of the mucous membranes of the uterus.
3. Gonadotropin-releasing hormone antagonists. Necessary for reducing ovarian hyperfunction, they act directly on the pituitary gland and hypothalamus.
4. Inhibitors of gonadotropic hormones. They reduce the production of their own estrogen, block the functions of the ovaries, and stop the growth of endometrial cells.

Depending on the severity, drugs can be used in combination. In the initial phase of the pathology, only oral contraceptives are often prescribed. If 3–6 months have passed after treatment, but endometrial growth continues, the question of surgical intervention arises.

Traditional methods

Used in complex treatment. To stop foci of the disease, reduce ovarian activity, normalize hormonal levels and the menstrual cycle, the following are used:

• plantain;
• propolis;
• hog uterus;
• clay;
• aloe juice

Decoctions and alcohol tinctures are prepared based on natural ingredients. They are also used as an impregnation for tampons and components of homemade vaginal suppositories.

Complications

One of the most common consequences of untreated chronic endometriosis is infertility. Pregnancy pathologies also often occur - spontaneous miscarriage, placental abruption, and arrest of fetal development.

The disease leads not only to infertility. If the cause of endometriosis is a malfunction of the ovaries, weight may increase, excess hair may appear on the body, and the condition of the skin may suffer. Also, the proliferation of cells in the mucous layer of the uterus leads to the appearance of polyps, cysts, and adhesions in the tubes.

Since endometriosis, especially in chronic form, rarely manifests itself with a clear clinical picture, it is necessary to observe preventive measures. These include the use of modern methods of contraception, minimizing abortions and diagnostic curettages, increasing immunity, monitoring hormonal status and regular gynecological examinations.

Chronic endometriosis is a poorly understood and very insidious disease of the female genital area. This is one of the most common ailments, affecting every 7th woman in the world. Mostly women aged 30–40 years old suffer from endometriosis, however, young girls are not immune from this scourge. The insidiousness of endometriosis is that it is often combined with infertility, and therefore every woman should know how to detect the disease in time and whether it is possible to get rid of it.

What is endometriosis

It is necessary to understand that endometriosis is a benign process in which endometrial cells grow beyond the confines of the reproductive organ (uterus). Often such tissue reaches the fallopian tubes, ovary, bladder and even rectum. Moreover, being endometrial tissues, these growths experience all the changes that occur in the walls of the uterus during menstruation. That is why exacerbation of endometriosis occurs during menstruation.

Causes of the disease

Doctors have not yet been able to establish the exact causes of this disease. It is associated with disruption of hormonal processes in the body, with cesarean sections and frequent abortions. As for the chronic form of the disease, it is the result of untreated endometriosis, and therefore due to the negligent attitude towards the treatment of doctors and the patient herself.

Symptoms of endometriosis

Typical symptoms of endometriosis include painful menstruation, pelvic pain, and spotting from the vagina before and after menstruation. In some cases, pain may occur during sexual intercourse or bowel movements. If endometrial tissue grows into neighboring organs, that is, into the bladder or rectum, constipation, hematuria or frequent urination may occur.

However, the chronic form of endometriosis is much easier to tolerate. A woman with this disease occasionally experiences premenstrual bleeding and occasional pain. Most often, such endometriosis is discovered at a doctor’s appointment after undergoing ultrasound diagnostics.

Complications of endometriosis

Representatives of the fair sex may not even suspect a chronic disease, while endometriosis slowly but surely worsens the patient’s condition. Frequent bleeding can lead to anemia, fatigue and constant weakness, increased heart rate, shortness of breath, pale skin and headaches. Moreover, while a woman is unaware of the processes occurring in the body, endometriosis contributes to the development of functional infertility, forming adhesions, epithelial plugs and cysts. But the most dangerous complication of this disease is the degeneration of endometrial tissue into a malignant tumor.

Treatment of endometriosis

Let us say right away that treating the chronic form of this disease is a complex matter, and complete recovery is extremely rare. Endometriosis can be treated with both medications and surgery. It all depends on the severity of the disease, the severity of symptoms, the woman’s age, as well as her plans for pregnancy.

Drug therapy is used to combat concomitant diseases, and therefore most often doctors prescribe antibiotics, vitamins, sedatives and desensitizing drugs. Do not forget about physiotherapy, which plays an important role in the fight against this disease. Doctors recommend sanatorium treatment, including various baths, herbal medicine, douching and irrigation of the uterus. This treatment can work real miracles.

Long-term use of hormonal contraceptives (COCs) is recommended for those representatives of the fair sex who are planning to give birth in the future. These drugs reduce the activity of endometrial cells, which means that a woman will subsequently have a chance to become pregnant. However, if treatment with these drugs does not help overcome chronic endometriosis and prevents pregnancy, doctors may perform surgery to remove adhesions and cysts.

By the way, pregnancy perfectly treats endometriosis, since during pregnancy the body maintains the necessary hormonal levels, as when treating with pills, which means believe in the best and take care of yourself!

Endometriosis is the appearance of cells in the inner layer of the uterus (endometrium) in atypical places: on the peritoneum, ovaries, fallopian tubes, wall and cervix, bladder, rectum and other organs and tissues.

This is one of the most mysterious women's diseases. Despite the fact that this diagnosis is made quite often, the question of what kind of disease this is, why and how to treat it, often remains unanswered. But what if a woman with endometriosis is planning a pregnancy - is anything necessary to be done in this case?

Statistics show that up to 30% of women of reproductive age suffer from endometriosis in one form or another.

What is it: causes of occurrence

Why does endometriosis occur and what is it? The causes of the disease have not been established and remain a matter of debate. Numerous hypotheses for endometriosis have been proposed, but none of them has become definitively proven and generally accepted.

1. One theory points to the process of retrograde menstruation, when part of the menstrual tissue penetrates the abdominal cavity, grows into it and enlarges.
2. Genetic theory puts forward the point of view that the genes of certain families contain the beginnings of endometriosis and, thus, members of these families are predisposed to endometriosis.
3. There is also a theory that explains the occurrence of endometriosis by saying that tissue affected by endometriosis spreads to other parts of the body through the lymphatic system.
4. Others believe that remnants of tissue from a woman's embryonic phase may subsequently develop into endometriosis, or that some of this tissue, under certain conditions, does not lose its ability to reproduce.

The likelihood of the disease increases with:

• frequent inflammation of the genital organs;
• tumors ();
• difficult childbirth;
• operations on the uterus;
• abortions;
• drinking alcohol;
• smoking;
• excessive “love” for products containing caffeine;
• disorders in the functioning of the endocrine system organs (thyroid gland, adrenal glands, hypothalamus,
• pituitary gland, female reproductive glands);
• reduced immunity.

Despite these studies, the real incidence of endometriosis is unknown, due to the fact that in most cases the disease is asymptomatic and very difficult to diagnose.

Therefore, undergo regular preventive examinations with a gynecologist. This is especially important for those who have had any operations on the uterus (abortion, caesarean section, cauterization of cervical erosion, etc.). Timely diagnosis is the key to successful treatment without consequences.

Is it possible to get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of becoming pregnant, but cannot harm the development of the fetus. If a woman with endometriosis does conceive a child, there is every reason to believe that the symptoms of the disease will become significantly weaker throughout the pregnancy.

If you have endometriosis, be sure to discuss the possibility and risks of pregnancy in your particular case with your gynecologist before you start trying to conceive.

Symptoms of endometriosis

The symptoms of this disease are so varied that they can sometimes mislead even experienced specialists. Endometriosis of the uterus can be accompanied by both pronounced symptoms and their absence at all.

However, certain symptoms should definitely alert a woman:

1. Pain of varying intensity, up to acute. They can be localized, radiating to the groin area, anus, leg. The pain either occurs in the first days of menstruation and disappears with its end, or does not leave the woman throughout the entire cycle, but after the end of menstruation they weaken.
2. Spotting dark bloody discharge from the genital tract 2-5 days before and after menstruation, especially if these same menstruation is quite heavy and prolonged;
3. Uterine bleeding during the intermenstrual period (metrorrhagia);
4. Spotting may also occur during sexual intercourse.

Menstruation with endometriosis becomes profuse, with clots, which leads to the development of chronic posthemorrhagic anemia:

• brittle nails,
• dyspnea,
• weakness, drowsiness
• dizziness,
• pallor of the skin and mucous membranes,
• frequent and so on.

Unfortunately, in some cases, the symptoms of endometriosis are very mild or non-existent. For this reason, you should visit the gynecologist’s office once every six months. Only timely diagnosis can protect against the development of undesirable consequences of endometriosis.

Endometriosis grades 1, 2 and 3

In the uterine wall, foci of endometriosis are detected at different depths, so endometriosis of the uterine body can have four degrees of distribution:

• 1st degree. There are one or more small areas of endometriosis.
• 2nd degree. There are several small foci of endometriosis that penetrate into the thickness of the organs affected by them.
• 3rd degree. There are many superficial lesions and a few deep lesions of endometriosis or a few cysts on the ovaries ("chocolate" cysts - the name comes from the characteristic dark brown color given to the cysts by decaying blood).
• 4th degree. Multiple and deep foci of endometriosis, multiple, large cysts on the ovaries, adhesions between the pelvic organs are diagnosed.

There is no linear relationship between the extent of endometriosis and the severity of the symptoms of the disease. Often, widespread endometriosis is less painful than mild endometriosis, which has only a couple of small lesions.

Diagnostics

In the effective treatment of endometriosis, the most important point is timely and correct diagnosis. The presence of endometriotic lesions can be determined using:

• X-ray contrast methods (hysterosalpingography)
• endoscopic examinations (for example, hysteroscopy),

However, the complaints and clinical symptoms listed above are of great importance. Sometimes endometriosis is diagnosed during pregnancy - as a result, treatment of such patients is ineffective due to difficulties in selecting a drug that minimally affects the fetus.

Prevention

The main measures aimed at preventing endometriosis are:

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

Complications

Endometriosis of the uterus can be asymptomatic and not affect a woman’s quality of life. On the other hand, undiagnosed endometriosis and lack of adequate treatment can lead to complications.

Most likely consequences:

• adhesions in the pelvis;
• fertility disorders;
• anemia due to excessive bleeding;
• endometrioid cysts;
• malignancy.

How to treat endometriosis

Treatment methods for endometriosis have been improved over many years and are currently divided into:

• surgical;
• medicinal;
• combined.

Medicinal methods of therapy include the use of various groups of drugs:

• combined estrogen-gestagen drugs;
• gestagens, antigonadotropic drugs;
• gonadotropin releasing hormone agonists.

The earlier a woman is diagnosed, the greater the likelihood of using only medications.

Conservative therapy

Conservative treatment is indicated for asymptomatic uterine endometriosis, at a young age, during the permenopausal period, for adenomyosis, endometriosis and infertility, when it is necessary to restore reproductive function.

The drug treatment route includes fairly traditional therapy:

• hormonal;
• anti-inflammatory;
• desensitizing;
• symptomatic.

The main drugs with proven effect for the treatment of confirmed endometriosis are:

• progesterone preparations;
• danazol;
• gestrinone (Nemestran);
• gonadotropin releasing hormone (GnRH) agonists;
• monophasic combined oral contraceptives.

The duration of courses of hormonal therapy and the intervals between them is determined by the results of treatment and the general condition of the patient, taking into account the tolerability of the drugs and the performance of functional diagnostic tests.

Other groups of drugs that “help” in the fight against painful symptoms of the disease:

• (anti-inflammatory therapy);
• antispasmodics and analgesics (painkillers);
• sedatives (elimination of neurological manifestations);
• vitamins A and C (correction of deficiency of the antioxidant system);
• iron supplements (elimination of the consequences of chronic blood loss);
• physiotherapy.

Research is currently underway around the world on the possibility of using immunomodulators for the treatment of endometriosis, especially for the treatment of associated infertility.

Surgical treatment of endometriosis

Surgical intervention is indicated in the absence of effect from conservative therapy for 6-9 months, with endometrioid ovarian cysts, with endometriosis of postoperative scars and the navel, with ongoing stenosis of the intestinal lumen or ureters, with intolerance to hormonal drugs or the presence of contraindications to their use.

Surgical methods for treating endometriosis involve removing endometrioid formations (most often cysts) from the ovaries or other affected areas. Modern surgery gives preference to gentle operations - laparoscopy.

After removal of the foci of the disease, physiotherapeutic and drug treatment is indicated to consolidate the result and restore the cycle. Severe forms of endometriosis are treated by removing the uterus.

The results of treatment depend on the extent of surgical intervention and the usefulness of hormonal therapy. The rehabilitation period in most cases is favorable: reproductive function is restored, pain during menstruation is significantly reduced. After treatment, dynamic monitoring by a gynecologist is recommended: gynecological examination, ultrasound monitoring (once every 3 months), monitoring the CA-125 marker in the blood.

Prognosis for endometriosis

This disease often recurs. For example, the rate of recurrence of endometriosis after surgery to remove lesions during the first year is 20%, that is, 1 out of 5 operated women will again encounter the same problems as before the operation during the first year after surgery.

Hormonal correction has a good effect, but the problem of this treatment method is the disruption of the process of natural maturation of the endometrium of the uterus, and therefore the impossibility of natural conception of a child. When pregnancy occurs, as a rule, the symptoms of endometriosis disappear for the entire period of pregnancy. When menopause occurs, endometriosis also disappears.

The appearance of tissue from the endometrium (lining of the uterus) outside the uterus, in places such as the ovaries or the surface of the fallopian tubes, on the outer back wall of the uterus, or in the pelvic cavity between the uterus and rectum, is a symptom of chronic endometriosis.

The endometrium is a thin, pinkish, velvety mucous membrane lining the uterus. It consists of several layers: superficial epithelium; glands that secrete an alkaline fluid that maintains moisture in the uterine cavity; blood vessels; tissue spaces.

The thickness of the endometrium changes during each menstrual cycle from 0.5 to 3-5 millimeters, gradually accumulating in preparation for pregnancy, and then, in the absence of fertilization, being largely washed away with blood in the menstrual flow.

Approximately three-quarters of cases of chronic endometriosis appear in the age range from 25 to 45 years, especially in the fourth decade.

The main signs of the chronic form of the disease are menstrual irregularities, most often extremely painful menstruation, which can progress to constant pain.

Some women also experience pain, sometimes severe, during vaginal intercourse. However, there is no true correlation between the intensity of pain and the extent of the disease. In addition, approximately a third of patients have no symptoms other than infertility. In the early stages of this disorder, it is often more painful than in later stages, possibly because increased production of prostaglandins causes cramping.

Causes of endometriosis

Why endometrial tissue leaves the uterus is unknown. According to one theory, part of this tissue during menstruation, instead of being washed out through the vagina, enters the fallopian tubes, implants in the abdominal area and begins to grow.

Another theory is that the immune system hormone, interleukin-1, is secreted by white blood cells in response to cells from the uterus that enter the abdominal area, causing the immune system to overreact to them. Or because the immune system overreacts to even a normal number of such cells.

Recent research suggests that chronic endometriosis may well be a disorder of the immune system itself, although other researchers suspect that environmental toxins, especially organic chlorines, play a role.

Development of the disease

The course of the disease is better known than its causes. During menstruation, when the lining of the uterus that accumulates during pregnancy is removed, the endometrial tissue outside the uterus reacts to hormones in exactly the same way - breaking down and bleeding. The blood stagnates and over time a blood-filled cyst - endometrial or chocolate - can form. So named because it is filled with old, dark, chocolate-colored blood.

At first, pain in the pelvic area is felt only during menstruation in the form of severe cramps. Over time, chronic inflammation of the tissue leads to the formation of adhesions and scars that surround the sensitive reproductive organs. As endometrial tissue builds up and presses on them, pain may precede menstruation by up to two weeks.

In turn, the adhesions can be extensive enough to block the fallopian tubes, ovaries and uterus. Eggs cannot break through the thick veil of scar tissue, which leads to infertility. As the disease progresses, old endometrial cells die, leaving behind scar tissue.

Diagnosis of chronic endometriosis

Chronic endometriosis - symptoms are similar to those of pelvic inflammation. The most common diagnostic methods are:

• Ultrasound examination of the pelvic organs with a vaginal probe. When examining a patient using ultrasound, the specialist always ascertains the medical history and determines the presence of complaints, since endometriosis is similar to other diseases. It is important to perform an ultrasound examination on a high-quality device with high resolution, which allows you to see even small foci of endometriosis. Ultrasound as a method is an auxiliary one, which, together with a clinical examination by a gynecologist, helps a specialist diagnostician make an accurate diagnosis of endometriosis in order to adopt the correct treatment tactics for the disease;
• Magnetic resonance imaging is not indicated for every patient. But if a woman is planning, then it is very important to determine the extent of the disease more accurately and as early as possible;

• hysterosalpingography helps to identify the patency of the fallopian tubes and the degree of damage to internal organs by endometrial tissue;
• Laparoscopy is considered the gold standard for diagnosing endometriosis, in which the external forms of the disease are determined. Laparoscopy is a method of examination without an incision in the abdominal cavity by puncture, laparoscopic tubes are inserted and endometriosis lesions are removed. Thus, this type of research often moves from diagnosis to treatment.

The scope of various types of research is determined by the gynecologist when the patient contacts him, focusing on his complaints.

Treatment of chronic endometriosis

Treatment of endometriosis is always complex. Over the past five years, doctors’ tactics and views on treatment strategies have changed. Previously, doctors believed that, having laparoscopy in their arsenal, they could use it every two years and everything would be fine.

But modern medicine has become convinced that repeated treatment with laparoscopy leads to a gradual thinning of healthy tissue (truncation or cauterization of the tissue occurs), thereby losing the ovarian reserve, i.e. tissue supply for subsequent pregnancy. Today, the most important task of treatment is to prove the disease and conduct long-term drug therapy in order to exclude surgical intervention.

Treatment may vary, but is usually aimed at reducing pain and interrupting the menstrual cycle. Sometimes the disease can be controlled by using oral contraceptives (combining estrogen and). Treatment usually lasts from three to nine months, depending on the severity of the disease. After treatment, relapses of the disease are possible.

Pregnancy can lead to a temporary cessation of symptoms of chronic endometriosis. However, half of women with this disease cannot conceive, even with normal menstruation, regular ovulation and unblocked fallopian tubes. This disease, even in its weakest form, prevents fertilization or implantation.

Some experts are of the opinion that the body produces antibodies against displaced endometrial tissue, which also attack the uterine tissue itself, thereby causing an increased risk of miscarriage three times greater than in a normal situation. Chronic endometriosis also causes an increased risk of ectopic pregnancy - 16% versus 1% under normal conditions.

For women who would like to have children, surgical treatment may be recommended. Conservative surgery using laparoscopy involves removing areas of endometrial tissue by cauterization (burning), curettage (scraping), or laser surgery. It restores fertility in approximately one third to half of patients.

During surgery, the surgeon may also perform uterine suspension, which involves shortening or relocating the uterine ligaments to keep the uterus higher and out of the pouch of Douglas, preventing the formation of adhesions. Sometimes the surgeon also cuts large nerve plexuses that transmit pain sensations to the brain, which reduces pain. Most, if not all, of these operations can be performed through laparoscopy, which replaces the major abdominal surgery previously required for these purposes.

If the adhesions are thick enough and the tubes are damaged, but the woman still wants to get pregnant, a major surgical operation - laparotomy - can be performed. If there are chocolate cysts in the ovaries, then treatment occurs by opening them with a laser. The purpose of this method is to cleanse and restore normal ovarian function.

Many women, after completing treatment for chronic endometriosis, notice weight gain and the appearance of acne. This occurs as a consequence of hormonal imbalance in patients. In search of alternative methods of treating the disease, they direct their attention to herbal medicine or homeopathic remedies. But you shouldn’t rely solely on these methods and expect a miracle. It makes more sense to approach this issue more comprehensively, paying attention to the state of immunity, on which the dynamics of the development of the disease depends.

However, herbalists note the positive effect of collecting herbs from chamomile, corn silk and guillemot herb, taken in equal parts and poured with boiling water. Take 150 grams 4 times a day half an hour before meals.

Menopause with chronic endometriosis

Hormonal imbalance is the main reason for irregular menstruation during menopause. Irregularity in itself may be normal, but some symptoms may signal the possibility of a serious illness. Exceptionally heavy bleeding (faster and heavier flow than any heavy menstruation, often with clots), bleeding at intervals of less than 21 days, prolonged bleeding outside of menstruation (for three to four weeks) - all this requires an immediate gynecological examination.

Sometimes the cause of heavy and prolonged bleeding is thickening of the endometrium - endometrial hyperplasia.

After menopause, endometriosis almost always goes away. However, women diagnosed with chronic endometriosis who can and want children are strongly recommended to do this as soon as possible, since until menopause the disease continues to progress (gradually worsen) and recur even after conservative surgery.

An effective solution to your problems is determined by a timely visit to a gynecologist - something every woman should remember. Be healthy!

Bibliography

1. Clinical guidelines for contraception. /Translation from English/ Edited by Professor V.N. Prilepskaya - 2009, M.: BINOM Publishing House.
2. Arterial hypertension in pregnant women. Is it just gestosis? Guide for doctors. Makarov O.V. 2006 Publisher: Geotar-Media.
3. Emergency care for extragenital pathology in pregnant women. 2008, 2nd edition, corrected and expanded, Moscow, “Triad-X”.
4. Preeclampsia: theory and practice. Ailamazyan E.K., Mozgovaya E.V. 2008 Publisher: MEDpress-inform.
5. Arterial hypertension in pregnant women Preeclampsia (preeclampsia). Makarov O.V., Volkova E.V. RASPM; Moscow; TsKMS GOU VPO RGMU.-31 pp.- 2010.

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

The tissue structure includes:

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

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

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

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

Causes of the disease

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

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

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

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

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

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

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

Symptoms of the disease

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

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

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

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

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

Classification of the disease

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

Medicine today identifies the following forms of the disease:

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

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

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

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

Stages of disease development

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

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

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

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

Degrees of disease and clinical manifestations

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

Today the following degrees of the disease are distinguished:

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

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

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

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

Diagnostics

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

Specialists have several methods for examining a patient:

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

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

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

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

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

Treatment and prevention

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

Modern medicine for this disease offers the following treatment:

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

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

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

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

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

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

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