Endometriosis - what is it? Endometriosis of the uterine body - what is it in simple terms and what you need to know about this pathology What kind of disease is endometriosis

is a benign invasion and proliferation of endometrial elements in the muscular layer of the uterus.

Traditionally, internal endometriosis is considered a local case of endometrioid disease -. At the same time, many authors describe it as an independent disease - adenomyosis.

Internal endometriosis: ICD-10 code

N80 Endometriosis
N80.0 Endometriosis of the uterus (adenomyosis, internal endometriosis)

Causes of development of internal endometriosis

• Destruction intermediate zone myometrium during instrumental or surgical interventions on the uterus (abortion, cesarean section, “blind” endometrial curettage, intrauterine device, etc.)
• Hereditary predisposition to tumor diseases, genetically determined failure of the intermediate zone of the myometrium.
• Chronic inflammatory diseases of the uterus and appendages.
• Immune and hormonal disorders.

• Frequent instrumental intrauterine interventions (abortions, diagnostic curettages, etc.)
• High infectious index.
• Chronic somatic diseases: hypertension, obesity, diabetes, gastrointestinal diseases, allergies, etc.
• Endocrine disorders.
• High incidence of past gynecological diseases.
• Shortened (less than 27 days) menstrual cycle, heavy, long periods.
• Senior reproductive age.

Symptoms of internal endometriosis

• Heavy, prolonged menstruation.
• Algomenorrhea.
• Pain varying intensity: lower abdomen, chronic pain in the pelvic area, in the lower back.

Other clinical signs of internal endometriosis

• Increase in the size of the uterus. Feeling of a “big belly” during menstruation.
• Spotting, bloody-brown (“chocolate”) discharge from the uterus a few days before and after menstruation.
• Secondary anemia.
• Acyclic spotting “chocolate” discharge after sexual intercourse, lifting weights.
• Painful intercourse.
• Miscarriage: early miscarriages, premature birth.
• Infertility.

Diagnosis of internal endometriosis

An experienced gynecologist will notice the classic signs of internal endometriosis during a routine bimanual examination:

• Increase in the size of the uterus.
• Change in the shape of the uterus (spherical or tuberous).
• Rough surface of the uterus in the second phase of the menstrual cycle.
• Painful uterus.

Despite the fairly high (up to 80-90%) diagnostic accuracy of ultrasound, the detection of grade 1-2 internal endometriosis by this method is associated with certain difficulties and is not always possible. When adenomyosis is combined with multiple fibroid nodes, the prognostic value of ultrasound is significantly reduced.

For a more accurate diagnosis of adenomyosis, ultrasound should be performed in the second half of the menstrual cycle, closer to the beginning of menstruation.

Echo signs of internal endometriosis

• The uterus is round in shape.
• In the myometrium, hyperechoic zones of various sizes are detected, often round in shape.
• Inside zones of increased echogenicity, anechoic (cystic) cavities can be found, sometimes large up to 3 cm, filled with fine suspension (symptom of “honeycomb”).
• The anteroposterior dimensions of the uterus are enlarged or one of the walls of the uterus is unevenly thickened.
• Defects of the basal layer of the endometrium: jaggedness, uneven thickening or thinning. The boundaries between the endometrium and myometrium are unclear.
• Hypo- and hyperechoic stripes in the myometrium, located close to each other, perpendicular to the scanning plane (echoic linear striations).

MRI of the uterus is a more accurate (compared to ultrasound) method of instrumental diagnosis of adenomyosis. Due to the high cost, this study is optional. However, many authors believe that MRI should become a standard diagnostic procedure in cases of high-grade algomenorrhea because this symptom always suggests internal endometriosis.

In addition, MRI can detect the disease at an early stage of its development. An important diagnostic MRI sign of adenomyosis is thickening of the intermediate zone of the myometrium by more than 12 mm (the norm is 2-8 mm).

This method of diagnosing adenomyosis is based on visual inspection of the inner surface of the uterus using endoscopic equipment.

• Deformation, expansion of the uterine cavity.
• Against the background of the pale pink mucous membrane of the uterus, the mouths of the bleeding endometriotic ducts are visible.
• The walls of the uterus have an uneven rocky topography - the phenomenon of “wave” or ridge formation.

To diagnose internal endometriosis, hysteroscopy is performed
on days 6-9 of the menstrual cycle.

In the case of adenomyosis, the most informative is hysteroscopy with mandatory targeted biopsy suspicious area of ​​the myometrium.

Diagnostic hysteroscopy and biopsy are always followed by separate diagnostic curettage mucous membrane of the uterus and cervical canal (under mandatory hysteroscopy control). All removed endometrial tissue and myometrial biopsy are sent for histological examination.

The final diagnosis of internal endometriosis is made after confirmation by histological conclusion

Internal endometriosis in 31-56% of cases is combined with other pathological transformation of the endometrium (including malignant). But most often - from the uterus (up to 85% of cases).

Degrees of internal endometriosis

The severity of the diffuse form of internal endometriosis is determined by the degree of damage to the uterus:

1. Ι degree - invasion of the endometrium into the myometrium is limited to the intermediate zone (submucosal layer of the myometrium).
2. ΙΙ degree - the depth of endometrioid ectopia does not exceed half of the myometrium (up to the middle of the thickness of the muscular layer of the uterine wall).
3. ΙΙΙ degree - damage to the largest part or all of the muscular layer of the uterus up to the outer serous membrane.
4. ΙV degree - the pathological process extends beyond the uterus and spreads to the parietal peritoneum of organs adjacent to the uterus.

Internal endometriosis stage 1

It is usually asymptomatic and often becomes a random histological finding or is predicted based on MRI results.

Asymptomatic grade 1 adenomyosis does not require special treatment. The patient is recommended to have a healthy lifestyle and follow-up with a gynecologist once every 6 months.

Internal endometriosis stage 2

And at this stage of the disease, the symptoms of internal endometriosis are not always noticeable. Therefore, the disease can be detected accidentally (during a routine ultrasound, during an examination of a patient with complaints of infertility).

But more often, grade 2 adenomyosis is accompanied by algomenorrhea, polymenorrhea, pelvic pain, “chocolate” spotting, and dyspareunia.

In some cases, the only sign of pathology is infertility or miscarriage.

The uterus at this stage of the disease is of normal size or slightly enlarged (does not exceed 5-6 weeks of pregnancy).

For asymptomatic forms of grade 2 adenomyosis, treatment is not carried out - dynamic observation is recommended.

In case of mild symptomatic course, it is permissible to prescribe monophasic COCs, for example, progestins, including intrauterine ones. Evaluation of the effectiveness of hormonal treatment - every 3-6 months.

For pelvic pain or algomenorrhea, short courses of NSAIDs are also prescribed.

Read more about drug treatment for internal endometriosis below.

Internal endometriosis grade 2-3

Accompanied by pain hyperpolymenorrhea, an increase in the size of the uterus, infertility (in 50% of cases) and other signs characteristic of adenomyosis.

The choice of treatment - hormonal or surgical - is individual. It depends on the severity of the disease, the age and reproductive plan of the woman, and the gynecological and somatic pathology accompanying adenomyosis.

Internal endometriosis grade 3-4

This advanced stage of the disease is accompanied by severe symptoms and requires surgical treatment.

The scope and access of surgical intervention, postoperative replacement or anti-relapse hormonal therapy is prescribed strictly individually, if necessary and according to indications.

Endometriosis of any localization is similar to a tumor with a chronic course and autonomous growth of pathological foci.

Therefore, a true cure for this disease is possible only with the most complete surgical removal of absolutely all endometrioid ectopia. In the case of internal endometriosis, this effect is achieved total removal of the uterus.

But if the disease affects young women interested in preserving reproductive function, they have to look for other, less radical, organ-preserving treatment methods.

Drug hormonal treatment of internal endometriosis

Drug therapy for internal endometriosis is justified in young nulliparous women.

In other cases, hormonal agents, if necessary, are prescribed after surgical treatment as anti-relapse therapy.

According to many clinicians, truly effective hormonal suppressive treatment of adenomyosis is possible only with 1-2 degrees of spread of the disease

Today, the following groups of hormonal drugs are used in the treatment of internal endometriosis:

• A-GnRH - analogues of gonadotropin-releasing hormone: Nafarelin, Buserilin, Leuprorelin, Triptorelin.
• Antigonadotropins: Danazol, Gestrinone.
• Progestins: Medroxyprogesterone, Dienogest (), Levonorgestrel.

Modern A-GnRH drugs are recognized as the most effective. They are called the “gold standard” for conservative treatment of endometriosis of any location.

Some hormonal treatment regimens for internal endometriosis

/consultation with a doctor is required/

Both antigonadotropins and GnRH A suppress menstrual function - creating a state of “medicated menopause” or pseudomenopause. Despite their high effectiveness against adenomyosis, treatment with these drugs is accompanied by many unwanted side effects and symptoms of menopause. Therefore, the duration of their use is strictly limited to six months.

After discontinuation of GnRH A, menstrual and reproductive function is restored independently within 6-12-36 months. Remission of the desired disease lasts up to 5 years or more. During this period, the woman manages to give birth to a child or approach natural menopause with the reverse development (involution) of the disease.

Recurrence of internal endometriosis after conservative therapy is an indication for surgical treatment.

Surgical treatment of internal endometriosis

Even taking into account all the complexity and imperfections of drug treatment of adenomyosis, radical surgical treatment of internal endometriosis - removal of the uterus - is carried out exclusively according to strict indications

• There is no positive effect from hormonal therapy during the first 3 months of treatment.
• Adenomyosis grade 2-3 in combination with ovarian tumors, fibroids, endometrial hyperplasia or other uterine pathology requiring surgical treatment.
• Adenomyosis of 2-3 degrees with symptoms of hyperplastic transformation of the muscular layer of the uterine wall.
• Adenomyosis, resistant to conservative treatment, accompanied by uterine bleeding and secondary anemia.
• Cystic form of adenomyosis.

• Supravaginal amputation of the uterus - supracervical or subtotal hysterectomy (with or without appendages).
• Complete removal or extirpation of the uterus - total hysterectomy (with or without appendages).

A supravaginal hysterectomy is less dangerous than a total hysterectomy. Therefore, when choosing the extent of surgical intervention, it is extremely important to adequately assess the feasibility of preserving the cervix and ovaries. Oncologists definitely recommend removing the fallopian tubes.

• Laparoscopy.
• Laparotomy.
• Vaginal access in combination with laparoscopy.

Laparoscopy traditionally occupies a priority place in the surgical treatment of internal endometriosis.

Advantages of laparoscopy:

• Minimal trauma.
• Significant reduction in postoperative rehabilitation time.

If the vaginal part of the cervix is ​​intact (not involved in disease), laparoscopic supracervical hysterectomy (LSH) is recommended. Otherwise, a total laparoscopic hysterectomy (TLH) is performed.

Contraindications to laparoscopy for adenomyosis:

• Suspicion of a late-stage malignant process.
• Combination of internal endometriosis with widespread endometriosis of another location.
• Severe extragenital pathology.
• Pronounced adhesions of the abdominal cavity.
• Relative contraindication: the size of the affected uterus is more than 12 weeks of pregnancy.

Complications of the disease

Patients with internal endometriosis should undergo regular examination by a gynecologist at least once every 3-6 months. Timely therapy will prevent progression of the disease.

• Uterine bleeding.
• Severe secondary anemia.
• Damage to neighboring organs.
• Infertility.
• Severe pain, severe limitation of physical activity, inability to have sexual activity.
• Malignancy.

According to oncologists, patients with internal endometriosis are at high risk for developing endometrial, ovarian and mammary gland cancer.

Endometriosis can cause painful periods, persistent pelvic pain, infertility and other symptoms. Symptoms of endometriosis can range from mild to severe.

Treatment options mainly include painkillers, hormonal treatments, and surgery.

It is worth explaining what it is in an accessible language and why it is dangerous, how the pathology develops, what methods have been developed for its detection and treatment is acceptable in various clinical situations.

What is endometriosis?

Photo of endometriosis

The endometrium is the tissue lining the inner mucous membrane of the uterine body (mucosal layer).

Uterine endometriosis is a condition in which endometrial tissue is found outside the uterus. It is "trapped" in the pelvis and lower abdomen, and, less commonly, in other areas of the body.

Endometriosis is a hormonally dependent pathological condition, accompanied by the growth of the glandular lining of the uterus in the fallopian tubes, ovaries, bladder, in the thickness of the uterus, on the peritoneum, in the intestines and on some other organs (see photo above).

Endometriosis is a common gynecological pathology, ranking third in frequency of occurrence after inflammation and uterine fibroids. Most often, uterine endometriosis is detected in women of reproductive age - from 25 to 40 years. Also, pathology can manifest itself in girls during the formation of menstrual function and in women. It should be borne in mind that difficulties in identifying pathology and the asymptomatic course of the disease allow us to conclude that the endometrioid process is more common.

Causes of endometriosis development

In medicine, there is not yet a unified theory about the causes of the development of endometriosis. There are, the most common of which is retrograde menstruation (meaning the reverse flow of menstrual blood). She explains the origin of endometriosis by the involvement of endometrial particles with menstrual blood in the fallopian tubes and abdominal cavity during retrograde menstruation.

When a number of conditions are combined, endometrioid cells attach to various organs and resume their ability to function cyclically. During menstruation, the presence of endometrium, localized on uncharacteristic organs, provokes microbleeding and inflammation.

Thus, those women who have retrograde menstruation may develop endometriosis, but not in all situations. The likelihood of developing pathology increases due to the following features:

• hereditary predisposition;
• disturbances in the functioning of the immune system;
• surgical interventions;
• environmental factors (properties of the environment that affect your body).

Progression of endometriosis is also possible with surgical interventions on the uterus. For this reason, after any surgery, it is important to be observed by a doctor for timely diagnosis of possible pathologies.

There are also a number of other theories about the causes of endometriosis, which include:

• theory of gene mutations;
• deviations in the interaction of receptor molecules with hormones;
• dysfunction of cellular enzymes;
• embryonic theory.

Risk factors for developing endometriosis

There are several main groups of women predisposed to the progression of endometriosis:

• women with shortening;
• women with metabolic disorders (obesity);
• using intrauterine contraceptives;
• age over 30-35 years;
• women with pathologically high levels of estrogen;
• women with pathologies that suppress the immune system;
• have undergone surgery on the uterus;
• smoking women.

Classification and degree of development of endometriosis

The exact answer to the question “what is uterine endometriosis” is determined by the localization and prevalence of the pathological process. For this reason, a classification of pathology has been developed according to location.

There are two main groups of the disease – extragenital and genital.

In the case of the genital form of pathology, areas of heterotopia are located on the genital organs, and in the case of extragenital pathology, they are located outside the reproductive organs. The genital form of the disease is divided into several conditions:

• peritoneal form of endometriosis – involvement of the pelvic peritoneum, ovaries and fallopian tubes in the pathological process;
• extraperitoneal form of endometriosis - foci of ectopia are localized in the lower part of the woman’s reproductive system (cervix, vagina, external genitalia);
• The internal form of endometriosis (uterine endometriosis or adenomyosis) can develop in the myometrium.

In the absence of proper treatment, the pathological process is mixed.

In the case of extragenital localization, the foci of the endometrium include the intestines, lungs, kidneys, and postoperative scars.

Based on the prevalence and depth of the pathological focus, there are 4 main degrees of development of endometriosis:

• First: single foci are localized on the surface.
• Second: a larger number of deep foci.
• Third: multiple deep foci, the presence of endometriotic lesions, adhesions.
• Fourth: a large number of deep foci of pathology, large endometrioid cysts, severe, endometrium grows into the thickness of the rectum and vagina.

In addition, the following degrees of internal endometriosis are distinguished according to the degree of involvement of the muscular layer of the uterus in the pathological process:

• First: the beginning of myometrial damage.
• Second: foci of pathology grow into half the myometrial layer.
• Third: damage to the entire thickness of the muscle layer of the organ.
• Fourth: damage to the walls of the organ, spread of the pathological process to the peritoneal tissue.

Endometriotic lesions differ from each other in shape and size: they can be small, round or shapeless and spread up to several centimeters in diameter.

Most often, they are characterized by a dark cherry color and delimitation from adjacent tissues by whitish scars. As a result of cyclical maturation, endometrioid lesions are more visible immediately before the onset of menstruation.

Clinical symptoms of endometriosis

The clinical picture of the condition can be varied, depending on the location of the pathological process and its severity. Timely detection of the disease is possible with regular visits to the gynecologist for a preventive examination.

There is a spectrum of symptoms that characterize the progression of endometriosis:

• Pain in the pelvic area. The pain syndrome can be both diffuse and localized. The pain may be constant or worsen during menstruation. Soreness is most often triggered by the inflammatory process that accompanies endometriosis.
• Dysmenorrhea. Menstrual irregularities.
• Dyspareunia, or painful sexual intercourse.
• Pain during urination and defecation.
• Menorrhagia is an increase in the volume and duration of menstrual bleeding.
• Posthemorrhagic. The condition is caused by the chronic nature of blood loss. It manifests itself in the form of increasing weakness, jaundice or pallor of the skin, fatigue, drowsiness, and dizziness.
• Infertility. Develops in 25-40% of patients with endometriosis. In this case, we are talking about a low probability of pregnancy, and not about its complete impossibility.

Possible complications of endometriosis

Due to hemorrhages and scar formation in endometriosis, adhesions are provoked in the abdominal organs and pelvis. Quite often, as a result of pathology, cysts are formed on the ovaries, which are filled with menstrual blood. Both adhesions and endometrioid cysts can cause infertility.

Also, with endometriosis, compression of the nerve trunks can be observed, which leads to the development of neurological symptoms. Due to significant blood loss, manifestations such as:

• anemization;
• irritability;
• constant weakness.

Foci of endometriosis in some cases undergo malignancy (malignancy).

Diagnosis of uterine endometriosis

When identifying endometriosis, it is important to exclude other gynecological pathologies that occur with similar symptoms. Diagnostic search includes the following activities:

• Anamnesis collection. It is important to take into account not only the patient’s clinical symptoms and complaints, but also family history, that is, cases of pathology among family members. It is also necessary to clarify whether gynecological operations were performed.
• Gynecological examination. Can be vaginal, rectovaginal, or in speculum. The most informative is to carry it out a few days before the start of menstruation.
• Colposcopy and hysterosalpingoscopy. They are carried out to clarify the location and parameters of the lesion, as well as to obtain a biopsy sample.
• Ultrasonography. It is necessary to clarify the location of foci of pathology and the dynamics of the condition during therapy.
• Spiral computed tomography or magnetic resonance imaging. These methods make it possible to clarify the nature and localization of endometriotic lesions.
• Laparoscopy. The method allows you to visually assess the number, maturity, and activity of endometriotic lesions.
• Hysterosalpingography is an examination of the uterus and fallopian tubes using x-rays.
• Hysteroscopy is an endoscopic examination of the uterus to identify.
• Laboratory tests: identifying tumor markers CEA, CA-125, CA 19-9 and performing a RO test. These indicators increase significantly in the case of endometriosis. Laboratory diagnostics are also carried out to detect anemia in patients with endometriosis.

Some diagnostic techniques are worth considering in more detail.

Hysterosalpingography

This technique is important for identifying internal endometriosis (adenomyosis or endometriosis of the uterus). The study is carried out with a water-soluble contrast agent on days 5, 6 or 7 of the cycle. The presence of contour shadows is noted on the x-ray.

Tomography

Computed tomography can provide information about the boundaries of the pathological process. Magnetic resonance imaging is more informative for endometriosis.

Ultrasonography

This technique allows you to characterize the pathology according to clear criteria. Endometrioid origin is characterized by the presence of a dense capsule and hyperechoic contents.

In the case of adenomyosis, examination can reveal areas with increased echogenicity, unevenness and jaggedness of the border areas of the endometrium and myometrium, and round inclusions about 5 mm in diameter. Nodular variants of adenomyosis are accompanied by the formation of cavities with fluid with a diameter of about 30 mm.

Hysteroscopy

This technique makes it possible to accurately identify endometriotic ducts and the roughness of the relief of the uterine walls in the form of crypts or ridges. In 1997 V.G. Breusenko and co-authors developed a hysteroscopic classification of the prevalence of the endometrioid process:

• The first stage: unchanged relief of the walls of the uterus, endometriotic ducts in the form of “eyes” of a blue hue or bleeding foci are detected. The uterine wall is characterized by unchanged density.
• Second stage: uneven relief of the uterine wall in the form of ridges or disintegrated muscle tissue. Endometriotic ducts are identified. The uterine cavity does not stretch well. The wall has a higher density.
• Third stage: the inner surface of the uterus includes many protrusions of varying sizes that do not have clear boundaries. Sometimes endometriotic tracts are noted on the upper part of the bulges. The uterine wall is very dense.

Differential diagnosis

Differential diagnosis is necessary to distinguish between endometrioid cysts and ovarian tumors. The final diagnosis is made based on medical history and ultrasound examination. With ovarian endometriosis, there may be no pain, but with an oncological process, non-localized pain may appear.

In cancer and endometriosis, there is an increase in the level of CA-125. Therefore, an increase in the concentration of this substance does not confirm only one diagnosis. In some cases, a definitive diagnosis is only possible during laparoscopic surgery.

In the case of rectovaginal localization of endometrioid lesions, a differential diagnosis with metastases of chorionic carcinoma is required. To make a final diagnosis in this case, a correct medical history and a study of the hCG concentration are required (in this case, signs of pregnancy are also determined).

The tubo-ovarian inflammatory process in the form of an abscess is difficult to diagnose due to the erased clinical inflammation (for example, chlamydial etiology) and the difficulty of distinguishing the process from a benign tumor or cyst of endometrioid origin.

If the formations on the ovary do not regress within two months, surgery is prescribed. Often the final diagnosis is made after surgery and examination of the biopsy specimen.

Also, in the case of endometriosis, differential diagnosis with endometrial hyperplastic process may be required. With the retrovaginal nature of the lesion and endometriosis of the ligamentous apparatus of the uterus, it is imperative to exclude malignant neoplasms in the organs of the digestive system.

Treatment of uterine endometriosis

The tactics of therapeutic correction are determined by the following parameters:

• age;
• number of pregnancies;
• number of births;
• prevalence of the pathological process;
• location of lesions;
• clinic intensity;
• accompanying illnesses.

There are the following treatment methods for endometriosis:

• Medication.
• Surgical – laparoscopy with elimination of endometrioid lesions or radical removal of the uterus and ovaries.
• Combined.

The goals of therapeutic correction of endometriosis are not only to eliminate symptoms, but also to prevent unfavorable processes in the form of adhesions, cysts and other pathologies.

Non-surgical treatment of uterine endometriosis with drugs

Conservative treatment (non-surgical) of the disease is carried out if endometriosis is asymptomatic, the patient is young or premenopausal, and there is a need to preserve reproductive functions.

The basis of conservative treatment is hormonal therapy with the following groups of medications:

• Combined estrogen-progestin drugs. These include Nonovlon, Silest, Marvelon. These medications contain small doses of gestagens and suppress estrogen synthesis and the ovulatory process. They are prescribed in the initial stages of endometriosis, since combination drugs do not have an effect in the case of widespread endometriosis or the presence of cysts. Possible side effects if used: nausea and vomiting, pain in the mammary glands, spotting during the intermenstrual period.
• Gestagens. These include Duphaston, Nemestran, Utrozhestan, Norkoput. Prescription is possible at all stages of the endometriotic process. Treatment with these drugs is carried out over a period of six months to 8 months. Possible side effects: intermenstrual bleeding, depression, pain in the mammary glands.
• Antigonadotropic drugs. These include Danol, Danogen, Danazol. The mechanism of action is to suppress the synthesis of gonadotropic hormones in the hypothalamic-pituitary system. A continuous course lasting from six months to 8 months is prescribed. Not used in case of hyperandrogenism. The following side effects are possible: hot flashes, sweating, fluctuations in body weight, roughness of voice, increased oily skin, increased hair growth.
• Gonadotropin releasing hormone agonists. These include goserepine, triptorelin and some other drugs. The advantages of taking medications from this group include the possibility of short-term use and the absence of significant side effects. These drugs suppress the ovulatory process, reduce the concentration of estrogen, which together suppresses the prevalence of endometriotic lesions.
• Auxiliary medications: immunostimulating drugs, antispasmodic, analgesic, anti-inflammatory drugs.

A specific regimen for drug correction of the endometriotic process is prescribed by the attending physician, based on the characteristics of the clinical situation. Treatment for the condition must be comprehensive; it is important to strictly follow medical recommendations to maximize the effectiveness of the chosen treatment tactics for endometriosis.

A detailed table of how to treat uterine endometriosis with medication, including drugs, their mechanism of action, dosages and side effects:

Surgical treatment of endometriosis

With moderate and severe degrees of development of the endometrioid process, organ-preserving surgery on the uterus is indicated. In this case, fragments of heterotopias in organs, endometrioid cysts are removed, and adhesions are dissected.

Video of how uterine surgery is performed for endometriosis:

The operation is prescribed if conservative treatment does not bring the desired effect, there are contraindications to taking medications, there are lesions more than 3 cm in diameter, and the function of the organs of the excretory system and intestines is impaired. Quite often, operational measures are combined with conservative ones. Surgical intervention is carried out through laparotomy or laparoscopy.

Radical surgery, that is, removal of the appendages and extirpation of the uterus itself, can be prescribed if the patient is over 40 years old, the pathological process has progressed, or there is no effect from less radical correction methods.

In some cases, endometriosis is prone to relapsing, which may require repeated surgery. It is important to undergo preventive examinations with a specialist at least once every six months for the earliest possible detection of pathology and the effectiveness of conservative correction measures.

The criteria for the effectiveness of pathology treatment are:

• good health;
• absence of pain and other subjective complaints;
• no cases of recurrence of the process over five years after a full therapeutic course.

If a woman is of reproductive age, then the effectiveness of therapy is determined by the preservation of reproductive function. In most patients, even surgical correction does not cause complications in the form of infertility due to the use of modern laparoscopic methods.

In the case of radical operations, resumption of the pathological process does not occur.

Treating symptoms at home

Complementary and alternative treatments may include acupuncture, chiropractic, and herbal medicine, but there is no evidence that they are effective.

• According to many reviews found on forums, it helps some people cope with their illness.
• Quitting caffeine may help reduce pain, as caffeine can worsen symptoms.
• Exercise, such as walking, can reduce pain and slow the progression of the condition by lowering estrogen levels.

It is important to monitor symptoms due to the long-term complications of endometriosis. Severe pain or unexpected bleeding should be reported to your doctor.

Although there is currently no cure for endometriosis, most women can find relief by reducing symptoms and still having children.

Measures to prevent endometriosis

The sooner a woman visits a gynecologist when initial signs of a pathological process appear, the greater the likelihood of recovery and the lower the likelihood of prescribing surgery.

Self-medication or neglect of therapy only worsens the condition: with new menstruation, the appearance of new endometrioid lesions, the formation of cysts, the progression of the formation of adhesions and scars are observed, and the patency of the fallopian tubes decreases.

Basic preventive measures regarding the endometriotic process include:

• Examination of patients with complaints of dysmenorrhea. Women of any age when symptoms of dysmenorrhea appear are examined for a tendency to develop the endometrioid process.
• Observation of women who have undergone gynecological operations for timely detection of pathological foci. Any surgical intervention in the area of ​​the reproductive system can provoke the progression of endometriosis, so after surgery it is necessary to be regularly monitored by a specialist.
• Timely diagnosis and treatment of acute, chronic inflammatory processes of the reproductive system. Inflammatory diseases can also lead to the development of the endometrioid process, so it is important to treat pathologies in a timely manner and not neglect the prescribed methods of therapy.
/ article author

Higher education (Cardiology). Cardiologist, therapist, functional diagnostics doctor. I am well versed in the diagnosis and treatment of diseases of the respiratory system, gastrointestinal tract and cardiovascular system. Graduated from the Academy (full-time), with extensive work experience behind her. Specialty: Cardiologist, Therapist, Functional Diagnostics Doctor. .

Endometriosis is a disease in which endometrial tissue (the lining of the uterus) grows beyond its normal location. It is one of the main causes of infertility and miscarriage.

Endometriosis is a benign growth of the glandular tissue of the uterus (endometrium) outside the uterus itself: in the ovaries, in the fallopian tubes, in the thickness of the uterus, in the bladder, on the peritoneum, in the rectum and even in other, more distant organs, even in the kidneys and lungs. In this case, fragments of the endometrium brought into other organs change in the same way as the endometrium in the uterus, that is, they menstruate, which is accompanied by pain and bleeding. Endometriosis can cause ovarian cysts and infertility.

There are:

• Internal genital endometriosis (adenomyosis) is the growth of the endometrium into the muscular lining of the uterus.
• External genital endometriosis is the location of endometrial tissue in the area of ​​the external genitalia, vagina, cervix, ovaries, fallopian tubes, and pelvic peritoneum.
• Extragenital endometriosis - the location of endometrial tissue in the intestines, bladder, postoperative scars, lungs, pleura, diaphragm.

Causes of endometriosis

Endometriosis is a common disease; it usually occurs in women 25-40 years old, but sometimes in girls and women after menopause. There is no consensus on the causes of endometriosis.

• Implantation, or retrograde menstruation. Some doctors believe that endometriosis develops in some women when menstrual blood containing endometrial particles enters the abdominal cavity and fallopian tubes (retrograde menstruation). There, the endometrium can attach to the tissues of various organs and menstruate cyclically, but cannot exit outside (like from the uterus).
• Hereditary predisposition. If the mother had endometriosis, there is a high probability that her daughters will also develop it.
• Surgical interventions on the uterus: caesarean section, abortion, cauterization of erosions.
• Immunosuppression.

Symptoms of endometriosis

• Sometimes endometriosis remains asymptomatic for a long time. But most patients still experience symptoms.
• Pelvic pain that has a clear localization or is diffused throughout the pelvis. It usually intensifies before menstruation, but can also be constant.
• Painful menstruation (more than half of patients with endometriosis)
• Painful intercourse
• Pain when defecating or urinating
• Heavy and prolonged menstruation, especially with internal endometriosis that has developed in the uterus itself
• Anemia due to large blood loss during menstruation
• Infertility occurs in 25-40% of patients with endometriosis. Most often it occurs due to changes in the ovaries and tubes and ovulation disorders. Violation of general and local immunity does not contribute to pregnancy.

With endometriosis, pregnancy is possible, but the likelihood of it decreases, and the likelihood of miscarriage increases. Therefore, if pregnancy with endometriosis has already occurred, constant professional medical supervision is necessary.

It is more correct to first get rid of endometriosis, and then get pregnant. The chance of pregnancy after treated endometriosis ranges from 15 to 56% in the first 6-14 months.

Diagnosis of endometriosis

The doctor carefully interviews and examines the woman, then prescribes tests:

• gynecological - if endometriosis is suspected, you should come on the eve of menstruation;
• colposcopy and hysterosalpingoscopy to clarify the location and shape of the lesion and obtain a tissue biopsy;
• Ultrasound of the pelvis and abdominal cavity to find foci of endometriosis;
• sometimes - CT or MRI, if there is a suspicion of distant lesions;
• and other studies, different in each case.

Treatment of endometriosis

It can be very different, since endometriosis itself can be different. The age of the patient, the prevalence and localization of the process, and possible pregnancy planning are important.

With drug treatment For endometriosis, at the initial stage they use combined estrogen-progestin drugs that suppress estrogen production and ovulation. Progesterone, antigonadotropic drugs that suppress the production of gonadotropins in the hypothalamus and other drugs are also used.

Endometriosis is a common disease that is quite treatable if started early. If left untreated, this disease can lead to a number of serious consequences, including infertility and the development of cancer. Therefore, it is important to start therapy in a timely manner. How to treat endometriosis? This is discussed in this article.

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Methods

Endometriosis is a process in which endometrial cells actively divide in one or another part of the reproductive system, resulting in significant tissue proliferation. This process is hormone-dependent; it develops only when there is a high level of estrogen in the patient’s blood. Therefore, the disease can be treated medicinally (by influencing hormone levels) or surgically (by directly removing the focus of active tissue growth).

Can endometriosis be cured? Typically, this disease responds quite well to drug therapy. Surgical methods are used extremely rarely. In addition, after 40 years, this disease is not treated at all, since during menopause, the production of estrogen stops, and the overgrown tissues degrade on their own, and the pathological process stops.

The occurrence of this disease after 50 years is very rare. But it is precisely in this case that it is most difficult to cure, since the effect of hormones is often already meaningless.

Drug treatment

How to treat uterine endometriosis with medication without surgery? For such therapy, hormonal drugs of one type or another are used. The doctor selects the appropriate type of medication and the specific drug based on the current hormonal balance and its changes. Self-medication in this case is extremely dangerous, as it can further disrupt the hormonal balance, worsen health and accelerate the development of the disease.

COOK

Combined oral contraceptives or COCs are drugs containing two main female sex hormones - estrogen and gestagen. When they enter the body in recommended dosages, the hormonal balance is normalized and the development of the disease stops. In addition, they protect against unwanted pregnancy. The following drugs are used:

1. Marvelon and its complete analogue, both in composition and principle of action - Regulon (about 600 rubles);
2. Janine (about 800 rubles);
3. Yarina (about 850 rubles);
4. Diana (about 1100 rubles) and others similar.

How is uterine endometriosis treated in this way? You need to take medications following several rules:

• Take one tablet a day, at the same time, preferably in the morning;
• If you miss a pill, take it as soon as possible, but if more than 12 hours have passed, it is better not to take it at all;
• Do not stop taking the tablets suddenly, as this may cause bleeding;
• The duration of the course of therapy is at least three months;
• Take the tablets strictly in the order indicated on the blister, since they have different hormonal compositions;
• Take the first tablet from the package on the first day of the menstrual cycle;
• After completing the package, take a break for the duration of your period, and then start the next package.

Such medications should not be taken if there is a dysfunction of the liver or kidneys, diseases of the brain or central nervous system, or a tendency to form blood clots. Side effects include migraines, abdominal and mammary gland pain.

Progesterone analogues

Drug treatment of endometriosis can be carried out with progesterone preparations. Such gels and tablets for endometriosis are prescribed when the content of this hormone is low. Progesterone suppresses endometrial growth. The following drugs are used:

1. Krinon gel (from 2000 rub.);
2. Duphaston (500 rub.);
3. Ingesta (300 rub.);
4. Utrozhestan (403 rubles).

Some patients note enlargement of the mammary glands while taking such drugs.

AGnRH

Gonadotropin releasing hormone agonists cause artificial menopause by completely stopping estrogen production. The most commonly used drug is Buserelin, which is administered by injection. It can be administered once a month. Usually, 3-4 injections are enough. This method is not used very often. The cost of the product is 2500-3000 rubles.

Surgery

This intervention is prescribed in cases where other treatment methods are ineffective. And also when endometriosis occurs in women after menopause, since in this case it may not have a hormonal cause. There are only three types of interventions:

• Cauterization with liquid nitrogen is suitable for all women. This treatment is carried out for endometriosis with its focal course. In this case, the area of ​​growth is so small that it can be cauterized. This is a relatively simple and safe intervention, the recovery period after which is no more than three weeks. There is only one consequence - a scar may form;
• Endometrial curettage is carried out using access through the cervical canal. This procedure is only suitable for women who have given birth. It allows you to cure endometriosis of any type, but is quite traumatic. May lead to the formation of scars and adhesions;
• In the most severe cases and when the patient is post-reproductive, complete removal of the uterus (or other affected organ) may be used. Such cases are extremely rare, since the intervention is quite severe and leads to the formation of adhesions, etc.

Treatment methods for endometriosis are selected by the doctor based on considerations of the least invasiveness and the greatest effectiveness. Surgical treatment is used quite rarely. Is it possible to permanently cure uterine endometriosis in this way? No, if the cause is not eliminated - if the hormonal imbalance persists, over time the tissues will begin to grow again.

Laparoscopy for endometriosis

Traditional methods

Non-hormonal medications for endometriosis can be prepared independently. But you need to take into account that such treatment must be agreed with your doctor, as it may have contraindications:

• Mix serpentine root, shepherd's purse (grass), bloodroot, calamus, knotweed and nettle in equal quantities. Pour two teaspoons of the mixture into a glass of boiling water and boil for five minutes. The treatment regimen for endometriosis is simple - drink a glass of the product a day half an hour before meals, divided into three doses;
• Copper sulfate is also used. Dilute one tablespoon with a liter of boiling water and wait for the sediment to settle. And then a tablespoon of the diluted composition without sediment is poured with one liter of boiled water. Make a bath with the mixture for about 30 minutes, periodically adding hot water. Duration of treatment is one month. This medicine for uterine endometriosis is poisonous, and its use should be discussed with your doctor.

Such drugs are good as additional means, but cannot be the main treatment.

Tampons

Tampons are indicated for endometriosis of the cervix and vagina, as they have a positive effect by acting directly on the affected areas. Some pharmacies sell Chinese tampons with herbal extracts. They must be inserted into the vagina at night and removed in the morning. This is alternative medicine, so such drugs should be used for the treatment of endometriosis with caution and after consultation with a doctor.

Homemade aloe tampons are safer. A gauze swab should be soaked in juice and inserted into the vagina. Use the same as the Chinese ones.

Diet

Both hormonal and non-hormonal treatment of endometriosis involves careful adherence to the diet. This is necessary because some foods contain phytoestrogens and can affect hormonal balance. In addition, strong immunity can reduce the rate of tissue growth, so it is necessary to eat food rich in vitamins and minerals. The following foods that increase estrogen levels should be excluded from the diet:

1. Pomegranates and juice from them;
2. Lentils, wheat, corn;
3. Beer, bourbon, red wine, green tea.

1. Breakfast: porridge, chicken egg, weak tea;
2. Second breakfast: fruit, kefir or fermented baked milk, or tea;
3. Lunch: vegetable or meat soup, a small piece of baked (not fried) meat with a vegetable or cereal side dish;
4. Afternoon snack: cottage cheese with tea and or fruit and kefir;
5. Dinner: Vegetable salad with boiled fish and tea.

Your doctor will describe the diet in more detail. How to get rid of endometriosis? Diet alone will not help you heal, but it can significantly speed up recovery and make treatment more effective.

Physical exercise

Sports are not contraindicated for this diagnosis. Moderate physical activity is recommended. Yoga, intense race walking, and dancing (without jumping) are especially recommended. This does not have a direct effect on the course of the disease, but it can prevent the formation of adhesions. In addition, when playing sports, endorphins are produced, which act as pain relievers.

You should avoid jumping, strength exercises, and activities that increase blood flow to the pelvic organs.

Mud therapy

Mud therapy can be done at home. Clay is used for this. Pure clay without sand is dissolved in water and infused overnight. In the morning, the mixture is stirred and brought to a boil on the stove. As soon as it boils, remove from heat and place on cling film. Cool the mixture and place it on the lower abdomen. Maintain this way for two hours.

Before using such medications to treat endometriosis, consult your doctor.

Acupuncture

Acupuncture for endometriosis is a controversial method of alternative medicine, the principle of which is to install needles on acupuncture points - projections of internal organs. It is believed that this method speeds up healing, increases the likelihood of getting pregnant, etc. It activates the blood supply to the pelvic organs, which is not very good for such a diagnosis. On the other hand, it relieves blood stagnation, which can also cause this disease. It is also possible to normalize the functioning of the ovaries, and as a result, normalize the hormonal balance.

Alternative treatment should be carried out strictly by a professional. Its purpose and start must be agreed upon with a gynecologist. It is important to remember that such products can cause significant harm and are not safe.

Hirudotherapy

Another controversial method of Eastern medicine, which is sometimes used for endometriosis of the uterus. Leeches, like needles, are installed on acupuncture points - projections. The principle of operation is approximately the same as that of needles. But the secretion of leeches additionally thins the blood and improves the functioning of blood vessels. As in the case of needles, leeches should be prescribed by a gynecologist, since unauthorized initiation of a course can be harmful to health. The procedure for installing leeches must be performed by a specialist.

Article outline

One of the most common, and at the same time unusual, gynecological diseases is uterine endometriosis. The disease itself can be characterized as a non-localized proliferation of the endometrium. What does this mean? Appearing for the first time in the endometrium lining the uterus, the pathological focus can spread not only to nearby tissues, but also to distant areas.

Methods of spread are through the circulatory and lymphatic systems (which makes the disease similar to cancer). But without changes at the cellular level (which is typical for benign neoplasms). Pathological foci are called heterotopias; they are prone to cyclic changes. Like normal areas of the uterine endometrium, they can increase in size and be shed in accordance with the menstrual cycle. A pathological focus located in a non-standard place may bleed slightly (which is typical for menstruation).

The prevalence of this disease is quite high; it ranks 3rd in the structure of gynecological pathologies. It is characterized by late detection, as there are no symptoms for a long time. Like many gynecological diseases, endometriosis can be detected during gynecological examinations, but if we are talking about the extragenital form (pathological process outside the uterus, for example, distant localization in the lungs), then its detection may not be related to gynecology.

Below we will explain in detail in accessible language the concept of uterine endometriosis, find out what it is, what causes, signs, symptoms and treatment are inherent in the disease.

Endometriosis concept

Endometriosis is a gynecological disease with an unclear etiology. It occurs at any age, from puberty to menopause. There are practically no recorded cases of the disease occurring in girls before the onset of menstruation. At the same time, there is evidence of regression of the pathological process in women after the complete attenuation of reproductive function and the associated hormonal activity of the body. In postmenopause, this female disease is absent.

The onset of the pathological process is associated with the structural features of the uterus. Its walls form 3 layers, the inside of the uterine cavity is lined by the endometrial. It, in turn, is divided into functional (external), internal and basal. During normal functioning of the body, the functional layer is constantly rejected and removed during menstruation. And then, at the beginning of the cycle, it is renewed due to the cells of the underlying basal layer (natural proliferation). What causes part of the functional layer to move to nearby or distant tissues and organs is still not fully understood. The mechanism of development is not fully understood, which in some way complicates treatment.

When endometriosis affects the organs of the reproductive system, complications such as infertility, cysts, and menstrual irregularities are possible. The prognosis in the early stages is quite favorable; with an uncomplicated course, complete recovery is possible. But at the same time, the disease is prone to relapse, which makes the need for regular preventive examinations by a gynecologist urgent and mandatory.

Statistics

In gynecology, endometriosis is considered the third most common, which makes the problem of its study, timely detection, treatment and prevention quite relevant. Some statistics indicate 10% of all gynecological diseases.

There is an opinion that endometriosis is more common, but the disease often has no symptoms, and it can be detected after several years of latency.

By age group, the structure of this pathology is as follows:

• up to 5% in menopausal women;
• up to 10% in girls during puberty;
• the remaining cases occur among women of reproductive age, most often from 25 to 40 years.

The most common is the genital form of the disease, the rarest cases are the extragenital form with distant lesions (urinary system, intestines and even lungs) - only 6-8%. According to statistics, most often the pathology is detected in combination with fibroids, and the main complication is infertility. If we consider that the majority of patients are of reproductive age, then the lack of regular examination becomes a rather pressing problem in gynecology. Since pathological lesions are sometimes discovered by chance, and the disease can be asymptomatic, diagnosis is often difficult. Therefore, it is important for women to know as much as possible about the pathology. Reliable information about the peculiarities of its course will help you detect the first signs of pathology and contact a specialized specialist in time.

Classification

There are two main classification systems for endometriosis. One system is based on the localization of the pathological focus, the second - on the degree of damage. Both systems are used to describe the clinical picture. When describing localization, the following is highlighted:

• genital form;
• extragenital form;
• combined.

The first group includes pathologies of the uterus itself, which come in different types:

• diffuse endometriosis: heterotopias appear on the entire surface of the mucosa, while cavities form in the myometrium;
• nodular adenomyosis: endometroid lesions are located locally, forming nodes that do not have a capsule;
• focal endometriosis: the pathological process is fixed exclusively in certain areas of the uterine wall.

There are also the following types of endometriosis:

• peritoneal endometriosis: the pathological process involves the ovaries, fallopian tubes and pelvic peritoneum;
• extraperitoneal endometriosis: the main localization is the lower parts of the reproductive system, lesions are observed on the vaginal segment of the cervix, rectovaginal septum, vagina, quite often external with damage to the genital organs;
• : affects the muscular layer of the body of the uterus, while the organ increases to a size corresponding to the gestation period of 5 - 6 weeks.

It should be understood that such a variety of heterotopia locations complicates diagnosis. During a visual gynecological examination, it is not always possible to detect problem areas and identify all pathological foci.

Degrees of endometriosis

In the classification according to the volume of damage, there are 4 degrees:

• endometriosis stage 1: the growth of heterotopias is limited to the muscle layer, they can be characterized as superficial and isolated;
• endometriosis grade 2: up to half the thickness of the muscle layer is involved in the pathological process, deeper heterotopias are found in the myometrium, their number increases;
• endometriosis grade 3: extends to the entire thickness of the muscle wall, right down to the serous membrane. Complicated by ovarian cysts (on both or one, single or multiple), single adhesions may form on the peritoneum;
• endometriosis grade 4: the volume of pathology increases significantly and extends beyond the uterus, affecting the peritoneum; fistulas can form, their passages leading to the pelvis. Complemented by bilateral polycystic ovary syndrome (large cysts). The endometrium grows into the peritoneum with the formation of adhesions; the pathological process covers the rectum and vagina.

Each stage progresses into the next, with the third and last being especially dangerous. Grade 3 is difficult to treat, but the fourth is the worst to treat, because the volume of the lesion is quite large and there is no clear localization. In this case, it is difficult to remove heterotopias surgically.

Causes

The causes of endometriosis are still not fully understood, the disease is considered to be polyetiological, and there is no consensus among experts on this issue. Existing theories, each individually, cannot fully explain why pathology appears. Therefore, when describing this disease, all existing theories and causes are considered.

The mechanism of spread associated with menstruation is more clear. He does not fully explain why the disease occurs, but it becomes clear how heterotopias end up far from the uterus.

The relationship with other gynecological diseases has been identified, but sometimes it is not entirely clear what is the cause and what is the effect. For example, endometriosis and infertility are certainly related. But problems with conception can be considered as a symptom (in case of polycystic ovary syndrome of another etiology) or as a root cause (if it is the result of an abortion, and abortion is considered a risk factor and is called one of the identified causes of the pathology). And also as one of the options for the negative consequences of the disease. Let us consider which theories of the occurrence of the disease are currently recognized by medicine.

Theories of disease development

Foci of endometriosis can occur in the following situations.

• Retrograde menstruation (this theory is also called implantation theory). The development mechanism is associated with retrograde processes during menstruation. What it is? It is assumed that some of the endometrial cells, which should be excreted from the body along with menstruation, are “thrown” into neighboring organs (a retrograde path for the penetration of part of the menstrual blood outside the uterus). This is how heterotopias are formed, which begin to behave like a normal section of the endometrium lining the uterus. That is, they go through the stage of normal proliferation, then are rejected, causing minor bleeding similar to menstrual bleeding. Proponents of this theory draw attention to the fact that the disease is not detected until puberty, and in postmenopause in the early stages it is prone to independent regression.
• Hormonal theory. The examined patients showed a similar picture of hormonal imbalance. They have low levels of progesterone, and excess levels of estrogen, FSH (follicle-stimulating hormone), prolactin and LH (luteinizing hormone). Dysfunction of the adrenal cortex, which plays an important role in the humoral regulation of reproductive function, is also observed.
• Immune disorders. The main function of the immune system is the destruction of all atypical lesions; any tissue that extends beyond its normal localization is usually destroyed. The appearance, further existence and development of heterotopias is considered a sign of a violation of the immune response to “foreign” cells of the uterine endometrium.
• Hereditary predisposition. New approaches to the study of endometriosis have made it possible to identify a specific hereditary marker. It indicates a hereditary predisposition and is detected in women whose family history shows this disease in several generations.
• Metaplastic theory. It is based on the assumption of the possibility of degeneration of certain types of tissue into endometroid. In particular, there is a version about the ability of peritoneal mesothelium to metaplasia.
• Embryonic theory. It is assumed that certain abnormalities in fetal development can lead to endometriosis. This conclusion was made based on observations. Cases of a combination of this pathology with malformations of the genital organs in girls aged 10–12 years have been recorded.

All of the above theories cannot fully explain the mechanism of endometriosis, especially since there are also risk factors that provoke the disease.

Risk factors

Risk factors for the disease include most of the standard causes for gynecological diseases:

• cycle disruption of various etiologies;
• any trauma to the uterus: as a result of abortion, curettage, use of intrauterine devices, complicated childbirth, surgical interventions, etc.;
• inflammatory processes of various etiologies, including infectious and viral diseases of the reproductive system;
• stenosis of the cervical canal;
• late onset of sexual activity and childbirth in the late reproductive period;
• diseases of the reproductive system associated with hormonal disorders. In gynecology, there are hormone-dependent diseases; their occurrence is most often caused by changes in the balance of estrogen - progesterone;
• diseases associated with changes in hormonal levels (diabetes mellitus, obesity, thyroid pathologies, autoimmune diseases);
• tendency to allergies, reduced immunity.

Additionally, risk factors include physical inactivity or excessive physical activity, stress, long-term use of hormonal contraceptives, liver disease, poor environment, iron deficiency, and low standard of living. Such an extensive list indicates a lack of clear understanding of the main causes of the occurrence and development of endometriosis, which significantly complicates further treatment.

Determination methods

The examination must be comprehensive, because there are certain difficulties in visualizing the pathological process. It is especially important to carry out differential diagnosis, since during examination, endometriosis can give a similar picture to other gynecological diseases. For timely detection and accurate determination of the type and stage of pathology, the following is required:

• at the appointment, collect anamnesis (including data on hereditary diseases);
• conduct a gynecological examination: with endometriosis, it is not always possible to determine the pathology on mirrors, and the visual picture can be unclear and similar to other pathological conditions;
• prescribe tests: preferably for genetic markers, to identify concomitant infections - a smear;
• hysteroscopy for endometriosis: can be used both for examination and for collecting material for histological examination (biopsy);
• colposcopy: allows you to more accurately visualize the picture;
• Ultrasound: helps to see the dynamics of a common pathological process;
• laparoscopy: more accurately visualizes the picture, allows you to determine the number of heterotopias, their condition, size, location;
• CT and MRI: allows you to identify the relationship of lesions with other organs; they are considered the most informative methods with an accuracy of assessing diagnostic results of up to 98%;
• hysterosalpingography: an x-ray method for examining the uterine body and tubes, less effective than the previous method (83%).

If you suspect endometriosis, you should immediately contact a specialized specialist to undergo a full comprehensive examination. Some methods (analysis for markers, colposcopy) can be done as part of a medical examination, which helps identify the disease in the initial stage. Symptoms characteristic of this pathology will be a cause for concern and an unscheduled visit to the gynecologist.

Symptoms and signs

Symptoms of endometriosis in women may not appear for a long time; in the initial stages, a latent course and absence of visible changes in the endometrium are characteristic, which makes diagnosis difficult. However, there are certain symptoms that are characteristic of this disease.

• Pain: any pain is grounds for an immediate visit to the gynecologist. Almost 25% of patients report diffuse or localized pelvic pain. Also, pain may appear and intensify: during urination, defecation and sexual intercourse (contact pain);
• Dysmenorrhea: this pain syndrome during menstruation is indicated separately, as it occurs in most patients (up to 60%);
• Menorrhagia: a change in the cycle with prolongation of menstruation and more heavy bleeding, occurs in 10 - 15% of patients;
• Posthemorrhagic anemia: chronic blood loss leads to symptoms characteristic of anemia (fatigue, pallor, weakness, drowsiness, dizziness);
• Infertility and threat of miscarriage: pathological processes can lead to spontaneous abortion, but the main difficulties are associated with the inability to conceive (according to some reports, up to 40% of women with this pathology have difficulty conceiving);

Signs that can be considered are: intoxication, problems with urination and defecation, shortening of the cycle or its irregular nature.

Possible complications and consequences

Complications of endometriosis include the formation of many cysts (polycystic disease) and adhesions, which become the main cause of infertility. In this case, problems with conception are considered not as a symptom, but as a complication. Statistics show that almost 50% of patients are able to become pregnant within the first year after treatment, while the rest have problems conceiving even after remission and complete recovery.

Also, the consequences of endometriosis can be neurological disorders that occur as a result of compression of the nerve trunks, and symptoms characteristic of anemia. Malignant degeneration is extremely rare; this disease is not a background disease. The atypical arrangement of uterine endometrial cells and the method of their distribution do not affect the cell structure itself. On the contrary, heterotopias manifest themselves as typical endometrial cells, which indicates their normal function and the absence of signs of degeneration.

How to treat

Treatment of endometriosis is aimed both at eliminating the pathological focus and at maximizing the restoration of the normal functions of the woman’s body, especially the reproductive system. This approach is associated with the characteristics of the disease (complications such as polycystic disease, infertility, etc.).

The doctor determines how to treat the pathology after studying the clinical picture, taking an anamnesis and conducting a differential diagnosis. If the examination revealed concomitant diseases (for example, infectious and viral diseases of the genitourinary system or hormone-dependent reproductive pathologies), the scheme is drawn up taking these facts into account.

Treatment methods are determined in accordance with the volume and location of the pathological focus. As well as prevalence in the body, the age of the patient, a history of childbirth and other factors. Since the main risk group is women of childbearing age, tactics are required that can preserve reproductive function (which is sometimes quite difficult). In the healing process, both conservative and surgical techniques are used.

Conservative therapy

How is it treated with therapeutic methods? The main drugs are hormonal agents. These include:

• COOK. The use of drugs in this group (combined oral contraceptives) is associated with their ability to suppress hormones such as LH, FSH, GnRH. Thus, suppression of the processes of proliferation and estradiol production is achieved. COCs are a fairly effective remedy, as they allow you to slow down the natural processes of the menstrual cycle, which are repeated in areas with heterotopias;
• to suppress gonadotropins, prolonged MPA is prescribed;
• Androgen derivatives help increase testosterone levels and reduce the amount of estradiol produced;
• Drugs containing GnRH help block ovarian function and estrogen production;
• norsteroid derivatives are prescribed in the form of an intrauterine device.

Contraceptives with different mechanisms of action are given a leading place. Therapy for endometriosis becomes effective, since atypical endometrial tissue is susceptible to their effects. Or rather, it stops responding to the normal natural hormonal background, which ensures the cyclic processes of maturation of this tissue. Other drugs are prescribed as symptomatic. Relieving pain, restoring the normal blood formula disturbed as a result of anemia, improving immunity - all characteristic symptoms can be stopped if the correct one is prescribed.

Surgical intervention

Removal of endometriosis by surgical methods is prescribed for:

• failure of conservative treatment;
• some types of underlying disease;
• complications in the form of cysts, bleeding, fibroids;
• functional disorders in other organs;
• the appearance of the first signs of atypical degeneration (threat of oncology).

The operation can be performed laparoscopically or laparotomically. In the first case, the lesion is cauterized with a laser or using electrocoagulation, ablation or embolization. They are recommended for small lesions.

If the lesion is large, then more radical surgical techniques are used:

• hysterectomy and adnexectomy are chosen if it is necessary to cope with a large volume of pathology;
• Hysterectomy is most often used in patients over 40.

Surgical methods cope well with the disease, but whenever possible, doctors choose minimally invasive and organ-preserving methods of removing the affected areas.

Alternative medicine

Is it possible to cure pathology with folk remedies? When choosing alternative medicine methods, you should remember that they will only be auxiliary means. This means that, firstly, they should not be used without the approval of your doctor. Secondly, that they are not a replacement for primary treatments. Even if the disease was detected in the early stages, it does not pose a clear threat, and the doctor chose the tactics of dispensary observation (regression of the pathological process is possible).

To get rid of endometriosis using folk remedies, the following may be prescribed:

• homeopathy: all drugs should be selected by an experienced homeopathic physician, taking into account the current clinical picture. Basically, agents are chosen that can reduce the activity of certain hormones. That is, homeopathic medicines can serve as a replacement for COCs or other hormonal drugs, for example, in case of intolerance or increased side effects as a result of long-term use. They can also relieve acute symptoms (stop bleeding, pain, remove the effects of anemia);
• douching: definitely cannot be used without consulting a doctor, as in some conditions it can worsen the current clinical picture. If the local use of herbs is indicated for a specific patient, then boron uterus, eucalyptus, and herbal preparations are usually used. But this method has many more contraindications than indications;
• herbal medicine: herbs are selected that are sources of phytoestrogens, or are capable of blocking the production of certain hormones that provoke pathological processes;
• suppositories with propolis: this waste product of bees has long gained popularity in the treatment of pathologies of the female reproductive system. It is usually mixed with honey and used both topically and internally. Reviews indicate that this method is very helpful in relieving symptoms and can serve as an excellent addition to the main treatment.

The most effective suppositories can be either vaginal or rectal; they are selected by a doctor and can relieve the main symptoms of the disease.

other methods

Alternative medicine techniques can be used as a complement to the main treatment. Well proven:

1. physiotherapy: electrophoresis with honey and zinc, radon baths, magnetic therapy in some pathological conditions are quite capable of improving the clinical picture. Physiotherapy procedures are prescribed by a doctor, taking into account their mechanism of action and effect on the patient’s body;
2. acupuncture: acupuncture can stimulate the body's protective functions;
3. hirudotherapy: leech saliva improves immunity, “starts” recovery processes, reduces pain and has anti-inflammatory properties;
4. Dietary supplements for endometriosis should be taken only as prescribed by a doctor and in combination with basic treatments. Dietary supplements are usually used to correct hormonal levels, saturate the body with vitamins, improve immunity, and relieve the effects of anemia.

Endometriosis and sex

Is it possible to have sex? There are no absolute contraindications for restrictions; usually intimate life is conducted in a familiar rhythm. The exception will be restrictions related to:

• with increased bleeding;
• if sexual intercourse brings painful sensations (often women with contact pain themselves refuse or significantly reduce the number of sexual acts);
• in the postoperative period, when rest is required until healing occurs.

Preventive measures

Prevention consists of:

• regularly visiting a gynecologist and paying close attention to your health;
• taking oral contraceptives (as prescribed by a doctor);
• caring for the safety of sexual relations (and, if necessary, timely treatment of the consequences);
• maintaining normal hormonal levels (treatment of diseases of the thyroid gland, adrenal glands, obesity, diabetes);
• balanced nutrition, maintaining a normal immune system, preventing vitamin deficiency, etc.

That is, all preventive measures are aimed at eliminating risk factors and causes of the disease.

Do's and Don'ts

Contraindications are directly related to the current clinical picture of endometriosis. For example, when identifying cysts and polyps, overheating is not recommended. This means that prolonged exposure to the sun, trips to the sauna and solarium are undesirable. Restrictions may also be associated with the incompatibility of some drugs with traditional methods of treatment, douching and the use of other vaginal products (suppositories, tampons). It is clear that all restrictions mainly depend on the prevalence and aggressiveness of the pathological process.

Possibility of pregnancy and bearing a healthy fetus

Pregnancy can occur both in the presence of endometriosis (can only be detected during the management of a pregnant patient) and after treatment. Since infertility is considered both a cause and a complication of the pathology, conception may become the main problem.

One of the complications may be the threat of miscarriage or spontaneous abortion in the absence of adequate treatment and a large amount of pathology. In the early stages, cessation of menstruation due to pregnancy can lead to regression, but later the pathological process can be activated again.

The disease usually does not affect the health of the unborn child, unless it is a hereditary factor that can be passed on to the daughter from the mother.

Can it be cured forever?

Whether the disease can be treated is usually a concern for all patients.

In the initial stages, the pathology responds well to therapeutic methods. If all possible provoking factors are eliminated, it is curable. But women of reproductive age remain at risk of relapse.

Therefore, the doctor decides how to treat the disease, but the woman should be observed in the future as a dispensary patient with the risk of resumption of the pathological process. When the hormonal (and, as a consequence, reproductive function) decays, as a rule, complete regression occurs and the disease does not return in the future.

Can it go away on its own?

Practice shows that such cases are not rare. They may be associated with changes in hormonal levels, pregnancy or postmenopause. Sometimes regression occurs for no apparent reason; it is impossible to say exactly what caused it. But you shouldn’t count on such an outcome.

When a disease is detected, it is necessary to begin comprehensive treatment. At the same time, you should not self-medicate and use folk remedies without medical advice. The argument “it helped someone” will be little consolation with the further development and spread of the pathological process. Only a specialized specialist decides whether to treat the disease or leave the woman for a while at the dispensary, based on the clinical picture, a complete examination and the medical history of the particular patient.

Can it develop into cancer?

Despite the fact that endometrial cells, by their method of propagation, can behave like malignant tumors, the risk of their degeneration into atypical ones is small. Concomitant diseases or provoking factors can be much more dangerous in this regard. In this case, it is difficult to answer what caused the cancer.

But the opinion of experts is almost unanimous on this issue: the disease is not precancerous or background, therefore, the risk of transition to oncology is minimal.

Treatment prices

The cost of treatment will depend on several factors:

• the level and status of the clinic, its location: usually in more prestigious medical institutions, examination and surgery are more expensive than in “average” level clinics, and in the periphery treatment is cheaper than in large cities;
• volume of medical procedures: the more examination methods are used, the more expensive the diagnosis in the end; therapeutic treatment is usually cheaper than surgery;
• the price depends on the method of its implementation: for endometriosis, surgical tactics can be different. The cost of endoscopic coagulation will depend on the volume of pathology (from 30 to 50 thousand rubles); removal of the uterus, naturally, will cost more.

The cost of conservative therapy will be affected by the number of medications prescribed. The patient may be offered analogue medications as an alternative.

Since the main drugs are contraceptives, they do not require large material costs, but do not forget that we are usually talking about stable use for six months to 9 months (rarely a year).