Endometriosis - Causes, symptoms and treatment. MF.

Endometriosis is a proliferation of the endometrium lining the inner surface of the uterus, beyond. Endometriosis is the most mysterious and actual disease in modern gynecology - the incidence of endometriosis is about 10% of all other gynecological diseases.

Causes of endometriosis

Endometriosis is a poly-tyological disease. This means that there are many reasons for its occurrence, and till now in some cases it is not possible to establish the true cause of endometriosis.

The most common and common causes of endometriosis are as follows:

- menstruation. In the vast majority of cases, endometriosis occurs in women of reproductive age. The peak incidence falls on the age of 30-50 years. It is believed that during menstruation there is a drop in blood with endometrial cells in the abdominal cavity. In the future, the endometrium is transported to surrounding tissues and peritoneum;

- hormonal disorders. It was noted that almost all patients with endometriosis have changes in the ratio of steroid hormones: there is a high release of FSH( follicle stimulating hormone) and LH( luteinizing hormone).In this case, the level of progesterone decreases, prolactin rises and the androgenic function of the adrenal cortex is disrupted;

- genetic predisposition - even family forms of endometriosis are isolated. There are cases of detection of endometriosis in eight daughters born from one mother. Specific genetic markers determining the woman's location to endometriosis incidence have been identified;

- Immunity - at a normal level of immunity, endometrial cells can not survive outside the uterus. The protective functions of the body destroy endometrial cells outside the inner layer of the uterus and prevent them from being implanted beyond it. And women with endometriosis have a different picture - because of immune system disorders, the endometrioid tissue calmly continues its growth outside the uterus or sprouts into the body of the uterus.

- metaplasia of the endometrium - that is, the transformation of one tissue into another. There is a theory that the endometrium, falling outside the uterus, can turn into another tissue. However, the cause of metaplasia is still not clear and causes controversy among researchers.

Factors triggering the onset of endometriosis:

Other likely factors leading to the onset of endometriosis include:

abortions in history,
environmental effects,
iron deficiency in the body,
operative interventions on pelvic organs( including cesarean section, moxibustioncervical erosion)
obesity,
inflammatory diseases of female genital organs,
wearing an intrauterine device,
impaired liver function, etc.

Forms of endometriosis

There are several clinical forms of endometriosis depending on the location of the endometrioid tissue:

- genital form of endometriosis : uterus, ovary, tubal lining, external genital organs, retrocervical endometriosis( behind the cervix), endometriosis of the vagina and peritoneum of the pelvis;

- Extragenital form of endometriosis : damage to the intestines, organs of the urinary system, postoperative scars, lungs and other organs;

- Combined form of endometriosis : a combination of genital and extragenital forms of endometriosis.

In gynecology, the genital form of endometriosis is more common, especially the endometriosis of the uterus body - adenomyosis .With adenomyosis, endometriotic foci are located in the myometrium - the muscular layer of the uterus. Depending on the depth of the lesion, adenomyosis is divided into several stages:

- 1st stage of adenomyosis - lesion of the mucosa to the myometrium;
- 2nd stage of adenomyosis - defeat to the middle of myometrium;
- 3rd stage of adenomyosis - lesion of the endometrium to the serous cover;
- 4th stage of adenomyosis - defeat of parietal peritoneum.

Symptoms of endometriosis

Symptomatology of endometriosis is so diverse that it sometimes misleads even the most experienced doctors. Symptoms may be completely absent or may be so pronounced that they disturb the sleep and peace of a woman.

The severity of symptoms in endometriosis depends on many factors: the shape of endometriosis, the extent of endometriosis, the concomitant diseases and even the psychological mood of a woman.

For all forms of endometriosis, and in particular for adenomyosis, almost the same symptoms of varying severity and with some nuances will be present:

- the most common complaint of patients with the symptom. When endometriosis is concerned about pain in the lower abdomen and lumbar region of varying intensity. Pain syndrome increases dramatically during menstruation( algodismenorea) and can be so intolerable that many women take pain medication during menstruation. Sexual intercourse and defecation can cause severe pain in the area of ​​the small pelvis, rectum, perineum and in the external genital area;

- , menstrual dysfunction of , characterized by the appearance of smearing brown discharge before and after menstruation( 1-3 days and 1-7 days after menstruation).The amount of discharge of menstrual blood increases, menstruation lengthens in duration. Such a symptomatology can also be caused by the fact that the uterine myoma is very often "inflated" to adenomyosis, which aggravates the condition of patients even more. Sometimes intermenstrual bleeding is disturbed, which is caused by an increase in the level of estrogens and a decrease in the production of progesterone;

- infertility - characteristic of "asymptomatic" endometriosis. In this case, the detection of endometriosis is a finding. Patients for years are treated for infertility to an accurate diagnosis. Violation of reproductive function, as a rule, is characteristic for genital endometriosis of the fallopian tubes and ovaries. Very often, this form of endometriosis is combined with the adhesive process in the small pelvis, which drastically reduces the likelihood of conception;

- symptoms of intoxication - occur along with a pronounced pain syndrome: weakness, vomiting, nausea, fever, chills, blood tests increase in leukocytes, ESR;

- other specific symptoms characteristic of rare forms of endometriosis : in case of endometriosis of the intestine - strengthened intestinal peristalsis, with endometriosis of the bladder - frequent, painful urination, with severe form, there may be blood in the urine;with endometriosis of the lung - hemoptysis during menstruation.

Many women confuse with symptoms of endometriosis with symptoms of uterine fibroids , especially if they have already been diagnosed with such a diagnosis. Others do not pay any attention to changes in menstrual function and pain symptoms, believing that this should be normal. Menstruation should not normally lead to loss of ability to work or to profuse blood loss .If such symptoms occur, a competent consultation of the gynecologist is needed, and the sooner, the better, you should not do self-diagnosis.

Diagnosis of endometriosis and what tests will have to be given for suspected endometriosis.

Recognition of endometriosis on first examination presents certain difficulties. The gynecologist can only make an accurate diagnosis after examination, analysis and additional instrumental methods of investigation.

With gynecological examination before and during menstruation - the uterus and its appendages affected by endometriosis are enlarged in size.

In ovarian endometriosis - in the area of ​​the uterine appendages, a tumor-like, painful, slow-moving formation is identified that can be soldered to the uterus( endometrioid ovarian cyst).Gynecological examination with endometriosis causes sharp painful sensations, which prevents a normal examination of the patient.

Retrocervical endometriosis and endometriosis of the vagina can be recognized during examination by colposcopy. The foci of endometriosis look like point zones of bluish color. However, these are rather rare forms of genital endometriosis, therefore, if to speak in general, then colposcopy does not belong to the basic methods of diagnosis in endometriosis.

Special diagnostic methods are required to establish an accurate diagnosis of endometriosis:

- ultrasound of the pelvic organs with a vaginal sensor. The method has a leading place in the diagnosis of adenomyosis. Ultrasound can also reveal endometriosis of the ovaries, especially clearly visible endometrioid ovarian cysts-benign non-tumor formations;

- Hysterosalpingography - a method with the use of contrast medium, which allows to assess the extent of adenomyosis and patency of the fallopian tubes( this is especially important in the presence of infertility);

- Hysteroscopy is an informative method for determining the diffuse form of adenomyosis. Allows you to see the surface of the uterus, the mouth of the fallopian tubes and endometriotic passages, which look like dark red dots on the background of pale pink mucosa;

- Laparoscopy is a highly informative microsurgical diagnostic method that allows you to diagnose any form of endometriosis and at the same time conduct appropriate treatment;

- The blood test for CA-125( endometriosis marker) is used as an auxiliary method for diagnosing endometriosis. The CA-125 level is usually elevated in endometriosis. This determines the severity of the course of the disease and allows you to evaluate the effectiveness of the therapy.

The scope of diagnostic studies is determined by a gynecologist. It can vary depending on the situation: sometimes for diagnosis it is enough to examine the chair and ultrasound of the pelvic organs, in other cases only laparoscopy helps to put the final accurate diagnosis.

Treatment of endometriosis

Treatment of endometriosis can be conservative, operative and combined( both).

Conservative treatment of endometriosis.

Conservative treatment of endometriosis is based on long-term hormone therapy.

The drugs used for the treatment of endometriosis are as follows:

- COC-single-phase combined oral contraceptives( Jeanine, Logest, Diane-35, Regulon), 6-9 months in continuous

- norsteroids-LNG( levonorgestrel).Recently, the use of levonorgestrel-containing hormonal intrauterine spiral Mirena has become increasingly popular. The spiral is placed for 5 years. The advantage of this method is that the hormonal component of Mirena works mainly locally;

- prolonged MPA( Depo-Provera), the drug is administered intramuscularly once in 2-3 months, the general course of treatment is 6-9 months;

- derivatives of androgens:( Danazol, Gestrinone), for 3-6 months

-aGNRG-gonadotropin-releasing hormone agonists( Zoladex, Buserelin) up to 6 months.

As an auxiliary symptomatic therapy, anti-inflammatory drugs( aspirin, ibuprofen), spasmolytics( no-shpa), enzyme preparations( lidase, chymotrypsin), sedatives( Leonurus and Valerian tinctures), vitamin therapy( retinol, B vitamins, ascorbic acid).

Surgical treatment of endometriosis.

Modern hormone therapy has a very high effectiveness in the fight against endometriosis. However, in some cases and certain forms of endometriosis, strictly operative treatment is indicated:

- with retrocervical endometriosis;
- in the presence of an endometrioid ovarian cyst and complications resulting in pelvioperitonitis;
- with ineffectiveness of conservative therapy;
- when combined with adenomyosis, fibroids and uterine bleeding;
- with oncologic alertness - a probable tumor of the ovaries;
- if the function of neighboring organs is disturbed.

Surgical treatment most often involves laparoscopy( microsurgical intervention), less often - in severe cases, laparotomy( dissection of the abdominal wall) is performed. Laparoscopy is performed with the help of electrocoagulation or laser - cauterize or remove foci of endometriosis. As a rule, surgical treatment is always combined with conservative treatment, that is, combined treatment is considered to be the "gold standard".Assign hormones from the group AHNRG for 3-6 months, then spend laparoscopy. Or another option is possible with the widespread form of endometriosis, first perform surgical treatment, then conservative.

The results of treatment depend on the volume of surgical intervention, on the usefulness of hormone therapy. The rehabilitation period in most cases passes favorably: the reproductive function is restored, pain during menstruation is significantly reduced. After treatment, a dynamic observation is recommended at the gynecologist: gynecological examination, ultrasound monitoring( once in 3 months), control of the CA-125 marker in the blood.

Folk remedies for endometriosis and physiotherapy.

Traditional folk remedies have been used for the treatment of endometriosis for a long time, but they are by no means a substitute for medical or surgical treatment. All described methods are effective in the initial stages of development of endometriosis and can be successfully applied as a supplement to the main treatment:

- acupuncture. Treatment is carried out under the supervision of a gynecologist. Apply from 2-4 courses of acupuncture, approximately 10-12 sessions for each;

- hirudotherapy - medical leeches treatment positively affects the patients' well-being. Saliva leech has an anti-inflammatory and analgesic effect;

- medicinal herbs: nettle, St. John's wort, plantain, hog queen, etc. Tincture of herbs is brewed, filtered and taken 3-4 times a day for 30 minutes before meals.

- physiotherapy: radon baths, magnetotherapy, electrophoresis with iodine and zinc.

Features of nutrition and lifestyle with endometriosis.

Endometriosis is a serious problem, but a woman can help herself by leading a certain lifestyle:

- it is recommended to lead an active lifestyle. Known is the fact that exercise reduces the level of estrogen, thereby inhibiting the progression of endometriosis;
- from the use of tampons with endometriosis it is better to refuse. The fact is that tampons can interfere with the natural outflow of blood, aggravating pain during menstruation and provoking the throwing of blood with endometrial cells into the fallopian tubes;
- consumed food should be full. It is recommended to include in the daily diet about 50% of fruits and vegetables. Consumption of coffee, tea and carbonated beverages is better restricted.

Complications of endometriosis

The lack of a competent approach and timely treatment of endometriosis at early stages can lead to serious complications:

- infertility - occurs in approximately 25-40% of the total number of women suffering from endometriosis;
- development of posthemorrhagic anemia due to chronic blood loss during localization;
- development of adhesive processes in the small pelvis and abdominal cavity;
- formation of endometrioid ovarian cysts;
- neurologic disorders in compression of nerve trunks;
- the most formidable complication of endometriosis - the degeneration of endometrioid tissue into a malignant tumor.

ENDOMETRIOSIS AND PREGNANCY:

In endometriosis, it is usually not a matter of absolute infertility, which only complex medical treatment can eliminate, but rather a significant reduction in the likelihood of pregnancy. In clinical practice, there are cases of conception in endometriosis, but, firstly, this happens rarely, and secondly, it presents a certain danger to the fetus - in particular, an arbitrary miscarriage. In such a situation, a woman should be observed during the entire pregnancy with a specialist doctor and strictly follow his recommendations.

The mechanism of origin and the cause-and-effect relationship between endometriosis and infertility are not clear enough. There are several points of view on factors leading to infertility in endometriosis:

mechanical impairment of patency of the fallopian tubes, violation of the anatomy of the ovaries, difficulty in the release of the ovule due to the adhesive process;
various endocrine and immunological disorders associated with endometriosis. Negatively affect both ovulation and fertilization and implantation of a fertilized egg into the uterus;
disruption of the transport function of the fallopian tubes associated with an increase in prostaglandins in endometriosis;
increased frequency of early spontaneous abortion;
syndrome of luteinized follicle;
inflammatory effects;
also recently expressed the view that conception does not occur because of unfavorable conditions for the fetus in the womb - that is, the body itself determines whether a woman is able at this time to bear and give birth to a healthy child. However, according to recent studies, in most women with endometriosis, despite regular menstruation, there is no true ovulation( anovulation), without which pregnancy is impossible. Various kinds of stimulants in this situation help little or no effect at all.

According to the literature, the frequency of pregnancy after treatment, as well as after organ-saving operations is approximately the same and ranges from 15 to 56%( depending on the severity of the disease).Most often, pregnancy occurs within 6-13 months after treatment. Therefore, it is recommended to wait for pregnancy within 6-14 months.

Very rarely there are cases when, after a successful treatment, pregnancy does not occur more than six months. In such a situation, a woman should undergo another examination aimed at identifying a number of other factors contributing to infertility. At the same time, one should never despair and remember that the development of modern medicine is capable of much.

Prophylaxis of endometriosis

Prevention of endometriosis is advisable to conduct as women who once recovered from endometriosis, and those who have never encountered such a disease. Necessary recommendations include:

- a regular visit to a gynecologist at any age, every six months, in the worst case, -1 times a year;
- timely treatment of chronic gynecological diseases;
- fighting with increased body weight, diet, exercise;
- sexual abstinence on menstruation days;
- the choice of hormonal contraception as the main method of preventing unwanted pregnancy, the abortion;
- prevention of stressful situations.

Questions and answers on the topic of endometriosis

1. How does pregnancy affect endometriosis?

2. How will pregnancy take place with endometriosis?

3. When infertility caused by endometriosis, is laparoscopy mandatory?

4. How fast should pregnancy be planned after laparoscopy?

5. Can I get rid of endometriosis without treatment?

6. I have adenomyosis and uterine myoma. If I remove the uterus - will I get rid of endometriosis?

7. Gynecologist Jeanin appointed to me because of adenomyosis. I started taking the pack from the beginning of menstruation - it got worse. Monthly there are already 10 days. What to do?

8. Is it possible to go to a sauna with adenomyosis?