Endometriosis is the appearance of cells of the inner layer of the uterus( endometrium) in atypical places: on the peritoneum, in the ovaries, fallopian tubes, wall and cervix, in the bladder, rectum and other organs and tissues.
This is one of the most mysterious female diseases. Despite the fact that this diagnosis is exhibited quite often, the question - what kind of illness is this, why and how to treat it, often remains unanswered. And what if a woman with endometriosis is planning a pregnancy - do I have to do something in this case?
Statistics show that up to 30% of women of reproductive age are affected in one form or another by endometriosis.
What is this: the causes of
Why does endometriosis occur, and what is it? Causes of the disease are not established and remain the subject of controversy. Numerous hypotheses of endometriosis have been proposed, but none of them has been finally proven and generally accepted.
- One theory points to the process of retrograde menstruation, when a part of the menstrual tissue penetrates into the abdominal cavity, grows into it and increases.
- Genetic theory suggests that the genes of some families contain the rudiments of endometriosis and, thus, the members of these families are predisposed to the disease with endometriosis.
- There is also a theory explaining the emergence of endometriosis in that tissue affected by endometriosis extends to other parts of the body through the lymphatic system.
- Others believe that tissue remains from the phase in which the woman was in a rudimentary state may subsequently develop into endometriosis, or that part of this tissue, under certain conditions, does not lose the ability to propagate
The likelihood of the disease increases with:
- frequent inflammation of the genital organs;
- tumors( myoma of the uterus);
- heavy delivery;
- operations on the uterus;
- abortion;
- anemia;
- drinking alcohol;
- smoking;
- unnecessary "love" for products containing caffeine;
- disorders in the work of the endocrine system( thyroid, adrenal, hypothalamus,
- pituitary, female gonads);
- reduced immunity.
Despite the findings of the study, the actual incidence of endometriosis is unknown, due to the fact that in most cases the disease is asymptomatic and is very difficult to diagnose.
Therefore, regularly undergo a preventive examination with a gynecologist. This is especially important for those who have had any operations on the uterus( abortions, caesarean section, cauterization of cervical erosion, etc.).Timely diagnosis is the key to successful treatment without consequences.
Can I get pregnant with endometriosis?
Endometriosis significantly reduces the chances of a woman becoming pregnant, but can not harm the development of the fetus. If a woman with endometriosis still conceived a child, there is every reason to believe that the symptoms of the disease will become much weaker during the entire period of pregnancy.
If you are sick with endometriosis, before you start trying to conceive a child, always discuss with a gynecologist the possibility and risks of pregnancy in your particular case.
Symptoms of endometriosis
Symptomatic of this disease is so diverse that it is sometimes capable of misleading even experienced specialists. Endometriosis of the uterus can be accompanied by both pronounced symptoms, and at all by their absence.
However, certain symptoms must necessarily alert the woman:
- Pains, of varying intensity, up to the acute ones. They can be located in the lower abdomen, give into the groin area, anus, leg. The pain either occurs in the first days of menstruation, and disappears with its end, or does not leave the woman throughout the cycle, but after the end of menstruation, they become weaker.
- Spotting dark spotting from the genital tract 2-5 days before and after menstruation, especially if these very menstruation are quite abundant and prolonged;
- Uterine bleeding in the intermenstrual period( metrorrhagia);
- Spotting can also occur during sexual intercourse.
Menstruation with endometriosis becomes abundant, with clots, which leads to the development of chronic posthemorrhagic anemia:
- nail brittleness,
- dyspnea,
- weakness, drowsiness
- dizziness,
- pallor of the skin and mucous membranes,
- low blood pressure,
- frequent ARVI and others.
Unfortunately, in some cases, the symptoms of endometriosis are very weak or nonexistent. For this reason, visit the office of a gynecologist every six months. Only timely diagnostics can save from the development of undesirable consequences of endometriosis.
Endometriosis 1, 2 and 3 degrees
In the uterine wall, endometriosis foci are detected at different depths, therefore the endometriosis of the uterus body can have four degrees of spread:
- 1 degree .There are one or more small foci of endometriosis.
- 2 degree .There are several small foci of endometriosis, which penetrate into the thickness of the organs affected by them.
- 3 degree .There are many surface foci and several deep foci of endometriosis or several cysts on the ovaries( "chocolate" cysts - the name is due to the characteristic dark brown color of the cysts attached to cysts by decaying blood).
- 4 degree .Diagnosed multiple and deep foci of endometriosis, multiple, large cysts on the ovaries, adhesions between the organs of the small pelvis.
There is no linear relationship between the extent of endometriosis and the strength of the symptoms of the disease. Often, widespread endometriosis is less painful than mild, in which there are only a couple of small foci.
Diagnosis
The most important thing in the effective treatment of endometriosis is timely and correct diagnosis. The presence of endometriotic foci can be determined using:
- radiopaque methods( hysterosalpingography) of
- endoscopic studies( eg, hysteroscopy),
- ultrasound.
However, of great importance are the complaints and clinical symptoms listed above. Sometimes it is diagnosed endometriosis and in pregnancy - as a result, the treatment of such patients is ineffective due to difficulties in selecting a drug that minimally affects the fetus.
Prevention of
The main measures aimed at the prevention of endometriosis are:
- , a specific survey of adolescent girls and women with complaints of painful menstruation( dysmenorrhea) in order to exclude endometriosis;
- observation of patients who underwent abortion and other surgical interventions on the uterus to eliminate possible consequences;
- timely and complete cure for acute and chronic genital pathology;
- intake of oral hormonal contraceptives.
Complications of
Endometriosis of the uterus can be asymptomatic, and not affect the quality of life of a woman. On the other hand, in time unconfirmed endometriosis and the lack of adequate treatment can lead to complications.
Most likely consequences:
- adhesive process in the pelvis;
- impairment of fertility;
- anemia due to heavy bleeding;
- endometrioid cysts;
- Malignancy.
How to treat endometriosis
Methods for the treatment of endometriosis are improved for many years and are now divided into:
- surgical;
- medicamentous;
- combined.
Drug therapies include the use of various drug groups:
- combined estrogen-progestational drugs;
- gestagens, antigonadotropic drugs;
- agonists of gonadotropic releasing hormones.
The earlier a woman is diagnosed, the more likely to use only medications.
Conservative therapy
Conservative treatment is indicated in asymptomatic uterine endometriosis, at a young age, in the permenopausal period, with adenomyosis, endometriosis and infertility, when it is necessary to restore the childbearing function.
The drug treatment pathway includes a rather traditional therapy:
- hormonal;
- is an anti-inflammatory;
- desensitizing;
- is symptomatic.
The main drugs with proven effect for the treatment of confirmed endometriosis are:
- progesterone preparations;
- danazol;
- gestrinone( Nemestran);
- gonadotropin releasing hormone agonists( GnRH);
- monophasic combined oral contraceptives.
The duration of hormone therapy and the intervals between them is determined by the results of treatment and the general condition of the patient, taking into account the tolerability of drugs and the indicators of functional diagnostic tests.
Other groups of drugs, "assistants" in dealing with the painful symptoms of the disease:
- NSAIDs( anti-inflammatory therapy);
- antispasmodics and analgesics( analgesic effect);
- sedatives( elimination of neurological manifestations);
- vitamins A and C( correction of the deficiency of the antioxidant system);
- iron preparations( elimination of consequences of chronic blood loss);
- physiotherapy.
Currently, the world is exploring the possibility of using immunomodulators for the treatment of endometriosis, especially for the treatment of related infertility.
Surgical treatment of endometriosis
Surgical treatment is indicated in the absence of the effect of conservative therapy for 6-9 months, with endometrioid cysts of the ovaries, with endometriosis of postoperative scars and navel, with continued stenosis of the lumen of the intestine or ureters, intolerance of hormonal agents or contraindications to theirapplication.
Surgical methods for the treatment of endometriosis are the removal of endometrioid formations( most often cysts) from the ovaries or other lesions. Modern surgery prefers sparing operations - laparoscopy.
After removal of the foci of the disease, physiotherapy and medication are shown to consolidate the result and restore the cycle. Severe forms of endometriosis are treated by removing the uterus.
The results of treatment depend on the 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.
Prognosis for endometriosis
This disease often recurs. For example, the frequency of recurrence of endometriosis after operations for removal of foci during the first year is 20%, that is, 1 in 5 operated women will again face the same problems as during the first year after surgery.
Hormonal correction has a good effect, but the problem with this method of treatment is a violation of the natural maturation of the endometrium of the uterus, and hence the impossibility of a natural conception of the child. At the onset of pregnancy, as a rule, for the entire period of pregnancy the symptoms of endometriosis disappear. At the onset of menopause, endometriosis also disappears.