Endometriosis is a pathological process of growth of the endometrium outside the body of the uterus that is not functional and similar in cellular structure with the tissue of the uterus itself. Very often there is adenomyosis( proliferation of endometrial cells in the muscle layer).The disease is most often affected by women of childbearing age, in rare cases, endometriosis occurs in young girls. The disease is dangerous because at the initial stages it does not show any obvious symptoms, and the woman consults a doctor with a neglected disease.
- Causes Symptoms Types
- Stage Diagnosis Treatment
- Hormone Therapy Pharmacotherapy Physiotherapy
- Pregnancy Complications
most common and known causes of uterine endometriosis:
- Menstruation. During menstruation in the abdominal cavity, blood is thrown with the cells of the endometrium. Further the endometrium moves to the peritoneum and the surrounding tissues.
- Hormonal disorders. It is noted that practically all patients with endometriosis have some changes in the ratio of steroid hormones - there is an outbreak of follicle-stimulating( FSH) and luteinizing( LH) hormones. This decreases progesterone, violated the androgenic function of the adrenal cortex and increases the level of prolactin.
- Genetic predisposition( there are also family endometriosis).
- Impaired immunity due to which the endometrioid tissue increases its growth outside the uterus or sprouts into its body.
Other factors provoking the appearance of endometriosis include:
- Late first birth.
- Early first monthly. Iron deficiency in the body.
- The impact of ecology.
- Operations on pelvic organs( including cauterization of erosion, caesarean section).
- Inflammatory diseases of female genital organs.
- Violation of the function of the liver.
- Installation of an intrauterine device.
The course of the disease is characterized by severe pain, the severity of the lower abdomen and problems in the process of urination shortly before the arrival of menstrual days.
Unusual property of the disease is expressed in the fact that living cells of the endometrium function equally in the uterus body and outside it. This means that they completely follow the phases of the menstrual cycle, loosening and bleeding, imitating menstrual flow. When they are in the kidneys, they can secrete blood in the urine, in the large intestine, stain the stool with bloody mucus. If you do not know about endometriosis, you can confuse its manifestation with the symptoms of more serious diseases.
Every month before the onset and at the time of menstruation, unbearable pains appear in the lower abdomen. On such days a woman can drink handfuls of painkillers and antispasmodics, without getting a special result. Pain can spread to the rectum, hips, back area, etc.
In severe cases, pain and discomfort can occur during sexual intercourse, sometimes so severe that it makes intimate life impossible.
Depending on the location of the endometrioid tissue, several types of disease are distinguished:
- Genital endometriosis, which is accompanied by damage to the body of the uterus, fallopian tubes, ovaries, external genitalia, peritoneum of the pelvis and vagina.
- Extragenital endometriosis( located outside the genitals): damage to the organs of the urinary system, intestines, lungs, postoperative scars and other organs.
- Combining endometriosis - a combination of extragenital and genital forms of the disease.
- Retrocervical endometriosis affects several organs simultaneously. Most often, the isthmus and posterior surface of the cervix are susceptible to this disease, then the foci can spread to the rectum and posterior vaginal fornix.
- Diffuse endometriosis( adenomyosis) affects the entire uterus uniformly. The endometrium penetrates the muscle layer and begins to expand, causing pain and malfunction in the entire reproductive system.
- Focal endometriosis is characterized by an increase in the uterus, hyperplasia of its walls and cystic positions in the lesion.
- Initial - germination of the uterine mucosa is limited to the extreme layer of the myometrium and endometrium.
- Moderate - lesions of the endometrium reach the middle of the muscular membrane of the uterus.
- Medium - endometrial foci reach the outer layers of the myometrium, up to the serous cover.
- Severe - the parietal abdominal cavity is affected.
Methods for the diagnosis of endometriosis:
- Colposcopy helps determine the place and nature of the lesion.
- Computed tomography accurately studies the finding of pathological tissues, interaction with surrounding organs.
- Magnetic resonance allows to provide high visualization of female organs.
- ultrasound allows you to specify the location and effectiveness of treatment.
- Laparoscopy for visualization of the body of the uterus from the inside, accuracy - 95-97%.
- Hysteroscopy can detect 83% of cases of endometriosis.
- Definition of blood cancer markers is a universal test for the pathological growth of tumor cells.
Treatment ofto table of contents ^
This is the surgical eradication of enlarged endometriosis tissue or its complete burning with a laser. Its main goal is to remove all visible foci of the disease and restore the correct anatomical relationships between organs and normalize their work. For carrying out laparoscopic surgery, sometimes even one small puncture, a few millimeters in size, is enough.
Blood loss and postoperative therapy are virtually minimized. The wound surface after the operation is very small, which allows a woman to return to the habitual way of life almost immediately. This same factor minimizes the problems with the removal of sutures, the possibility of infection, inflammation and a long period of healing.
Laparoscopy is effective only in cases of I and II stages of the disease, when one operation is sufficient to eliminate all foci of endometrioid tissue. However, with recurrent form, repeated laparoscopic interventions are necessary. For the treatment of severe forms of endometriosis, the operative method is combined with hormone therapy.to the table of contents ^
The hormonal method of treatment should be started with the first menstruation occurring after the operation. Usually hormonal therapy lasts for 4-10 months without interruptions, the term will depend on the nature and degree of growth of pathological tissues throughout the body.
Recently, for the more effective treatment of endometriosis, the following hormonal suspensions are used: Medroxyprogesterone acetate, Norethinodrel, sometimes it can be Norethisterone and Retroprogesterone. The first of these hormones is used for 30-50 mg every day, lasting at least 2-4 months.
Drugs containing the hormone danazol are prescribed for up to six months. After 1-2 months of treatment, amenorrhea occurs in most cases( no monthly).Approximately 25-35 days after the end of treatment, the monthly cycle is fully restored. To treat the initial forms of endometriosis, enough 400 mg of danazol per day, here in severe cases the dose rises to 600-800 mg.
The hormone nemestran is prescribed by a dose of 2.5 mg not more than 2 times a week. The menstrual cycle can also disappear for a while, this period varies depending on the amount of the drug taken and the initial characteristics of the menstrual cycle. Usually a full-fledged menstrual cycle resumes 4-6 weeks after discontinuation of the drug.
The drug Zoladex( Goserelin) is administered subcutaneously. Its dose is usually 3.6 mg not more than once in 26 days. At the end of the course of hormone therapy, symptoms such as pain and discomfort in the lower abdomen are reduced by about 4 times, which is an excellent indicator for a drug of a narrow spectrum of action.
- Body mass gain.
- A constant feeling of hunger.
- Acne rash all over the body.
- Strengthening of hair growth by male type.
- Coarsening of the voice.
- Occasionally a decrease in the volume of mammary glands.
- Frequent headaches.
- Causeless apathy and depressive mood.
- Allergy to new products.
- Inhibition of liver and gastrointestinal function. Hot flashes like at menopause. Excessive dryness of the mucous of the genital organs.
- Reducing libido.
- Discomfort during intercourse.
With a clear manifestation of these side effects, the dose of the hormone drug is reduced.to table of contents ^
- Immunomodulators( Decaris, Splenina, Timogen, Cecloferon, Tactivina, Timalin, etc.).
- Antioxidants( Unithiol with ascorbic acid, vitamin E, pycnogenol).
- Degradants( Wobenzym, Ronidasa).
- Non-steroidal anti-inflammatory drugs that reduce pain syndrome( mainly prescribed candles - Indomethacin, Artrocol, Diclofenac, Etymizol, Baralgin, etc.).
- Antihistamines, reducing the severity of the body's allergic reaction( Suprastin, Tavegil, Diazolin).
- Hemostatic drugs that reduce bleeding( Tranexam, Diferelin, Vikasol, Dicycinum, Oxytocin, Ergometrin, etc.).
- Tranquilizers and sedatives, in case of violation of the psychoemotional state of the patient( Anselan, Seduxen, Fenazepam, Elenium, Tazepam).
- Antibiotics, only with the development of an infectious-inflammatory process( Penicillin, Streptomycin, Cephalosporin).
Electrophoresis with potassium iodide, zinc helps relieve inflammation and pain after surgical treatment. The procedures activate microcirculation and promote the acceleration of the reverse development of infiltrates.
Magnetotherapy after surgical treatment of endometriosis in the absence of estrogen-stimulating and thermal effects, has analgesic, anti-inflammatory, desensitizing and metabolic stimulating effects. Pulsed magnetic field helps to normalize the state of the vegetative and central nervous system, and also improves microcirculation after the operation.
Laser radiation on the postoperative wound zone has a bactericidal effect, accelerates the process of epithelization( healing of superficial and deep wounds) and stimulates the phagocytic activity of leukocytes( the ability of phagocytic cells to eliminate the pathogenic microflora that has entered the body).In addition, laser radiation has anti-inflammatory, biostimulating, analgesic effect.
Balneotherapy - iodide-bromine and radon baths. Iodide-bromine baths affect the function of the thyroid gland, suppress hyperestrogenism, reduce blood pressure, and also have an anti-inflammatory and sedative effect. Rodon baths calm the nervous system, normalize metabolic processes in the body, strengthen immunity, stimulate the regenerative processes of tissues after surgery and prevent the formation of adhesions.to contents ^
In clinical practice, there are rare cases when pregnancy occurs in endometriosis of the uterus, but this situation is dangerous for the development of the fetus up to the miscarriage. If a woman with this diagnosis still became pregnant, then she needs to be observed for a full period of time from a specialist and follow all his recommendations.to table of contents ^
During the menopause, the clinic of the disease usually decreases and gradually completely disappears, as the hormonal background is significantly reduced. However, there are cases when the endometriosis begins to recur or occurs for the first time. Endometriosis may be affected by men with excess weight or diabetes during menopause. In addition, the cause of the disease during the menopause are some infectious diseases of the reproductive system, as well as surgical interventions on the organs of the reproductive system.
The lack of correct and timely treatment of the disease canlead to serious complications:
- Development of adhesive processes in the peritoneum and small pelvis.
- Infertility develops in 20-45% of women diagnosed with endometriosis.
- Due to the large blood loss during menstruation, posthemorrhagic anemia may develop.
- Neurological disorders in the infringement of nerve trunks.
- Education of ovarian cysts.
- Rebirth of benign endometrial tissue in a malignant tumor.
- Regularly( every 6 months) visit a gynecologist.
- Timely treatment of chronic gynecological diseases.
- Combat excess body weight.
- Mandatory sexual abstinence in days of menstruation.
- Refuse from abortion, use contraception.
- Avoid stressful situations.
- Sports - exercise can reduce the level of estrogen, which prevents the progression of the disease.
- Discard the use of tampons. They can interfere with the natural release of blood - this will exacerbate pain during menstruation and provoke a drop in blood with endometrial cells in the fallopian tubes.
- A full-fledged diet, the daily diet should include 50% of vegetables and fruits. Consumption of tea, carbonated drinks, coffee is better limited.