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is a hormone-dependent pathological growth of the glandular tissue of the uterus (endometrium) outside it: in the ovaries, in the fallopian tubes, in the thickness of the uterus, in the bladder, on the peritoneum, in the rectum and other, more distant organs. Fragments of the endometrium (heterotopia), growing in other organs, undergo the same cyclical changes as the endometrium in the uterus, in accordance with the phases of the menstrual cycle. These changes in the endometrium are manifested by pain, an increase in the volume of the affected organ, monthly bleeding from heterotopias, menstrual dysfunction, discharge from the mammary glands, and infertility.

Endometriosis is the third most common gynecological disease, after inflammation and uterine fibroids. Endometriosis in most cases occurs in women in the reproductive period, that is, at the age of 25-40 years (about 27%), occurs in 10% of girls during the formation of menstrual function and in 2-5% of women in menopausal age. Difficulties in diagnosis, and in some cases the asymptomatic course of endometriosis, suggest that the disease is much more common.

General information and classification of endometriosis

Manifestations of endometriosis depend on the location of its foci. In this regard, endometriosis is classified according to localization. According to localization, genital and extragenital forms of endometriosis are distinguished. In the genital form of endometriosis, heterotopias are localized on the tissues of the genital organs, in the extragenital form - outside the reproductive system.

In the genital form of endometriosis, there are:

peritoneal endometriosis - with damage to the ovaries, pelvic peritoneum, fallopian tubes
extraperitoneal endometriosis, localized in the lower parts of the reproductive system - the external genitalia, the vagina, the vaginal segment of the cervix, the rectovaginal septum, etc.
internal endometriosis (adenomyosis), which develops in the muscular layer of the uterus. With adenomyosis, the uterus becomes spherical in shape, increased in size up to 5-6 weeks of pregnancy.

Localization of endometriosis can be mixed, it occurs, as a rule, when the disease is neglected. In the extragenital form of endometriosis, foci of heterotopy occur in the intestines, navel, lungs, kidneys, and postoperative scars. Depending on the depth and distribution of focal growths of the endometrium, 4 degrees of endometriosis are distinguished:

I degree - foci of endometriosis are superficial and single;
II degree - foci of endometriosis are deeper and in greater numbers;
III degree - deep multiple foci of endometriosis, endometrioid cysts on one or both ovaries, separate adhesions on the peritoneum;
IV degree - multiple and deep foci of endometriosis, bilateral large endometrioid cysts on the ovaries, dense adhesions, germination of the endometrium in the walls of the vagina and rectum. IV degree of endometriosis is characterized by the prevalence and severity of the lesion, it is difficult to treat.

There is also a generally accepted classification of uterine adenomyosis (internal endometriosis), in the development of which there are four stages according to the degree of damage to the muscle layer (myometrium):

Stage I - initial germination of the myometrium;
Stage II - the spread of foci of endometriosis to half the depth of the muscular layer of the uterus;
Stage III - germination of the entire thickness of the myometrium up to the serous membrane of the uterus;
Stage IV - germination of the walls of the uterus and the spread of foci of endometriosis to the peritoneum.

Endometrioid lesions can vary in size and shape, from rounded lesions a few millimeters in size to shapeless growths of several centimeters in diameter. Usually they have a dark cherry color and are separated from the surrounding tissues by whitish connective tissue scars. Foci of endometriosis become more noticeable on the eve of menstruation due to their cyclic maturation. Spreading to the internal organs and peritoneum, areas of endometriosis can grow deep into the tissues or be located superficially. Endometriosis of the ovaries is expressed in the appearance of cystic growths with dark red contents. Heterotopias are usually arranged in groups. The degree of endometriosis is assessed in points, taking into account the diameter, depth of germination and localization of foci. Endometriosis is often the cause of adhesions in the pelvis, limiting the mobility of the ovaries, fallopian tubes and uterus, leading to menstrual irregularities and infertility.

Causes of endometriosis

Among experts there is no consensus on the causes of endometriosis. Most of them lean towards the theory of retrograde menstruation (or implantation theory). According to this theory, in some women, menstrual blood with particles of the endometrium enters the abdominal cavity and fallopian tubes - the so-called retrograde menstruation. Under certain conditions, the endometrium is attached to the tissues of various organs and continues to function cyclically. In the absence of pregnancy, the endometrium is shed from the uterus during menstruation, while microhemorrhage occurs in other organs, causing an inflammatory process.

Thus, women who have such a feature as retrograde menstruation are predisposed to the development of endometriosis, but not in all cases. Increase the likelihood of endometriosis factors such as peculiarities in the structure of the fallopian tubes, immunosuppression, heredity. The role of hereditary predisposition to the development of endometriosis and its transmission from mother to daughter is very high. Knowing about her heredity, a woman must comply with the necessary preventive measures. Surgical interventions on the uterus contribute to the development of endometriosis: surgical termination of pregnancy, cauterization of erosions, caesarean section, etc. Therefore, after any operations on the uterus, medical supervision is necessary for the timely detection of abnormalities in the reproductive system.

Other theories of the development of endometriosis, which are not widely used, consider gene mutations, abnormalities in the function of cellular enzymes, and hormone receptor responses as its causes.

Symptoms of endometriosis

The course of endometriosis can be varied, at the beginning of its occurrence it is asymptomatic, and its presence can be detected in time only with regular medical examinations. However, there are reliable symptoms that indicate the presence of endometriosis.

Pelvic pain.

Accompanies endometriosis in 16-24% of patients. The pain may have a clear localization or diffuse character throughout the pelvis, occur or intensify immediately before menstruation, or be present all the time. Often, pelvic pain is caused by inflammation that develops in organs affected by endometriosis.

Dysmenorrhea is painful menstruation.

It is observed in 40-60% of patients. It is most manifested in the first three days of menstruation. With endometriosis, dysmenorrhea is often associated with bleeding into the cavity of the cyst and an increase in pressure in it, with irritation of the peritoneum by hemorrhages from the foci of endometriosis, spasm of the vessels of the uterus.

Painful intercourse (dyspareunia).
Pain during bowel movements or urination.
Discomfort and pain during sexual intercourse is especially pronounced with the localization of endometriosis foci in the vagina, the wall of the rectovaginal septum, in the area of the sacro-uterine ligaments, and the uterine-rectal space.
Menorrhagia - heavy and prolonged menstruation.

It is observed in 2-16% of patients with endometriosis. It often accompanies adenomyosis and concomitant diseases: uterine myoma, polycystic ovaries, etc.

Development of posthemorrhagic anemia

Occurs due to significant chronic blood loss during menstruation. It is characterized by increasing weakness, pallor or yellowness of the skin and mucous membranes, drowsiness, fatigue, dizziness.

Infertility.

In patients with endometriosis is 25-40%. So far, gynecology cannot accurately answer the question of the mechanism for the development of infertility in endometriosis. Among the most likely causes of infertility are changes in the ovaries and tubes due to endometriosis, a violation of general and local immunity, and a concomitant violation of ovulation. With endometriosis, one should not talk about the absolute impossibility of pregnancy, but about its low probability. Endometriosis drastically reduces the chances of bearing a child and can provoke a spontaneous miscarriage, so the management of pregnancy with endometriosis should be carried out with constant medical supervision. The chance of pregnancy after endometriosis treatment ranges from 15 to 56% in the first 6-14 months.

Complications of endometriosis

Hemorrhages and cicatricial changes in endometriosis cause the development of adhesions in the pelvis and abdominal organs. Another common complication of endometriosis is the formation

endometrioid ovarian cysts

Filled with old menstrual blood ("chocolate" cysts). Both of these complications can cause infertility. Compression of the nerve trunks can lead to various neurological disorders. Significant blood loss during menstruation causes anemia, weakness, irritability and tearfulness. In some cases, malignant degeneration of endometriosis foci occurs.

Diagnosis of endometriosis

When diagnosing endometriosis, it is necessary to exclude other diseases of the genital organs that occur with similar symptoms. If endometriosis is suspected, it is necessary to collect complaints and anamnesis, in which pain, information about past diseases of the genital organs, operations, and the presence of gynecological pathology in relatives are indicative. Further examination of a woman with suspected endometriosis may include:

gynecological examination (vaginal, rectovaginal, in mirrors) is most informative on the eve of menstruation;
colposcopy and hysterosalpingoscopy to clarify the location and form of the lesion, obtaining a tissue biopsy;
ultrasound examination of the pelvic organs, abdominal cavity to clarify the localization and dynamic picture in the treatment of endometriosis;
spiral computed tomography or magnetic resonance to clarify the nature, localization of endometriosis, its relationship with other organs, etc. The accuracy of the results of these methods for endometriosis is 96%;
laparoscopy, which allows you to visually examine the foci of endometriosis, assess their number, degree of maturity, activity;
hysterosalpingography (X-ray images of the fallopian tubes and uterus) and hysteroscopy (endoscopic examination of the uterine cavity), which allow diagnosing adenomyosis with an accuracy of 83%;
study of tumor markers CA-125, CEA and CA 19-9 and RO-test, the indicators of which in the blood in endometriosis increase several times.

Treatment of endometriosis

When choosing a method of treating endometriosis, they are guided by such indicators as the age of the patient, the number of pregnancies and childbirth, the prevalence of the process, its localization, the severity of manifestations, the presence of concomitant pathologies, the need for pregnancy. Methods for the treatment of endometriosis are divided into medical, surgical (laparoscopic with removal of endometriosis foci and preservation of the organ or radical - removal of the uterus and oophorectomy) and combined.

Treatment of endometriosis aims not only to eliminate the active manifestations of the disease, but also its consequences (adhesive and cystic formations, neuropsychiatric manifestations, etc.). Indications for conservative treatment of endometriosis are its asymptomatic course, the young age of the patient, premenopause, the need to preserve or restore childbearing function. Leading in the drug treatment of endometriosis is hormone therapy with the following groups of drugs:

combined estrogen-gestagen preparations.

These drugs, containing small doses of progestogens, suppress estrogen production and ovulation. Shown at the initial stage of endometriosis, because they are not effective in the prevalence of the endometrioid process, ovarian cysts. Side effects are expressed by nausea, vomiting, intermenstrual bleeding, soreness of the mammary glands.

gestagens (norethisterone, progesterone, gestrinone, dydrogesterone).

Shown at any stage of endometriosis, continuously - from 6 to 8 months. Reception of gestagens may be accompanied by intermenstrual spotting, depression, soreness of the mammary glands.

antigonadotropic drugs (danazol, etc.)

Suppress the production of gonadotropins in the hypothalamus-pituitary system. Apply continuously for 6-8 months. Contraindicated in hyperandrogenism in women (excess of androgenic hormones). Side effects are sweating, hot flashes, changes in weight, coarsening of the voice, increased oily skin, increased intensity of hair growth.

agonists of gonadotropic releasing hormones (triptorelin, goserelin, etc.)

The advantage of this group of drugs in the treatment of endometriosis is the possibility of using drugs once a month and the absence of serious side effects. Releasing hormone agonists cause suppression of the ovulation process and estrogen content, leading to suppression of the spread of endometriosis foci. In addition to hormonal drugs in the treatment of endometriosis, immunostimulants, symptomatic therapy are used: antispasmodics, analgesics, anti-inflammatory drugs.

Organ-preserving surgical treatment with removal of heterotopias is indicated for moderate and severe stages of the course of endometriosis. Treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, dissection of adhesions. It is carried out in the absence of the expected effect of drug therapy, the presence of contraindications or intolerance to drugs, the presence of lesions with a diameter of more than 3 cm, dysfunction of the intestines, bladder, ureters, kidneys. In practice, it is often combined with drug treatment of endometriosis. It is performed laparoscopically or laparotomically.

Radical surgical treatment of endometriosis (hysterectomy and adnexectomy) is performed for patients over the age of 40 with active progression of the disease and the ineffectiveness of conservative surgical measures. Unfortunately, radical measures in the treatment of endometriosis are required in 12% of patients. Operations are performed laparoscopically or laparotomically.

Endometriosis tends to recur, in some cases, forcing to resort to repeated surgical intervention. Relapses of endometriosis occur in 15-40% of patients and depend on the prevalence of the process in the body, its severity, localization, radicalness of the first operation.

Endometriosis is a formidable disease for the female body, and only its early detection and persistent treatment leads to complete relief from the disease. The criteria for the cure of endometriosis are satisfactory health, the absence of pain and other subjective complaints, the absence of relapses within 5 years after completing the full course of treatment.

In childbearing age, the success of the treatment of endometriosis is determined by the restoration or preservation of childbearing function. With the current level of surgical gynecology, the widespread use of sparing laparoscopic techniques, such results are achieved in 60% of patients with endometriosis aged 20 to 36 years. In patients with endometriosis after radical surgery, the disease does not recur.

Prevention of endometriosis

The earlier, when the first symptoms of endometriosis appear, a woman comes to a gynecologist's consultation, the more likely a complete cure and no need for surgical intervention. Attempts at self-treatment or expectant management in the case of endometriosis are absolutely not justified: with each subsequent menstruation, new foci of endometriosis appear in the organs, cysts form, cicatricial and adhesive processes progress, and the patency of the fallopian tubes decreases.

The main measures aimed at the prevention of endometriosis are:

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

The risk of developing endometriosis is higher in the following groups of women:

noting the shortening of the menstrual cycle;
suffering from metabolic disorders, obesity, overweight;
using intrauterine contraceptives;
aged after 30-35 years;
having elevated estrogen levels;
suffering from immunosuppression;
having a hereditary predisposition;
who underwent surgery on the uterus;
smoking women.

With regard to endometriosis, like many other gynecological diseases, a strict rule applies: the best treatment for the disease is its active prevention. Attention to one's health, the regularity of medical examinations, timely treatment of gynecological pathology make it possible to catch endometriosis in the very initial stage or completely avoid its occurrence.

The term "endometriosis", from the Latin "endometrium", means the tissue in the inner lining of the uterus. The disease occurs when tissue that looks and functions like endometrial tissue is found outside the uterus, usually inside the pelvic cavity.

This is a chronic disease that affects the reproductive organs of a woman. This happens when the endometrium, which normally lines the uterus from the inside, begins to grow on the outside. It often affects the abdominal organs, including the ovaries and pelvis. In some cases, endometrial tissues are found in other areas of the body.

According to various estimates, about 176 million women in the world face this medical problem between the ages of 15 and 49.

Endometrial tissue, which is outside the uterus, behaves during the menstrual cycle in much the same way as tissue inside the uterus. At the end of the cycle, when hormones affect the shedding of the lining tissue in the uterus, the endometrium outside of it begins to disintegrate and bleed. But while the menstrual fluid leaves the uterus with menstruation, the blood of the decaying endometrium has no way out. The tissues around the affected area become inflamed and swollen.

These abnormal areas of tissue can grow into what are known as "lesions," also known as "implants," "nodules," or "growths." The most common site for growths is a woman's ovaries.

Endometriosis according to its location is divided into genital and extragenital. Genital affects the reproductive organs of women - the ovaries and uterus. With extragenital endometriosis, other organs of the body, such as the bladder or intestines, and even the lungs, are affected by the growing endometrium.

Mild forms of endometriosis are the most common, may be asymptomatic, and sometimes do not require treatment. But you should know that this disease can be a source of moderate or severe pain during menstruation, as well as painful intercourse, and even an obstacle to a desired pregnancy.

Signs of endometriosis

The biggest problem is that any signs of illness in the early stages seem to be the body's natural reactions to the onset of the menstrual cycle.

The main symptom of endometriosis is pelvic pain, which in women is often associated with menstrual cycles.

Although a large number of women constantly experience menstrual cramps with monthly peeling of the inner layer of the uterine wall, many women with endometriosis experience pain more than usual. According to the observations of doctors, patients usually complain that the pain increases with time.

Some signs of endometriosis:

Painful periods. Cramps in the pelvic region and uterine cramps can disturb before and for some time after the onset of menstruation.
Pain during intercourse. Pain during intercourse or after it is often a sign of internal appearance.
Urination or defecation is painful. Often this occurs during menstruation.
Profuse bleeding.
Difficulties with conception. There are many cases when uterine endometriosis is diagnosed in women who initially applied to the clinic for infertility treatment.

It should be borne in mind that the intensity of pain is not always a sure sign of a late degree of the disease.

Some patients with a shallow degree of damage may suffer from sharp pain and spasms, while some women with advanced endometriosis feel little or no pain at all.

Symptoms of endometriosis

A significant number of women with endometriosis do not report pronounced symptoms. Even when symptoms do develop, they can vary, even women at different ages have different symptoms.

In general, it is believed that the larger the lesions, the more symptoms.

About one third of women with uterine endometriosis find that they are sick because they were unable to conceive and went to a specialist, or the endometriosis was discovered during surgery for another reason. Therefore, the severity of the disease and the number of symptoms are likely to be related to the location of the tissues, rather than their size and quantity.

The following symptoms of endometriosis can be distinguished:

Also, the patient may feel tired and lack of strength, anxiety, experience frequent mood swings. Such symptoms may be manifestations of premenstrual syndrome, however, together with the rest of the listed symptoms, they may indicate ovarian endometriosis.

Symptoms of endometriosis disappear with the onset of pregnancy. This, as doctors believe, is due to the progesterone produced by the body. After the birth of a child, the consequences of the disease remain unclear.

Causes of endometriosis

The causes of the disease cannot be precisely named. Some experts believe that pieces of the endometrium move back through the fallopian tubes and exit into the pelvic cavity, where the reproductive organs are located. Tissue cells settle on the surfaces of the genital organs. With the onset of menstruation, the tissue bleeds, as does the tissue in the uterus. The blood from these areas irritates the surrounding tissues on the organs, which become inflamed and swollen.

Because doctors don't know exactly what causes endometriosis, the possible causes or factors may vary from woman to woman.

Heredity. In women, among whose close relatives there are patients with endometriosis, the probability of the disease increases by 7-10 times. In addition, in the case of twins, both are more likely to have endometriosis, especially if they are identical twins.
Retrograde menses. When women have their period, blood flows from the vagina, but also in the opposite direction - into the pelvic cavity. In 90% of women, blood with endometrial tissues simply disintegrates or is absorbed and does not cause any symptoms; in women prone to endometriosis, endometrial tissue begins to grow.

Other likely causes of endometriosis include:

menstruation lasting more than 5 days;
profuse bleeding during menstruation;
first menstruation up to 11 years;
an interval of less than 26 days between periods;
early pregnancy;
underweight;
alcohol consumption.

In some cases, endometriosis is misdiagnosed because its symptoms are similar to some other diseases of the ovaries or pelvic organs. The disease may resemble irritable bowel syndrome, which may be accompanied by endometriosis, which greatly complicates its detection.

To diagnose this disease, the doctor, first of all, finds out the patient's symptoms, specifies the location of the focus of pain and the time when it started.

A physical exam for endometriosis often consists of the following:

Examination at the gynecologist. A gynecological examination allows the doctor to feel areas in the rectum and vagina and determine
the presence of anomalies. For example, there may be cysts on the reproductive organs.
Ultrasound. The ultrasound transducer is either pressed against the skin on the abdomen or inserted into the vagina. Ultrasound examination cannot 100% confirm whether a woman has endometriosis, but it does detect cysts.
Laparoscopy. This is a procedure performed by a surgeon and is most commonly used to detect and treat endometriosis. Under anesthesia, the patient makes a small incision in the navel area, where an instrument called a laparoscope is inserted. With it, the doctor is able to find tissues located outside the uterus. Laparoscopy provides information about the location, spread, and size of endometrial implants so that the doctor can determine the best treatment options.

Endometriosis is difficult to recognize and detect because pelvic pain, as the main symptom of the disease, is often an integral part of the menstrual cycle. And yet, a timely appeal to a gynecologist with the manifestation of any of the symptoms will help to diagnose the disease at an early stage of development and start treatment on time.

Treatment of endometriosis

There are no specific drugs that would be used in the treatment of the disease. Treatment focuses on reducing pain and
cure for infertility. Treatment occurs depending on the degree, symptoms and impact on the subsequent ability to become pregnant. If a woman suffers from severe pain, then hormone therapy may be used to reduce the level of estrogen in the body. If the patient wants to become pregnant, the doctor may prescribe infertility treatment or surgery.

Medical preparations

If you complain of severe pain or heavy bleeding, if you are not planning a pregnancy in the near future, then contraceptives or anti-inflammatory drugs can help control pain. Contraceptive hormones can keep tissues from growing further. If a woman has severe endometriosis, or if these remedies do not help, stronger hormonal therapy may be tried.

"Duphaston"

The most commonly used drugs in the hormonal treatment of endometriosis include Duphaston. It is a progestogen or the so-called synthetic progesterone. Its action is similar to that of progesterone, which is produced by the female ovaries. It is not known for sure how Duphaston eliminates endometrial implants, because, unlike other drugs used in the treatment of endometriosis, it does not stop menstruation and does not affect ovulation at a relatively low dosage. Presumably, Duphaston inhibits the growth of abnormally located endometrial cells, causing them to gradually die.

The dosage of the drug will largely depend on the technique of the gynecologist. A visit to this specialist during the treatment with Duphaston will require 6 to 8 weeks after the start of the course, since the doctor must observe how the treatment progresses.

Many women prefer the treatment of various diseases with folk remedies, but is it possible to treat endometriosis at home?
conditions?

Of course, it will not be possible to completely cure this disease with folk remedies, however, in order to control the severity of the disease and
To relieve the main symptoms of pain and heavy bleeding, some natural remedies can be tried.

Castor oil helps the body get rid of excess tissue and toxins. It should be used at the beginning of the menstrual period.
cycle when spasms are just starting.
Massaging your pelvis and lower abdomen with lavender or sandalwood essential oil can help you relax and soothe minor aches and pains.
Turmeric. This spice contains a naturally occurring compound known as curcumin, which has a strong anti-inflammatory effect and hence can be used as a home remedy.
Chamomile has anti-inflammatory properties that help reduce inflammation as well as swelling.
Dandelion. Dandelion decoction helps regulate hormone levels.

In addition to the use of various natural remedies, it is also necessary to monitor the lifestyle. For example, reduce the intake of fatty foods, pay enough attention to physical activity, walking and swimming. And also give up alcohol and smoking, avoid stressful situations.

It is worth remembering that not all women with endometriosis feel pain. And the degree of the disease does not always worsen over time.

After menopause and during pregnancy, the condition usually improves. If in women after 40 years of age the pain is barely perceptible, there are no plans for a future pregnancy, or the onset of menopause is expected, then there is no urgent need for treatment.

At home, treatment helps relieve pain, but the problem may remain. But even when visiting a gynecologist, the decision always remains with the patient.

Classification of endometriosis

Specialists classify endometriosis according to the localization of this pathology. Given this factor, there are genital endometriosis, adenomyosis, external endometriosis, as well as peritoneal, extragenital and extraperitoneal endometriosis. With internal genital endometriosis, the endometrium grows in the cervix and uterine canal. With extragenital endometriosis, cells of the uterine mucosa grow in the kidneys, bladder, intestines, lungs, and also in scars after operations. With peritoneal extragenital endometriosis, the ovaries, pelvic peritoneum, and fallopian tubes are affected. With the extraperitoneal form of the disease, endometriosis grows in the external genitalia. Allocate "small" and severe forms of the disease. In severe forms, the disease develops if the patient does not undergo appropriate treatment on time. From how deep the affected areas are, four stages of the disease are distinguished: minimal, mild, moderate, severe. The most difficult to cure the last stage of endometriosis.

Symptoms of endometriosis

It is important to consider that the symptoms of endometriosis can be very different. Their manifestations directly depend on the individual characteristics of the patient's body. Very rarely, this disease is generally asymptomatic, therefore, it can only be diagnosed if you undergo a regular examination by a doctor. However, as a rule, certain symptoms of this disease still occur. Pain is the main symptom of endometriosis. In most patients, pain manifests itself in various forms. Another common symptom of the disease is dysmenorrhea. This symptom is maximally manifested on the first or third day. This symptom is associated with menstrual bleeding into the cyst and, accordingly, an increase in pressure in the cyst. Also, dysmenorrhea can occur due to retrograde menstruation and irritation in the peritoneum. It can also manifest itself as a result of the active production of prostaglandins, which cause vasospasm and strong contractions in the uterus. Pain during the days of menstruation is also manifested due to touching nearby organs with an endometrioid focus. In addition to the symptoms described, with endometriosis, dark brown discharge may appear, which persists for several days after menstruation.

A certain number of women complain of pelvic pain that is not related to the menstrual cycle. It occurs due to secondary inflammation in those organs that have been affected by endometriosis. Symptoms of endometriosis can also be painful during intercourse. Most often, a similar symptom occurs in women with endometriosis affected by the vagina, rectovaginal septum, recto-uterine space. There are also pains in the lower back, menstruation is irregular, but they are especially plentiful.

The second unpleasant symptom of this disease is the impossibility of conception. manifests itself in 25-40% of affected women. To date, all the causes of infertility in endometriosis have not been fully elucidated. Obviously, there are changes in the fallopian tubes, ovaries, which provoked endometriosis, and pregnancy does not eventually occur. The second reason for the impossibility of conception with this disease is a malfunction of the immune system. Endometriosis can similarly affect the regularity of ovulation, and then pregnancy will not occur due to disturbances in the ovulation process that accompany this disease. Another symptom of endometriosis is menorrhagia. However, this symptom of the disease is less common than the main symptoms.

Diagnosis of endometriosis

In the process of making a diagnosis, an examination and all the necessary procedures under the guidance of a doctor of a certain profile are very important. First of all, when diagnosing, you should undergo an initial examination by a gynecologist. Next, the doctor interviews the patient in detail in order to find out the nature of pain, to find out what gynecological diseases she has suffered before, whether appropriate surgical interventions have ever been performed. Also, the specialist should find out information about gynecological diseases of the patient's relatives.

Further, in the process of making a diagnosis, the following methods are used: a gynecological examination is performed using a mirror, ultrasound examination of organs in the small pelvis, rectovaginal, rectal examination, colposcopy, laparoscopy, hysteroscopy. It is the last two procedures that are the most commonly used methods for the diagnosis of endometriosis of the uterus. They should only be performed in a clinical setting. Pelvic pain, which lasts for more than six months, is the main indication for the use of laparoscopy and hysteroscopy.

Most patients with this disease have an increase in the uterus, usually moderate. Also, in a certain part of the patients (in about 15-20% of cases), fixed and non-fixed bending of the uterus is determined. In the process of diagnosis, in some patients, the presence of nodules in the posterior fornix is determined, provoking the onset of pain. To assess whether there are similar phenomena in the rectovaginal septum, a rectovaginal examination is performed. During a study aimed at examining the fallopian tubes and ovaries, the specialist determines whether these organs are enlarged, whether they are motionless, and whether pain occurs. During colposcopy and hysteroscopy, the specialist receives the material used for the biopsy. It is biopsy and histology that are considered an effective addition to endoscopic examination methods and contribute to determining the correct method of therapy.

Treatment of endometriosis

When choosing an adequate method of treatment, the specialist takes into account many factors, including the age of the patient, the presence of pregnancy in the past, the characteristics of the disease at this stage. The doctor should assess how pronounced the symptoms of endometriosis are, whether this disease is combined with other inflammatory processes, whether it is necessary to work on restoring the woman's reproductive function.

There are currently several effective treatments for endometriosis. So, depending on the above points, experts suggest the use of a conservative medical method for the treatment of endometriosis, as well as surgical methods. During the operation, an organ-preserving method (laparoscopy and laparotomy) can be used, with the help of which only the foci of the disease are removed and the organs are preserved. In some cases, a radical method is shown in which the uterus and ovaries are removed. A combination of these methods of treatment is also used.

So, conservative therapy is used if the disease is asymptomatic, in the permenopausal period, with infertility, adenomyosis, endometriosis to restore fertility. For this, the patient is prescribed a course of hormonal, anti-inflammatory, desensitizing and symptomatic agents. However, hormone therapy is considered the main component of such treatment. It is important to consider that only a long course of drug treatment guarantees the effect of such therapy. During treatment, regular monitoring by the treating specialist is indicated.

Prevention of endometriosis

To prevent endometriosis, it is imperative to undergo regular preventive examinations by a gynecologist. Particular attention should be paid to this rule for women and girls suffering from too strong menstrual pain, which can be a symptom of endometriosis. It is important to undergo preventive examinations after an abortion or other surgical intervention in the uterus. To prevent the occurrence of endometriosis, all inflammatory diseases of the genital organs, including chronic ones, should be promptly cured. Tests aimed at determining the level of hormones that directly affect the work of both the immune system and other systems in the body will also help prevent the disease.

Women who notice a reduction, a metabolic failure and, accordingly, a sharp weight gain, should pay special attention to preventive measures. Also, examinations and consultations with a doctor should be regularly carried out by those women who use intrauterine contraceptives, those who are already thirty years old, and also regularly smokers. Especially for: - http: // site

Endometrioid disease (endometriosis) is a pathological benign process of growth of endometrial-like tissue outside the cavity.

Endometriosis of the uterus or adenomyosis is the germination and reproduction of endometrial-like tissue in various parts of the muscular layer of the uterine wall.

In adenomyosis, endometrioid "implants", similar to the glandular and stromal components of the basal mucosal layer, are introduced into the myometrium at different depths, causing deformation and inflammation of the surrounding tissues.

Internal endometriosis

Endometriosis of the body of the uterus - what is it?

Endometriosis of the body of the uterus, adenomyosis, internal endometriosis, endometriosis of the uterus - all this is the same disease.

Recently, endometriosis of the body of the uterus is considered as a special, independent variant of endometrioid disease.

Endometriosis of the uterus in the structure of endometriosis.

Adenomyosis in the classification of endometriosis

Endometriosis of the uterus: ICD-10 code

N80.0 Endometriosis of uterus (adenomyosis)

Causes of the disease

There is still no single point of view on the causes of endometriosis of the uterus. Since the end of the twentieth century, a significant role has been assigned to genetic factors, i.e. congenital predisposition to the development of the disease.

The key link and trigger mechanism of adenomyosis today is considered mechanical damage to the transition zone of the myometrium(Junctional Zone, JZ).

The transitional zone (JZ) or subendometrial myometrium is the border layer of myometrium located directly under the uterine mucosa. Normally, the JZ thickness in women of childbearing age does not exceed 2-8 mm.

It has been proven that during abortions, especially those performed with the help of curettage (curettage), when taking a biopsy of the endometrium or other gynecological, surgical manipulations, the border between the endo- and myometrium can be destroyed. This makes it easier for endometrial components to enter and survive in the new environment.

However, further formation and progressive growth of endometrioid foci in the muscular layer of the uterus is possible only against the background of a weakening of immune control and a violation of the hormonal status of a woman. Endometriosis of the uterus is a complex, multifactorial pathological process.

The mechanism of development of endometriosis of the uterus

Pathological circle of adenomyosis Risk factors for uterine endometriosis

Genetic predisposition ("familial" form of endometriosis).
Curettage of the uterus.
Prolonged use of a contraceptive intrauterine device (IUD).
Inflammatory processes of the mucous membrane of the uterus.
Violation of immunity: local and / or general.
Local hormonal imbalance: increased regional estrogen synthesis (local hyperestrogenism), reduced sensitivity to progesterone in the focus of endometriosis.
Adverse environmental and social factors.
chronic stress.

There are several types (forms) of adenomyosis:

Diffuse (up to 80% of cases).
Diffuse-nodular (approximately 10%).
Focal (up to 7%).
(until 3%).

With the formation of endometrial cavities in the myomertium, they speak of cystic endometriosis.

Types of adenomyosis

According to the modern classification (L. V. Adamyan), internal diffuse endometriosis, depending on the depth of the lesion, is divided into 4 degrees (stages):

Ι degree (stage) of adenomyosis - the pathological process is limited to the submucosa and transition zone.
ΙΙ degree (stage) - the process extends to the myometrium, but does not reach the outer (serous) membrane of the uterus.
ΙΙΙ degree (stage) - the entire myometrium is involved in the disease process, up to the serous membrane of the uterus.
ΙV degree (stage) - the pathological process goes beyond the uterus, affecting other organs and tissues.

The combination of adenomyosis with external genital endometriosis is noted in 70% of cases.

Stages of adenomyosis

What is dangerous endometriosis of the uterus:

Decreased quality of life and work capacity.
Development of severe, life-threatening secondary anemia.
Infertility.
Malignancy (malignancy).

The ability of endometrioid foci to "filter" (infiltrate) into the surrounding tissues, the tendency of their growth in distant organs, the absence of a connective tissue capsule around the pathological areas - all this brings endometriosis of the uterus closer to the tumor process.

The disease is distinguished from a true tumor by the absence of pronounced cellular atypia and the dependence of the clinical manifestations of the disease on menstrual function. Wherein the possibility of malignant degeneration of endometriosis is undeniable.

Pain in the pelvic area and lower back. In most cases, the intensity of pain is associated with the menstrual cycle: during the period of menstruation, it is maximum.

Unlike sometimes occurring (periodic) "monthly" pain, pain with endometriosis of the uterus during menstruation always occurs and is observed regularly for 6 or more months in a row.

The nature of the pain:

- pulling, stabbing, cutting ... variable; in the lower abdomen, in the lower back;

— constant: from mild to moderate to intense.

- increases on the eve of menstruation;

- pain during menstruation may resemble a picture of an acute abdomen, accompanied by bloating, flatulence.

Painful menstruation (algomenorrhea).
Painful intercourse (dyspareunia).
Scanty, chocolate-brown bloody discharge from uterus a few days before and after menstruation.
Prolonged heavy menstruation, up to cyclic uterine bleeding (hyperpolymenorrhea) with the occurrence of secondary anemia.
Miscarriages in early pregnancy.
Infertility (primary and/or secondary).
PMS: nervousness, headaches, fever, sleep disturbance, vegetative-vascular disorders.

Clinical symptoms of uterine endometriosis

One of the frequent signs of the disease and the only reason for the patient to see a doctor is infertility. Miscarriage (spontaneous abortion, miscarriage) often precedes the development of typical (pain, "chocolate daub", heavy periods) clinical symptoms of endometriosis.

Pain, although a frequent, but subjective sign of the disease - each woman evaluates the intensity and / or significance of the pain syndrome in different ways.

Sometimes the first sign by which adenomyosis can be suspected is heavy and prolonged periods(hyperpolymenorrhea).

Signs of internal endometriosis

Diagnosis of endometriosis of the uterus

1. Gynecological examination

With a bimanual gynecological examination, a clinical sign of adenomyosis may be an increase in the size of the uterus, especially pronounced on the eve of menstruation.

A spherical uterus is a sign of diffuse adenomyosis.
A tuberous uterus is a sign of the nodular form of adenomyosis.

Small forms of adenomyosis (endometrioid lesions

Complaints of the patient and a routine gynecological examination can only suggest the presence of uterine endometriosis. Instrumental studies are needed to make an accurate diagnosis.

2. Transvaginal ultrasound

Sonography (ultrasound) remains the most accessible and fairly informative method for diagnosing adenomyosis today.

When conducting ultrasound using a vaginal sensor in the second half of the menstrual cycle, uterine endometriosis is detected
in 90-95% of cases

Optimal timing of ultrasound if adenomyosis is suspected:
- in the second phase of the menstrual cycle, preferably on the eve of menstruation.
- control ultrasound is performed immediately after the end of menstruation.

Clinical ultrasound signs of uterine endometriosis:

Adenomyosis Ι degree(small forms of endometriosis):

Anechogenic tubular zones, up to 1.0 cm in size, located from the endometrium to the myometrium.
Small, up to 0.2 cm, hypo- and anechogenic oval-shaped structures in the basal layer of the endometrium.
Unevenness, serration, indentation of the basal layer of the endometrium; other endometrial defects.
Small (up to 0.3 cm) areas of increased echogenicity in the transition zone of the myometrium.
The thickness of the wall of the uterus: normal, close to normal.

Adenomyosis ΙΙ degree:

In the subendometrial layer of the myometrium, there are zones of increased heterogeneous echogenicity of various sizes with the content of rounded anechoic inclusions, 0.2-0.5 cm in diameter.
The thickness of the uterine wall slightly exceeds the upper limit of normal.
The walls of the uterus are thickened unevenly, with a difference of up to 0.4 cm or more in relation to each other.

Adenomyosis ΙΙΙ degree:

The uterus is enlarged.
The walls of the uterus are thickened unevenly.
In the myometrium: a zone of increased heterogeneous echogenicity, occupying more than half the thickness of the uterine wall. Bands of increased and medium echogenicity.
In areas of increased echogenicity, there are many anechoic inclusions and cavities of various shapes, 2.0–4.0 cm in diameter.
A significant decrease in the thickness of the endometrium.

Nodular, focal adenomyosis:

In the wall of the uterus, a rounded zone of increased echogenicity with small (0.2-0.4 cm) anechoic inclusions or cavities is determined.
M-echo deformity (with submucosal location of endometrioid nodes).
The change in the size of the uterus and the thickness of the uterine wall depends on the size and number of nodular formations.

Ultrasound cannot reliably distinguish fibroids from the nodular form of uterine endometriosis.

Additional methods for diagnosing uterine endometriosis

CT, hysterosalpingoscopy (-graphy) and laparoscopy are not methods of choice for the diagnosis of adeomyosis. These studies are carried out on an individual basis.

1. Magnetic resonance imaging

MRI is the most accurate method for diagnosing endometrioid disease. But in the case of adenomyosis, the significance of MRI is comparable to a transvaginal ultrasound performed on the eve of menstruation.

MRI is prescribed according to individual indications, to exclude / confirm the combination of adenomyosis with various forms of external genital and / or extragenital endometriosis, other types of benign and / or malignant proliferative diseases. With the help of MRI, it determines the exact localization of endometriotic lesions.

2.CFM - color Doppler mapping.

This is a study of the rate of blood flow in the uterus.
Endometrioid heterotopias are avascular formations, they do not reveal growth zones of new vessels. The resistance index in the foci of endometriosis increases with the severity of the pathological process.

Allows you to visualize the signs of adenomyosis, to make a targeted biopsy of suspicious areas.

Hysteroscopic signs of uterine endometriosis:

The uterine cavity is deformed.
On the pale pink mucosa, dark red crypts are visible - the mouths of endometrioid "moves" of various sizes. They may ooze dark red blood.

Separate diagnostic curettage of the endometrium with further histological examination of the removed tissue to determine the endometriosis of the uterus does not have great diagnostic value (after all, endometrioid foci are located in the thickness of the myometrium). Curettage under the control of hysteroscopy is done to identify / exclude the combination of adenomyosis with cancer of the uterine body,. This is important for choosing the right tactics for further treatment.

Instrumental diagnosis of uterine endometriosis 4. Surgical hysteroscopy and histology.

Histological verification of adenomyosis is carried out after hysteroresectoscopy. During a minimally invasive endoscopic operation performed by vaginal access, endometrial tissue is taken along with a portion of the myometrium. Then the removed tissue is examined under a microscope (histological examination) and an accurate diagnosis is made.

5.Laparoscopy.

The "gold standard" for diagnosing external forms of endometriosis
at stage 4 of adenomyosis, laparoscopy remains. This therapeutic and diagnostic operation is carried out by introducing endoscopic equipment into the abdominal cavity through punctures of the abdominal wall.

How to treat endometriosis of the uterus

The treatment of adenomyosis remains a complex and ambiguous problem, purely individual for each patient, for each specific case of the disease.

Treatment of internal endometriosis

Hormonal treatment of uterine endometriosis

Speaking about the effectiveness of hormonal treatment, you need to know that none of the drug therapy regimens leads to a complete cure and does not eliminate the possibility of recurrence of endometriosis.

The effect of hormonal treatment is temporary - after discontinuation of drugs, the disease may gradually return.

In cases of asymptomatic course of uterine endometriosis, ultrasound signs of the disease are not an indication for hormone therapy.

With asymptomatic adenomyosis of 1-2 degrees, “waiting tactics” is advisable, i.e. the patient does not receive hormonal treatment, but is under close dynamic observation. According to the indications, restorative and physiotherapy, immunocorrection, antioxidant and anti-inflammatory therapy can be prescribed (see below).

Goals of hormone therapy:

Reducing the size of endometriosis foci.
Reducing the severity of symptoms of the disease.
Reducing the risk of surgical and / or repeated surgical intervention.
Fight against hyperestrogenism, stabilization of hormonal levels.
Prevention of progression and recurrence of the disease.
Preservation of fertility (childbearing function).

Drug therapy of endometriosis of the uterus is primarily focused on patients interested in a future pregnancy.

Hormone therapy is based on the significant role of endocrine factors in the development of endometrioid disease. It is carried out in the absence of contraindications and side effects. Initially, treatment is prescribed for 3 months. Then evaluate its effectiveness and, if successful, extend it for 6-9 months. In case of an unsatisfactory result, a replacement of the drug or surgical treatment is indicated.

Hormonal preparations of the first stage for endometriosis of the uterus

1. Oral progestogens.
Monotherapy with progesterone-like drugs is considered quite effective with adenomyosis. Progestogens are prescribed continuously, in sufficiently high doses for 3-6 months or more. The frequency of side effects they have is significantly lower than that of A-GnRH (see below).

Pills for endometriosis of the uterus

2. COC - combined oral contraceptives.
They are used to reduce pain (pelvic pain relief) associated with uterine endometriosis in women who are not interested in pregnancy. With dysmenorrhea (hyperpolymenorrhea), COCs are prescribed continuously. The effectiveness of these drugs in the treatment of endometriosis is low. More often they are prescribed as maintenance postoperative therapy, to prevent the recurrence of the disease.
The drug of choice for the treatment of endometriosis is considered a remedy.

COC preparations are contraindicated in women with adenomyosis suffering from migraine.

Hormonal preparations of the second stage for endometriosis of the uterus

1. Gonadotropin-releasing hormone (A-GnRH) agonists
/doctor's consultation required/

Name A-GnRH	Reception scheme (a course of treatment up to 6 months)	Possible side effects
Goserelin (Zoladex)	3.6 mg subcutaneously 1 time in 28 days	Hot flashes, sweating, vaginal dryness, headache, mood lability, osteoporosis, negative effects on the cardiovascular system, liver.
Leuprorelin (Lyukrin depot)	3.75 mg each intramuscularly 1 time in 28 days	Same
Buserelin	3.75 mg each intramuscularly 1 time in 28 days. Or 150 mcg each squirting in every nostril 3 times a day.	Same
Triptorelin (Diferelin, Decapeptyl depot)	3.75 mg each intramuscularly 1 time in 28 days.	Same

Treatment with A-GnRH drugs is considered the "gold standard" of drug therapy for endometriosis.

A-GnRH is used to treat severe forms of uterine endometriosis. Against the background of taking these drugs, menstruation stops in women (a "medicated pseudomenopause" occurs). After discontinuation of the drug, the menstrual cycle is restored independently. The frequency of recurrence of endometriosis 5 years after the end of the course of A-GnRH reaches approximately 50%.

Long-term (more than 6 months) A-GnRH therapy is possible, but always under the guise of "return" hormone replacement therapy (HRT) with estrogen and progesterone. This method of treatment of endometriosis is considered efficient enough.

2. Parenteral progestogens.

Depot medroxyprogesterone acetate (Depo-Provera) - injected under the skin at 104 mg every 12 weeks.

The effectiveness of parenteral progestogens is comparable to A-GnRH. But the long-term use of both is undesirable due to the negative impact on bone mineral density (risk of osteoporosis).

A significant disadvantage of progestogen treatment is breakthrough bleeding (dysfunctional uterine bleeding that occurs in response to progesterone stimulation of the endometrium). Therefore, it is more expedient to inject therapeutic agents directly into the uterus, in the form of an IUD.

3. Hormonal intrauterine device LNG-IUD Mirena:
A levonorgestrel-releasing intrauterine system is recommended for the treatment of adenomyosis in women uninterested in pregnancy.
High performance Mirena proven by the agency of the Ministry of Health and Social. USFDA services.
Duration of application is 5 years.

4. Antigonadotropins for the treatment of endometriosis:

Gestrinone (Nemestran)
Danazol (Danol, Danoval)

These drugs are currently rarely used due to frequent side effects due to androgenic influence (acne, seborrhea, male pattern hair growth, weight gain, voice change, reduction of mammary glands, etc.)

General information and classification of endometriosis

Causes of endometriosis

Symptoms of endometriosis

Complications of endometriosis

Diagnosis of endometriosis

Treatment of endometriosis

Prevention of endometriosis

Signs of endometriosis

Symptoms of endometriosis

Causes of endometriosis

Treatment of endometriosis

Medical preparations

"Duphaston"

Read more about endometriosis treatment

Classification of endometriosis

Symptoms of endometriosis

Diagnosis of endometriosis

Treatment of endometriosis

Prevention of endometriosis

Endometriosis of the body of the uterus - what is it?

Endometriosis of the uterus: ICD-10 code

Causes of the disease

What is dangerous endometriosis of the uterus:

Diagnosis of endometriosis of the uterus

Clinical ultrasound signs of uterine endometriosis:

Additional methods for diagnosing uterine endometriosis

How to treat endometriosis of the uterus

Hormonal treatment of uterine endometriosis

Pills for endometriosis of the uterus