What is endometriosis? Causes, Symptoms, Diagnosis and Treatment

What is endometriosis? This is a common question. We will understand it in more detail.

Endometriosis is a disease characterized by the expansion of endometrial cells on the surface of the uterus, in its internal cavity layer and in the tissues of other organs. The classification of endometriosis and the division into two types depends on where the foci of the enlarged endometrium are localized: genital, including uterine endometriosis, and extragenital. There is a generally accepted opinion that this disease appears only in mature women, but the symptoms are characteristic of both adolescents and men. However, among women, the prevalence of pathology is much higher (approximately a third of women in reproductive age undergo endometriosis).

The causes of endometriosis are discussed below.

Causes of pathology

For this disease to occur in the body, two main factors are required: the presence of endometrial cells, which may be congenital or due to casting along with menstruation to inappropriate places, as well as hormonal disorders that are accompanied by increased secretion of the hormone estrogen.

Let us explain what it is - endometriosis, in an accessible language.

Currently, there are a number of versions that explain the reasons for the growth of particles of endometrial tissue and the spread of its foci in the human body. Among them are:

• Transfer of endometrial cells during menstruation and their subsequent fixation on the external uterine layer, in the tissues of the uterine neck, on the vaginal wall and external genital organs, and retrograde menstruation, which promotes the transfer of endometrial tissues to the pelvic organs, peritoneal cavity, ovaries.
• Distribution of composite particles affected by endometriosis, together with lymphatic flow, which explains the location of foci of pathology in tissues and organs that are not connected by other means of distribution with the uterine cavity.
• The possibility of transformation of the remains of the embryonic tissue of the genitourinary system and their ability to remain in small quantities in other organs, developing pathogenic activity under the influence of adverse factors; This theory can explain the episodes of the occurrence of male endometriosis, if the fetus cells of the genitourinary system did not fully receive sexual specificity during gestation. In men, the possibility of forming foci of endometriosis is enhanced by the use of estrogens, for example, during the treatment of tumor pathologies of the prostate.
• There is also an opinion about the genetic predisposition to the disease. The causes of endometriosis are not known to everyone.

Significantly increase the possibility of the appearance of pathological foci of endometrial distribution such factors as:

• frequent inflammatory, infectious manifestations in the organs of the reproductive system and pelvis;
• fibroids, tumors, neoplasms of the uterus;
• invasive procedures, surgical measures (abortion, cesarean section, uterine cavity cleaning, surgeon intervention, surgical treatment of uterine neck erosion, etc.);
• complicated birth;
• disorders of the endocrine system, hormonal imbalances of different origin;
• anemia and immune defect;
• excessive intake of alcohol, drugs and drinks containing caffeine, smoking.

To understand what endometriosis is, you need to know its symptoms.

Symptoms of the disease

Symptoms may be blurry, unexpressed, consistent with manifestations of other diseases and dysfunctions, in some women it is asymptomatic.

There are no specific symptoms of endometriosis in women, but its occurrence in the uterine membrane and reproductive organs can be suspected by such manifestations as:

• painful sensations, sometimes prolonged and pronounced, in the lower abdomen, which give back to the lower back and groin, pelvic pains of a "chronic nature";
• increased pain during intercourse, gynecological examinations, bowel movements;
• long painful critical days with strong discharge (even to the state of anemia), cycle disturbances;
• both primary and secondary infertility.

When the endometrial tissues are located outside the reproductive organs, depending on their location, signs such as nosebleed, presence of blood in urine, saliva, feces, sputum, tears, as well as its discharge from the navel, etc. Symptoms of endometriosis in women should not be to remain without attention.

Disease classification

Endometriosis manifests itself depending on the location of pathological foci. Because of this, the disease is classified according to location. Thus, genital and extragenital varieties of endometriosis are distinguished. During the genital type of endometriosis, localization of heterotopia on the tissues of the organs of the reproductive system occurs, and in the case of extragenital - beyond the framework of the reproductive system.

Endometriosis in genital form has the following varieties:

• peritoneal - with inflammation of the pelvic peritoneum, uterine tubes, ovaries;
• extraperitoneal, which is localized in the lower parts of the reproductive system - in the vagina, external genitalia, the vaginal segment of the uterine neck, rectovaginal septum, etc .;
• internal endometriosis (adenomyosis), which occurs in the muscular uterine layer, when the uterus takes on the shape of a ball and increases in size until the fifth or sixth week of pregnancy.

With endometriosis, localization can have a mixed character, this occurs, as a rule, if the disease is started. In the extragenital variety, foci of heterotopia appear in the navel, intestines, kidneys, lungs, and scars after surgery. Depending on the distribution and depth of the focal distribution of the endometrium, four degrees are distinguished:

• the first degree - single and superficial foci;
• the second degree - deeper and more numerous foci;
• the third degree - multiple deep foci, endometrial cysts on both or one ovary, individual adhesions in the peritoneum;
• the fourth degree - deep and multiple lesions, large bilateral endometrioid cysts on the ovaries, germination in the vaginal walls, as well as in the rectum, dense adhesions; with the fourth degree, the lesion is expressed and widespread, difficult to treat.

What is uterine endometriosis?

Uterine endometriosis

Genital internal endometriosis and in a more specialized diagnosis of adenomyosis is characterized by proliferation of endometrial cells, germination in the uterine muscle layer to the serous membrane. This phenomenon is characterized by severe blood loss during menstruation, uterine bleeding, which entail the appearance of anemia and severe pain. Often, adenomyosis becomes the cause of infertility in a woman and prevents the onset of pregnancy and / or the course of gestation. By the way, fibroids and endometriosis often accompany each other.

Therapy begins with the appointment of hormonal drugs. If there is no effectiveness, then surgical treatment is required (manipulations to eliminate, cauterize foci of spreading endometrium). If indications are expressed and there is a threat to the patient's health, then with the advanced stages of endometriosis, it may be necessary to quickly remove a certain part of the uterus or the entire organ in general. Reviews of uterine endometriosis are given at the end of the article.

Cervical endometriosis

An increase in the number of cases of endometrial overgrowth in the uterine neck and endometriosis in this area of ​​the reproductive system is associated by specialists with surgical procedures for the treatment of erosion. If cauterization or other manipulations were carried out during the premenstrual period, then it is possible to implant the components of the endometrium during their transportation along with the discharge of menstrual blood.

A typical symptom with a similar placement of endometriosis is bloody intermenstrual flow, there may be increased soreness during menstruation.

Therapy for cervical endometriosis is also based on hormonal treatment and, if necessary, surgical procedures, namely, cauterization of excision of pathological sites of endometrial distribution in the body.

Ovarian endometriosis

One of the common types of endometriosis is inflammation of the ovarian tissues.

In this case, a violation of reproductive function occurs: cysts in the ovaries prevent the course of ovulation.

Ovarian inflammation is dangerous because the follicle reserve is depleted, and a woman can become infertile. The main symptom is stitching, sharp pains in the lower abdomen, especially during or after intercourse. Ovarian endometriosis can be detected by ultrasound. Differentiation of functional and endometrioid cysts is required, and for this purpose, an examination is done several times during the menstrual cycle.

If the diagnosis is confirmed, then the patient needs surgical treatment with a laparoscopic method. A number of altered tissues are removed, as well as the cyst and ovary itself, if the endometrium struck it in a significant amount. The treatment of endometriosis with folk remedies is of interest to many. About it below.

Peritoneal endometriosis

In contrast to the genital internal form, there is also extragenital endometriosis. If the foci of endometrial distribution are localized in the peritoneum, in the pelvic region, but at the same time outside the organs of the reproductive system, they speak of abdominal peritoneal endometriosis. The etiology of its origin is associated with the transfer of endometrial cells during retrograde menstruation, cell germination from other foci of endometriosis through the tissues of inflamed organs and with abnormalities in the development of the fetus. With abdominal endometriosis, the symptomatology also manifests itself in the form of pain in the pelvic area, which occur or intensify during intercourse, menstruation, and bowel movements. Diagnosis of this type of disease is difficult, most often the places of peritoneal endometriosis are determined by surgical intervention, which is performed as a therapeutic and diagnostic procedure.

Symptoms and treatment of endometriosis in women are interrelated.

Signs and causes of vaginal endometriosis

Uterine endometriosis can spread both to the neck of this organ and to the vagina, especially if it has inflammation, abrasions, and wounds that violate the integrity of its surface.

In this case, the clinical picture includes painful sensations and blood discharge with intimate connection, localization of unpleasant sensations in the vagina during menstruation.

Diagnosis is carried out during a gynecological examination of a woman and taking her material for analysis. The therapeutic method - treatment with medications, the appointment of hormones. If the effectiveness of the drug course is not available, then surgical procedures are performed to cauterize and excise foci of pathology.

Reviews on the treatment of endometriosis are abundant.

Rectovaginal endometriosis

This form of the disease has a mixed character, while there is damage to the body of the uterus, genitals, vagina along with the germination of endometrial tissues in the rectum. This kind of pathology is characterized by a clear pain syndrome, especially during bowel movements, as well as bloody spots in the feces during menstruation. In this case, the diagnosis is carried out using a rectal examination and surgical treatment is performed.

The specifics of bladder endometriosis

The endometrium rarely affects the walls of the bladder. Among the causes of this kind of disease, retrograde reflux of blood, including endometrial cells, during critical days, its germination through the uterine wall, and the spread of pathological cells by endometrioid cysts of other organs are distinguished.

Often there is a situation in which the disease proceeds without symptoms and is diagnosed only during the surgical operation of the peritoneal region according to other indications. But with the growth of the endometrium in the mouth of the ureters or on the back wall of the bladder, pain and difficulty during urination, an increase in the frequency of urges, a feeling of heaviness, especially in the period before menstruation, can be noted.

Such a clinical picture often leads to incorrect diagnosis and treatment for cystitis. If a disease develops that does not respond to cystitis therapy, then blood impurities appear in the urine, and there is an increase in pain. To facilitate the correct diagnosis, focusing on the correlation of the signs of the disease and the menstrual cycle is required. To make a final diagnosis, a cystoscopic method is required.

Diagnosis of endometriosis

During the diagnosis of endometriosis, the exclusion of other pathologies of the genital organs, which proceed with similar symptoms, is required. If there is a suspicion of endometriosis, then it is necessary to collect complaints and a medical history in which pain will be indicative, information about past diseases in the genital area, operations, and the presence of gynecological abnormalities in relatives. The examination will further include the following manipulations:

• gynecological examination (vaginal, in the mirrors, rectovaginal), especially informative before critical days;
• hysterosalpingoscopy and colposcopy in order to clarify the shape and location of inflammation, obtain tissue biopsy;
• ultrasound examination of the abdominal cavity and pelvic organs to clarify the location and dynamic picture in the treatment of endometriosis;
• computed spiral tomography or magnetic resonance to clarify the location and nature of endometriosis, its relationship with other organs, etc .; the accuracy of the results obtained due to this with endometriosis is 96%;
• hysterosalpingography (pictures of the uterus and fallopian tubes using x-rays) and hysteroscopy (that is, endoscopic examination of the uterine cavity), which allows to determine adenomyosis with high accuracy - about 83%;
• laparoscopy, which allows you to examine foci of endometriosis visually, to assess their degree of maturity, quantity, activity;
• analysis of tumor markers CEA, CA-125 PO and CA 19-9 test, their blood counts during endometriosis increase several times.
  

What is the treatment for uterine endometriosis?

Therapy Features

When choosing a method of treating endometriosis, they are based on indicators such as the number of births and pregnancies, the patient’s age, the prevalence of pathology, localization, the presence of concomitant pathologies, the severity of symptoms, and the need for pregnancy. Methods of treating endometriosis are divided into surgical (radical - with removal of the uterus, laparoscopic - with removal of foci of the disease and preservation of the uterus, oophorectomy), medication and combined.

In the treatment of endometriosis, the goal is the elimination of both active manifestations of the pathology and its consequences (cystic and adhesions, manifestations of a neuropsychiatric nature, etc.).

Conservative therapy of endometriosis is required in the following cases:

• the course of the disease is asymptomatic;
• young patient;
• during premenopause;
• the requirement to restore or maintain the function of childbearing.

Leading in the medical treatment of uterine endometriosis is the use of hormones, namely the following groups of drugs:

• Combined-type estrogen-progestogen drugs are drugs that contain progestogens in small doses, inhibit estrogen production, as well as ovulation. They are indicated at the initial stage of endometriosis, since they are ineffective if the endometrioid process is common and there are ovarian cysts. When using, the following side effects can be observed: nausea, bloody menstrual flow, vomiting, soreness in the mammary gland.
• Antigonadotropic drugs ("Danazol", etc.). Instructions for use in endometriosis report that they inhibit the production of gonadotropins in a system such as the hypothalamus-pituitary gland. Used in a continuous course for 6-8 months. Their use is contraindicated in female hyperandrogenism (excessive amounts of androgen hormones). The following side effects are noted: flushing, sweating, changes in body weight, coarsening of the voice, increased oily skin and more intensive hair growth.
• Progestogens ("Progesterone", "Dydrogesterone", "Gestrinon", "Norethisterone", "Vizanne" for endometriosis). They are used at any stage of the disease, the course is continuous - from 6 to 8 months. The use of gestagens can accompany a depressive state, discomfort in the area of ​​the mammary glands, blood secretion between menstruation.
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Surgical radical treatment of endometriosis (adnexectomy and hysterectomy) is carried out for those patients whose age is after forty years, also with actively progressing disease and the lack of effectiveness of conservative surgical procedures. Unfortunately, such a radical method in the treatment requires twelve percent of patients. The methods of operations are laparotomy and laparoscopic. Reviews of women about endometriosis and its therapy are given below.

Endometriosis is prone to recurrence of pathological processes, in some cases it forces the use of a new surgical intervention. According to statistics, relapses occur in 15-40% of patients and are determined by the prevalence of the disease in the body, its location, severity and radicalism of the first operation.

Since endometriosis is a dangerous disease, thanks to its early detection and serious treatment, you can completely get rid of the pathology.

Treatment of endometriosis with folk remedies

1. Calendula. With endometriosis, they drink it, make tampons and douching with it. First make a decoction. To prepare it, take 2 tablespoons of dry or fresh grass, pour boiling water and cool. Take orally three times a day, 0.5 cup. In order to improve the effect of calendula, you can add immortelle, St. John's wort and viburnum.
2. Scarlet, honey and propolis. Mix aloe juice with 1 teaspoon of honey, add propolis, mix everything, then grease the swab with the mixture. Place in vagina for 1 hour.
3. Hemp grains. If you can’t get them, you can replace the linen, 3 tbsp. l., and pour boiling water, insist and drink three times a day.
4. Hemlock or marin root. In therapy, use a decoction and tincture. To prepare tinctures for 500 g of vodka, you need 5 tbsp. l herbs, insist for two weeks, take before meals three times a day. A decoction is made for douching - 2 tbsp. l herbs and a glass of boiling water.
5. Pine uterus and red brush. With endometriosis, they are taken in combination. You need to prepare a decoction for oral administration, drink it three times a day, half a glass before meals.

Treatment of endometriosis with folk remedies is very effective. Here are a few more recipes:

1. Compress of honey and rosin. 2-3 tbsp. l honey, 10 ml of pine rosin and vegetable oil, everything is mixed and laid out on a cotton cloth. The compress is applied to the lower abdomen and worn for several days.
2. Goose fat swabs. 10 tablespoons of fresh goose fat need to be melted and add to it a decoction of calendula, apply tampons for 10 days.
3. Swabs with fish oil. Impregnated with a swab and used for 10 days.

Reviews

Reviews about this pathology are abundant. Many women of childbearing age suffer from it. The disease is uncomfortable, fraught with consequences, therefore, requires immediate and comprehensive treatment.

We examined what endometriosis is and how to treat it.