Endometriosis is a female benign disease, the course of which is characterized by the proliferation of the inner uterine membrane. In simple words, tissues that normally should only be in the uterus, with this pathology, spread to other organs. The exact causes of the development of uterine endometriosis, the symptoms of which will not take long, are currently unknown. Meanwhile, scientists allegedly associate its appearance with immune, hormonal, hereditary and other disorders in the body.
Brief Description of the Disease
Every woman has a uterus in the pelvis - this is the reproductive organ to which the fallopian tubes are adjacent. It is in the uterus that the fetus develops and grows during pregnancy. In it, as if in a cocoon, the future baby is reliably protected from external and internal factors. The uterus is covered with three membranes - the internal endometrium, myometrium and perimeter. In our case, the endometrium is of particular interest.
This membrane consists of a basal layer and a functional layer, which is a cluster of cells of a cylindrical shape. Between them is a kind of glandular layer. When menstruation occurs, a partial rejection of the functional layer occurs, and the process of cell division of the basal membrane starts. As a result, new cells appear that replace the rejected area. Symptoms of uterine endometriosis occur when the glandular layer of the cylindrical epithelium begins to produce excess mucus.
Gynecologists note that this disease is one of the most common in women, second only to the diagnosis of uterine fibroids and inflammatory processes of the internal genital organs. Symptoms and treatment of endometriosis are mainly experienced by women of childbearing age, most often women who are not giving birth to women over 40 years old. Remarkably, adolescent girls may also experience this pathology.
It is impossible to determine the true indicators by the frequency of detection of the disease, due to difficulties in its diagnosis. In the predominant number of cases, the pathology proceeds latently, without symptoms. The reasons for uterine endometriosis, the treatment of which often requires surgical intervention, can only be guessed. Often, patients learn about their diagnosis by accident, turning to a gynecologist with a completely different problem, or during a routine physical examination.
Etiology of the disease: major versions
According to doctors, endometriosis is a multifactorial pathology, which can provoke a number of factors. Since accurate data on its pathogenesis are not yet available, we will familiarize ourselves with the alleged causes of the development of the disease.
Symptoms of uterine endometriosis, according to one version, arise due to retrograde (reverse) menstruation. What is this violation? A small amount of blood released during menstruation enters the abdominal cavity through the fallopian tubes. It is interesting that this phenomenon is considered by gynecologists as a variant of the norm; it also occurs in absolutely healthy women. However, unlike women with endometriosis, their immune system is able to restrain the growth of the epithelium and does not allow it to spread throughout the abdominal cavity.
According to other theories, the causes of uterine endometriosis, the symptoms of which will be addressed in more detail in the following sections, may be the following factors:
- Genetic predisposition. It is believed that the risk of this pathology increases if it has a history of relatives in an ascending line (mother, grandmothers, aunts).
- Weakened immunity. With violations in the functioning of the immune system, the body is unable to withstand the endometrium growing on tissues and organs.
- Gynecological surgery. Any surgical intervention in the uterine cavity is considered as a significant predisposing condition for the appearance of symptoms of uterine endometriosis. Operations that increase the risk of developing the disease include artificial termination of pregnancy, cesarean section, curettage, cauterization of erosion.
- Hormonal imbalance. The endometrium is epithelial tissue sensitive to the level of female sex hormones. Under the influence of estrogen, even minor foci of the endometrium can react with active proliferation.
In addition to the above versions, there are other hypotheses for the development of symptoms of endometriosis in women. The first signs of the disease can occur against the background of:
- iron deficiency anemia;
- adverse environmental conditions;
- urinary tract infections, including STDs;
- pathologies of the liver and thyroid gland;
- diabetes mellitus;
- taking oral contraceptives;
- the action of the hormonal intrauterine device.
Forms and types of pathology
Before you get an idea of the symptoms and treatment of uterine endometriosis, you should familiarize yourself with its classification. In gynecology, the types of disease are conditionally divided into two types - extragenital and genital endometriosis. The latter, in turn, is external or internal.
Symptoms of extragenital uterine endometriosis are usually more pronounced than manifestations of the genital form. This can be explained by the fact that this disease goes beyond the genitourinary system and affects the internal organs:
- bladder;
- intestines;
- postoperative scar on the anterior abdominal wall;
- kidneys
- lungs;
- conjunctiva of the eyes;
- vocal cords.
Treatment of internal uterine endometriosis, the symptoms of which may not occur immediately, affects the myometrium. Genital endometriosis is also external extraperitoneal, extending to the cervix and vagina, or external peritoneal, affecting the ovaries, fallopian tubes, peritoneum of the rectum-uterine cavity, sacral and rectal-uterine ligaments.
Based on the various depths of endometrial lesions, several stages of uterine endometriosis are distinguished. Symptoms of each of them differ in severity. For example, the stages of internal endometriosis can be described as follows:
- First stage. Only the mucosa is affected, the foci of the endometrium do not affect the myometrium.
- Second stage. The epithelium extends to the muscle membrane of the uterus and affects it to the middle.
- Third stage. Uterine tissue reaches the parietal peritoneum and internal organs.
Another classification of endometriosis is distinguished, starting from specific organs of the small pelvis and peritoneum, affected by endometrium.
The clinical picture of the growth of tissue in the uterus
The second name for uterine endometriosis is adenomyosis. As the disease progresses and focal lesion of the myometrium, its characteristic symptoms increase. According to reviews, uterine endometriosis is manifested:
- Painful menstruation (algodismenorea). The cause of the pain syndrome is the accumulation of fluid in the tissues due to adhesions that affect the uterine cavity.
- Failures in the menstrual cycle. In almost all cases of the disease, this symptom occurs. With uterine endometriosis, however, as with many other gynecological pathologies, this manifestation should become a disturbing “bell” for a woman, indicating the need to visit a doctor. Speaking of cycle disorders, it means the premature or, conversely, the delayed appearance of menstruation. In this case, the nature and duration of the discharge can change.
- The impossibility of conception. Infertility is another symptom of uterine endometriosis. According to reviews, the treatment of this disease subsequently allowed women to endure pregnancy. With adenomyosis, there is not even a minimal possibility of implantation of the ovum. Infertility in endometriosis is not the final verdict for women of reproductive age. According to statistics, every fifth cured patient has a pregnancy.
- Endocrine Disorders Due to hormonal disorders, spotting in women sometimes occurs between menstruation. Against the background of adenomyosis, this manifestation occurs especially often.
The condition of young girls can worsen dramatically without proper treatment. With menopause, the symptoms of uterine endometriosis gradually disappear. In other cases, the disease develops rapidly, exacerbations and spontaneous onset of remission alternate with each other. It is worth noting that a prolonged lull in the pathological process is usually observed in pregnant patients.
Ovarian lesion
With the flow of blood and lymph through the lumen of the fallopian tube, endometrial cells enter the ovaries. So far, none of the gynecologists can answer the question of why the disease develops in the ovaries, and foci of uterine tissues can be attached not only outside the organ, but also inside it.
Symptoms of endometriosis that affects the ovaries can vary significantly in each case. To a greater extent, this depends on the size of the foci of the endometrium and their localization. In this case, for the pathology of the ovaries, a common characteristic phenomenon can be considered constant pain in the lower abdomen. This syndrome has no relationship with the menstrual cycle, discomfort can occur at any time, especially often during sexual intercourse, physical activity. Pain can spread to the inguinal and lumbar region. Sometimes they indicate inflammation of the peritoneum due to irritation caused by proliferation of endometriotic foci.
Proliferation of the endometrium
For the peritoneal type of pathology, the interaction of the elements of the uterine epithelium and peritoneal mesotheliocytes is characteristic. This form of the disease can occur due to reflux of menstrual blood, which was mentioned earlier.
Peritoneal endometriosis can be of two types. The first is characterized by a limited extent of the lesion - the endometrium spreads only along the peritoneum. The second type of peritoneal endometriosis is a more complex form - in this case, the uterine tissue grows pointwise not only within the abdominal cavity, but also behind it, located on the uterus, ovaries and fallopian tubes. In the initial stages of such endometriosis, any symptoms may be absent altogether. However, the latent course of the disease brings many problems. As the pathology progresses, the chances of a successful infertility treatment decrease.
Sometimes foci of the endometrium, going beyond the peritoneum, "take root" in the rectum and its muscle tissue. The disease immediately lets the patient know about her development, manifested by increased pelvic pain due to damage to pararectal tissue. Also, pain can be felt during intimacy with a partner.
Signs of vaginal endometriosis
The main symptom in this form of the disease is intense pain, localized in the vagina and deepening of the pelvis. The severity of uncomfortable sensations corresponds to the average, much less pain is painful, exhausting. The intensification of the pain syndrome of a woman is noted during intercourse, as well as several days before menstruation and after them. By the way, an increase in the intensity of pain may indicate the involvement of the anterior perineum and the external rectal sphincter in the pathological process.
Against the background of vaginal endometriosis, soreness increases during the act of defecation. Each attempt to empty the intestines is accompanied by exhausting, burning and throbbing pain, which feels similar to an abscess.
Before the onset of menstruation, swelling, cystic and nodular formations are often found in the vagina, which after menstruation become much smaller or completely disappear. Places of tumors are scarred, which is why they lose their sensitivity.
Vaginal endometriosis is often confused with sphincteritis and rectitis, and an erroneous diagnosis leads to the appointment of incorrect therapy. Taking the growth of the endometrium for inflammation of the muscular sphincters, the patient is prescribed thermal procedures, including warming sitz baths, which are the most favorable condition for the progression of endometriosis. As a result, the pain in the vagina intensifies, itching occurs, brownish and bloody discharge appears, regardless of the day of the cycle.
Cervical canal
Symptoms of cervical endometriosis are a frequent reason to consult a gynecologist. This form of pathology is very common in women due to the anatomical features of the location and functions of the cervical canal. Abortion, curettage, installation of the intrauterine device, its removal - during most gynecological procedures, it is the cervix that is affected.
Symptoms of endometriosis are largely similar to the clinical manifestations of other areas of the urogenital female system. Signs of damage to the cervix include:
- spotting brown color for more than 5 days before menstruation;
- discomfort during sex;
- brownish discharge appearing at the end of intercourse.
Bladder affection
This form of endometriosis is considered a rare disease of unknown etiology, but today cases of this disease are diagnosed more and more often. It is possible that the reason for this is the meager knowledge of urologists and gynecologists about pathology. Over the years, the symptoms of uterine endometriosis, the consequences of which are damage to the bladder, have been diagnosed by specialists as manifestations of cyclic hematuria. This definition of diagnosis was fundamentally wrong.
The bladder can be affected differently by the endometrium. One of the options for the spread of uterine tissue is the ingress of particles of the endometrioid ovarian cyst or menstrual blood onto the surface of the bladder, in which the epithelium is present. Another method of damage is the growth of tissue from the uterine wall to the bladder.
Probable complications
If you abandon the treatment of this disease, continue to ignore the causes and symptoms of uterine endometriosis, the consequences may not be most pleasant for the health of a woman and her urogenital system, in particular. The most common complications of this disease in patients are:
- incurable form of infertility;
- the formation of adhesions in the pelvis and abdominal cavity;
- posthemorrhagic anemia, developing against a background of heavy menstrual blood loss;
- neurological disorders caused by compression of the nerve endings;
- cystic benign ovarian tumors ;
- malignant malignancy of endometrioid tissues.
How to recognize this disease
To establish a diagnosis of endometriosis, the patient will have to undergo a comprehensive gynecological examination. According to the results of the studies, the attending physician will be able to determine the form of the lesion, the severity and nature of the disease. The diagnostic course consists of a number of research procedures, which include:
- Ultrasound of the pelvic organs using a transvaginal sensor.
- Hysterosalpingography - this technique allows you to assess how deep the formed foci are, whether the patency of the fallopian tubes has suffered from overgrown endometrium. The procedure is performed using a contrast medium. In most cases, it is prescribed to women in whom pregnancy is terminated in the early stages.
- Hysteroscopy is an instrumental study with which you can examine the surface of the uterus, endometrioid passages, determine the width of the mouths of the fallopian tubes.
- Laparoscopy is a microsurgical manipulation that allows you to diagnose, based on patient complaints and symptoms, cervical endometriosis. The treatment of this disease is often carried out immediately, during this research procedure.
- A blood test for the presence of endometriosis markers.
As a rule, the expediency of passing a particular procedure is determined by the doctor. Taking into account the peculiarities of the pathological process, the examination plan can be changed.
Differences from fibroids
If a disease such as adenomyosis is suspected, it is fundamentally important to conduct a differential diagnosis with uterine myoma. Symptoms of endometriosis are partially similar to the manifestations of this benign tumor, but according to the results of a comprehensive examination, it will not be difficult for an experienced gynecologist to distinguish one disease from another.
Uterine fibroids women suffer much more often than endometriosis.A tumor is found in almost every second woman after 40 years. Both of these pathologies are united by the general medical term "hyperplastic processes of the reproductive system." The occurrence of both fibroids and uterine endometriosis, the symptoms and treatment of which this article is devoted to, is due to hormonal disruptions in the female body.
As you know, the course of endometriosis is accompanied by pain, abnormal inflammatory and immune reactions. In comparison, uterine fibroids has a number of features. A tumor often develops without symptoms, it can grow or remain stable, suddenly increase or disappear. If endometriosis is classified as a systemic disease, then fibroids is a local pathological process.
Endometriosis treatment
Therapy of the disease is carried out in two directions. Most often resort to surgical intervention in order to eliminate foci in the areas of endometriosis. In severe cases, complete organ removal may be required. At the initial stages, conservative treatment with medications is carried out, which helps to adjust the production of estrogen and reduce the hormonal activity of the endometrium.
Often, surgery has no alternatives due to the rapid deterioration of patients and the emergence of threats of incurable infertility. In addition, the pain associated with endometriosis often becomes unbearable due to the proliferation of foci. All these factors often lead to an unfavorable prognosis for women.
Intervention can be done in different ways. The choice of surgical technique depends on the location of the foci, the availability of access to them and the ability to provide the necessary impact. In case of damage to the vagina, cervix or perineum, it is preferable to carry out endoscopy - partial excision of the endometrioid foci with cauterization. The operation is performed outside or through the cavity of the vagina. In case of damage to the internal uterine cavity, a decision may be made on the complete removal of the organ. Endometriosis of the ovaries and peritoneal organs is a direct indication for laparoscopy. During this operation, the surgeon makes several small holes through which a laparoscope is inserted. Such an operation has several advantages due to the low degree of tissue injury.
What drugs are used for endometriosis?
Drug therapy is aimed at inhibiting the reproduction of endometrial cells. Deciding on the use of drugs on their own is fraught with dangerous consequences and worsening conditions, therefore, the drugs should be prescribed exclusively by the attending physician. For the treatment of endometriosis, medications of several groups are used:
- oral combined contraceptives ("Marvelon", "Diane-35", "Femoden");
- antigonadotropins ("Gestrinon", "Danazol");
- progestins ("Depost", "Duphaston");
- agonists (Decapeptil Depot, Zoladex);
- antiestrogens ("Tamoxifen", "Arimidex", "Letrozole").
Folk recipes
Together with pharmacy drugs, in the absence of contraindications, women are often recommended to use folk remedies for the treatment of uterine endometriosis. Symptoms of this disease (aching pain in the lower abdomen, algodismenorrhea) disappear much faster if you apply infusion and decoctions of medicinal herbs, do douching, compresses. To your attention options for the most effective folk remedies for endometriosis.
One of the plants that are often used for female diseases is the red brush. Due to the content of phytohormones, this herb helps to stabilize the hormonal background and stop the growth of foci, the growth of uterine fibroids. The red brush is popular with women who use it in the treatment of endometriosis as:
- Decoction - pour one tablespoon of medicinal herbs with a glass of boiling water, put on the stove and cook for 5 minutes. The cooled and filtered drink is drunk three times a day, 100 ml after a meal.
- Alcohol tincture, which is prepared as follows: 500 ml of vodka is poured 3 tbsp. l red brushes and set aside for a month. Take the medicine several times a day before meals for 1 tsp.
- Syringe solution, breeding 1 tsp. the above tinctures per 500 ml of warm boiled water.
For the treatment of endometriosis, the substances contained in the celandine are excellent. This plant helps fight various skin and joint diseases, infections and even cancer. With uterine endometriosis, dried celandine is used. Take grass in the amount of one tablespoon, pour boiling water and insist a couple of hours under the lid. Take the infusion for 2-3 weeks at 50 ml in the morning and in the evening before eating.
Alternative therapy for endometriosis involves the use of not only herbs, but also other components. For example, blue clay is used for therapeutic compresses. If this is not, gray or green kaolin is suitable. Clay is diluted with water and the resulting slurry is laid out on the lower abdomen. Covering with cling film and a warm cloth, the compress is left for a couple of hours. The course of treatment is 10 procedures. For each session, you need to prepare a fresh mixture. Clay can be used in parallel with taking medicinal decoctions and infusions.