We will find out why uterine endometriosis is dangerous. This is a pathological hormone-dependent proliferation of glandular uterine tissue outside this organ - in the fallopian tubes, ovaries, in the thickness of the uterus, on the peritoneum, in the bladder, in the intestines, as well as in more distant organs. Moreover, heterotopies (endometrial fragments), sprouting in other organs, also cyclically change, like the endometrium located directly in the uterus, that is, in accordance with the menstrual cycle. Such changes are manifested by pain, an increase in the affected organ in volume, bloody discharge from heterotopy structures, menstrual dysfunction, infertility, and pathological discharge from the mammary glands.
Description
The disease is characterized by benign proliferation of tissues functionally and morphologically similar to uterine endometrium. What is an accessible language? This is the tissue lining the inner mucous membrane of the body of the female genital organ (mucous layer). The clinical manifestations of this disease directly depend on the localization of the pathological process. The disease can cause the formation of ovarian cysts and menstrual irregularities.
Many patients are interested in whether it is possible to become pregnant with endometriosis of the uterus. We will talk about this below.
This disease in women is the third most common gynecological pathology, after uterine fibroids and various inflammatory processes. In the majority of cases, endometriosis occurs in women of reproductive age — 25–40 years (approximately 27%), is observed in 10% of girls during the formation of menstrual functions, and in 2–5% in menopause. The danger of uterine endometriosis is important to find out.
Disease classification
Manifestations of the disease depend on the location of the foci of endometriosis. In this regard, it is divided into extragenital and genital forms. With the genital form, heterotopias are located on the tissue of the genital organs, with the development of the extragenital form - outside the structures of the reproductive system.
With the genital form of the disease, they differ:
- peritoneal endometriosis, which is characterized by damage to the ovaries, fallopian tubes, pelvic peritoneum;
- extraperitoneal endometriosis, which is localized in the lower parts of the reproductive system - in the vagina, external reproductive organs, in the area of the rectovaginal septum, on the cervix, etc .;
- internal endometriosis developing in the muscle layers of the uterus.
The localization of endometriosis is mixed, which is often found when the pathological process is neglected. With extragenital type, foci of heterotopia are noted in the intestine, lungs, navel, and kidneys.
Degrees of disease
Depending on the distribution and depth of germination of focal growths of the endometrium, 4 degrees of uterine endometriosis are distinguished:
- I degree - single and superficial foci;
- II degree - multiple foci;
- III degree - deep multiple foci, cysts on the ovaries, adhesions in the peritoneum;
- IV degree - deep multiple foci of endomeriosis, large endometrioid ovarian cysts (on both sides), germination of cells in the walls of the rectum and vagina, pronounced adhesions.
In addition, there is also a generally accepted classification of internal uterine endometriosis, in the development of which there are four stages according to the level of damage to the muscle layers:
- Stage I - the initial germination of the myometrium;
- Stage II - foci spread to half of the uterine muscle layer;
- Stage III - germination through the entire thickness of the uterus;
- Stage IV - germination on the abdominal cavity.
Pathological foci can vary in shape and size: from rounded formations of several millimeters to growths of several centimeters with shapeless outlines. They differ in dark cherry color and are separated from the surrounding tissues by whitish connective tissue scars.
The foci become more noticeable before menstruation due to its periodic maturation, depending on the cycle. Spreading to the peritoneum and other organs, sites of endometriosis sometimes grow deep in the tissue or are located superficially.
Causes of uterine endometriosis
In medicine, there is still no consensus on what causes the development of endometriosis. Most scientists adhere to the theory of retrograde menstruation. In accordance with it, in some women menstrual blood with particles of the endometrium enters the abdominal cavity and fallopian tubes - retrograde menstruation. There they attach to the tissues of other organs and particles of the uterine endometrium continue to function cyclically. What is this, in an accessible language, we have already said.
If a woman does not have a pregnancy, the endometrium during menstruation begins to be rejected from the uterus, while in other organs there is a microbleeding, which provokes the development of the inflammatory process.
Such factors as heredity, structural features of the fallopian tubes, and immunosuppression also increase the likelihood of developing the disease. The role of genetic predisposition to the development of the disease and its transmission by inheritance is very high.
Surgical interventions in the uterus also contribute to the development of this pathological process: cesarean section, artificial termination of pregnancy, cauterization of erosion, etc. Therefore, after surgical interventions of this type, medical supervision is necessary to identify abnormalities in the functioning of the reproductive system.
Other theories of the occurrence of endometriosis are not widespread. As the reasons for its development, they consider gene mutations, dysfunction of cellular enzymes and receptor reactions to hormones.
Symptomatology
The course of the disease can be varied, however, there are some reliable symptoms that indicate the development of endometriosis:
- Pelvic pain - occurs in 16-24% of cases. It has a clear localization or is characterized by diffusion throughout the pelvis, may intensify before menstruation.
- Dysmenorrhea - observed in 40-60% of patients. This symptom is maximally manifested in the first 3 days of menstruation.
- Painful intercourse.
- Pain when urinating or defecating.
- Menorrhagia - long-term and heavy menstruation. It is observed in about 2-16% of women.
- The occurrence of posthemorrhagic anemia.
- Infertility.
Can I get pregnant with uterine endometriosis?
In the presence of this pathology, we should not talk about absolute infertility, but a low probability of pregnancy. Endometriosis dramatically reduces the chances of successfully carrying a child and can provoke spontaneous miscarriages, so pregnancy management with such a disease should be carried out under the constant supervision of specialists. The probability of conception after treatment of the disease varies from 15 to 56% in the first 6-12 months.
Possible complications and consequences
Many women are concerned about the question: what is the danger of uterine endometriosis? Cicatricial changes and hemorrhages cause the formation of adhesions in the pelvic area and abdominal cavity. Another common complication of this disease is the formation of endometrioid ovarian cysts, which are filled with old menstrual blood. Both of these complications can cause women to develop infertility. Compression of the nerve trunks leads to various neurological disorders. Significant blood loss during menstruation causes the development of anemia, weakness, irritability and tearfulness. In some cases, malignant degeneration of pathological foci is observed. So the complications and consequences of endometriosis should always be remembered.
Diagnostics
In the process of diagnosing this pathology, other pathologies of the reproductive organs that occur with similar symptoms should be excluded. It is also necessary to collect an anamnesis and complaints, the most indicative of which are pain, information about past diseases, operations, the presence of gynecological pathologies in relatives.
Subsequent examination may include:
- gynecological examination (rectovaginal, vaginal, in the mirror) which is most informative before menstruation;
- hysterosalpingoscopy and colposcopy to clarify the location and form of the lesion, tissue biopsy;
- Ultrasound of the pelvis and abdomen;
- CT or MRI in order to clarify the nature of endometriosis, its relationship with other organs, etc.
- laparoscopy, which allows you to visually examine pathological foci, assess their number, activity, degree of maturity;
- hysterosalpingography and hysteroscopy, allowing to diagnose the disease with an accuracy of 83%;
- laboratory research of oncological markers CEA, CA-125 and CA 19-9, as well as the PO test, the presence of which in the blood with this disease is significant.
Whether uterine endometriosis is treated, we will find out below.
Treatment methods
When choosing a method of treating an ailment, doctors are guided by such indicators as the number of births and pregnancies, the age of the patient, the prevalence of the pathological process, its localization, the intensity of pain, the presence of concomitant diseases, the need for pregnancy.
The methods of therapy are divided into surgical (laparoscopy with removal of foci and preservation of the uterus or its complete removal and oophorectomy), medication and complex.
What drugs are prescribed for uterine endometriosis?
Drug treatment
Indications for conservative treatment are the asymptomatic course of endometriosis, young age, the presence of the need to restore or maintain reproductive functions, premenopause. The main in drug treatment is hormone therapy with such groups of drugs:
- Complex estrogen-progestogen drugs. These medicines contain small dosages of progestogens that suppress ovulation by lowering estrogen production. Such funds are shown at the initial stages of endometriosis, because they are not effective when the endometrioid process is neglected and if ovarian cysts are present.
- Gestagens (Norethisterone, Gestrinone, Progesterone, Dydrogesterone), which are indicated at any stage of the pathology, continuously - up to 8 months. Taking these drugs may be accompanied by hemorrhage in the middle of the cycle, a depressed state.
- Antigonadotropic drugs (Danazol, etc.) that inhibit the production of gonadotropins in the structure of the hypothalamus-pituitary gland. They are used in a continuous course for 6-8 months and are contraindicated in women with hyperandrogenism (an excess of androgen hormones).
- Agonists of releasing hormones of the gonadotropic type (Goserelin, Triptorelin, etc.). The advantage of drugs in this category is the possibility of using once a month and the absence of pronounced side effects. Such drugs inhibit ovulation and estrogen levels, which inhibits the progression of foci of endometriosis.
In addition to the above medications, immunostimulants are also used in the treatment of endometriosis, and for symptomatic therapy - analgesics, antispasmodics, anti-inflammatory drugs.
Alternative treatment
With endometriosis in folk medicine, the use of a variety of herbs is proposed. All medicinal plants used in the treatment of this disease are divided into two categories:
- Anti-inflammatory herbs for uterine endometriosis: chamomile, coltsfoot, calendula, St. John's wort, celandine. Decoctions and infusions of these herbs help fight the progression of the inflammatory process, have antiseptic properties.
- Specific: hemorrhage, uterine uterus, round-leaved wintergreen, red brush. Such plants fight directly against diseases of the female organs - the uterus and appendages.
Propolis is often used in the treatment, there are also recommendations for the use of leeches.
We found out why uterine endometriosis is dangerous.