Endometriosis of the uterus: symptoms and treatment

Endometriosis treatment Endometriosis is the appearance of cells of the inner layer of the uterus (endometrium) in atypical sites: on the peritoneum, in the ovaries, uterine tubes, wall and cervix, in the bladder, rectum and other organs and tissues.

This is one of the most mysterious female diseases. Despite the fact that this diagnosis is exhibited quite often, the question - what kind of illness is this, why and how to treat it, often remains unanswered. And what if a woman with endometriosis is planning a pregnancy - do I have to do something in this case?

Statistics show that up to 30% of women of reproductive age are affected in one form or another by endometriosis.

What is this?

Why does endometriosis occur, and what is it? Causes of the disease are not established and remain the subject of controversy. Numerous hypotheses of endometriosis have been proposed, but none of them has been finally proven and generally accepted.

One of the theories points to the process of retrograde menstruation, when a part of the menstrual tissue penetrates into the abdominal cavity, grows into it and increases.

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Genetic theory raises the view that the genes of some families contain the rudiments of endometriosis and, thus, the members of these families are predisposed to the disease with endometriosis.
There is also a theory explaining the emergence of endometriosis in that tissue affected by endometriosis, extends to other parts of the body through the lymphatic system.
Others believe that the remains of tissue from the phase when the woman was in its infancy may later develop into endometriosis, or that part of this tissue, under certain conditions, does not lose its ability to reproduce.

The likelihood of the disease increases with:

frequent inflammation of the genitals;
tumors (myoma of the uterus);
heavy childbirth;
operations on the uterus;
abortion;
anemia;
drinking alcohol;
smoking;
excessive "love" for products containing caffeine;
disorders in the work of the organs of the endocrine system (thyroid, adrenal, hypothalamus,
pituitary gland, female gonads);
lowered immunity.

Despite these studies, the actual incidence of endometriosis is unknown, due to the fact that in most cases the disease is asymptomatic and is very difficult to diagnose.

Therefore, regularly undergo a preventive examination with a gynecologist. This is especially important for those who have had any operations on the uterus (abortions, caesarean section, cauterization of cervical erosion, etc.). Timely diagnosis is the key to successful treatment without consequences.

Can I get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of becoming pregnant, but can not harm the development of the fetus. If a woman with endometriosis still conceived a child, there is every reason to believe that the symptoms of the disease will become much weaker during the entire period of pregnancy.

If you are sick with endometriosis, before you start trying to conceive a child, be sure to discuss with a gynecologist the possibility and risks of pregnancy in your particular case.

Symptoms of endometriosis

The symptomatology of this disease is so diverse that it is sometimes capable of misleading even experienced specialists. Endometriosis of the uterus can be accompanied by both pronounced symptoms, and at all by their absence.

However, certain symptoms must necessarily alert the woman:

Pain, varying intensity, up to acute. They can be located in the lower abdomen, give into the groin area, anus, leg. The pain either occurs in the first days of menstruation, and disappears with its end, or does not leave the woman throughout the cycle, but after the end of menstruation, they become weaker.
Spotting dark spotting from the genital tract 2-5 days before and after menstruation, especially if these very menstruation are quite abundant and prolonged;
Uterine bleeding in the intermenstrual period (metrorrhagia);
Spotting can also occur during sexual intercourse.

Menstruation with endometriosis becomes abundant, with clots, which leads to the development of chronic posthemorrhagic anemia:

brittle nails,
dyspnea,
weakness, drowsiness
dizziness,
pallor of the skin and mucous membranes,
low blood pressure,
frequent ARVI and others.

Unfortunately, in some cases, the symptoms of endometriosis are very weak or nonexistent. For this reason, visit the office of a gynecologist every six months. Only timely diagnostics can save from the development of undesirable consequences of endometriosis.

Endometriosis 1, 2 and 3 degrees

In the uterine wall, the foci of endometriosis appear at different depths, and therefore the endometriosis of the uterus body can have four degrees of spread:

1 degree. There are one or more small foci of endometriosis.
2 degree. There are several small foci of endometriosis, which penetrate into the thickness of the organs affected by them.
3 degree. There are many surface foci and several deep foci of endometriosis or several cysts on the ovaries ("chocolate" cysts - the name is due to the characteristic dark brown color of cysts attached to cysts by decaying blood).
4 degree. Diagnosed multiple and deep foci of endometriosis, multiple, large cysts on the ovaries, adhesions between the organs of the small pelvis.

Between the extent of the spread of endometriosis and the strength of the symptoms of the disease there is no linear dependence. Often, widespread endometriosis is less painful than mild, in which there are only a couple of small foci.

Diagnostics

In the effective treatment of endometriosis, the most important thing is timely and correct diagnosis. Determine the presence of endometriosis foci can be done with:

radiopaque methods (hysterosalpingography)
endoscopic studies (eg, hysteroscopy),
Ultrasound.

However, of great importance are the complaints and clinical symptoms listed above. Sometimes it is diagnosed endometriosis and in pregnancy - as a result, the treatment of such patients is ineffective due to difficulties in selecting a drug that minimally affects the fetus.

Prevention

The main measures aimed at the prevention of endometriosis are:

specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) with the aim of excluding 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;
reception of oral hormonal contraceptives.

Complications

Endometriosis of the uterus can be low-symptom, and not affect the quality of life of a woman. On the other hand, in time unconfirmed endometriosis and the lack of adequate treatment can lead to complications.

The most likely consequences are:

adhesive process in the small pelvis;
impaired fertility;
anemia due to heavy bleeding;
endometrioid cysts;
malignancy.

How to treat endometriosis

Methods for the treatment of endometriosis have been improving for many years and are currently divided into:

surgical;
medicamentous;
combined.

Medicinal methods of therapy include the use of different groups of drugs:

combined estrogen-progestogen preparations;
gestagens, antigonadotropic drugs;
agonists of gonadotropin releasing hormones.

The earlier a woman is diagnosed, the more likely to use only medications.

Conservative therapy

Conservative treatment is indicated in asymptomatic uterine endometriosis, at a young age, in the permenopausal period, with adenomyosis, endometriosis and infertility, when it is necessary to restore the childbearing function.

The drug treatment pathway includes a rather traditional therapy:

hormonal;
anti-inflammatory;
desensitizing;
symptomatic.

The main drugs with proven effect for the treatment of confirmed endometriosis are:

preparations of progesterone;
danazol;
gestrinone (Nemestran);
gonadotropin-releasing hormone agonists (GnRH);
monophasic combined oral contraceptives.

The length of the course of hormone therapy and the intervals between them is determined by the results of treatment and general state of the patient taking into account the tolerability of drugs and indicators of tests of functional diagnostics.

Other groups of drugs, "assistants" in the fight against painful symptoms of the disease:

NSAIDs (anti-inflammatory therapy);
antispasmodics and anlgetics (analgesic effect);
sedatives (elimination of neurological manifestations);
vitamins A and C (correction of the deficiency of the antioxidant system);
iron preparations (elimination of consequences of chronic blood loss);
physiotherapy.

Currently, studies are underway in the world of the use of immunomodulators for the treatment of endometriosis, especially for the treatment of related infertility.

Surgical treatment of endometriosis

Surgical intervention is indicated in the absence of the effect of conservative therapy for 6-9 months, with endometrioid cysts of the ovaries, with endometriosis of postoperative scars and navel, with continued stenosis of the lumen of the intestine or ureters, with intolerance to hormonal drugs or the presence of contraindications to their use.

Surgical methods of treatment of endometriosis consist in the removal of endometrioid formations (most often - cysts) from ovaries or other lesions. Modern surgery prefers sparing operations - laparoscopy.

After removal of the foci of the disease, physiotherapeutic and medicamental treatment is shown to consolidate the result and restore the cycle. Severe forms of endometriosis are treated by removing the uterus.

The results of treatment depend on the volume of surgical intervention, on the usefulness of hormone therapy. The rehabilitation period in most cases passes favorably: the reproductive function is restored, pain during menstruation is significantly reduced. After treatment, a dynamic observation is recommended at the gynecologist: gynecological examination, ultrasound control (once in 3 months), control of the CA-125 marker in the blood.

Prognosis for endometriosis

This disease often recurs. For example, the frequency of recurrence of endometriosis after operations for removal of foci in the first year is 20%, that is 1 out of 5 operated women during the first year after the operation will again face the same problems as before the operation.

Hormonal correction has a good effect, but the problem with this method of treatment is a violation of the process natural maturation of the endometrium of the uterus, and hence in the impossibility of a natural conception of the child. At the onset of pregnancy, as a rule, for the entire period of pregnancy the symptoms of endometriosis disappear. At the onset of menopause, endometriosis also disappears.