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Endometriosis: Symptoms and Treatment

Content:

Endometriosis is a disease with an unexplained reliable cause of its development. This disease is being carefully studied, but many questions remain unanswered.



What is endometriosis?

Endometriosis is a condition characterized by the appearance of ectopic sites of the endometrial Tacna. This means that the tissue that is histologically and functionally similar to the endometrium (mucous membrane lining the uterus), falls into the tissues and organs for which its presence is not characteristic. Endometrioid tissue undergoes all changes that are characteristic of the menstrual cycle. Gradually, this tissue germinates surrounding tissue. Endometriosis occurs mainly in women of reproductive age.

Factors and causes of the disease:

  • Metaplasia (rebirth) of mesothelium cells into endometrioid cells
  • Implantation of endometrium cells that were torn off during menstruation or intrauterine manipulations. In this case, cells can enter the lymphatic route or through the bloodstream. Often, the endometrium is thrown into the abdominal cavity through the fallopian tubes

When conducting diagnostic laparoscopy in many women endometrioid heterotopies are detected, which disappear on their own without any treatment and do not manifest themselves in any way, they are a “random finding”. However, certain risk factors and a genetic predisposition to endometriosis contribute to infiltration and the formation of endometrial ovarian cysts.

Classification of Endometriosis

Endometriosis is classified as follows:

  • Genital form. This means that endometriosis affects the genitals: the uterus, ovaries, tubes, external genitals, the cervix, the vagina and the pelvic peritoneum.
  • Extragenital form. A form of endometriosis in which the remaining organs are affected: the intestines, lungs, scars after operations, organs of the urinary system
  • Mixed forms

There is another classification, by stages:

  1. only the mucous membrane is affected
  2. myometrium is affected to the middle
  3. endometrium affected to serous (outer) membrane
  4. endometriosis germinates the entire thickness of the uterus and the peritoneum covering it  



The main symptoms of endometriosis

  • . Dysmenorrhea (painful menstruation) . Dysmenorrhea is expressed in varying degrees. In the initial stage of dysmenorrhea is often almost not expressed. Over time, the pain becomes more pronounced. The prevalence of endometriosis does not correlate with the severity of pain. Often there is a pronounced pain syndrome in women with single heterotopias and minor pain in patients with common endometriosis. The pain appears before menstruation and increases during it. This phenomenon is associated with a menstrual-like reaction in endometrioid heterotopies.
    Read more about dysmenorrhea here: Dysmenorrhea: causes and treatment
  • . Dyspareunia (painful sexual contact) .
  • . Blood spotting before menstruation . This symptom is in 35% of women suffering from endometriosis. A few days before the expected menstruation.
  • . Infertility

On examination, foci of endometriosis can be found on the perineum and on the external genitals, as well as on the cervix and vagina. The uterus is painful at displacement, it can be rejected backwards and firmly fixed in this position. Endometrioid ovarian cysts can be detected.

Endometriosis can affect not only the genitals, but also the urinary system: the bladder, urethra, ureters, and kidneys. This can lead to serious consequences, such as hydronephrosis, kidney blockade and loss of its function.

Infertility is detected in 25-40% of women suffering from endometriosis.

Causes of endometriosis

Currently, there are many different theories of the development of endometriosis, but none of them have been fully proven. Only the most likely risk factors that may contribute to the occurrence of the disease have been identified. It:

  • Intrauterine manipulations
  • Abortions
  • Inflammatory diseases of the female genital organs
  • Operations
  • Cauterization of the cervix
  • Unfavorable ecology
  • Anemia
  • Metabolic disorders
  • Navy

Diagnosis of Endometriosis

First of all, these are the clinical manifestations and complaints of the patient. Significantly helps in the diagnosis of ultrasound. But the main method is laparoscopy, during which you can diagnose endometriosis with certainty. All foci look typical and are visualized as red, black or white foci. Red foci are similar to endometrium, and black and white foci are inactive. Classic for endometriosis are black-brown.

During laparoscopy, they conduct a sequential examination of the pelvic cavity, the surface of the ovaries, the pelvic peritoneum, the uterine ligaments, the appendix, the sigmoid colon, the fallopian tubes. To improve the quality of diagnosis, laparoscopy is supplemented with a biopsy.

Endometrial ovarian cysts are also called "chocolate", as their contents are dark brown in color. 90% of all endometriotic cysts are paraovarian cysts.

Endometriotic nodes - a manifestation of deep endometriosis. Nodes consist of fibrous tissue and smooth muscle cells, they are the basis of the node, not endometriotic tissue. Most often, such nodes affect the sacro-uterine ligaments, retrocervical fascia, rectal uterine septum and ovarian ligaments. All these structures form the ligamentous apparatus of the uterus and appendages, with which they are held in a physiological position in the pelvis. Necrosis and bleeding are almost not characteristic of the nodes; they do not undergo secretory changes in phase 2 of the cycle. From here, the endometrial process can spread to the side walls of the pelvis, ureters, and iliac vessels.

Endometriosis treatment

Treatment of endometriosis is long and not always successful. After drug therapy relapse occurs up to 50%, after surgical treatment in 20% of patients relapse occurs within 5 years. Drug therapy does not eliminate the foci of endometriosis and, unfortunately, the effect is temporary.

In this case, drug therapy does not increase the percentage of pregnancy in women who are interested in this. The main objectives of the treatment of endometriosis: reducing the intensity of symptoms, improving the quality of life, accurate diagnosis. The choice of treatment method depends on a number of factors. It takes into account whether a woman wants to preserve fertility, severity of symptoms, from what treatment preceded and what was the effect of it, from the location of foci of endometriosis.

Principles of drug therapy for endometriosis

A fairly high analgesic effect has general therapeutic measures - exercise, psychological support, relaxation, nonsteroidal anti-inflammatory drugs, and paracetamol.

The most common in the treatment of endometriosis has received the use of combined oral contraceptives, as they have less pronounced side effects. In this case, three-phase COCs are preferred.

Apply progestogens for the schemes, it helps to reduce the level of estradiol.

Danazol is a synthetic derivative of 17alpha-ethinyl estradiol, its effect is to suppress ovulation and menstruation (cessation of menstruation). This drug causes atrophy of the mucous membrane of the vagina and in the endometrium, decreases the intensity of pelvic pain, decreases dyspareunia and menstrual pain. Foci of ectopic endometrium are reduced, germination of heterotopic foci stops. By reducing blood loss, hemoglobin levels increase. Side effects of the drug: irregular uterine bleeding, a slight anabolic effect, acne , hirsutism (increased hair growth on the body), edema, weight gain, change in timbre of the voice, reduced mammary glands. In connection with the phenomena of androgenization, patients often refuse treatment with danazol, despite its high efficacy.

Gestrinone is a synthetic steroid hormone with high antiprogestin activity. It acts on the hypothalamic-pituitary system and suppresses the action of hormones of the central nervous system (gonadotropins). This drug has anti-estrogenic activity too. As a result, there is a sharp decrease in the production of LH and FSH in ovulation and there is no peak. As a consequence, the ovaries produce fewer hormones, which leads to atrophy of the endometrium and, accordingly, endometrioid heterotopies. The dosage is selected by the doctor. Despite the suppression of ovulation, some women may become pregnant, so reliable contraception is necessary for the period of treatment.

Another group of drugs used in the treatment of endometriosis is gonadoliberin agonists . The mechanism of their action is to suppress the production of pituitary luteinizing and follicle-stimulating hormones, which leads to a decrease in the production of estrogen by the ovaries. This leads to a state of pseudomenopause. These drugs can not be used for more than 6 months due to bone demineralization. Manifestations of hypoestrogenism can be significantly expressed, namely, all of the symptoms of menopause: dry vaginal mucosa, flushing, palpitations, and others. These drugs are quite expensive and apply them only as an alternative method, then, when there is no effect from all other methods of therapy. Gonadotropin agonists are produced in various forms: nasal spray, subcutaneous injections, intramuscular injections, depot forms. Menstruation resumes in 2-3 months after the end of the medication. To reduce the pronounced menopausal syndrome, hormone replacement therapy is acceptable. Gonadotropin agonists can be called salvation in endometriosis stages 2 and 3.

Mifepristone is a drug with anti-progesterone activity, when taken for 3 months it reduces pain, while a positive effect is observed at the end of the first month. The mechanism of action of mifepristone is that it prevents menstrual-like bleeding in endometriotic foci.

Surgical treatment of endometriosis is to remove heterotopias with maximum organ preservation. This is especially important for women who plan to continue pregnancy and childbirth. Relapse after such treatment occurs in no more than 20% of cases within 5 years. Surgical treatment is very effective against persistent pelvic pain syndrome. Endometrial ovarian cysts are removed along with their capsule.

As is well known, severe endometriosis can cause infertility. Surgical treatment in this case can play a big role. During the operation, dissection of adhesions, removal of cysts, restoration of anatomical structures and their relationship with each other is carried out. But not always only the surgical method leads to the restoration of fertility. In some cases, you will need modern technology reproduction.

Consequences of endometriosis

Endometriosis can be asymptomatic and not affect the quality of life of a woman. On the other hand, endometriosis not diagnosed in time and the lack of adequate treatment can lead to complications. The most likely complications are:

  • Adhesions in the pelvis
  • Fertility disorders
  • Anemia due to heavy bleeding
  • Endometrial cysts
  • Malignancy

Is there prevention of endometriosis?

Since the reliable causes of endometriosis are unknown, there is no effective prevention. However, you can influence the development and outcome of the disease, if you follow a number of recommendations:

  • Regularly visit a gynecologist as a preventive examination
  • Timely treatment of identified diseases
  • Regulation of body weight and its maintenance within normal limits
  • Sexual rest on “critical” days
  • Taking COCs as a contraceptive
  • Lack of abortion

Endometriosis and pregnancy

Endometriosis violates the fertility of a woman, but this does not mean that pregnancy is impossible or contraindicated. On the contrary, many experts recommend pregnancy, as it has a beneficial effect on the course of the disease. The fact is that during pregnancy a state of prolonged anovulation occurs, menstruation is absent, and the body is under the influence of progesterone for 9 months. All these conditions contribute to the regression of heterotopias.

However, endometriosis itself is a risk factor in pregnancy, as it can cause a threat of miscarriage. Therefore, it is recommended to conduct pregravid training for women suffering from endometriosis, and during pregnancy to carry out prevention of miscarriage and placental insufficiency. To do this, it is recommended to visit a gynecologist before pregnancy, and register as early as possible. Endometriosis has no direct effect on the child, so there is no need to fear for the health of the baby. However, the indirect effect can be manifested in the development of placental insufficiency, when the child does not receive enough nutrients and oxygen due to disruption of the placenta.

Endometriosis and uterine myoma

Often there is a combination of endometriosis with uterine myoma. Diagnostics today has become more accurate, so this condition has become more frequently detected. The combination of uterine fibroids with adenomyosis causes more pronounced clinical manifestations, since one pathology aggravates the other. Treatment causes difficulties and often the only method is surgical treatment. Such an approach to the problem deprives young women of the opportunity to become pregnant and successfully endure the pregnancy. It leads to early menopause and pronounced menopausal syndrome (if you have to remove the ovaries). Nowadays, minimally invasive treatment methods are available and are being improved, which have the goal not only to preserve the organ, but also to preserve its full functioning.
In some cases, hormone therapy with progesterone and gonadotropic hormone agonists is used. They lead to pseudomenopause and make it possible to reduce myoma and heterotopies by half or more. This advantage is used in the preparation of women for surgical treatment with large fibroids in order to reduce its volume, which, in turn, will facilitate the technical side of surgical treatment. This method is not used in young women of childbearing age, especially those planning pregnancy.
Herbal medicines and traditional medicine methods are not sufficiently effective. They are not able to eliminate myoma or endometriotic foci. With the purpose of prevention and in combination with other methods of treatment they can be used, but as a separate method of treatment will not bring effect, but on the contrary, can delay precious time. The best treatment option for adenomyosis combined with uterine myoma of any location with a node diameter of more than 1 cm in women of child-bearing age is a surgical treatment. Moreover, it is an absolute indication for the operation.

Cervical Endometriosis

With the defeat of endometriosis of the cervix, endometrioid heterotopies are located on the cervix and visualized by a doctor when viewed on a gynecological chair. They look like small red color formations. Since heterotopies are subject to cyclic changes in the menstrual cycle, they undergo the same changes in different phases as the endometrium. During menstruation, endometriotic lesions are bleeding formations. Endometriosis can also be localized in the cervical canal. In this case, infertility may develop over time due to the formation of adhesions in the cervical canal.

On the cervix, endometriosis often occurs after manipulations performed on it and in the uterus - cauterization, curettage, abortion. Treatment of endometrioid heterotopias involves the destruction of foci using liquid nitrogen, radio wave therapy or a laser.

Retrocervical endometriosis

Approximately 6-7% of all localizations of endometriosis are retrocervical endometriosis. The process is located in the posterior surface of the cervix at the level of the sacro-uterine ligaments. Heterotopies can grow into the depths, down to the rectum and Douglas space. This form of endometriosis can bring a woman to complete disability. Manifested in the form of pain in the lower abdomen and in the lumbar region with irradiation to the rectum during menstruation, the pain increases. During sexual intercourse, there may be bleeding (if endometriotic foci are localized in the vaginal vaults). If endometriosis affects the rectum, then another symptom during menstruation joins - blood discharge from the rectum during bowel movements.

Ovarian Endometriosis

Ovarian endometriosis may not manifest for a long time and is asymptomatic. Over time, the peritoneum is involved in the process, the lesions spread, and the adhesive process is formed. As with other forms of endometriosis, there are characteristic abdominal pains, aggravated during menstruation. Pain in the rectum, groin. Menstruation is always painful, dyspareunia is also present (painful intercourse).

Small cysts gradually increase, can even merge with each other, forming endometriomas, which are well palpated during a bimanual examination, can be clearly seen on ultrasound. Cysts contain a dark brown substance, thanks to the scab, they are called "chocolate" cysts. Treatment is carried out mainly laparoscopically, the volume of the operation depends on the reproductive plans of the woman and the degree of distribution.


    | January 22, 2014 | | 5,374 | Uncategorized
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    • | Irina | November 22, 2015

      I have endometriosis, Janine was prescribed, only in weight gain is strong. Which drug is better?

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