Endometriosis is a disease in which pathological proliferation of endometrial tissue occurs. These cells can grow in the uterus, on the ovaries, and even outside the reproductive system.
There are two main forms of the disease:
In internal lesions, an increase in the endometrial layer occurs only in the uterus. If a diagnosis of vaginal endometriosis is made, the pathology can be classified as an external disease. The problem is determined by the doctor after a gynecological examination.
External endometriosis is a form of the disease in which pathological foci are formed not only on the uterus. Both genitals and other body systems can be involved in the process.
When the lesion is internal, it occurs only in the uterus. The endometrial layer grows and thickens. Often, women do not have clear symptoms of the disease.
In advanced cases there may be uterine bleeding, heavy and painful periods. Sometimes spotting appears between menstruations, it should alert the woman.
External endometriosis of the vagina may be accompanied by the growth of endometrial tissue not only in the genitals, but also in the internal organs. Examination can reveal foci of the disease in the abdominal cavity, kidney, bladder, liver, and even in the lungs.
Pathological proliferation of the external type of the endometrium is rarely localized on the internal organs. The lesion of the labia, genitals, fallopian tubes and ovarian endometriosis is diagnosed first. There are cases when the cells of the uterine mucosa were found inside the scar tissue after undergoing surgical interventions.
Causes of external genital endometriosis
Factors that can trigger the development of external endometriosis, a lot. The risk of pathology is influenced by a woman’s lifestyle, age, and health. Transmitted infections of the genital tract can also weaken the natural defenses.
The reasons for the development of outdoor pathology are:
- hormonal disbalance,
- genetic predisposition
- living in adverse conditions
- previous surgery on the uterus.
Sometimes postpartum endometriosis appears as a result of uterine injuries. Any strong impact on the woman’s body, including a nervous breakdown, can contribute to the development of pathology.
Symptoms of external endometriosis
Common manifestations of external endometriosis are similar to internal ones. The differences are related to another place of localization of the process. The location of lesions on the genitals of a woman causes additional discomfort and pain in endometriosis. During sexual intercourse, unpleasant sensations can significantly increase if the abnormal tissues grow in the cervix or vagina.
The main symptoms are pain and bleeding. Due to the fact that during menstruation, all tissues that depend on hormonal levels begin to be rejected, the vessels rupture not only in the uterus, but also in any other parts of the body where a layer of endometrial cells has formed.
External-genital endometriosis is characterized by the following symptoms:
- severe menstrual pain, localized in the lower back,
- heavy discharge with a dark brown tint,
- signs of anemia due to high blood loss.
If the growth of the endometrium in the external type was formed outside the reproductive system, for example, in the lungs or digestive tract, nausea, vomiting, diarrhea with blood, and hemoptysis may occur. With the defeat of the lacrimal glands, blood appears in the tears, and if the kidneys or the bladder are involved in the process, it is also noticeable in the urine.
If endometrioid ovarian cysts have formed, the symptoms only occur after their contents enter the abdominal cavity. There is an inflammatory process of the pelvic peritoneum or adjacent organs.
Stage of the disease
The woman’s well-being and the severity of the symptoms depend on the localization of the lesions, their size and quantity. There are 4 degrees of development of external endometriosis.
- In the presence of pathology in the 1st stage, one or more lesions are formed. They differ in small size and often do not bother.
- At the 2nd degree, the lesions are still small. May increase their number. Tissues germinate into the affected organs.
- The 3rd degree of the external form of pathology is characterized by the formation of endometrial cysts. Lesions become multiple.
- At the 4th stage there are many foci, most of them are germinated deep into the damaged tissues. Between the internal organs begin adhesions. During examination, the doctor can detect the formation of large cysts.
In any form of adenomyosis, the nature of menstruation changes. Reguls become more abundant.. If a woman notices this symptom and turns to a doctor in time, it is possible to use sparing methods.
Complications of genital endometriosis
In the case of external endometriosis, possible complications appear more often with delayed treatment. The organs that are involved in the process, there is a violation of the function. Recovery is not always possible.
The external form of the disease can lead to the following adverse effects:
- adhesions and infertility in women
- the formation of large cysts, the rupture of which leads to peritonitis and acute abdominal syndrome,
- increase the likelihood of developing paraproctitis,
- inflammation of the abdominal organs,
- prolapse or prolapse of the uterus.
In particularly advanced cases, when the growths are significant, the cells may acquire the ability for malignant degeneration. Consequently, external endometriosis leads to an increased risk of developing cervical cancer.
Pregnancy with external endometriosis is possible, but not always. Adhesions interfere with the passage of the egg through the fallopian tubes. The risk of ectopic pregnancy remains. In the presence of the disease, labor may be complicated.
Methods for diagnosing a disease depend on the stage of the pathology. It is almost impossible to notice the disease at the initial stage during ultrasound examination. To detect foci of endometriosis, colposcopy is performed on the inner surfaces of the genitals.
An ultrasound study can help in examining other organs that may have developed pathological foci of endometriosis. Identify which systems are affected, it is not easy, especially if the disease occurs long enough.
To confirm the diagnosis, histological examination is performed. If endometrial tissue is detected, there is no doubt about the presence of pathology.
The goal of the doctor is to determine the most likely cause of the disease. In the vast majority of women, the pathological proliferation of endometrial tissues is triggered by an incorrect level of hormones. To correct this condition, hormone therapy is prescribed.
If a woman is worried by severe pain due to external endometriosis, analgesic and anesthetic drugs can be recommended.. Paracetamol and Analgin are most commonly prescribed.
Although it is possible to reduce the severity of the disease with the help of medications, surgery is the most effective method of dealing with external endometriosis.
The technique of intervention depends on the location of the outbreaks of abnormal tissue. The most common removal of the formed nodes of the disease. In the most severe cases, the uterus and appendages are removed completely.
Acceptance of hormonal drugs and surgical intervention are simultaneously required for the rapid development of the disease. Emergency surgery, supplemented by drug therapy, is necessary for ectopic pregnancy, endometrial cyst rupture.
Excision of adjacent tissues and organs may be necessary if external endometriosis has affected the intestines, bladder or kidneys. In this case, endometrial foci are removed everywhere.
Forecast and consequences
A progressive disease can lead to serious consequences for a woman. Timely treatment (even surgery on the affected organs) allows you to fully preserve reproductive functions.
High-quality therapy helps to get rid of endometriosis. If no surgical intervention has been performed, there is always a risk of recurrence of the pathology in the background of changes in hormonal levels. Therefore, it is important for women to be constantly examined. The most unpleasant consequence of the disease is the disappearance of the childbearing function.
Gynecological pathologies may be asymptomatic. If a woman notices changes in her state of health and seeks medical help, she can maintain her health and the ability to have children.
Causes of development
There are several factors that can cause the development of endometriosis. However, it is quite difficult to establish the true cause of the appearance of pathology in a woman.
What can provoke the migration of endometrial cells to unusual places:
- Retrograde nature of menstruation. In this case, part of the discharge during menstruation does not come out through the vagina, but rises up into the abdominal cavity through the fallopian tubes.
- Gynecological interventions - surgery, curettage.
- Hereditary factor.
- Casting of endometrial tissue cells from the uterus by moving through the lymphatic and blood vessels.
- Hormonal imbalance in the body.
But why endometrial cells take root in an uncharacteristic place for them? The following reasons contribute to this:
- Decrease in the immune forces of the body.
- Not enough progesterone.
- Diseases of the endocrine system.
- Sedentary lifestyle.
- Alcohol use, smoking.
In case of late detection of the disease and the absence of adequate therapy, the following complications are possible:
In case of late detection of the disease and the absence of adequate therapy, the following complications are possible:
- The development of anemia.
- Damage to endometrial cells of a larger area of tissues and organs located nearby.
- The impossibility of conception.
- Acquisition of endometrial cells of a malignant nature.
The most effective method in the treatment of genital endometriosis is the removal of all pathological foci by surgery. However, the disease is more common in women of reproductive age who are planning a future pregnancy. Therefore, when choosing a treatment method, it is important to preserve reproductive function.
Therefore, whenever possible, treatment should be carried out with the help of medical preparations, which should reduce pain, as well as suppress the growth of pathological foci of the endometrium.
General information about the disease and its types
Endometriosis is a pathological proliferation of the mucous membrane of the uterus, which can be observed in the organs of the reproductive system or outside (the intestines, bladder, kidneys, pelvic organs, abdominal wall, lungs, and so on).
Depending on the location, the disease is divided into two main types:
- Genital endometriosis. In this case, heterotopies are found on genital tissues.
- Extragenital endometriosis. Endometrial tissues grow outside the reproductive system.
At the advanced stage of the disease, mixed localization of heterotopy foci is observed.
In turn, genital endometriosis is divided into:
- extraperitoneal - localized in the lower part of the reproductive system (vagina, rectovaginal septum, external genitalia, etc.),
- peritoneal - affects the pelvic peritoneum, ovaries, fallopian tubes,
- internal genital endometriosis (adenomyosis) - is observed in the muscle layer of the uterus. At the same time, the body becomes spherical and increases in size (approximately as at the 6th week of pregnancy).
Endometriosis in most cases occurs in women of childbearing age (from 25 to 40 years). Much less often it occurs in adolescents in the period of the formation of menstrual function (10%) and during menopause (2-5%).
Often the disease is asymptomatic, so it is possible that it occurs much more often.
Depending on the degree of damage to the muscle layer, there are four stages of endometriosis:
- I degree - initial germination.
- Grade II - foci of endometriosis reach half the depth of the muscle layer of the uterus.
- Grade III - germination extends to the serous membrane of the uterus.
- Stage IV - endometriosis lesions extend beyond the uterus and extend to the abdominal cavity.
In each case, the size and shape of the lesions may vary: from very small round formations to shapeless growths with a diameter of several centimeters. Moreover, they are characterized by cyclical ripening. The easiest way to notice the foci of endometriosis on the eve of menstruation.
Stages of development of the disease
Depending on the number of foci of endometriosis and the severity of other symptoms, there are 4 stages of the disease:
- Stage I - the beginning of the development of the disease, in which only single superficial foci of endometriosis can be noticed.
- Stage II - the number of foci of the disease begins to increase, they quickly germinate into other tissues and reach the internal organs.
- Stage III - the number of inflamed lesions continues to grow. They begin to merge among themselves and grow into the tissues of other genital organs. The appearance of adhesions on the peritoneum and endometrial cysts on one or both ovaries is noted.
- Stage IV - endometrioid cysts on the ovaries increase, adhesions become denser, the endometrium grows into the walls of the bladder, rectum and vagina.
With timely treatment for help from a specialist (in the first and second stages of endometriosis), a positive prognosis of treatment is possible. The only thing that is required from the patient is to listen to all the recommendations of the doctor and not interrupt the prescribed course of therapy.
With endometriosis of the third and fourth stage, the chances of a woman to become pregnant and successfully endure the child, unfortunately, tend to zero. I am glad only that at this stage the treatment, although it will be quite difficult, will still help to cope with the problem.
Signs of disease
In some cases, the woman does not pay any attention to the symptoms of genital endometriosis. That's because they have a dim severity and almost no discomfort. In this case, it will be possible to detect the presence of the disease only during the next visit to the gynecologist. That is why it is not necessary to refuse preventive examinations at least once every six months!
But some signs, after the appearance of which it is necessary to appear to a specialist, still exist. The symptoms of external and external genital endometriosis in women include:
- Pain in the pelvic region. In most cases, they are localized in the lower abdomen and lower back, occurring several days before, during or immediately after menstruation. Sometimes the pain is very pronounced, does not disappear after the use of analgesics. Every day the situation worsens even more, since in the inflamed hearth there is a strong tension of the capsules.
- Soreness or discomfort during intercourse.
- Inflammatory processes in the genital area. Not observed in all cases of endometriosis.
- Irregular menstruation.
- Unusually abundant menstrual flow.
- The appearance of spotting between periods.
- Emotional disturbances. These include insomnia, headaches, decreased performance, and a depressed state that can lead to depression.
Treatment of genital endometriosis is primarily aimed at correcting hormonal levels, reducing the rate of spread of lesions, and eliminating the symptoms associated with the disease. In addition, there is a need to use special preparations that will preserve the fertility function of a woman.
As a rule, at first, women are prescribed the use of contraceptive drugs that contain estrogen and progesterone. It will be necessary to accept them according to the scheme developed individually. The most difficult thing at this stage is to find the right drug. Evaluation of the effectiveness of the tool is carried out one month after the start of its use. In the absence of positive dynamics, deterioration or the appearance of side effects, the selected drug is replaced by another.
Drug therapy does not end with the use of contraceptives. In case of genital endometriosis of moderate severity, for example, they may additionally prescribe the use of potent painkillers. Do not abuse them, as these tools are addictive!
If indicated, the treatment of endometriosis of the uterus can also be used:
- anti-inflammatory drugs
- antibacterial agents
- vitamin complexes.
If drug therapy has not brought any results, it will be necessary to get rid of the problem surgically.Immediately it should be noted that this type of treatment can be quite long (with the running form), traumatic and requires highly qualified specialists.
As a rule, lesions are removed by laparoscopic method. This type of intervention is characterized by the absence of serious complications and the rapid course of the rehabilitation period.
In difficult cases, it may be necessary to radical surgery, which involves the removal of the uterus.
There are other modern techniques, such as:
- laser vaporization.
They are very effective, but have an important disadvantage - a fairly high cost. Not every patient can afford one of the above methods of treatment.
At the end of surgical treatment, patients are usually recommended to undergo physiotherapy courses. These include:
Traditional methods of treatment
Folk remedies can only be used as an adjuvant therapy. Infusions and decoctions of various medicinal plants can be designed for both external and internal use.
It is important to remember! Not all medicinal plants are safe for health! Before you begin to use them, you should consult with your doctor.
Consequences of the disease
In addition to the fact that genital endometriosis of grade 2 or more gives the patient a lot of inconvenience, it can cause serious complications and affect women's health. What is so dangerous disease?
First of all - it is:
- an increase in the risk of miscarriage during pregnancy,
- hormonal changes,
- violation of the cycle, changing the nature of menstrual flow, the possible development of anemia as a result of large blood loss,
- appearance of bleeding between menstruation,
- the occurrence of a malignant tumor as a result of proliferation of endometrial cells.
As you can see, the disease seems completely harmless only at first glance. But in practice, it can lead to very serious consequences. Therefore, the sooner it turns out to identify genital endometriosis, the greater the likelihood of its successful treatment. It will also increase the chances of preserving the childbearing function and avoiding other dangerous consequences that we mentioned above.
Unfortunately, there is no certain way that will help to completely protect a woman from the disease. But the observance of some preventive measures will significantly reduce the risk of endometriosis, or contribute to its timely diagnosis:
- Observation of patients who recently underwent surgery in the uterus (curettage, abortion, cesarean section, various surgeries, and so on).
- Conducting a specific type of examination of girls and women who complain of very painful periods (if there is a suspicion of endometriosis).
- Timely treatment of acute and chronic diseases of the reproductive organs.
- Acceptance of the correct hormonal contraceptives.
- Refusal from bad habits, maintaining a healthy lifestyle (proper nutrition, physical activity).
- Providing psychological comfort (lack of nervous overvoltages, stress, and so on).
1. Vaginal endometriosis
The presence of foci of endometriotic disease in any part of the vaginal wall, in the vulva at the level of the small and large labia, is referred to as vaginal endometriosis. Endometrial particles in the vaginal wall may occur against the background of various injuries:
- in childbirth at breaks in the wall of the vaginal tube,
- with mechanical trauma (fracture of the pelvis, any injury to the perineum),
- in case of accidental microtraumas during diagnostic interventions,
- with microtrauma associated with sexual intercourse.
If certain conditions are present (reduced immune protection, hormonal disorders), endometriotic tissue takes root in an atypical place and causes unpleasant symptoms that regularly occur.
Symptoms of vaginal endometriosis
Quite often, with this localization, there are no clinical symptoms. Often, random detection of foci of endometriosis in the vagina occurs during a routine examination by a gynecologist. However, extremely unpleasant versions of the disease are possible.
Most often, the pain associated with the menstrual cycle: every month, a few days before the arrival of critical days, a woman has discomfort and periodic pain in the vagina. The severity of pain depends on the number and size of endometriotic foci. Possible options:
- pulling feeling
- burning pain,
- bursting and pressing feeling
- irradiation of pain deep into the pelvis towards the adjacent organs.
Treatment of vaginal endometriosis
If there are no symptoms, then endometriosis of the vagina is not treated. In this case, it is quite enough to observe regularly. However, in the presence of symptoms that violate the ordinary life of a woman, apply:
- conservative therapy, if the lesions are small and located deep in the vagina,
- surgical treatment is practiced in the formation of large-sized foci of endometriosis with severe symptoms (removal with a scalpel with localization on the vulva, laser therapy).
2. Endometriosis of the cervix
With the defeat of the outer part of the cervix endometriosis, reddish or bluish "eyes" and brushes appear, which can increase in size before menstruation and almost completely disappear after the end of critical days. The main causes of this problem may be:
- cervical tears in labor
- conducting repeated, unreasonable cryodestruction of erosion,
- cervical trauma during any diagnostic interventions or when an intrauterine contraceptive device is introduced into the uterus.
Before the arrival of menstruation, dark bloody discharge from the vagina first appears, which can last for several days. Immediately after the end of critical days, blood loss may continue for some time. Frequent symptom of the disease can be contact blood discharge, when after sexual intercourse or gynecological examination, regardless of the closeness of menstruation, hemorrhage continues for several days.
Treatment of endometriosis of the cervix
The optimal method of treatment of endometriosis of the cervix uteri is the removal of foci using surgical methods. The best option is laser therapy, in which the risk of spreading endometrioid heterotopies to neighboring organs and tissues is minimal. Conservative treatment methods are ineffective and practically not used.
3. Endometriosis fallopian tubes
Fallopian tubes are affected by endometriosis most often in the interstitial regions. This is the part that leaves the uterus. And this is one of the most difficult to diagnose places in the reproductive system of women. In addition, endometriosis of the fallopian tubes in most cases combined with adenomyosis. The main causes of this problem are:
- utero-tubal reflux, due to which endometrial particles fall into the tubes during menstruation,
- trauma to the mouth of the pipe during diagnostic interventions,
- trauma of uterine-uterine corners with an intrauterine contraceptive.
1. Pain syndrome
All the symptoms in terms of pain associated with the menstrual cycle, similar to the manifestations of adenomyosis. As a rule, before critical days, the pain increases, reaching a maximum on the day of the beginning of menstruation. And then gradually the pain subsides. In some cases, the pain syndrome is not very pronounced, but sometimes it is even worse - the pulling and aching sensations exhaust the woman morally and physically.
Treatment of endometriosis of the fallopian tubes
The optimal treatment method is conservative treatment according to the pattern typical for adenomyosis. Most often, this technique is used for young women who want to preserve the uterus for future childbirth.
Surgical method - removal of the fallopian tubes. This treatment option is used in the extirpation of the uterus about the expressed forms of adenomyosis. In some cases, tubectomy in ectopic pregnancy becomes a method of surgical treatment of endometriosis of the fallopian tube.
When examining uterine forms of infertility during hysteroscopy, the doctor can see the foci of endometriosis in the corners of the uterus - at the mouth of the fallopian tubes. Laser coagulation of endometriosis using hysteroresectoscopy is a good method of therapy in this case.
4. Ovarian endometriosis
The frequency of endometriotic damage to the ovarian tissue occurs in 10-15% of all tumor-like formations in the appendages. All variants of the disease are divided into 4 stages:
- at stage 1, small endometrial foci are scattered on the surface of the ovaries without the formation of cystic cavities,
- at stage 2 - there is a small cyst (up to 6 cm in diameter) on the one hand,
- at stage 3 - cysts on the ovaries arise from two sides, but one of the cystic tumors does not exceed 6 cm in diameter,
- at stage 4 there are large cysts (more than 6 cm) on both ovaries.
Of great importance is the presence of small endometrioid lesions on adjacent organs (bladder, uterus, intestines, peritoneum) and adhesions.
Typical symptoms of ovarian endometriosis
Any large cyst in the appendages will necessarily give pain. On the background of endometriosis, the cystic cavity increases before menstruation, so the pain will increase before menstruation and decrease after. However, quite often the pain does not pass completely, continuing to disturb the woman until the next menstruation. Acute pain can be when torsion of the cyst legs or rupture of the cystic cavity, which will require emergency surgery.
Violations of ovulation due to anatomical and functional changes in the ovaries become the main cause of infertility.
For diagnosis, the doctor will use the following methods:
- Ultrasound of the pelvic organs with an assessment of the size of the tumor and the severity of blood flow in the appendages,
- computed tomography
- MRI diagnostics, which allows to accurately record the relationship of the endometrioid tumor with neighboring organs,
- definition of a tumor marker in blood (CA-125).
Ovarian endometriosis treatment
As with any cystic tumors in the appendages, in case of ovarian endometriosis, the doctor, choosing a method of treatment, relies on the basic rule: any cysts in the ovaries must be removed surgically. For formations that are small in size, laparoscopy is optimally performed. For large cysts, the doctor may use 2 options:
- remove the cyst through a normal incision in the lower abdomen (laparotomy),
- reduce the size of the tumor, using conservative methods of treatment, then to perform endoscopic surgery.
A radical and effective method of treating genital endometriosis is considered to be the surgical removal of all detected lesions, both outside and inside. If for any reason the operation cannot be performed, conservative therapies are applied. This is especially true for young women who in the near future want to get pregnant and have a baby.
A frequent treatment option is the use of combination therapy, when at the first stage the doctor uses hormonal drugs to reduce the activity of endometriosis or reduce the size of a cystic tumor. And at stage 2, an operation is performed to remove all identified endometrioid heterotopies.
Features of internal genital endometriosis
Internal genital endometriosis is characterized by the proliferation of endometrial cells inside the uterus. That is, the pathological process does not go beyond the genital organ, but develops and proceeds directly in it.
Internal endometriosis is no less dangerous than external, therefore, it is absolutely impossible to neglect the alarming symptoms.
External, or extragenital endometriosis
External genital endometriosis differs from internal one in that in this case the pathological growths are located not in the muscle layer of the uterus, but outside of it. In this form of the disease, the following internal organs are affected:
- the fallopian tubes,
- lungs, etc.
External genital endometriosis has its own, special, classification by degrees of severity, and not one. Each of these gradations depends on which particular organ was affected by endometriotic growths. This nuance is necessarily taken into account by the doctor when making a diagnosis and prescribing treatment.
Note. It is worth noting that the first alarming symptoms begin to appear already with 2 degrees of development of external genital endometriosis.
Of course, it is possible and absolutely asymptomatic course of the disease, when no symptoms indicate its presence.
But if signs, nevertheless, have appeared, it is better not to neglect them, since the consequences can be extremely serious.
Classification of genital endometriosis in stages
Genital endometriosis can be divided into 4 stages of development:
- The first degree of the disease is characterized by superficial and single growths of endometrial cells.
- When the second stage of development of the pathology of pathological growths becomes much more, they take root deeper and continue to grow.
- The third stage of development is characterized by the formation of endometrial cysts on the surface of the ovaries, as well as adhesions in the peritoneal region. The patient has multiple foci of the disease.
- The fourth stage is the most difficult and dangerous because it is very difficult to treat. In this case, there are multiple cysts on both ovaries, adhesion tissues are significantly compacted, and the endometrium begins to grow into the walls of nearby internal organs.
This is the generally accepted classification of endometriosis, which expresses the picture of the disease as a whole. Adenomyosis is characterized by another gradation according to the degrees of severity of the pathology:
- At the first stage, the myometrium begins to slowly grow.
- For the second stage of development of genital endometriosis, germination of pathological areas up to half the depth of the muscle layer of the reproductive organ is typical.
- In the third stage, the myometrium affects the serous membrane of the uterus.
- The last degree of severity - the fourth - is accompanied by the spread of pathological growths on the walls of the peritoneum.
Endometriotic nodes may have different sizes and shapes, which differ from each other depending on where the focus of the disease is located. With this in mind, the methods of treating a disease also differ.
Causes and predisposing factors
External genital endometriosis, like internal, never develops without cause. In order for endometriotic tissue to begin to grow rapidly, the necessary good reasons, as well as favorable conditions. These are:
- changes in the hormonal background of a woman
- genetic predisposition
- serious disorders in the immune status of the patient,
- frequent abortions,
- surgical intervention in the uterus (curettage, removal of various tumors, etc.),
- throwing menstrual blood and endometrial particles into the fallopian tubes and the abdominal cavity,
- late pregnancy
- cauterization of erosions in the cervix,
- use of cesarean section during childbirth,
- abuse of hormonal contraceptives, etc.
In addition to the causes and factors, there are also many theories concerning the development of external and internal genital endometriosis. However, they have not become particularly widespread, so doctors do not take them into account when making a diagnosis.
Symptoms and diagnosis of pathology
Internal genital endometriosis can manifest itself with the help of:
- severe pelvic pain in the lower back,
- pain during intercourse,
- failures in the menstrual cycle,
- intermenstrual bleeding,
- discomfort and pain when emptying the bladder,
- severe weakness, accompanied by dizziness and fatigue,
- bouts of nausea
- increase body temperature
- blanching of the epidermal covers,
- migraine headache.
As for external genital endometriosis, the signs of its development depend on the particular organ that was affected by pathological growths.
However, it is worth considering the fact that the manifestations of pathology will directly depend on the woman's menstrual cycle.
Let's look at a small example. Suppose that endometriotic nodes hit the bladder. Throughout the entire period of time, the patient is unaware of the presence of the disease in her, but as soon as she has a period of PMS, external genital endometriosis, which affected the bladder, manifests itself through the appearance of red blood cells in the urine (hematuria), pain during urination, discomfort in the area of the diseased organ.
Over time, the woman appears dense adhesions on the walls of the bladder, which lead to chronic pain in the pelvic region.
To prescribe the correct treatment, the doctor must carry out certain diagnostic procedures. Based on the results of the analyzes, the gynecologist will be able to evaluate the entire clinical picture, as well as develop the safest and most effective treatment regimen.
So, to make a correct diagnosis, the doctor:
- Directs to ultrasound and MRI of the pelvic organs.
- Takes a smear on the flora.
- Takes a tissue sample for cytology.
- Does the analysis of hormonal background.
- Conducts colposcopy.
- Conducts diagnostic laparoscopy and hysterosalpingography.
Treatment and possible consequences of a dangerous pathology
The treatment regimens for external and internal genital endometriosis are almost identical, however, in the first case, drugs are used in parallel to relieve the dangerous processes that take place in the internal organs affected by endometriotic nodes.
Modern gynecology divides therapy in this pathology into several types:
- Hormonal treatment with the use of progesterone, antigonadotropic agents, tonadoliberin agonists, etc.
- The use of anti-inflammatory drugs.
- Antibacterial therapy.
- Acceptance of desensitizing drugs.
- The use of hormonal contraceptives.
- The use of progestin implants.
If a conservative treatment for an external or internal form of the pathology did not produce results, the patient may be given a surgical (laparoscopy) or instrumental removal of endometriotic nodes. These include:
- laser therapy
In extreme cases, resorting to the complete removal of the reproductive organ - hysterectomy.
Remember! Despite the fact that the treatment of genital type of endometriosis does not differ from the treatment regimen used for the external form of this disease, it should be carried out exclusively by a qualified specialist. All information about the drugs and their use in this disease should not be used by you for self-treatment, because endometriosis is an extremely dangerous pathology!
The most serious complications of a non-treated or neglected disease include:
- formation of adhesions in the peritoneum and pelvic organs,
- post-hemorrhagic anemia on the background of intermenstrual bleeding,
- psychological problems
- nervous disorders
- the spread of the pathological process to other organs, and not only those that perform the reproductive function,
- malignancy of endometrial nodes.
Summing up, it should be noted that if this pathology is transmitted along your genetic line, then you should be more attentive to your health. With the appearance of even minor deviations in the reproductive system, be sure to consult a doctor, and undergo a preventive examination. Remember that no one will take care of your health more and better than you!
What is genital endometriosis?
Genital endometriosis is an estrogen-dependent inflammatory gynecological disease caused by the introduction and growth of the ectopic endometrium in the genitals: the uterus, ovaries, fallopian tubes, vagina ...
Genital endometriosis in the structure of endometrial disease
A dangerous feature of endometriosis is the ability to invasive and infiltrative growth. In other words, a pathological focus is formed from several ectopic endometrial cells, which grows, infiltrates into neighboring organs, destroys them and infiltrates (infiltrates) further.
Endometrial cells are extremely viable. Due to the autonomous production of estrogens, they independently maintain their independent proliferative growth.
In addition, the endometrial focus actively synthesizes prostaglandins, immunosuppressive and other bioactive substances. Therefore, the course of genital endometriosis is always accompanied by local estrogenia, chronic inflammation, adhesions and immunity disorders with a decrease in apoptosis.
Being anywhere, endometrioid tissue is similar in properties to the uterine lining - during menstruation, it “menstruates”. The bleeding accumulates in the pathological focus and forms endometrial cysts.
Pregnancy, childbirth, postmenopause - the natural "nonmenstrual" periods of a woman's life - stabilize the endometrial process. Contribute to the regression and resorption of pathological foci.
External genital endometriosis
If the endometriotic lesion affects any other (except for the uterus myometrium) genitals, more precisely, the fallopian tubes, ovaries, cervix, the posterior (retrocervical) space, the vagina and vulva, and the pelvic peritoneum - speak of external genital endometriosis.
Localization of external genital endometriosis
More than 20 variants of this form of the disease have been described: polypoid, muscle-fibrous, proliferative, cystic (endometrioid cysts), etc. But none of the many classifications developed is recognized as universal. It is not easy to decide on the stages of genital endometriosis - for each form its own criteria for assessing the severity of the process.
Causes of genital endometriosis
There are many theories of the appearance of endometriosis. But the true reason for its development remains unknown. Moreover, different forms of the disease have different pathogenesis and course.
What contributes to the penetration of endometrial cells in the wrong places - in the abdominal cavity, myometrium, in other organs and tissues?
- Retrograde menstruation - “reverse” movement of the menstrual blood with fragments of the uterine mucosa - not through the cervical canal into the vagina, but through the fallopian tubes into the peritoneum.
- Cell transfer endometrium from the place of normal localization of the blood and lymphatic vessels.
- Translocation (movement) of endometrial particles into myometrium (in cases of internal genital endometriosis) or into the pelvic cavity (in cases of external genital endometriosis) during surgical gynecological procedures.
- Anomalies of embryonic development certain structures of the reproductive system.
Hormonal disorders and genetic predisposition are key causes of endometriosis. Survival in unusual conditions can only endometrial cells, endowed with certain congenital properties.
What allows endometrial cells that are “in the wrong place” to settle down, multiply and form a pathological focus?
- Specific genetic properties of endometrioid cells.
- Epigenetic disorders - changes in gene activity in local foci (increased expression of aromatase, estrogen receptor (EG-β), steroidogenic factor (SF-1), a significant decrease in progesterone sensitivity due to the actual absence of PgR-B in the foci of endometriosis).
- Reduction in general and local immunity.
- Local hyperestrogina.
- Lack of baseline progesterone progesterone resistance.
Hormonal disorders in patients with endometriosis occur at the local level (in local endometriotic foci). The concentration of hormones in the blood of such patients is usually in the normal range.
Factors that increase the risk of developing genital endometriosis:
- Genetic predisposition - cases of this disease in close relatives: grandmother, mother, sister.
- Diseases of the thyroid gland.
- Chronic inflammatory processes, infections of the genitals.
- Surgical procedures on the uterus: cesarean section, instrumental abortion, diagnostic curettage, etc.
- Hormonal imbalance.
- Immune disorders, allergic and autoimmune diseases.
- Chronic stress.
Symptoms of genital endometriosis
The diagnosis of endometriosis, unfortunately, is made very late. Although the characteristic symptom for this disease is chronic pain in the lower abdomen, in the pelvic region it appears very early.
Chronic pelvic pain of varying intensity is the leading symptom of genital endometriosis of any location. Types of pain in endometriosis:
- Pelvic pains: aching, nagging pains in the abdomen, pains in the lumbosacral region.
- Painful menstruation (dysmenorrhea or algomenorrhea).
- Painful intercourse (dyspareunia).
The clinical severity of pain syndrome is associated with menstrual function: it increases the day before and during menstruation, decreases or disappears in the first half of the next menstrual cycle.
Painful periods, many women mistakenly consider normal. Therefore, they do not consult a doctor and miss the possibility of effective conservative treatment of the disease.
The following symptoms of genital endometriosis after chronic pelvic pain: external - infertility, internal - hyperpolymenorrhea and dysmenorrhea.
Symptoms of internal genital endometriosis (adenomyosis):
- Painful menstruation (dysmenorrhea).
- Painful intercourse (dyspareunia).
- Chronic lower abdominal pain.
- Abundant prolonged menstruation.
- Pre- and postmenstrual bloody-brown spotting from the genitals.
- Miscarriages in the early stages, preterm labor.
- Pre- and postpartum hemorrhage.
- Chronic pelvic pains of varying strength.
- Violations of the menstrual cycle, dysmenorrhea.
- Painful intercourse.
- Pre- and postmenstrual bleeding (with cervical endometriosis).
Symptoms suggesting endometriosis in women of reproductive age
The timely diagnosis of genital endometriosis is significantly hampered not only by the subjectivity of the perception of the symptoms of the disease, but also by the diversity of their manifestations.
Types and classification of the disease
Endometriosis is divided into two main types - non-sexual (extragenital) and sexual and origin. In the second type of the disease, there can be two types of development of the disease - external genital endometriosis and the internal form of the disease, which is called uterine adenomyosis.
The most common cystic formations on the ovaries, when small focal accumulations or large growths up to 120 mm long are formed. In some cases, women have endometriosis at the corners of the uterus. Usually these places become dark blue. The disease may occur after surgery on the uterus of a sick woman after sewing it with threads, behind which endometrial cells stretch. Therefore, it is recommended not to flash this layer.
Endometriosis after removal of cystic growths may recur. Therapeutic therapy with hormonal drugs can not always cope with the disease completely. During the development of endometriosis, women should be checked for the presence of cancer.
The main signs of the disease
Manifestations of endometriosis are cyclical and associated with menstruation. Foci of the disease are activated before the onset of menstruation or after them. As soon as menstruation is over, all signs of endometriosis disappear immediately.
The main symptoms of the disease are as follows:
- In a woman, before menstruation, pain increases, which disappear after the process begins in the first three days. At first, the pain has a low intensity, but as a result of the development of the disease, it increases, becoming unbearable. At the same time, women end up in medical institutions with various diagnoses - intestinal colic, appendicitis, acute inflammation, etc.
- Pain syndrome expands, covering the lower back and lower abdomen. It is impossible to stop analgesics, painkillers and other means. Sometimes doctors do anesthesia to patients.
- From the cycle to the cycle of menstruation, an increase in pain occurs, as the capsules of the lesion focus are stretched. The pain can stop only after resorption of its contents.
- The woman appears discharge before menstruation, which have a color from red-brown to chocolate. Most often this happens in uterine adenomyosis. Endometriosis foci have the smallest exits, whence the contents flow from them. When your period ends, the discharge appears much less frequently.
- The patient has anemia due to large blood loss during menstruation. This process can occur throughout the year, which makes it possible to use anemia as a diagnosis.
- The patient before the cycle of menstruation is suppressed and complains of feeling unwell, she has a fear of pain.
- A woman develops insomnia, her working capacity drops sharply.
- The patient has headaches and mood deteriorates.
Diagnosing a disease with ultrasound equipment
On the screen, cystic masses are clearly visible on the ovaries. They consist of a thick capsule interspersed. There may be liquid inside. Other sites with endometriosis are viewed relatively poorly. Adenomyosis on the uterus is clearly visible - cystic formations appear in the form of small cells deep in the myometrium.
If the method of hysterosalpingography is used, doctors can sometimes detect the main foci of endometriosis. When using a contrast agent, it is possible to detect tortuous channels that pass from the uterus to the myometrium. Pain appears in the pelvic region and lower back. Innervation is violated, inflammation develops in the nerve plexuses. Ischialgia, radiculitis or lumbago may occur.
Due to the migration of endometriosis in the small pelvis, patients may experience shooting pain in the rectum, on the bladder and on the orifices of the ureters. In this case, a violation of the release of urine, cystalgia. Some women have symptoms of hydronephrosis or pyelonephritis.
With a low intensity of endometriosis, he may have no symptoms. This can happen if you have an ovarian or cervical disease. But then there will be pain in the lower abdomen and a tumor appears, which can be felt with the fingers. It can change its size: during the menstrual cycle - to increase, and after its completion - to decrease. With endometriosis of the posterior vaginal fornix, before menstruation, bleeding begins. There you can feel the formation in the form of a mound, which can change its size depending on the menstrual cycle.
Hormonal methods of examination of a sick woman most often confirm the presence of the disease. The definition of the disease is possible with the help of laparoscopy. This technique is well suited for detecting endometriosis of the fallopian tubes, peritoneum and ovaries. After collecting all the data, you plan ways to eliminate the disease.
How to treat the disease using various techniques
Treatment can be carried out by conservative methods or by surgery. The most commonly used surgery. The indications for it are the following:
- If a woman has developed adenomyosis of 3 degrees. The first stage is the germination of the endometrium, 2 - the myometrium germinates, and the third is the fully germinated layers of the uterus.
- When combined with endometriosis and adenomyosis.
- The patient has a progressive lesion in chronic anemia.
- The ineffectiveness of a conservative method of curing a woman with hormonal drugs.
The entire organ is removed during laparotomy. The elimination of cysts on the ovary is extremely rare, more often the patient is medically treated. With the full damage of all tissues of the ovary, an operation called ovariectomy is performed. If a woman has adenomyosis, then the uterus is removed, or its removal over the vagina. If the entire organ with appendages is affected, it is removed.
During laparoscopic surgery, small foci of disease coagulate. When conservative therapy is used mainly hormones. Their task is to suppress the excess production of FSH while simultaneously increasing the level of LH. Medicines must have gestogenic elements in their composition. To this end, drugs such as Non-Ovlon and Norkolut are used. The first medication is used in the second stage of the menstrual cycle, and the second drug is allowed to use 10 days pill, starting from the 15th day of menstruation.
For the same purposes, it is allowed to give medicines to women who are ill, such as Miniziston or Triziston. With long courses of treatment of the patient, but already with contraception, such means as Donoval are recommended. It is an inhibitor of pituitary type hormones. The drug lowers the synthesis of substances in the liver and the amount of enzyme in the ovaries, enhances immunity to the effects of endometriosis. The treatment cycle lasts six months. Donato or Gonozol fights disease recurrences well, but it also suppresses the menstrual cycle.
After surgery, the patient is given a medication called Zoladex for six months.
It reduces the number of estrogens and causes the active production of LH. This causes cessation of menstruation, foci of endometriosis die. This tool can be recommended to patients before surgery. Anti-inflammatory medications are used to resorb the affected areas. Along with this, effective physiotherapy with microclysters with sodium thiosulfate, electrophoresis, antioxidant techniques.
To stimulate the immunity of the sick woman give T-activin, Timalin, Timogen. Ultraviolet radiation of a patient’s blood or a laser can be used. Often use lidazuu. Electrophoresis can be performed with zinc or copper. A woman can be sent by a doctor to radon sources in a sanatorium. If all the above listed conservative cure techniques do not help, then an operation is performed.