Treatment of endometriosis in women: why the disease is dangerous, and is it possible to get rid of it

The number of detected cases of endometriosis is steadily increasing. This is due to an increase in the frequency of surgical interventions in women, especially cesarean section. An important role is played by modern diagnostic abilities - ultrasound machines, hysteroscopy and laparoscopy allow you to see foci of less than 1 ml. How to cope with an ailment, will folk methods, douching, and diet help?

Gynecology endomitosis.What is this ailment and how is it manifested

Everything about the endometrioma is speculation. The true causes and mechanism of the formation of the disease are unknown. Therefore, there are many theories about the occurrence of pathology. This can be cleaned in detail on the Internet with a photo.

The essence of endometriosis can be described as follows. Normally, endometrial cells should only be inside the uterine cavity. They undergo cyclical changes - the layers of the endometrium gradually grow, and near the end of the cycle, the upper tissues begin to be rejected - menstruation occurs. Menstrual blood is represented not only by the liquid part with red blood cells, white blood cells and platelets, it contains a large number of rejected endometrial cells.

For reasons not completely understood, foci, similar in structure to the inner layer of the uterus, are found in other places uncharacteristic for this. Namely:

• deep in the muscle layer of the uterus;
• on the cervix;
• outside and inside the fallopian tubes;
• on the ovaries;
• on the peritoneum (covers part of the internal organs, muscles).

In addition to the genitals, the neighboring organs are first involved in the process (bladder, rectum, ureters, large and small intestines), and then distant. In the literature, cases of endometriosis of the tissues of the brain, retina, liver, spleen are described, areas in the area of ​​scars on the skin in places of postoperative wounds are very often found.

The focus of endometriosis, wherever it is, undergoes cyclic changes and secrets a special secret. If the cavity is closed (as in the ovary) - a cyst is formed, if an area on the surface of the organ - adhesions are formed with neighboring tissues.

Causes of occurrence

The mystery and subject of discussion remains the question of how endometrioid tissue gets into other tissues and why it “takes root” there. There are a large number of assumptions, and each is based on some well-known facts about the disease.

• Implantation theory. The most common and accepted. According to it, endometrial cells with retrograde current enter the fallopian tubes, and then into the abdominal cavity and “settle” there. The option of moving cells with a flow of lymph and venous blood is allowed. The proof of this theory is the fact that in 90% of cases, foci of endometriosis are located in the pelvis.
• Embryonic origin. According to this view, endometriosis develops from tissue sites that remained after histogenesis and organogenesis in the prenatal period. The theory is based on observations of cases of endometriosis in children.
• Theory of histogenesis. According to these ideas, endometriosis is formed from ordinary cells that cover organs. But under the influence of certain factors, normal tissues turn into similar to endometrioid.
• Heredity. Given that in 70% of cases of endometriosis, a hereditary predisposition is detected, it is customary to attribute this ailment to family diseases associated with a malfunction of the immune system.

Who is more often found

It is possible to predict the appearance of endometriosis. The following women are at risk:

• burdened heredity - if mom, grandmother, sister, aunt had endometriosis, the likelihood of getting sick increases;
• frequent illnesses in childhood - revealed a pattern between the girl’s pain and the likelihood of endometriosis, this is associated with a change in the functioning of the immune system;
• irregularities during the menarche period - if the girl's period of formation of menstrual function was longer or with juvenile uterine bleeding and vitamin deficiency;
• complicated birth - ruptures of the cervix and vagina, manual examination of the uterine cavity, cesarean section increase the likelihood of mechanical spreading of endometrial cells to other parts of the genital organs;
• operations - even non-gynecological interventions increase the risk of endometriosis; this is due to both accidental cell transfer and a change in the functioning of the endocrine and nervous systems;
• frequent stressful situations - in this case, the interconnections in the structures of the brain are violated, which leads to a change in the functioning of the genital organs.

It is paradoxical that hormonal imbalance in women does not lead to endometriosis. The disease itself is the cause of the violation of the ratio between estrogens and gestagens, provoking an increase in the proportion of androgens.

Symptoms of endometriosis in women

Signs of endometriosis almost always leave no doubt. You can even suspect an ailment on your own, as the doctor’s suggestion comes from the woman’s complaints.

Pain

This is the most common sign of endometriosis. The severity of pain depends on the location of the altered tissues, and not on the degree of the disease. Most often, focal endometriosis of the peritoneum gives a pronounced pain syndrome, and, for example, areas on the cervix flow without unpleasant sensations. For pain, the following is characteristic:

• most pronounced - during menstruation, often aggravated by bowel movements;
• with common endometriosis - worries throughout the cycle;
• may have a “dagger" character - with localization between the uterus and the rectum.

Menstrual irregularities

For endometriosis, the following disorders are characteristic:

• heavy periods - with damage to the uterine body (adenomyosis);
• bloody daub - it occurs a few days before the onset of menstruation and continues even after the completion of the main discharge, the color is dark brown, “dirty”;
• rhythm disturbance - the duration of the menstrual cycle increases or breakthrough bleeding occurs; often, women against the background of spotting discharge are confused in terms.

Infertility

It is not uncommon when endometriosis is detected only with a thorough examination for infertility. Problems with conception arise for the following reasons:

• lack of regular ovulation;
• insufficiency of the second phase of the cycle;
• obstruction of the fallopian tubes due to adhesions.

The defeat of other organs and the postoperative scar

If there are foci in the bladder, rectum, the following symptoms occur:

• blood in urine and feces on the eve of menstruation;
• pain in the lower abdomen, in the sacrum, in the perineum.

Most often, endometriosis of the postoperative scar develops after gynecological operations and cesarean section. Foci are formed in the subcutaneous fatty tissue and inside the dermis. Such formations appear several months or even years after the intervention.

With endometriosis of the scar, a woman notes its soreness and swelling on the eve of menstruation, while the symptoms practically do not bother on other days of the cycle. Dark blue or purple rounded lesions on the surface of the skin, also on the eve of menstruation, can pass and pass after them. Sometimes, during menstruation, dark brown discharge may appear on the skin of the abdomen if the areas are in contact with the surface of the skin.

Classification

Endometriosis is multifaceted and can affect different organs. Therefore, it is conditionally divided into genital (external and internal) and extragenital. The classification is described in more detail in the table.

Table - Classification of endometriosis by location of foci

Based on the histological structure of tissues, the following types of endometriosis are distinguished:

• highly differentiated - the cells are indistinguishable from those inside the uterine cavity, undergo cyclic changes, therefore they respond well to hormonal therapy;
• low-grade - cells only resemble the structure of the endometrium, but do not undergo significant changes during the cycle, so hormone treatment in this case does not give a significant effect.

Stages

Three degrees of the disease are distinguished depending on the number of endometrioid foci and their sizes:

• light - single foci (up to five) of no more than 0.5 cm in diameter are detected without any clinical symptoms;
• moderate - a small number (up to 15) of foci with an unexpressed adhesive process and without involving other organs;
• pronounced - damage to adjacent structures, pronounced adhesions, kitties on the ovaries.

Separate classification has endometriosis of the uterus and retrovaginal endometriosis, described in the table below.

Table - Degrees of adenomyosis and endometriosis

Adenomyosis can also be nodular (several large foci in the myometrium form), focal (many small areas) and diffuse when the tissues are completely rearranged.

How to detect

Endometriosis can be suspected according to the complaints of the woman, as well as the results of a routine gynecological examination. In this case, it is determined:

• slightly enlarged uterus;
• spherical shape of the uterus;
• pain during the study;
• appendage heaviness;
• cords in the retrovaginal region due to adhesions.

Ultrasound scan

The main advantage of ultrasound is its non-invasiveness - there is no need to carry out complex manipulations, to injure tissue. But the possibilities of ultrasound are limited - only common endometriosis can be reliably detected.
The main echo signs of the pathology are as follows:

• after measuring the size of the uterus - its spherical shape is revealed;
• uterine body - often increased in the transverse and longitudinal directions, and tissue density is increased;
• in the body of the uterus can be detected - echo-positive (dark in relation to others) tissue;
• often accompanied by - endometrial hyperplasia, ovarian cysts with characteristic content.

Hysteroscopy

Hysteroscopy can diagnose uterine endometriosis. In this case, a special instrument in the form of a tube with a small diameter is inserted into the uterine cavity and allows the endometrium and all its structures to be examined under magnification.

If endometriosis is suspected, a hysterocopy is best done in the second phase of the cycle. In this case, areas of adenomyosis will look like “snakes” - reddish trickles come out of them under the pressure of the injected physiological solution.

During hysteroscopy, curettage of the uterine cavity is performed (cleaning). During a histological examination of the material obtained, sections of endometrial hyperplasia with signs of adenomyosis may come across. The same results can be obtained in women after the usual separate diagnostic curettage against the background of bleeding or constant spotting.

Colposcopy and biopsy

These studies are necessary to confirm cervical endometriosis. Colposcopy is a study of tissues under a magnifying 10, 100 or more times the microscope during a routine gynecological examination. Identification of sites similar to enometrioid degeneration is an indication for performing targeted biopsies.

Hysterosalpingography (GHA)

The method is the introduction of contrast through the cervical canal into the uterine cavity and the study of its further movement on x-rays.It can be performed together with laparoscopy, for example, to clarify the patency of the fallopian tubes.
The method allows to detect adenomyosis. In this case, the endometrium in the images looks “corroded”.

Laparoscopy

This is a method of both diagnosis and treatment. The operations are performed under endotracheal anesthesia, for their performance significant indications are required, for example, infertility or education on the ovaries.

Laparoscopy is the most preferred method for the diagnosis and treatment of endometriosis, as it allows you to see and remove completely invisible foci. Moreover, the rehabilitation period after laparoscopy is only a few days.

CT and MRI

They help diagnose endometriosis in the early and late stages with a high detection rate. CT and MRI allow not only to see the foci, but also to determine the level of involvement of adjacent organs, the degree of germination in the tissue. A CT or MRI scan is often performed as a preoperative preparation, including severe forms of endometriosis.

Treatment principles

Treatment of endometriosis in women involves conservative methods and surgical interventions. The choice largely depends on the presence of complaints in women and related diseases.

Folk remedies for the fight against endometriosis are ineffective and can only reduce the manifestation of symptoms. For example, the famous grass - uterus, will help establish hormonal balance, reduce blood loss, pain during menstruation.

Tablets, injections, implants

The essence of conservative treatment is to create conditions similar to the menopausal or “pregnant” states of a woman when ovarian function is suppressed. For this, hormonal drugs are used that act at different levels and have different prescribing schemes, indications and side effects. The hormonal preparations indicated in the table are the only way to treat internal uterine endometriosis, especially if a woman is planning a pregnancy.

Table - Medicines for the treatment of endometriosis of any localization

All hormonal drugs have a significant side effect - a sharp inhibition of ovarian function and a decrease in estrogen levels lead to an “acute” menopause. Everything changes, and the reviews of women confirm this:

• psyche of a woman - ladies become irritable, tearful, unassembled;
• sex life - decreased libido, there is dryness of all mucous membranes;
• appearance - fragility of hair and nails appears, extra pounds are gained.

In addition to the main treatment, anti-inflammatory and painkillers, vitamin complexes, homeopathic remedies, as well as medicines to reduce the adhesion process are prescribed.

Operation

Unambiguous indications for surgical treatment are as follows:

• endometrioid ovarian cysts;
• infertility;
• severe adenomyosis.

In all other cases, the need for surgery is decided individually.

The method of choice for surgical treatment is laparoscopy. Firstly, it is a minimally invasive technology. Secondly, the increase allows you to see very small areas and carefully remove them. During laparoscopy, the following may be performed:

• tissue excision;
• coagulation of foci by electric shock;
• laser cauterization of endometriosis;
• dissection and separation of adhesions.

With cervical endometriosis, laser cauterization should be preferred. The method provides the least blood loss, quick healing.

Surgical removal of foci is a stage of treatment. Even if all visible areas are excised after a while without treatment, endometriosis will reappear. Therefore, after surgery, they often resort to the appointment of hormonal drugs. Removal of the uterus is indicated only with combined pathology.

What is complicated

The consequences of endometriosis are different and largely depend on the stage of the disease. The most common are:

• menstrual irregularities - entails pathology of the endometrium (hyperplasia and the formation of polyps), anovulation;
• adhesion process - leads to infertility, chronic pelvic pain;
• miscarriage - especially characteristic of adenomyosis due to inferior endometrium;
• dysfunctions of adjacent organs - from the endometriosis, the intestines and bladder “suffer” primarily, stool disorders, pain during bowel movements;
• anemia - develops against a background of heavy menstruation.

Does cancer risk increase

The question of whether uterine endometriosis is dangerous in relation to the development of cancer remains an open question. It is known that in no more than 1% of cases malignant tissues of endometriotic foci occur. But the fact that many tests for tumor markers increase with this ailment remains a fact. Most often this applies to SA-125, CEA. However, the numbers increase only slightly, for example, CA-125 normal to 25 U / L, with endometriosis it rises to 50 U / L, and with cancer - 1000 U / L or more.

It is noted that in women suffering from endometriosis, malignant neoplasms of other organs are more often detected. This gives the right to reason that they have violated the regulation of the internal systems of the body.

How to prevent a disease

Prevention of endometriosis should be carried out in girls since adolescence. It includes strengthening immunity, the prevention of diseases, sufficient physical activity. The recommendations also include the following:

• avoid surgery - if possible, abandon cesarean section, curettage, abortion;
• have more than one pregnancy - hormonal background contributes to the attenuation of existing foci;
• maintain lactation for a long time - acts as pregnancy hormones;
• use hormones - oral contraceptives will serve as a direct warning of the disease in healthy girls.

Endometriosis of the uterus, other parts of the reproductive system and related organs is a serious pathology, the severe degree of which can even lead to disability and impairment of a woman's ability to work. The causes of endometriosis are not completely clear, so there is no effective treatment - all known methods help only remove the ailment for a while.

Reviews: “It’s clear that you won’t get pregnant, you shouldn’t ...”

Hello. I am 24 years old. Two months ago they did laparoscopy and were diagnosed with grade 2 endometriosis. They said that you need to put a spiral and chop a berelin. I don’t have children and I don’t want to have them until the age of 30, there has never been a pregnancy. Of course, I did not set the spiral. Many side effects, plus, I have a huge tendency to be overweight, hormones are simply contraindicated for me. Buserelin was pricked by many of my friends, but no one could stand it for more than two months — a lot of side effects. I decided not to stab. The doctor said, I quote "You can not chop and put a spiral, but then by the age of 40 you will become disabled, because endometriosis will progress."

Anna, http://www.woman.ru/health/woman-health/thread/4157880/

Hello. I had endometriosis. The proposed treatment was: pregnancy (then it was not very part of our plans), hormonal contraceptives Janine and Mirena. I chose Janine, he cured endometriosis quite quickly with this drug, and they were protected for 2.5 years. When they matured on the second baby, she became pregnant 4 months after the cancellation. I read about Mirena for a long time, weighed all the pros and cons, but somehow I didn’t like the presence of a foreign body, albeit of the latest development and with a bunch of positive reviews (the gynecologist promised that there would be no problems with conception).

Eve, http://www.komarovskiy.net/forum/viewtopic.php?t=22138

I also have a diagnosis of endometriosis and endometrioid cysts of both ovaries. So several doctors told me that it would not be possible to get pregnant, they prescribed danazol for 6-9 months, then surgery, recovery after it and only then think about pregnancy. And I got pregnant in the first month. I don’t know how much the pregnancy will affect the treatment of endometriosis, but I definitely don’t say that “I won’t get pregnant” ...

Maria, 22 years old, http://www.sikirina.tsi.ru/forum/ginekologicheskie-zabolevaniya/endometrioz-lechenie7.html

I have a diagnosis of endometriosis. Menstruation begins on time but then there is a long daub. It was treated with Buserelin spray for 2 months. On the ultrasound again endometriosis, adenomyosis. The doctor offers to put Mirena but I'm afraid. They proposed to continue treatment with Buserelin for 6 months. After a 3-week intake, the daub started again. Is this normal or not.

Helena, http://www.sikirina.tsi.ru/forum/ginekologicheskie-zabolevaniya/endometrioz-lechenie8.html

I can share my experience ... At twenty-three I did the first operation to remove the cyst - rupture of the cyst on the right ovary, well, non-endometrioid ... At twenty-six I found an endometrioid cyst on the left ovary ... I had a choice: try to be treated with hormones or surgery ... I chose the second: did laparoscopy , at the same time we checked the patency of the pipes, removed the adhesions ... I was treated after this year: I took progesterone (duphaston) ... doctors (bad word) did not predict an easy chance to get pregnant ... and really - t lko eighteen months pregnant when not particularly trying for forty weeks now, I rely Masika see in the next week.

Lisanna, https://forum.9months.ru/memberlist.php?mode=viewprofile&u=4035&sid=a525a21e40337cbad374b8eb7a9f6af9