The disease leads to disturbances in the reproductive system, negatively affects the psycho-emotional state of patients and can significantly reduce their quality of life.
This article will try to tell about the disease in accessible language with a minimum of necessary medical terms.
What it is?
Speaking in accessible language, the Endometriosis is a widespread gynecological disease in which cells of the endometrium (the inner layer of the uterus) grow outside of this layer. It occurs in women of reproductive age.
Since endometrial tissue has receptors for hormones therein having the same changes as in normal endometrium manifested monthly bleeding. These small bleeding leads to inflammation in the surrounding tissues and cause the main manifestations of the disease: pain, increased body volume, sterility.
Symptoms of endometriosis in women depends on the position of its center.
The issue before us is polyetiological disease, which, in turn, indicates the presence of a number of different possible reasons causing it. However, as has already been allocated, the true cause of endometriosis is still not possible to determine. Let us discuss some options that are currently considered to be essential.
- Retrograde menstruation. Or as it is designated, "reverse" menstruation. This phenomenon determines the following process: a certain amount of menstrual blood released during menstruation is sent into the abdominal cavity through fallopian tube. Menstruation on a similar "scenario" - not uncommon, moreover, it is often found in healthy women. The only difference from patients with endometriosis becomes that of healthy women in the immune system restrains the endometrium, rather than letting it grow in the area in which it appears, that is, in the abdominal cavity.
- Disorders of the immune system. This reason is also considered as putative factor leading to the development of endometriosis. If the immune system is weakened, then find themselves in the abdominal cavity with the embodiment already discussed "reverse" menstruation cells endometrium, not only not collapse, but also adhere to the tissues and organs located here, thus forming pockets endometriosis.
- Metaplasia of the endometrium. This implies a factor this transformation, in which the fabric is converted into one another. There is a theory according to which the endometrium, being outside of the uterus, can be transformed in a similar way to other tissues. Meanwhile, metaplasia reasons currently unclear, moreover, any speculation about her rise to a lot of controversy among researchers.
- Hormonal changes. This factor is believed to promotes the development of endometriosis. The fact that the endometrium is quite sensitive to the effects of female sex hormones, endometriosis lesions react to them in a similar way. Proliferation of such foci, e.g., promote the female sex hormones, estrogens.
- Surgical intervention on the part of gynecology. Any kind of surgical exposure, which curettage (scraping), abortions, cesarean section, cauterization of erosion and so on. - all this is usually regarded as a weighty predisposing factors to the development of endometriosis.
- Heredity. This factor is relevant for many diseases, encountered a man and endometriosis can also be viewed as a disease associated with this factor. Accordingly, it is considered that the risk of developing the disease in question is increased in the presence of his relatives in the next.
In addition, the release factors directly provoke the development of disease. Most often, they are the hormonal imbalances and pathology of the immune system. Predisposing processes are:
- Inhibition of natural defensive properties of an organism;
- Decrease in functional activity of granular lymphocytes;
- Inhibition of genetically caused cell death;
- Violation progesterone exchange;
- Hypersecretion of vascular endothelial growth factor.
Allocate genital (in the uterus, the cervix channel and its) and extragenital endometriosis (inflammation foci observed in other organs).
body of the uterus endometriosis is of two kinds: internal and external.
Internal (another name - adenomyosis) - uterine damage. Quite often, this type of disease is accompanied by fibroids. Outer affects the vagina, cervix, perineum, peritoneum, fallopian tubes, ovaries (endometriosis right or left ovary).
Depending on which organs settles endometrium distinguish endometriosis ovaries, fallopian tubes, intestines, bladder, uterus, cervix and other organs.
This type of endometriosis as diffuse characterized consistent lesions of uterine tissue. Layer after layer, gradually endometrial cells infiltrate and grow into the fabric that form the uterus. treatment of the problem lies in the absence of lesions, as the entire uterus is struck uniformly.
symptoms of endometriosis
For a long time, endometriosis does not manifest itself, the disease occurs without noticeable symptoms. In this regard, in its early stages, the disease is diagnosed very rarely.
The main features of having endometriosis in women include:
- Infertility is not associated with a history of other illnesses.
- I feel uncomfortable and frequent, obvious pain with sexual intercourse.
- Blood smearing vaginal discharge, almost chocolate color, both before and after menstruation.
- The resulting pain urinating and pink-colored urine (developing endometriosis and urinary system).
- Constipation, frequent urge to "go in a little" (with involvement of developing bowel disease and urinary tract organs).
- Failure and various disorders of the female menstrual cycle, accompanied by enough heavy bleeding, pain.
- Intense, sharp nagging pain in the lower abdomen, as well as in the lumbar area of the spine, initially associated with the onset of menses but at least manifesting symptoms of the disease, regardless of it.
None of these symptoms, or the presence of them all together, makes it impossible to assert the presence of the diagnosis of endometriosis. It is only those beacons that should serve as an occasion for an immediate march to the gynecologist!
The distribution and depth of lesions of endometriosis tissue are 4 degrees of the disease:
- I degree - single superficial lesions.
- II degree - somewhat deeper lesions.
- III degree - a plurality of deep endometriosis, small endometriotic cysts of one or both ovaries, thin peritoneal adhesions.
- Grade IV - Many deep lesions larger bilateral endometrioid ovarian cysts, dense fusion of bodies, the germination of the vagina or rectum.
Diagnosis begins with an explanation of the patient's complaints, which is manifested by pain and discomfort associated with menstruation. Also questioning, in the diagnosis are important following methods:
Average gynecological examination (as vaginal and rectal palpation to the anterior abdominal wall).
On the eve of menstruation can detect dense formations that can protrudes into the lumen of hollow organs. This is nothing like endometrial cysts. They can not be reduced because there is no exit from the cysts. They face only a gradual increase with each subsequent periods, until a cyst rupture.
- CT and MRI. Under these imaging methods, visible localization various cysts.
- Laparoscopy is a possibility in the case of biopsy extragenital embodiment endometriosis.
- Hysteroscopy. During the examination of the uterus can be seen lesions similar to that seen during colposcopy.
- Colposcopy. In some cases, the localization of lesions on the cervix and vaginal walls, you can see the specific eyes, knots or bluish color.
- Ultrasonography. Is a modern, fast, accurate and painless way to determine the location, size, internal structure of the cyst, and, in some cases, to give a forecast.
In addition to these common diagnostic methods used and the other - in each case to search for a particular lesion localization.
Wipe the same: all about endometritis.
The most common complication in patients is the inability of women now or in the future to become a mother. According to doctors, every second woman, who suffers from infertility, endometriosis. Infertility also occurs in 40-60% of patients.
Its causes are usually:
- Violation of the current process of ovulation.
- Adhesions formed in the area of the ovaries and fallopian tubes.
- Due to the irregular menstruation flow occurs inferiority of endometrium.
- Inflammation around the foci of the endometrium results in the formation of adhesions that disrupt function of internal organs and cause pain.
- Too much of an inflammatory kind of hormones that prevent the egg to attach properly to the walls of the genitals.
Endometriosis and Pregnancy
Endometriosis violates a woman's fertility, but this does not mean that the pregnancy is not possible or is contraindicated. On the contrary, many experts recommend that pregnant, as it has a beneficial effect on the disease. The fact is that during pregnancy there is a state of prolonged anovulation, no menstruation, and the body is under the influence of progesterone for 9 months. All of these conditions contribute to the regression of heterotopias.
However, endometriosis itself is a risk factor during pregnancy, as it may cause a threat of miscarriage. Therefore it is recommended to conduct training pregravid women suffering from endometriosis, and during pregnancy to carry out prevention of miscarriage and placental insufficiency. It is recommended to visit a gynecologist before pregnancy, and on the account to become as soon as possible.
On the child's direct endometriosis has no effect, so there is no fear for the health of your baby. However, the indirect effect can be manifested in the development of placental insufficiency when the child is not getting enough nutrients and oxygen due to malfunction placenta.
How to treat endometriosis?
Common and the only effective date methods of treatment of endometriosis in women are:
- therapeutic (conservative, medical);
- organ-preserving surgery (laparotomy and laparoscopy), comprising removing endometriosis with organ preservation;
- radical surgery to remove the uterus and ovaries;
Conservative treatment is indicated in asymptomatic disease at a young age, in premenopazualny period, with adenomyosis, endometriosis and infertility, when it is necessary to restore fertility. Medical treatment path includes a fairly conventional therapy: hormonal, anti-inflammatory, desensitizing and symptomatic. And in any case do not need to engage in treatment of endometriosis folk ways. When the first symptoms immediately contact a specialist!
Selection of a method of treatment in each case is individual and depends on many factors (age of the patient, desires preserve future fertility, severity of disease, the presence / absence of comorbidity and others).
Currently, the treatment of women with endometriosis are used several hormones:
- Medroxyprogesterone acetate used 30-50 mg daily for 3-4 months. Side effects of medroxyprogesterone acetate: decreased libido and weight gain.
- Nemestran used in a dosage of 2.5 mg 2 times a week. Timing cessation of menstruation can vary depending on the applied dosage and baseline characteristics of the menstrual cycle. A normal menstrual cycle is restored after about 4 weeks after stopping treatment. Pain caused by endometriosis or disappear by the second month of treatment in half of patients. Of side effects that usually are mild, the most frequently reported: increase in body weight, the appearance of acne and seborrhea, excess hair growth. Less commonly observed deepening of voice, decrease breast tenderness, swelling, headaches, depression, hot flashes, nausea, allergic reactions.
- Zoladex (goserelin) is administered subcutaneously at a dose of 3.6 mg 1 time per 26 days, and Dekapeptil depot, administering 3.75 mg intramuscularly 1 time which ensures its operation for 28 days. By the end of the treatment of pain intensity decreased by an average of 4 times.
- Danazol is used for 6 months. After 1-2 months of treatment with danazol, usually comes amenorrhea (cessation of menses). The menstrual cycle is restored within 28-35 days after cessation of treatment. The efficacy was dose-dependent: at relatively mild or moderate disease sufficient dose of 400 mg / day., but in severe cases (stage III-IV endometriosis) may increase the dosage to 600-800 mg / day. Side effects of danazol: weight gain, increased appetite, acne, seborrhea, deepening of voice, excessive hair growth, disorders of the gastrointestinal tract and liver, allergic reactions, hot flashes, dryness of vaginal mucosa, decrease of libido - limit the use of this the drug.
In addition to the basic treatment in order to adjuvant therapy may designate anti-inflammatory, relieves spasms, anti-anxiety drugs, "New Pass", "Ibuprofen" "No-spa", as well as vitamins.
Surgical treatment of endometriosis
Under the surgical treatment often involves laparoscopy (microsurgical intervention), at least - in severe cases a laparotomy (abdominal incision).
Modern hormonal therapy has a very high efficiency in the fight against endometriosis. However, in some cases, and certain forms of endometriosis shown strictly operative treatment:
- retrotservikalnogo with endometriosis;
- in violation of the neighboring organs;
- after failure of conservative therapy;
- when combined adenomyosis, fibroids, and uterine bleeding;
- in cancer alertness - probable ovarian tumor;
- in the presence of endometrioid ovarian cyst and complications leading to pelvioperitonitu.
Laparoscopy is performed using a laser or electrocautery - cauterize or removed endometriosis. Usually, surgical treatment is always combined with a conservative, that is, the combination treatment is considered to be the "gold standard". Prescribe hormones of GnRHa group for 3-6 months and then spend a laparoscopy. Or there is another option at first carried out endometrioza- common form of surgery, then a conservative.
The results of treatment depend on the extent of surgical intervention, the usefulness of hormonal therapy. Rehabilitation period, in most cases takes place favorably: restored reproductive function, significantly reduced pain during menstruation. After treatment recommended by a gynecologist dynamic observation: gynecological examination, ultrasound control (1 every 3 months), the control of the CA-125 marker in blood.
Is it possible to fully cure endometriosis?
endometriosis - a relapsing chronic disease. Relapses after conservative therapy or organ operations during the year occur in 20% of cases, after 5 years of development, the number of relapses of the disease increases to 75%. In the combined treatment (conservative and conducting operational-sparing surgery) there is a more lasting effect, but still inevitable aggravation.
The most optimistic forecast of adenomyosis in women during pre-menopause, because the activity of the disease subsides with normal ovarian function (see. hormonal and non-hormonal drugs in menopause).
Some responses of women who are faced with the problem of endometriosis.
- Vera. Visan took 4 months. for uterine endometriosis on the background of uterine fibroids. First, since the first days of the first time began to rise in blood pressure numbers 180-160 / 100-110. Headaches at the same time there was, was a tremor of the hands and the feeling of general anxiety + tachycardia. I had to take antihypertensive drugs, such as indapamide. As soon as the medication was withdrawn Visan -normalizovalos blood pressure, antihypertensive canceled, for 9 months. BP surge was not after the drug episodes. Second, for the preparation Visan turned sharply increase in uterine fibroids that before the treatment was 1-1.5 cm in diameter, and after - 3, see the diameter. The attending physician said that my fibroids was gestagenchuvstvitelnoy. Fibroids continue to grow and after treatment visa. Before treatment 2.5 years was unchanged in size - 1-1.5 cm in diameter. According to the ultrasound manifestations of endometriosis at the time control after prolechivaniya visa was less than before.
- Natalia. Girls, I have endometriosis until subsided. I accept Janine in July 2012. in April this finishing. give rest tummy. before taking Jeanine did lapar one of the best doctors in this part of Moscow, Shtyrov, in June 2011. but he said, as well as other experts, in my interpretation that this byaku hard to bring it back. gynecologist in my gold, she said, let's try to Janine. I like nothing yet. but I gave birth in 2004. A pain, cramps in my menstru have always been. Maybe she got pregnant for the first time since endometriosis. Well this happens.
- every six months, at least once a year to visit a gynecologist, especially for women after age 40;
- time to treat infectious and inflammatory gynecological diseases;
- avoid intimacy during menstruation;
- to monitor the weight and not exceed the norm;
- avoid unwanted pregnancies and abortions;
- avoid depression and emotional stress.
In fact, special prevention methods do not exist. The recommendations above should take into account women who want to prevent the disease or been treated for endometriosis in order to prevent relapse.