endometriosis (Adenomyosis uteri and in particular) represents one of the most diverse and puzzling gynecological diseases. Despite the fact that the main symptoms of this disease are described centuries ago, its causes and mechanisms of development of pathological process is still unclear.
GENERAL INFORMATION
Endometriosis is meant a pathological condition in which the functioning of the endometrium cell (endometrioid heterotopia) of various reasons spread outside the uterus - in the genital tract structures or extragenital (peritoneum, skin, internal organs and t. d.).
According to current statistics, almost half of the total female population of the world has a different localization endometrioid heterotopias. In this case, one in five such women the disease is completely asymptomatic.
The development of the pathological process of endometriosis in the female genital organs (both external and internal) is the most common. Accordingly genital (sexual) endometriosis also divided into external and internal.
uterine body damage, interstitial portion of the fallopian tubes and / or the cervical canal is called the inner endometriosis or adenomyosis. That is, the difference between adenomyosis and endometriosis is only in the localization of endometrial lesions. And, in fact, adenomyosis is a special case of endometriosis.
Some scientists believe adenomyosis independent nosological unit, however, this theory is still in the process of scientific research.
CAUSES
Adenomyosis and endometriosis have similar causes and mechanisms of development of pathological process.
Currently, there are several theories of the formation and development of the disease. The main causes of endometriosis and, in particular, adenomyosis, according to various disturbances in the hypothalamic-pituitary hormonal regulation. A significant role played by heredity and immune status disorders.
Allocate a plurality of risk factors which impact in combination with the above disorders may trigger mechanism of the development of pathological reactions with endometriosis.
For example, various intrauterine manipulation (diagnostic curettage, abortion, long wearing IUD) early or late menarche and menopause, inflammatory diseases can serve as a "trigger" for the development of adenomyosis.
COURSE FEATURES Endometriosis Uterine
The structure of all localizations of endometriosis uterine lesion develops in more than 80% of cases. This disease affects women of childbearing age.
Its most common complication is the occurrence of primary or secondary infertility is diagnosed in more than half of these patients. And accompanying for adenomyosis menstrual dysfunction and quite severe pain is often markedly impaired quality of life and ability to work.
By the nature of the changes in the uterus during the development of adenomyosis are several forms of this disease.
Form of adenomyosis:
- Diffuse.
- Alopecia.
- Nodal.
- Mixed.
Severity of clinical manifestations, as well as selection of methods of treatment directly correlate with the stage of disease, which is caused by the degree of penetration into the uterine endometrial heterotopias thickness. When adenomyosis distinguish four stages of flow. At the same time the prevalence of pathological process may be limited to a small area myometrium at the first stage and capturing almost the entire thickness of the uterine body with serous covering at Fourth.
CLINICAL PICTURE
Adenomyosis and endometriosis different clinical manifestations. So, when adenomyosis to the fore symptoms, characterized by the presence of the pathological process itself in the uterus.
The main features of adenomyosis:
- The leading manifestation of adenomyosis is a typical menstrual cycle. Change the quality of menstruation, which become heavy and prolonged (giperpolimenoreya).
- Quite often there are scarce ( "smearing") spotting throughout the cycle, especially a few days before and after the expected menstrual period.
- In a significant number of cases occur pain in the lower abdomen and / or lower back during menstruation (algomenoreya).
- Pain in the lower abdomen and lower back may arise outside of menstruation, actually getting a permanent nature. They often radiating to the crotch and groin area.
- Often there is discomfort in the commission of sexual intercourse.
- Most women develop infertility or miscarriage occurs.
In all forms of endometriosis and adenomyosis including often develop neuropsychiatric and autonomic disorders - headaches, emotional lability, sweating, palpitations and so on..
PRINCIPLES OF TREATMENT
There are two main areas of treatment of endometriosis, regardless of its location: conservative and surgical.
The guiding principle is the successful treatment of the disease complex approach in which there is an influence on all the links of the pathogenesis of the pathological process.
Selection of a particular method of treatment of endometriosis and adenomyosis depends on several criteria, chief among which is the localization and extent of endometriotic foci. It is also important to consider the presence of complications, comorbidity, age and the ability to preserve fertility by women in her interest in it.
Conservative therapy:
- Gormonolechenie is the basis of conservative treatment of endometriosis absolutely any location, given the proven hormonal nature of its origin. For this purpose, various medications are used FarmGruppa: progestogens antigonadotropiny agonists, gonadotropin-releasing hormones, etc...
- When unexpressed adenomyosis good effect gives local gormonolechenie, such as intra-uterine system with progestogen.
- The use of nonsteroidal anti-inflammatory drugs having analgesic effect and reduces inflammation in affected areas.
- ALWAYS immunomodulating therapy and the use of resources, improve the digestive tract.
- Resorbable therapy and physical factors carried by indications in case of expressed adhesions.
Surgical treatment in most cases is accompanied by a conservative. It may be organ-or radical. However, with the possibility of organ adenomyosis surgical treatment are limited features of the localization of the pathological process.
Radical surgery should be performed under strict indications, since most of them lead to the inability of women to fertility. Such indications include, e.g., a combination adenomyosis and atypical endometrial hyperplasia (adenomatosis).
Adenomatosis and adenomyosis
Endometrial hyperplasia (GGE) - a pathological proliferation (growth) of the endometrial glands and tissues within the basement membrane. Endometrial hyperplasia may be simple, complex and atypical (adenomatosis - refers to precancerous lesions of the uterus).
GGE quite often accompany endometriosis. This is due to a common etiopathogenic processes and risk factors affecting the occurrence of both diseases: various hormonal disturbances, intrauterine manipulation history, and so on. n. Also, for both pathologies characterized by disruption of the menstrual cycle giperpolimenorei type, however, adenomatosis in isolation is rarely accompanied by pain.
The main difference from the uterine endometriosis adenomatosis that in the latter case, the disease process is limited endometrial cavity of the uterus. In this case, there is no penetration of endometrial cells outside the endometrium as endometriosis. And when not carried adenomyosis atypical cell transformation structure, that is an extremely benign process.
In diagnostics of adenomatosis leading value has histological examination of scrapings from the uterus. Uterine endometriosis, this method is not informative study.
Gormonolechenie is a leading treatment of both pathologies, however, indications for radical surgery at adenomatosis much broader view of the frequent progression of the disease and a high risk of malignant transformation.
PREVENTION AND FORECAST
It is important to know that the earlier identified endometrioid heterotopias any location, the greater the chance of successful treatment and prognosis. When running forms of endometriosis, a full recovery of the affected organs is sometimes impossible to functions.
Unfortunately, quite often it recurs endometriosis. It is therefore a decisive factor in its treatment is mandatory comprehensive approach.
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