Symptoms of endometriosis and basic methods of treating the disease

The main approach to the treatment of endometrioid disease currently involves the following principles.

1. Surgical treatment, the purpose of which is the maximum possible elimination of foci of endometriosis;
2. Hormonal therapy;
3. Immunostimulating and corrective therapy in case of common forms of the disease.

When treating genital forms of endometriotic disease, combined treatment is used, the main role in which is played by the surgical method. The choice of the form of intervention and access to the affected organ depends on the location of the lesions and their prevalence.

When treating endometrioid lesions located on the cervix, electrocoagulation, laser and radiocoagulation, as well as cryodestruction (destruction by cold) of pathological elements are used.

In the future, in terms of complex therapy, in order to prevent relapses, it is recommended to prescribe low-dose drugs containing estrogens and gestagens for a period of three to six months.

In the event of a retrocervical type of disease, surgical intervention and excision of endometrioid lesions are performed. If the disease is severe, then removal of the uterus and appendages is indicated.

 If necessary, plastic surgery of the rectum, vagina, and urinary system is performed.

In terms of preparation before surgery, in order to reduce the area of ​​destruction and possible blood loss, hormone therapy is used for six months.

Internal endometriosis of the uterus : treatment methods

A differentiated approach is required in the treatment of this type of endometrioid disease..

Hormonal treatment is prescribed to patients with endometriosis of the uterine body, which is complicated by bleeding during the intermenstrual period, menstrual irregularities (increased duration and abundance of discharge) and painful sensations during sexual intercourse.

If there is no positive effect from the ongoing hormonal therapy or if there are contraindications to its use, surgical intervention with removal of the uterus is recommended, while the woman’s uterine appendages are preserved.

In the last decade, for the treatment of internal endometriosis of the uterine body, operations using endoscopic equipment have begun to be used, which are aimed at preserving the organ and reducing the volume of blood lost during menstruation by partially reducing the uterine cavity.

Stage 1 endometriosis (initial form) can be cured by partial removal of the surface layer of the uterus (endometrial resection), the effectiveness of such therapy ranges from 40 to 60%.

Also, treatment of superficial forms of adenomyosis can be carried out using cold (cryotherapy), heat (thermoresection) and laser. A positive effect with these treatment methods is achieved in 85% of cases of pathology.

However, when using these methods of surgical interventions, it is necessary to take into account the fact that any types of cauterization and resection lead to the initiation of the process of formation of adhesions in the uterine cavity, and therefore it is advisable to use these methods only in patients who have achieved their childbearing function. When “ fibroids and endometriosis of the uterine body” are combined, both diseases will be very difficult to correct with hormonal drugs, so patients are immediately recommended to undergo surgical treatment with removal of the uterus.

Treatment of common forms of external endometriosis

Therapy for these types of endometrioid disease, especially when there are adhesions and infiltrative growth with penetration into neighboring organs, will include the use of hormonal drugs during preoperative preparation in order to limit the actively occurring pathological process and facilitate surgical intervention.

If the patient has of external endometriosis , then prescribing hormonal medications is inappropriate, since the effect of hormones can lead to a reduction and regression of endometriotic lesions, which will make their removal difficult.

When performing an operation laparoscopically, pathological formations are treated using an electrocoagulator, a laser beam, cold (cryotherapy) or an ultrasonic scalpel.

Hormonal therapy for endometriosis

The basic principle of hormonal treatment is to suppress the process of the release of an egg from the ovary, create an artificially low level of the hormone estrogen and stop menstruation. Based on this, two main methods of hormonal therapy for this pathology emerge.

The first is that the hormonal cycle is artificially interrupted in the body, a low concentration of the hormone estrogen in the blood is achieved, which contributes to the process of atrophy beginning in the uterine mucosa.

The principle of the second method is that a woman’s body achieves an increase in the content of male sex hormones (androgens), while the concentration of estrogen also decreases, and atrophic processes occur in the uterine mucosa and foci of endometriosis.

For hormonal treatment, various groups of drugs are used:

1. Synthetic derivatives of progesterone (progestogens): dydrogesterone, medoxyprogesterone. These substances cause a decrease in the concentration of estrogen in the blood due to an increase in progesterone, which leads to atrophy of the endometrium and endometriotic lesions. The drugs are also effective in treating pain. The main side effects when using this group of drugs will be: weight gain, swelling, increased appetite, irregular discharge from the uterus;
2. Preparations containing both estrogens and gestagens, which include Marvelon, Janine, Rigevidon, Femoden. This group of medications is recommended for those patients who suffer from severe pelvic pain and bleeding during the intermenstrual period. These drugs are used in continuous therapy for at least six months. The main side effect is an increased risk of blood clots
3. Antigestagens, representatives of which are currently the two most commonly used drugs: gestrinone and mifepritson. Gestrinone is a derivative of testosterone and has the ability to cause a decrease in the concentration of estrogen and progesterone in the blood, which leads to the development of endometrial atrophy and cessation of menstrual flow. The effect of this drug is similar to the effect of male sex hormones (androgens) and is caused by a decrease in substances that bind testosterone and, accordingly, an increase in its amount in the blood plasma. The use of gestrion for 4 months leads to a significant reduction in the manifestations of endometriosis in 90% of patients. Mifepristone is an artificial hormonal drug that can inhibit the production of progesterone. It can also have a depressing effect on the process of vascular formation, which prevents the growth of the endometrium.

Symptomatic treatment

Along with methods aimed at eliminating the pathogenetic mechanisms of the disease, which lead to a significant reduction in the existing pain syndrome in endometriosis, it is also necessary to carry out symptomatic therapy.

  To relieve pain and the ongoing inflammatory process, drugs from the group of non-steroidal anti-inflammatory drugs (indomethacin, ibuprofen, diclofenac, ketoprofen, etc.) are used. Antispasmodics and analgesics are also used for this purpose.

In cases of significant blood loss and the development of chronic posthemorrhagic anemia, the administration of iron-containing drugs is recommended.

The effectiveness of the treatment and the positive result obtained will depend on the correct selection of the hormonal drug and timely surgical intervention.

Prevention of endometriosis development

When performing surgical interventions on the organs of the reproductive system, the doctor must always remember about the possibility of implementing the implantation method of occurrence of endometriotic lesions and try to avoid contact of the mucous membrane of the uterine cavity and other tissues with pathological lesions with healthy organs, peritoneum and surgical wounds. When performing an operation laparoscopically, removal of excised formations must be carried out very carefully, avoiding contact with surrounding tissues. If the uterus was preserved during treatment, then to prevent relapse, it is necessary to prescribe hormonal drugs after surgery. Young women are recommended to use hormonal contraceptives to prevent the occurrence and development of endometrioid disease .

Surgical treatment of endometriosis, video

Forecast

Endometriosis is a disease that has a relapsing course with constant exacerbations. The probability of recurrent pathological lesions in the first five years after treatment is about 45%, and in subsequent years reaches 75%.

The most favorable prognosis is for postmenopausal women who have received hormonal therapy, since the onset of physiological menopause helps reduce the likelihood of pathology occurring.

In those patients who have undergone radical surgery with removal of the uterus, the disease does not reappear.

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Source: https://lechenie-simptomy.ru/endometrioz-osnovnye-principy-i-metody-lecheniya

Treatment of endometriosis in women - the most effective methods

Gynecological diseases are more often recorded in women of reproductive age. This is due to the active functioning of the hormonal system, the failure of which provokes the disease. Among the common pathologies is endometriosis, which mainly affects women 20–40 years old.

What is endometriosis in women?

Endometriosis of the uterus is classified as a benign disease. The pathology is characterized by the proliferation of the uterine mucosa - the endometrium.

As a result, single cells or their clusters can be found in other organs and pelvic tissues (extragenital endometriosis). As a result of the changes, the functioning of the reproductive system is disrupted.

Endometriosis often occurs in women suffering from infertility and undergoing surgery on the pelvic organs (laparoscopy, laparotomy). The probability of developing the disease in such cases is 6–44%.

Why is endometriosis dangerous?

When considering the complications of the disease, listing to patients the dangers of endometriosis and the consequences of the pathology, doctors put secondary infertility in the first place. The disease disrupts the normal growth of the endometrium.

As a result of such changes, after fertilization has occurred, the egg cannot be normally implanted into the wall of the uterus due to insufficient thickness of the mucous membrane.

Lack of pregnancy with endometriosis may be due to the following factors:

1. Ovulation failure due to hormonal changes accompanying the disease.
2. The appearance of foci of endometriosis in the fallopian tubes, which prevents the normal advancement of the egg, causes deformation of the fallopian tubes.
3. The formation of cystic formations that prevent the maturation of follicles.
4. In addition to reproductive dysfunction, endometriosis can cause disorders such as:

• anemia due to frequent blood loss;
• peritonitis;
• damage to nerve fibers in areas of endometriosis, which leads to neurological disorders.

Can endometriosis be cured forever?

Faced with such a disease, patients often ask their doctor whether endometriosis can be cured completely. As medical practice shows, the disease is highly treatable.

In 30% of cases, spontaneous elimination of endometriosis foci is possible after stabilization of hormonal levels.

Given this feature, when foci of endometriosis are accidentally detected, gynecologists use a wait-and-see approach.

Effective therapy for endometriosis should always be comprehensive. Among the main directions used to treat the disease:

• hormone therapy;
• surgical intervention.

How to properly treat endometriosis?

When choosing which methods of treating endometriosis are best to use and how to treat endometriosis, doctors take into account several factors. Initially, experts pay attention to the number of foci of growth, their volume and location.

For small endometriosis and isolated lesions, drug treatment is used. It is based on hormonal and anti-inflammatory drugs. The duration of the course of such treatment reaches six months.

After the specified time period, an interim examination is carried out.

Hormonal therapy for endometriosis

Treatment of endometriosis with hormones forms the basis of a conservative method of therapy. The drug, its dosage and frequency of administration are prescribed individually. In this case, experts take into account:

• stage of the pathological process;
• volume of growth foci;
• patient's age;
• the presence of concomitant inflammatory diseases in the body.

Since the development of pathology in most cases is provoked by hormonal imbalance, taking hormone-based drugs stabilizes the functioning of the endocrine system. To speed up the treatment of endometriosis in women, drugs and dosage are selected individually.

In most cases, hormonal treatment is based on the artificial cessation of cyclic changes in the uterus. During the menstrual stage, endometrial cells begin to bleed, worsening the woman’s well-being.

Hormones used in the treatment of endometriosis reduce the concentration of estrogen in a woman’s body.

Treatment of endometriosis - drugs

Treatment of uterine endometriosis is not complete without the use of the following groups of hormonal drugs:

1. Oral contraceptives. These drugs help control the growth of endometrial tissue. Patients using these drugs notice a decrease in the volume of menstrual flow and shorter periods. Treatment of endometriosis is carried out using the following drugs in this group:

• Jess;
• Janine;
• Yarina;
• Diana is 35;
• Claira.

2. Gonadotropin-releasing hormone antagonists. These substances block the synthesis of hormones that stimulate the ovaries. At the same time, there is a decrease in estrogen levels.

They cause the endometrium to thin, inhibiting its growth. The result is an artificial menopause, which causes regression. Treatment of endometriosis with drugs of this group gives a lasting effect.

Among the drugs used:

• Difeline;
• Decapeptyl Depot;
• Zoladex;
• Buserelin;
• Lucrine depot.

3. Progestins. These drugs inhibit menstruation by slowing the growth of endometrial tissue. This makes endometriosis easier. Among the drugs in this group:

• Duphaston;
• Orgametril;
• Byzanne.

IUD for endometriosis

To permanently exclude endometriosis, treatment is carried out using intrauterine hormonal devices. An example is the Mirena spiral. It perfectly helps to cope with the initial stages of endometriosis.

The IUD is inserted into the cavity of the reproductive organ, after which the release of a special substance, levonorgestrel, begins. Under the influence of this compound, the process of endometrial growth is inhibited.

As a result, there is a decrease in the volume of vaginal discharge and pain disappears.

Treatment of endometriosis with folk remedies

Treatment of endometriosis in women can be supplemented by the use of traditional methods of therapy. However, before using any medicinal plant or folk remedy, you must consult your doctor about this.

In some cases, treatment of endometriosis with plants may be contraindicated.

Independent use of such products based on positive reviews from friends can lead to irreversible consequences and cause the spread of endometriosis.

Treatment of endometriosis with herbs

Among the existing methods and methods of treating the disease with the help of medicinal herbs, the treatment of endometriosis with boron uterus deserves special attention. This herb is known for its healing and anti-inflammatory properties and is often used in gynecology.

Treatment of endometriosis with boron uterus - recipe

Ingredients:

• boron uterus - 1 teaspoon;
• water – 200 ml.

Preparation, use

1. The grass is poured with boiling water.
2. Leave for 15 minutes.
3. Take half a glass with meals several times a day.

Nettle is no less common in the treatment of endometriosis. The herb has a pronounced anti-inflammatory effect. In case of illness, it is used as follows.

Nettle for endometriosis

Ingredients:

• nettle – 2 tbsp. spoons;
• water – 200 ml.

Preparation, use

1. The herb is poured with boiling water and kept in a water bath for 15 minutes.
2. The infusion is topped up with boiled water to 200 ml and taken 50–70 ml 2-3 times a day.

In search of how to cure endometriosis, women often encounter therapeutic methods that involve the use of propolis. According to doctors, this natural bee product has a strong anti-inflammatory effect. This resinous substance is collected by bees from the leaves and bark of coniferous trees and is used to disinfect hives.

Treatment of endometriosis with propolis - tincture recipe

Ingredients:

• propolis – 100 g;
• vodka – 500 ml.

Preparation, use

1. Propolis is grated.
2. The raw materials are poured with vodka and placed in a glass container.
3. Infuse for 7 days in a dark place, shaking daily.
4. The resulting tincture is used for douching: 3–4 tbsp. spoons are diluted in 100 ml of boiled warm water and the procedure is performed. The course of treatment lasts 2 weeks, after which a break is taken.

Propolis candles

Ingredients:

• propolis – 20 g;
• honey – 100 g.

Preparation, use

1. Propolis is melted in a water bath and then mixed with honey.
2. Place in the refrigerator for half an hour.
3. After cooling, candles are formed from the resulting mass.
4. Use daily, inserting into the vagina at night for 7 days.

Treatment of endometriosis without hormones is possible through hirudotherapy. This method involves the use of medicinal leeches. The mucus they secrete contains gerudin. This enzyme has a number of useful properties:

• relieves inflammation;
• accelerates blood clotting;
• reduces thrombosis;
• reduces the intensity of bleeding during menstruation.

Based on these properties, the following beneficial effects can be identified from the use of leeches during endometriosis:

• anti-inflammatory;
• antispasmodic;
• immunostimulating;
• prevention of adhesions;
• normalization of blood flow in the ovaries and uterus.

Surgical treatment of endometriosis

Chronic endometriosis is difficult to treat with hormones. The outbreaks appear again after some time. The only way out is surgery. The operation is performed by laparoscopy.

In case of multiple foci of endometriosis, its appearance in neighboring tissues and organs, abdominal surgery is performed by dissecting the anterior abdominal wall.

The objective of surgical treatment of endometriosis is carried out by:

• excision of endometrioid ovarian cysts;
• excision of recto-vaginal infiltrate - accumulation of endometrioid cells and connective tissue in the retrouterine space.

Treatment of endometriosis with laser

New methods of treating endometriosis can significantly reduce the duration of therapy and reduce the risk of relapse. Among these are laser treatment of endometrial growths.

The beam penetrates the tissue shallowly, which eliminates injury to healthy tissue. After the course there are no adhesions or scars left.

Within a few days after the procedure, a woman can resume sexual activity, and a month later she can attempt to conceive, which was previously prevented by endometriosis.

Source: https://womanadvice.ru/lechenie-endometrioza-u-zhenshchin-samye-effektivnye-metody

Endometriosis: symptoms and treatment

The largest number of women suffering from endometriosis are between the ages of 25 and 35 years. It is during this period that most families decide to plan a pregnancy.

About 25–40% of female infertility is due to this disease. This pathology can become a significant obstacle, preventing the fertilized egg from remaining in the uterine cavity or leading to miscarriages. Moreover, endometriosis can affect the entire female body, leading to disruption of the functioning of many internal organs and systems.

Endometriosis is a disease of the female reproductive system, in which the tissue of the inner lining of the uterus (endometrium) begins to penetrate into the underlying structures (myometrium), neighboring organs (fallopian tubes, ovaries, bladder) and even affecting distant parts of the body (lungs, liver, etc.). d.). At the same time, endometrial foci outside the uterus are also subject to the menstrual cycle, periodically contributing to the development of bleeding. The initial manifestations of the pathology are painful, heavy and prolonged menstruation.

Why does endometriosis develop and its classification?

Despite the many studies conducted to identify the reliable causes of the development of endometriosis, a consensus in the scientific community has not yet been achieved. There are many genetic, immune and other less common theories. The following is considered the most reliable.

There are two main forms of endometriosis, different in their causes and manifestations:

• Genital. Affects the internal genital organs: uterus, fallopian tubes, ovaries, vagina. Due to the presence of a chronic inflammatory process (endometritis of any nature), abortion, injury, the presence of an intrauterine device, or spontaneously, endometrial cells begin to grow into the muscular layer of the uterus. There are also two subspecies:
• External genital. It affects only the ovaries and peritoneum of the small pelvis.
• Internal genital (adenomyosis or endometriosis of the uterus). Grows into the muscle layer, leading to an increase in the body of the uterus. Often combined with fibroids.
• Extragenital. Foci of endometriosis occur in the pelvic organs, abdominal cavity, lungs, intestines, skin, etc. During menstruation, blood with rejected endometrial cells, for various reasons, first enters the fallopian tubes, and then into the abdominal cavity. On the surface of the peritoneum, endometrial cells take root, gradually increase in number, menstruate and, subsequently, spread further throughout the body.

There are known cases of a combination of genital and extragenital endometriosis.

There are 4 stages of development of this pathology, based on the prevalence and depth of the lesions:

• Stage I - Lesions of small size, superficial (affect only the uterine mucosa) - minimal endometriosis.
• Stage II - Some lesions penetrate the muscular layer - mild endometriosis.
• Stage III - deep, transmural (through the entire wall of the uterus) foci of endometriosis appear. Small endometriotic ovarian cysts develop.
• Stage IV - there are many deep foci, cysts reach significant sizes. Foci of endometriosis grow into neighboring organs (vagina, rectum, bladder), and adhesions develop in the pelvis - severe endometriosis.

How does the disease manifest itself?

Depending on the form of the disease (genital, extragenital) and the stage of the process, manifestations may be different. And if in the extragenital form the symptoms depend on the affected organs, then genital endometriosis has a number of characteristic signs:

• Pain syndrome. Pain is felt in the pelvic area, it can either intensify before the onset of menstruation or be constant (chronic pelvic pain). Pain often occurs during sexual intercourse. In stage IV of the disease, pain may occur during urination or defecation. In case of damage to other internal organs, pain may also occur in their area, which is usually cyclical in nature.
• Bleeding. In the initial stages of endometriosis, excessive bleeding develops only during menstruation. They become long-lasting, profuse, and after they end the characteristic brown discharge may continue. In late stages of the disease, blood appears in the stool and urine. The extragenital form can cause the discharge of bloody sputum and the occurrence of subcutaneous hemorrhages. These manifestations occur synchronously with the onset of menstruation. A rather rare manifestation of extragenital endometriosis is a bloody tear. The presence of this symptom gave rise to many myths and legends in ancient times and the Middle Ages.
• Dysmenorrhea. It manifests itself as painful, prolonged and profuse cyclic discharge. It may be combined with anemia that develops at the end of menstruation.
• Infertility. Due to changes occurring in the endometrium and ovaries, constant anemia due to bleeding, the onset and normal course of pregnancy becomes quite problematic.
• Adhesive disease. Due to the constant flow of menstrual blood into the abdominal cavity, especially in the pelvic area, adhesions gradually develop. They reduce the mobility of internal organs, fallopian tubes, and the body of the uterus, which can further reduce the chance of pregnancy. In severe cases, acute or chronic intestinal obstruction may develop.
• Extragenital lesion. Perhaps this group of symptoms is the most diverse. This is due to the polymorphism of symptoms inherent in damage to a particular organ. Signs of neoplasm of the liver, lungs, respiratory failure, jaundice, gastrointestinal bleeding, hematuria (blood in the urine), etc. may develop.

What are the dangers of endometriosis?

The development of complications of this pathology is closely related to its manifestations and symptoms. The most serious consequences of endometriosis are:

• Infertility.
• Adhesive disease.
• Anemia.
• Damage to the central nervous system.
• Malignancy of endometriosis foci.

If pregnancy nevertheless occurs against the background of endometriosis, its course may be complicated by the threat of miscarriage, improper attachment of the placenta, and fetal hypoxia. The adhesive process can lead to the development of an ectopic pregnancy.

Diagnostics

If the patient is bothered by abdominal pain and attempts to become pregnant are unsuccessful, the question arises about the presence or absence of endometriosis.

What are the symptoms associated with endometriosis?

• painful menstruation
• painful intercourse
• chronic pelvic pain
• pain in the lumbosacral region
• painful urination
• painful bowel movement.

Studying the patient’s complaints, her medical history, and a gynecological examination are only the initial stages in diagnosing endometriosis.

To clarify the diagnosis, ultrasound, computed tomography or MRI (magnetic resonance imaging) and other research methods are performed.

But the “gold standard” in diagnosing this pathology is laparoscopy with biopsy.

Treatment of endometriosis

Today, there are three main methods of treating endometriosis: medication, surgery and combination. Each method has its own positive and negative sides and scope of application. When choosing treatment, the doctor is guided by age, stage and form of the disease, and planning for subsequent pregnancy.

Drug treatment

Conservative treatment is used if it is necessary to preserve the reproductive function of a woman at a young age or premenopause and in preparation for surgical treatment.

When carrying out drug therapy for endometriosis, treatment is carried out in two directions: eliminating pain (analgesics, NSAIDs) and suppressing the activity of pathological foci with the help of hormonal drugs.

It should be clearly understood that conservative treatment of endometriosis without hormones is impossible.

To reduce pain symptoms, analgesics and non-steroidal anti-inflammatory drugs are prescribed.

Hormone therapy is aimed at suppressing the activity and reducing the size of endometrial lesions. The selection of a treatment regimen is based on the maximum reduction in the occurrence of side effects from medications. The most widely used means are:

• Progestins (gestagens). Taken in a course of 6–8 months for any form and stage of endometriosis. They help normalize endometrial secretion, slow down its growth and reduce the volume of menstrual bleeding until it is completely absent. Dienogest, dydrogesterone, progesterone, norethisterone are used. Side effects may include the development of depression, intermenstrual bleeding, and pain in the mammary glands.
• Monophasic COCs. Oral contraceptives completely block cyclic mechanisms in the female body, which prevents the growth and subsequent rejection of the endometrium and the development of menstrual bleeding. This leads to complete or almost complete elimination of the manifestations of endometriosis. The use of COCs can cause headaches, depression, insomnia, increased blood pressure, and decreased libido. Rigevidon, Novinet, Diane-35, Regulon and others are used.
• Gonadotropin-releasing hormone agonists, hormonal releasing systems: vaginal and transdermal combined hormonal contraceptives, subcutaneous and intramuscular depot forms of progestins, intrauterine levonorgestrel releasing system (LNG-IUD) are used when COCs and gestagens are ineffective or before laparoscopic surgery for endometriosis.
• Gonadotropin-releasing hormone agonists are taken once a month and are the “heavy artillery” in hormonal therapy. Indicated for stage III – IV endometriosis. They block the production of specific releasing factors in the hypothalamus, which prevents further production of sex hormones according to the female cycle. These drugs can cause hot flashes, decreased libido, vaginal dryness, menopause symptoms, osteoporosis, headaches and muscle pain.

Surgery

Currently, more and more preference is given to organ-preserving operations that exclude resection of the uterus and its appendages. This trend is due to great progress in minimally invasive surgery over the past 10–15 years. The main goal of surgical treatment of endometriosis today is the removal of lesions and maximum restoration of the functionality of the female reproductive system.

Excision of endometrioid lesions is recommended where possible, especially deep endometrioid lesions, and laparoscopic cystectomy for endometrioid cysts (endometriomas). This helps avoid recurrence of symptoms and endometrioma.

The level of professionalism of the operating doctor plays a significant role during the postoperative period and the possibility of developing complications. The Mother and Child clinics employ world-famous specialists who have techniques for conducting modern surgical interventions to remove endometriotic lesions.

Prevention

In order to prevent the development of endometriosis, the following provoking factors should be avoided: acute or chronic inflammatory processes in the uterus, uterine injuries, medical abortions.

If you suspect the first manifestations of this disease, do not delay diagnosis and treatment. Identification and elimination of endometriosis at stages I – II contributes to the maximum preservation of all functions of the female reproductive system.

Source: https://mamadeti.ru/article/gynecology/treatment-of-endometriosis/

Endometriosis: causes and consequences

The endometrium is a very common pathology in gynecology: it accounts for 10% of all female diseases.

The early stages of the disease are asymptomatic, and often the problem is discovered too late - when an adhesive process begins to develop in the uterus, accompanied by pain, cycle disruption and general discomfort.

Endometriosis is not a fatal disease, but it can significantly complicate the patient’s life: if left untreated, ovarian cancer, problems with bearing a child, and relapses may occur.

General description of the disease

Endometriosis is a disease that is quite common in gynecological practice. Characterized by the proliferation of endometrial cells outside the inner layer of the uterus.

Reference! The endometrium is the inner mucous membrane that lines the muscular layer of the uterus. Consists of two layers: basal and functional. The structure and thickness of the basal layer are unchanged, while the functional layer, through which menstruation occurs, is particularly sensitive and immediately responds to changes in the concentration of female hormones. Particles of the endometrium are washed out of the organ every month during bleeding, but in some cases, pieces of the membrane stick to the internal walls of the organs (fallopian tubes, ovaries, bladder, intestines) and begin to grow, preventing blood from freely exiting. It thickens and, accumulating, puts pressure on the nerve endings, causing the patient severe pain, nausea and loss of strength.

The previously existing opinion that endometriosis is a disease of mature women after 35 years of age turned out to be completely wrong.

The fact is that several decades ago, diagnosis of the disease could only be done during open surgery on the abdominal cavity, and such manipulations were done very rarely.

Statistics say: in total, 176 million representatives of the fair sex suffer from this disease on the planet, of which 117 million are women from 30 to 50 years old (peak - 40-44 years), the rest are girls from 14 to 30.

What is the impetus for the onset of the disease is still not exactly clear. The disease can be detected in a woman without serious pathologies and hormonal imbalances, but the risk is significantly higher in the group of women who:

• there is a predisposition to endometriosis (the disease was diagnosed in close female relatives);
• there are serious hormonal disorders;
• in the past there were difficult childbirths or caesarean sections, abortions or other surgical interventions that affected the organs of the reproductive system;
• cycle disruptions and menstruation delays often occur;
• there is a habit of independently, without contacting a gynecologist and taking tests, choosing contraceptive drugs for yourself, especially emergency contraception;
• there are infectious and inflammatory diseases of the pelvic organs in a chronic form;
• I am overweight and have an addiction to smoking and alcohol.

Classification

There are three forms of uterine endometriosis:

1. Diffuse adenomyosis or internal endometriosis of the uterus. Mucosal cells gradually grow into the submucosa of the uterine cavity, up to half the depth of the myometrium, changing its structure. It is easily diagnosed using ultrasound and hysteroscopy, as well as during an external examination in a gynecological chair.
2. Nodular adenomyosis. A more dangerous form that affects not only the quality of life, but also the ability to bear children. Main signs: formation in the muscle layer of formations in the form of nodes, singly or in groups. The presence of glandular and connective tissue rather than capsules inside helps to avoid confusing them with myomatous nodes. The lesion can also affect the pelvic organs.
3. Focal endometriosis. In this case, a number of organs suffer, in addition to the uterus: appendages, intestines, bladder. As the disease develops, it affects not the entire organ, but its individual parts. The number of lesions increases gradually, they become deeper, the process is accompanied by the growth of cysts in the ovarian area, adhesions on the pelvic organs.

Reference! Adenomyosis is a disease that occurs due to an imbalance of progesterone and estrogen. An excess of the first substance causes pathological growth of the inner surface of the uterine organ and the symptoms of the disease are similar to ordinary endometriosis, but several differences are still present. With adenomyosis, the overgrown layer of the uterus does not extend beyond its boundaries, unlike endometriosis. In addition, in the first case, the disease does not make itself known until the formation of internal cysts, and in adenomyosis - immediately.

According to the depth of the lesion:

Endometrioid lesions are not deep, affecting only the upper muscle layer. A single ultrasound does not show any signs of the disease, the menstrual cycle is normal, there are no problems with conception.

The first symptom is abdominal pain before and during menstruation. For diagnosis, ultrasound should be done 2 times: before menstruation and the day after it.

It is completely curable by taking hormonal contraceptives orally and installing an intrauterine device.

Pain manifests itself in each menstrual cycle, the cycle itself shortens, and the volume of blood lost increases.

The treatment regimen, in addition to combined oral contraceptives, includes gestagens (tablets or injections).

Reference! Sometimes doctors recommend conceiving a child at this stage, since hormonal changes during pregnancy can cause endometrial lesions to regress.

The disease covers the entire muscle wall and reaches the outer layer of the uterus. The number of cysts on internal organs increases, adhesions between the intestines and appendages are clearly expressed. The lesions involve the outer layer of the rectal wall and the cruciate muscle ligaments.

Blood loss during menstruation increases, a woman during this period feels fatigue and loss of strength, severe pain, which causes lightheadedness and vomiting. A concomitant diagnosis of anemia is often made.

Depending on the patient’s age, she is prescribed either medicinal hormonal therapy with the use of contraceptives and gestagens (in reproductive age), or surgical removal of endometrial lesions.

The peritoneum and all neighboring organs (bladder, sigmoid and rectum) are already involved in the process. The resulting cysts exceed 6 cm in diameter and are located in clusters. The patient feels constant pain and deterioration in her general condition. Treatment is only surgical.

Symptoms of endometriosis

The disease does not have pronounced clinical symptoms, so a diagnosis cannot be made without a special examination. However, the presence of four or more signs absolutely definitely indicates pathology:

• Menstrual irregularities, in which menstruation may take longer than usual or be absent for several months.
• Bloody discharge found in urine, feces or after intimacy.
• Prolonged pain syndrome (painful menstruation, pain during sexual intercourse, defecation or urination).
• Problems with conception.
• Heavy uterine bleeding and discharge between periods.
• Nausea, vomiting.
• Constipation, flatulence, bloating.

Complications

Complications include:

• Hormonal imbalance.
• Tubal obstruction.
• Infertility (a woman is diagnosed with infertility if, after a year of regular sexual activity without the use of contraceptives, she does not become pregnant).
• Miscarriages.
• Endometrioid cysts.
• Anemia.
• Weakened labor, leading to cesarean section, uterine bleeding and hemorrhagic shock.
• Perforation of the walls of the uterus or intestines.
• Intestinal obstruction.
• The occurrence of inflammatory processes in the kidneys, difficulty urinating.
• Peritonitis.
• Formation of malignant tumors.
• Damage to the nerve fibers of the sciatic nerve, lumbosacral and pelvic plexuses.
• Neurotic disorders.

Diagnostics

Diagnosis requires a comprehensive approach:

1. Collection of complaints and medical history.
2. Gynecological examination.
3. Blood test for increased levels of cancer protein (markers CA-125) and placental protein (PP-14).
4. Ultrasound examination of the pelvic organs.
5. Hysteroscopy.
6. Colposcopy.
7. Metrosalpingography.
8. Magnetic resonance imaging.

Treatment of endometriosis

Treatment can be conservative, surgical or combined. The doctor chooses an option depending on the patient’s age, history of other diseases, severity and a number of others.

Conservative treatment includes anti-inflammatory, hormonal and desensitizing therapy, in addition - a special diet, long walks in the fresh air, and physical therapy. It is prescribed if the disease is asymptomatic, the woman is under 30 years old and in cases where it is necessary to restore the ability to conceive a child.

Indications for surgical treatment are: grade 3 and 4 endometriosis, numerous cysts, adenomyosis and endometrial hyperplasia in combination with fibroids, inability to use hormonal drugs, lack of effect from treatment 3 months after the start of the procedures.

Important! It is necessary to pay attention to the restoration of the body after operations on the pelvic organs - hirudotherapy, acupuncture, physiotherapeutic procedures.

Forecast and prevention of endometriosis

Measures to prevent endometriosis:

• Avoid using tampons - they accumulate bacteria and disrupt the movement of endometrial cells.
• Don't have vaginal sex during your period.
• Limit physical activity on “critical days” (you can’t do deep bends or squats).
• Get a preventive examination from a gynecologist every six months.
• Do not take birth control pills without first consulting a specialist.
• Avoid prolonged exposure to the scorching sun or solarium.

Nutrition

Proper nutrition is important for two reasons: firstly, with the help of certain foods you can correct estrogen levels, and secondly, it supports the immune system, which suppresses pathological cell division.

What you need:

• Products rich in vitamins B (cereals, liver, wholemeal flour), C (sea buckthorn, dogwood, rose hips, black currants), A and E (vegetable oil, fish, walnuts, dried apricots).
• Foods high in plant sterols (peas, apples, beans, fennel, parsley and celery).
• Fiber in large quantities (bran, greens, sweet fruits).
• Fatty acids (pumpkin seeds, fish oil).

Attention! Products containing phytoestrogens should be temporarily excluded or their amount reduced to a minimum. These are pomegranates, carrots, spinach, corn, buckwheat and millet groats, coriander, dill, green tea and beer, whole grains and dairy products, eggs, beef and pork. You should eat in small portions, 4-5 times a day. Avoid fatty, spicy and fried foods, give up coffee and tea.

Conclusion

The sooner uterine pathology is diagnosed, the more effective treatment will be. Contacting a medical institution for help and following all medical recommendations will help you cope with endometriosis with minimal losses and feel the joy of motherhood in the future. Do not forget to undergo regular preventive examinations and monitor your health.

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Source: https://vclinica.ru/stati/endometrioz/

Endometriosis: playing ahead. Symptoms and treatment of endometriosis as one of the causes of infertility

Why is endometriosis so often mentioned in connection with infertility? How to “catch” the symptoms of endometriosis, which are almost indistinguishable from menstrual symptoms? And is there a non-surgical treatment for endometriosis? We will answer these and other questions related to endometriosis with the help of leading experts!

Menstruation accompanied by severe pain should alert a woman, as this may be one of the signs of the development of endometriosis. True, the disease can be asymptomatic. As a result, the woman does not receive the necessary treatment, endometriosis progresses and can cause infertility.

Endometriosis: causes of the disease and main symptoms

Today, and this data is absolutely reliable, in the world about 16% of women of reproductive age suffer from endometriosis. A terrifying number! Among all gynecological pathologies, this disease is one of the top three, along with inflammatory diseases and uterine fibroids, leading to significant reproductive dysfunction, persistent pain and infertility.

Endometriosis used to be called the disease of nuns because the disease most often occurred in women who had never been sexually active. And now symptoms of endometriosis are diagnosed even in very young girls. According to the results of a study by the International Endometriosis Association, which involved 40,000 sick women, 50% of respondents showed the first signs of the disease before the age of 24 years, in 21% before the age of 15, in 17% between 15-19 years.

At its core, endometriosis is a benign growth of tissue similar in properties to the endometrium, the layer lining the uterine cavity.

Alexander Popov, Doctor of Medical Sciences, Professor, Director of the Moskvorechye Medical Center, Head of the Department of Endoscopic Surgery at the Moscow Regional Research Institute of Obstetrics and Gynecology: “During menstruation, in almost the majority of healthy women, menstrual blood comes out not only through the vagina. Blood also flows into the abdominal cavity through the fallopian tubes. Normally, these introduced endometrioid cells must be killed by killer cells, which are found in the body of every person. But for some reason this doesn't happen. This is how endometriosis begins.”

And then the endometrial cells are carried throughout the body through the bloodstream and develop in places where they should not be. For example, in the fallopian tubes, ovaries, intestines, kidneys, peritoneum and other organs.

Having attached to an atypical place, endometrial cells begin to perform the same functions as in the uterus, that is, to menstruate. These bleedings lead to inflammation in the surrounding tissues, the formation of adhesions, which contributes to the appearance of the main symptoms of endometriosis:

• nagging pain in the lower abdomen and lumbar region throughout the month, intensifying on the eve of menstruation;
• pain during sexual intercourse (dyspaurenia);
• bloody spotting of a dark “chocolate” color before and after menstruation;
• prolonged and heavy bleeding during menstruation;
• insomnia, headaches, nervousness, worsening mood, decreased performance.

In some cases, the first and only symptom of endometriosis is infertility. About a third of women with endometriosis cannot become pregnant. The resulting adhesions disrupt the patency of the fallopian tubes and the anatomy of the small pelvis, and also interfere with normal ovulation of the ovaries.

There are many theories about the occurrence of endometriosis, but none of them are proven. The background for the development of the disease can be frequent infectious diseases in childhood, hormonal disorders, and inflammation of the appendages. The “trigger point” for the development of pathology can be an abortion or diagnostic curettage. Recently, genetic factors have become increasingly important.

According to Alexander Popov , science has proven that the development of endometriosis can be provoked by unfavorable environmental factors, for example, poor ecology.

That is, the pathological process has not yet started, and if there were no harmful effects, and this enhances the proliferative activity of endometrioid cells (their reproduction by division), then the woman would not have developed endometriosis.

Endometriosis: diagnostic methods

The tricky thing about endometriosis is that it still needs to be detected. There are many forms of the disease, the manifestations are varied, which makes diagnosis difficult.

A gynecological examination and questioning of a woman at a doctor’s appointment can only suggest the presence of the disease. It is also not always possible to diagnose the disease using ultrasound.

For example, with the initial stage of endometriosis, when there are few foci of the disease.

The most reliable method for diagnosing endometriosis is laparoscopy - examination of the pelvic organs using a special instrument - a laparoscope, which is inserted through a small incision on the anterior abdominal wall. During the examination, the surgeon may remove a section of tissue and send it to the laboratory for further analysis.

To date, surgery remains the main treatment for endometriosis. Laparoscopy is most often used to remove foci of the disease. As a rule, the operation is performed for chronic pelvic pain (pain in the lower abdomen) and infertility, as well as for the formation of endometrioid ovarian cysts.

According to an international survey in which 14,000 women aged 16-45 years from 13 countries took part, 80% of women suffering from painful menstruation do not associate the discomfort with any disease and simply take painkillers. While endometriosis is detected in 75% of women who consult specialists for pain in the lower abdomen.

Surprisingly, doctors sometimes do not attach much importance to this main symptom of endometriosis and do not prescribe adequate treatment in a timely manner.

Endometriosis: treatment simple and complex

To date, surgery remains the main treatment for endometriosis. As a rule, laparoscopy is used to remove foci of the disease.

Other types of technologies are also used (laser, electrical, cryo-, ultrasound and plasma). However, during surgery, especially with widespread endometriosis, only visible and accessible lesions are removed, while microscopic ones may go unnoticed. This can lead to further relapses of endometriosis.

As a rule, the operation is performed for chronic pelvic pain (pain in the lower abdomen) and infertility, as well as for the formation of endometrioid ovarian cysts - one of the most dangerous types of disease for women.

The fact is that several surgical interventions on the ovaries reduce the number of eggs in a woman that can be used for fertilization.

This reduces the chances of getting pregnant on your own and giving birth to a biological child.

When sending for surgery, not all doctors, unfortunately, show concern for a woman’s reproductive potential. But several operations on the ovaries may well lead to a woman entering menopause at the age of 30. She is infertile because her entire supply of eggs was destroyed during surgery. That is why before surgery it is very important to consult with a reproductologist who can “preserve” eggs for use in an IVF program (if necessary).

The good news is that if the disease is detected in the early stages, surgery may not be necessary.

You can stop the development of endometriosis and relieve pain with medications.

One of the effective methods of drug treatment for endometriosis is the prescription of hormonal contraceptives, which suppress a woman’s menstrual function, as a result of which the growth and spread of endometrioid lesions stops. The disease does not develop.

Actually, the best treatment for endometriosis is pregnancy and cessation of menstruation. Against this background, the risk of developing the disease is zero.

However, a modern woman plans her own life and it is impossible to force her to always be pregnant, so contraceptives in this case are the only alternative.

It is important that the course does not need to be interrupted; it is better to take the drugs for a long time, since the peaks that occur when the drug is discontinued are very risky for a sharp increase in the disease.

In addition, drug treatment is used after surgical confirmation of endometriosis and removal of visible foci of the disease - as a prevention of its recurrence, as well as for the treatment of relapses in order to reduce the risk of re-operation.

Hormonal contraceptives are not a death sentence, as many believe. It is a safe and effective treatment for endometriosis. The main thing is to choose an individual course of therapy together with your doctor.

Vera Vyacheslavovna Korennaya, Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology of the Russian Medical Academy of Postgraduate Education, leading gynecologist at the Swiss University Clinic: “It is important to understand that endometriosis is a chronic disease, it cannot be cured completely, but modern medicine is able to offer a woman adequate therapy that will stop development of endometriosis, relieve the main symptoms of the disease, postpone surgical intervention or abandon it altogether. And most importantly, preserve a woman’s reproductive function and give her the opportunity to become a mother without resorting to assisted reproductive technologies.”

Source: http://www.woman.ru/health/woman-health/article/84617/