Endometriosis of the uterus – what is it and how to treat it?

Endometriosis of the uterus: what is it in an accessible language?

The problem of endometriosis of the uterus is very relevant for modern medicine. This is due to the fact that the frequency of the disease increases from year to year. According to statistics, from 5 to 10% of young women worldwide suffer from endometriosis. Among patients diagnosed with infertility, endometriosis is much more common: in 20-30% of cases.

Endometriosis – this is a pathological proliferation of glandular tissues of the uterus, which is benign. The newly formed cells are similar in structure and function to the cells of the endometrium of the uterus, but are able to exist outside of it. The growths (heterotopias) that have appeared are constantly undergoing cyclic changes, similar to those changes that occur every month with the endometrium in the uterus. They have the ability to penetrate into neighboring healthy tissues and form adhesions there. Often endometriosis is accompanied by other diseases of hormonal etiology, for example, uterine fibroids, GPE, etc.

Endometriosis is a gynecological disease, accompanied by the formation of benign nodes that have a similar structure to the inner lining of the uterus. These nodes can be located both in the uterus itself and outside the organ. Particles of the endometrium, which every month are rejected by the inner wall of the uterus during menstrual bleeding, may not come out completely. Under certain conditions, some of them linger in the fallopian tubes, as well as other organs, and begin to grow, which leads to endometriosis. Women who experience frequent stress are more susceptible to the disease.

With a disease, the endometrium grows where it should not normally be. Moreover, cells outside the uterus continue to function in the same way as in its cavity, that is, increase during menstruation. Most often, endometriosis affects the ovaries, fallopian tubes, the fixing ligamentous apparatus of the uterus, and the bladder. But sometimes endometriosis is detected even in the lungs and on the mucous membranes of the nasal cavity.

Reasons for the development of endometriosis

Endometriosis can be called a disease with an unexplained etiology. So far, doctors have not been able to find the exact cause of its occurrence. There are only scientific theories on this subject, but none of them is proven. It is believed that risk factors for the development of endometriosis are frequent infections suffered in childhood, hormonal imbalance in the body, inflammation of the ovaries. As mentioned, endometriosis is often associated with uterine fibroids.

The theory of retrograde menstruation to date has found the greatest response among specialists involved in the study of the problem of endometriosis. The hypothesis boils down to the fact that during menstrual bleeding, particles of the uterine mucosa with the blood flow enter the peritoneal cavity and fallopian tubes, settle there and begin to function. While the menstrual blood from the uterus through the vagina enters the external environment, the blood secreted by endometrial particles that have taken root in other organs does not find a way out. As a result, microhemorrhages occur every month in the area of ​​​​endometriosis foci, which entail inflammatory processes.

Other theories that highlight the causes of endometriosis are as follows:

• implantation hypothesis. It boils down to the fact that endometrial particles are implanted in the tissues of organs, getting there with menstrual blood.

• metaplastic hypothesis. It boils down to the fact that endometrial cells do not themselves take root in areas unusual for them, but only stimulate tissues to pathological changes (to metaplasia).

However, until now there is no answer to the main question: why endometriosis develops only in some women, and not in all of the fairer sex. After all, retrograde menstruation is observed in each of them.

Scientists suggest that endometriosis develops only in the presence of the following risk factors:

• Immune disorders in the body.

• Hereditary predisposition to the development of the disease.

• A certain structure of the appendages, which leads to too much blood entering the peritoneal cavity during menstruation.

• High levels of estrogen in the blood.

• Age from 30 to 45 years.

• Excessive consumption of alcohol and drinks containing caffeine.

• Taking certain medications.

• Metabolic disorders leading to obesity.

• Shortening of the menstrual cycle.

When the immune system is working properly, it monitors and stops all pathological cell divisions in the body. Fragments of tissues that enter the peritoneal cavity along with menstrual blood are also destroyed by the immune system. They are destroyed by lymphocytes and macrophages. When the immune system fails, the smallest particles of the endometrium linger in the abdominal cavity and begin to engraft. Thus, endometriosis develops.

Postponed operations on the uterus increase the risk of developing the disease. This also includes curettage, abortion, cauterization of cervical erosion, etc.

As for the hereditary predisposition to endometriosis, science knows cases when in one family all female representatives suffered from the disease, starting with the grandmother and ending with the granddaughters.

Despite the fact that there are many theories of the development of endometriosis, none of them can 100% explain why the disease still manifests itself. However, it is scientifically proven that the risk of developing endometriosis is increased in those women who have undergone an abortion. Artificial termination of pregnancy is a stress for the body, which affects all systems without exception: nervous, hormonal, and sexual.

In general, those women who often experience emotional overload (stress, nervous shock, depression) are susceptible to endometriosis. Against their background, immunity fails, which allows endometrial cells to germinate more easily in other organs and tissues. As gynecological practice shows, those women whose professional activities are associated with increased nervous tension are more likely to be diagnosed with endometriosis.

Another risk factor for the development of the disease is living in an unfavorable environmental environment. Scientists have found that one of the most dangerous substances present in the air is dioxin. It is emitted in significant quantities by industrial enterprises. It has been proven that women who constantly breathe air with a high content of dioxin are more likely to suffer from endometriosis, even at a young age.

The following endogenous and exogenous factors can increase the risk of developing endometriosis:

• Installation of an intrauterine device.

• Taking hormonal contraceptives.

• Tobacco smoking.

Symptoms of endometriosis in women

Symptoms of endometriosis do not form a vivid clinical picture. Therefore, until a woman passes a high-quality diagnostic examination, she will not know about her disease. Often, even an examination on a gynecological chair using mirrors does not allow a diagnosis to be made. Therefore, it is worth paying attention to the symptoms of endometriosis. Moreover, every woman suffering from this disease always has a combination of several characteristic features.

First, it is the inability to conceive a child. Infertility is when a woman is unable to become pregnant with regular unprotected intercourse for a year. Endometriosis prevents an egg from being fertilized by a sperm or from retaining its viability. Pathological proliferation of endometrial cells leads to hormonal disruptions, prevents the production of hormones that are necessary for the normal course of pregnancy.

When endometriotic adhesions grow in the appendages, in the cervical region, this will lead to fusion of the organs and their walls with each other. As a result, obstruction of the fallopian tubes is formed, which is the main cause of infertility in women against the background of endometriosis.

Second, pain. The nature of pain in women suffering from endometriosis is different. Pain can be pulling and dull, present on an ongoing basis. Sometimes they are sharp and cutting and occur in the lower abdomen only periodically.

As a rule, pain due to endometriosis is not so pronounced that a woman should consult a doctor because of their occurrence. In most cases, they are considered symptoms of PMS, or the result of physical exertion.

Therefore, it is important to pay attention to the chronic nature of pain that regularly occurs during sexual intercourse, during the next menstruation and when lifting weights.

Thirdly, bleeding. The appearance of spotting after intercourse is one of the signs of endometriosis, regardless of the location of the nodes. When adhesions have formed in the area of ​​the organs of the urinary system or intestines, then drops of blood will be present in the feces or in the urine.

As a rule, the blood appears a few days before the start of the next menstrual cycle. Its release is accompanied by pain. After 1-3 days, the blood stops appearing, and after 1-2 days, the woman begins another menstruation.

During menstrual bleeding, blood clots are released from the vagina. Their appearance resembles pieces of raw liver. Therefore, if a woman observes this kind of discharge and she has other signs of endometriosis, then it is necessary to report her problem to the doctor.

Fourth, menstrual irregularities. It is almost always irregular in endometriosis.

A woman should be alert to the following points:

• The cycle is constantly changing.

• Menstruation may be absent for several months.

• Menstruation is prolonged and accompanied by profuse bleeding.

With such failures, you should not hesitate to contact the doctor. Otherwise, a woman runs the risk of acquiring serious health problems. If left untreated, endometriosis can provoke the formation of benign tumors, infertility and inflammation of the internal organs.

Symptoms of different forms of endometriosis

Signs of endometriosis in older women

Endometriosis develops not only in young, but also in older women over the age of 50 years. Moreover, after menopause, the risk of developing the disease increases, which is due to a lack of progesterone in the body.

The following factors can provoke the development of endometriosis in old age:

• Obesity;

• Diabetes;

• Diseases of the thyroid gland;

• Frequent infectious diseases suffered by a woman throughout her life;

• Multiple surgical interventions, and the place of their localization does not matter.

Symptoms of endometriosis in women over 50 may include:

• Nausea;

• Headache;

• Dizziness;

• Sometimes vomiting occurs;

• Increased irritability, tearfulness, aggressiveness.

Pain in the lower abdomen rarely disturbs older women.

Signs of internal endometriosis

The following symptoms will indicate internal endometriosis:

• Soreness of the affected area on palpation.

• Sharp pains during menstrual bleeding, which are localized in the lower abdomen.

• Increased pain during intimacy, after lifting weights.

An ultrasound diagnostician visualizes on the screen the characteristic nodes located on the wall of the uterus.

The picture of a clinical blood test is characterized by anemia, which is explained by regular bleeding.

Symptoms of illness after caesarean section

Endometriosis develops in women who have undergone a caesarean section in 20% of cases. Cells begin to grow in the area of ​​the scar and suture.

The following symptoms will indicate the disease:

• The appearance of bloody discharge from the seam;

• Slow overgrowth of the scar;

• Itching in the seam;

• The appearance of nodular growths under the seam;

• Drawing pains in the lower abdomen.

If a woman finds such symptoms in herself, she should contact a gynecologist and undergo an examination. In some cases, inpatient treatment is required.

Endometriosis, endometritis and uterine fibroids – what’s the difference?

Endometriosis, endometritis and uterine fibroids are different diseases.

Endometritis is an inflammation of the inner layer of the uterus, which develops against the background of the penetration of pathogenic microorganisms into its cavity. Endometritis is caused by viruses, bacteria, fungi, parasites. Endometritis does not affect other organs, only the uterus. The disease begins acutely, accompanied by fever, pain in the lower abdomen, discharge from the genital tract. Chronic endometritis resembles the symptoms of endometriosis.

Uterine fibroids is a benign tumor of the smooth muscle and connective layer of the uterus. Myoma develops against the background of hormonal disorders.

Are endometriosis and adenomyosis the same thing?

Adenomyosis is a type of endometriosis. In adenomyosis, the endometrium grows into the muscle tissue of the uterus. This disease affects women of reproductive age, and after the onset of menopause it goes away on its own. Adenomyosis can be called internal endometriosis. It is possible that these two pathologies will be combined with each other.

Why is uterine endometriosis dangerous?

Endometriosis of the uterus is dangerous for its complications, including:

• The formation of ovarian cysts that will be filled with menstrual blood.

• Infertility, miscarriage (missed pregnancy, miscarriage).

• Neurological disorders due to compression of the nerve trunks by the overgrown endometrium.

• Anemia, which entails weakness, irritability, increased fatigue and other negative manifestations.

• Foci of endometriosis can degenerate into malignant tumors. Although this occurs no more than in 3% of cases, nevertheless, such a risk exists.

In addition, the chronic pain syndrome that haunts a woman affects her well-being and worsens the quality of life. Therefore, endometriosis is a disease that is subject to mandatory treatment.

Can the stomach hurt with endometriosis?

The stomach can hurt with endometriosis. And sometimes the pain is quite intense. As mentioned above, the pain intensifies after intercourse, during intimacy, after physical exertion, when lifting weights.

Pelvic pain occurs in 16-24% of all women. It may have a diffuse character, or it may have a clear localization. Often the pain intensifies before the start of the next menstruation, but may also be present on an ongoing basis.

Nearly 60% of women with endometriosis say they have painful periods. Pain has a maximum intensity in the first 2 days from the onset of menstruation.

Diagnosis of endometriosis

Diagnosis of endometriosis begins with a visit to the doctor. The doctor listens to the patient’s complaints and collects an anamnesis. Then the woman is examined on a gynecological chair. During the examination, it is possible to detect an enlarged uterus, and it will be the larger, the closer the next menstruation. The uterus is spherical. If adhesions of the uterus have already formed, then its mobility will be limited. It is possible to detect individual nodules, while the walls of the organ will have a bumpy and uneven surface.

To clarify the diagnosis, the following examinations may be required:

1. Ultrasound examination of the pelvic organs. The following symptoms indicate endometriosis:

   • Anechogenic formations up to 6 mm in diameter;

   • The presence of a zone of increased echogenicity;

   • Enlargement of the uterus in size;

   • The presence of cavities with liquid;

   • The presence of nodes that have blurry forms, resembling an oval (with the nodular form of the disease), which reach 6 mm in diameter;

   • The presence of saccular formations up to 15 mm in diameter, if the disease has a focal form.

2. Hysteroscopy of the uterus. The following symptoms indicate endometriosis:

   • The presence of holes in the form of burgundy dots that stand out against the background of a pale uterine mucosa;

   • Expanded uterine cavity;

   • The basal layer of the uterus has a relief contour resembling a toothed comb.

3. Metrosalpingography. The study should be carried out immediately after the completion of the next menstruation. Signs of endometriosis:

   • Enlarged uterus;

   • The location of the contrast agent outside of it.

4. MRI. This study is 90% informative. But because of the high cost, tomography is rarely performed.

5. Colposcopy. The doctor examines the cervix using binoculars and a light fixture.

6. Identification of markers of endometriosis in the blood. Indirect signs of the disease is an increase in CA-125 and PP-12. It should be taken into account that a jump in protein-125 is observed not only against the background of endometriosis, but also in the presence of malignant neoplasms of the ovaries, with uterine fibromyoma, with inflammation, as well as in early pregnancy. If a woman has endometriosis, then CA-125 will be elevated during menstruation and in the second phase of the cycle.

Treatment of endometriosis of the uterus

Only complex treatment of endometriosis will achieve a positive effect.

With the timely detection of the disease, there is every chance to get rid of it without involving a surgeon in the treatment. In the event that a woman ignores the signs of the disease and does not visit a gynecologist, this will lead to the fact that every month new foci of endometriosis will appear in her body, cystic cavities will begin to form, tissue will scar, adhesions will form. All this will lead to blockage of the appendages and infertility.

Modern medicine considers several ways to treat endometriosis:

• Operation. Doctors try to resort to surgical intervention extremely rarely, when drug treatment has not given a positive result. The fact is that after the operation, the chance of conceiving a child in a woman will be low. Although the latest advances in medicine and the introduction of laparoscopes into surgical practice make it possible to carry out interventions with minimal trauma to the body. Therefore, the likelihood of subsequent conception still remains.

• Medical correction. Taking medications in the treatment of endometriosis is one of the most effective methods of treatment. A woman is prescribed hormones that help normalize the functioning of the ovaries and prevent the formation of foci of endometriosis.

The drugs that are used to treat the disease have a similar composition to oral hormonal contraceptives from the Decapeptyl and Danazol group. Treatment for a woman will be long, as a rule, it is not limited to several months.

To reduce the severity of pain, the patient is prescribed painkillers.

Until the early 80s, contraceptive drugs were used to treat endometriosis, which acted as an alternative to surgery. They were prescribed for a period of six months to a year, 1 tablet per day. Then the dose was increased to 2 tablets, which avoided the development of bleeding. After the completion of such medical correction, the probability of conceiving a child was 40-50%.

Medical treatment

• Antiprogestins – is one of the most effective drugs for the treatment of endometriosis. Its action is aimed at suppressing the production of gonadotropins, which causes the cessation of the menstrual cycle. After discontinuation of the drug, menstruation resumes. At the time of treatment, the ovaries do not produce estradiol, which leads to the extinction of endometriosis foci.

  Among these adverse events:

  • Weight gain;

  • Reduction in the size of the mammary glands;

  • swelling;

  • Tendency to depression;

  • Excessive growth of hair on the face and body.

• GnRH agonists – suppress the work of the hypothalamic-pituitary system, which leads to a decrease in the production of gonadotropins, and then affects the secretion of the ovaries. As a result, endometriosis foci die off.

  Side effects of treatment with GnRH agonists are:

  • Violation of bone metabolism with possible bone resorption;

  • Protracted menopause, which can persist even after the abolition of drugs in this group, which requires the appointment of hormone replacement therapy.

• Combined oral contraceptives (COCs). Clinical studies have established that they eliminate the manifestations of endometriosis, but have virtually no effect on metabolic processes, suppressing the production of estradiol by the ovaries.

Surgical treatment of endometriosis

Surgical treatment of endometriosis guarantees the removal of its foci, but does not rule out a recurrence of the disease. Often, women with this pathology have to undergo several interventions. The risk of recurrence varies between 15-45%, which largely depends on the degree of spread of endometriosis throughout the body, as well as on the location of the pathological process. It affects the possibility of relapse and how radical the first intervention was.

Laparoscopy is the gold standard of modern surgery for the treatment of endometriosis. With the help of a laparoscope inserted into the abdominal cavity, it is possible to remove even the most minimal pathological foci, remove cysts and adhesions, cut the nerve pathways that provoke the appearance of persistent pain. It is worth noting that cysts that are provoked by endometriosis must be removed. Otherwise, the risk of recurrence of the disease remains high.

Self-treatment of endometriosis is unacceptable. Therapeutic tactics should be determined by the doctor.

If endometriosis is severe, then it is necessary to remove the affected organ. This is also possible with the use of a laparoscope.

Doctors consider a woman cured of endometriosis if she is not bothered by pain and has not relapsed 5 years after the therapy.

If endometriosis is diagnosed in a woman of childbearing age, then doctors do their best to preserve her reproductive function. It should be noted that the level of modern surgery is quite high and allows women aged 20-36 years in 60% of cases to endure and give birth to a healthy child.

The use of endoscopes during surgery allows you to remove even the smallest foci of endometriosis. Further hormonal treatment makes it possible to avoid the recurrence of the disease. If endometriosis leads to infertility, then endoscopic treatment is practically the only chance a woman has for successful motherhood.

Endometriosis is a disease with dangerous complications. Therefore, it is so important to diagnose and treat it in a timely manner. The complex use of all modern technologies of surgical intervention: the combination of cryocoagulation, laser removal, electrocoagulation makes it possible to carry out the operation with the maximum chance of successful completion.

The most effective way to treat endometriosis is considered to be laparoscopy (of course, with the failure of conservative treatment) with further hormonal therapy. The use of GTRG after surgery increases its effectiveness by 50%.

Which doctor treats endometriosis?

Endometriosis is treated by an obstetrician-gynecologist.