How does endometriosis appear in women? What is endometriosis? Symptoms, treatment of gynecological pathology

Endometriosis is the appearance of cells in the inner layer of the uterus (endometrium) in atypical places: on the peritoneum, ovaries, fallopian tubes, the wall and cervix of the uterus, in the bladder, rectum and other organs and tissues.

This is one of the most mysterious female diseases... Despite the fact that this diagnosis is made quite often, the question - what kind of disease is it, why and how to treat it - often remains unanswered. But what if a woman with endometriosis is planning a pregnancy - is it necessary to do something in this case?

Statistics show that up to 30% of women of reproductive age suffer from endometriosis in one form or another.

What is it: causes of occurrence

Why does endometriosis occur, and what is it? The causes of the disease have not been established and remain the subject of controversy. Numerous hypotheses of endometriosis have been proposed, but none of them has become definitively proven and generally accepted.

1. One theory points to the process of retrograde menstruation, when part of the menstrual tissue enters the abdominal cavity, grows into it and grows.
2. The genetic theory puts forward the point of view that the genes of some families contain the rudiments of endometriosis and, thus, members of these families are prone to endometriosis.
3. There is also a theory that explains the occurrence of endometriosis by the fact that tissue affected by endometriosis spreads to other parts of the body through the lymphatic system.
4. Others believe that the remnants of tissue from the phase when the woman was in its infancy may subsequently develop into endometriosis, or that part of this tissue, under certain conditions, does not lose its ability to reproduce.

The likelihood of the disease increases with:

• frequent inflammation of the genitals;
• tumors ();
• difficult childbirth;
• operations on the uterus;
• abortion;
• drinking alcohol;
• smoking;
• excessive "love" for products containing caffeine;
• organ dysfunction endocrine system (thyroid, adrenal, hypothalamus,
• pituitary gland, female reproductive glands);
• reduced immunity.

Despite the research data, the real frequency of endometriosis is unknown, due to the fact that in most cases the disease is asymptomatic and very difficult to diagnose.

Therefore, regularly undergo a preventive examination by a gynecologist. This is especially important for those who have had any operations on the uterus (abortion, cesarean section, cauterization of cervical erosion, etc.). Timely diagnosis is the key to successful treatment without consequences.

Is it possible to get pregnant with endometriosis?

Endometriosis significantly reduces a woman's chances of becoming pregnant, but it cannot harm the development of the fetus. If a woman with endometriosis does conceive a child, there is every reason to believe that the symptoms of the disease will become significantly weaker during the entire period of pregnancy.

If you are sick with endometriosis, before you start trying to conceive a child, be sure to discuss with your gynecologist the possibility and risks of pregnancy in your particular case.

Endometriosis symptoms

The symptomatology of this disease is so diverse that it can sometimes mislead even experienced specialists. Endometriosis of the uterus can be accompanied by both pronounced symptoms and their absence at all.

However, certain symptoms should definitely alert a woman:

1. Pain of varying intensity, up to acute. They can be localized, given to the groin, anus, leg. Pain either occurs in the first days of menstruation, and disappears with the end of it, or does not leave the woman throughout the entire cycle, but at the end of menstruation they weaken.
2. Smearing dark spotting from the genital tract 2-5 days before and after menstruation, especially if these same menstruation is quite abundant and prolonged;
3. Uterine bleeding during the intermenstrual period (metrorrhagia);
4. Spotting discharge can be during sexual intercourse.

Menstruation with endometriosis becomes profuse, with clots, which leads to the development of chronic post-hemorrhagic anemia:

• brittle nails
• dyspnea,
• weakness, drowsiness
• dizziness,
• pallor skin and mucous membranes,
• frequent and so on.

Unfortunately, in some cases, the symptoms of endometriosis are very mild or nonexistent. For this reason, you should visit the gynecologist's office once every six months. Only timely diagnosis can protect against the development of undesirable consequences of endometriosis.

Endometriosis 1, 2 and 3 degrees

In the uterine wall, foci of endometriosis are detected at different depths, so endometriosis of the uterine body can have four degrees of distribution:

• 1 degree. There are one or more small foci of endometriosis.
• 2nd degree. There are several small foci of endometriosis that penetrate into the thickness of the organs affected by them.
• 3 degree. There are many superficial foci and several deep foci of endometriosis or several cysts on the ovaries ("chocolate" cysts - the name comes from the characteristic dark brown color of the cysts given to the cysts by disintegrating blood).
• 4 degree. Diagnosed with multiple and deep foci of endometriosis, multiple, large cysts on the ovaries, adhesions between the pelvic organs.

There is no linear relationship between the extent of endometriosis and the severity of symptoms. Often, common endometriosis is less painful than mild endometriosis, in which there are only a couple of small lesions.

Diagnostics

IN effective treatment endometriosis, the most important point is timely and correct diagnosis. You can determine the presence of endometriotic foci using:

• x-ray contrast methods (hysterosalpingography)
• endoscopic examinations (for example, hysteroscopy),

However, the complaints and clinical symptoms listed above are of great importance. Sometimes endometriosis is also diagnosed during pregnancy - as a result, the treatment of such patients is ineffective due to the difficulties in choosing a drug that minimally affects the fetus.

Prevention

The main activities aimed at preventing endometriosis are:

• specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) in order to exclude endometriosis;
• observation of patients who have undergone abortion and others surgical interventions on the uterus to eliminate possible consequences;
• timely and complete cure of acute and chronic pathology of the genitals;
• taking oral hormonal contraceptives.

Complications

Endometriosis of the uterus may be asymptomatic and not affect the quality of a woman's life. On the other hand, endometriosis not diagnosed in time and the lack of adequate treatment can lead to complications.

Most likely consequences:

• adhesive process in the small pelvis;
• impaired fertility;
• anemia due to profuse bleeding;
• endometrioid cysts;
• malignancy.

How to treat endometriosis

Endometriosis treatment methods have been improved for many years and are currently divided into:

• surgical;
• medicinal;
• combined.

Medicinal methods of therapy include the use of various groups of drugs:

• combined estrogen-gestagenic drugs;
• gestagens, antigonadotropic drugs;
• agonists of gonadotropic releasing hormones.

The earlier a woman is diagnosed, the more likely she is to use only medication.

Conservative therapy

Conservative treatment is indicated for the asymptomatic course of endometriosis of the uterus, at a young age, in the permenopausal period, with adenomyosis, endometriosis and infertility, when it is necessary to restore fertility.

The drug treatment path includes a fairly traditional therapy:

• hormonal;
• anti-inflammatory;
• desensitizing;
• symptomatic.

The main drugs with proven effect for the treatment of confirmed endometriosis are:

• progesterone preparations;
• danazol;
• gestrinone (Nemestran);
• gonadotropin-releasing hormone (GnRH) agonists;
• monophasic combined oral contraceptives.

Duration of courses hormone therapy and the intervals between them are determined by the results of treatment and the general condition of the patient, taking into account the tolerance of drugs and indicators of functional diagnostics tests.

Other groups of drugs, "helpers" in the fight against painful symptoms of the disease:

• (anti-inflammatory therapy);
• antispasmodics and analgesics (analgesic action);
• sedatives (elimination of neurological manifestations);
• vitamins A and C (correction of the deficiency of the antioxidant system);
• iron preparations (elimination of the consequences of chronic blood loss);
• physiotherapy.

Currently, research is underway in the world on the possibility of using immunomodulators for the treatment of endometriosis, especially for the treatment of associated infertility.

Surgical treatment of endometriosis

Surgical intervention is indicated in the absence of the effect of conservative therapy for 6-9 months, with endometrioid ovarian cysts, with endometriosis postoperative scars and the navel, with continued stenosis of the lumen of the intestine or ureters, with intolerance hormonal agents or the presence of contraindications to their use.

Surgical methods for the treatment of endometriosis are to remove endometriotic formations (most often cysts) from the ovaries or other lesions. Modern surgery gives preference to sparing operations - laparoscopy.

After removal of the foci of the disease, physiotherapeutic and drug treatment is shown to consolidate the result and restore the cycle. Severe endometriosis is treated by removing the uterus.

Treatment results vary by volume surgical intervention, on the usefulness of hormone therapy. Rehabilitation period in most cases, it goes well: fertility is restored, pain during menstruation is significantly reduced. After treatment, dynamic observation by a gynecologist is recommended: gynecological examination, ultrasound control (once every 3 months), control of the CA-125 marker in the blood.

Endometriosis prognosis

This disease often recurs. For example, the rate of recurrence of endometriosis after surgery to remove lesions during the first year is 20%, that is, 1 in 5 women operated on during the first year after surgery will again face the same problems as before the surgery.

Hormonal correction has good effect, but the problem of this method of treatment lies in the disruption of the process of natural maturation of the endometrium of the uterus, and therefore in the impossibility of the natural conception of a child. With the onset of pregnancy, as a rule, for the entire period of pregnancy, the symptoms of endometriosis disappear. With the onset of menopause, endometriosis also disappears.

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

Endometriosis of the uterus - what to expect for a woman who has heard such a diagnosis? In the structure of gynecological pathology, this disease occupies one of the leading positions. Recently, there has been a tendency to rejuvenate the disease and increase its prevalence.

The disease leads to disturbances in the reproductive system, negatively affects the psychoemotional state of patients and can significantly reduce their quality of life.

In this article, we will try to talk about the disease in an accessible language with a minimum of necessary medical terms.

What it is?

In simple terms, endometriosis is a common gynecological disease in which the cells of the endometrium (the inner layer of the uterine wall) grow outside this layer. It develops in women of reproductive age.

Since the endometrioid tissue has receptors for hormones, the same changes occur in it as in the normal endometrium, manifested by monthly bleeding. These minor bleeding leads to inflammation in the surrounding tissues and causes the main manifestations of the disease: pain, enlargement of the organ, infertility.

The symptoms of endometriosis in women depend on the location of its foci.

Development reasons

The disease we are considering is polyetiological, which, in turn, indicates the presence of many different probable causes that cause it. At the same time, as has already been highlighted, the true cause of endometriosis has not yet been determined. Let's dwell on some of the options that are currently considered as the main ones.

1. Retrograde menstruation. Or, as it is called, "reverse" menstruation. This phenomenon determines the following process: a certain amount of menstrual blood secreted during menstruation is directed into the abdominal cavity through the fallopian tubes. Menstruation according to this "scenario" is not uncommon, moreover, it is often found in healthy women. The only difference from patients with endometriosis is that in healthy women, the immune system suppresses the endometrium, preventing it from growing in the area in which it finds itself, that is, in abdominal cavity.
2. Disorders immune system... This cause is also considered a putative factor in the development of endometriosis. If the immune system is weakened, then being in the abdominal cavity with the already considered variant of "reverse" menstruation, the endometrial cells not only do not break down, but also attach to the tissues and organs located here, thereby forming foci of endometriosis.
3. Endometrial metaplasia. This factor implies such a transformation in which one tissue is transformed into another. There is a theory according to which the endometrium, once outside the uterus, can transform into another tissue in a similar way. Meanwhile, the reasons for metaplasia are currently unclear, moreover, any assumptions about it generate a lot of controversy among researchers.
4. Hormonal changes. This factor is also thought to contribute to the development of endometriosis. The fact is that the endometrium is quite sensitive to the effects of female sex hormones, the foci of endometriosis react to them in a similar way. The growth of such foci, for example, is facilitated by female sex hormones, estrogens.
5. Gynecological surgery. Any kind of surgical intervention, and this is curettage (curettage), abortion, cesarean section, cauterization of erosion, etc. - all this is considered to be significant predisposing factors to the development of endometriosis.
6. Heredity. This factor is relevant in many diseases that a person has to deal with, and endometriosis can also be considered as a disease associated with this factor. Accordingly, it is believed that the risk of developing the disease in question increases if the closest relatives have it.

In addition, there are factors that directly provoke the development of the disease. Most often, they are hormonal imbalances and pathology in the work of the immune system. Such predisposing processes are:

• Oppression of the natural protective properties of the body;
• Decreased functional activity of granular lymphocytes;
• Inhibition of genetically determined cell death;
• Hyperestrogenism;
• Progesterone metabolism disorder;
• Hyperprolactinemia;
• Hypersecretion of vascular endothelial growth factor.

Classification

Allocate genital (in the uterus, its canal and cervix) and extragenital endometriosis (foci of inflammation are observed in other organs).

Genital endometriosis of the uterine body is of two types: internal and external.

Internal (another name -) - damage to the uterus. Quite often, this type of disease accompanies fibroids. External affects the vagina, cervix, perineum, peritoneum, fallopian tubes, ovaries (endometriosis of the right or left ovary).

Depending on which organs the endometrium settles on, endometriosis of the ovaries, fallopian tubes, intestines, bladder, uterus, cervix and other organs.

This type of endometriosis, as diffuse, is characterized by consistent damage to the uterine tissue. Layer by layer, gradually endometrial cells invade and grow into the tissues that form the uterus. The problem of treatment is the absence of foci, since the entire uterus is evenly affected.

Endometriosis symptoms

For a long time, endometriosis does not manifest itself in any way, the disease proceeds without noticeable symptoms. In this regard, on early stages development, the disease is diagnosed very rarely.

The main signs of endometriosis in women are:

1. Infertility not associated with a history of other medical conditions.
2. Perceived discomfort and frequent, obvious pain during intercourse.
3. Bloody smearing vaginal discharge, almost chocolate color, both before and after menses.
4. Pain arising during urination and pink color of urine (develops with endometriosis of the urinary system).
5. Constipation, frequent urge to "go small" (with involvement in the development of pathology of the intestines and organs of the urinary system).
6. Failure and various violations of the female menstrual cycle, accompanied by severe enough bleeding, soreness.
7. Intense, sharp nagging pain in the lower abdomen, as well as in the lumbar region of the spine, at first associated with the onset of menstruation, but as the disease manifests itself independently of it.

None of these symptoms, or the presence of all of them together, makes it possible to assert the presence of a diagnosis of endometriosis. These are just those signal beacons that should serve as a reason for an immediate visit to the gynecologist!

Degrees

According to the distribution and depth of tissue damage by endometriosis, 4 degrees of the disease are distinguished:

• I degree - single superficial foci.
• II degree - several deeper foci.
• III degree - many deep foci of endometriosis, small endometrioid cysts of one or both ovaries, thin adhesions of the peritoneum.
• IV degree - Many deep foci, large bilateral endometrioid ovarian cysts, dense adhesions of organs, invasion of the vagina or rectum.

Diagnostics

The diagnosis begins with clarifying the patient's complaints, which are manifested by pain and malaise associated with menstruation. In addition to questioning, the following methods are of great importance in diagnosis:

Routine gynecological examination (both vaginal and rectal, with palpation of the anterior abdominal wall).

On the eve of menstruation, dense formations can be found that can bulge into the lumen of hollow organs. These are nothing more than endometrioid cysts. They cannot decrease because there is no way out of the cysts. They are only threatened with a gradual increase with each subsequent period until the cyst ruptures.

1. CT and MRI. With these imaging techniques, localizations of various cysts are visible.
2. Laparoscopy with the possibility of biopsy in the case of extragenital endometriosis.
3. Hysteroscopy. During examination of the uterus, lesions can be seen, similar to those seen with colposcopy.
4. Colposcopy. In some cases, with the localization of foci on the cervix and the walls of the vagina, you can see specific eyes, or bluish nodules.
5. Ultrasound procedure. It is a modern, fast, accurate and painless way to determine the localization, size, internal structure of a cyst, and, in some cases, to give a prognosis.

In addition to these general diagnostic methods, others are used - in each case to search for a lesion of a particular localization.

Effects

The most common complication in sick women is the inability to become a mother now or in the future. According to doctors, every second woman who suffers from infertility has endometriosis. Infertility occurs in 40-60% of patients.

Its causes are usually:

1. Violation of the course of the ovulation process.
2. Formed adhesions in the area of \u200b\u200bthe ovaries and fallopian tubes.
3. Due to a violation of the flow of the menstrual cycle, an inferiority of the endometrium occurs.
4. Inflammation around the lesions of the endometrium leads to the formation of adhesions, which disrupt the functioning of internal organs and cause pain.
5. Too many hormones of an inflammatory kind that prevent the egg from attaching properly to the walls of the genital organ.

Endometriosis and pregnancy

Endometriosis interferes with a woman's fertility, but this does not mean that pregnancy is impossible or contraindicated. On the contrary, many experts recommend pregnancy, as it has a beneficial effect on the course of the disease. The fact is that during pregnancy there is a state of prolonged anovulation, menstruation is absent, and the body is under the influence of progesterone for 9 months. All these conditions contribute to the regression of heterotopies.

However, endometriosis itself is a risk factor in pregnancy, as it can pose a threat of miscarriage. Therefore, it is recommended to carry out pregravid training for women suffering from endometriosis, and during pregnancy to prevent miscarriage and placental insufficiency. To do this, it is recommended to visit a gynecologist even before pregnancy, and register as early as possible.

Endometriosis has no direct effect on the child, so there is no need to fear for the baby's health. However, an indirect effect can manifest itself in the development of placental insufficiency, when the child does not receive a sufficient amount nutrients and oxygen due to malfunction of the placenta.

How is endometriosis treated?

The generally accepted and only effective today methods of treating endometriosis in women are:

• therapeutic (conservative, medication);
• surgical organ-preserving (laparoscopy and laparotomy), providing for the removal of foci of endometriosis while preserving organs;
• surgical radical with removal of the uterus and ovaries;
• combined.

Conservative treatment is indicated for asymptomatic disease, at a young age, in the premenopasual period, with adenomyosis, endometriosis and infertility, when it is necessary to restore fertility. The drug route of treatment includes a fairly traditional therapy: hormonal, anti-inflammatory, desensitizing and symptomatic. And in no case need to deal with the treatment of endometriosis. folk ways... At the first symptoms, urgently contact a specialist!

The selection of the treatment method in each case is individual and depends on many factors (the patient's age, the desire to preserve fertility, the severity of the disease, the presence / absence of concomitant pathology, etc.).

Several hormones are currently used to treat women with endometriosis:

1. Medroxyprogesterone acetate is used at 30-50 mg per day for 3-4 months. Side effects of medroxyprogesterone acetate: decreased sex drive and increased body weight.
2. Nemestran is used at a dosage of 2.5 mg 2 times a week. The timing of the cessation of menstruation varies depending on the dosage used and the initial characteristics of the menstrual cycle. The normal menstrual cycle is restored approximately 4 weeks after stopping treatment. The pain caused by endometriosis weakens or disappears by the second month of treatment in half of the patients. Of side effects, which, as a rule, are moderately expressed, are most often noted: weight gain, acne and seborrhea, excess hair growth. Less commonly, there is a coarsening of the voice, a decrease in the mammary glands, edema, headaches, depression, hot flashes, nausea, allergic reactions.
3. Zoladex (goserelin) is administered subcutaneously at a dose of 3.6 mg once every 26 days, and decapeptyl depot, the introduction of 3.75 mg of which intramuscularly 1 time, ensures its effect for 28 days. By the end of the course of treatment, the intensity of pain decreases by an average of 4 times.
4. Danazol is used for 6 months. After 1-2 months of treatment with danazol, amenorrhea (cessation of menstrual flow) usually occurs. The menstrual cycle is restored 28–35 days after stopping treatment. Efficacy depends on the dose: for a relatively mild or moderate disease, a dose of 400 mg / day is sufficient, but in severe cases (with stages III – IV of endometriosis), the dose may be increased to 600–800 mg / day. Side effects of danazol: weight gain, increased appetite, acne, seborrhea, coarsening of the voice, excess hair growth, disturbances in the activity of the gastrointestinal tract and liver, allergic reactions, hot flashes, dryness of the vaginal mucosa, decreased sex drive - limit the use of this drug.

In addition to basic treatment for adjunctive therapy can prescribe anti-inflammatory, spasm-relieving, sedative drugs: "Novo-Passit", "Ibuprofen", "No-shpa", as well as vitamins.

Surgical treatment of endometriosis

Surgical treatment most often means laparoscopy (microsurgical intervention), less often - in severe cases, laparotomy (dissection of the abdominal wall) is performed.

Modern hormone therapy is very effective in the fight against endometriosis. However, in some cases and certain forms of endometriosis, strictly surgical treatment is indicated:

• with retrocervical endometriosis;
• in violation of the function of neighboring organs;
• with the ineffectiveness of conservative therapy;
• with a combination of adenomyosis, fibroids and uterine bleeding;
• with oncological alertness - a probable ovarian tumor;
• in the presence of an endometrioid ovarian cyst and complications leading to pelvioperitonitis.

Laparoscopy is performed using electrocoagulation or laser - cauterize or remove foci of endometriosis. As a rule, surgical treatment is always combined with conservative treatment, that is, combined treatment is considered to be the “gold standard”. Hormones from the GnRH group are prescribed for 3-6 months, then laparoscopy is performed. Or another option is possible with a common form of endometriosis - first they carry out surgery, then conservative.

The results of treatment depend on the volume of surgery, on the usefulness of hormone therapy. The rehabilitation period in most cases is favorable: fertility is restored, pain during menstruation is significantly reduced. After treatment, dynamic observation by a gynecologist is recommended: gynecological examination, ultrasound control (once every 3 months), control of the CA-125 marker in the blood.

Can endometriosis be completely cured?

Endometriosis of the uterus is a recurrent chronic illness... Relapses after conservative therapy or organ-preserving surgeries occur within a year in 20% of cases, after 5 years of disease development, the number of relapses increases to 75%. With combined treatment (conservative and surgical organ-preserving intervention), a more lasting effect is observed, but exacerbations are still inevitable.

The most optimistic prognosis of adenomyosis in women during premenopause, since the activity of the disease subsides with physiological extinction of ovarian function (see hormonal and non-hormonal drugs in menopause).

Endometriosis - this is a pathology of the internal organs of a woman, expressed by the proliferation of tissue on them, similar to the endometrium - the tissue lining the uterus from the inside.

Endometrium and its structure

To understand the physiology of the disease, it is necessary to define the concepts of "menstruation" and "endometrium".

- the inner layer of the uterine lining (from the Greek "endo" - inside, "meter" - the uterus). The endometrium is complexly structured. Its first layer is called basal, the second, which comes out with the blood during the menstrual period, is functional.

In the event of pregnancy, the fertilized egg attaches to the functional layer of the endometrium and no rejection occurs. The basal layer is the basis for the growth of the functional layer.

Menstruation in gynecology, the process of endometrial rejection under the influence of sex hormones is called, which normally occurs at intervals of one month. Menstrual flow is made up of endometrial cells mixed with blood.

In addition to the vagina, a small amount of menstrual flow enters the fallopian tubes, entering the peritoneal cavity, where it is destroyed by special protective cells.

But there are times when menstrual flow is not completely destroyed, and endometrial cells, once in the cavity of the pelvic organs, attach to the tissues of various organs and begin to grow, forming endometrioid tissue.

The endometrioid tissue differs from that of the endometrium that is located inside the surface of the uterus. Such tissue is more resilient. Getting into other organs, it spreads and actively develops, independently going through phases similar to the endometrium: growth and menstruation, disrupting the proper functioning of the woman's reproductive system.

Endometriosis can spread in the organs of the genital area (on the ovaries, in the bladder, fallopian tubes), in the organs of the genital area (genital) and outside it (in the lungs, in the spinal cord and brain). This pathology is common especially among women before menopause.

According to the latest data, there is a trend towards the spread of the disease among young women and even adolescents. The disease has a negative moral impact on patients, worsens the quality of life, and causes pathologies of the reproductive system.

Therefore, timely diagnosis of signs of the disease and treatment in the early stages, prevention of the chronic form are important. With endometriosis, a combination is possible severe pain in the area of \u200b\u200bthe pelvic organs and adhesions. This is due to the arrest of nerve endings on the surface of internal organs.

Most often, the uterus, ovaries, rectum and bladder are affected by endometrioid tissue. Endometriosis of the cervix is \u200b\u200bnot so common and, according to statistics, occurs less often than other forms.

The causes of endometriosis

Until now, scientists argue about the causes of the development of endometriosis.

Here are the most common causes given by doctors:

The following factors can provoke the disease:

• Infectious and inflammatory processes of the reproductive system;
• surgical interventions in the uterine cavity;
• difficult childbirth;
• anemia, lowered immunity;
• violation of hormonal balance, endocrine system;
• irregular menstrual cycle;
• long-term contraception with intrauterine devices;
• the presence of malignant tumors;
• the use of alcohol, as well as substances containing nicotine, caffeine.

Endometriosis can occur due to a combination of several factors at the same time. Endometriosis is usually accompanied by an increase blood pressure (hypertension), weight gain and diabetes.

Diagnostics of the endometriosis of the uterus

If symptoms of endometriosis appear, you should consult your gynecologist. It is possible to make a diagnosis only after collecting anamnestic data and comprehensive survey the patient.

To make a diagnosis, determine the location of pathological foci, the degree of the disease, resort to the following types of examinations:

There is a known case of a patient who consulted a gynecologist at the age of 31 due to infertility. At the age of 26, she had an unplanned pregnancy, which was terminated by an abortion. Based on the results of the examination, the doctor diagnosed secondary infertility. The patient did not have complaints of painful menstruation or menstrual irregularities, but was agitated. The doctor recommended that the patient, in addition to the standard examination for infertility, undergo ultrasound procedureto confirm or rule out endometriosis. The test results and ultrasound scan confirmed the doctor's assumption. The woman was diagnosed with endometriosis or uterine adenomyosis. After a course of treatment for a period of 2 years, the woman managed to become pregnant and successfully bear the child. The birth was successful, but it cost a lot of work and money.

Types of endometriosis

Depending on the localization of the foci of the disease, genital (inside or outside the genital organs, surface of the uterus) and extragenital (outside the genital organs) endometriosis are distinguished.

Endometriosis is classified according to the affected organs:

The degree of development of the disease

There are 4 degrees of endometriosis development:

1. 1st degree - the initial stage of the disease, in which single foci of pathological changes are formed;
2. 2nd degree characterized by a deeper penetration of endometrioid cells into the tissues of the affected organs;
3. Grade 3 expressed by an increase in the number of foci of endometriosis, spread over the entire surface of the uterus and ovaries, by the formation of adhesions;
4. 4 degree expressed by the presence of numerous foci, endometrioid lesions of the ovaries and adhesions.

Endometriosis symptoms

Endometriosis is known for its asymptomatic course. The presence of a disease can be detected by chance, by seeking advice for another reason. It is necessary to visit the gynecologist regularly and undergo examinations.

Diagnosis of endometriosis is complicated by symptoms similar to a number of other diseases of the genital organs. Therefore, for an accurate diagnosis, a comprehensive examination is necessary.

There are the following symptoms characteristic of endometriosis:

• Pain in the pelvic area (painful sensations occur a few days before menstruation, during intercourse or during bowel movements);
• Nausea, vomiting, weakness, similar to the symptoms of poisoning - a consequence of an increase in the level of leukocytes in the blood and the development of endometriosis;
• Disruption of the menstrual cycle, as evidenced by spotting in the middle of the cycle, the protracted nature of menstruation, a tangible deterioration general condition organism;
• Difficulty getting pregnant. Endometriosis in most cases directly indicates the development of infertility.

Treatment of endometriosis of the uterus

It is necessary to approach the treatment of endometriosis in a comprehensive manner, conduct an examination and draw up a course of treatment, taking into account the following factors, such as pregnancy planning, the patient's age, the degree of development of the disease, and the localization of foci of the disease.

Conservative treatment

The following methods are used for treatment:

• Anti-inflammatory drugs;
• Vitamins and mineral supplements;
• Sedatives;
• Preparations for maintaining immunity;
• Physiotherapy procedures

Operative treatment

There are two types:

In addition, for a speedy recovery, it is recommended to take the following measures:

1. To lead healthy image life. Meals should include fresh fruits and vegetables, foods rich in omega-3 fatty acids (nuts, sea fish, vegetable oils). Foods containing sugar, caffeine, alcohol contribute to increased pain. They should be discarded;
2. Move more. An active lifestyle helps to keep the body in good shape, helps to speed up metabolism and improve mental health;
3. Avoid toxins. Toxins are found in the environment, air, water, food. It is necessary to periodically cleanse the body of toxins, strive to live in a healthy ecological environment;
4. Find support. Struggling with the disease, it is important for a woman to have psychological strength, to be positive.

Treatment with hormonal drugs

With the onset of menopause, we can talk about a less aggressive course of the disease, which is associated with a change in the hormonal background of a woman. But it is also possible for the disease to flow into another phase with new symptoms and the nature of the treatment.

About successful treatment and recovery can be said in the absence of symptoms of the disease and endometrioid growths.

Home treatment

When diagnosing endometriosis, do not rely on homeopathy and folk remedies... But in conjunction with a therapeutic course of treatment, vitamins and biological supplements to food, as well as folk recipes are effective enough.

Many women also use hirudotherapy and acupuncture treatments. The use of these funds is best done after consultation and under the supervision of the attending physician.

Homeopathic candles (with herbs and sea buckthorn) or dipped in sea \u200b\u200bbuckthorn oil tampons. Sea buckthorn possesses useful properties and substances that have a beneficial effect on the female reproductive system.

Another home treatment method is douching with herbal solutions. For these purposes, tinctures and decoctions of sage, red brush, St. John's wort, and yarrow are used. The most popular plant for treating diseases of the pelvic organs is the boron uterus, which is also available in drops in pharmacies.

Before using herbal medicine, you should consult a doctor, as some plants have contraindications for use.

Recipes:

• Recipe 1: 1 tablespoon of St. John's wort must be poured with a glass of boiling water and placed in a boiling water bath for 15 minutes. Then cool to room temperature and take 4 tablespoons 3 times a day.
• Recipe 2: 2 tablespoons of sage, pour 0.5 liters of boiling water and let it brew for 1 hour. Drink during the day.
• Recipe 3: Pour 1 tablespoon of borax uterus herb with a glass of boiling water, then boil for 15 minutes over low heat. Let it brew for 2 hours. Take 2 tbsp. l. 3 times a day.

The consequences of endometriosis

More than 60% of women suffer from infertility, which has arisen against the background of developed endometriosis, as:

Pregnancy with endometriosis

Pregnancy with endometriosis is possible, it should be under constant medical supervision. In the first three months, there is a high probability of miscarriage, so the doctor prescribes hormonal drugs to maintain the pregnancy.

The risk of miscarriage decreases after the formation of a placenta not affected by endometriosis, which is capable of forming hormones on its own. After childbirth, as a rule, the disease returns again, so treatment must be continued again.

Prognosis for endometriosis of the uterus

The prognosis for endometriosis is positive in most cases. The result of treatment, first of all, depends on the stage at which the disease was detected. With treatment in the early stages of endometriosis, the chances of finally getting rid of the disease are higher.

Launched forms may require surgery and lead to infertility. Removal of the uterus with the help of surgical procedures provides women with an acceptable quality of life after menopause.

Can endometriosis be permanently cured? Endometriosis is treatable if it is not detected at an advanced stage. The prognosis of treatment in the early stages of the disease is positive. The earlier the disease is detected and measures are taken, the more effective the treatment will be.

Prevention of the disease

The best prevention of endometriosis - timely diagnosis and a healthy lifestyle. In women with realized reproductive function and the absence of surgical interventions in the pelvic organs, the risk of endometriosis is reduced.

Preventive measures can prevent or slow down the onset of the disease if the disease is hereditary.

These measures include primarily:

Special attention should be paid to the need preventive measures in the following cases:

• when the duration of the menstrual cycle changes;
• with an increase or a sharp decrease in weight, indicating that the metabolism is impaired;
• women over the age of 40;
• with an increase in estrogen levels.

For the timely detection of the disease, it is necessary to regularly visit a gynecologist (at least 3 times a year) and take tests.

These are hormone-dependent pathological growths of the glandular tissue of the uterus (endometrium) outside of it: in the ovaries, in the fallopian tubes, in the thickness of the uterus, in the bladder, on the peritoneum, in the rectum and other organs. Clinical manifestations depend on the localization of the process. Common symptoms - pelvic pain, enlargement of endometriotic nodes, spotting from the outer areas before and during menstruation. Diagnostics includes a gynecological examination, ultrasound, hysteroscopy. Treatment - hormone therapy, surgical removal gerotopy, in severe cases, a hysterectomy is required.

ICD-10

N80

General information

Endometriosis is a pathological benign proliferation of tissue, morphologically and functionally similar to the endometrium (uterine lining). It is observed both in various parts of the reproductive system and outside it (on the abdominal wall, the mucous membrane of the bladder, intestines, pelvic peritoneum, lungs, kidneys, and other organs). Fragments of the endometrium (heterotopia), growing in other organs, undergo the same cyclical changes as the endometrium in the uterus, in accordance with the phases of the menstrual cycle. These changes in the endometrium are manifested by pain, an increase in the affected organ in volume, monthly bloody discharge from heterotopia, a violation menstrual function, secretions from the mammary glands. Genital endometriosis can cause ovarian cysts, menstrual irregularities, and infertility.

Endometriosis is the third most common gynecological disease, after inflammatory processes and uterine fibroids. Endometriosis in most cases occurs in women in the reproductive period, that is, at the age of 25-40 years (about 27%), occurs in 10% of girls during the formation of menstrual function and in 2-5% in women in menopause. Difficulties in diagnosis, and in some cases the asymptomatic course of endometriosis suggest that the disease is much more common.

Endometriosis causes

There is no consensus among experts about the causes of endometriosis. Most of them lean towards the theory of retrograde menstruation (or implantation theory). According to this theory, in some women, menstrual blood with endometrial particles gets into the abdominal cavity and fallopian tubes - the so-called retrograde menstruation. Under certain conditions, there the endometrium attaches to the tissues of various organs and continues to function cyclically. In the absence of pregnancy, the endometrium from the uterus is rejected during menstruation, while microbleeding occurs in other organs, causing inflammatory process.

Other theories of the development of endometriosis, which are not widespread, consider gene mutations, abnormalities in the function of cellular enzymes and the reaction of receptors to hormones as its causes.

Risk factors

Women who have such a feature as retrograde menstruation are prone to developing endometriosis, but not in all cases. The following factors increase the likelihood of endometriosis:

• Heredity. The role of hereditary predisposition to the development of endometriosis and its transmission from mother to daughter is very high.
• Surgical interventions on the uterus: surgical termination of pregnancy, cauterization of erosion, cesarean section, etc.
• Immunosuppression.
• Violations metabolic processes, obesity, overweight.
• Use of intrauterine contraceptives.
• Age after 30-35 years.
• Increased estrogen levels.
• Smoking.

Pathomorphology

Endometrioid foci can vary in size and shape: from rounded formations a few millimeters in size to shapeless growths a few centimeters in diameter. They are usually dark cherry in color and are separated from the surrounding tissues by connective tissue whitish scars. The lesions of endometriosis become more noticeable on the eve of menstruation due to their cyclical maturation. Spreading over internal organs and the peritoneum, areas of endometriosis can grow deep into the tissue or be located superficially.

• Development of post-hemorrhagic anemia

Occurs due to significant chronic blood loss during menstruation. It is characterized by increasing weakness, pallor or yellowness of the skin and mucous membranes, drowsiness, fatigue, dizziness.

• Infertility.

In patients with endometriosis, it is 25-40%. So far, gynecology cannot accurately answer the question of the mechanism of the development of infertility in patients with endometriosis. Among the most likely causes of infertility are changes in the ovaries and tubes due to endometriosis, violation of general and local immunity, concomitant violation of ovulation.

With endometriosis, we should talk not about the absolute impossibility of pregnancy, but about its low probability. Endometriosis dramatically reduces the chances of carrying a child and can provoke a spontaneous miscarriage, therefore, pregnancy management with endometriosis should be carried out with constant medical supervision. The likelihood of pregnancy after endometriosis treatment ranges from 15 to 56% in the first 6-14 months.

Complications

Hemorrhages and cicatricial changes in endometriosis cause the development of adhesive processes in the small pelvis and abdominal organs. Another common complication of endometriosis is the formation of endometrioid ovarian cysts filled with old menstrual blood ("chocolate" cysts). Both of these complications can cause infertility. Compression of the nerve trunks can lead to various neurological disorders... Significant blood loss during menstruation causes anemization, weakness, irritability and tearfulness. In some cases, there is a malignant transformation of foci of endometriosis.

Diagnostics

When diagnosing endometriosis, it is necessary to exclude other diseases of the genital organs that occur with similar symptoms. If endometriosis is suspected, it is necessary to collect complaints and anamnesis, in which pain is indicative, information about past diseases of the genital organs, operations, the presence of gynecological pathology in relatives. Further examination of a woman with suspected endometriosis may include:

• gynecological examination (vaginal, rectovaginal, in mirrors) is most informative on the eve of menstruation;
• colposcopy and hysterosalpingoscopy to clarify the location and form of the lesion, obtain tissue biopsy;
• ultrasound examination of the pelvic organs, abdominal cavity to clarify the localization and dynamic picture in the treatment of endometriosis;
• spiral computed tomography or magnetic resonance in order to clarify the nature, localization of endometriosis, its relationship with other organs, etc. The accuracy of the results of these methods for endometriosis is 96%;
• laparoscopy, which allows you to visually examine the foci of endometriosis, assess their number, degree of maturity, activity;
• hysterosalpingography (x-rays of the fallopian tubes and uterus) and hysteroscopy ( endoscopic examination uterine cavity), allowing to diagnose adenomyosis with an accuracy of 83%;
• study of tumor markers CA-125, CEA and CA 19-9 and RO-test, the indicators of which in the blood in endometriosis increase several times.

Endometriosis treatment

When choosing a method of treating endometriosis, they are guided by such indicators as the patient's age, the number of pregnancies and childbirth, the prevalence of the process, its localization, the severity of manifestations, the presence of concomitant pathologies, the need for pregnancy. Methods of treatment of endometriosis are divided into medical, surgical (laparoscopic with removal of foci of endometriosis and preservation of the organ, or radical - removal of the uterus and oophorectomy) and combined.

Conservative treatment

Endometriosis treatment aims not only to eliminate active manifestations of the disease, but also its consequences (adhesive and cystic formations, neuropsychiatric manifestations, etc.). Indications for conservative treatment endometriosis is its asymptomatic course, the young age of the patient, premenopause, the need to maintain or restore fertility. Leading in the medical treatment of endometriosis is hormone therapy with the following groups of drugs:

• combined estrogen-gestagenic drugs.

These drugs, which contain small doses of gestagens, suppress estrogen production and ovulation. Shown at the initial stage of endometriosis, since they are not effective in the prevalence of the endometrioid process, ovarian cysts. Side effects are expressed by nausea, vomiting, intermenstrual bleeding, breast tenderness.

• gestagens (norethisterone, progesterone, gestrinone, dydrogesterone).

Shown at any stage of endometriosis, continuously - from 6 to 8 months. Taking gestagens can be accompanied by intermenstrual bleeding, depression, breast tenderness.

• antigonadotropic drugs (danazol, etc.)

Suppress the production of gonadotropins in the hypothalamus-pituitary gland. They are applied in a continuous course for 6-8 months. Contraindicated in women with hyperandrogenism (excess of androgenic hormones). Side effect are sweating, hot flashes, changes in weight, coarsening of the voice, increased oiliness of the skin, increased intensity of hair growth.

• agonists of gonadotropic releasing hormones (triptorelin, goserelin, etc.)

The advantage of this group of drugs in the treatment of endometriosis is the ability to use drugs once a month and the absence of serious side effects... Agonists of releasing hormones cause suppression of the ovulation process and estrogen content, leading to suppression of the spread of foci of endometriosis. In addition to hormonal drugs in the treatment of endometriosis, immunostimulants, symptomatic therapy are used: antispasmodics, analgesics, anti-inflammatory drugs.

Surgical tactics

Organ-preserving surgical treatment with removal of heterotopies is indicated for moderate and severe stages of endometriosis. Treatment is aimed at removing foci of endometriosis in various organs, endometrioid cysts, dissection of adhesions. It is carried out in the absence of the expected effect of drug therapy, the presence of contraindications or drug intolerance, the presence of lesions with a diameter of more than 3 cm, dysfunction of the intestines, bladder, ureters, kidneys. In practice, it is often combined with drug treatment endometriosis. It is performed by laparoscopic or laparotomy approaches.

Radical surgical treatment of endometriosis (hysterectomy and adnexectomy) is carried out for patients over the age of 40 with active progression of the disease and ineffectiveness of conservative surgical measures. Unfortunately, radical measures in the treatment of endometriosis are required for 12% of patients. Operations are performed by laparoscopic or laparotomy methods.

Forecast

Endometriosis has a tendency to recurrence of processes, in some cases forcing to resort to repeated surgical intervention. Relapses of endometriosis occur in 15-40% of patients and depend on the prevalence of the process in the body, its severity, localization, radicality of the first operation.

Endometriosis is a formidable disease for the female body, and only its identification in early dates and persistent treatment leads to complete deliverance from the disease. The criteria for the cure of endometriosis are satisfactory health, the absence of pain and other subjective complaints, the absence of relapses within 5 years after completing the full course of treatment.

In childbearing age, the success of endometriosis treatment is determined by the restoration or preservation of fertility. With the modern level of surgical gynecology, the widespread use of sparing laparoscopic techniques, such results are achieved in 60% of patients with endometriosis aged 20 to 36 years. In patients with endometriosis after radical operations the disease does not recur.

Prevention

The earlier, when the first symptoms of endometriosis appear, a woman comes to the consultation of a gynecologist, the more likely a complete cure and the absence of the need for surgery. Attempts self-treatment or wait-and-see tactics in the case of endometriosis are absolutely not justified: with each subsequent menstruation, new foci of endometriosis appear in the organs, cysts are formed, cicatricial and adhesions progress, there is a decrease in the patency of the fallopian tubes.

The main activities aimed at preventing endometriosis are:

• specific examination of adolescent girls and women with complaints of painful menstruation (dysmenorrhea) in order to exclude endometriosis;
• observation of patients who have undergone abortion and other surgical interventions on the uterus to eliminate possible consequences;
• timely and complete cure of acute and chronic pathology of the genitals;
• taking oral hormonal contraceptives.

In relation to endometriosis, like many other gynecological diseases, applicable strict rule: best treatment diseases are its active prevention. Attention to your health, regularity of medical examinations, timely therapy of gynecological pathology allow you to catch endometriosis in the very initial stage or avoid its occurrence altogether.

Endometriosis is an inflammatory process in which the cells of the epithelial layer lining the inner surface of the uterus grow outside the organ. Doctors consider hormonal disorders to be the main cause of pathology. In most women, endometriosis develops as a result of a lack or, conversely, increased synthesis of estrogen - the main female hormone that regulates the activity of the reproductive system, reproductive organs and is responsible for the appearance of the skin, nails and hair.

To determine which hormone caused pathological changes in the epithelium, diagnostic curettage is performed. The received material is sent to histological examination, according to the results of which the woman is prescribed treatment. It is necessary to start therapy for this disease as early as possible, since a complication of chronic endometriosis can be various gynecological diseases, breakthrough uterine bleeding and infertility. For this, it is important to know the symptoms and signs of pathology.

Endometriosis does not have pronounced clinical symptoms, therefore, diagnose the disease without special examination impossible. Even an examination on a chair using a gynecological mirror does not always allow determining the pathological growth of endometrial cells, therefore, the symptoms of the disease must be treated very carefully. It is important to inform the doctor about all existing disorders, because endometriosis is characterized by a combination of four signs that are manifested in almost every woman with endometriosis.

Infertility

The diagnosis of "infertility" is made if pregnancy does not occur after a year of regular sexual activity without the use of contraceptive methods. The main reason for the absence of pregnancy in endometriosis is the anatomical changes in the endometrium, in which it becomes impossible to attach and preserve a fertilized egg. Hormonal disruptions that cause pathological growth and changes in the structure of the endometrium affect the synthesis of hormones necessary for the development of pregnancy.

If the cells of the epithelial layer go beyond the organ (into the ovaries, cervix, fallopian tubes, etc.), adhesions can form in the space of the fallopian tubes - compacted areas connective tissuethat connect two or more organs. The adhesion process causes obstruction fallopian tube - one of the causes of infertility with internal endometriosis.

Note! Chronic endometriosis negatively affects the state of the immune system and inhibits its activity. Even if pregnancy occurs, the probability of its termination or fetal freezing will be very high - more than 65%.

Pain syndrome

Endometriosis pain may have different character, intensity and localization. Sharp pain usually cutting or stabbing, localized in the lower abdomen. Chronic pain can be dull, pulling. Their intensity is usually moderate, so most women do not pay attention to them, taking given feature for manifestations of premenstrual syndrome or the result of increased stress.

Chronic pain in endometriosis can be aggravated by the following factors:

• intimacy;
• menstrual flow;
• lifting weights.

Important! Pain sensations in chronic endometriosis, they are easily stopped by painkillers, so many ignore this symptom. The hallmark is a constant, chronic course, that is, the symptom weakens or disappears while acting medicinal product, after which the soreness returns.

Bleeding

In almost all cases of endometriosis, regardless of its location, a woman is worried about contact spotting that appears after sexual intercourse. If the lesion touches the organs genitourinary system or parts of the intestine, drops of blood or blood streaks can be found in urine or stool.

Insufficient bleeding with severe pain syndrome is noted several days before the onset of menstruation (about 4-5 days). Blood anointing usually lasts 1-3 days, after which it passes, and after 24-48 hours the woman begins menstruation.

Menstruation may be accompanied by education blood clots dark scarlet or brown. Their size can reach several centimeters, and their appearance is somewhat reminiscent of raw liver. By themselves, clots are not a symptom of endometriosis, as they can occur in other pathologies (for example, endometrial hyperplasia), but in combination with other signs, one can almost certainly suspect pathological growth of epithelial cells.

Irregular menstrual cycle

Women with this disease always have menstrual irregularities. These include:

• constant cycle fluctuations;
• absence of menstruation for several months in a row;
• profuse and prolonged menstruation (menorrhagia).

In case of any failures in the cycle, women should immediately consult a doctor, since in the absence of timely treatment, the risk of serious consequences and complications will be very high. Untreated endometriosis can lead to benign tumors, infertility, inflammatory processes.

Signs and symptoms with different types endometriosis

Sign	Internal endometriosis	External form of pathology (the walls of the vagina and the cervix are affected)	Ovarian cystic formations
Painful bleeding before menstruation	Yes	No	Yes
Breaking the cycle	Yes	Yes	Yes
Discharge of blood during or after intimacy	Yes	Yes	Yes
Menorrhagias (heavy periods that last more than 7 days)	Yes	No	No
Pain in the lower abdomen during intercourse or menstruation	Yes	Yes	No
Absence of pregnancy within 1 year without the use of methods of contraception	Yes	Yes	In most cases

Video: Dr. Myasnikov about endometriosis

The role of the psychological factor in diagnosis

Almost 80% of women with chronic forms of endometriosis have psychological problems. They are prone to depressive disorders, psychosis, their emotional condition, there is a tendency to sudden mood swings. Some women may completely lose interest in events happening around them. They stop watching their own appearance, reduce communication with friends and loved ones, avoid appearing in public places.

A distinctive symptom of pathology (subject to the presence of other clinical manifestations) is anxiety, causeless fear. In severe cases, panic attacks may occur.

Important! Some women start taking sedative medications to cope with emerging psychological problems. It is important to understand that such treatment will give a short-term result, since the cause of the pathology will not go anywhere.

How does the disease manifest in older women?

Some people mistakenly believe that endometriosis is a disease of women of reproductive age. Pathological proliferation of the endometrium outside the epithelial layer can occur at any age, and in women over 45, the risk of developing the disease is several times higher, since after menopause the production of progesterone is blocked. Other factors that are often found in elderly women can also contribute to the onset of pathology. These include:

• overweight;
• diabetes;
• disorders in the thyroid gland;
• a large number of infectious diseases history;
• the transferred operations (regardless of the localization of the pathological process).

Elderly women with endometriosis often experience headaches, dizziness, and nausea. In severe cases, a single vomiting is possible. The pain syndrome is usually of mild to moderate intensity, exacerbations are rare. The psychological state of a woman is also different from normal performance: irritability appears, aggression towards others, tearfulness.

Important! A hallmark of the disease during menopause is spotting. They can be scarce (bleeding) or voluminous - in this case, we are already talking about bleeding. This clinical picture is typical for endometriosis of the uterus.

Ovarian endometriosis: signs

The consequence of endometriosis is the appearance of cystic formations. The main symptom in this pathology will be pain syndrome, which is most often permanent and intensifies after intense exertion or intimacy. Menstruation with ovarian endometriosis painful, use medicines often does not bring significant relief.

Ovarian endometriosis can be distinguished from other forms of the disease by the characteristic shooting pain in the perineum, rectum and lumbar region. Pain occurs at any time of the day and does not depend on the physical activity of the woman. At night, when the muscles and ligaments are relaxed, the pain may be more intense.

Endometriosis of the cervix: the clinical picture of the disease

The defeat of the cervical part of the body of the uterus is the only form of endometriosis in which painful sensations are practically absent (in rare cases, the pain may be mild). This is due to the fact that there are no nerve endings and pain receptors on the neck. Pathology can be suspected by uncharacteristic bloody discharge in the second half of the menstrual cycle. Bleeding can also be observed before the onset of menstruation - it usually lasts 2-3 days and does not cause discomfort, unlike internal endometriosis.

Video: Endometriosis - symptoms, treatment

Internal endometriosis symptoms

On ultrasound, the doctor discovers nodular formations on the surface of the uterus, which indicate the development of pathology. During palpation of the uterus, severe pain appears. In the period between menstruation, the pain is localized mainly in the lower abdomen, has an acute character. The intensity of sensations increases during sexual contact and lifting heavy objects. If a woman's blood is examined during this period, you can notice signs of anemia, which are associated with constant bleeding.

Symptoms of the disease after cesarean section

Delivery by cesarean section is considered a straightforward operation (in terms of technique), but it is important that it be performed by a qualified surgeon. It is also worth checking with the doctor what kind of material will be used for suturing, since some types of surgical threads can cause itching, discomfort in the suture area and increase the risk of gynecological pathologies.

The proliferation of epithelial cells in the area of \u200b\u200bthe suture and postoperative scar occurs in 20% of cases. You can suspect pathological changes in a woman's body after a cesarean section by the following symptoms:

• poor healing of the scar surface;
• release of brown fluid from the seam;
• severe itching in the suture area;
• probing knots under the seams;
• severe drawing pain in the lower abdomen.

If these signs are found, a woman is advised to contact the antenatal clinic to the doctor who led the pregnancy. In some cases, hospitalization may be required to exclude suppuration and inflammation of the seams, so you should not ignore the pathological symptoms.

Diagnosis of the disease

Endometriosis refers to diseases that are difficult to diagnose due to blurred clinical picture, since the pathology has signs and symptoms characteristic of most gynecological diseases. Even during the examination, it is not always possible to determine the presence of pathology. The doctor will be able to suspect endometriosis during palpation of the vagina and rectum, if nodules or cysts are found.

One examination and palpation to diagnose the disease, as a rule, is not enough, therefore the doctor must prescribe additional procedures, for example, ultrasound of the pelvic organs. The examination can be done abdominal (through the skin of the abdomen) or using a vaginal ultrasound probe that is inserted into the vagina. Ultrasound is not 100% an informative method for diagnosing endometriosis, but with the help of this examination, the presence of cystic cavities can be detected.

If in doubt, the woman will undergo a laparoscopy. This operation is performed under local anesthesia or general anesthesia and can be used not only for the purpose of diagnosis, but also for the treatment of pathology. Laparoscopy rarely causes complications, but to prevent the consequences, it is important to maintain sexual rest after the procedure (at least 2-4 weeks).