Endometriosis uterine - it is hormone-dependent diseases with unknown origin, the essence of which consists in the growth of such endometrium tissue outside its normal location, ie,outside the boundaries of the mucous membrane of the uterus (the endometrium).
The causes of the disease limited to a few theories, but none can reliably explain the causes of the disease.One of the most likely causes of endometriosis uterus is considered a hormonal dysfunction to the damage mechanisms of normal immune homeostasis.
endometriosis is considered to be a disease with a genetic predisposition.
Hormone nature of the disease confirms the absence of occurrences of endometriosis uterus in girls before the end of the period of puberty and postmenopausal women.With the fading of ovarian hormonal function, available in patients of endometriosis uterus runs independently subjected to reverse development.
uterine wall consists of three layers:
- endometrium.The inner mucosa, contain
- myometrium.Powerful muscle of the uterus.
- perimeter.Durable serous layer, a protective function.
All structural cyclic changes in the endometrium are controlled by ovarian hormones.The first phase of the cycle, accompanied by the growth of the outer, functional, layer of the endometrium, and the second phase of the functional layer is torn away, causing menstrual bleeding.
essence of lesions of endometriosis is that outside the inner mucosal layer of the uterus in tissues and organs begin to appear islands of cells that are similar in structure and function to the endometrium, that is, they not only resemble the endometrium, but also capable of cyclicallychange, allocating a small amount of blood.Structural changes in the foci of endometriosis are similar to those in the endometrium, so we can say that they are "menstruate" along with the uterus.Around endometriotic lesions develop inflammation and destructive changes.
Edometrioidnaya fabric has amazing properties that allow it to migrate throughout the body:
- it constitutes the center without delimiting the capsule;
- has the ability to infiltrative growth, literally "raspolzayas" in the next few tissues, causing their destruction;
- like a cancer "travels" through the blood and lymphatic vessels, forming a distant foci.
Land endometriosis sometimes (6-8%) exhibit far beyond the genitals: in tissues of the urinary system, intestine, lung and even in scars located on the skin of the abdominal wall.One patient can coexist endometriosis several locations, but the nature of the cyclic changes in them did not amount.Endometriosis occurs most others.When edometrioze uterine pathological foci appear in the thickness of its muscular layer and cause inflammatory and destructive processes.
incidence of endometriosis in different age groups ranging from 7 to 45%.This difference is due to the hormonal nature of the disease, it is often diagnosed in young women in a period of high activity of the ovaries.The peak incidence occurs 20 - 40 years (75%).
risk of endometriosis is increased in the presence of uterine fibroids (33-85%).
Symptoms depend on the location and extent of the pathological process.For uterine endometriosis characterized pelvic pain, menstrual dysfunction.Often (40-80%), endometriosis, uterus and ovaries is accompanied by infertility.Reproductive function is determined by location and stage of the disease.The woman who became pregnant due to endometriosis, there are good chances of a normal pregnancy.
definite diagnosis of endometriosis uterus can only be made by means of instrumental methods of examination, during which detect specific areas of endometrial tissue in the atypical place.The volume is determined according to a survey of localization of the pathological process.Sometimes proper diagnosis is sufficient to carry an ultrasound scan of the pelvic cavity, as in other situations is carried out X-ray or laparoscopic exploration.
Difficult task is the treatment of endometriosis uterus.It is performed taking into account the clinical situation and the patient's age.Good results in the early stages of the disease provides hormone therapy.
If a young patient recovers fertility treatment is successful.With advanced forms of the disease, or in the case of elderly patients spent only surgical treatment.
In some cases, a combination, conservative and surgical treatment.
Complete cure patients with endometriosis of the uterus is unlikely.
cause of endometriosis uterus
Endometriosis does not have a reliable set of reasons.There are the most likely mechanism of the disease:
- menstruation.There is speculation that the cells of the endometrium during menstruation "thrown" by retrograde outside the uterus, and then spread to adjacent organs (tubes, ovaries) and tissues (eg, peritoneum).This assumption is based implant theory of endometriosis uterus.
- hormonal dysfunction.In a study of patients with endometriosis revealed high concentrations of estrogen, follicle-stimulating hormone (FSH), luteinizing hormone (LH) hormone, prolactin and low levels of progesterone.And there androgenic adrenal hyperplasia.
- Genetic predisposition.There are "familial forms of endometriosis uterus", when the disease is present in women in several generations of one family.In this case, the patients can be allocated specific hereditary marker indicating the predisposition to endometriosis.
- Immune disorders.Immune defense mechanisms aimed at the removal of any tissue that appears outside its normal position.In case of deviations in the immune system cells of the endometrium of the uterus is not destroyed as foreign, and even take root and function.
- Mataplaziya (transformation) of the endometrium.Some researchers believe that certain tissues are able to turn into endometrial.
- Violation of the mechanisms of fetal female (embryonic development theory).There are cases of endometriosis uterus revealing the girls 11-12 years old, some of them combined with malformations of the sexual organs.
important role in the appearance of endometriosis play neuroendocrine abnormalities in the pituitary - hypothalamus - the ovaries, leading to disruption of normal hormonal regulation.
most likely provoking factors of occurrence of endometriosis uterus are:
- extensive mechanical damage to the mucous membrane.During diagnostic curettage abortion or violated "defensive" zone delimited by the endometrium to be the muscular layer, allowing epithelial cells penetrate deeper, continuing changes cyclically.
- Gynecologic manipulations on the genitals, in which endometrial cells can penetrate the adjacent organs.For example, burning the erosion of the cervix can cause penetration of endometrial tissue in the vaginal part of it with the subsequent development of endometriosis, and during cesarean section endometrial tissue gets into the abdominal cavity.
- chronic infectious-inflammatory processes in the genital organs.They lead to a reduction of the immune defense, hormonal dysfunction and structural changes in tissues, all this facilitates the formation of endometriosis uterus.
- Incorrect hormonal therapy.
- Intrauterine contraception.Present in patients with endometriosis IUD can cause the development of the disease.In the area of contact with the mucous helix formed inflammation underlying tissues become loose, and during menstruation through this site endometrial cells penetrate deep into the uterine wall.
- Liver disease.The liver acts as a factory for recycling of estrogen.When liver disease, this process is disrupted, and estrogen accumulates in the body.As a result of developing a hormonal dysfunction.
Adverse environmental conditions, stress stress and endocrine diseases can be attributed to indirect "provocateurs" of the disease.
Symptoms and signs of endometriosis uterus
by location endometrioid hearth identify several clinical forms of the disease:
- genital form of endometriosis is associated with damage to the uterus, ovaries, fallopian tubes, vulva, pozadisheechny (retrotservikalnogo) endometriosis, as well asendometriosis of the vagina and pelvic peritoneum.
Usually genital shape is divided into internal and external uterine endometriosis endometriosis, which includes ectopic lesion of the genitals.
- extragenital endometriosis affects the intestines, urinary tract organs, lungs and all other organs.
- combined forms of endometriosis involves the simultaneous defeat of the internal organs and genitals.
most urgent for gynecologists is a genital form of the disease.
Symptoms of endometriosis any location always alone, but differ in degree.
The most common form of genital lesions of endometriosis with the muscle layer of uterine wall.The cardinal symptom in this form is a violation of menstrual function.Most monthly endometriosis are characterized by cyclic bleeding as:
- regular menses with significant blood loss (hyper- and polimenoreya);
- acyclic uterine bleeding with unequal duration and intensity.
nature of bleeding depends on the hormonal function, the extent of vascular lesions of the uterus, its contractility disorders, the presence of uterine and endometrial hyperplasia, and other important conditions.
Most patients endometriosis, uterine body accompany persistent, poorly amenable to conservative therapy of bleeding.
During a pelvic exam to diagnose internal endometriosis of the uterus is very difficult.Uterine palpation enlarged to the size of 5 - 8 weeks of pregnancy, asymmetric, uneven consistency.You can find the dependence of the size of the uterus from the phase of the cycle.During the initial diagnosis of endometriosis can be confused with uterine myoma.
second most important symptom of endometriosis uterus is pain in the lower abdomen.They start on the eve of menstruation, worse with the onset of menstruation and subside after.Menstrual pain of endometriosis uterus have cramping in nature.
in second place out of all locations is ovarian endometriosis, often one-sided.Ovarian Endometriosis can be of different sizes - from a small nodule to large cysts.Cystic cavity filled with blood or dark tar-like liquid, because of what are called "chocolate cysts".Clinical signs of ovarian endometriosis lack specificity and resemble symptoms of inflammation or adhesive disease.Most ovarian endometriosis pain are permanent, but less pronounced, radiating to the sacrum and the rectum.On palpation on the affected side of the ovary revealed signs similar to those of ovarian cyst or inflammation.Ovarian endometriosis often combined with adhesive disease and infertility.Intermenstrual bleeding ovarian endometriosis associated with hormonal dysfunction.
In third place among genital localization is retrotservikalnogo endometriosis with defeat of structures located behind the cervix: the sacro-uterine ligaments, vaginal walls and rectum tissue between the rectum and the vagina.
Patients concerned excruciating pain.Associated with damage to the rectal bleeding endometriosis pozadisheechnoy localization coincide with menstruation.
On palpation of the posterior fornix well palpated still small, painful nodules that may coalesce into larger conglomerates.
endometriosis may be asymptomatic and discovered incidentally.Sometimes it is found when examining patients with infertility.
Endometriosis is among the diseases that have acute and chronic.The term chronic endometriosis is incorrect.In using it, the patient is likely to confuse the chronic endometriosis with chronic endometritis - an inflammatory disease of the uterus.
degrees of endometriosis uterus
variety of forms and localizations of endometriosis explain the lack of a single reliable classification of the disease.It is generally accepted conventional classification of certain forms of the disease in place and depth of the pathological process.The degree of endometriosis in this stage is characterized by the development of the disease.
believed that endometriosis of the uterus can exist in three forms:
- diffuse when endometroidnoy tissue sections are placed randomly across the surface, do not have clear boundaries and do not form clusters;
- focal form with the formation of "islands" in the thickness of the endometrial layer of muscle;
- node, if it is determined delimited tight "knot" that simulates the fibroids.
The simultaneous presence of not one but several forms of endometriosis in the uterus.
The uterine wall endometriosis are identified at different depths, so endometriosis, uterine body can have four degrees (or stage of development) Distribution:
first degree appears as small lesions in the mucous layer of the uterine body at a depth of no more than 1 cm.
The second stage is characterized by the germination of pathological focus in the muscle layer is not more than half.
When the pathological process involves the entire muscle wall of the uterus, say about a third the prevalence of endometriosis.
If the endometrium grows through the entire thickness of the uterine wall and goes beyond it, overcoming the serous layer affects the neighboring organs and pelvic peritoneum, he was awarded the fourth power distribution.
external genital endometriosis according to the extent of the share on:
- Small forms: small shallow isolated foci on the pelvic peritoneum and the surface of the ovaries.
- Moderate: pathological small cystic lesions on one or both ovaries and Moderate pelvic adhesions, uterine displacement due to scarring of the peritoneum pozadimatochnogo space.
- severe forms of endometriosis.The pathological process spreads to all organs and tissues of the pelvis, including the urinary tract and / or rectum.
Ovarian Endometriosis occurs in the form of cysts and has several stages (degrees) of:
- The first stage is accompanied by the formation of small point on the surface of ovarian inclusion, non-cystic cavities.
- Second Stage.If one or more foci of cystic cavity is formed, which does not exceed 6 cm.
- In the third step, large (but not more than 6 cm) endometrial cysts detected in both ovaries.
- The fourth stage is accompanied by the formation of large (more than 6 cm) cysts in both ovaries followed by the spread of the pathological process in the nearby area.
Starting from the second stage of the disease, pelvic adhesions develop, which corresponds to the degree of severity of endometriosis.
These classifications are not international, but are used by practitioners as "workers."
Endometriosis uterine pregnancy
Every third overcome the 25-year milestone patients with endometriosis develop infertility.