Endometriosis - a disease accompanied by ectopic growth of the mucous membrane, which is the inner membrane of the uterus, in other structures of the female body.Endometriosis is most often triggered by hormonal failure, and impaired immune genesis.
danger of this disease lies in its primary lesion of females under the age of 40 years and 50% of the causes of difficulties in the planning of conception and birth.Risk for endometriosis are women of reproductive age suffer from infertility, but even in their teens and premenopausal there are cases of endometriosis.
In the structure of morbidity gynecological endometriosis in women is a leader on par with diseases of inflammatory nature and tumors of the uterus.There is a clear relationship of symptoms of endometriosis and childbirth.So, scientifically confirmed that the multiparous women do not suffer from endometriosis.
statistical count of all cases of disease endometriosis is significantly impeded, because not all women att
cause of endometriosis
Currently, there are several theories etiopathogenetical growths endometrial tissue in various organs and tissues, each of which has the right to exist, so endometriosis can be classified as polietiologichesky diseases.
According to the theory of implantation, endometrial particles grow as a result of retrograde casting cell lining of the uterus to various organs in the bending of the uterus during menstruation.If implanted into the peritoneum of endometrial or abdominal organs always develop inflammatory changes and mikroizliyaniya around endometriotic lesions, as opposed to the uterus, from which it is possible to isolate the menstrual blood, they do not have such a function.
Also, many scientists have a different theory of the development of endometriosis peritoneum and abdominal organs, according to which the endometrial tissue is implanted in the peritoneum are not, and it provokes the regeneration of tissue structures resembling the uterine lining.
Do not forget about the environmental microclimate, which is always a woman.So, scientifically proven fact is that young women in areas with high concentration of dioxin, more than others suffer from endometriosis.
special role in causing symptoms of endometriosis has a state of the hormonal system of the female body.Thus, a sharp and sustained increase in the level of luteinizing hormone and follicle-stimulating due to lower emissions of progesterone is a precipitating factor for the growth of endometrial tissue.Keep in mind that at the moment of an artificial or natural menopause occurs in most cases, partial regression of the disease.
great importance on the progression of endometriosis female body has the ability to produce an adequate immune response to the proliferation in various organs of foreign tissue.In a situation where the immune system is functioning effectively enough, endometrial tissue is not rejected, but constantly growing, hitting deeper structures of the uterus and surrounding organs.Thus, a woman suffering from diseases accompanied by immunosuppression, are at risk for the occurrence of endometriosis.
There are predisposing factors to endometriosis, which include developmental abnormalities of the fallopian tubes, family history, immunosuppression.Women who have had repeated medical abortion, surgery on the pelvic organs, require more careful attention, consisting in the dispensary observation, since they are more likely to develop other endometriosis.
Recent randomized studies to prove the genetic nature of endometriosis, since there is a family type of the disease.Modern technologies in the field of genetic engineering have developed a specific DNA test aimed at determining whether predisposition to endometriosis in one way or another woman.In identifying the positive DNA test, a woman should observe preventive measures for prevention of endometriosis: the timely treatment of inflammatory diseases of the genital organs, systematic laboratory study of hormonal background, as well as the passage of the regular ultrasound examination of the pelvic organs.
Symptoms and signs of endometriosis
Clinical symptoms of endometriosis depends on the localization of the pathological process and individual defense mechanisms of the body.In 40% of cases the diagnosis of endometriosis is a random finding during preventive visits gynecological surgeries and is not accompanied by specific symptoms expressed.
most specific symptom that is observed in the majority of patients with endometriosis is pain in the projection of the pelvis.Pain in endometriosis are permanent in nature and amplified a few days before the onset of menstruation, that is, women with this disorder tend to suffer algomenoreya.Also algomenoree observed disorders of the menstrual cycle as a violation of their regularity, duration and abundant.Pain during menstruation due to the expiration of retrograde menstrual blood and stimulation of receptors of parietal peritoneum, as well as a touch of endometrioid hearth with neighboring authorities.
pain syndrome in patients with endometriosis and there is a menstrual period.The emergence of pelvic pain in this situation is related to inflammatory changes in organs containing endometriosis.The occurrence of pain in the pelvic area radiating to the lumbar region during intercourse favors the development of endometrial changes rectovaginal septum and vagina.
a result of menstrual disorders endometriosis increases the risk of secondary infertility on the background of tubal occlusion due to the rapid growth of endometrial foci and anovulation.
In 15% of cases of endometriosis, uterine bleeding is accompanied by a low-intensity, non-menstrual period.Menorrhagia often say patients with endometriosis localized in the body of the uterus caused by the presence of tumor formation surround nature.
In a situation where endometriotic lesions extend to the abdominal organs and urinary system, there are symptoms that characterize a violation of their function (difficulty urinating, the occurrence of pain in the perianal area and lower abdomen during defecation, a violation of a chair).
Endometriosis can be attributed to a slowly progressive disease, as for the dissemination of endometrial tissue in the remote distance requires a long period of time.At the same time, provided the total absence of treatment, this pathology provokes the development of a number of complications caused by the occurrence of irreversible changes in the affected organs, as well as the development of adhesive disease of the abdomen and pelvis.
Recent scientific research on endometriosis proven fact of a possible degeneration of endometrial lesions in the malignant process.The percentage of malignancy of endometriosis is not less than 4%.
Depending on the size of the pathological process, that is, the depth of penetration of endometrial released several stages of endometriosis uterus body:
- 1 degree of endometriosis is characterized by the growth of the endometrium to the myometrium;
- 2 degrees of endometriosis is accompanied by a deep growth of the uterine mucosa, extending it to the entire myometrium;
- 3 degrees of endometriosis is characterized by proliferation of the mucous membrane to the serous layer;
- the fourth and the most severe degree of endometriosis is accompanied by the appearance of endometrial cells in the parietal peritoneum.
volume of clinical symptoms of endometriosis depends on the localization of the pathological process and the appearance of endometrial tissue in various organs.The most common form is genital endometriosis, which is characterized by overgrowth of the endometrium in nearby organs.In situations where the lining of the uterus applies only to the external genitalia, developing external endometriosis (cervical, pozadisheechny, vaginal, rectovaginal).
When Extragenital distributing endometriosis affects all parts of the small intestine, organs of urinary system, post-surgical scars, and even the bodies of the thoracic cavity.
In severe pathology of endometrial tissue grows in the pelvic organs and abroad and develops mixed form of endometriosis.
ovaries endometriosis affects 50% of cases, and the share of one-sided defeat of not less than 80% of cases.The main etiopathogenetic factor of endometriosis in this case is retrograde reflux of endometrial cells not only in the wall of the fallopian tubes, and ovaries during the retrograde type of menstruation, as well as infection of the lymph and hematogenous route.
pathomorphological manifestations of endometriosis is the formation of small nodules or cavities containing liquid blood in the ovary, which are clearly responding to hormonal disorders of the female body.
ovarian endometriosis often proceeds with the formation of massive adhesions in the pelvis, which limit the mobility of not only the affected ovary and other internal reproductive organs, so the conditions are created for the development of the primary fertility.
Due to the fact that ovarian endometriosis is not accompanied by marked specific clinical manifestations, in addition to pain in the projection of the pelvic organs, this condition requires difdiagnostiki with inflammatory diseases of appendages and oncopathology.
only efficient way of treating patients with endometrial changes in the ovaries is surgery.Young women of reproductive age is preferable to perform a partial removal of the ovary, which belongs to the category-sparing surgery.However, in this case, it does not exclude the possibility of a recurrence of endometriosis and re-treatment (radical salpingo).
Endometriosis in the cervix is the second frequency of localization of this disease and its causes are the same as any other form of endometriosis but retrograde casting endometrial tissue during the onset of menstruation.
Often endometriosis cervical canal becomes a random finding a gynecologist for prophylactic examinations of women, since in some cases, this pathology does not cause complaints from the patient.An experienced doctor already at the initial examination in the mirror can visualize changes in the cervix as the appearance of a dark-blue spots on a pink background intact mucosa.These changes need to be further histological and cytological confirmation, for which the patient is recommended to perform a colposcopy with biopsy-related modified portion of the mucous membrane.
With long-term course of the disease develop a characteristic clinical syndrome, which is the appearance of a scant bleeding dark brown a few days before the expected date of the onset of menstruation, feelings of discomfort and even pain during sexual intercourse, as well as the development of common pelvic pain, wearing a permanentcharacter.
Due to the fact that endometriosis of the cervix often occurs against a background of hormonal and immunological disorders, pathogenetically justified preparations for the treatment of patients are hormonal and immune-boosting drugs.In most cases, a positive effect against the leveling of endometriotic lesions have combined estrogen-progestin drugs and antigonadotropiny.
immunostimulatory therapy is used under the clear control of the main indicators of immunogram and most effective drug in this case is considered TSikloferon a daily dose of 1500 mg.
Besides using conservative medical treatment, be sure you need to use a topical treatment aimed at the destruction of endometriosis.It is now widely applied ultrasonic disruption endometriotic lesions of the cervix, but cryosurgery and electrocoagulation also has positive results in the treatment of endometriosis, uterine cervix.
Even after the complex therapy including local and medication, there is a risk of recurrence of endometriosis, so women who suffer from this disorder for a long time subject to dispensary observation.
Endometriosis uterine body
uterus Endometriosis occurs most often compared to other sites, and endometriosis is accompanied by a bright clinical symptoms, allowing an early stage to establish a reliable diagnosis.
The earliest sign of endometriosis, uterine body is a violation of the menstrual cycle as changes in cyclical occurrence of menstruation, heavy menstrual discharge, as well as the appearance of uterine bleeding not associated with the menstrual cycle.All these changes are due to ovarian dysfunction with a penchant for hyperestrogenism, hyperplastic changes of the endometrium, reducing the intensity and amplitude of uterine contractions, inflammatory changes in the myometrium and pathological changes of the walls of the uterine vessels.A feature of uterine bleeding endometriosis is their stability in relation to the application of conservative methods of treatment, so the necessary therapeutic interventions in this case is considered to be scraping the uterine cavity.
Under the developed clinical picture of the patient with endometriosis, uterine body complain of pain of varying intensity in the projection of the pelvis and lumbar region, with a clear dependence on the menstrual cycle.Pathogenetic link of occurrence of pain is a compression of the vascular wall of uterine arteries as a result of increased endometrial foci and concomitant stimulation of the receptors.
At the initial examination of the patient with endometriosis, uterine body drew the attention of a significant increase in the size of the uterus, and therefore, the patient should be evaluated for the presence of space-occupying lesions of the uterine cavity.In a situation when endometriosis is focal in nature, there is a change of structure of the uterine wall which becomes uneven and rough surface texture to the presence of areas of high density.
main methods of diagnosing endometriosis, uterine body considered ray imaging techniques (ultrasound scanning, contrast uterography) to assess the size and shape of the uterus, the structure of its walls, the presence of changes in the myometrium, and also to exclude the presence of other pathological changes.
Under the initial symptoms in women with endometriosis, uterine body shows conduct a comprehensive medical treatment with agents enhancing the contractility of the uterus, hemostatic drugs, as well as adequate scheme of hormone therapy.
operational benefits apply in the absence of a positive result of using drug therapy and are a radical hysterectomy with appendages.