Endometriosis - Causes, Symptoms and Treatment .MF .
Endometriosis - is the proliferation of the endometrium lining the inner surface of the uterus, outside. Endometriosis - is the most mysterious and the actual disease in modern gynecology - Endometriosis incidence rate is about 10% of all other gynecological diseases.
Causes Endometriosis Endometriosis
- it polietiologic disease.This means that the reasons for its occurrence are many, and still, in some cases, can not establish the true cause of endometriosis.
most well-known and common causes of endometriosis following:
- menstruation.In most cases, endometriosis occurs in women of reproductive age.The peak incidence occurs at age 30-50 years.It is believed that during menstruation blood casting occurs with endometrial cells in the peritoneal cavity.The endometrium is transported further into the surrounding tissue and peritoneum;
- hormonal disorders.It is noted that almost all patients with endometriosis are changes in the ratio of steroid hormones has a high release of FSH
- genetic predisposition - isolated even familial forms of endometriosis .There are cases to identify endometriosis in eight daughters born to the same mother.Identified specific genetic markers that determine the disposition of women to the incidence of endometriosis;
- impaired immunity - with normal immunity endometrial cells can not survive outside the womb.The protective functions of the body destroy endometrial cells outside the inner layer of the uterus and do not let them be implanted beyond.A different picture is observed in women with endometriosis - because of immune system disorders, endometrial quietly continues to grow outside of the uterus and grows into the uterine body.
- metaplasia of the endometrium - that is, the transformation of one tissue to another.There is a theory that the endometrium, falling outside the uterus is able to turn to other tissue.However, the cause metaplasia is still not clear, and a matter of controversy among researchers.
factors that trigger the appearance of endometriosis:
Other likely factors leading to the occurrence of endometriosis include:
iron deficiency in the body,
surgery on the pelvic organs (including Caesareansection moxibustion cervical erosion)
pelvic inflammatory disease,
abnormal liver function, etc.
There are several clinical forms of endometriosis, depending on the localization of endometrial tissue:
- genital form of endometriosis : uterine damage, ovaries, fallopian tubes, vulva, retrotservikalnogo endometriosis (behind the neck of the uterus), endometriosis, vaginal andpelvic peritoneum;
- extragenital endometriosis : intestinal failure, urinary tract, postoperative scarring of the lungs and other organs;
- mixed form of endometriosis : combination of genital and extragenital endometriosis.
In gynecology more common form of genital endometriosis , particularly common endometriosis, uterine body - adenomyosis .When adenomyosis endometriodnyh centers are located in the myometrium - muscle layer of the uterus.Depending on the depth of adenomyosis lesion is divided into several stages:
- 1st stage adenomyosis - mucosal damage to the myometrium;
- 2nd stage adenomyosis - damage to the middle of the myometrium;
- 3rd stage adenomyosis - to defeat endometrial serous cover;
- 4th stage adenomyosis - defeat parietal peritoneum.
Symptoms of endometriosis Symptoms of endometriosis
is so diverse that sometimes misleading even the most experienced physicians.Symptoms may be absent altogether or may be so pronounced that disrupts sleep and rest women.
severity of symptoms of endometriosis depends on many factors: the shape of the endometriosis, the degree of spread of endometriosis from concomitant diseases and even mood psihologichekogo women.
In all forms of endometriosis and in particular, for adenomyosis, will be attended by almost the same symptoms of varying severity and with some nuances:
- pain symptom most common complaint of patients.When endometriosis concerned about pain in the lower abdomen and the lumbar region of varying intensity.Pain increases sharply during menstruation (algomenorrhea) and may be of such a character unbearable that many women take painkillers during menstruation.Sexual intercourse and defecation may cause a sharp pain in the pelvic area, rectum, perineum and vulva;
- menstrual function - characterized by the appearance of brown smearing secretions before and after menstruation (1-3 days and 1-7 days after menstruation).The number of discharge of menstrual blood, menstruation lengthened in duration.Such symptoms may be due to the fact that very often in adenomyosis "plus" uterine fibroids, which further aggravates the condition of patients.Sometimes worried intermenstrual bleeding that is caused by an increase in estrogen levels and decreased production of progesterone;
- infertility - characteristic of "asymptomatic" endometriosis.In this case, the identification of endometriosis is a godsend.Patients being treated for infertility for years before an accurate diagnosis.Reproductive disorders, usually characteristic of endometriosis of the fallopian tubes and ovaries.Very often, this form of endometriosis combined with the adhesive process in the pelvis, which drastically reduces the probability of conception;
- intoxication symptoms - occur along with severe pain: fatigue, vomiting, nausea, fever, chills, blood tests there is an increase of leukocytes, erythrocyte sedimentation rate;
- other specific symptoms of the rare forms of endometriosis : kishechnika- hypercatharsis endometriosis, endometriosis bladder puzyrya- frequent, painful urination, when expressed forme- may be blood in the urine;endometriosis legkih- coughing up blood during menstruation.
Many women confuse the symptoms of endometriosis with symptomatic fibroids uterus, especially if they've already put such a diagnosis.Other and does not pay attention to changes in menstrual function and pain symptoms, believing that it should be OK. Menses should not normally lead to disability or profuse bleeding .If you have any of these symptoms requires competent consultation of the gynecologist, and the sooner the better, do not engage in self-diagnosis.
diagnosis of endometriosis, and what tests have to take for suspected endometriosis
recognition of endometriosis during the first examination presents certain difficulties.An accurate diagnosis can only gynecologist after inspection, testing and other imaging studies.
gynecological examination before and during menstruation - the uterus and its appendages, endometriosis lesions, increased in size.
In endometriosis ovaries - in the uterus is determined by tumor unhealthy sedentary education, which can be welded to the uterus (endometrial ovarian cyst).Gynecological examination in endometriosis causes sharp pain that interferes with the normal examination of the patient.
retrotservikalnogo endometriosis, vaginal endometriosis can be recognized during the inspection using colposcopy.Endometriosis appear as point area bluish color.However, it is quite rare forms of endometriosis, so, generally speaking, that colposcopy does not apply to the main methods of diagnosing endometriosis.
For accurate diagnosis of endometriosis requires special methods of diagnosis:
- pelvic ultrasound with a vaginal probe.The method has the leading position in the diagnosis of adenomyosis.In the US, you can also detect ovarian endometriosis, particularly clearly visible endometrioid cysts are benign yaichnika- neopuholevidnye education;
- Hysterosalpingography - method using a contrast agent for assessing the extent of adenomyosis and tubal patency (especially important if you have infertility);
- Hysteroscopy - informative method for the determination of the diffuse form of adenomyosis.It allows you to see the surface of the uterus, fallopian tubes, and the mouth of the endometrioid moves that look like dark red dots on a background of pale pink mucous;
- Laparoscopy - microsurgical highly informative diagnostic method that allows you to diagnose any form of endometriosis and hold the appropriate treatment at the same time;
- Blood on the CA-125 (endometriosis marker) is used as an auxiliary method of diagnosis of endometriosis.CA-125 level is usually elevated in endometriosis.This determines the severity of the disease and to evaluate the effectiveness of the therapy.
volume of diagnostic tests determine the gynecologist.It can vary depending on the situation: sometimes for raising sufficient examination of the diagnosis on the chair and pelvic ultrasound, in other cases, only a laparoscopy helps to put the final diagnosis.
treatment of endometriosis
endometriosis treatment may be conservative, operative, and combined (both).
Conservative treatment of endometriosis.
The basis of conservative treatment of endometriosis is long-term hormone therapy.
Drugs used to treat endometriosis following:
- KOC-single-phase combined oral contraceptives (Jeanine, Logest, Diane-35, regulon), administered 6-9 months continuously
- derivatives norsteroidov - LNG (LNG).In recent years become increasingly popular use of levonorgestrel-containing hormonal intrauterine device "Mirena".Spiral tied for 5 years.The advantage of this method is that the Mirena hormonal component acts predominantly locally;
- prolongirorovannye MPA (Depo-Provera), the drug is administered intramuscularly 1 time in 2-3 months, the total course of treatment 6-9 months;
- derivatives of androgens (Danazol, Gestrinone) for 3-6 months
- GnRHa - agonist of gonadotropin-releasing hormone (Zoladex, Buserelin) rate up to 6 months.
As auxiliary symptomatic therapy using anti-inflammatory drugs (aspirin, ibuprofen), antispasmodics (no-spa), enzyme preparations (lidasa, chymotrypsin), sedatives (tincture of motherwort and valerian), vitamin (retinol, vitamins, ascorbic acid).
Surgical treatment of endometriosis.
modern hormone therapy has a very high efficiency in the fight against endometriosis.However, in some cases, certain forms of endometriosis demonstrated a strictly surgical treatment:
- retrotservikalnogo with endometriosis;
- in the presence of ovarian endometrioid cyst and complications leading to pelvioperitonitu;
- after failure of conservative therapy;
- when combined adenomyosis, fibroids and uterine bleeding;
- with oncological alertness - a probable ovarian tumor;
- in violation of the functions of adjacent organs.Under
surgery often involves laparoscopy (microsurgical vmeshateltvo), at least - in severe cases a laparotomy (incision of the abdominal wall).Laparoscopy is performed by electrocautery or laser - cauterize or remove endometriosis.Usually, surgical treatment is always combined with a conservative, that is, the combination treatment is considered to be the "gold standard".Assign GnRHa group of hormones for 3-6 months and then spend a laparoscopy.Or there is another option if endometrioza- first conduct a common form of surgery, then a conservative.
treatment results depend on the extent of surgical intervention, the usefulness of hormonal therapy.The rehabilitation period in most cases takes place favorably: restored reproductive function, significantly reduced pain during menstruation.After treatment, the recommended dynamic observation by a gynecologist: gynecological examination, ultrasound control (1 every 3 months), the control of the CA-125 marker in the blood.
Folk remedies for the treatment of endometriosis and physiotherapy.
for the treatment of endometriosis for a long time use traditional folk remedies, but they are in any case are not a substitute for medical or surgical treatment.All these methods are effective in the initial stages of development of endometriosis and can be successfully used as a supplement to the basic treatment:
- acupuncture.Treatment is carried out under the supervision of a gynecologist.Apply from 2-4 courses of acupuncture for about 10-12 sessions each;
- hirudotherapy - treatment of medical leeches positively affects the well-being of patients.Leech saliva has anti-inflammatory and analgesic effect;
- herbs: nettle, St. John's wort, plantain, upland uterus, etc. The infusion of herbs brewed, filter and take 3-4 times a day for 30 minutes before eating..
- physiotherapy: radon baths, magnetic therapy, electrophoresis with iodine and zinc.
Features of diet and lifestyle with endometriosis.
Endometriosis - a serious problem, but the woman herself can help themselves by driving a certain lifestyle:
- are encouraged to maintain an active lifestyle.Known fact that exercise reduces estrogen levels, thereby inhibit the progression of endometriosis;
- the use of tampons with endometriosis should be abandoned.The fact that tampons may inhibit the natural outflow of blood, exacerbating the pain during menstruation and causing blood to throw endometrial cells in the fallopian tubes;
- consumption of food should be complete.Recommended daily diet include about 50% of fruits and vegetables.The consumption of coffee, tea and carbonated drinks is better to limit.
Complications of endometriosis
lack of competent approach and timely treatment in the early stages of endometriosis can lead to serious complications:
- besplodie- occurs in approximately 25-40% of the total number of women with endometriosis;
- the development of post-hemorrhagic anemia due to chronic blood loss during mestruatsy;
- development of adhesions in the pelvis and abdomen;
- education endometrioid ovarian cysts;
- neurological disorders with compression of nerve trunks;
- the most serious complication of endometriosis - endometrial tissue degeneration into a malignant tumor.
Endometriosis and Pregnancy:
In endometriosis usually this is not an absolute sterility, which is able to eliminate the only complex medical treatment, but rather a significant reduction in the probability of pregnancy.In clinical practice, there are cases of conception for endometriosis, but, firstly, it happens very often, and secondly, is dangerous to the fetus - in particular, an arbitrary miscarriage.In this situation, a woman needs during pregnancy occur in a specialist doctor and strictly follow its recommendations.
mechanism of cause-and-sledsvtennye relationship between endometriosis and infertility are not sufficiently clear.There are several points of view on the factors leading to infertility in endometriosis:
mechanical interruption of tubal patency, the violation of the anatomy of the ovaries, difficulty in leaving the egg due to adhesions;What to do?