Endometriosis is a chronic, recurrent, progressive disease characterized by benign overgrowth of the uterine mucosa outside the uterine cavity. Pathology ranks third among all gynecological diseases in terms of frequency of occurrence. In most cases, it manifests itself in childbearing age. If left untreated, it leads to the development of cicatricial adhesions in the pelvis, endometrioid ovarian cysts, and infertility. In rare cases, malignant degeneration of endometriosis foci is diagnosed.
What causes a female disease - endometriosis of the uterus? Researchers have different opinions about the causes of endometriosis. Most specialists adhere to the implantation theory (the theory of retrograde menstruation), according to which, during menstruation, endometrial particles enter the fallopian tubes, abdominal cavity, and pelvic organs, attach to tissues and continue to function, causing microbleeds and inflammation. Some authors point to gene mutations, changes in the function of cellular enzymes, and hormonal disorders as the causes of the pathological overgrowth of the endometrium.
All women have retrograde menstruation, but the likelihood of endometriosis increases in the presence of predisposing factors, which include:
The high-risk group includes women over the age of thirty who have had abortions, cesarean sections, cauterization of cervical erosions, and family cases of endometriosis in their mother and grandmother.
Clinical manifestations of endometriosis largely depend on the localization of endometrial foci (heterotopias), in connection with which the genital and extragenital forms of the disease are distinguished.
In the genital form, heterotopias do not spread beyond the reproductive system; in the extragenital form, they occur in the intestines, bladder, kidneys, lungs, and in the area of postoperative scars. Depending on the localization of heterotopias in the genital form of the disease, the following are distinguished:
There are four degrees of disease development in the clinical picture, each of which is characterized by the prevalence and depth of the lesion:
Endometriosis of the uterus of the III–IV degree is less treatable, often leads to infertility, and when pregnancy occurs, it can provoke miscarriage. After treatment, the probability of conception in the first 12 months increases to 50-55%.
The disease can be asymptomatic for a long time, and often a woman is not even aware of the presence of health problems. Preventive gynecological examinations and screening programs for women help to identify endometriosis in the early stages.
The following signs help to suggest the development of the disease in the early clinical stages:
Infertility in endometriosis develops in 25-40% of cases. Obstetricians and gynecologists do not have a clear answer as to why the disease leads to impaired fertility. However, there are many known mechanisms by which endometrioid lesions contribute to changes in the ovaries and fallopian tubes, decreased general and local immunity, and menstrual cycle disorders. They interfere with conception by reducing the activity of spermatozoa in the fallopian tubes and uterine cavity.
Long”term endometriosis causes the formation of endometrioid cysts in the ovaries, scars and adhesions in the pelvic organs and abdominal cavity, in the last stages endometrioid infiltrates form with the germination of the rectum, ureters, “frozen pelvis" and as a result, infertility.
Extensive pathological foci can compress nerve endings and cause neurological disorders, such as discomfort in the pelvis and lower extremities, paresthesia, and chronic pain.
The malignant degeneration of endometriosis remains an unresolved scientific and clinical problem. According to various medical sources, malignancy of pathology occurs in 0.6–11.4% of patients with genital form. The prognosis of the disease is better than with conventional epithelial malignant tumors of the ovaries. The five-year survival rate for nondisseminated forms is 65%.
The symptoms of endometriosis are not specific and may occur with other gynecological diseases. A comprehensive examination of the patient helps to make an accurate diagnosis, which may include:
The diagnostic program is designed individually for each patient, so it may include other studies, as well as consultations with specialists in related fields. Based on the results of a comprehensive diagnosis, the doctor makes a diagnosis and draws up a treatment plan.
When choosing treatment tactics for a gynecological disease, the doctor is guided by several parameters: the localization and prevalence of the pathological process, the depth of the lesion, the patient's age, medical history, the presence of concomitant diseases.
Drug treatment of endometriosis (without surgery) is indicated in the early stages of the disease, with an asymptomatic course, at a young age of the patient, during premenopause. The leading place in drug therapy is given to hormonal drugs of the latest generation of progestogens. Gonadotropin releasing hormone agonists are used only in extremely severe recurrent forms of endometriosis.
In addition to the main treatment, the patient may also be prescribed immunostimulants, antispasmodic and analgesic drugs, and anti-inflammatory drugs.
Removal of foci of pathological tissue surgically is the most effective method of treating grade II–IV endometriosis. Preference is given to minimally invasive surgical procedures, which are highly effective but less traumatic for the patient. In all cases, laparoscopy is the gold standard of surgical treatment of endometriosis worldwide!
Regardless of the depth and prevalence of the pathological process, doctors try to preserve healthy tissues and reproductive function as much as possible. Radical operations with the removal of the uterus and appendages are performed only in extreme cases: patients over the age of 50 with children, with active rapidly progressive endometriosis, and without the effect of medication and gentle surgical treatment.
There is no specific prevention of pathology. Preventive examinations by a gynecologist help to identify the disease at an early preclinical stage. To reduce the risk of developing pathology, it is necessary to adhere to a healthy lifestyle, keep a menstrual cycle calendar, treat infectious diseases on time, maintain immunity, and seek medical help immediately if you feel unwell.
The Department of Gynecology and Oncogynecology at the EMC Clinic treats patients with endometriosis of any severity. Our experienced gynecologists carry out medical treatment of the disease, perform minimally invasive laparoscopic operations, and monitor patients in the postoperative period.
The EMC Clinic is equipped with the most modern diagnostic, therapeutic and surgical equipment, and patients are treated in accordance with approved international protocols. You can make an appointment with a gynecologist by calling the clinic or using the online form.
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