Endometriosis is one of the most common gynecological diseases of the XXI century
After inflammatory pathologies of the small pelvic organs and uterine fibroids.
In this disease, inside the uterus, cells of the mucous membrane (endometrium) are localized outside the uterus or in other organs. For example, the so-called In uterine appendages or in the fallopian tubes and ovaries, in the uterine wall, in the abdomen, in the bladder, in the rectum and in other organs. Accordingly, differentiate between genital and extragenital endometriosis. Most often in endometriosis, endometrial cells cover the pelvic organs.
Anatomically, the endometrium is represented by two layers – basal and functional layers, of which the functional layer collapses during menstruation and is expelled with menstrual blood. In endometriosis, the cells outside the uterus function in the same way as the endometrium (the lining of the uterus), that is, they develop changes corresponding to the menstrual cycle.
What causes the development of endometriosis
Exactly what causes the development of endometriosis is still unknown today, however, several factors have been identified that create favorable conditions for endometrial cells to migrate (move) outside the uterus and for the development of the disease. These are: hereditary predisposition, excessive menstruation, short menstrual cycle, peculiar structure of the fallopian tubes, imbalance of sex hormones, changes in general and local immunity.
Specialists also name abortions and gross intrauterine manipulations as a catalyst for the development of genital endometriosis.
Endometriosis is usually a problem of young, women of reproductive age (30-50 years). Virtually all patients with this diagnosis have a change in hormonal background. At this time, the ratio of steroid hormones changes, the level of follicle-stimulating and melatonin-producing hormones increases, at the same time the level of progesterone begins to decrease, the prolactin content in the blood increases, the androgenic function of the cortical layer of the adrenal glands is violated. In some cases, endometriosis is “familial”, ie this problem affects several women in one family at a time.
To date, genetic markers of endometriosis have been identified by scientists. According to experts, if a woman has a healthy immune system, then the endometrial cells outside the uterus do not exist and function, it is the full immunity that destroys and shrinks the endometrial cells outside the uterus, does not allow them to develop new ones.
Among the provocative factors in the development of endometriosis are:
- Iron deficiency in the body
- Poor ecology
- Small pelvic surgeries (caesarean section, cervical erosion, etc.)
- Wearing an IUD
- Inflammatory diseases of the genitals
- Impaired liver function
Risk groups are created by women:
- Whose age is 30-45 years
- Who have no children
- Who have a long menstrual period – longer than 7 days
- Who have a short menstrual cycle – shorter than 28 days
- Who start menstruating earlier – before the age of 12
- Whose mother and sister have endometriosis
Most women with endometriosis experience an improvement in their condition during menopause and pregnancy. The symptoms of endometriosis may simply disappear during these periods.
What are the symptoms of endometriosis?
One of the characteristic symptoms of endometriosis of any localization is pain in the small pelvis. Pain is found in 40-60% of patients. The pain peaks on the days of menstruation and subsides as soon as it is over. As the disease progresses, the pain symptom loses its periodicity and acquires the character of a chronic pain syndrome. Pain in endometriosis may also be noted during defecation and urination, with pain sensation and discomfort developing during sexual intercourse. During endometriosis, the menstrual cycle is often violated – 1-3 days before menstruation and 1-7 days after menstruation, brown discharge is observed, menstrual bleeding is prolonged and intense, bloody discharge is observed between menstruations, sometimes signs of intoxication, heartburn, heartburn Increase in temperature, fever, increase in leukocytes and EDS (erythrocyte sedimentation rate).
Endometriosis is often the cause of infertility (in 45-50%), however, the causal link between these two conditions is often unclear.
What is the diagnosis of endometriosis based on?
- Ultrasound examination of the small pelvic organs
- Hysteroscopy (examination of the uterine cavity)
- Laparoscopy (endoscopic examination of the abdomen)
- Blood test for endometriosis marker
Treatment includes a conservative method or drug therapy, surgery or a combined approach (combining the two named methods).
The method of treatment is selected taking into account the individual characteristics of the clinical course of the disease, the age of the patient and the state of his reproductive function. The conservative method involves long-term hormone therapy. Sometimes a combined approach is used to treat endometriosis, after a certain course of drug therapy surgery is resorted to, mainly laparoscopy, laser or electrocoagulation of the relevant areas. Sometimes medication is prescribed after surgery.
After successful treatment of endometriosis, a woman’s uterine function is restored, the pain characteristic of the disease disappears during menstruation.