If I say that endometriosis is the growth of the endometrium, will this be enough for understanding the process? Perhaps, after all, no. So, for starters, let’s see, what is this the endometrium.
The content of the article
Endometrium and endometriosis
The proliferation of the endometrium with endometriosis Endometrium is not that other, as the mucous membrane lining the inner surface of the uterine body and is densely penetrated by blood vessels. The growth of this tissue outside its normal localization and is called endometriosis. To say that this is a very common disease, it means nothing to say: the incidence of endometriosis among women of childbearing age is 50%. He is considered one of the main reasons for the development of female infertility, although some sources had a chance to read and failure to prove this assertion, which confirms the thesis about medicine, mostly as a descriptive science.
The cause and pathogenesis of endometriosis
Endometriosis (photos) This article is obscenely scanty, as the causes of endometriosis are still the subject of heated debate in medical circles, during which the mentioned family history, and malfunctions of the immune system, and inflammation of the pelvic organs… the mechanism of development of disease as follows: cells of the endometrium during menstruation “migrate” through the fallopian tubes into the pelvic cavity, where it is embedded in the fabric of the peritoneum (in this case we speak of external endometriosis) or in itself the muscular layer of the uterus or myometrium (internal endometriosis)in the “wrong” place. In principle, these “travel” of the endometrium occur in healthy women, and this process is called uterine reflux, just when the immune system is able to cope with the alien tissue: macrophages “consume” the endometrial cells and they do not have time to cause any harm. Impaired immune system of this natural obstacle to the endometrium not. Blood and lymph it spreads to other organs, where it behaves like the mucous membrane, which, in fact, is undergoing the same cyclic transformations, as’t menstruate.
There are certain factors conducive to the development of endometriosis. This, for example, difficult birth, abortion, caesarean section.
Symptoms of endometriosis
- painful menstruation;
- pain in the pelvic area;
- spotting spotting before and after menstruation (as is typical for vaginal endometriosis and endometriosis of the cervix);
- infertility (still include this symptom in our list);
- there may be pain during sexual contact (vaginal endometriosis) and defecation (endometriosis of the rectum);
- at extragenital endometriosis (localized outside of the pelvic organs, vagina, cervix), depending on the region of the lesion is marked abdominal pain, constipation (endometriosis of the large intestine), urinary frequency, hematuria (bladder endometriosis).
Diagnosis of endometriosis
Colposcopy is one of the methods of diagnosis of endometriosis of the cervix Diagnosis of endometriosis is simple and complex at the same time. Simple, because the disease has a pronounced symptoms, but complications arise due to the fact that all of the above symptoms are also characteristic of other diseases of the pelvic organs. Initially, a gynecologist carefully collect the anamnesis of the patient, examines and interrogates her, and then selects a method of diagnosis. In relation to endometriosis using:
- ultrasound examination (only effective in case of ovarian endometriosis), in which it is possible to observe ovarian enlargement, the presence of cysts;
- colposcopy. This method is a visual inspection of the vulva and vaginal walls using a special device — colposcope. Colposcopy is used in particular for the diagnosis of endometriosis of the cervix in the premenstrual period;
- hysteroscopy or hysterography. It’s two complementary methods. Hysteroscopy is the examination of the internal walls of the uterus, both diagnostic and therapeutic purposes with the aid of a hysteroscope. Not always possible with hysteroscopy to assess the size and location of intrauterine structures. In this case, to help the gynecologist comes hysterography: the introduction of a radiopaque substance through the genital tract into the uterus and observing its passage with the help of the monitor with the subsequent interpretation of the obtained images;
- laparoscopy: a method of diagnosis and treatment, implemented by ociania small incisions or punctures of the natural barriers of the body with the further observation or treatment. It also uses a special device — a laparoscope (tube with a system of lenses and joined to the relay of visual signals).
Treatment and prevention of endometriosis
Traditionally, the treatment of endometriosis is divided into three aspects: surgical (operative) treatment, conservative treatment and combined. Depending on the severity of the disease, the doctor chooses either to use only conservative treatment, or a combination that combines surgical removal of foci of disease and subsequent drug therapy.
The basis of conservative treatment of endometriosis — a long-term hormonal therapy, which is implemented by means of the following preparations:
- GnRH agonists — goserelin (Zoladex). It is very comfortable for prolonged use of the drug, as it contains the active ingredient in depo-form (prolonged action). As a result of receiving the Zoladex endometriosis foci decreases, inhibits the formation of adhesions, cropped symptoms of endometriosis, like pain in the pelvis, vagina, menstrual pain;
- antigonadotropin — danazol (Vero-danazol, danoval, danol). Inhibits the production of autoantibodies, softening the inflammatory process in patients with endometriosis, contributes to atrophy of the endometrium;
- the progestogen — norethisterone (on a monitor), lynestrenol (orgametril, exluton), dydrogesterone (antiseptic). All of these drugs help to accelerate the transition of the endometrium from the proliferative (phase propagation) in the secretory phase of its development, slowing the endometrial hyperplasia that is increase in the number of endometrial cells;
- androgens — gestrinone (nemectron). Reducing the secretion of gonadotropin, leading to atrophy of the endometrium;
- antigestagen — mifepristone (mifegin, penkrofton). Antiproliferative action on the endometrium;
- combination estrogen-progestin — novinet, regulon, lindinet. Inhibit the secretion of estradiol by the ovaries, thus blocking the spread of endometriosis.
Besides hormonal medicines conservative therapy of endometriosis can include the use of homeopathic medicines (remens, ovarium-compositum, mastodinon), physiotherapy (electrophoresis of iodine, magnesium, zinc, copper, phonophoresis lidazy, trypsin, electrical stimulation of the cervix, pulsed ultrasound). To eliminate the pain syndrome use antispasmodics (no-Spa), anti-inflammatory (ibuprofen, aspirin), sedatives (tincture of Valerian and motherwort) funds.
Surgical (combined) treatment
If conservative treatment of endometriosis has the desired effect, in this case, resort to surgical treatment, accompanied by the reception of the above medicines. This usually laparoscopic method, which is used not only for diagnosis but also with therapeutic purposes. During a laparoscopy, as a coagulant, a laser is used, which prizhivayutsya endometriosis foci. Rarely (in severe cases) are used laparotomy, i.e., more extensive dissection of the abdominal wall, when instead a puncture, as in laparoscopy, an incision is made.
As a means of prevention of endometriosis may be called the use of contraception (abortion is one of the risk factors of endometriosis), the timely treatment of inflammation localized in the urogenital tract, any intrauterine interventions strictly on the testimony, the control of hormonal status.