Endometriosis is one of the most diverse and mysterious gynecological diseases. According to various estimates, endometriosis affects 3-15% of women of childbearing age, with a peak incidence of 20-35 years. To assess the medical and social significance of the disease, it suffices to say that endometriosis is the second most frequent cause of female infertility. Here it is second only to inflammatory diseases.
Hyperplasia of the endometrium, adenomyosis and endometriosis.
The name “endometriosis” comes from the term “endometrium”. This is the name for the uterine lining, which undergoes cyclic changes during the menstrual cycle and is sloughing during menstruation. In endometriosis, the endometrium goes beyond the uterus and extends to areas unusual for it.
Most often it is the vagina, fallopian tubes, ovaries, peritoneum. Sometimes excessive development (hyperplasia) of the endometrium leads to its germination into the deep layers of the uterine wall. Such endometriosis is called internal (the doctors sometimes call it adenomyosis) and is also a pathology.
It is assumed that the basis for the development of the disease is a complex of immune and hormonal disorders, but the exact causes of it have not yet been established. The most likely risk factors for endometrial hyperplasia, adenomyosis and endometriosis include adverse heredity, obesity, complicated delivery, abortion, use of intrauterine spirals, and late menopause.
Symptoms of endometriosis and examination possibilities.
The most frequent symptoms of endometriosis are pain in the lower abdomen and various disorders of the menstrual cycle (profuse, painful menstruation, irregular cycle, etc.)
In a number of cases, the suspected disease can be caused by vaginal bleeding, which can occur both during and outside menstruation.
To diagnose endometriosis and adenomyosis, to establish the localization of endometrial hyperplasia and the degree of the process can be done by a comprehensive examination in an institution that provides qualified gynecological care.
The use of such instrumental methods as hystero- and colposcopy, ultrasound of the pelvic organs, computer (CT) and magnetic resonance imaging (MRI) makes it possible to increase the informative value of the survey. The most accessible methods of non-invasive (not associated with penetration into the patient’s body) study include ultrasound. See the image obtained with a transvaginal ultrasound sensor. The ellipsoidal focus of hyperplasia is lighter.
CT and MRI are somewhat more informative, but are more expensive methods.
With hysteroscopy, a doctor can use a special device inserted into the uterine cavity to directly examine the condition of the endometrium and see the hyperplasia.
The professionalism of gynecologists at our clinic allows them not to send their patients to other specialists, but personally to perform gynecological ultrasound and to diagnose immediately in most cases of endometriosis.
Treatment of endometriosis: old approaches.
Today, doctors have a large arsenal of means for treating endometriosis. For a long time, the treatment of endometriosis with pseudopregnancy and pseudomenopause remained popular.
At the same time, doctors tried to simulate the hormonal background, which is observed in the body of a woman during pregnancy or during menopause, by means of the appointment of various hormones. At present, both methods are considered obsolete and ineffective.
The previously widespread belief that a real pregnancy can completely heal a woman from endometriosis has also failed. It is shown that, although in most cases in pregnancy the prevalence of the disease is somewhat reduced, a part of the foci that persists even after pregnancy gives rise to a new growth of the disease. Moreover, endometriosis calls into question the possibility of conception.
New methods of treatment of endometriosis.
Existing modern methods of treatment of endometriosis include both medicinal (the doctors also call them conservative) and surgical.
With conservative treatment most often used drugs that enhance or weaken the effect of sex hormones produced in the body. Among the most effective developments include, for example, such drugs as decapeptil, buserelin, zoladex. Also use danazol, gestrinone, norethisterone, levonorgestrel and drugs from the group of oral contraceptives. All these drugs are prescribed only by a doctor, self-medication of endometriosis is unacceptable and dangerous.
As auxiliaries, various vitamins, immunostimulants, and physiotherapy are used. Surgical treatment of endometriosis is carried out in case the drug therapy is not effective enough or there are contraindications to it. In this case, depending on the age of the woman and her desire to preserve the childbearing function, either individual foci of endometrial hyperplasia or the entire organ affected by the disease (uterus, fallopian tubes, ovaries) are removed. To avoid surgical intervention, it is necessary to consult a doctor as early as possible or to undergo regular check-ups.
Timely detection and qualitative treatment of endometriosis allows to avoid the development of the most formidable of its complications – infertility and improve the quality of life of patients.
In conclusion, we note that according to modern concepts, endometriosis is a common disease that affects the entire body as a whole. The immune, hormonal and metabolic disturbances observed during endometriosis and its frequent combination with various “non-gynecological” diseases compel, along with a gynecologist, to involve in the treatment of endometrial hyperplasia and other specialists (endocrinologist, neurologist, therapist.