Endometriosis is a disease that occurs only in the fairer sex. Endometriosis has nothing to do with endometritis, although the names of the diseases are very similar. Both diseases are united by the fact that the pathological process affects the inner mucous layer of the uterus – the endometrium, only in endometritis it develops inflammation, and in endometriosis – its excessive growth. In this article we will talk about endometriosis, what it is and how to treat it.
What is endometriosis?
As already mentioned, Endometriosis is an overgrowth of endometrial cells lining the uterus from the inside. Endometriosis is neither a cancer nor even a precancerous condition, but like a malignant tumor it can grow and germinate the surrounding tissues, penetrate the walls of blood vessels and spread throughout the body. Unlike cancer, growths in endometriosis consist of highly differentiated endometrial cells, ie fully mature and able to perform their characteristic function. Malignant tumor grows from undifferentiated cells, ie those that are not fully mature and have not acquired the characteristic morphological and functional characteristics of any tissue, in other words, cancer cells are completely foreign to the organism in which they grow.
Normally, the endometrium exists only in the uterus and lines it from the inside. In endometriosis, endometrioid cells penetrate the uterine wall, surrounding tissues and organs (ovaries, fallopian tubes, peritoneum, bladder, and rectum) and can even spread to distant parts of the female body (such as the lungs or eyes). Glandular tissue of the endometrium is hormone-dependent and undergoes changes in accordance with the menstrual cycle, and endometrioid cells do not care where they are. Therefore, at the same time begins to menstruate the endometrium, located in the uterus and the endometrium, growing far beyond it.
The development of endometriosis is characteristic of mature women of reproductive age, but also occurs in girls.
Why does endometriosis appear?
Despite the achievements of modern clinical medicine, the exact causes of endometriosis have not yet been established. However, there are several theories that can explain this benign growth:
- According to the implantation theory, for the development of the disease it is necessary that the endometrial cells through the fallopian tubes get into the abdominal cavity. Then the cells attach to any organ (ovary, peritoneum) and actively divide and multiply.
- Scientists who are inclined to the embryonic theory are convinced that the pathological growth of glandular tissue comes from cells of the coelomic epithelium, which has been in this area since the embryonic development of the genitourinary system.
- Hereditary theory is confirmed by statistics: girls whose mothers suffer from this disease, the risk of endometriosis is several times higher.
- Proponents of the induction theory believe that the pathological growth of the endometrium is associated with the influence of external factors.
- Hormonal theory is based on stimulating the growth of the endometrium with insufficient production of prostaglandins.
- The theory of lymphatic or venous embolism suggests that endometrial cells enter the bloodstream as a result of germination of vascular walls or, more likely, during any medical procedures involving mechanical impact on the inner layer of the uterus, such as caesarean section, abortion and etc.
Despite the fact that there is no single theory of endometriosis, there is a clear risk factors for the development of this disease, ie external and internal factors in which the risk of endometriosis will increase:
- the presence of urogenital infections in women;
- postponed surgical interventions on the uterus (scraping, installation of the spiral) and labor ruptures;
- concomitant endocrine pathologies and hormonal disorders;
- concomitant diseases of internal organs;
- leading an unhealthy lifestyle, including non-use of contraceptives, incomprehensibility in choosing sexual partners.
Classification of endometriosis
One of the classifications of endometriosis is based on the location of the pathological process:
- Genital endometriosis:
- Internal:
- Endometriosis of the uterine body (adenomyosis), comes in two forms: diffuse and focal, and fourth degree, up to germination in the pelvis;
- Endometriosis of the cervix. Localized in the outer part of the cervical canal (ectocervical endometriosis), or in its inner part (endocervical);
- Ovarian endometriosis (pseudocysts);
- Endometriosis of the fallopian tubes (often complicated by the adhesion process in the tube, as a result of which it loses patency for the fertilized egg).
- External:
- Vaginal endometriosis;
- Perineal endometriosis.
- Internal:
- Extragenital endometriosis
- Intestinal endometriosis;
- Pelvic endometriosis;
- Umbilical endometriosis;
- Endometriosis of the lungs, eyes, etc. It can be found in any organs and tissues.
In nine cases out of ten, genital endometriosis occurs.
Symptoms of endometriosis in women
The symptoms of endometriosis are not very specific and do not always depend on the location of the focus of pathological growth. Most often, women with this disease are concerned about the following symptoms:
- Pain in the pelvis, which may appear only before and during menstruation or be present constantly. It is associated with peritoneal irritation, spasm of the smooth muscle muscles of the uterine arteries, as well as mechanical pressure of the endometrioid cyst on the surrounding organs.
- Algomonorrhea (painful menstruation) is the result of simultaneous rejection of glandular cells not only in the mucous membrane of the uterus, but also in other foci. At the same time there is a bleeding, hypostasis and an inflammation of surrounding fabrics.
- Dysmenorrhea (menstrual disorders) is associated with hormonal disorders and is accompanied by constant smearing of blood. At the same time the menstrual periods themselves become abundant and long.
- Painful sensations during defecation and urination, as well as during sexual intercourse due to the appropriate localization of foci of endometriosis.
- If glandular tissue appears in distant parts of the body, then at the onset of menstruation they have characteristic changes, including bleeding, for example, if endometriosis has affected the mucous membrane of the eye, then once a month a woman’s tears will be with blood.
Complication
Among the complications of endometriosis the most significant and serious are:
- Rupture of the endometrioid cyst of the ovary. At the same time its contents leave in an abdominal cavity that leads to irritation of pain receptors. In severe cases, local or diffuse peritonitis develops.
- Uterine bleeding with the development of posthemorrhagic anemia often accompanies this disease. At the same time patients complain of increasing weakness, dizziness, fatigue, pale skin and tachycardia.
- Infertility in women with endometriosis occurs in approximately 30% of cases and is associated primarily with changes in the regulation of the menstrual cycle and ovulation. Also plays a significant role in obstruction of the fallopian tubes and reduced local immunity.
- Malignant degeneration of foci of endometriosis is extremely rare.
How to treat endometriosis
Treatment of endometriosis can be performed conservatively or radically. The approach to choosing a specific method of influencing pathological foci is strictly individual and is determined by a number of factors (age of the patient, location of the focus, comorbidities, etc.).
Among the drugs for the treatment of endometriosis use the following groups of hormonal drugs:
- Combination drugs (progestogen-estrogen) inhibit estrogen production and ovulation. They are used only in the initial stages of the pathological process in young patients.
- Progestogens are prescribed at any stage of the disease in long courses (at least six months).
- Antigonadotropic drugs affect the hypothalamic-pituitary system and are contraindicated in excess of androgens. They are also prescribed for a long time.
In addition to oral contraceptives for endometriosis use immunostimulants, antispasmodics and nonsteroidal anti-inflammatory drugs, which help to eliminate severe symptoms of the disease.
Surgical removal of pathological foci is the most effective treatment. However, it is not always possible to radically remove all endometrial growths. In this regard, there is a recurrence of the process, which requires repeated intervention. The operation is performed more often laparoscopically through several small incisions. In the common process, the abdominal cavity is dissected and all available cells are rehabilitated. It should be noted that the first six months after surgery are optimal for conceiving a child. In addition, pregnancy itself has a positive effect on the clinical course of the disease and often leads to a reduction or complete disappearance of pathological foci.
