ENDOMETRIOSIS

ENDOMETRIOZ is a disease characterized by growth morphologically and functionally similar to the mucous membrane of the body of the uterus (endometrium) of the tissue beyond its usual location. It occurs frequently and is one of the leading causes of infertility in women and menstrual cycle disorders. The etiology of endometriosis is not well understood. A certain role is played by heredity. The important, perhaps, leading role of reducing the body's defenses is proved. Endometrial cells normally enter the pelvic cavity through the fallopian tubes during menstruation. In the vast majority of cases, they are destroyed by macrophages and other factors of immune defense. With a decrease in humoral and cellular immunity, endometrial cells do not die, but are introduced into the thickness of the myometrium (adenomyosis) or peritoneum covering the pelvic organs (external endometriosis); They can also be carried by the flow of blood and lymph to distant organs. Reproduction of endometrial cells occurs, the growth of so-called endometrioid heterotopia, which under the influence of ovarian hormones undergo the same changes as the mucous membrane lining the uterine cavity, and also "bleed" during menstruation.

Factors contributing to the development of endometriosis are complicated labor , cesarean section, abortion , as well as diathermocoagulation of the cervix, which is often used to treat erosion . If this intervention is performed on the eve of menstruation, then the probability of introducing endometrial cells into the wound surface is high, with the subsequent development of endometrioid growths in the thickness of the cervix and pelvic cavity.

Localization of endometriosis can be genital, affecting the organs of the small pelvis, cervix and vagina; Extragenital, localized in the bladder; Intestines, lungs, postoperative scars, navel. Genital endometriosis, in turn, is divided into the external, localized on the peritoneum of the small pelvis and ovaries, often with the formation of endometrioid cysts containing liquid blood and clots, and internal endometriosis (adenomyosis), localized in the submucosal layer of the myometrium, penetrating the thickness of the muscle layer into different layers of it Depth.

The most typical location is the foci of endometriosis in the rectovaginal septum, utero-sacral ligaments, wide ligament of the uterus, its serous membrane, ovaries and sigmoid colon; Less typical location in the cervical region, perineum, appendix, ileum, navel, postoperative scars.

Clinical picture . Typical clinical symptoms are painful menstruation, pelvic pain, infertility , pre- and postmenstrual inflammation, uterine bleeding . Less common are pain during defecation and sexual intercourse. With the involvement of neighboring organs (rectum, bladder) in the pathological process, constipation, frequent urination, hematuria , etc. can be observed. Bloody discharge from the genital tract in the intermenstrual period is a characteristic sign of endometriosis of the cervix. In vaginal endometriosis, spotting from the genital tract before and after menstruation can occur, and when the vaginal wall grows, there are pains in the vagina during menstruation, with sexual intercourse.

Endometriosis of the fallopian tubes is more often combined with internal endometriosis and endometriosis of the ovaries. Foci of the endometrioid tissue may be located and the area of ​​serous cover, in the muscular membrane or extend to all layers of the fallopian tube. The leading symptoms are abdominal pain during menstruation and infertility .

The clinical picture of ovarian endometriosis depends on the nature of the lesion. In the so-called small forms, when there are small (up to 0.5 cm in diameter) foci of the endometrioid tissue in the surface layers or on the serous cover of the ovary, cyclic abdominal pain and infertility are observed. In the formation of endometrioid cysts, filled with hemorrhagic contents, abdominal pain dramatically increases. With the help of bimanual research in the field of the uterine appendages, painful tumor-like formations of the ovoid form, a tauto-elastic consistency, are limitedly mobile, soldered to the uterus and peritoneum of the rectum-uterine space.

In endometriosis of the colon, abdominal pain is noted, initially coinciding with menstruation, then constant; May develop intestinal obstruction . With endometriosis of the bladder, dysuric disorders occur during menstruation, sometimes hematuria.

The diagnosis of genital endometriosis is established on the basis of a characteristic anamnesis. Prolonged ineffective treatment of inflammation of the appendages in combination with infertility and pain, intensifying during menstruation, suggests an endometriosis. The diagnosis is confirmed by the results of laparoscopy, in which the localization and degree of prevalence of external endometriosis are determined. Ultrasound is informative only for the diagnosis of endometrioid ovarian cysts that have a characteristic echoscopic pattern. The diagnosis of internal endometriosis (adenomyosis) is established using hysteroscopy or hysterography after scraping the uterine cavity. With hysteroscopy, the mouth of the endometrial ducts in the walls of the uterus is clearly visible. In hysterography, the x-ray diffraction pattern clearly identifies tree-like endometrioid passages filled with radiopaque material, penetrating into the uterus sometimes to the serous cover. Diagnosis of endometriosis of the cervix is ​​made in colposcopy in the premenstrual period - endometrioid heterotopies look like cyanotic "eyes", from which the blood oozes. The diagnosis of extragenital endometriosis requires the use of special research methods.

Treatment . Combined therapy is used to treat common external endometriosis. In the first stage, laparoscopy removes endometrioid growths with laser radiation, separates spikes, and resects the ovaries. The second stage is hormonal therapy to suppress ovarian function and achieve temporary amenorrhea. To this end, use preparations of estrogens, gestagens, derivatives of androgens and hypothalamic hormones. Depending on the severity and prevalence of the process, the drugs are used continuously for 3-6 months. For the therapy of less severe forms, only hormonal drugs are used for 6 to 8 months. Unfortunately, cures can be achieved quite rarely. More often we are talking about remission.

Prevention of genital endometriosis includes the introduction of modern contraceptives for the prevention of abortion , the performance of diagnostic and therapeutic intrauterine manipulation only according to indications, the prevention of trauma to the birth canal and their treatment (careful stitching of the cervical and vaginal wall ruptures), timely and adequate treatment of inflammatory diseases of the genital organs and Hormonal disorders.