endometriosis is a benign hormone-dependent disease that is characterized by the growth and functioning of the endometrium (the lining of the uterus) outside the lining of the uterus. Among gynecological diseases, endometriosis ranks third after inflammation of the genital organs and uterine fibroids.
Endometriosis predominantly occurs in women of childbearing age between 18 and 45 years of age, but can also occur in girls who have recently established menstruation. The disease is detected in 7-10% of women, while in 25-40% of patients with infertility.
According to the location of the foci, endometriosis is divided into:
The endometrium is divided into two layers: basal and functional. Every month during the first phase of the menstrual cycle, under the influence of estrogens - female sex hormones produced by the ovaries, the functional layer grows and thickens several times. In the second phase of the cycle, under the action of another female sex hormone - progesterone - the endometrium is loosened, and thus favorable conditions are created for the attachment and growth of a fertilized egg, i.e. for the onset of pregnancy. In the absence of conception, the functional layer of the endometrium is rejected and excreted with menstrual blood. With endometriosis, in those places where the endometrial tissue is located, the same cyclic changes occur as in the uterine mucosa.
Endometriosis can be in the form of nodes, infiltrates without clear contours, or cysts filled with a thick brown liquid (they are also called chocolate cysts).
Causes of endometriosis
The exact cause of endometriosis is not yet known. There are several theories for the origin of this disease.
Risk factors for endometriosis
Risk factors for endometriosis include:
Symptoms of endometriosis
The symptoms of endometriosis depend on the organ that is affected.
At adenomyosis- germination of the endometrium in the wall of the uterus - women present the following complaints:
At perineal or vaginal endometriosis on the mucous membrane there are rounded cyanotic foci, which increase before menstruation, and during it dark blood is released from them.
At endometriosis of the cervix on its surface there are red foci up to 2-5 mm in diameter, which become blue-purple before menstruation, increase in size, and bleed on the days of menstruation.
At ovarian endometriosis endometrioid cysts may form or endometrioid tissue is located in the thickness of the ovary. There are constant pains in the lower abdomen, which on the eve and during menstruation become stronger and can be given to the lower back, sacrum or rectum.
At endometriosis Bladder during the days of menstruation, blood appears in the urine and pain in the lower abdomen.
If it develops intestinal endometriosis, then there are pains in the rectal area, in the lower abdomen or lower back, and blood is released from the rectum on the days of menstruation, there may be diarrhea or constipation.
At endometriosis of the umbilicus or postoperative scarring in their area there are tumor-like formations, and on the days of menstruation, pain occurs and dark blood begins to be released from the foci of endometriosis.
If there is pulmonary endometriosis, then in the days of menstruation there is hemoptysis.
Diagnosis of endometriosis
An obstetrician-gynecologist can establish the diagnosis of endometriosis. If the focus of endometriosis is not located in the genital area, you may need to consult a urologist, proctologist, pulmonologist, surgeon and other specialists.
For the diagnosis of endometriosis, instrumental research methods are used:
Diseases with similar symptoms
Complications of endometriosis
With endometriosis, there are the following complications:
Treatment of endometriosis
For the treatment of endometriosis, conservative methods of treatment are used (prescribe medications) or perform surgery.
Conservative treatment endometriosis is the appointment of a woman hormonal drugs that suppress the growth of foci of endometriosis, they undergo reverse development. Use combined oral contraceptives(COC), progesterone preparations, antigonadotropins, gonadotropin-releasing hormone agonists.
Surgery is to remove the focus of endometriosis or the entire affected organ. With adenomyosis - endometriosis of the body of the uterus - the body of the uterus is removed, and the cervix is left (supravaginal amputation of the uterus) or the uterus is completely removed (hysterectomy).
If endometriosis of the cervix or vagina has arisen, then the foci of endometriosis are removed using a laser or exposure to low temperatures (cryolysis), as well as using radio waves (radio wave surgery). If endometriosis of the ovaries is detected, then the formed cysts are removed, mainly during laparoscopy. In the case of endometriosis of the peritoneum during laparoscopy, the foci are cauterized with an electric current.
Nota Bene!
In order for the surgical treatment to have an effect, after the operation, the patient is prescribed hormonal drugs for 3-6 months in order to avoid the re-development of endometriosis.
Prevention of endometriosis
Expert: Isaeva I. A., obstetrician-gynecologist
Prepared from:
www.medweb.ru
Umbilical endometriosis is round, oval or other irregular shape. In the foci is a liquid of light or dark color. The causes of this pathology have not yet been fully studied, but there are common signs that contribute to the development of this disease:
The following factors provoke the appearance of pathology:
This disease affects women under 40 years of age and girls whose menstruation began early, or during menstruation, abundant discharge is observed for more than 7 days.
In some cases, endometriosis occurs without severe symptoms, so only a doctor can determine it during a routine examination. However, more often the disease is manifested by such characteristic signs:
With exacerbation, there is a sharp pain in the lower abdomen. Such sensations indicate the presence of an inflammatory process in the organs where endometrial cells began to function.
It is possible to diagnose the disease only after examination using different methods. In this case, the following methods are used:
Studies are carried out in the pelvic region, but if the foci of endometriosis cannot be detected, the examination area is expanded.
Ultrasound is a common method because it is available in most hospitals. The result is a graphic photo. The presence of pathology in the picture is reflected in the form of circles and ellipses.
Hysterosalpinography uses a fluoroscope, x-ray tube and monitor. A contrast agent is injected and an x-ray is taken.
The most accurate data can be obtained during laparoscopy. This technique gives comprehensive results. It is used not only to diagnose the disease, but to treat it. In most cases, the operation is done immediately, without removing the patient from anesthesia, if the suspicion of endometriosis is confirmed.
Treatment of pathology is carried out in two directions:
Often, surgery has no alternative if the condition is rapidly deteriorating and there is a threat to subsequent infertility. In many cases, the pain becomes unbearable, pathological formations rapidly grow.
Surgical intervention can be performed in different ways, the method is determined by the location of the foci. Often even removal of the uterus is required.
Drug therapy is aimed at suppressing the reproduction of endometrial cells. The following groups of drugs are used:
A course of treatment is prescribed and the choice of drugs is carried out by the attending physician after the diagnosis. Treatment with leeches, acupuncture, medicinal herbs. Herbal medicine has an analgesic and hemostatic effect, but does not contribute to the disappearance of pathological formations. Hirudotherapy is considered more effective methodology and therefore has become widespread. The leech bites at biologically active points and injects its saliva. The enzymes that it contains contribute to blood thinning, restore hormonal balance, and improve blood circulation.
Despite the positive properties folk remedies, they should be used only after consultation with a gynecologist.
If treatment is not timely, you may encounter a number of complications:
For preventive purposes, you should follow these tips:
At risk are women after thirty years who have not yet given birth, so you should not postpone the birth of a child for a long time. Contributes to the emergence of pathological changes frequent climate change. For this reason, young women should refrain from frequent business trips or travel to countries located in a different climate zone.
venerologia03.ru
This form of the disease is diagnosed in women from the age of the first menstruation to the period of extinction of reproductive function. By definition, genital or internal endometriosis is the spread of endometrial cells outside the uterus.
The main reasons for the development of this process are still unknown, all assumptions remain at the hypothesis stage.
According to experts, the disease is based on a violation of the hormonal background or manipulations on the pelvic organs, provoked by the following factors:
The clinical picture of the genital form of pathology varies depending on its localization. Since foci of endometrioid tissue (heterotopia), even when outside the uterus, retain the properties of endometrial cells, they are subject to cyclic processes.
Properties of endometrioid cells:
There are common symptoms characteristic of this form of the disease:
In 50% of cases, with the genital form of the pathology, the ovaries are affected. On one or both paired organs, heterotopias appear, menstruating cyclically with the simultaneous development of the inflammatory process.
There is another form of ovarian endometriosis - an endometrioid cyst, which is a cavity with chocolate-colored contents. Inside the cyst is thick menstrual blood. This pathology is fraught with loss of follicles, the development of infertility.
Symptoms of ovarian endometriosis:
With the reverse reflux of menstrual blood through the fallopian tubes, endometriosis of the pelvic peritoneum develops, which is characterized by a rapid spread of the process. Painful infiltrates with signs of inflammation and swelling are formed on the peritoneal tissue.
IN initial stage endometriosis of the pelvic peritoneum is asymptomatic. On examination, one can see foci of heterotopia in the form of tubercles of light tissue, or vesicles of blue, purple, black. A woman complains of pain during exertion, during sexual contact, the inability to conceive a child.
Rare forms of internal endometriosis:
To diagnose this form of the disease, transvaginal ultrasound, hysterosalpingography, and laparoscopy are used. In the picture obtained as a result of ultrasound of the pelvic organs, heterotopias are presented as rounded or ellipsoidal formations.
Hysterosalpingography is an x-ray study with the introduction of a contrast agent.
The most informative diagnostic method is laparoscopy. The operation is performed under general anesthesia, it is also a medical procedure. During intervention in the area of localization of the reproductive organs, the doctor can remove endometrioid lesions.
External, or extragenital endometriosis, is much less common than the genital form of the disease. Foci of endometrioid tissue in this type of disease extend to organs located outside the small pelvis.
Possible causes of external endometriosis are transplantation of the uterine epithelium with blood flow against the background of reduced immunity, autoimmune disorders, and heredity. The clinical picture of this form of the disease depends on which organ is affected by the endometriotic focus.
How external endometriosis manifests itself - the main symptoms:
In the rectum.
Colitis develops, intestinal obstruction, bloating appears, alternating constipation and diarrhea, pain radiating to the coccyx, pain during defecation, blood in the feces.
In the appendix.
There is a pain syndrome on the right in the iliac region before and during menstruation.
Endometriosis of the umbilicus.
Characterized by bloody or bloody discharge from the navel during the menstrual period, bluish color, endometriosis of the navel in women is characterized by its “turning out” and cutting cyclic pains.
Lung endometriosis.
Appears hemoptysis during menstruation, pulmonary edema and shortness of breath, with the growth of infiltrate, the respiratory functions of the affected organ are lost.
Endometriosis of the kidneys and ureter.
Characterized by renal colic, blood in the urine during menstruation, pain in the lower abdomen with a return to the groin, thigh, lower back, urinary retention, the outcome of endometriosis of the kidneys and ureter - the development of pyelonephritis, hydronephrosis, wrinkling of the kidney and loss of its functionality.
Endometriosis of the abdominal cavity.
There are pelvic pains, aggravated by menstruation, physical activity, sexual contact.
The manifestations of the external form of this pathology are often mistaken for symptoms of other diseases. For example, endometriosis of the anterior abdominal wall can be diagnosed as inflammation of the peritoneum.
He is treated with antibiotics and antiseptics, which do not bring any relief. The choice of treatment tactics directly depends on the exact diagnosis of the pathology.
The main methods for diagnosing external endometriosis:
Bronchoscopy.
Method for studying structural changes in the respiratory organs.
Laparoscopy.
Allows you to detect formations characteristic of endometriosis of the abdomen.
Sigmoidoscopy.
Examination of the rectum at a distance of up to 35 cm.
Cystoscopy.
Definition of pathologies of a bladder.
During the diagnosis, the doctor can see characteristic endometrioid formations, Clinical signs heterotopias.
Since endometriosis is a hormone-dependent pathology, the treatment of both the internal and external forms of the disease is carried out in two directions:
The degree of surgical intervention depends on the age of the woman, her reproductive plans, and the stage of development of the disease. With a sharp deterioration in the patient's condition, severe pain syndrome, the operation is performed as soon as possible. After laparoscopy or after abdominal surgery, a woman is forced to take the following groups of drugs:
A similar scheme of drug treatment is used in conservative therapy. It includes analgesics, vitamins, anti-inflammatory drugs, immunomodulators. The course of treatment is long, requires scrupulous implementation of the doctor's recommendations.
cystitus.ru
UDC b18.14-002
ENDOMETRIOSIS OF THE NAUL: CLINICAL CASES
© N.A. Ognerubov
Key words: endometriosis; extragenital endometriosis; umbilical endometriosis.
Dan short review literature on extragenital endometriosis with lesions of the navel, including pathogenesis, issues of its diagnosis at the prehospital stage. The main method of treatment is surgical. The author reports the successful treatment of two patients with navel endometriosis.
Endometriosis is one of the most common benign diseases of the female reproductive system and takes 3rd place after inflammatory processes and uterine fibroids. The maximum incidence is observed in women aged 30-40 years.
The essence of endometriosis is the functioning of endometrial tissue outside the uterine cavity. The first report on endometriosis was made by Von Recklinghausen in 1860. There are genital and extragenital endometriosis. Genital, in turn, is divided into internal - endometriosis of the body of the uterus (adenomyosis) - and external - the cervix, vagina, ovaries, fallopian tubes, peritoneum, recto-uterine cavity, perineum, retrocervical region. Extragenital foci of endometriosis can be both an independent disease and a component of a combined lesion. In 1989 S.M. Markham et al. proposed a classification of extragenital endometriosis, according to which 4 classes are distinguished: class I - intestinal; class U - urinary; class L - bronchopulmonary; class O - other organs. Moreover, each group includes a variant of the disease with or without a defect in the affected organ. This is important in determining treatment tactics. Extragenital endometriosis is less common - up to 12%, however, it affects almost all organs and tissues of the female body: kidneys, ureters, liver, lungs, diaphragm, mammary gland, abdominal wall, skin.
The belly button is one of the unusual places where endometriosis can develop. Endometriosis of the umbilicus was first described in 1886 by Villar. Its frequency varies from 0.42 to 4% of all cases of extragenital endometriosis. Until 1938, R. Boggs (1938) collected 97 cases of navel endometriosis in the literature. H.S. Chapman (1940) added 4 more observations to them. J.V. Latcher analyzed 109 cases of umbilical endometriosis reported in the European and American literature. M. Michowitz et al. (1983) described 6 cases of spontaneous umbilical endometriosis. NOT. Williams et al. (197b) described a case of spontaneous endometriosis of the umbilicus in a 24-year-old woman with no symptomatic course.
phenomena, after excision the diagnosis was confirmed histologically.
In the domestic literature, this pathology was observed and described by Ya.I. Shereshevsky (1930), Ya.S. Valigura (1958), M.L. Davydov (1960) and others. In Lately publications devoted to various issues of navel endometriosis appear both in foreign and domestic literature.
Endometriosis is also the most mysterious disease, the causes and mechanisms of its development are not fully understood today. There are a number of theories about the origin of endometriosis. J.A. Sampson (1940) believes that endometriosis occurs due to reflux of menstrual blood and implantation of endometrial cells along the peritoneum of the small pelvis and its organs. However, this theory cannot explain the mechanisms of development of extragenital endometriosis. Other authors believe that endometriosis develops as a result of metaplasia of the coelomic embryonic peritoneum, the cells of which, under the influence of stimuli, such as inflammation or trauma, dedifferentiate into endometrial tissue. According to the dysontogenetic theory, endometriosis develops from abnormally located rudiments of the Müllerian canal, from which the reproductive apparatus of a woman, in particular, the endometrium, is formed later in the process of embryogenesis. This is supported by the fact of a combination of active endometriosis at a young age with congenital anomalies in the development of the genital organs (bicornuate uterus, accessory uterine horn). According to the migration theory of the pathogenesis of endometriosis, embolization and retrograde flow of endometrial particles through the blood and lymphatic vessels from the pelvic cavity, as well as the transfer of endometrial cells during surgical procedures, are possible. This theory is consistent with experimental data in which the introduction of menstrual blood into the subcutaneous tissue is accompanied by the development of endometriosis. The vast majority of experts explain the defeat of the navel by entering the endometrial tissue along the lymphatic pathways leading to the navel from the pelvis along the obliterated hypogastric vessels.
By the way, metastases of malignant tumors of the ovaries and uterus spread to the navel in a similar way. The presence of a large number of theories cannot
fully explain the isolated damage to organs and tissues in extragenital endometriosis.
Clinically, endometriosis of the navel is manifested by the presence of a tumor-like formation in the navel, ranging in size from a few mm to 6 cm, swelling, soreness, and bloody discharge associated with the menstrual cycle. Isolation of blood with pressure on the tumor in the umbilical region is a pathognomonic symptom. Differential diagnosis is carried out with umbilical hernia, primary and metastatic tumors (ovaries, stomach), inflammatory granulomas, lipoma, abscess.
Diagnosis, along with clinical diagnosis, is carried out using ultrasound with duplex scanning, magnetic resonance imaging and epiluminescence microscopy. G. Chene (2007) proposed an immunohistochemical study of the surgical material with CD-10 antibodies to confirm the endometrial stroma, with a sensitivity of 88%.
When choosing a treatment strategy, it is necessary to take into account the localization and extent of the spread of endometrial tissue, the severity clinical manifestations, age of the patient. Surgery is the treatment of choice for umbilical endometriosis. After the operation, in order to prevent recurrence, gestagen therapy is carried out continuously for 6 months. The prognosis for timely diagnosis and rational treatment of endometriosis is favorable. Malignant degeneration of extragenital endometriosis occurs up to 21.3%. For the first time, malignant degeneration was reported by J.A. Sampson in 1925, having determined the pathological criteria for a malignant process in the endometriotic focus.
Over the past 12 years, we have observed 2 cases of navel endometriosis in combination with genital endometriosis.
Patient N., aged 42, was admitted to the gynecological department with a diagnosis of endometriosis of the navel, internal endometriosis of the uterus II stage, endometriosis of the cervix for surgical treatment.
Complaints of prolonged painful menstruation, pain in the lower abdomen with irradiation to the rectum during menstruation, pain in the umbilical ring and bloody discharge from it during menstruation. From the anamnesis it is known that after the removal of the intrauterine device, the patient was found to have internal endometriosis. Subsequently adequate hormone therapy did not receive. Later, over the course of two years, the pain syndrome intensified, longer menstruation was noted, starting with sanious spotting discharge for 3-4 days. Then the pains in the navel area began to disturb, and bloody discharge from the umbilical ring appeared during menstruation. The patient sought medical help at the clinic at the place of residence, where a metastatic lesion of the navel was suspected. Performed fibrogastroscopy, diagnosed with chronic gastritis. Ultrasound of the pelvic organs revealed adenomyosis of the uterus, endometriosis of the cervix, multiple uterine fibroids. Irrigoscopy revealed no organic pathology of the large intestine. An objective examination of the patient hypersthenic physique, obesity 2 degrees. In the area of the umbilical
There is a papillomatous tumor of 1.0 x 1.5 cm in the form of a cauliflower, which bleeds on pressure. Cytological examination of a smear from the tumor revealed endometrial cells. Ultrasound was not performed due to the peculiarities of the anatomical structure of the umbilical region (obesity). The diagnosis was made: endometriosis of the navel in combination with internal and external endometriosis. Taking into account the degree of spread of the process, the age of the patient, we performed surgical treatment in the amount of extirpation of the uterus with appendages and excision of endometrioid ectopia in the area of the umbilical ring with plasty. Macroscopically, in the soft tissues of the navel there is a tumor, 1.0 x 1.5 cm in size, in the form of a cauliflower. On the section there are small cavities with "chocolate" contents. Histological examination revealed adenomyosis of the uterus, endometriosis of the cervix, uterine fibromyoma and endometriosis of the soft tissues of the umbilical region. Subsequently, the patient received gestagens for 6 months. Examined after 3 years, there were no signs of recurrence of the disease.
Second case. Patient B., 38 years old, was admitted to the gynecology department for surgical treatment with complaints: painful menstruation, swelling and pain in the navel, bloody discharge from it during menstruation. According to the patient, the patient has been suffering from internal endometriosis for 8 years, for which she irregularly took hormonal drugs. About a year ago, I noticed bloody spots on my underwear during my period. Subsequently, a tumor appeared in the umbilical region, which began to grow intensively in the next 6 months. She sought medical help at the place of residence, where a metastatic lesion of the navel was suspected. In order to exclude a tumor of the stomach and large intestine, fibrogastro- and colonoscopy was performed. A diagnosis of chronic gastritis and colitis was made. An objective examination in the umbilical region has a tumor-like formation, 3.0 × 2.5 cm in size, dense, its surface is bumpy, and when pressed, a brown liquid is released. The patient underwent a laparoscopic examination: the uterus is 14.0×8.0×7.0 cm in size, tuberous, deformed by multiple subserous and intramural nodes of various sizes. Irregular consistency and color. There is a pronounced vascular pattern of the peritoneum, the appendages are not changed. The peritoneum in the projection of the umbilical ring is thickened, bluish in color, motley due to inclusions of varying intensity, with endoscopic palpation of a heterogeneous structure. Cytological examination of a smear - an imprint from a tumor of the navel - endometrial cells with signs of dystrophy. A diagnosis of umbilical endometriosis was established in combination with internal endometriosis and multiple uterine myoma. Given the prevalence of the process, the patient underwent surgical treatment in the amount of extirpation of the uterus with appendages and excision of the navel tumor. Macroscopically soft tissues of the navel with a tumor 3.0 × 2.5 cm in size on a section with a cystic cavity in the center with a diameter of 1.5 cm, filled with thick "chocolate" contents. According to the morphological study, endometriosis of the body of the uterus, endometriosis of the soft tissues of the navel and multiple uterine fibromyoma were identified. The patient received a long-
body hormone therapy with gestagens. Reviewed after 4 years. There are no signs of relapse.
These clinical cases indicate the difficulty of diagnosing endometriosis of the navel at the prehospital stage. Despite the rarity of this pathology, in order to develop the correct treatment tactics, it is necessary to differentiate umbilical endometriosis with other diseases, primarily with tumors, umbilical hernia and skin diseases. Typical clinical picture indicating the relationship of discharge from the navel to the menstrual cycle, as well as the results cytological examination secretions allow you to accurately diagnose this disease. The main method of its treatment is surgical, the volume of which depends on the prevalence of the process. To prevent relapse, patients should receive long-term hormone therapy.
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nocrynma b pegaKunro 1 hkim 2013 r.
Ognerubov N.A. NAVEL ENDOMETRIOSIS: CLINICAL CASES
A brief review of the literature on extragenital endometriosis lesions with the navel, including the pathogenesis, diagnosis of problems of its pre-hospital is given. The main treatment is surgery. The author informs on the successful treatment of two patients with endometriosis navel.
Key words: endometriosis; extragenital endometriosis; navel endometriosis.
cyberleninka.ru
navel endometriosis
Before answering the question - is endometriosis treated - let's take a look at what this disease is.
Endometriosis is characterized by the growth in some organs of tissue, similar in structure to the endometrium - the inner lining of the uterus.
Most scientists associate the development of this disease with the introduction of particles of the endometrium itself into other organs. In their opinion, the spread of the uterine epithelium occurs through the tubes and through the blood and lymphatic pathways mainly during abortions, even if they are performed in the most thorough way. Another option is also possible - during menstruation. When the uterus is bent, for example, or the cervical canal is narrowed, the natural outflow of menstrual blood is difficult, and instead of flowing out of the uterus, it is thrown through the tubes into the abdominal cavity.
Sometimes development is promoted by hormonal disorders associated with ovarian dysfunction. Most often, endometrioid growths occur in the thickness of the uterus itself, somewhat less often - in its neck, fallopian (fallopian) tubes, ovaries, and vagina. Sometimes they also appear on the site of the external genitalia, perineum, navel, in scars left as a result of caesarean section, appendectomy and other abdominal operations.
Wherever there are growths of endometrioid tissue, monthly changes occur in them, which are observed in the mucous membrane of the uterus. Therefore, during the days of menstruation, they bleed. In the uterus, the ovaries behind the cervix, and wherever endometrial tissue develops, cavities (cysts) form that contain these secretions.
Pain that occurs, as a rule, on the eve and during menstruation. Endometriosis of the body of the uterus is manifested by pain in the lower abdomen and lower back. Sometimes it is painful, accompanied by nausea and vomiting. Due to the spread of endometrioid tissue into the thickness of the uterine wall, its contractility is reduced. As a result, menstruation becomes abundant and prolonged, which can lead to anemia.
For end. ovaries are also characterized by pain in the lower abdomen and in the lower back, but it is of a slightly different nature: constant, aching, aggravated during menstruation; often very sharp and accompanied by nausea, vomiting, bloating. During this disease, there may be periods of significant improvement, followed by exacerbations.
The fact is that the blood that flows into the endometrioid ovarian cysts during menstruation stretches them more and more each time. Gradually, the wall of the cyst becomes thinner, its integrity may be broken. And then the contents of the cyst seeps into the abdominal cavity. Adhesions and adhesions are formed. A rupture of the cyst is also possible, there is a sharp pain in the abdomen, fainting. In such cases, urgent surgery is needed.
When endometrial particles grow between the vagina and the rectum, pain appears in the lower abdomen, in the sacrum, lower back, rectum, which intensifies on the eve and during menstruation. Sometimes the pain is "tearing", pulsating in nature. The act of defecation and intimacy during this period is extremely painful. It hurts even to sit, there is a feeling of a "foreign body" in the rectum.
The spread of the process to the vaginal mucosa or rectum usually makes itself felt with dark brown discharge, which occurs a few days before menstruation, and sometimes lasts even after it ends.
Dark brown discharge before and after menstruation. But pain, as a rule, does not happen.
Endometriosis of the navel is manifested by cyanosis, soreness and swelling around it, especially before menstruation and on the days of menstruation. Bloody discharge may appear from the navel during this period. The same picture is observed in endometriosis, which developed in the scars of the abdominal wall after abdominal operations.
People often ask what threatens endometriosis, whether it goes, for example, into cancer. There is no consensus on this issue yet. Endometriosis is a benign disease, but some scientists believe that it may predispose to the development of malignant forms. Therefore, a woman suffering from endometriosis must be under the constant supervision of a doctor.
Of course, this disease is curable! Modern medicine has very effective hormonal agents that help fight this disease. However, there are times when such treatment has no effect and you have to turn to surgery. Surgical intervention, as a rule, is unavoidable in ovarian endometriosis.
Many women with endometriosis experience infertility. But it is not so much a consequence of endometriosis as the result of its accompanying hormonal disorders and inflammatory processes.
To prevent the occurrence, you must, first of all, be careful during the days of menstruation: do not lift weights, refrain from playing sports; Sexual life is strictly prohibited, even if spotting has already become insignificant. This reduces the possibility of backflow of blood (through the tubes) and the transfer of particles of the mucous membrane from the uterus to the peritoneal cavity.
According to many experts, the best remedy treatment - pregnancy and childbirth. The fact is that during pregnancy, and often during breastfeeding the child in the uterus stops cyclical changes and, therefore, the disease does not progress. Moreover, during this period, endometrioid growths undergo reverse development.
Timely detection and elimination of hormonal disorders, as well as the consequences of inflammatory processes that prevent the normal outflow of blood during menstruation, also contributes to prevention. Therefore, it is necessary that every woman sees a gynecologist twice a year. In this case, she will not have to think about whether endometriosis is treated?
Endometriosis is one of the most common and misunderstood gynecological diseases. This diagnosis is made by gynecologists quite often, but women, as a rule, remain in the dark - what exactly was found in them, why it should be treated, and how dangerous this condition is.
Let's figure it out!
In order to understand what endometriosis is, you need to understand how menstruation occurs and what the endometrium is.
The uterine cavity is lined from the inside with a mucous membrane called the endometrium (I will decipher the name: meter - uterus (Greek); endo - inside). This mucous membrane has a complex structure. It consists of two layers - the first is basal, the second is functional.
I explain: the functional layer is the layer of the mucous membrane that is shed every month during menstruation (if pregnancy has occurred, then it is in this layer that the fertilized egg is implanted). The basal layer is the layer from which a new functional layer grows every month.
This process can be compared to a lawn - you cut the grown grass, and after a while the grass grows again - the lawn is the basal layer; grown grass is functional.
Outcome: every month, under the influence of ovarian hormones, the endometrium grows in the uterus, if pregnancy does not occur, the endometrium is rejected, accompanied by bloody discharge - this is menstruation.
What is the discharge during menstruation? It is a mixture of blood and fragments of sloughing endometrium.
In almost all women, menstrual flow not only goes out (through the vagina), but some of it also enters the abdominal cavity through the tubes. Normally, menstrual flow that has entered the abdominal cavity is quickly destroyed by special protective cells in the abdominal cavity.
However, menstrual flow is not always completely cleared from the abdominal cavity. Pieces of the torn endometrium have the ability to attach to various tissues, implant in them and take root. Again, let me give you an example with a lawn. Imagine that you took a shovel and began to dig up sections of the lawn and scatter them on the soil. Most of these scattered fragments will take root, and will grow in the form of individual grass bushes.
Thus, endometriosis is a disease when the mucous membrane of the uterine cavity (endometrium) in the form of separate foci is located outside the uterine cavity, and in different places organism - most often on the peritoneum (what the abdominal cavity is lined with from the inside, and what the intestines are covered with). These fragments of the endometrium (also called endometrioid explants) can be found on the ovaries, tubes, uterine ligaments, intestines, and can also take root in other places outside the abdominal cavity, but more on that later.
After these fragments of the endometrium take root, they begin to exist in the same way as they did when they were in the uterine cavity - that is, under the influence of ovarian hormones, the explants (foci) increase in size, and then some of them are rejected during menstruation. That is, a woman with endometriosis has not only based menstruation, but also a lot of miniature menstruation in the foci of endometriosis.
Since these miniature menses occur in the abdominal cavity on the peritoneum, which is very well innervated, pain occurs during this process. That is why the leading symptom of endometriosis is abdominal pain.
The theory of the origin of endometriosis that I have described is called "implantation". This is one of the oldest and most obvious theories. In addition to this theory, there are also others. These theories suggest that endometriosis foci may be formed as a result of the transformation of peritoneal cells into endometrial cells, or these foci are formed as a result of genetic predisposition, immunological disorders, or as a result of hormonal influences.
Until now, there is no single view on the problem of endometriosis, but the implantation theory is considered the most obvious.
Anything that will contribute to more frequent entry of menstrual flow into the abdominal cavity.
In particular:
Other factors include:
Foci of endometriosis can be found not only on the peritoneum, but also in various organs and tissues of the body (this is very rare). It is assumed that this is due to the fact that fragments of endometrial tissue can be carried throughout the body by the lymphatic or circulatory system, and also get into wounds during surgery. For example, there is endometriosis of the kidneys, ureters, bladder, lungs, intestines. Endometriosis was found in the navel, in the suture after caesarean section, and also on the skin of the perineum in the scar after skin incision during childbirth.
Endometriosis lesions come in a variety of shapes, sizes, and colors. Most often, these are small seals of white, red, black, brown, yellow and other colors that are scattered throughout the peritoneum. Sometimes these foci merge and infiltrate tissues, especially often behind the uterus on its ligaments. Quite large masses of endometrioid tissue can form in this area (a condition called "retrocervical endometriosis").
If endometrial tissue enters the ovary, then endometrioid cysts can form in it, they are also called “chocolate cysts”. These are benign ovarian cysts. Their contents accumulate in the process of "miniature menstruation" of those foci of endometriosis that line the walls of the cyst.
Pain is the most common symptom of endometriosis. Pain syndrome is characterized by a gradual increase in pain that occurs immediately before or during menstruation, pain during intercourse and painful bowel movements. In some cases, the pain syndrome may not be designated as an acquired phenomenon, but simply a woman notes that she has always had painful menstruation, although most patients indicate increased pain in menstruation.
The pain is most often bilateral and varies in intensity from slight to extremely pronounced, often the pain is associated with a feeling of pressure in the rectal area and can radiate to the back and leg.
Constant “discomfort” throughout the entire menstrual cycle, aggravated before menstruation or during intercourse, may be the only complaint made by a patient with endometriosis.
The cause of the pain is not fully established, it is assumed that it may be associated with the phenomenon of “miniature menstruation” of endometrioid explants, which leads to irritation of the nerve endings. The disappearance of pain when menstruation is stopped in patients with endometriosis, that is, the exclusion of cyclic hormonal effects on endometrioid explants, actually proves the mechanism of the pain syndrome.
Other manifestations of endometriosis include spotting, brownish spotting before or after a period. Pain over the womb, painful urination, the appearance of blood in the urine (must be distinguished from cystitis - the latter most often occurs acutely and quickly passes in the process of proper treatment).
A separate manifestation of endometriosis is infertility. It is believed that endometriosis can lead to infertility through two mechanisms: the formation of adhesions that disrupt the patency of the fallopian tubes and due to impaired egg and sperm function.
Adhesions in endometriosis are formed due to the fact that at the site of endometriosis foci on the peritoneum, an inflammatory process actually constantly occurs, which stimulates the formation of adhesions. Adhesions disrupt the patency of the fallopian tubes, which leads to infertility.
Violation of the function of spermatozoa and the egg is due to the fact that in the presence of endometriosis in the abdominal cavity, the activity of the local immune system changes. It does not work correctly - too actively. In addition, the presence of endometriotic foci on the ovary can disrupt the process of egg maturation, the process of its release (ovulation), and it is also assumed that foci of endometriosis can change the quality of eggs, which leads to the fact that fertilization and implantation of a fertilized egg are disturbed.
The gold standard for diagnosing endometriosis is laparoscopy. In fact, only with the help of this method it is possible to see the foci of endometriosis and take a biopsy from them to confirm the diagnosis. Endometriotic cysts are visible on ultrasound, for which quite accurate characteristics are formulated, however, in some cases, such cysts can be similar to other ovarian formations, for example, to the "yellow body".
With endometriosis, the level of a special marker CA125 increases in the blood. This marker is also used to diagnose ovarian masses (often prescribed when there are suspicious ovarian cysts). This marker is not very specific as it does not reflect the severity of endometriosis. In general, its diagnostic value has remained only for assessing the regression of endometriosis during treatment, although this is not performed as often.
Other methods have also been developed, but they have not yet been widely used.
Thus, without laparoscopy, the diagnosis of endometriosis can only be assumed (with the exception of endometriotic cysts, which are visible on ultrasound). Ultrasound cannot determine the presence of foci of endometriosis in the peritoneum. With this method, it is only possible to detect the accumulation of endometrial tissue in the retrouterine space in a condition such as retrocervical endometriosis.
It is possible to assume the presence of endometriosis on the basis of the clinical picture and gynecological examination. The doctor most often pays attention to pain, their connection with menstruation and sexual life. During the examination, the doctor can palpate in the posterior fornix of the uterus (this is deep behind the cervix) painful seals in the form of "spikes" - these are, as a rule, foci of endometriosis. Patients with such seals often complain of pain during sexual activity, especially during deep penetration of a partner or in a certain position.
Endometriosis can be assumed as one of the causes of infertility in a couple. This question is still open. There are proven facts indicating that after laparoscopic destruction of endometriosis foci, pregnancies occur that have not occurred before. There are facts of detection of endometriosis in women who became pregnant on their own.
There are many opinions and tactics - in one clinic you may be told that laparoscopy to exclude or confirm endometriosis with its subsequent treatment is necessary for almost all patients with infertility, in another - the opinion may be radically different - they will leave laparoscopy for later and will search for and treat other causes infertility. What is paradoxical - both will have nice results in the treatment of infertility. This is such a mysterious disease - endometriosis.
How to be? I cannot answer this question unambiguously either. I believe that each specific situation should be dealt with separately. If a couple has other causes that can lead to infertility besides endometriosis, you need to correct them and try to get a result. If it is not there, perform laparoscopy (if there were no other indications for it before). If you have passed all the examinations and everything is normal, you can exclude the role of endometriosis. So logical, in my opinion. After all, if a woman has a disturbed ovulatory function, there are problems with the endometrium and a bad spermogram in her husband, you must first correct these violations and try to get pregnant.
The most common and accepted worldwide classification of endometriosis is the classification proposed by the American Fertility Society (AFS). It is based on determining the type, size, and depth of penetration of endometriosis foci on the peritoneum and ovary; the presence, prevalence and type of adhesions and the degree of sealing of the retrouterine space.
This classification is based on the prevalence of endometriosis and does not take into account parameters such as pain and fertility. According to this classification, there are 4 degrees of severity of endometriosis, which are determined by the sum of points that evaluate the various manifestations of the disease.
First I want to note that endometriosis completely disappears only after menopause (unless the woman receives hormone replacement therapy, against which endometriosis may persist). Before that, with the help of medical methods, we can achieve a stable remission, but it is impossible to guarantee complete elimination of endometriosis, as long as menstruation continues and there is sufficient hormonal activity of the ovaries or other hormone-producing tissues (subcutaneous fatty tissue).
There are two ways to treat endometriosis: removing endometriosis foci or temporarily turning off menstrual function so that the foci of endometriosis atrophy. Often these two methods are combined.
For the complete shutdown of menstrual function, drugs of the GnRH agonists group (buserelin-depot, zoladex, lucrin-depot, diphereline, etc.) are most often used. Such drugs are usually prescribed for a course of 3 to 6 months (drugs are administered intramuscularly 1 injection 1 time in 28 days). Against their background, a woman's menstruation disappears and a state similar to menopause sets in, with all the characteristic symptoms - hot flashes, mood lability, etc. But this condition is reversible, that is, after the last injection of the drug, after 1-2 months, menstruation is restored, and the state of "menopause" disappears. During this time, foci of endometriosis, devoid of hormonal stimuli, undergo atrophy.
Sadly, after such treatment, there are quite a few relapses. Apparently, after the restoration of menstruation, the mechanism for the formation of foci of endometriosis starts up again and a relapse of the disease occurs.
Other drugs that affect the foci of endometriosis include derivatives of male sex hormones - danazol, nemestran, etc. These drugs are quite effective, they are still used. Against the background of their intake, a condition similar to menopause also develops. The negative point in their use is quite pronounced side effects (especially from danazol, nemestran is relatively well tolerated). These drugs are also prescribed for a course of 3 to 6 months, relapses also occur frequently.
Hormonal contraceptives have a curative and preventive effect on endometriosis. Against the background of hormonal contraception, the cyclic effect of hormones on the foci of endometriosis is turned off, and they lose their activity. In addition, some contraceptives (for example, Jeanine) include a progestogen component, which can have an additional therapeutic effect due to a direct effect on endometriosis foci.
The effect of contraceptives on the foci of endometriosis is less pronounced than that of the drugs described above. Contraceptives are effective in small and medium forms of endometriosis, in addition, their intake provides prevention of this disease.
In order for contraceptives to have the most pronounced effect, they must be taken according to a new, so-called “prolonged scheme”. The essence of this scheme is as follows: contraceptives are taken not for 21 days and then a 7-day break, but for 63 days (that is, 3 packs in a row) and only after that follows a break for 7 days. Thus, a woman has one menstruation every three months. Such a prolonged regimen not only has a therapeutic and preventive effect on endometriosis, but is also better tolerated in general.
Contraceptives can also be used as a second stage after the main therapy with medications (GnRH agonists). As I noted above, after the abolition of these drugs, a relapse of the disease often occurs due to the fact that menstrual function is restored. Therefore, if, after the end of the main course, you start taking contraceptives according to a prolonged scheme, the likelihood of relapse is sharply reduced and the effect achieved by the main treatment course lasts longer.
Laparoscopy is used to treat endometriosis. During the operation, endometriosis foci are destroyed using various energies. Endometrial cysts are simply removed from the ovary. If endometriosis has led to the appearance of adhesions (it occurs quite often), the adhesions are destroyed, and the patency of the fallopian tubes is immediately checked.
Unfortunately, the effect of such an operation does not last long. After some time, foci of endometriosis reappear, and adhesions also develop again. In order for the effect of the operation to last longer, immediately after the operation, patients are prescribed a course drug therapy(GnRH agonists, nemestran).
If a woman did not plan a pregnancy, after completing the main course, she can start taking contraceptives to further prevent relapses.
If pregnancy was planned, it is necessary to make attempts to become pregnant immediately after the operation. It is important to remember that the more time has passed after the operation, the more likely it is that the effect achieved by the operation has already passed - most likely, adhesions have formed again and new foci of endometriosis have appeared.
If endometriosis-related disorders lead to the development of infertility, then surgical treatment of such conditions usually has good results. The appointment of drug therapy with GnRH agonists, danazol and gestrinone in the postoperative period is irrational, since this treatment leads to the suppression of reproductive function, and the highest frequency of pregnancies after surgical treatment is observed in the first 6-12 months after surgery.
The need for surgical treatment of women suffering from infertility against the background of mild and moderate forms of endometriosis is controversial. On average, 90% of women with mild to moderate endometriosis become pregnant on their own within 5 years. This is comparable to the pregnancy rate in healthy women in the same time period (93%).
The fact that surgical treatment increases the fertility of women suffering from mild and moderate forms of endometriosis is supported by only a part of the authors, the other part refutes these data. And, although it can be assumed that surgical treatment increases the fertility index in the first 6-12 months after surgery, and also contributes to the prevention of relapses, on the other hand, unjustified surgical activity in any case increases the likelihood of occurrence and inevitable recurrence of the adhesive process.
Long-term results of surgical treatment of pain syndrome associated with endometriosis largely depend on the individual characteristics of each particular patient, in particular, on her psychological status. Only diagnostic laparoscopy without complete removal of all foci of endometriosis (in other words, placebo-surgical treatment) can lead to the disappearance of pain in 50% of women. Laparoscopic laser destruction of endometriosis foci with moderate severity of the disease usually leads to the disappearance of pain in 74% of women. At the same time, surgical treatment of mild forms of endometriosis usually does not lead to significant pain relief.
In custody:
Endometriosis of the abdominal wall on scans is depicted as a rounded formation of reduced echogenicity with clear, somewhat uneven contours. Its diameter is usually about 1.5-2.5 cm.
Subcutaneous formations have increased echogenicity and heterogeneous structure. Their shape is usually elongated or elongated oval. The length of the formations varies within 1.5-4.4 cm, and the diameter varies from 0.8 to 1.7 cm. The boundaries of the formations are mostly clear and even.
It is noteworthy that behind them there is usually a pronounced acoustic effect of amplification.
In the study of the organs of patients with common external forms of endometriosis, in a third of cases, endometriosis of the peritoneum and ligamentous apparatus was detected. To diagnose these forms of endometriosis, it is advisable to orient MRI scans in the axial plane, as this helps to most clearly differentiate the ligamentous apparatus, especially the sacro-uterine ligaments.
In every fifth patient, endometrioid heterotopias were detected as round-oval foci filled with hemorrhagic contents, 0.3 to 1.5 cm in diameter, with MR characteristics typical of the endometrium. These changes were especially clearly visualized on T1-weighted image with fat suppression.
On scans, endometriosis of the navel was depicted as a round shape, predominantly spongy structure formation, with a diameter of 0.4-2.5 cm.
The echogenicity of the navel is mostly average, and the structure is homogeneous. The contour of education is usually even and clear. In most cases, its high sound conductivity is noteworthy, as evidenced by a pronounced increase in the echogenicity of the far contour and the anatomical structures located behind it.
Scar endometriosis on scans is depicted as an elongated formation of a heterogeneous structure, medium or low echogenicity, with clear and not always smooth contours. Inside the scar, cystic cavities are often determined. Behind the scar, a significant proportion of patients have some acoustic amplification effect. Accounting for clinical and ultrasound signs allows you to make the correct diagnosis in almost all cases.
Endometriosis is a common condition in women of childbearing age. Endometriosis affects various genital organs (uterus, cervix, ovaries, vagina, etc.), but sometimes it develops in the intestines, bladder and other organs. The disease is insidious in that it can lead to infertility, but if the disease is detected at an early stage, then treatment helps to avoid this complication.
endometriosis is a benign hormone-dependent disease that is characterized by the growth and functioning of the endometrium (the lining of the uterus) outside the lining of the uterus. Among gynecological diseases, endometriosis ranks third after inflammation of the genital organs and uterine fibroids.
Endometriosis predominantly occurs in women of childbearing age between 18 and 45 years of age, but can also occur in girls who have recently established menstruation. The disease is detected in 7-10% of women, while in 25-40% of patients with infertility.
According to the location of the foci, endometriosis is divided into:
The endometrium is divided into two layers: basal and functional. Every month during the first phase of the menstrual cycle, under the influence of estrogens - female sex hormones produced by the ovaries, the functional layer grows and thickens several times. In the second phase of the cycle, under the action of another female sex hormone - progesterone - the endometrium is loosened, and thus favorable conditions are created for the attachment and growth of a fertilized egg, i.e. for the onset of pregnancy. In the absence of conception, the functional layer of the endometrium is rejected and excreted with menstrual blood. With endometriosis, in those places where the endometrial tissue is located, the same cyclic changes occur as in the uterine mucosa.
Endometriosis can be in the form of nodes, infiltrates without clear contours, or cysts filled with a thick brown liquid (they are also called chocolate cysts).
Causes of endometriosis
The exact cause of endometriosis is not yet known. There are several theories for the origin of this disease.
Risk factors for endometriosis
Risk factors for endometriosis include:
Symptoms of endometriosis
The symptoms of endometriosis depend on the organ that is affected.
At adenomyosis- germination of the endometrium in the wall of the uterus - women present the following complaints:
At perineal or vaginal endometriosis on the mucous membrane there are rounded cyanotic foci, which increase before menstruation, and during it dark blood is released from them.
At endometriosis of the cervix on its surface there are red foci up to 2-5 mm in diameter, which become blue-purple before menstruation, increase in size, and bleed on the days of menstruation.
At ovarian endometriosis endometrioid cysts may form or endometrioid tissue is located in the thickness of the ovary. There are constant pains in the lower abdomen, which on the eve and during menstruation become stronger and can be given to the lower back, sacrum or rectum.
At bladder endometriosis during the days of menstruation, blood appears in the urine and pain in the lower abdomen.
If it develops intestinal endometriosis, then there are pains in the rectal area, in the lower abdomen or lower back, and blood is released from the rectum on the days of menstruation, there may be diarrhea or constipation.
At endometriosis of the umbilicus or postoperative scarring in their area there are tumor-like formations, and on the days of menstruation, pain occurs and dark blood begins to be released from the foci of endometriosis.
If there is pulmonary endometriosis, then in the days of menstruation there is hemoptysis.
Diagnosis of endometriosis
An obstetrician-gynecologist can establish the diagnosis of endometriosis. If the focus of endometriosis is not located in the genital area, you may need to consult a urologist, proctologist, pulmonologist, surgeon and other specialists.
For the diagnosis of endometriosis, instrumental research methods are used:
Diseases with similar symptoms
Complications of endometriosis
With endometriosis, there are the following complications:
Treatment of endometriosis
For the treatment of endometriosis, conservative methods of treatment are used (medication is prescribed) or a surgical operation is performed.
Conservative treatment endometriosis is the appointment of a woman hormonal drugs that suppress the growth of foci of endometriosis, they undergo reverse development. Combined oral contraceptives (COCs), progesterone preparations, antigonadotropins, gonadotropin-releasing hormone agonists are used.
Surgery is to remove the focus of endometriosis or the entire affected organ. With adenomyosis - endometriosis of the body of the uterus - the body of the uterus is removed, and the cervix is left (supravaginal amputation of the uterus) or the uterus is completely removed (hysterectomy). If endometriosis of the cervix or vagina occurs, then the foci of endometriosis are removed using a laser or exposure to low temperatures (cryolysis), as well as using radio waves (radio wave surgery). If endometriosis of the ovaries is detected, then the formed cysts are removed, mainly during laparoscopy. In the case of endometriosis of the peritoneum during laparoscopy, the foci are cauterized with an electric current.
Nota Bene!
In order for the surgical treatment to have an effect, after the operation, the patient is prescribed hormonal drugs for 3-6 months in order to avoid the re-development of endometriosis.
Prevention of endometriosis
Expert: Isaeva I. A., obstetrician-gynecologist
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