Endometriosis is an insidious disease that mainly affects women of childbearing age. Although physiologically uterine epithelial cells should exfoliate and shed during monthly menstruation, due to various hormonal disorders, these cells may "travel" to more distant parts of the body. Where are endometriosis outbreaks most common? What is the treatment?

Generalthe mechanism of endometriosisrelies on the transfer of uterine epithelial cells, or endometrium, and their implantation in other organs in the form of the so-calledendometrial lesions , which may grow gradually. The specific location of the foci is related to the type of endometriosis.

There are 3 types of this disease:

  • peritoneal endometriosis- endometrial lesions occur within the peritoneal cavity and may vary in size, from one to several centimeters,
  • ovarian endometriosis- foci are formed within the ovaries - in the form of endometrial cysts, also known as chocolate cysts,
  • deep infiltrating endometriosis(Deep Infiltrating Endometriosis, DIE) - uterine epithelial tissue infiltrates the peritoneum "deep", more than 5 mm thick.

Location of endometriosis lesions

Depending on the type of endometriosis, its foci can be found in many areas, often having nothing to do with the reproductive system. Endometrial nodules are most often detected within the pelvic organs and the abdominal cavity, including:

  • large intestine (rectum, sigmoid colon),
  • broad ligaments of the uterus,
  • recto-uterine cavity (the so-called Douglas Bay),
  • rectovaginal septum,
  • adjaciczu,
  • vaginal wall,
  • ureters,
  • bladder,
  • diaphragm.

In very rare cases of advanced disease, endometriosis foci, forming characteristic adhesions or tumors, were also detected in organs located far from the uterus, e.g. in:

  • perierdziu,
  • pleura,
  • oku
  • or the brain.

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Complications of endometriosis

Untreated endometriosis, especially deeply infiltrating endometriosis, may lead to serious complications, e.g.

  • gastrointestinal obstruction,
  • narrowing of the intestinal lumen,
  • narrowing of the ureteral lumen, and thus even kidney death.

The aggressiveness of endometriosis is compared by some specialists to neoplastic diseases.

The expanding "foreign", infiltrating tissue causes the formation of adhesions and tumors within the proper tissue. It is suspected that long-term endometriosis lesions, especially cystic or deeply infiltrating lesions, may also increase the risk of cancer.

Symptoms of endometriosis

Symptoms of endometriosis can vary from woman to woman, depending on the specific location of the lesions. The most common are:

  • persistent and recurrent pelvic or lower back pain,
  • heavy menstrual bleeding
  • or pain during intercourse.

In the event of an outbreak in the intestines, digestive problems may arise:

  • flatulence,
  • diarrhea
  • or painful bowel movements.

Pain complaints, regardless of the organ in which the endometriosis occurs, are caused by the formation ofadhesions and clotsin the affected tissue. Local inflammation is then formed, and endometrial cells often infiltrate the nerve fibers, which is perceived as a sensation of pain.

Fertility disorders and endometriosis

Endometriosis also significantly affects the dysfunction of the reproductive system. It is estimated that evenin over 90% of women with this disease have problems with conceiving a childnaturally, and sometimes it will be impossible. This is because the expanding tissue of the endometrium interferes with the secretion of hormones by the ovaries and may impair their function.

The formation of endometrial cysts in the ovary can also significantly reduce the number of ovarian follicles that can be transformed into egg cells capable of fertilization (i.e. the so-called ovarian reserve).

Similarly, inflammation within the abdominal cavity, which often occurs with endometriosis, will negatively affect the implantation of the embryo, and thus reduce the woman's fertility.

Search for endometriosis

When suspecting endometriosis, it is very important to accurately diagnose, which will enable the preparation of a "map" of existing pathological changes. Various methods of imaging diagnostics are of the greatest importance here, such as:

  • ultrasoundtransabdominal,
  • transvaginal ultrasound,
  • transrectal ultrasound (the so-called TRUS examination),
  • magnetic resonance imaging.

In the advanced stage of the disease, when the patient complains of intestinal dysfunction, bleeding from the lower gastrointestinal tract and recurrent pains during menstruation, ultrasound examination of TRUS is especially useful.

This variant of the ultrasound examination can also be used when a previous examination performed through the abdominal or vaginal integuments revealed the presence of a large focal lesion (more than 3 cm) in the area of ​​the posterior vaginal fornix.

During in-depth diagnosis, when some disturbing change has already been detected earlier, magnetic resonance imaging is often used. This examination perfectly illustrates the disease processes taking place in soft tissues, tendons, ligaments and muscles.

Additionally, this test is very specific to the diagnosis of endometrial cysts. It also enables a simultaneous, detailed assessment of the anterior and posterior areas of the pelvis, along with the depth of tissue infiltration (which is particularly important in assessing the advancement of deeply infiltrating endometriosis).

Sometimes, in order to clearly identify the suspected tissue, it may be necessary to perform a diagnostic laparoscopy, i.e. endoscopy of the peritoneal cavity through a small incision in the abdominal wall. This technique enables the examination of the reproductive organs and the removal of tissue specimens without the necessity of invasive opening of the abdominal cavity, which may be associated with later complications and scarring on the body.

This procedure is recommended especially when pharmacological treatment is ineffective, the patient's quality of life deteriorates, there are numerous nodules around the appendages or the existing cyst has ruptured.

Removal of endometriosis lesions

Treatment of endometriosis, especially in young girls and women in the reproductive period, usually begins with the administration of pharmacological preparations. Most often these are estrogen-progestogen or progestogen pills with a contraceptive effect and analgesics.

With extensive advancement of the disease, especially deeply infiltrating endometriosis and the presence of several foci and cysts, the basic form of treatment will be complete excision of disturbing lesions.

Surgical treatment can be divided into:

  • conservative- is performed in women planning to become pregnant. It involves the excision of adhesions from the area of ​​the ovaries and fallopian tubes, but possibly without damaging their structure,excision of the cyst and excision or ablation (burning) of foci in adjacent organs.
  • radical- used in patients with advanced lesions who are no longer planning a pregnancy. It consists in bilateral removal of the ovaries and the uterus, most often using the laparoscopic method. The treatment is also called the so-called surgical menopause.

Unfortunately, even such an advanced surgical intervention does not always lead to a cure. In about 15% of patients, after radical treatment of endometriosis, pain still persists, and the foci may reappear with time.

Endometriosis, although it is usually asymptomatic in the initial stages, is a chronic disease that is difficult to treat. Long-term underestimation of symptoms related to menstrual disorders and pains in the pelvic area may lead to serious complications, including infertility.

Therefore, regular visits to the gynecologist should not be neglected, which should be routinely supplemented by a follow-up ultrasound examination.

Category:

Female diseases