Endometriosis of the uterus: symptoms and treatment. Hormone therapy and its features

Endometriosis is a disease at which an increase in the number of cells of the intrauterine lining layer (endometrial) occurs, as a result of which its growth is observed and the output beyond the limits of the uterus, and in some cases beyond the limits of the reproductive system. Endometrial fragments are found in the digestive system, ovaries and other places.

Often endometriosis accompany various gynecological inflammatory processes, as well as the mioma of the uterus. As a rule, the course of the disease is rapidly, but only in 5% of cases, tissue growth is converted into a malignant tumor.

Classification

At the place of formation, endometriosis is divided into 3 types:

• Genital. It is found in 92 - 95% of cases. It is divided into the internal muscular body of the uterus (adenomyosis) and outer endometriosis - the disease is striking the vagina, ovaries, the cervix, crotch, retrocervical fiber, sacaches, uterine pipes, a straightforward-uterine deepening of the peritoneum.
• Extgazenital. Develops in the organs of the excretory system, intestines, lungs and other organs, as well as in postoperative seams;
• Mixed. Combines both types.

It is often found in chronic form. The disease is characterized by alternating temporary exacerbations and remissions. Treatment chronic endometriosis is not amenable. The principles of treatment are based on symptomatic therapy and a slowdown in the development of alend.

Endometriosis of the uterus in turn has 3 forms:

• diffuse - formed when the endometrioid tissue expansion across the entire area of \u200b\u200bthe mucous membrane. As a result, cavities are formed in myiometry;
• nodal - Local endometrium foci arise with non-permanent nodes;
• some small sections of the walls are exposed to exploration.

There are 4 degrees of endometrial penetration depth:

• 1 degree - endometrium foci ground shallow (within the muscular layer);
• 2 degree - Half myometry is amazed;
• 3 degree - endometrium penetrates the whole thickness of the muscular uterine wall;
• 4 Degree - growing affects the adjacent bodies and covering their peritoneum, in the uterus there is a faster movement, which goes into a small pelvis.

Video fragment of the maparoscopic operation about the nodal form of the endometriosis of the body of the uterus

The reasons

Factors that potentially affect the occurrence of the disease, quite a lot, however, the exact causes are not installed so far. Most likely:

• hormonal failures;
• menses;
• endometrial metaplasia (biotransformation of one type of fabric in another);
• stenosis of the cervical canal;
• impairment of the immune system;
• genetic heredity.

Possible reasons also include the transferred operations of the small pelvis organs (here also include the ignition of the erosion of the cervix and cesarean section), iron deficiency anemia, abortion in history, complex or late first labor, availability of inflammatory processes, intrauterine spiral, obesity, hypodynamia, stressful situations, Bad ecology and others.

Symptoms

Frequent phenomenon is the absence of any symptoms. However, it is worth consulting a doctor when manifesting any of the signs below.

The main symptom - disorders of the menstrual cycle. Mozhuchi allocations and painful sensations begin in 2-3 days before menstruation and last a few days after its end.
Often in the middle of the cycle, uterine bleeding of various intensities are observed. For menstruation, the abundance and availability of clots are characteristic, the result of which chronic postgemorgic anemia can become.

Half of the sick women arises premenstrual syndrome, while the duration of the monthly shortens. Menstruation is accompanied by parietal pains. Pulling painful sensations in the lower abdomen are manifested at sexual acts.

Diagnostics

Since there are a number of gynecological diseases similar in symptoms with endometriosis, a complex of certain procedures is carried out to confirm the diagnosis. These include the following:

Treatment

It is carried out by hormonal, symptomatic and operational methods.

For hormone therapy, the following drugs are prescribed:

• oral contraceptives (combined single-phase), such as regular, zhinin, Diana-35, Logest. Course treatment - 7-9 months;
• the prolonged shape of the medroxyprogesterone (for example, depot-wire). The medicine is used intramuscularly once in 2.5-3 months. The duration of treatment lasts from six months to 9 months;
• preparations that are agonists hormone Gonadotropin Rilizing (Zoladex, Bususorelin). Used for half a year;
• nuclearoid derivatives (for example, Levonorgestrel). On the basis of this drug, some intrauterine spirals are made, the main advantage of which is local hormonal impact;
• androgens and their derivatives (Gestrinon, Danazole). Apply no more than 4-6 months.

Symptomatic treatment includes the use of antispasmodics (but-shap, drootaverin), anti-inflammatory drugs (ibuprofen), sedative (tincture of valerian, mother-in-law) and enzyme preparations (chymotrypsin, lidase). Mandatory condition is the saturation of the body with vitamins.

These methods are characterized by high efficiency, but in some cases surgical intervention is inevitable:

• when revealing retrocervical endometriosis;
• in suspected oncology;
• with the simultaneous diagnosis of myoma and endometriosis, accompanied by uterine bleeding;
• when detecting in the ovary of the endometrioid cyst and in the development of complications leading to the occurrence of pelvioperitonitis;
• in the case of low hormonal treatment;
• if there is a violation of the functioning of a number of organs.

Laparoscopy (microsurgical operation) is used as the main operational manipulation. Its carrying out through a laser or electrocoagulation. At the same time, the foci of endometriosis is migrated or completely removed. In the launched cases, laparotomy is assigned (incision of the front abdominal wall).

The maximum result in the treatment gives comprehensive therapy, including hormonal and operational methods.

To get rid of the disease, folk remedies are often used (use of drugs from medicinal herbs) and physiotherapy procedures (needlestextlexotherapy, magnetotherapy, radon baths, hirudotherapy, electrophoresis with zinc and iodine).

Forecast

The endometriosis of the uterus is characterized by a chronic flow accompanied by periodic exacerbations whose frequency is growing over the years. If a parable is launched, the consequences may be irreversible. The main complications with an unfavorable endomiosis forecast - education in the ovaries of the cyst, the formation of adhesions in a small pelvic and abdominal cavity, postgemorgic anemia, problems in the field of neurology. The worst option is to rebirth endometrium tissues in oncological neoplasm.

If the disease is diagnosed on time and therapeutic therapy is immediately launched, the forecast of the disease is favorable.

Endometriosis of the uterus is the cause of female infertility in each third case (endometriosis and pregnancy). However, in the presence of this disease, pregnancy is not only real, but also strongly recommended. This is due to long-term anovulation, lack of menstruation and the beneficial effect of progesterone during pregnancy.

However, the presence of endometriosis in a woman can cause miscarriage. For such patients, preparation for pregnancy is recommended, as well as the adoption of preventive measures due to the possible development of fetoplacentage failure.

Endometriosis and myoma uterus

The combination of these two diseases is a fairly common phenomenon. Symptomatics is similar to signs manifested in endometriosis. However, in this case, manifestations are largely expressed. Most often, the only treatment for such pathology is a surgical operation. A few years ago, this treatment method deprived women chances to get pregnant and fully endow the child, however, the current medicine makes it possible not only to preserve the uterus, then not to lose its ability to fully function.

Sometimes treatment is limited to the appointment of hormonal drugs, which reduces the size of myoma. However, in the future, the operation is still recommended. The use of folk remedies in this case is inefficient.

Endometriosis of the uterus is the cause of female infertility in each third case. However, in the presence of this disease, pregnancy is not only real, but also strongly recommended. This is due to long-term anovulation, lack of menstruation and the beneficial effect of progesterone during pregnancy.

However, the presence of endometriosis in a woman can cause miscarriage. For such patients, it was recommended to conduct a preventive preparation, as well as the adoption of preventive measures in connection with the possible development of fetoplacentage insufficiency.

Endometriosis occupies 3rd place among gynecological diseases after inflammation and misa. It is mostly diagnosed in women of reproductive age, sometimes in adolescents, quite rarely - in the post-block cell period.

The endometriosis of the body of the uterus is a hormonally dependent disease associated with the growing epithelium beyond the body. Endometrium (mucosa of the uterine cavity) consists of a connecting base layer and a cylindrical epithelium. In the thickness of the endometrium there are tubular glands, a thick network of capillaries.

If a woman is healthy, fabrics are localized in the uterus cavity. Under the action of certain factors, fragments of ferrous cells are found in the thickness of the organs where they should not be. Such growths are called heterotopy.

Plots may occur in uterine pipes, muscle layer of uterus, ovaries, urinary bubble, peritoneum, intestines, other organs. This fabric is experiencing the same cyclic changes that endometrium. That is, during menstruation heterotopic sections bleeding, increasing pathological education. With each cycle, more and more organs of the small pelvis are involved.

Causes of internal endometriosis of the bodies of the uterus

Endometriosis disease

Pathology has not been understood little, there is no consensus on the mechanisms of its development. Risk factors Endometriosis:

• reproductive age;
• inability to conceive and give birth;
• abortions Earlier, other manipulations on the uterine cavity;
• long use of intrauterine helix;
• menstrual cycle failures;
• abnormalities of the structure of the genital organs;
• obesity;
• chronic inflammatory processes;
• genetic predisposition.

Immune and hormonal failures are becoming provoking factors. The prerequisite for the progression of endometriosis is excess estrogen and prolactin, violation of the exchange of progesterone. These hormones regulate the normal course of the menstrual cycle.

Signs of internal endometriosis of the body of the uterus

There are very insidious diseases, since a long time is asymptomatic. The hidden flow is often found by chance when a woman appeals to the doctor about infertility.

Endometriosis symptoms resemble signs of other gynecological diseases. It:

• pain in the area of \u200b\u200bthe belt, the lower abdomen appearing during menstruation;
• fainting, nausea vomiting - signals about the widespread process;
• pains during intimate proximity, defecation - depend on the location of the focus and the severity of the disease;
• menstrual cycle failures, monthly becomes long and abundant, the cycle is reduced;
• brownish allocations that appear a few days before menstruation;
• breakthrough uterine bleeding, hormonal imbalance - characteristic of diffuse form;
• signs of general intoxication (temperature, fatigue, weakness).

The basis for applying to the gynecologist is any changes in the menstrual cycle and the nature of the monthly, the appearance of pain, discomfort and other signs that are not characteristic of normal menstruation. It is better to diagnose pathology in the early stages, when it is amenable to medication correction.

There is pain at proximity

Echographic signs of adenomiosis of the body of the uterus

Symptoms of endometriosis are easy to confuse with other diseases of the gynecological sphere. Exact diagnosis can only be delivered by a doctor with a personal inspection and tool diagnostics.

The most common method of detecting endometriosis is an ultrasound study. Echo signs against the background of general symptoms help clarify the disease:

• thickening of the walls of the uterus;
• round anechogenic inclusions of 0.2-0.6 cm;
• an increase in the overall size of the uterus to a spherical shape;
• it is possible to detect a cyst in the field of damage.

Adenomiosis nodes are different from Moma. They do not have clear contours and capsule. Vaginal research is more informative in the second phase of the cycle (23 - 25 day).

Damage to the disease

Treatment of endometriosis of the body of the uterus

The disease is seriously amenable to therapy. In many cases, complete recovery does not occur. The situations of independent healing endometriosis after delivery are described. But this happens rarely. More often endometriosis passes after the occurrence of Klimaks when the hormonal background changes.

A comprehensive treatment program is developed on the basis of the survey results. In addition to localization, severity, the form of pathology The doctor takes into account the age of a woman, her desire to conceive a child.

If the disease is revealed at an early stage, conservative treatment is shown. The course of medication therapy includes:

• hormonal drugs;
• NSAIDs;
• sedative medicines;
• immunomodulators;
• vitamins and minerals.

Additionally show physiotherapy methods. In severe cases, with the ineffectiveness of drug therapy, the presence of contraindications to some preparations is prescribed surgical treatment.

The operation may be radical or organ-powder. The gold standard is considered to be a laparoscopy technique at which the elimination of endometrial foci is eliminated.

Process operation

With an aggressive course, high risk of rebirth into the cancer tumor, the presence of life-focused complications is recommended to extract the uterus. After such intervention, the woman cannot have children, so the technique is applicable at the age of 40 and older.

The success of therapy is determined to restore or maintain a childbearing function. If there are no symptoms of relapse for 5 years, the woman is considered recovered.

Forms of the disease

Depending on the location of foci, endometriosis is genital and extragenital. The first form includes damage to the genital organs, to the second - other organs. At multiple foci, a mixed form of the disease is diagnosed.

Endometriosis of the uterus body is a genital variety. The lesions are external with the involvement of the cervix and pipes. With internal adenomyosis, the body of the uterus is affected, the foci are introduced into the muscular layer of the organ. According to the nature, adenomyosis focal, diffuse, nodal, mixed.

Forms of adenomiosis

Diffuse endometriosis of the uterus body

Differs the specifics of the process. Endometrial cells penetrate the muscular layer of the organ and gradually affect it completely.

The disease brings serious inconvenience, but in the early threshers there is no symptomatic. Usually the patient feels pain in the pelvic area, abundant bleeding, discomfort during sex, lack of pregnancy.

The development of pathology affects the state of the endocrine system, the presence of inflammatory processes transferred earlier gynecological interventions.

You can get reliable information about the disease using endoscopic research. Palpation, characteristic symptomatology, ultrasound allow you to suspect pathology, but without an internal inspection of the uterus, you cannot be sure.

The negative moment of treatment of diffuse adenomiosis is the impossibility of conducting a organ-breaching operation. In the early stages, it is possible to stop the disease by appointing hormones. Such treatment introduces the patient to artificial climax, anomalous growth of the endometrium stops. Latest stages show the removal of the uterus.

Focal endometriosis of the uterine body

In this form, local foci in muscle tissue are observed. Pathology is fraught with frequent pelvic pains, protracted menstruation, brownish intermenstrual bleeding, inability to conceive.

The risk group of focal endometriosis includes women of reproductive age, whose relatives also suffered from this disease.

Conservative, operational and combined measures are used to combat the disease. The focal form is fully corrected by hormonal preparations at stage 1. When the dimensions exceed 2.5-3 cm, minimally invasive techniques (laparoscopy, hysteroscopy) are shown. The destruction of formations is carried out by excision with a laser or electrocoagulation.

With early diagnosis, a complete recovery of a woman comes and restoring its reproductive function.

Nodular

Formed knots

At the same time, sites filled with connective and glandular cloth are formed on the endometrium penetration site. The nodal form meets not as often as others. But it is the most dangerous.

Often, nodal adenomy is combined with the uterine, which represents certain difficulties in the diagnosis. The main features are the formation in the muscular layer of uterus of different sizes.

At the first stages, adenomyosis does not manifest itself, does not affect the quality of life and the childbody function. With the development of the disease, symptoms become pronounced.

An early degree is easily corrected by oral contraceptives. The most sparing method of operational intervention is laparoscopy. It is used only with a small size of the nodes, and if the process did not affect the serous layer of the uterus.

Degree of development

Pathology depends on the depth of the uterus's defeat. 4 stages of the disease are distinguished.

From the normal state to defeat

Endometriosis of the body of the uterus 1 degree

Not characterized by any changes in the state of health. There is no pronounced symptomatology, the disease is diagnosed when a planned inspection of a gynecologist is randomly.

Women almost never turn to a doctor with suspected adenomyosis of 1 degree. It may slightly increase the menstrual cycle, but the monthly not abundant, the form of the uterus and the size does not change.

Outmaline Endometriosis 2 degrees

Endometrial cells penetrate into deeper muscle layers. The first symptoms appear: the overtakers, the severity at the bottom of the abdomen. The progression of the disease is developing nausea, vomiting, frequent headaches, body temperature lift.

On the 2 stages in the interruptions between the monthly, the selection of brown can appear. Surgical treatment is not yet required, sufficiently conservative techniques.

2 degree

3 degree

Myometry is affected to the serous layer. On the examination, significant changes in the surface and structure of the uterus are noted, some areas are enlarged, there are no clear boundaries and contours for formations. There is a significant thickening of the walls of the uterus.

At this stage, abundant and long monthly, strong bleeding between them are noted.

4 degree

Endometrial growth goes beyond the uterus, penetration into the ovaries, pipes, bladder.

A woman is experiencing regular pain in the head, can faint. Shortly before menstruation and during her severe pain appear, feeling of gravity at thenore of the abdomen. The only treatment at such a stage is surgical removal of the uterus.

May develop infertility

Consequences of the endometriosis of the body of the uterus

What does the absence of treatment of pathology lead to? On its background, many women develop secondary infertility. In the launched cases, cysts appear in the ovaries, spikes in the abdominal cavity or small pelvis. Subsequently, they lead to obstruction of phallopy pipes or intestines.

On the background of abundant bleeding, severe anemia develops. Depending on the localization of foci, neurological disorders are possible. They arise due to the mechanical compression of nervous endings.

In the absence of therapy, the organs of the small pelvis are affected. There is a possibility of malignant rebirth (approximately 12%).

Progressive endometriosis refers to the risk of risk of cancer tumors in other places that are not related to the focus of the defeat.

Start the treatment

What is the endometriosis of the body of the uterus? This is a very common disease, so every woman is useful to know about him. Endometriosis (adenomyosis) is characterized by the growth of the uterine mucosa beyond its normal location. At the same time, endometrial cells germinate between the fibers of the muscular layer (myometrium) of the uterus. The danger of endometriosis is that its development can lead to female infertility.

Process of development and types of disease

Separate sections are affected, the pathological process more often covers the front and rear walls of the uterus. In a nodule type of disease in germination places, seals are formed in the form of nodules.

Internal endometriosis of the uterus's body may have a diffuse species characterized by uniform germination of endometrial throughout the entire inner region of the pedberized organ and the defeat of all muscle layers. Such adenomyosis is very difficult to cure. Any type of adenomyosis is accompanied by an increase in the size of the uterus.

The development of the disease leads to failures in the functioning of the uterus, to a violation of the process of producing hormones. The resulting endometrium cells cause hemorrhages in the affected area, which is the cause of the development of inflammatory processes. With the disease, the inner layer of the mucous membrane becomes loose, so the embryo is difficult to gain on it. As a result of these processes, infertility may occur.

The conditions for the occurrence and symptoms of adenomyosis

The disease in the early stages often flows without external manifestations, the following symptoms can serve:

• various disorders of the menstrual cycle;
• the appearance of pain in the area of \u200b\u200bthe small pelvis;
• pains starting 2-3 days before the start of menstruation;
• changing the size and shape of the uterus.

Under normal conditions, the cyclical development of the endometrium occurs, it thickens at the beginning and is rejected at the end of the cycle. Moreover, the growth (in contrast to adenomyosis) occurs only inside the uterine cavity without affecting the muscle layer.

The development of endometriosis can lead the following reasons:

• physical overload and stress;
• surgical operations carried out in the uterine cavity;
• the abuse of sunbaths;
• hereditary predisposition;
• hormonal disorders;
• retrograde menstruation accompanied by blood cell cast and endometrial in the ovarian area and uterine pipes;
• immune violations.

These phenomena cause damage to the shell protecting the muscular layer, and contribute to the advent of the endometrial cell growth.

Methods of diagnosis and treatment

The gynecologist diagnoses the disease according to the results of a survey and examination of the patient, as well as using the data obtained during laboratory tests and diagnostic studies. The doctor may assign such research as hysteroscopy, transvaginal ultrasound, MRI, biopsy.

The survey helps not only identify signs of the disease, but also to determine the stage of its progression. In the initial stage, the endometrium grows into a muscular layer to a depth of 1 cm. In 2 stages, painful sensations appear and the depth of germination appears half the thickness of the walls of the uterus. In the 3 stages, the pathological process amazes the whole depth of the uterus and can switch to ovaries and pipes.

Treatment of pathology can be conservative, surgical or combined.

If there is no pronounced symptoms, hormonal therapy can be used using estrogen-gestaggenic preparations (for example, anlanlar) and agents that have antigonydotropic (overwhelming gonadotropic hormones) action. The duration of treatment and dosage of drugs is determined by the doctor. In conservative treatment, physiotherapy can be used. Medicaseous means stop the growth of endometrial and contribute to the purification of muscle tissue.

To eliminate infertility, small foci of lesion in the bodies of the uterus can be removed by means of a conservative-plastic surgery. After surgery, the probability of occurrence of pregnancy increases sharply. Pregnancy, promoting the restoration of hormonal balance in the body, can naturally lead to the elimination of endometriosis. With a high degree of development of the internal endometriosis of diffuse or nodular form, extirpation (removal) of the uterus may be required.

The prevention of the disease is to eliminate stressful situations and excessive loads, timely treatment of hormonal disorders and foci of inflammation. To preserve the integrity of the membrane that protects the muscular layer, you need to prevent abortions (using contraceptives) and treat injuries of the generic paths. Regular visits to the gynecologist will help you to detect and stop the development of endometriosis.

In his practice, gynecologists have to deal with various diseases of the female genital sphere. And often they diagnose the endometriosis of the body of the uterus. And women, having heard such a name, do not always understand what it is. Therefore, for patients, it is especially important to focus on issues of origin, characteristics and symptoms of endometriosis, and also know what methods of its treatment.

General

The uterus is a central body of sexual tract. It provides menstrual function and most importantly - gives a woman the opportunity to endure and give birth to a child. This is a hollow organ, the wall of which consists of several layers: internal or mucous (endometrial), medium or muscle (mineometry) and outdoor or serous (parameter). The first is subjected to cyclic changes throughout the reproductive period.

Under the influence of the ovarian hormones in the endometrium, the processes referred to as a royal cycle. It begins with the end of the monthly. The first phase is proliferative - passes under the main region of estradiol. The mucous membrane is restored by increasing the functional layer from basal cells. This process goes through the first phase of the cycle, and after ovulation in the endometrium, another restructuring is observed. Progesterone stimulates its secretory transformation, that is, it contributes to the development of glands producing mucus. In the second phase, the endometrium becomes loose and juicy, getting ready to take a fertilized egg. But in the absence of conception, it is rejected again, moving to the phase of natural desquamation.

Causes and mechanisms

To speak an affordable language, endometriosis is a disease at which the cells of the uterine mucosa are penetrated into places, they are unusual, and continue to function under the influence of ovarian hormones. Normally, therefore, it should not be, but deviations may appear for various reasons. There is a lot of hypotheses explaining the development of the endometriosis of the body of the uterus, and each of them affects only some one mechanism. Therefore, it is believed that the disease has a multifactor nature. Its origin is associated with the following states:

• Embryogenesis anomalies.
• Operational interventions.
• Hormonal disorders.
• Inflammatory diseases.
• Immune violations.
• Genetic predisposition.

Researchers are allocated to the theory of implantation drift, according to which the endometrial cells penetrate inside the organ wall with a retrograde cast of menstrual blood. This contributes to an increase in intrauterine pressure during spikes, stenosis or atresia of the cervical canal. Cellular dissemination is very often observed during the damage to the mucous membrane: during operational interventions (cesarean cross section, abortions, pathological genera, diagnostic scraping, removal of polyps and mioms), with inflammation (endometritis) or long-term use of uterine contraceptives (spiral).

Endometriosis necessarily proceeds against the background of hormonal and immune disorders in the body of a woman. Therefore, it is necessary to pay attention to other factors, quite common in modern life:

• Endocrine diseases (obesity, diabetes mellitus, hypothyroidism).
• Menstrual dysfunction.
• Allergic reactions.
• Excessive insolation.
• Emotional stress.
• Physical exercise.
• Environmental pollution.
• Bad habits.
• Loading (hypodynamia).

Many of these aspects are familiar to women, so it is necessary to relate to their own health very carefully, avoiding adverse external influence. So you can reduce the risk of many diseases, including endometriosis of the uterus.

Endometrial cells can penetrate into the uterus wall for various reasons. And a list of factors contributing to the disease is quite wide.

Classification

According to the generally accepted classification, the uterus defeat is internal endometriosis or, as it is also called, adenomyosis. Based on the prevalence of the cells of the mucous membrane, there are several forms of the disease:

• Diffuse - endometrium foci is evenly scattered over the entire surface.
• The focal - only individual sections are affected.
• Nodovaya - group clusters of cells are formed.

According to the nature of histological relationship, adenomyosis can be ferocular, cystic or fibrous. The foci of the latter possess minimal functional activity or do not have it at all. It should be said that the diffuse form of ferrous endometriosis is most often observed. And if we take into account the depth of damage to the wall of the uterus, then several stages should be distinguished:

• I - penetrates the basal layer of the mucous membrane.
• II - Invasia to the Miometry (until the middle of its thickness).
• Iii - applies to the serous shell.
• IV - striking the cluster peritoneum.

Often there is a combination of adenomiosis with outer forms of the disease (foci in the ovaries, pipes, in the vagina and on the peritoneum). In addition, various gynecological and extragenital diseases may accompany the uterine endometriosis.

Clinical picture

The symptoms of this disease is very diverse. In some cases, pathology does not appear at all, so it is possible to identify it only with an additional examination. But it happens most often if the endometriosis of the body of the uterus of 1 degree is diagnosed. And with a more extensive and deep defeat, the symptoms will be bright enough. Basically, pathology declares themselves as follows:

• Long and abundant monthly (hypermenestrual syndrome).
• Intermenlar bleeding (menorragia).
• The pain at the bottom of the abdomen, giving in the crescents (appear at the beginning of the month).
• Discomfort with sexual intercourse (dispensing).
• Problems with the conception of the child (infertility).

The central place among the clinical signs of endometriosis in the body of the uterus is occupied by Algodismenorea. In addition to painful syndrome, emerging on the eve of menstruation, women are concerned with common disorders, such as irritability, nausea, migraine paroxy. And due to abundant discharge, signs of anemia appear:

• Total weakness.
• Dizziness.
• Dyspnea.
• Pallor.
• Hair bulk.
• Changing taste.

The infertility is connected not so much with pathological foci in the thickness of the uterus wall, as with concomitant hormonal disorders (anointulation, insufficiency of the yellow body), as well as the adhesive process in the fallopian tubes and the abdominal cavity. Diffuse endometriosis of the uterus can be suspected with a gynecological examination: the organ will be increased, dense, limitedly moving and sensitive to palpation (especially on the eve and with the beginning of menstruation). In the nodal form, the uterus often has a barride surface.

Adenomyosis can be combined with other diseases of the gynecological sphere: ovarian cysts, fibromic, endometrial hyperplasia. But more serious associations are also possible, for example, with a malignant process (carcinoma). Therefore, it is impossible to underestimate the role of differential diagnosis of endometriosis.

Endometrioid foci, located in the uterus, give a rather bright clinical picture. But many of the symptoms are nonspecific and require differentiation with other diseases.

Additional diagnostics

Since clinical grounds can only assume the disease, additional methods play a key role in diagnostics. With internal endometriosis, the following studies are shown:

• General blood test (red blood cells, hemoglobin, echo, color indicator, hematocrit).
• Biochemical blood test (hormonal spectrum, specific markers, inflammation indicators).
• Ultrasound of a small pelvis.
• Hysteroscopy.
• Colposcopy.
• Metrosalpingography.
• Tomography.
• Laparoscopy.

Ultrasound examination conducted by a vaginal sensor allows you to diagnose pathology in 90% of cases. EchoDometriosis echoDometriosis will include foci of an increased acoustic density in myiometry, not surrounded by a capsule, an increase in the size of the uterus in the frontroad plane. The focal process is characterized by the formation of cystic cavities with liquid content and small impurities. Hysteroscopically disease verification in small foci of blue and moves from which blood flows. The mucous membrane will have uneven contours.

Treatment

Therapeutic correction with endometriosis, affecting the body of the uterus, should be complex. For each patient, the doctor constitutes an individual program in which the age factor is taken into account, the prevalence of pathology, the presence of related states and the desire to maintain the reproductive function. Based on this, conservative and surgical measures are used.

Conservative therapy

The use of conservative methods is based on the suppression of further growth of endometrio foci, restoring regulatory equilibrium and immunological processes in the body, eliminating the symptoms of the disease. For this use drugs. And the main group of medicines are hormonal agents:

• Progestins and Gestagens (Primarut, Duphaston, Gestrinon).
• Estrogen Gestagen (Zhanin, Marvelon).
• Anti-Estrogens (Tamoksen, Nolvadex).
• Gonadotropin inhibitors (data).
• Agonists Gonadotropin-Rilizing Factor (Zoladex, Bususorelin).

Which of the drugs to apply in a particular case will say the doctor. He also sets dosages and a reception course. In addition to these funds, the complex of drug treatment includes non-steroidal anti-inflammatory, immunotropic and sedatives.

The basis of drug therapy Endometriosis - hormonal drugs. They allow to reduce the size of the foci and suppress their development.

Operational correction

Indications for surgical treatment are combined diseases with endometrial hyperplasia or fibromyoma, assembly and common forms of pathology, the ineffectiveness of hormone therapy for 3 months or the presence of contraindications to it. In order to eliminate endometride foci, organ-breaching or radical interventions can be used. The first consist in resection or cryoablation of the mucous membrane of the uterus. For dissection of adhesions in a small pelvis, laparoscopy is also carried out. But these methods will become effective only with surface and small foci. If they are located diffuse and deeply, the only means will be the removal of the uterus (hysterectomy).

When endometriosis is affected by the uterus, it creates serious problems associated with menstrual disorders and the inability to become pregnant. But with the early detection of illness and its full-fledged treatment, surgical intervention can be avoided and successfully restore the reproductive ability of a woman.

Endometrioid uterine body disease progresses gradually: the stage of the pathological process is manifested by typical symptoms, the worsen state of the woman. For effective treatment, it is important to identify endometriosis of 1 degree in time, in which it is possible to completely get rid of menstrual problems. The form of the disease directly determines the risk of infertility, so the initial stages of adenomyosis will not interfere with the woman to perform a critical function. Diffuse endometriosis can be treated with drugs, especially with minimal manifestations and at that stage, when the risk of complications is minimal.

Diagnosis of initial adenomiosis

Internal endometriosis of 1 degree is difficult to reveal. The causes of the late diagnosis of pathology can be the following factors:

• lack of vivid manifestations of endometrioid disease;
• no time disorders;
• pain in the lower abdomen in front of menstruation happens, but a woman connects this problem with the arrival of critical days;
• changes in the uterus are minimal, so the doctor of ultrasound diagnostics may not see typical signs;
• lack of problems with conception: if contraceptives are not used, pregnancy occurs.

Usually adenomyosis 1 degree is a random diagnostic find, which occurs during the operation about cystic ovarian tumors or when removing the uterine mioma. Sometimes the doctor can identify the disease in diagnostic laparoscopy performed to detect the causes of pain syndrome. Or with hysteroscopy over the removal of the body of the uterus.

At 1 stage of endometrioid disease, 2 options for the disease are possible:

• the diffuse form of adenomiosis at which multiple fine endometrium foci does not penetrate the deeper submembrance layer of the uterus;
• a nodal form of the disease when there are 1-2 endometrium nodules that do not reach the muscular layer.

The main type of diagnosis in the endometriosis of the body of the uterus is ultrasound scanning, performed twice - until menstruation and after the end of critical days. Suspicious bobbies are:

• irregularity of the inner layer of the uterus;
• asymmetric change in the size of the uterus, when one of the walls of the organ is more different;
• detection of sections of increased and reduced echogenicity;
• identification of small liquid cavities;
• changing the vascular blood flow in the alleged pathological parts of the body of the uterus.

It is necessary to confirm the ultrasound diagnosis using the following research methods:

• blood test on the monacker CA-125;
• diagnostic hysteroscopy with endometrial biopsy.

However, it should be understood that with endometriosis of 1 degree, there may be a situation where no research method will give guaranteed confirmation of the diagnosis. In this case, the doctor will appoint prophylactic treatment. With proven detection of initial adenomyosis, it is necessary to follow the recommendations of a specialist in the treatment of endometrioid disease.

Treatment of pathology

Hormonal therapy of adenomiosis 1 degree provides excellent results. Using the recommendations of the doctor, it is possible not only to prevent the development of complicated forms of the disease, but also to create optimal conditions for the desired conception. If a woman does not need a pregnancy, the treatment is aimed at normalizing the menstrual cycle and creating reliable contraceptive protection.

The following drugs are usually applied:

• Zhanin;
• Silica;
• Yarina;
• Visan.

In cases where a woman wants to get pregnant, the following drugs are used:

• Duphaston;
• Uremines.

With endometriosis of 1 degree, it extremely rarely the need for the use of strong drugs with a long action, but according to the testimony, the doctor may recommend:

• injections Buserelin-Depot;
• the introduction of the hormonal spiral of peaceful.

Any treatment is conducted under the control of the doctor and with the obligatory implementation of ultrasound research on the designated time. Criteria for a positive result of therapy:

• painless and regular menstruation;
• lack of endometriosis progression;
• offensive of welcome pregnancy.

Surgical treatment with the initial degree of diffuse or nodular endometriosis is not used.

Conception and beating at adenomyosis 1 degree

Endometrioidal disease can cause complications that are possible on any months of pregnancy. The following problems should be fear:

• frozen pregnancy;
• spontaneous abortion in early time;
• threat of interrupts in 1-2 trimesters;
• bleeding disorders in the placenta;
• misconception of placenta;
• premature childbirth;
• royal bleeding immediately after delivery.

The effective prevention of complications will be strictly implementing the recommendations of the doctor at all stages of the reproductive process. Duphaston must be taken for a long time, starting long before conception and ending in the period of 20 weeks. The doctor will then advise the use of candles urozhastan to 34 weeks. It is necessary to comply with the recommended dosage and the use of medicines in order to make a dream of the baby without any special problems.