Internal uterine endometriosis. Ultrasound results

Date: 15.04.2019

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Ultrasound examination is one of the most commonly used diagnostic methods in gynecology. It can be carried out transvaginally and transabdominally, but the first method for diseases of the reproductive system is more informative. This diagnostic method is used even if endometriosis is suspected. But is such a study so effective and informative, is endometriosis reliably visible on ultrasound.

Indications

In what cases is such a procedure necessary? Strictly speaking, the very suspicion of endometriosis that a doctor has is an indication for such a diagnosis. However, in the case of endometriosis, ultrasound is as informative as in many other diseases (for example, fibroids, cysts). If neoplasms are visually visible on ultrasound, then this often does not happen with adenomyosis. This is due to the fact that the changes can be quite minor.

So at the first and second stages of the development of the disease, when there are only small single foci of shallow depth, ultrasound is completely useless, since it will almost certainly not show them. The only reliable way to make a diagnosis at this stage is to do magnetic resonance imaging (MRI) of the pelvic organs, which will give a reliable result.

Nevertheless, an ultrasound diagnosis is prescribed when such a diagnosis is suspected in the vast majority of cases. This is due to the hormone-dependent nature of the process. It develops with an increased content of estrogen, as a result of which the active proliferation of tissue begins, since cells are dividing too quickly. Against this background, various other pathologies and neoplasms may arise. Therefore, even if the signs of endometriosis are not visible on ultrasound, it allows you to diagnose the presence of other neoplasms.

Training

No special preparation is required for this process. The only feature is that it must be done strictly under the condition of a full bladder. Due to this, such a position of the organs is achieved, in which the maximum information content of the study is possible. To achieve this effect, it is recommended to drink half a liter of liquid a few hours before the examination and not empty the bladder before leaving the doctor's office.

Time spending

Since the endometrium is hormone dependent, its thickness and characteristics change throughout the entire menstrual cycle. Therefore, it is very important to carry out gynecological ultrasound examinations on the day of the cycle that the specialist prescribes. In the case of endometriosis, the most favorable days of the cycle are from the fifth to the seventh, if you count from the first day of menstruation.

It is very important to carry out diagnostics during this period. Therefore, it is necessary to do it, even if there are still residual menstrual bleeding. It is impossible to carry out during this period only if the bleeding is still strong.

At the same time, sometimes doctors recommend doing several repeated studies in a row in the following cycles. Only in this case it will be possible to accurately confirm or refute the pathology. You should not be afraid of this, since ultrasound is a relatively safe procedure that does not have a negative effect on the body. If any treatment was prescribed, then at certain stages of it, studies are also needed to assess the effectiveness of therapy.

Diagnostic progress and its essence

The principle of operation of the ultrasound machine is that different tissues have different permeability to ultrasound. Based on this, you can get an idea of the location of several types of tissues and their nature. Thus, an image of the patient's internal organs is built on the screen of the ultrasound machine.

To diagnose endometriosis, it is necessary to position the sensor as close as possible to the area of interest. Therefore, the study is carried out mainly in a transvaginal way. That is, the sensor located on the handle is inserted into the vagina. The transabdominal method, when the transducer is guided over the peritoneum, is almost completely uninformative in this case, due to its remote position from the study area.

In the doctor's office, a woman strips to the waist and sits in a chair. At the entrance of the procedure, the sensor is inserted into the vagina, and an image of the internal organ appears on the screen of the ultrasound machine. He examines him, and on the basis of this makes a conclusion about the presence of endometriosis. The procedure itself takes 10-15 minutes, and the entire time spent in the doctor's office is usually no more than half an hour.

It is worth remembering that it is impossible to determine endometriosis, especially with its chronic course, with absolute accuracy. But during the study, you can find other neoplasms, the presence of which is undesirable.

Signs on ultrasound

Is endometriosis visible on ultrasound? As mentioned above, this is not always possible. What exactly does this study show?

Irregularities and thickening of the endometrium in cases where they are significant enough;

The vagueness of this layer, the reasons for which may be many;

The presence of nodes, cysts, neoplasms, etc.;

Violation of the symmetry of the walls of the organs.

What are the signs of endometrisis on ultrasound examination? At the first stage of the development of the disease, signs are almost completely absent, with rare exceptions. On the second, they can already be seen, on the third and above, the picture of endometriosis is clear, as in the photo. What are the signs of the process?

Small-dotted structure of tissue locally, in several areas, or throughout the organ;

Inhomogeneous structure of uterine tissue;

Small focal neoplasms are also present in some cases;

Sometimes endometrial thickening is visible visually, but this is not a typical sign.

Can endometriosis be seen on ultrasound? It all depends on the stage and nature of the course of the disease. But this study is recommended to take place regularly for preventive purposes. Therefore, it is worth making it in any case. This method is one of the main diagnostic tools in gynecology.

Endometriosis of the body of the uterus is a disease characterized by a pathological process of proliferation of endometrioid tissue outside the uterine cavity.

Other names for pathology are internal endometriosis, endometriosis of the uterus, etc.

Normally, the endometrium lines the inner cavity of the uterus. During fertilization, the function of the endometrioid tissue is to retain the embryo in the uterus. If conception does not occur, the endometrium exfoliates and comes out with menstrual flow every month.

In a pathological process, endometrial cells move to other organs of the small pelvis, continuing to function there.

Endometriosis of the body of the uterus in some cases occurs in combination with other diseases - endometrial hyperplasia and.

Causes

The exact cause that contributes to the development of endometriosis has not been established. It is believed that in most cases a hereditary factor provokes the development of the disease, that is, a genetic predisposition to the development of endometriosis.

Other factors contributing to the onset of pathology:

curettage of the uterus - according to indications or with artificial termination of pregnancy;
long-term use of an intrauterine contraceptive device;
violation of the natural hormonal balance in the body;
inflammatory and infectious diseases of the pelvic organs;
decrease in the body's immune forces.

The following types of disease are distinguished:

Diffuse (diagnosed in 80% of patients).
Diffuse-nodular (occurs in about 10% of women).
Focal (diagnosed in 7% of patients).
Nodular (this form occurs in a small part of patients - 3%).

Depending on the degree of damage, diffuse endometriosis is divided into stages:

Stage 1. Adenomyosis affects the submucosa of the inner cavity of the uterus and the transition zone.
Stage 2. The spread of pathological foci to the myometrium, however, they do not reach the outer tissue of the uterus.
Stage 3. The defeat of the entire muscle tissue of the uterus, up to the defeat of the pathological cells of the serous membrane of the organ.
Stage 4. The exit of endometrioid foci outside the uterus. Localization of lesions on other organs and tissues of the small pelvis.

Endometriosis of the body of the uterus and its symptoms

One of the symptoms of endometriosis of the uterine body is pain. The pain occurs in the lower abdomen, in the lower back. Its intensity depends on the day of the menstrual cycle. The strongest sensations.

Other signs that may indicate the presence of endometriosis:

pain during sexual intercourse;
prolonged menstruation;
spotting before and after menstruation;
spontaneous termination of pregnancy in the early stages;
impossibility of conception, i.e. infertility;
bright - premenstrual syndrome.

Danger of disease

The danger of the disease is as follows:

the development of anemia due to heavy periods;
infertility;
malignancy of endometrioid foci;
deterioration in general well-being, a decrease in the quality of life.

Is pregnancy possible?

The presence of adenomyosis in most cases interferes with natural conception. But there are cases of pregnancy in the presence of endometriosis of the body of the uterus, however, it is combined with a high risk.

The causes of infertility in endometriosis:

disruption of the normal functioning of the endometrium in the uterine cavity (an obstacle to the implantation of the embryo);
inflammatory process in the uterine cavity;
dysfunction of the myometrium;
dysfunction of the ovaries due to hormonal imbalance.

The onset of pregnancy after the completed course of therapy is not an absolute guarantee. If a woman is also diagnosed with infertility after treatment, in this case IVF is indicated.

Diagnostic methods

Initially, a gynecologist is examined. An enlarged uterus may indicate the presence of endometriosis.

However, for an accurate diagnosis, a more detailed examination is necessary:

Transvaginal ultrasound examination.
Hysteroscopy and biopsy.
Laparoscopy.

Treatment methods

Treatment is possible in two ways - medication and surgical.

In the first case, hormonal drugs are prescribed, the purpose of which is:

elimination of symptoms of the disease;
reduction of endometriotic foci;
normalizing hormonal balance;
restoration of reproductive function.

Medicines used:

Gestagens - Dyufaston, Norkolut, Vizanne.
Combined oral contraceptives -.
Agonists of gonadotropin-releasing hormone (A-GnRH) -, Dipherelin.
Progestogens - Depo-Provera.
Hormonal IUD (intrauterine device) -.
Antigonadotropins - Danoval, Danazol.

It should be borne in mind that the effect of medication treatment is often temporary. The disease is prone to relapse, and therefore there is a high probability that it will develop again over time.

This therapy is focused primarily on women planning pregnancy in the near future.

In combination with hormones, pain relievers and anti-inflammatory drugs, immunomodulators, vitamins are prescribed.

If adenomyosis is asymptomatic, its 1 or 2 stages are diagnosed, then expectant tactics makes sense. The woman is under the supervision of a doctor, hormones are not prescribed, and physiotherapy, immunostimulating drugs, anti-inflammatory drugs are prescribed to strengthen the body.

The duration of hormone therapy is from three months to six months or more. In the absence of effectiveness, the operation is indicated.

Watch the video about the treatment of endometriosis:

Surgical intervention

The method of the operation and its volume depend directly on the form and stage of endometriosis, the woman's desire to become a mother in the future.

Organ-preserving surgery is performed by laparoscopy. During the operation, the endometriotic nodes are removed, as a result of which the walls of the uterus are restored. The disadvantage of this technique is the extremely high risk of recurrence of the disease.

An extreme measure during surgical treatment is hysterectomy, that is, the complete removal of the uterus. It is shown as a result of late diagnosis of adenomyosis and its advanced forms.

Indications for removal of the uterus with endometriosis:

lack of effectiveness of hormone treatment;
intense pain;
uterine bleeding, which causes severe anemia;
the presence of endometrial hyperplasia, uterine fibroids and other pathologies in parallel with adenomyosis;
the patient's unwillingness to give birth in the future;
suspicion of the development of malignant cells.

Prevention measures

The following recommendations will help prevent the development of endometriosis of the body of the uterus or its recurrence:

using contraception to avoid the need for abortion;
elimination of excess weight;
prevention of stressful situations;
increasing the body's immune forces;
quitting smoking, alcohol;
healthy food.

Endometriosis of the body of the uterus or adenomyosis is not a sentence. If you monitor your women's health and consult a doctor in a timely manner, you can identify pathology in the early stages, which will allow you to successfully undergo a course of therapy. And, on the contrary, the neglect of the disease leads to its further development and bad consequences, which will have to be eliminated only by surgery.

Endometrioid disease (endometriosis) is a pathological, benign process of proliferation of tissue, similar to the endometrium, outside the cavity.

Endometriosis of the uterus, or adenomyosis, is the invasion and proliferation of endometrial-like tissue in various parts of the muscle layer of the uterine wall.

In adenomyosis, endometrioid "implants", similar to the glandular and stromal components of the basal layer of the mucosa, are introduced into the myometrium at different depths, causing deformation and inflammation of the surrounding tissues.

Internal endometriosis

Endometriosis of the body of the uterus - what is it?

Endometriosis of the body of the uterus, adenomyosis, internal endometriosis, endometriosis of the uterus are all one and the same disease.

Recently, endometriosis of the uterine body has been considered as a special, independent variant of endometrioid disease.

Endometriosis of the uterus in the structure of endometriosis.

Adenomyosis in the classification of endometriosis

Endometriosis of the uterus: ICD-10 code

N80.0 Endometriosis of the uterus (adenomyosis)

Causes of the disease

There is still no unified point of view on the causes of endometriosis of the uterus. Since the end of the twentieth century, a significant role has been assigned to genetic factors, i.e. congenital predisposition to the development of the disease.

Today, the key link and trigger mechanism of adenomyosis is considered mechanical damage to the transition zone of the myometrium(Junctional Zone, JZ).

The transition zone (JZ) or subendometrial myometrium is the border layer of the myometrium located directly under the mucous membrane of the uterus. Normally, the thickness of JZ in women of childbearing age does not exceed 2-8 mm.

It has been proven that during abortions, especially those performed using curettage (curettage), when taking an endometrial biopsy or other gynecological, surgical procedures, the border between the endometrium and myometrium can be destroyed. This makes it easier for the components of the endometrium to enter and survive in the new conditions.

However, the further formation and progressive growth of endometrioid foci in the muscular layer of the uterus is possible only against the background of a weakening of immune control and a violation of the hormonal status of a woman. Endometriosis of the uterus is a complex, multifactorial pathological process.

The mechanism of development of endometriosis of the uterus

Pathological circle of adenomyosis Risk factors for endometriosis of the uterus

Genetic predisposition ("family" form of endometriosis).
Curettage of the uterus.
Long-term use of a contraceptive intrauterine device (IUD).
Inflammatory processes of the mucous membrane of the uterus.
Immunity disorders: local and / or general.
Local hormonal imbalance: increased regional synthesis of estrogens (local hyperestrogenism), decreased sensitivity to progesterone in the focus of endometriosis.
Unfavorable environmental and social factors.
Chronic stress.

There are several types (forms) of adenomyosis:

Diffuse (up to 80% of cases).
Diffuse-nodular (approximately 10%).
Focal (up to 7%).
(until 3%).

With the formation of endometrioid cavities in the myomertia, they speak of cystic endometriosis.

Types of adenomyosis

According to the modern classification (L. V. Adamyan), internal diffuse endometriosis, depending on the depth of the lesion, is divided into 4 degrees (stages):

Ι degree (stage) of adenomyosis - the pathological process is limited to the submucosa and the transition zone.
ΙΙ degree (stage) - the process extends to the myometrium, but does not reach the outer (serous) membrane of the uterus.
ΙΙΙ degree (stage) - the entire myometrium is involved in the painful process, up to the serous membrane of the uterus.
ΙV degree (stage) - the pathological process goes beyond the uterus, affecting other organs and tissues.

The combination of adenomyosis with external genital endometriosis is noted in 70% of cases.

Stages of adenomyosis

What is the danger of endometriosis of the uterus:

Decreased quality of life and work capacity.
Development of severe, life-threatening secondary anemia.
Infertility.
Malignancy (malignancy).

The ability of endometrioid foci to "filter" (infiltrate) into the surrounding tissues, the tendency of their growth in distant organs, the absence of a connective tissue capsule around the pathological areas - all this brings uterine endometriosis closer to the tumor process.

The disease is distinguished from a true tumor by the absence of pronounced cellular atypia and the dependence of the clinical manifestations of the disease on menstrual function. Wherein the possibility of malignant transformation of endometriosis is undeniable.

Pain in the pelvic area and lower back. In most cases, the intensity of pain is associated with the menstrual cycle: during menstruation, it is maximum.

Unlike the sometimes occurring (periodic) "monthly" pain, pain with endometriosis of the uterus during menstruation always occurs and is observed regularly for 6 or more months in a row.

The nature of the pain:

- pulling, stabbing, cutting ... variable; lower abdomen, lower back;

- constant: mild-moderate to intense.

- increases on the eve of menstruation;

- pain during menstruation can resemble a picture of an acute abdomen, accompanied by bloating, flatulence.

Painful periods (algomenorrhea).
Painful intercourse (dyspareunia).
Scanty bloody brown-chocolate discharge from uterus a few days before and after menses.
Prolonged heavy menstruation, up to cyclic uterine bleeding (hyperpolymenorrhea) with the occurrence of secondary anemia.
Miscarriages in early pregnancy.
Infertility (primary and / or secondary).
PMS: nervousness, headaches, fever, sleep disturbance, vegetative-vascular disorders.

Clinical symptoms of endometriosis of the uterus

One of the most common signs of illness and the only reason a patient seeks a doctor is infertility. Miscarriage (spontaneous abortion, miscarriage) often precedes the development of typical (pain, "chocolate daub", profuse monthly) clinical symptoms of endometriosis.

Pain, albeit a frequent, but subjective sign of the disease - each woman assesses the intensity and / or significance of the pain syndrome differently.

Sometimes the first sign by which one can suspect adenomyosis is profuse and prolonged periods(hyperpolymenorrhea).

Signs of internal endometriosis

Diagnostics of the endometriosis of the uterus

1. Gynecological examination

With a bimanual gynecological examination, the clinical sign of adenomyosis may be an increase in the size of the uterus, especially pronounced on the eve of menstruation.

The globular uterus is a sign of diffuse adenomyosis.
A lumpy uterus is a sign of a nodular form of adenomyosis.

Small forms of adenomyosis (endometrioid foci

The patient's complaints and a routine gynecological examination can only suggest the presence of endometriosis of the uterus. To make an accurate diagnosis, instrumental studies are needed.

2.Transvaginal ultrasound

Echography (ultrasound) today remains the most accessible and fairly informative method for diagnosing adenomyosis.

When performing an ultrasound scan using a vaginal sensor in the second half of the menstrual cycle, endometriosis of the uterus is detected
in 90-95% of cases

Optimal timing of ultrasound if adenomyosis is suspected:
- in the second phase of the menstrual cycle, preferably on the eve of menstruation.
- control ultrasound is performed immediately after the end of menstruation.

Clinical ultrasound signs of uterine endometriosis:

Adenomyosis Ι degree(minor forms of endometriosis):

Anechoic tubular zones, up to 1.0 cm in size, located from the endometrium to the myometrium.
Small, up to 0.2 cm hypo- and anechogenic oval-shaped structures in the basal layer of the endometrium.
Irregularity, serration, ruggedness of the basal layer of the endometrium; other endometrial defects.
Small (up to 0.3 cm) areas of increased echogenicity in the transition zone of the myometrium.
Uterine wall thickness: normal, close to normal.

Adenomyosis ΙΙ degree:

In the subendometrial layer of the myometrium, there are zones of increased heterogeneous echogenicity of various sizes with the content of rounded anechoic inclusions, 0.2-0.5 cm in diameter.
The thickness of the uterine wall slightly exceeds the upper limit of the norm.
The walls of the uterus are not uniformly thickened, with a difference of up to 0.4 cm or more in relation to each other.

Adenomyosis ΙΙΙ degree:

The uterus is enlarged.
The walls of the uterus are thickened unevenly.
In the myometrium: a zone of increased heterogeneous echogenicity, occupying more than half of the thickness of the uterine wall. Bands of increased and medium echogenicity.
In areas of increased echogenicity, there are many anechoic inclusions and cavities of various shapes, measuring 2.0 - 4.0 cm in diameter.
Significant reduction in endometrial thickness.

Nodular, focal adenomyosis:

A rounded zone of increased echogenicity with small (0.2-0.4 cm) anechoic inclusions or cavities is determined in the uterine wall.
Deformation of the M-echo (with submucosal location of the endometrioid nodes).
The change in the size of the uterus and the thickness of the uterine wall depends on the size and number of nodules.

Ultrasound cannot reliably distinguish fibroid nodes from the nodular form of endometriosis of the uterus.

Additional methods for diagnosing endometriosis of the uterus

CT, hysterosalpingoscopy (-graphic), and laparoscopy are not the methods of choice for diagnosing adeomyosis. These studies are carried out according to individual indications.

1.Magnetic resonance imaging

MRI is the most accurate method for diagnosing endometrioid disease. But in the case of adenomyosis, the significance of MRI is comparable to transvaginal ultrasound performed on the eve of menstruation.

MRI is prescribed for individual indications, to exclude / confirm the combination of adenomyosis with various forms of external genital and / or extragenital endometriosis, other types of benign and / or malignant proliferative diseases. With the help of MRI, it determines the exact localization of endometrioid foci.

2.CDK - color Doppler mapping.

This is a study of the speed of blood flow in the uterus.
Endometrioid heterotopies are avascular formations, in which zones of growth of new vessels are not detected. The index of resistance in the foci of endometriosis increases with the severity of the pathological process.

Allows you to visualize the signs of adenomyosis, to make a targeted biopsy of suspicious areas.

Hysteroscopic signs of endometriosis of the uterus:

The uterine cavity is deformed.
On the pale pink mucosa, dark red crypts are visible - the mouths of the endometrioid "passages" of various sizes. Dark red blood may ooze from them.

Separate diagnostic curettage of the endometrium with further histological examination of the removed tissue to determine endometriosis of the uterus does not have great diagnostic value (after all, endometrioid foci are located in the thickness of the myometrium). Curettage under the control of hysteroscopy is done to identify / exclude the combination of adenomyosis with cancer of the uterine body. This is important for choosing the right tactics for further treatment.

Instrumental diagnosis of endometriosis of the uterus 4. Surgical hysteroscopy and histology.

Histological verification of adenomyosis is carried out after hysteroresectoscopy. In the course of minimally invasive endoscopic surgery performed by vaginal access, endometrial tissue is taken along with a portion of the myometrium. Then the removed tissue is examined under a microscope (histological examination) and an accurate diagnosis is made.

5. Laparoscopy.

The "gold standard" for the diagnosis of external forms of endometriosis
at stage 4 of adenomyosis, laparoscopy remains. This diagnostic and treatment operation is performed by introducing endoscopic equipment into the abdominal cavity through punctures of the abdominal wall.

How to treat endometriosis of the uterus

Treatment of adenomyosis remains a complex controversial problem, purely individual for each patient, for each specific case of the disease.

Treatment of internal endometriosis

Hormonal treatment of endometriosis of the uterus

Speaking about the effectiveness of hormonal treatment, one should know that none of the drug therapy regimens leads to a complete cure and does not eliminate the possibility of a relapse of endometriosis.

The effect of hormonal treatment is temporary - after drug withdrawal, the disease may gradually return.

In cases of asymptomatic course of endometriosis of the uterus, ultrasound signs of the disease are not an indication for the appointment of hormonal therapy.

With asymptomatic adenomyosis of 1-2 degrees, it is advisable to "wait", ie. the patient does not receive hormonal treatment, but is closely monitored. According to indications, general strengthening and physiotherapy, immunocorrection, antioxidant and anti-inflammatory therapy can be prescribed (see below).

The objectives of hormone therapy:

Reducing the size of the foci of endometriosis.
Reducing the severity of symptoms of the disease.
Reducing the risk of surgery and / or repeated surgery.
Fight against hyperestrogenism, stabilization of hormonal levels.
Prevention of disease progression and recurrence.
Preservation of fertility (fertility).

Medical therapy for endometriosis of the uterus is primarily focused on patients interested in future pregnancy.

Hormone therapy is based on the significant role of endocrine factors in the development of endometrioid disease. It is carried out in the absence of contraindications and side effects. Initially, treatment is prescribed for 3 months. Then its effectiveness is assessed and, if successful, extended by 6-9 months. In case of an unsatisfactory result, drug replacement or surgical treatment is indicated.

Hormonal drugs of the first stage for endometriosis of the uterus

1. Oral progestogens.
Monotherapy with drugs like progesterone is considered quite effective with adenomyosis. Progestogens are prescribed continuously, in high enough doses for 3-6 months or more. The incidence of side effects is significantly lower than that of GnRH-A (see below).

Tablets for endometriosis of the uterus

2.KOC - combined oral contraceptives.
They are used to reduce pain (relief of pelvic pain) associated with endometriosis of the uterus in women who are not interested in pregnancy. With dysmenorrhea (hyperpolymenorrhea), COCs are prescribed in a continuous mode. The effectiveness of these drugs in the treatment of endometriosis is low. Most often they are prescribed as supportive postoperative therapy, to prevent recurrence of the disease.
The drug of choice for the treatment of endometriosis is considered a remedy.

COC preparations are contraindicated in women with adenomyosis and migraine.

Hormonal drugs of the second stage for endometriosis of the uterus

1.Gonadotropin-releasing hormone (GnRH-A) agonists
/ doctor's consultation required /

Name A-GnRH	Reception scheme (a course of treatment up to 6 months)	Possible side effects
Goserelin (Zoladex)	3.6 mg subcutaneously Once every 28 days	Hot flashes, sweating, vaginal dryness, headache, mood lability, osteoporosis, negative effects on the cardiovascular system, liver.
Leiprorelin (Lukrin depot)	3.75 mg intramuscularly Once every 28 days	Also
Buserelin	3.75 mg intramuscularly 1 time in 28 days. Or 150 mcg each, injection into every nostril, 3 times a day.	Also
Triptorelin (Diphereline, Decapeptyl depot)	3.75 mg intramuscularly 1 time in 28 days.	Also

Treatment with GnRH-A drugs is considered the "gold standard" of drug therapy for endometriosis.

GnRH-A is used to treat severe forms of endometriosis of the uterus. Against the background of taking these funds in women, menstruation stops ("drug pseudomenopause" sets in). After discontinuation of the drug, the menstrual cycle is restored on its own. The frequency of endometriosis recurrence 5 years after the end of the course of GnRH-A reaches approximately 50%.

Long-term (more than 6 months) therapy for GnRH-A is possible, but always under the guise of “return” hormone replacement therapy (HRT) with estrogens and progesterone. It is this method of treating endometriosis that is considered quite effective.

2. Parenteral progestogens.

Depo Medroxyprogesterone Acetate (Depo-Provera) - 104 mg is injected under the skin every 12 weeks.

The effectiveness of parenteral progestogens is comparable to that of GnRH-A. But long-term use of both is undesirable due to the negative effect on bone mineral density (risk of osteoporosis).

A significant drawback of treatment with progestogens is breakthrough bleeding (dysfunctional uterine bleeding that occurs in response to progesterone stimulation of the endometrium). Therefore, it is more advisable to inject medications directly into the uterus, in the form of an IUD.

3.Hormonal intrauterine device LNG-IUD Mirena:
The levonorgestrel-releasing intrauterine system is recommended for the treatment of adenomyosis in women who are not interested in pregnancy.
Mirena's high efficiency proven by the agency of the Ministry of Health and Social. services of the USFDA.
Duration of use is 5 years.

4 antigonadotropins for the treatment of endometriosis:

Gestrinone (Nemestran)
Danazol (Danol, Danoval)

These drugs are currently rarely used due to frequent side effects due to androgenic effects (acne, seborrhea, male-pattern hair growth, weight gain, change in voice tone, decrease in mammary glands, etc.)

To understand the essence of the disease, it is necessary to understand key medical terms.

Let's consider the most basic ones.

Endometriosis- one of the common diseases in gynecology, in which endometrial cells grow in the thickness of the uterus or even go beyond the reproductive system.

Endometrium- the mucous membrane lining the walls of the uterus. The norm is considered to be endometrial rejection regularly every month during menstruation.

Myometrium- muscle tissue of the uterus.

Causes of pathology

Scientists do not name the exact reasons contributing to the development of such a pathology, but among them they distinguish:

hormonal background, or rather its violation. In the event of a malfunction of the endocrine system, estrogens - female sex hormones in the ovaries are formed much more than the norm. The endometrium in the first half of the menstrual cycle fills the thickness of the uterus, and when rejected, it causes severe bleeding.
weakening of immunity. With reduced immunity, the body does not effectively fight the proliferation of endometrial cells.
frequent abortions, curettage, surgical interventions. Various operations damage the integrity of the membrane. And, despite its restoration, scar tissue promotes the germination of endometrial cells.
menses. Prolonged heavy menstruation, early puberty can also cause the development of the disease. Discharge during menstruation contains not only blood, but also endometrial particles. With heavy bleeding, the discharge not only finds a way out through the vagina, but also enters the abdominal cavity. Normally, these cells are destroyed, and in pathology they are able to fixate in the tissues of various organs.
stress, environmental impact, nutritional quality. Stressful situations, toxins and unbearable physical exertion on the body lead to hormonal disorders.
hereditary factor. At risk are girls whose mothers, grandmothers or sisters suffered from a similar ailment, or in the case of an anomaly in the structure of the genitals. Pulling painful sensations in the lower abdomen in girls may appear 2-3 years before the onset of the first menstruation.

How to recognize endometriosis

The first signs that should alert a woman are deviations from the regular menstrual cycle, pain during menstruation and during sexual intercourse.

2-3 days before and after menstruation, bloody discharge may appear. Often, bleeding occurs in the middle of the cycle. Menses become profuse and painful.

If the patient is already at an advanced stage, endometrial cells can infect the bladder, rectum and, as a result, cause pain during urination and defecation. After menstruation, the pain syndrome usually subsides, but this is not a reason to postpone a visit to the doctor. If you notice at least one of the signs, be sure to get tested.

Forms of endometriosis

Endometriosis of the uterine body is divided into diffuse, focal and nodular forms.

The diffuse form of endometriosis is characterized by a uniform compaction of the walls of the uterus, affecting each layer. The most difficult thing in terms of therapy is diffuse endometriosis of the uterine body. However, most often there is a focal form, in which either the anterior or posterior wall of the uterus is affected. In the thickness of the myometrium, small or large nodules that do not have certain boundaries can also be found. In this case, there is a nodular form of endometriosis of the uterus. Due to these neoplasms, the uterus increases in size. But for the appointment of a course of treatment, there is practically no particular difference between the focal and nodular form of the lesion.

With a diffuse form, pathological processes can cover different depths of the walls of the uterus. In this connection, the following degrees of distribution are distinguished:

first degree - shallow lesions of the myometrium;
second degree - the depth of the lesion reaches the middle of the myometrium;
third degree - the uterine wall is completely affected, pathological changes.

affect the fallopian tubes, ovaries, adjacent organs.

How is endometriosis of the uterine body diagnosed?

Diagnosis of the disease is complicated by a number of reasons.

First, while asymptomatic, you can skip the initial stage.
Secondly, the disease may be similar in symptoms to other gynecological pathologies.

For an accurate diagnosis, a comprehensive examination is required. It consists of an examination by a gynecologist, ultrasound of the pelvic and abdominal organs, colposcopy and laparoscopy.

The development of the disease occurs gradually, each time worsening the woman's well-being. Having identified endometriosis of the uterus of the 1st degree, you can permanently get rid of disturbing symptoms and eliminate the problem. Unfortunately, this is extremely rare and occurs for the following reasons:

obvious signs of the disease do not bother the patient;
a woman equates pain during critical days with periodic women's days and does not consider it as a pathology;
when undergoing an ultrasound scan, the doctor may not notice the changes, because they are extremely insignificant;
there are no problems with conception.

The most reliable results will be shown by ultrasound and laparoscopy. So, to make a diagnosis, the doctor pays attention to the echoes characteristic of internal endometriosis:

"Round uterus", that is, enlarged;
thickening of the walls of the uterus
the presence of open uterine cysts.

Treatment

As a treatment, hormonal therapy is used to stop the growth of the endometrium for a while.

Treatment is selected based on the severity of the disease, the woman's age and her plans for planning pregnancy. After all, while there are menstruation and active hormonal work of the ovaries, the ailment can come back again and again. Complete elimination of the problem can be guaranteed only after the onset of menopause. For surgical intervention, the most gentle method at the moment is used.

All about endometriosis from Elena Malysheva, video

The consequences of endometriosis

In the absence of proper treatment, the consequences of endometriosis of the uterine body are very dangerous.

First of all, endometriosis can lead to problems with conception or provoke difficulties in bearing a child. Pregnancy does not occur as a result of the formed adhesions and dysfunction of the egg. Adhesions are the result of a continuous inflammatory process that blocks the patency of the fallopian tubes.
In another case, the fertilization process is hampered by the presence of endometriotic foci on the ovaries. The process of maturation of the egg is disrupted. Endometriosis lesions can affect the quality of the eggs and also prevent the fertilized egg from attaching. With hormonal imbalance, ovulation may not occur at all.
The possibility of pregnancy in women with a similar diagnosis remains. However, it will be extremely difficult to carry the child safely. The risk of developing an ectopic pregnancy or miscarriage increases significantly.

In most cases, endometriosis is treatable and the problem of infertility is eliminated. Only in the most advanced cases, when all methods of treatment have been tried, the uterus has to be removed.
Every woman should monitor the regularity of her menstrual cycle and undergo routine check-ups.