It's great if pregnancy occurs at the moment when both spouses want it! But, unfortunately, there are situations in which a woman, after unsuccessful attempts to conceive a baby, hears from a doctor - a diagnosis - you have endometriosis!
But in 44% of women suffering from infertility, this diagnosis is in the first place! And how to live with it further? How to conquer and enjoy motherhood? Why does this diagnosis interfere with the pregnancy process?
What is this - endometriosis?
This is a pathological process in which the tissue of the mucous membrane of the uterus (endometrium), for certain reasons, begins to grow in places that are not typical for it. The endometrium should normally be located only in the uterine cavity and monthly, under the influence of hormones, be rejected in the form of secretions, but with an excess of estrogen hormone in the woman's body, this process is disrupted and metastasizing hematogenous or lymphogenous, the endometrium spreads to organs unusual for it, causing cyclic unpleasant sensations and complaints.
Scientists consider endometriosis as a benign tumor, comparing it with cancer, since endometrioid heterotopies also give metastases, penetrating deep into the tissue (invasive growth), disrupt the quality of life, in addition to not having an atypical structure.
It is customary to distinguish by localization - genital and extragenital endometriosis. In the first case, the process affects the female genitals (uterus, tubes, ovaries, cervix, external genitalia). And in the second case, it spreads to other organs (intestines, navel, postoperative suture).
Causes contributing to the development of endometriosis
Until now, scientists have not precisely established the cause of endometriosis. But more often women who underwent intrauterine medical operations (curettage, abortion, cesarean section) are susceptible to it, after which such patients developed uterine endometriosis (adenomyosis).
There is even thorium, according to which, in the embryonic period, all organs of the body develop from three tissues of different structure, and from one of them, regardless of gender, endometrial tissue develops. That is why there are known cases of endometriosis (of course, not the uterus) in men and girls who have never had a period!
But nevertheless, the main role in the occurrence of endometriosis belongs to disturbances in hormonal balance and a decrease in immunity. So, more often endometriosis occurs in women of reproductive age and less often in menopause (when the level of hormones is physiologically reduced).
And during pregnancy, the disease "fades" and stabilizes. Therefore, looking ahead, the main goal of treatment will be to achieve a decrease in estrogen levels by introducing into artificial menopause or by increasing the level of progesterone (which is observed during normal pregnancy).
Endometriosis of the body of the uterus (adenomyosis)
Depending on the depth of the lesion of the myometrium, the following stages of endometriosis are distinguished:
- Endometrial invasion to the myometrium
- Mid-thickness invasion of the myometrium
- Invasion to the serous layer of the uterus
- Germination to the peritoneum
The main symptoms
- Painful periods come to the fore. More pronounced complaints with endometrioid heterotopia lesions of the uterine isthmus and sacro-uterine ligaments, while pain can radiate to the rectal region. After the end of menstruation, the pain goes away.
- A few days before the onset of menstruation and after it, there is a smearing brown discharge ("chocolate"). Menses may be long and heavy.
- Pain during intercourse can be observed, which significantly disrupts the quality of life of partners.
- Due to abundant regular blood loss, there may be a decrease in hemoglobin and, as a result, anemia.
- And, of course, the worst thing is infertility.
Diagnosis of adenomyosis
- Examination, collection of anamnesis and complaints
- Ultrasound examination (transvaginal) in the second phase of the menstrual cycle.
- Hysteroscopy (an optical device that examines the uterine cavity) followed by biopsy and histological confirmation.
Endometriosis of the cervix
The reasons for the development of endometriosis are presented below, and they all contribute to the penetration of the endometrium into the tissue through the injured mucous membrane of the cervix.
- Gynecological invasive interventions
- Diathermo-treatment of erosive processes of the cervix
- Traumatic damage to the cervix postpartum trauma or cicatricial changes after curettage of the uterine cavity and cervical canal
Diagnostics of the endometriosis of the cervix
Inspection (with a colposcope or cervicoscope) or visually with gynecological mirrors
Complaints about "chocolate" discharge from the genital tract on the eve, or after menstruation, or intercourse
Histological confirmation of endometriosis after separate diagnostic curettage of the mucous membrane of the uterine cavity and cervical canal
Endometriosis of the ovaries and endometrioma (endometrioid cyst)
Endometrioid heterotopies are located in the ovarian tissue and look like cysts, the diameter of which can be from 5 mm to several cm, filled with brown ("chocolate") contents. When several small such cysts are interconnected in the thickness of the ovarian tissue, then we are already talking about an endometrioid cyst (endometrioma). Pathological heterotopies penetrate into the ovarian tissue by the hematogenous, lymphogenous route.
Clinically, such a cyst may not manifest itself in any way, but it may make itself felt on the eve or after menstruation, after physical exertion or intercourse, in the form of aching pains. Often these cysts are involved in adhesions in the pelvis.
Diagnosis of ovarian endometriosis
- Taking anamnesis, complaints, examination (often not diagnosed by palpation, since the size does not go beyond the healthy ovarian tissue). But endometriomas can be detected by palpation, since they are enlarged (can be up to 15 cm) and are located on both sides behind the uterus, painful to the touch.
- Ultrasound examination visualizes small endometrioid cysts in the form of hypoechoic inclusions in the ovarian tissue. Endometrioma is defined as a rounded formation with an echo-positive capsule and a fine suspension against the background of fluid inside the cyst on both sides of the uterus.
- The greatest value in the diagnosis of endometrioma is laparoscopy. With the help of it you can see cysts of endometriosis in the tissue of the ovary of a cyanotic or "chocolate" color.
With retrocervical and vaginal endometriosis, complaints of pain on the eve or during menstruation, during bowel movements and during sexual intercourse come to the fore. And with endometriosis of the fallopian tubes, the most important and unpleasant complication is the adhesion process in the fallopian tubes, leading to infertility.
Endometriosis and pregnancy
Very often, these concepts are not compatible, but do not be discouraged even with the right treatment, and most importantly, when prescribed on time, this terrible, at first glance, diagnosis is treatable.
It should be said that infertility is a consequence of endometriosis, but pregnancy with endometriosis is still possible, but most importantly, when it occurs, a regression of the pathological process occurs, due to the hormonal suppression of estrogens by progesterones - pregnancy hormones.
And yet, if pregnancy occurred against the background of endometriosis, the threat of its termination is possible, since it initially occurred against an altered hormonal background, so here the doctor may recommend an additional intake of hormonal drugs (progesterone series).
As mentioned above, it is necessary in the treatment of endometriodal heterotopies to use the suppression of the hormones of the estrogen series, which are elevated in this pathology. And also to prevent possible consequences, such as pain syndrome, adhesive disease and infertility, in a conservative and possibly surgical way.
Hormone therapy includes one of the following regimens:
- Oral contraceptives
- Gestagens (progesterone)
- Antigonadotropins
- Gonadotropin agonists - hormone releasing
- Antiestrogens
- Androgens
Immunostimulants are also used, since above we considered the causes of endometriosis, and one of the theories was immune.
For the treatment of pain syndrome, non-steroidal anti-inflammatory drugs, analgesics and antispasmodics are used.
In the presence of anemia, iron supplements. If, nevertheless, it is not possible to cure endometriosis in a conservative way, they resort to surgical treatment using laparoscopy or hysteroscopy, while removing endometrioid heterotopies, followed by the appointment of hormones. The success of treatment depends on the time of the operation performed and the selected hormonal therapy.
As always, I do not recommend self-medication, since you have already seen that in this case, this can lead to disastrous results and advanced forms of endometriosis, and as a result, terrible pain syndromes and the inability to have babies.
- Hirudotherapy (leech therapy)
- Use of phyto preparations based on indole and epigallate
- Antihomotoxic therapy (Heel preparations)
And yet, despite the fact that endometriosis has not been sufficiently studied, and remains a mystery of medicine, successful approaches to its treatment have been found. And with a timely visit to the doctor, a woman can be spared from many unpleasant syndromes of this disease, including infertility. Take care of your health and yourself!
Endometriosis remains one of the most common and most incomprehensible diseases in gynecological practice. The disease can occur with both minimal symptoms and bring the woman intolerable pain and other problems, including interfering with conception and the normal course of pregnancy. What can be done to prevent endometriosis and pregnancy from opposing each other?
The extent to which endometriosis can affect the process of conception and gestation depends largely on the stage and prevalence of the disease. Many women have minor symptoms of the disease with localization of foci in the ovaries or cervix, while their pregnancy proceeds without complications. In others, endometriosis is detected only with a thorough examination, when infertility has already been established.
Features of the disease
There is no unified theory of the onset of the disease. Some scientists even believe that endometriosis is not a separate pathology of the genital organs, but systemic disorders. Others compare the disease with cancer - with pronounced forms, the disease brings no less problems, and the only thing that distinguishes it from a malignant neoplasm is that endometriosis is not fatal.
The incidence of endometriosis is steadily increasing. Perhaps this is due to the improvement of diagnostics and equipment. Approximately one third of women with established pathology have problems with conception and pregnancy. The following facts concerning endometriosis are reliably known.
- There is no radical cure. The lack of a reliable theory of the onset of the disease entails the impossibility of constructing an effective treatment plan. All the methods and methods that are used can only temporarily relieve the manifestations of the disease. Very quickly, lesions appear in other places, even if endometriosis was treated with surgery.
- There are endometrial cells in the foci. Endometriosis of any localization during ultrasound examination has tissue identical to that in the uterine cavity. Endometrial cells undergo the same cyclical changes. But unlike the uterine cavity, where there is a communication with the vagina and this makes it possible to remove its contents monthly, other structures and organs of the small pelvis do not have such conditions. Therefore, a semblance of menstrual blood accumulates or is secreted into the abdominal cavity. This leads to the formation of cysts (on the ovaries) with thick dark brown and sometimes even black contents. In addition, bloody lesions irritate the tissues every month, causing adhesions, pain and local inflammation.
- There is a hereditary predisposition. It has been noticed that the likelihood of developing the disease is several times higher in women whose grandmothers and mothers suffered from a similar ailment.
- The disease is hormone-dependent. One feature of endometriosis is reliably known - the manifestations of the disease intensify with an imbalance of sex hormones and sharply decrease with an excess of gestagens - hormones of the second phase of the menstrual cycle. The latter happens during pregnancy, therefore, often after childbirth, endometriosis recedes for a while. Also, with the onset of menopause, when the level of sex hormones is minimal, the disease goes away and only some of its consequences remain. All this is used for the treatment and attenuation of the disease, including when planning pregnancy.
- Surgery increases the risk of endometriosis. Any surgical intervention, especially on the genitals, increases the risk of developing endometriosis. This applies to cesarean section, removal of myomatous nodes with surgical penetration into the uterine cavity. Endometriosis of the cervix often forms after cauterization.
Who is at risk
Endometriosis can occur at any time during your life. The risk group includes the following women:
- if childbirth was accompanied by massive ruptures;
- if during childbirth a manual examination or curettage was carried out;
- if a cesarean section was performed;
- if close relatives have endometriosis;
- with multiple abortions;
- with chronic inflammatory processes in the small pelvis;
- in conditions of chronic stressful situations.
How to understand what pathology is
The clinical picture of endometriosis is nonspecific, but based on the combination of signs, a correct diagnosis can be assumed with a high degree of probability.
- Chronic pelvic pain. This is one of the persistent signs of endometriosis. Painful periods, discomfort in the lower abdomen disturb on the eve of critical days and after them. Pain occurs during sexual intercourse, and sometimes intimate relationships become almost impossible. The intensity of pain varies from slight pulling to unbearable.
- Daub. Spotting is a sign of endometriosis of the cervix or adenomyosis (damage to the muscular part of the body of the uterus). The duration and intensity of the daub depends on the severity of endometriosis. As a rule, spotting occurs two to three or more days before menstruation and lasts a week or more after it.
- Violation of the cycle of menstruation. Spotting discharge may become more abundant, then it is difficult to establish the time of the beginning and end of menstruation. Also, with endometriosis in women, hormonal disorders often occur, which lead to disruptions in menstruation.
- Profuse menses. With damage to the body of the uterus (adenomyosis), the volume of blood loss increases during critical days. This is one of the obvious manifestations of adenomyosis along with daubs.
- Infertility. Endometriosis of the body of the uterus, cervix, fallopian tubes, endometrioid ovarian cysts, as well as complications of the disease often lead to infertility.
- Psychological problems. Constant pain, discomfort, restrictions in intimate relationships are imprinted on the psycho-emotional state of a woman. It has been noticed that the pain threshold may decrease - even minor pains are perceived as very intense. As a result, women with endometriosis are more irritable, quick-tempered, insecure, hysterical.
- Signs of damage to other organs. Endometriotic lesions can appear on absolutely any internal organs and even on the skin (especially in the area of postoperative scars). When the bladder is damaged, blood appears in the urine during menstruation, the rectum - traces of blood in the feces. Often there are foci on the loops of the intestine, peritoneum (covers the abdominal cavity from the inside), cases of endometriosis on the liver, in the brain and the eyeball are described.
The stage and degree of the disease
Depending on the localization, genital endometriosis (with lesions of the genitals) and extragenital (with the occurrence of foci on other organs) are distinguished. According to ICD-10, endometriosis has the code N80. Based on the lesion of the intra-abdominal organs, the following stages of endometriosis are distinguished.
- Stage 1. Small foci are found along the peritoneum adjacent to the uterine appendages.
- Stage 2. The defeat of the appendages and fallopian tubes with the appearance of adhesions. Formation of small foci on the parietal peritoneum.
- Stage 3. The spread of foci to the space behind the uterus (rectovaginal) and in front (vesicovaginal) with the involvement of other organs (bladder, ureters, urethra, rectum, small intestine, including the appendicular process).
- Stage 4. It is characterized by the appearance of multiple foci of endometriosis on all structures and organs of the small pelvis. Numerous adhesions, deformities of organs (eg, ureters) are present.
As the stage of the disease increases, the clinical picture worsens. In the first, the woman's quality of life does not suffer, in the fourth, in addition to infertility, questions arise in intimate relationships and work capacity, for example, because of pain during critical days.
If only the body of the uterus is affected, endometriosis can also have significant consequences for a woman, but the foci on the internal organs and the peritoneum will be minimal. In this case, there is a separate classification.
- 1 degree. It is characterized by a lesion of the uterine wall at the level of the submucosal layer.
- 2nd degree. The myometrium is not more than half affected.
- 3 degree. Endometrioid "passages" reach the outer (serous) membrane of the uterus.
- 4 degree. It is characterized by the spread of the process to all layers of the uterus, peritoneum and organs located nearby.
How to identify
Endometriosis is diagnosed before pregnancy. During gestation, all the symptoms of pathology are significantly reduced due to an increase in the amount of gestagens during this period. Endometriosis can be suspected based on the woman's complaints and a general gynecological examination. But the diagnosis can only be finally confirmed with the help of certain manipulations.
- Ultrasound of the small pelvis. Echoes of endometriosis are not always visible on ultrasound. Most often, the assumption of the disease can be made with endometrioid cysts and adenomyosis.
- Hysteroscopy. This is an instrumental research method in which a special device (hysteroscope) is placed through the cervical canal into the uterine cavity. This allows not only viewing the endometrium through the eyepieces (or the image is displayed on the monitor screen), but also cauterizing areas of hyperplasia, removing polyps and small fibroids in the submucosal layer, which can be detected along with endometriosis and cause infertility. Hysteroscopy helps to detect lesions on the cervix and in the cervical canal, as well as in the myometrium (adenomyosis). It is necessary to carry out hysteroscopy on the eve of menstruation, then the areas of endometriosis look like "honeycombs" with bleeding "snakes".
- Laparoscopy. This is the "gold standard" not only in diagnosis, but also in the treatment of endometriosis. In addition, planning for pregnancy with overt endometriosis should always include diagnostic laparoscopy. It, like any operation, requires some preparation (diet the day before, sanitation of the genital tract with suppositories) and prevention of complications after implementation (antibiotics). Laparoscopy is an operation in which manipulators are installed through several punctures, with the help of which you can view the structures of internal organs and carry out high-tech interventions. During laparoscopy, it is possible to remove myomatous nodes, ovarian cysts. But the main thing is that during the manipulation, a several times enlarged picture is received on the monitor screen, so even the smallest foci of endometriosis on the peritoneum can be identified and removed using cauterization or tissue excision.
- Abdominal surgery. Sometimes the diagnosis of endometriosis is made during a routine operation, such as a ruptured endometrioid cyst.
- Hysterosalpingography. Helps to find out the patency of the fallopian tubes in endometriosis.
- Colposcopy. This is a study of the cervix, which, using a magnifying technique, allows you to identify foci of endometriosis in it.
- Other methods. Less often, it is necessary to conduct an MRI or CT scan of the pelvic organs to determine the extent of the process.
Endometriosis and pregnancy: how disease interferes with conception
The question often arises whether it is possible to become pregnant with endometriosis, and whether the concepts of adenomyosis and pregnancy are compatible. Approximately two out of three women with infertility develop some form of endometriosis, but it is not always the disease that is the reason for the inability to become a mother. The main problems that can lead to infertility in endometriosis are as follows.
- Hormonal Disorders. Endometriosis can occur against the background of hormonal changes or cause them on their own. Because of this, the ovulation process is disrupted, there is a pathology of gestation.
- Depletion of the ovaries. Detection of endometrioid cysts (they are often bilateral) is an indication for their removal. During the operation, most of the ovarian tissue must be excised. Even at a young age, this can lead to premature depletion of the ovaries, a decrease in their reserve. In this case, the likelihood of an independent pregnancy decreases sharply.
- Obstruction of the fallopian tubes. Almost always, endometriosis is accompanied by an adhesive process in the small pelvis. Fallopian tube lesions and adhesions lead to obstruction and a mechanical barrier in the path of the sperm to the egg. If the lumen of the tubes is not completely blocked, the risk of ectopic pregnancy increases even after treatment for endometriosis. Laparoscopy helps to partially overcome the adhesions and increase the chances of conception.
- Miscarriage. Even if conception is successful and the ovum enters the uterine cavity, the process of implantation is not always successful - its introduction into the endometrium. Adenomyosis during early pregnancy can lead to detachment and arrest of chorionic development. In this case, hysteroscopy will help to reduce the manifestations of internal endometriosis in the uterine cavity and increase the chances of a successful pregnancy, during which it is possible to precisely remove and cauterize pathological areas.
Treatment to help you become a mom
Many women have heard that the treatment of adenomyosis, endometriosis of the cervix and other localization can be carried out during pregnancy. In fact, during gestation, serious hormonal changes occur in a woman's body. The predominance of gestagens leads to regression of the foci of endometriosis, but not to its complete disappearance. This also happens during breastfeeding, so women are advised to continue lactating as long as possible.
ECO
With adenomyosis and endometriosis, women often lose hope of finding the first signs of pregnancy in themselves. At the same time, it is difficult not only to conceive, but also to endure. Therefore, it is often necessary to resort to ECO technologies. When several of the following factors are combined against the background of endometriosis, assisted reproductive technologies should be used:
- woman's age after 40 years;
- problems with reproductive function in a man (insufficient sperm count, their poor motility);
- the presence of several miscarriages or missed pregnancies;
- infertility for more than two to three years on the background of treatment;
- obstruction of the fallopian tubes or their absence.
But even IVF guarantees a successful pregnancy only in 50-60% of cases. Therefore, couples should not waste precious time on unsuccessful treatment of endometriosis for many years - a woman's reproductive age is short.
When turning to assistive technologies after 35 years, it is useful to carry out cryopreservation of eggs, which will increase the chances of conceiving in the future. Reviews of women and doctors confirm the fact that babies born from frozen eggs do not differ in terms of health and development from ordinary children.
Is it possible to conceive naturally
If the cause of infertility in a woman is endometriosis, she should undergo comprehensive treatment to increase the likelihood of conception and gestation. It includes the following points.
- Extended laparoscopy and hysteroscopy. Laparoscopy is performed to determine the prevalence of endometriosis and to remove obstacles to conception. Simultaneously with it, hysteroscopy and hysterosalpingography for patency of the fallopian tubes are performed. Thus, in the course of one operation, it is possible to remove foci on the peritoneum and pelvic organs, remove endometrioid cysts (if any), examine the uterine cavity for polyps, hyperplasia, and maximally remove foci of endometriosis inside the uterus. The duration of such an operation varies from an hour to two or three, it is performed under general anesthesia. But the result after such an intervention is worth it.
- Long-term hormonal treatment. To consolidate the effect and increase the chances of a successful pregnancy for three to six months, the girl is prescribed hormonal treatment. The choice of drugs and regimens depend on the age and severity of the disease. The usual contraceptives are used (for example, "Janine", "Yarina", "Jess"), agonists and antagonists of gonadotropins (injections "Buserelin"), gestagenic drugs (good effect after the tablets "Duphaston", "Vizanna", "Mirena").
- Complementary treatment. In combination with the main therapy, vitamins (especially A, E, C), homeopathy, folk remedies (various herbs, fees, bee products, candles with mummy) can be used. In some cases, hirudotherapy helps - treatment with leeches, however, contraindications to the procedure must be taken into account. Proper nutrition and normalization of body weight are useful. But it is not worth waiting for the lesions to dissolve - as an independent treatment, all these methods are ineffective, the result is noticeable only in combination with the main therapy and surgical interventions.
How is the gestation going
Symptoms of pregnancy with adenomyosis and in healthy women are no different - signs of toxicosis appear, the basal temperature rises, and according to the analyzes, the level of chorionic gonadotropin increases. If conception occurs on the background of endometriosis on its own or after treatment, the risk of complications increases most in the first trimester. This is due to the fact that during this period the ovum moves along the fallopian tubes, then its introduction into the wall of the uterus.
After the second trimester, in most cases, gestation proceeds without deviations. However, diffuse adenomyosis and endometriosis of other regions increase the risks of missed pregnancies and spontaneous miscarriages, as well as ectopic pregnancy.
Endometriosis is a serious disease, the causes of which remain unknown to this day. Pathology brings many inconveniences and problems to a woman, including the cause of infertility. Treatment of endometriosis during pregnancy is carried out by the body itself - a certain hormonal background helps to reduce the symptoms and size of the lesions. But often for conception, serious surgical interventions, long-term hormonal therapy are required, and the entire preparation process can take several years.
Among the most common diseases, gynecologists call uterine endometriosis, which is one of the causes of female infertility. Until now, the reasons for its occurrence have not been fully clarified, but, according to statistics, this pathology is often detected during a routine examination. Women periodically complain of recognizable symptoms - 15% to 40% of patients of childbearing age. They are often interested in whether it is possible to become pregnant with endometriosis. Although doctors do not give an unambiguous answer, but with a detailed consideration of the topic, everyone for themselves will have an understanding of this issue.
Endometriosis: what is it and how does it manifest?
Any gynecological disease jeopardizes the ability to become pregnant, bear and give birth to a full-fledged baby. Women are aware of this, so they try to be treated for any diagnosis, not even fully understanding its meaning:- inflammation of the appendages;
- endometriosis;
- myoma;
- ovarian cyst;
- hormonal imbalance, etc.
Some ladies are in no hurry to treat pathology that prevents normal fertilization, using as a natural "contraceptive" means. The disease enters the chronic phase, after which it is much more difficult to fight it. It happens that the pathological tissues, growing, cover the nearby tissues located from the abdominal cavity near the uterus, ovaries and appendages.
The other extreme is to make any diagnosis tragic. Having learned about the pathology and the inflammatory process, they first of all want to know whether this will affect the possibility of getting pregnant and giving birth to a baby in the future. On women's forums, there are often topics like "is it possible to get pregnant with chronic endometriosis?" or "girls, please share who suddenly got pregnant with endometriosis."
Much less often they are interested in the causes of the disease and its symptoms. But they are individual for each, for example, abnormalities in the functioning of the immune system or hormones. Often added to this are hereditary factors, poor ecology and unhealthy nutrition - beer and crackers, which are abused by young people.
In medical practice, cases of similar diseases have been recorded in young girls who have not had sexual experience, and in mature women after the cessation of menstruation. Most often, endometriosis occurs in women of reproductive age - from 30 to 45 years. Only after effective treatment can the doctor answer the question - is it possible to get pregnant after endometriosis treatment?
How endometriosis is formed and what affects
With endometriosis, there is a pathological proliferation of the mucous membrane and tissue located in the inner layer of the uterus. But such fouling can envelop other organs as well, forming adhesions and making it difficult for them to fully function.Often, pathological tissues form whole clusters on the surface of the uterus, ovaries and nearby organs:
- fibrous and cystic;
- polyps;
- benign and malignant formations.
Not all women complain about their pathologies to doctors, even during a routine examination, especially when deviations from the norm are not accompanied by pain. Someone is terrified of surgical operations and hardware cleaning, so they are in no hurry to solve infertility problems with the help of traditional medicine. At the same time, at every opportunity, they try to find out whether it is possible to become pregnant with a diagnosis of endometriosis.
Most often, painful sensations and prolonged periods are referred to as their "norm" and "treat" pain, and not the disease itself. With the pathology of the uterus, many women try to live up to menopause and live on, in the hope that "it will pass by itself." They are more worried about spotting (between menstruation and after sexual intercourse), as well as cycling failure, than their own health and why endometriosis interferes with getting pregnant.
Mucosal nodes grow in the reproductive organs - this is genital endometriosis, but there is also an extragenital or external process. The foci of the disease are also detected in the abdominal organs, postoperative scars. All this negatively affects the female reproductive organs, affecting the uterus. Depending on the localization, doctors distinguish between the following varieties:
- retrocervical;
- peritoneal;
- extraperitoneal endometriosis.
- lower abdominal pain;
- acute pain on the days of menstruation;
- deviations in the frequency of the cycle;
- hemorrhage after sex, which interferes with normal married life;
- pain when urinating or defecating;
- bloody issues;
- infertility (in the absence of obvious pathologies);
- a large amount of bloody discharge during menopause.
Why is it impossible to get pregnant with endometriosis, what interferes
When there are gynecological pathologies, many are interested in the consequences, as well as why it is not possible to become pregnant due to endometriosis.- Hormonal imbalance with a predominance of estrogen suppresses the process of normal ovulation - this is anovulation.
- The problem is not only this, the increased concentration of female hormones is able to suppress the activity of "livestock", reducing the likelihood of fertilization. This is another reason why it is not possible to become pregnant after endometriosis.
- There is also an obstacle to the passage of the egg into the uterine cavity through the tubes due to adhesive processes. Such deviations from the norm are the cause of an ectopic pregnancy. This is not to say that it is directly related to endometriosis, but it is like trees from a common root.
- In medical practice, there are also frequent cases of extensive damage to the uterine cavity with endometriosis. Because of this, a fertilized egg cannot develop further without full implantation in the uterine wall. The development of the ovum below (in the cervical region of the uterus) leads to miscarriage.
How to treat endometriosis to get pregnant
It is already clear what happens in the abdominal cavity with gynecological pathologies, now it is worth clarifying how to treat uterine endometriosis in order to become pregnant.You should not be left alone with a problem if there is no child in the family, it is recommended to be effectively treated. The hormonal background must be corrected. But nature can take its toll, and endometriosis is formed again, even during pregnancy.
Most often prescribed:
- medical correction (Duphaston and other medications);
- laparoscopy;
- anti-inflammatory therapy if an infectious process develops in the abdominal cavity;
- concomitant treatment with herbal tinctures according to folk recipes and homeopathic remedies;
- pregnancy is possible after treatment of endometriosis with a visanna.
It is often difficult to get rid of the proliferation of the mucous membrane inside the uterus, but it is pregnancy that positively affects the state of these tissues. Some women on the forums indicate that they managed to get pregnant unplanned after the discovery of endometriosis in the peritoneum. At the same time, there were no problems with the "travel" of the ovum through the fallopian tubes. There were also many cases when a child was fully conceived, carried and given birth after effective treatment and correction of hormonal levels.
Purposeful women succeed in everything, even to give birth to a baby with pathologies. So do not look for an answer to the question "how to treat endometriosis in order to get pregnant", it is better to ask your doctor!
Endometriosis is the appearance of cells in the inner layer of the uterus (endometrium) in atypical places: on the peritoneum, ovaries, fallopian tubes, the wall and cervix of the uterus, in the bladder, rectum and other organs and tissues.
Why is this happening? Endometriosis causes
Doctors have no definite answer to this question. In general, the picture looks like this.
The uterine cavity is lined from the inside with a mucous membrane called the "endometrium". This mucous membrane consists of two layers - basal and functional... The functional layer is rejected every month during menstruation, unless pregnancy occurs. In the next month, the endometrium grows again due to the multiplication of cells of the basal layer, under the influence of ovarian hormones, in particular, estrogen and progesterone.
Estrogens (hormones of the first half of the menstrual cycle) promote the growth of the inner layer of the uterus and the maturation of the egg. After ovulation, the amount of estrogen decreases, the ovaries begin to secrete progesterone, which inhibits the growth of the endometrium and promotes the development of glands in it, preparing it for the introduction of a fertilized egg. If pregnancy does not occur, then the level of estrogen and progesterone falls, the endometrium is rejected by the uterus, and this is externally manifested by menstruation. Discharge during menstruation is a mixture of blood and fragments of exfoliating endometrium.
So, for the occurrence of endometriosis, at least two factors are necessary: a violation of the hormonal background and a decrease in immunity.
Hormones in Endometriosis: Imbalance Provided
Endometriosis does not develop in a woman's body if she does not have a malfunction of the hormonal system. The regulation of the female reproductive system is controlled by a variety of hormones produced by the glands of the brain (hypothalamus, pituitary gland) and ovaries. Moreover, the ovaries themselves are under the control of the hypothalamus. Hormones in endometriosis behave "incorrectly": the ratio of estrogen and progesterone is disturbed in the body. This leads to suppression of ovulation and overgrowth of the endometrium, which is then rejected, causing bleeding. Individual cells of the immature endometrium are thrown into atypical places - this is how the foci of endometriosis are formed.
Immune compromise and endometriosis
Another cause of endometriosis is impaired immunity. The human immune system is designed in such a way that it protects the body from any "unusual" proteins, destroying the "foreign" proteins of infections, foreign bodies or tumor cells. In the same way, it destroys cells that are uncharacteristic for a particular tissue, in particular, endometrial cells that have fallen into "inappropriate" places for them. In almost all women, during menstruation, discharge not only goes out (through the vagina), but is partially thrown through the pipes into the abdominal cavity, uterine wall, ovaries, as well as into the blood and is carried throughout the body. Normally, menstrual flow that has entered the abdominal cavity is quickly destroyed by special protective cells. Endometriosis occurs when the immune system stops recognizing endometrial cells in other tissues, allowing them to proliferate anywhere.
After the endometrial cells take root in a new place, they continue to exist according to the laws of the menstrual cycle, as they did while in the uterine cavity - in the first half of the cycle they actively multiply and grow, and when menstruation comes, they are rejected into the abdominal cavity, leading to the formation of new foci of endometriosis. If endometrial tissue enters the ovary, then benign endometrioid cysts can form in it. Endometriosis of the body of the uterus (adenomyosis) occurs when endometrial cells are introduced into the muscular layer of the uterus. In rare cases, foci of endometriosis can be found in a wide variety of organs and tissues of the body. So, there is endometriosis of the kidneys, ureters, bladder, lungs, intestines. This is due to the fact that fragments of endometrial tissue are carried throughout the body by the lymphatic or circulatory system.
During pregnancy, menopause and menopause, the foci of endometriosis undergo the reverse process, which leads to an improvement in the woman's condition.
Endometriosis symptoms: if your stomach hurts ...
In rare cases, a woman does not even suspect that she has endometriosis, since it can proceed without showing itself at all. But more often this disease seriously disrupts the state of health. One of the main symptoms of endometriosis is lower abdominal pain associated with the menstrual cycle. They subside at the beginning of the cycle, increase towards the end, becoming especially strong during menstruation. The pain is most often bilateral, sometimes accompanied by a feeling of pressure in the rectal area and can radiate to the back and leg. Discomfort and pain can also occur during sexual intercourse, as well as during bowel movements. Sometimes the pain is so severe that sexual life becomes impossible. Their cause lies in irritation by the "menstruating" endometriotic foci of the nerve endings of the peritoneum. This causes the formation of adhesions (connective tissue cords) in the abdominal cavity, which, in turn, lead to constipation up to intestinal obstruction, as well as frequent, painful urination. Almost all women with genital endometriosis complain of pain during intercourse. Other signs of this condition are prolonged periods, dark spotting before and after menstruation, and bleeding between periods. The cycle becomes irregular or shortened, and your period is heavy, clotted, and painful. The woman constantly suffers from blood loss, which leads to anemia. And endometriosis of the uterus is manifested by bloody discharge after sexual intercourse.
Often this insidious disease is reflected in the emotional state of a woman: constant pain, disturbances in the sexual sphere, difficulties with conception lead to irritability, imbalance and depression.
Planning a pregnancy with endometriosis
It is believed that endometriosis and pregnancy are not very compatible. Endometriosis can interfere with the maturation of the egg and its release into the fallopian tube (ovulation). It is clear that all this cannot but affect the possibility of conception, and the chances of getting pregnant with endometriosis, unfortunately, decrease. In addition, with prolonged course of endometriosis, adhesions are often formed in the genitals, which increases the risk of developing infertility. Adhesions in the fallopian tubes and ovaries are especially dangerous in this regard, which create an obstacle to the advancement of the egg, which makes it impossible for it to meet with the sperm and conception.
However, endometriosis is not a "guarantee" of absolute infertility. There are proven facts of accidental detection of this ailment in women who have never had problems with conception. Also, many women finally manage to get pregnant after endometriosis.
How is the diagnosis made?
The doctor is able to predict the diagnosis of endometriosis during a routine gynecological examination: for example, he can see its focus on the cervix or feel painful seals in the vagina. Also, the doctor pays attention to pain, their connection with menstruation and sexual activity. To confirm or clarify the diagnosis, pelvic ultrasound, magnetic resonance imaging, colposcopy (examination of the vagina and cervix with a microscope), hysteroscopy (examination of the uterine cavity using a special hysteroscope device) and laparoscopy are used. The latter method is the "gold standard" in the diagnosis of endometriosis. This is a gentle surgical operation that allows you to examine the abdominal cavity under magnification (using a special device - a laparoscope) through small holes in the abdominal wall. In fact, only with this method can you see the foci of endometriosis and take a biopsy (pieces of tissue) from them to confirm the diagnosis. Without laparoscopy, the presence of endometriosis can only be assumed.
Treatment and planning of pregnancy after endometriosis
It should be noted right away that the treatment of endometriosis is a long process. Conservative, operative and complex methods can be applied. When choosing a method of treatment, the specialist takes into account the age of the patient, the severity of the course of the disease, whether the woman is planning a pregnancy after endometriosis.
With the conservative treatment of endometriosis, hormonal drugs are prescribed primarily.
Depending on where the malfunction was detected in the hormonal regulation, the doctor will select the appropriate medications to correct the disorder.
Be sure to treat iron deficiency anemia with iron preparations and a special diet. Immunomodulating, analgesic and hemostatic drugs are also prescribed. It is almost impossible to eliminate endometriotic lesions, but treatment allows you to cope with pain and tidy up the menstrual cycle, which increases a woman's chances of getting pregnant after endometriosis.
In some cases, for example, when adhesions are formed due to endometriosis, it is necessary to resort to surgical treatment. Most often, laparoscopy is used, which allows the least traumatic removal of foci of affected tissue and adhesions.
In the treatment of endometriosis, conservative and surgical treatment is often combined. Unfortunately, it is rarely possible to completely get rid of this disease, treatment only allows you to suspend the ailment, which gives a temporary head start for the onset of pregnancy.
Endometriosis and pregnancy
After conservative treatment, it is recommended to plan conception no earlier than 3 months after the course of therapy, so that the body of the expectant mother can fully recover.
Surgical intervention, on the contrary, presupposes an early onset of pregnancy after endometriosis (unless a combined course is prescribed - a combination of surgical and hormonal treatment). Many doctors advise, before undertaking surgical treatment of endometriosis, to make sure that infertility is not caused by other disorders. If there are several possible causes of infertility, it is recommended to first eliminate all other problems and only then have surgery for endometriosis. This is due to the fact that the effect of the operation does not last long - the chances of pregnancy after endometriosis increase only in the first 6-12 months after surgery.
On average, 90% of women receiving conservative treatment for mild to moderate endometriosis manage to get pregnant without surgery within 5 years.
The course of pregnancy with endometriosis
Although it is believed that pregnancy and endometriosis are not very compatible, it is still possible to become pregnant with this disease, moreover, even without treating the disease. During pregnancy, endometriosis, as a rule, is not treated, but it is dealt with after the birth of the baby.
The only exceptions are cases when an endometrioid ovarian cyst is found in the expectant mother: if there is a danger of rupture or torsion, then an operation is planned, which is usually performed at 16–20 weeks of pregnancy (this period is safest for the fetus).
The combination of pregnancy with endometriosis requires special attention from doctors. Pregnancy often has to be maintained with hormones to prevent miscarriage. The threat of termination can arise in the first and second trimesters due to a lack of the female sex hormone progesterone in the body, which is necessary during this period for the proper development of pregnancy and suppression of contraction of the uterine muscles. Once the placenta has formed, the likelihood of miscarriage is reduced. By itself, endometriosis no longer threatens the fetus and does not affect its development in any way.
Article outline
One of the most common and insidious female diseases is endometriosis. This disease manifests itself in the form of a layering of uterine tissue in an unusual place: in the abdominal zone, fallopian tube, on the ovaries, and also on the walls of the uterus. Pathological manifestations of endometriosis are especially dangerous when planning pregnancy, since they significantly complicate the process of conception, and in severe cases, they can provoke infertility. In this regard, endometriosis and pregnancy are considered the most relevant topic among the fair sex.
How endometriosis manifests itself and its types
The symptoms of endometriosis depend on the area of manifestation of the pathological process and the general condition of the girl. According to medical practice, there are cases when the disease proceeds without symptoms, and a gynecologist can diagnose it during a routine examination.
The development of endometriosis is characterized by the following symptoms:
- The appearance of painful sensations in the pelvic zone - this symptom manifests itself in 25% of women. The pain is clearly localized in a certain place for a long period.
- Painful sensations of a cyclical nature accompanying menstruation - the symptom worries 50% of patients. A pronounced manifestation occurs on the first day of the menstrual cycle as a result of the following factors: the formation of spasms in the uterine vessel, bleeding in the abdominal region, increased pressure.
- Discomfort during sexual intercourse is present when the pathology affects the uterine ligaments or the vagina.
- Menstrual irregularities:
- prolonged, heavy menstruation;
- the presence of a brownish discharge after menstruation;
- reduction of the menstrual period;
- heavy bleeding.
- The most dangerous symptom is problematic conception and bearing of the fetus. This feature is present in 40% of girls.
In the presence of severe complications, the manifestation of specific symptoms is observed:
- the formation of bloody discharge in the urine;
- impaired bowel movement;
- cough accompanied by hemoptysis.
- The genital view is divided into three forms: internal, peritoneal, extraperitoneal. The first subspecies, adenomyosis, involves the proliferation of foci inside the uterus, while penetration deep into the mucous tissue occurs. With the peritoneal form, other organs of the reproductive system are affected: the cervix and tubes of the uterus, ovaries, vagina. The extraperitoneal subspecies involves the defeat of external organs.
- The extragenital form is diagnosed in the case of the formation of pathological foci in the intestines, lungs, and bladder.
What does the disease lead to
First of all, endometriosis affects the uterus, as well as the nearest genitals. Endometrial tissues are sensitive to hormone cells, therefore, the following changes occur in distant areas covered with mucous membranes:
- The endometrial tissue in the uterus grows and becomes dense - this is due to the release of estrogen cells in the early days of the menstrual period.
- The second half of the period is characterized by the influence of progesterone, which destroys the newly formed layer. This process is accompanied by inflammation and bleeding.
Thus, endometriosis of the uterus leads to the formation of a cyst, malfunctioning of the reproductive system, and in severe cases jeopardizes the possibility of conceiving a fetus and the normal course of pregnancy.
Treatment of endometriosis during pregnancy
It is believed that endometriosis is effectively treated with pregnancy. This point of view is based on the fact that pregnancy helps stabilize the functioning of the uterus by stopping the production of hormone cells that contribute to the progression of the disease.
Despite this, medical experts believe that it is impossible to cure this pathology with pregnancy: a positive effect will be observed until ovulation occurs. In this regard, this method is ineffective.
Pregnancy planning - is it possible
The negative impact of endometriosis on pregnancy is explained by the high probability of miscarriage, and later - infertility. According to medical statistics, 40% of girls suffer from problems related to conception throughout the year. Against the background of endometriosis, fertility is significantly reduced:
- The formed adhesions in the tubes of the uterus lead to a violation of the passage of the egg, thereby interfering with conception.
- An excess of prostaglandins in the female body provokes the formation of numerous microspasms that disrupt the transport function of the uterine tubes.
- Hormonal imbalances and decreased immunity interfere with the normal course of ovulation. Pregnancy is possible with complete stabilization of the hormonal background.
- Neoplasms in the form of endometrioid cysts have a negative effect on pregnancy. If the fertilization process was successful, there is a possibility of termination of the pregnancy.
The reproductive function of the girl is significantly reduced, but with effective treatment, the body quickly recovers and returns to its previous shape. Pregnancy with endometriosis of the uterus is allowed if the patient takes a course of hormonal medications. If the process of natural fertilization was unsuccessful, the doctor advises using the method of in vitro conception.
Pregnancy after treatment
Treatment of endometriosis is long and complex, since surgical and conservative intervention is used. When composing an individual technique, the doctor necessarily takes into account the biological age, with the help of which the possibility of getting pregnant is determined, as well as the severity of the pathology.
Conservative therapy consists in the use of hormonal drugs. In order to become pregnant after endometriosis it was not difficult, it is necessary to eliminate iron deficiency anemia using iron-containing medications. To improve the general condition of the patient, the doctor prescribes the intake of painkillers, hemostatic, immunity-enhancing drugs.
Surgical intervention is carried out in case of adhesions formation. In most cases, the doctor uses the method of laparoscopy, which effectively removes the focus on the affected tissues, but does not injure the body. Pregnancy after treatment of endometriosis proceeds with positive dynamics and without serious complications.
How is pregnancy and childbirth going?
Endometriosis during pregnancy is not treated: conservative and surgical methods can have a negative impact on the development of the fetus. According to medical practice, there is an exception, which is the development of an endometrioid cyst that affects the ovary. In order for a woman to be able to bear a fetus, it is necessary to perform surgery in the fourth month of pregnancy.
Carrying a child, accompanied by endometriosis, should be closely monitored by medical professionals. In order to preserve the pregnancy, the girl takes hormonal medications without fail. There are cases when in the early stages there is a threat of miscarriage due to a deficiency of progesterone, which ensures the correct development of the fetus. If the placenta has formed, the pregnancy is positive.
Thus, endometriosis suggests the following adjustments during pregnancy:
- with the development of pathology, the chance of such an outcome as an ectopic pregnancy increases significantly. For the timely detection of abnormalities, the patient is recommended to do an ultrasound;
- medical professionals must monitor hormonal levels to avoid an increase in uterine tone. Otherwise, the girl will not be able to give birth;
- a weakened uterus can rupture as a result of fetal growth. For complete safety, expectant mothers are assigned to inpatient treatment;
- with endometriosis, the process of childbirth becomes much more complicated: since the uterus is not elastic, it is recommended to give birth using a cesarean section.
Will surgery help you get pregnant?
Modern medicine is impossible without surgical operations, which are subdivided into conservative intervention and radical intervention. Most often they are combined and applied as the most gentle way.
With endometriosis, laparoscopy is most often performed, during which the neoplasms are cauterized with a special laser. If the disease is accompanied by severe complications, the doctor uses the laparotomy method - cutting the abdominal wall. After surgery, the patient needs to take a medication course on drink, undergo physiotherapy procedures to consolidate a positive result. In general, the operation relieves of unpleasant painful sensations, relieves the inflammatory process, restores the reproductive function, which makes it possible for the patient to become pregnant.
IVF as an option for a long-awaited child
The in vitro fertilization program is drawn up individually for each patient, based on her biological age, the number of unsuccessful attempts at conception, health status, and the severity of the disease. IVF is contraindicated in diagnosing external endometriosis. In this case, an effective treatment method is drawn up for a woman, aimed at reducing symptoms, as well as removing neoplasms.
If pregnancy does not occur after treatment, the girl is prescribed an in vitro fertilization procedure. For patients over 30 years old, the procedure is carried out after surgery and taking hormonal drugs. If the patient is at the age of 23-27 years, doctors recommend not to rush with IVF and try to conceive a child naturally.
Endometriosis in the last stages of development is not an obstacle to the implementation of in vitro fertilization. As a rule, the procedure is scheduled immediately after the delivery of special tests and a thorough examination.
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