The endometrium is a richly vascularized (permeated with blood vessels) mucous layer that covers the inner surface of the uterus. Endometriosis is a systemic pathological process in which the cells of the endometrial layer spread outside the uterus and, growing, form foci of the uterine mucosa in other parts of the body.
The prevalence of endometriosis has increased dramatically in recent decades. If in the middle of the twentieth century only specialists knew about this disease, today characteristic complaints are constantly heard at gynecologists; the diagnosis itself, as they say, is becoming more and more popular and attracts the attention of research medicine more and more, since many questions remain unclear. There are also no exact epidemiological data: published approximate estimates vary from 6-7% to 50% of the general population of women. A number of authors consider endometriosis one of the most common gynecological diseases today, affecting women of the most active age (usually in the range from 20 to 40 years, although there are cases of much earlier manifestation). It is known that endometriosis is found in half of the patients undergoing treatment for infertility, and most women (up to 80%) with chronic pelvic pain. The Caucasoid race is more susceptible to this pathology than the other two.
The reasons
To date, the etiopathogenesis remains unknown. Several main hypotheses are considered, discussed and confirmed (to one degree or another). Thus, a significant relationship has been established between the likelihood of endometriosis and the number of traumatic gynecological manipulations. According to the “retrograde menstruation” hypothesis, the greatest risk factor is the backflow of menstrual blood into the fallopian tubes. The possibility of degeneration of other tissues (eg, coelomic epithelium) into the uterine endometrium is being actively studied; this “metaplastic” hypothesis, in particular, explains the occasionally observed cases of endometriosis in men. In some sources, endometriosis is considered as a purely oncological (precancerous or intermediate) pathology, especially since endometrial cells are indeed capable of metastasizing and growing into other tissues (eg, bladder walls, skin, lungs, peritoneum, etc.). A number of facts indicate that harmful effects at the stage of intrauterine development, hereditary predisposition (it is reported that in the presence of cases in a family history, the risk of getting endometriosis in a woman is up to five times higher than in the general population), hormonal disorders can play a role in the development of endometriosis and imbalances, autoimmune mechanisms.
Perhaps endometriosis is a disease of a polyetiological nature, which is “launched” by a certain combination of triggers under adverse internal conditions.
Symptoms
The most common and pronounced symptom of endometriosis is the soreness of physiological acts (urination, menstruation, coitus, defecation) and a standard gynecological examination. Sometimes there are also cycle disorders, menorrhagia (abnormal abundance of menstruation), persistent nausea. As mentioned above, endometriosis can cause infertility and constant pain in the lower abdomen.
In general, the clinical picture depends on exactly where the proliferation (growth) of endometrial cells begins. On this basis, two main forms of the disease are distinguished: genital and extragenital. In the first case, endometrial sites are found on the ovaries, fallopian tubes, in the vagina and other structures of the reproductive system. Extragenital endometriosis (less than 10% of the total reported cases) can be localized, in fact, anywhere. However, in any case, well-being and symptoms depend on the phase of the menstrual cycle, since the endometrial receptors respond to the appropriate hormonal “commands” and begin to bleed, which can easily lead to an inflammatory process.
As a relatively independent form, the so-called. adenomyosis (endometriosis of the body of the uterus), in which the mucous endometrial layer grows into the muscular space of the uterine wall; this situation is particularly difficult to treat.
According to the severity and prevalence of endometriosis, four stages are distinguished.
Diagnostics
Ultrasound of the pelvic organs (even with transvaginal access, which gives much more informative results) does not always allow visualizing characteristic changes, so the absence of signs of endometriosis on ultrasound cannot be considered as evidence of its actual absence. More accurate diagnostic methods in this case are certain types of X-ray examination (eg, hysterosalpingography), hysteroscopy, MRI – when using these studies, the probability of reliable detection of endometriosis, if it really exists, is 85-90%. In many sources, however, the most reliable way to detect endometriosis is called diagnostic laparoscopy.
Treatment
The treatment of endometriosis is a complex and multifactorial task, which today is most often solved by a combined approach. Of great importance is hormonal therapy, the purpose of which is the suppression of abnormal growth. With adenomyosis, the only way out may be extirpation of the uterus (total removal); 15-20 years ago, such an operation for endometriosis of the uterine body was performed unambiguously. Today, treatment is started with small doses of hormones, and if a woman applied at a very early stage, endometriosis can be cured without any consequences, incl. for reproductive performance.
If surgery is unavoidable, in all cases they tend to resort to the least invasive of all possible methods (laparoscopy, cryo- or laser ablation, radiocoagulation, etc.); as a rule, a surgical operation is performed with extragenital forms.
Important areas of therapy are the reduction of pain and inflammatory symptoms, the normalization of hormonal levels; according to indications, antioxidant complexes, neurological drugs, physiotherapy are prescribed.
Unfortunately, endometriosis exhibits a strong tendency to relapse, which is blocked only with radical surgical intervention.
