1ST CITY CLINICAL HOSPITAL

Endometriosis is a gynecological disease that occurs in women during the childbearing period. The name of the disease comes from the word endometrium (this is the membrane that is located on the inside of the uterus and which grows every month and is shed during menstruation). In the presence of this disease, the endometrium is observed in other places, such as outside the uterus.

Since endometrioid tissue has receptors for hormones, the same changes occur in it as in normal endometrium, manifested by monthly bleeding. These small bleedings lead to inflammation in the surrounding tissues and cause the main manifestations of the disease. The most common place for endometriosis to develop is the abdominal cavity, including the ovaries, the fallopian tubes and ligaments that support the uterus, the area between the vagina and rectum, the surface of the uterus, and the lining that covers the abdominal cavity. Further complications, depending on the location of the lesions, may include such phenomena as the growth of lesions into neighboring organs, which can contribute to the spread of endometriosis, the occurrence of adhesions (impaired patency of the fallopian tubes), bleeding in the intestines or difficulty in bladder function. Symptoms usually worsen over time, although in some cases there is temporary relief. Sometimes endometriosis occurs on scars after surgery, on the intestines, rectum, bladder and external genitalia. In rare cases, lesions occur outside the abdominal cavity, such as in the lungs or thighs.

Risk factors:

• hormonal and immune disorders,
• thyroid diseases,
• sexual infections,
• heredity,
• stress,
• age (30-50 years),
• as well as intrauterine manipulations (therapeutic and diagnostic),
• abortions,
• complicated childbirth,
• bad habits (smoking, addiction to alcohol and caffeine),
• excess weight

Common symptoms of endometriosis are:

pain in the lower abdomen during menstruation (more severe than usual), pain during sexual intercourse, increased bleeding during menstruation, irregular menstruation. Further symptoms may include fatigue, lower back pain, bowel dysfunction (diarrhea or constipation) or bladder dysfunction (pain or discomfort when urinating), while some women may have no symptoms. There is not always a correlation between the degree of symptoms and the extent of endometriosis. Sometimes with large foci of endometriosis there is no pain, while minor foci can cause unbearable suffering. Due to heavy bleeding, women often show signs of anemia.

Endometriosis can also be detected during a special examination when a woman consults a gynecologist with complaints of infertility. Women suffering from endometriosis have an increased risk of developing an ectopic pregnancy.

To diagnose endometriosis and conditions associated with it, a study is required

• general blood test,
• blood test to assess the functional activity of the endocrine system:
  • pituitary gland
  • thyroid gland,
  • adrenal glands
  • gonads.
• transvaginal ultrasound examination;
• blood test for markers inherent in endometriotic cells (CA-125);
• analysis of urogenital scrapings for viral markers
• and bacterial infection to identify past or current genitourinary tract infections
• etc.

The diagnosis of endometriosis is considered final only after confirmation by histological examination of material collected by laparoscopy. This is a surgical operation performed under anesthesia as follows: the patient's abdominal cavity is stretched with carbon dioxide, and a laparoscope - a tube with a light bulb at the end - is inserted into a small incision in the abdominal cavity, and instruments are inserted through two small incisions to perform surgical manipulation. By carefully moving the laparoscope, the surgeon can easily examine the organs and determine the location of the lesions.

There are conservative and surgical methods of treating endometriosis. The latter are divided into hormonal and non-hormonal. The best results are achieved with complex therapy of endometriosis and its combined treatment.

Painkillers are usually prescribed for endometriosis. Treatment with hormones aims to stop ovulation for as long as possible. Hormone treatment uses dienogest (Visanne), combinations of estrogens and progesterones (combined oral contraceptives), testosterone derivatives (danazol) and gonadotropin-releasing hormone agonists. During treatment, some women may experience side effects (hot flashes, mood changes, weight changes, etc.)

Since the symptoms of endometriosis often stop temporarily during pregnancy, and the likelihood of sterility increases with the duration of the disease, women suffering from endometriosis are advised not to delay pregnancy. On the other hand, a number of non-medical difficulties may arise: the woman, perhaps, has not yet made a decision regarding childbearing (and this is one of the most important decisions in her life); she may not have the conditions necessary for childbearing.

For the purpose of treatment, surgical cauterization of foci of endometriosis or removal of endometrioid cysts from the surface of the ovaries is performed during laparoscopy. However, in some cases, relapses of the disease are possible with the appearance of foci of endometriosis and endometrioid cysts. The best results are achieved with complex therapy of endometriosis and its combined treatment.

Such a radical method as removal of the uterus, removal of all tumors and ovaries (to stop further hormonal irritation) is considered necessary in cases of prolonged endometriosis, accompanied by anemia, prolonged and recurrent bleeding, and lack of effect from the therapy after the reproductive function has been performed.