Endometriosis of the uterus – what to expect a woman who has heard such a diagnosis? In the structure of gynecological pathology, this disease occupies one of the leading positions. Recently there has been a tendency to rejuvenate the disease and increase its prevalence. The disease leads to disturbances in the reproductive system, adversely affects the psycho-emotional state of patients and can significantly reduce their quality of life. In this article we will try to talk about the disease in accessible language with a minimum of necessary medical terms.
What is endometriosis of the uterus
Endometriosis is a chronic hormonal growth of the glandular tissue of the inner layer of the uterus (endometrium) beyond its limits. The growth of the endometrium can be within the reproductive system (then they are talking about the genital form of endometriosis) and outside of it (extragenital form). Internal endometriosis accounts for the vast majority of cases.
Endometriosis of the uterus is one of the varieties of the genital form of the disease, in which the foci of hypertrophic endometrium directly affect the organ itself (its muscle layer, serous cover, neck). The disease is systemic and has a benign course. However, when exposed to a number of pathological factors, endometrial cells may undergo a malignant transformation.
The structure of the uterus
To understand the mechanisms of development of endometriosis, it is necessary to know the structural features of the uterus. The uterus is a hollow organ located in the pelvis of a woman.
The wall of the uterus is represented by three layers:
Serous membrane (or perimetry) is the area of the peritoneum covering the body and partly the cervix. Perimetry is predominantly spliced with the muscular layer.
Muscular coat (myometrium) – the widest layer, which is ensured by the longitudinal and circular arrangement of smooth muscle fibers.
Mucosa (endometrium) is the inner layer of the uterus. The histological structure of its heterogeneous. The main mucosal cells are the cylindrical epithelium and connective tissue, which have abundant blood supply. The layers of the endometrium are pierced with tubular glands. In the endometrium, surface and basal layers are distinguished. The surface layer of the endometrium under the influence of hormones is periodically rejected and menstrual bleeding occurs. In this case, the basal layer does not undergo significant changes, but is a source for restoring the surface endometrium. It is changes in the mucous membrane of the uterus that can trigger the development of endometriosis.
Causes and mechanism of development of endometriosis of the uterus
The exact root causes of the disease remain unexplained in today’s time. The main theories of the development of pathology are considered:
- Implant hypothesis. According to it, the ability of endometrial tissue to adhere (adhesion) and implant (implant) increases under the influence of hormonal and immune disorders. Under conditions of increasing intrauterine pressure, such functionally modified cells migrate to other structures, where they continue to grow.
- Hypothesis of endometrial origin of lesions. The origin of areas of endometriosis in myometrium is explained by any invasive procedures carried out in the uterus, which violate the integrity of the mucous membranes (diagnostic curettage, abortions, surgical interventions affecting the endometrium).
- Metablastic hypothesis. Proponents of this theory believe that almost any tissue can undergo a degeneration into endometrial-like cells. Thus, foci of endometriosis do not arise as a result of the migration of mucosal structures, but are formed locally.
- Fetal hypothesis. The frequent combination of endometriosis of the uterus with congenital malformations of the urogenital system suggested that foci of adenomyosis can develop from the germs of embryonic tissue. Such abnormal areas are able to form as a result of improper laying of genital structures during fetal development.
Some scientists agree that in each specific clinical case different theories can be used as a mechanism for the formation of endometriosis. In addition, a combination of these hypotheses is possible.
The risk factors for endometriosis of the uterus include:
- Genetic predisposition;
- Fertile age;
- Disruption of the menstrual cycle;
- Lack of pregnancy and childbirth;
- Prolonged use of intrauterine devices;
- Abortion and diagnostic curettage of the uterus.
In addition, there are factors that directly provoke the development of the disease. Most often they are the hormonal imbalance and pathology in the immune system. Such predisposing processes are:
- Inhibition of the body’s natural defenses;
- Decreased functional activity of granular lymphocytes;
- Inhibition of genetically determined cell death;
- Progesterone exchange disorder;
- Hypersecretion of vascular endothelial growth factor.
Types of endometriosis of the uterus
Endometriosis of the uterus is not the same type of disease. Depending on the location, pathological lesions may affect the bottom of the uterus, its body or neck. This separation is rather arbitrary, since in most cases the process is localized in all the anatomical structures of the organ.
Morphological forms of the disease are:
- Nodal variant of adenomyosis;
A diffuse form is indicated if the adenomyous process is distributed relatively evenly in the myometrium. The nodal form is characterized by clearly formed foci of various sizes. The mixed form is morphologically represented by a combination of the characteristics of the first two species.
Ectopic sites are most often found in the myometrium, but may be localized in the serous membrane of the organ.
Depending on the severity of the organ damage, adenomyosis is classified into four degrees:
I degree – single superficial foci;
Grade II – several foci capable of penetrating into the myometrial circular layer;
Grade III – multiple foci of endometriosis, localized throughout the muscular layer of the uterus;
IV degree – many deep foci with germination in nearby organs and tissues.
The clinical picture of endometriosis of the uterus
The most common manifestation of symptoms is a change in the characteristics of menstrual bleeding. First of all, menstruation becomes profuse and painful. The severity of these clinical signs directly depends on the type of disease, the degree of organ damage and the involvement of nearby anatomical structures in the disease.
Patients describe pain as a feeling of fullness and heaviness in the lower abdomen. However, these manifestations can be combined with nausea, vomiting and fainting. Pain may accompany and sexual intercourse (dyspareunia). In some patients, during and in the first days after menstruation, body temperature may rise.
The increase in the duration of menstruation due to the fact that after its completion for 3-5 days it is possible the outpouring of blood from endometrial cracks into the uterus. Abundant and prolonged periods, as a rule, are difficult to medication correction and often lead to the development of iron deficiency anemia. The presence of the pathology of the exchange of sex hormones, accompanying endometriosis, adversely affects blood formation and aggravates anemia. This also contribute to burst uterine bleeding. They appear in the middle of the cycle, especially often occurring in the diffuse form of adenomyosis. In this case, the symptoms of anemia join the clinical picture of endometriosis:
- General weakness;
- Fast fatiguability;
- Increased drowsiness;
- Tendency to fainting;
- Headaches and dizziness.
The diagnosis of adenomyosis is a cumulative process. First you need to carefully listen to the complaints of the patient and correctly collect anamnestic data. As a rule, already at this stage a qualified doctor is able to suspect endometriosis of the uterus.
Physical examination (on the gynecological chair) is able to reveal the increased size of the uterus and its spherical shape. When the nodular form is sometimes possible to palpate the roughness of the uterus.
To confirm the diagnosis, clarify the localization process, the severity of the disease and the choice of treatment tactics resort to instrumental studies:
- Ultrasound diagnosis;
- Magnetic resonance imaging;
Adenomyosis is a systemic process, so the treatment approach must be comprehensive. Based on the data obtained as a result of diagnostics, the specialist develops an individual program of therapeutic and surgical measures. Be sure to take into account:
- The desire of a woman to have children;
- Degree of organ damage;
- Forms of the disease;
- Localization process.
Methods of dealing with adenomyosis are reduced to surgical, conservative and combination treatment. When a diagnosis is first identified, conservative therapy is prescribed. If there is a pronounced running process or limitations to the conduct of drug treatment, they resort to surgical methods.
Operational activities can be:
- Radical (uterine extirpation);
- Organ-preserving (excision of foci of endometriosis).
Mostly used laporoscopic organ-sparing surgery. However, with the aggressive course of adenomyosis in women older than 40 years, the persistent absence of results from conservative treatment, the risk of malignant transformation is resorted to radical surgery.
Conservative therapy is carried out:
- Hormonal drugs;
- Nonsteroidal anti-inflammatory drugs;
- Sedative medicines;
- Vitamin and mineral complexes;
- Physical therapy (magnetic therapy, acupuncture, laser, impulse currents).
The prognosis of the disease is relatively favorable. Without timely treatment, advanced forms of adenomyosis can lead to persistent secondary infertility. Radical surgery during the pre- and postmenopausal period ensures an acceptable quality of life.
Is there prevention of endometriosis?
Unfortunately, measures to prevent the development of endometriosis have not been developed. The likelihood of adenomyosis decreases with the implementation of a woman’s reproductive function, timely treatment of disorders of the ovulatory cycle and the absence of invasive intrauterine manipulations in history.
Can adenomyosis develop into uterine cancer?
Adenomyosis is a benign process that, in most cases, does not undergo a malignant degeneration. However, the course of the disease is quite aggressive. Such characteristics of the disease can lead to atypical cell transformation.
At what age does endometriosis occur?
Endometriosis is mainly a lot of women of reproductive age. However, cases of manifestations of adenomyosis in girls before the arrival of the first menstruation, as well as in women in menopausal period are described.
How does pregnancy affect the course of endometriosis?
Endometriosis is one of the risk factors for infertility. However, if a woman becomes pregnant against the background of existing adenomyosis, the activity of its manifestations, as a rule, fades away. This is due to a change in the hormonal status of women – a decrease in estrogen levels and an increase in progesterone levels. During pregnancy and the feeding period, a long-term remission of the disease is likely.
Is endometriosis inherited?
Hereditary forms of endometriosis are described in the literature. At the same time, identical variants of the disease are observed in several generations, and a predisposition gene for this pathology is detected. However, these patterns are not typical for most cases of adenomyosis.