It is known that pregnancy and lactation are excellent remedies against endometriosis and often lead to its stable remission. However, the sad paradox is that endometriosis is often . Why does this disease occur? How to diagnose it? How to treat? On the treatment of endometriosis, sibmum is consulted by Evgenia BONDARENKO, an obstetrician-gynecologist of the first category of the network of family medicine centers "Zdravitsa".
What is endometriosis?
Endometriosis is as common as it is mysterious. For some reason that is not entirely clear, the endometrioid tissue that lines the inside of the uterus begins to behave strangely. It grows in excess in the body of the uterus, on other genital organs - on the cervix, in the tubes, ovaries, or even begins to "travel" through the body, and it is found in completely unexpected and inappropriate places for this - in the intestines, urinary tract, lungs, and even in the tissues of the eyes.
Everything would be fine, but the endometrium is a special tissue that was conceived by nature to receive a fertilized egg and create comfortable conditions for it. For these purposes, every month at the beginning of the cycle, the endometrium actively grows and thickens under the influence of the hormone estrogen. By about the 15th day of the cycle, another hormone, progesterone, is connected to the process: endometrial tissues begin to secrete a lot of mucus, the vessels expand and become full-blooded to provide the best reception for a new life. If conception did not occur, then by the end of the cycle, the content of both hormones decreases sharply, the overgrown layer of the endometrium is destroyed and rejected - menstruation begins.
Excessive growth of the endometrium inside the uterus or its presence in other organs leads to pathology - endometriosis. Like the normal lining of the uterus, these tissues grow at the beginning of each cycle and are destroyed during menstruation. This can lead to the formation of adhesions and endometrioid cysts.
Expert comment
Endometriosis is a dishormonal, immune-dependent and genetically determined disease, which is characterized by a benign growth of tissue similar in morphological structure and function to the endometrium, but outside the uterine cavity. Endometriosis is one of the most common gynecological diseases, it is especially common in women aged 20-40 years. According to the localization of the foci, it is divided into genital and extragenital.
Genital endometriosis is internal - when the tissue grows in the body of the uterus, isthmus and interstitial sections of the tubes, and external - when the vaginal part of the cervix, vagina, ovaries, tubes and peritoneum of the small pelvis are affected.
Extragenital endometriosis is a lesion of all other organs, except for the genitals. The foci of endometriosis are subject to hormonal influence during the menstrual cycle, and it is these cyclic changes that are responsible for the main symptoms and complaints of women suffering from this pathology.
Causes of endometriosis
There is no unequivocal opinion on why endometriosis occurs in the medical community. It is assumed that endometrial cells enter the abdominal cavity during menstruation from the fallopian tubes, or are carried throughout the body with lymph and blood flow coming from the uterus.
There are known cases of endometriosis in men undergoing estrogen therapy, which proves the hormonal nature of this disease.
Expert comment
The occurrence of endometriosis is explained by several theories, and none of them has been clearly proven. At present, the theory of the displacement of endometrioid particles "inward" has become the leading one, that is, with retrograde flow of menstrual blood through the fallopian tubes into the peritoneum; viable uterine lining cells in menstrual blood attach to the peritoneum and proliferate. It has been established that this phenomenon is especially common during abortions and medical interventions (curettage of the uterine cavity, caesarean section).
However, due to the prevalence of endometriosis in girls, the genetically determined theory of the origin of endometriosis is now in second place: changes that occur at the stage of fetal formation in the womb. Often at a young age, the disease is combined with malformations of the genital organs.
Risk factors for endometriosis include:
hormonal disorders, when receptors capture hormones with increased activity;
depressed immunity;
genetic predisposition;
frequent intrauterine interventions;
chronic stress state of the body.
Symptoms of endometriosis
Often endometriosis does not manifest itself in any way and signs of this disease are visible only with an ultrasound examination.
In other cases, endometriosis can lead to such consequences as:
- pain in the lower abdomen, especially in the second half of the cycle;
- discomfort during sex;
- spotting between periods;
- violation of the menstrual cycle;
- difficulty conceiving.
Expert comment
The symptoms of endometriosis are extremely varied. The most common symptom is aching pain in the lower abdomen that occurs cyclically. Often its intensity increases in the second half of the menstrual cycle and during menstruation. As the disease progresses, the pain becomes debilitating, becomes permanent, radiating to the perineum and legs. Often this leads to a decrease in mood, performance, depression and chronic fatigue. One of the symptoms of endometriosis is a violation of menstrual function: spotting before and after menstruation, irregular menstruation. It has been established that about 40% of women with endometriosis suffer from infertility, which occurs both due to hormonal imbalance and due to altered endometrium, and in some cases due to adhesions (with localization of foci in the abdominal cavity).
Diagnosis of endometriosis
A whole range of methods helps to accurately diagnose endometriosis:
Gynecological examination.
Indicators of tumor markers in the blood test. With endometriosis of the ovaries, the indicators of markers CA 125, CEA and CA 19-9 are often increased several times.
On ultrasound, the diagnostician can see endometrial foci and cysts.
Has the highest accuracy - it allows you to accurately determine the presence and localization of foci of endometriosis, adhesions and cysts. In addition, with the help of laparoscopy, it is possible to simultaneously remove the diagnosed foci and cysts, to separate the adhesions.
Expert comment
In the diagnosis of endometriosis, in addition to assessing complaints and objective status, the gynecologist is helped by an ultrasound diagnosis picture, which can be done to clarify the diagnosis not only on the standard 5-7 day of the cycle, but also repeated on the 21-24 days of the cycle, when indirect signs are more clearly visible. of this disease. Blood for markers CA-125 and CA-19-9 are often slightly elevated in endometriosis, but are not specific, since these are markers of all oncological processes. Their combination increases the sensitivity of diagnosis, but also gives 10% false positive results. Thus, none of the biomarkers is specific for diagnosing the disease. The only accurate method is laparoscopy with the detection of endometrioid lesions.
Treatment of endometriosis
Unfortunately, in some cases, endometriosis is an obstacle to conception: extensive foci of the disease can provoke the formation of adhesions in the pelvic organs. This prevents fertilization and the advancement of a fertilized egg into the uterus. In addition, the adhesive process can cause an ectopic pregnancy. Therefore, in some cases, before planning a pregnancy, a course of treatment for endometriosis is necessary.
To date, there are two main methods of treating the disease:
- Surgical- in case there are large foci of endometriosis, cysts, as well as adhesions that prevent the onset of pregnancy, doctors recommend surgical intervention. The operation is performed by a minimally invasive laparoscopic method. The surgeon accurately removes the foci of the disease, while carefully preserving the organs.
Hormonal- the doctor recommends taking hormonal drugs (in some cases, properly selected hormonal contraceptives are enough), which temporarily block the work of the ovaries, stopping the cyclic growth and destruction of endometrial cells;
Expert comment
Treatment of endometrioid disease depends on the degree of damage, localization of foci and the need to preserve reproductive function. In young women, this is most often hormonal therapy, which is aimed at suppressing menstruation and reducing the clinical symptoms of the disease. Surgical treatment is indicated for concomitant infertility as a stage of preparation before a planned pregnancy.
Endometriosis and pregnancy
Doctors allow planning for conception, as a rule, as soon as possible after treatment. It should not be delayed, because reduced or surgically removed lesions may return again. If endometriosis does not prevent conception, the doctor may recommend to the nulliparous woman as a therapy ... pregnancy and breastfeeding. During pregnancy and lactation, cyclic hormonal processes in a woman's body stop, they are replaced by completely different ones, aimed at carrying and maintaining pregnancy. The growth of the endometrium also stops, and in some cases even reverses.
Signs of endometriosis decrease or completely disappear for the entire period of pregnancy and lactation, however, after the end of breastfeeding, pathological processes in the endometrium may reappear, so control over this disease is necessary.
Expert comment
Since endometriosis of the abdominal cavity often leads to the formation of an adhesive process, the likelihood of an ectopic pregnancy in such a situation is quite high. Pregnancy itself affects the course of endometriosis favorably, as well as prolonged lactation, because it is at this time that cyclic hormonal fluctuations do not occur, leading to a worsening of the course of the disease.
Interviewed by Evgenia Peltek
on the forum ("related" topic)
Yes. True, a slightly different problem arose, not related to endometriosis, because of it there may be problems. And since the size is small, they let Mdeee))
Good afternoon. Do they take you into the protocol with cysts? Mdeee))
Thanks for the answer!
And what about cysts after visanne? Not growing? I read that after the cancellation of the visages, they begin to grow again, it turns out that the operation cannot be avoided
Sorry, I just read it now. There were one in the region of 3 cm, the second is smaller, they did not reach 2. Now I don’t drink anything, I’m resting before the upcoming protocol. Well, so, the periods became painless, they went immediately abnormally from the first cycle of cancellation, there were no failures. You just need to control the blood and nutrition during the reception and I think there will be no problems) Lencha09
Everything is going great, I personally went through the entire course after the operation, I didn’t gain a single gram, the main thing is to read less everything on the Internet, everything is in my head, how you set yourself up and it will be Mdeee))
Thank you!
This is a good result. And what size have you decreased from?
Do you take anything after the cancellation of Visanne?
The cysts decreased by 2 times, I had two of them, I could only drink visanne for 4 months, then my legs started to swell wildly and go numb, my head hurt, I passed the d-dimer test and the pti were very elevated, so these pills were canceled. I gained 7 kg in 4 months, although I have always been thin. In short, I have only negative impressions. But the doctor said that Bysanne was the best medicine.
Hello Valentine. I beg you, if suddenly you still go to this topic, please write how to get to Chursin in this center. Good afternoon!
I was diagnosed with ovarian endometriosis, the cyst is a little more than 3 cm.
Appointed Bysanne. I read the reviews and I'm shocked. I think my hair has already started to fall out and my beard is growing.
Has anyone taken it with such a diagnosis? What was the result and how did you feel?
Thanks in advance! Mdeee))
I did it on December 26, in my residential complex and it's okay, everything is safe, fast and without consequences, and most importantly, it's free.
Regarding laparoscopy, I join the question, but I went there for plasmapheresis, my overall impressions of the clinic are positive. She is now being sent to a laparo with a hysteria - I am observed for a fee in the Russian Railways, the gynecologist first said the price is "about 50", when she clarified in more detail they voiced 80-90, I won't pull that much. Ava is even more expensive. I don’t know where to go, is it worth going to a free gynecologist and trying to get in for free? Or will they kick back endlessly there? Do they do it for free at all? The problem is that the quota for IVF is already waiting for me. And I won’t be able to wait for a free operation for more than a month or two (Hello everyone! then she was observed by Ovsyaniko * howl. But she did not prescribe anything, I remember she just said that this is for life.
On the eve of the year, 1.5 years before, there was a strong stress after which the whole body "fell down" - digestion, gynecology (the pain was especially in the middle of the cycle).
Another doctor prescribed Janine, I drank for a month - varicose veins got out and I gave up on hormones. I read and studied a lot about this disease. Periodically I went for an ultrasound scan - they found endometrioid cysts in me, then adenomyosis (and not any kind of ultrasound), and against this background, uterine fibroids began to grow. Against this background, I somehow managed to get pregnant, but it all ended in an early miscarriage ((
Then some doctor gave me a kick and I decided to have an operation. I was operated on by Koroleva E.G. and ... did not find any endometriosis, only fibroids were removed! I ask the doctors why so, where did they go - they shrug.
3 years have passed since the operation, I'm planning a pregnancy, and I again see endometriosis on ultrasound - a cyst and adenomyosis (Janine was prescribed, although I read the forum - they will give everyone Visanne. On the second pack, all the pains that were.
Of the symptoms for the whole life, there were only severe pains in the middle of the cycle (although the doctor says that this is the norm during ovulation. I don’t think so), pains sometimes on the eve of the month, the months themselves were never painful or plentiful. On the contrary, I felt great during this period. And in the last six months, almost constant pain in the lower abdomen and from the slightest hypothermia ((
Helena_Palpite
Thanks for the video link!
Doctors say everything is interesting and correct, but only very little about prevention.
Hidden text: Show From my own experience, for example, I was convinced that it is extremely important not to engage in physical activity and sex during the months! (I did both stupidly). And while I was reading, I studied about this disease, I also watched the lectures of a gynecologist - she said that with endometriosis it is not advisable to eat sweets and fast carbohydrates. That insulin stimulates the ovaries and the release of estrogen. What is important is to carry out anti-inflammatory therapy in parallel, take vitamins (especially omega-3, vitamin D, magnesium), eat more fiber (it helps to remove estrogens from the body), flax seed and chicory are useful for the hormonal system (this is of course not for treatment, but additionally ). But most importantly, according to her, our main enemy is chronic stress, poor sleep and nutrition. When stressed, the hormones adrenaline and norepinephrine are released into the body, and the body first of all utilizes them, and only then estrogen. Therefore, hormonal disruptions occur and hello endometriosis, fibroids and all sorts of cysts. Unfortunately, Karmanov did not say that this is a malfunction of the immune system, and not just hormonal. And about the hereditary theory, I also disagree - neither my grandmother nor my mother was sick with anything like that🤔 |
You know, I also had grade 3 endometriosis, but you can’t cure it with pills in life, only surgery！ Don’t waste time！ Hello everyone！ I have a similar problem. Endometriosis was discovered a long time ago, something was even prescribed. But years passed, and I didn’t manage to get pregnant, I decided on IVF, before which I had an ultrasound in our perinatal center, and they found hydrosalpinx. They said that first you need to remove the tube and only then they will take it to IVF. Although I had done ultrasound many times before, no one spoke about hydrosalpinx. Okay, I went to the operation in this perinatal center, hoping for the best. Before the operation, the doctor looked at me on the armchair, and said, most likely we won’t be able to remove the tube for you, because of endometriosis everything is soldered to you, it’s not a fact that we will get to it. And so it turned out, they did a diagnostic laproscopy, where they saw that the pelvic organs and intestines were soldered, they could not even see the tube, since the gynecologist has no right to touch the intestines. Here again, all over again, they said go to Moscow to the Perinatal Center. Kulakova, there is a doctor Chursin V.V., he knows how to perform such operations, they will help you and give you quotas. I won’t write how I got into this quota, but I’ll say that I need to get to Chursin, others can offer for a fee, and he immediately allows me to write an application for a quota, immediately appoint a date for hospitalization. And so it happened, I went to this famous center, to a very good doctor. Before the operation, I was warned that if there is endometriosis in the intestines, then I will have to remove the colostomy for 3-4 months, and then do the second operation, which they also have for free. And so it turned out, now I have been walking with a colostomy for 3 months, during the operation they cut all the adhesions, removed the foci of endometriosis from the ovaries, removed 10 cm of the intestine, even on the urinary tract there were these foci, but thank God they did not have time to germinate. They finally removed this pipe and all the bullshit that should not be there. Already in 2 weeks, the operation to close the colostomy will have to follow a diet for some time after it, but after 4 months, I have a chance to get pregnant myself. I really hope so. Here is a story, and to everyone who sits here and reads the comments, I want to advise if you have endometriosis, severe pain during menstruation and problems with stools during these days, do not pull. Ultrasound cannot show everything, diagnostic laproscopy is better, the sooner everything becomes clear, the less likely it is that endometriosis will have time to germinate to neighboring organs, and there will be fewer problems after surgery. Well, if you already have serious endometriosis, then my advice to you is to go to Kulakov, to Chursin. They have extensive experience in the treatment and removal of endometriosis and good equipment, all the conditions for this. In ordinary city and paid clinics, they will not be able to help you, you will only lose time. Health to all！ Hello, who used Aktifert gel for conception? What were the consequences?
Endometriosis is one of the most common gynecological diseases associated with immune and hormonal disorders in the body. It is characterized by the growth of the uterine mucosa (tissue) outside the uterine cavity, and is expressed in the formation of cysts that appear in those organs where they should not normally be (fallopian tubes, bladder, uterine wall).
Endometriosis is most common in women over 40. But sometimes it also occurs in girls who are just about to get pregnant in subsequent years. Therefore, the correct diagnosis and timely treatment play an important role.
There is still no consensus on the nature of the disease. Some structural features of the fallopian tubes, malfunctions in the immune system, hereditary predisposition can contribute to the development of endometriosis.
Symptoms of a gynecological disease depend on the individual characteristics of the organism. Sometimes a woman does not even realize that she has endometriosis, because it can be asymptomatic. But this happens very rarely. In most cases, there are some symptoms. Pain in the pelvis, which is not associated with the menstrual cycle, is one of the common signs of the disease. Sometimes severe pain and discomfort occur during intercourse. The presence of the disease may be indicated by the release of milk-like fluid from the mammary glands, menstrual irregularities, and pain during menstruation.
In addition, most women with endometriosis are unable to conceive for a long time because they do not actually ovulate despite having regular periods. Therefore, many associate the disease with infertility. In fact, it is quite possible to become a mother (such cases are common), it will just be more difficult to do this (due to a violation of the anatomy of the ovaries, a decrease in the patency of the fallopian tubes, and difficulty in the release of an egg). The chances of getting pregnant increase after the course of treatment. A child should be planned in about six months or a year, when the body is fully restored. If the disease is successfully eliminated, then after this period, pregnancy often occurs. Very rarely, but it happens when, after successful treatment, pregnancy does not occur for more than six months. Then the woman needs to undergo another examination to identify other factors that cause infertility.
If a woman becomes pregnant with endometriosis, then there is a real threat of miscarriage. In this case, the doctor who will monitor the course of the pregnancy will be able to prevent it. It is often necessary to maintain pregnancy with the help of hormones. When a placenta is formed in the body that is not affected by endometriosis, the risk of miscarriage is reduced. But the expectant mother during the entire period should be observed by a specialist and clearly follow his recommendations. Do not worry about the health of the unborn child - endometriosis does not affect his condition and development.
The sooner you start treatment, the better. The scheme depends on the age of the woman, the severity of the disease, its localization, and in addition, the factor of the previous pregnancy is taken into account. Often this gynecological disorder can be cured without surgery (laparoscopy and laparotomy). With asymptomatic course of endometriosis, medical treatment is resorted to. The patient simply takes special medications (hormonal, anti-inflammatory, symptomatic drugs). The main component of conservative treatment is hormone therapy.
The diagnosis of "endometriosis" can only be made by a doctor of the appropriate profile after the procedures performed (gynecological examination, "survey" of the patient for pain, past gynecological diseases, operations, gynecological diseases of relatives). Also, colposcopy, laparoscopy, hysteroscopy, ultrasound of the pelvic organs, vaginal examination, examination using a mirror, rectal and rectovaginal examination are done as diagnostic methods.
To prevent endometriosis, regular examinations should be carried out, especially for those girls and women who experience severe pain during menstruation. Timely treat inflammatory diseases of the genital organs, including chronic ones. In addition, it is recommended to conduct special tests to determine the level of hormones.
Specially for- Olga Zima
From Guest
I have been trying to cure endometriosis for 7 years now. What did laparo, hormones, pipe blowing and even Eco do. All to no avail, this infection prevents me from getting pregnant, so I'm seriously considering adoption)
One of the most common gynecological diseases is endometriosis. This disease is characterized by the growth of endometrial tissue, the inner layer of the walls of the uterus. The danger lies in the fact that the growth is pathological in nature and largely depends on the hormonal background of the woman. The growing endometrial tissue can grow into the uterus itself or, after menstrual bleeding, become fixed outside the uterus, forming an external type of disease.
Despite the fact that endometriosis in one form or another occurs in every third woman of reproductive age, the disease remains a big mystery to modern doctors. There are about 10 theories about how the disease arises and develops. However, no theory explains the huge variety of forms and places of origin of pathology 1 .
Given the prevalence of the disease, no woman is immune from its manifestation. Any type of endometriosis significantly complicates conception, the course of pregnancy, and a neglected form can lead to complete infertility.
Known Types and Grades of Endometriosis
Despite the wide variety of types and forms, doctors have tried to classify endometriosis. The main forms of the disease are the following 2:
- The genital form, in which the endometrium grows on the genitals of a woman.
- The extragenital form is characterized by the development of endometriosis outside the reproductive system, for example, in the abdominal cavity.
The genital form, in turn, is divided into external view, peritoneal view and internal view. With external endometriosis, the labia, vagina, and cervix are affected. The peritoneal appearance is characterized by growth in the uterine appendages - the ovaries (endometrioid ovarian cyst) and fallopian tubes. Accordingly, the internal view reflects the growth of the endometrium in the uterus itself.
What contributes to the development of endometriosis
Doctors tend to believe that the main cause of endometriosis is hormonal imbalance. Most of the examined women revealed an excess of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Progesterone levels remain low. Any hormonal processes that affect the menstrual cycle affect the endometrium, which begins to become inflamed and grow in size due to this 1 .
Other factors contributing to the development of endometriosis 1:
- increased physical activity during the menstrual cycle;
- the mental state of a woman - overstrain, stress, etc.;
- stagnation of blood in the uterus;
- sexual intercourse during menstruation;
- genetic factors;
- atresia of the cervical canal and retroflection;
- surgery and possible complications;
- any infectious and inflammatory processes in the uterus, appendages and ovaries;
- malfunctions of the immune system.
Additional factors that are not the main cause, but can significantly increase the chance of the onset and growth of endometriosis, are the following 3 conditions and pathologies:
- abortions and spontaneous abortions;
- C-section;
- problem ecology;
- obesity of any stage;
- long-term use of an intrauterine device;
- liver disease.
Symptoms and signs of endometriosis
In most cases, especially in the early stages of development, endometriosis does not manifest itself in any way, that is, the disease is asymptomatic. It gets to the point that doctors are not even sure about the approximate figures for the prevalence of the disease. Without a clear visual examination, it is possible to suspect endometriosis, but it is extremely difficult to confirm 2 .
If endometriosis makes itself felt, then the growth has already reached a significant size. The symptoms may be the following 2:
- progressively increasing pain, especially noticeable before or during menstruation;
- discomfort and discomfort during intercourse;
- pain during bowel movements;
- the presence of spotting spotting before the onset of menstruation;
- short menstrual cycle (polymenorrhea);
- the presence of blood in the urine (hematuria);
- impossibility of conception.
With any such symptoms, you should immediately contact a gynecologist, since advanced endometriosis is the main cause of infertility and surgical removal of the uterus.
Endometriosis during pregnancy - risk or opportunity?
Pregnancy with endometriosis is a popular dilemma that many women face. In most cases, it all depends on the stage of endometriosis, the place of growth and the effect of the disease on the woman's body. When planning a pregnancy and a confirmed unpleasant diagnosis, three questions 4 are particularly clearly considered:
- Problems with the conception and maturation of the egg in the ovary.
- Attachment of the egg to the wall of the uterus, with an overgrown endometrium, termination of pregnancy is possible.
- Hormonal disorders that affect the entire body as a whole, increase the rate of growth of the endometrium and are extremely dangerous during pregnancy.
In general, in the early stages of endometriosis, it is possible to plan a pregnancy. If conception has occurred, and the egg has successfully attached and the growth of the fetal egg has begun, then the chances of success are quite high. Naturally, patients will need constant supervision by doctors, the so-called conservation.
In the presence of endometriosis, it is important to establish the exact form of the disease, its degree and other factors. Only after a thorough diagnosis can a doctor confirm the possibility of a successful pregnancy. The consequences of pregnancy with dangerous forms of endometriosis are extremely sad, both for the fetus and for the future of the woman. Spontaneous termination of pregnancy further provokes the growth of the endometrium, severe uterine bleeding and complete infertility are possible 4.
Diagnosis and treatment
Diagnostic methods for undeveloped endometriosis are not very informative, but in some cases they can confirm the assumption of the presence of an unpleasant ailment. The following diagnostic methods are used 5:
- Ultrasound examination (ultrasound) of the abdominal cavity on the eve of menstruation;
- General analysis of blood, urine, sampling for oncomarker CA 125;
- Taking smears from the vagina to identify pathologies and tissue biopsy;
- Magnetic resonance imaging (MRI) of the pelvic region;
- Hysteroscopy of the uterus;
- Colposcopy;
- Laparoscopy;
- Metrosalpingography (MSG).
Treatment for endometriosis will depend on dozens of factors identified during the diagnosis. A special role is played by the causes of the disease, the form of the disease, the places of growth, the degree of growth, pregnancy or its planning.
Given that in most cases, endometriosis is affected by the hormonal background of a woman, doctors prescribe hormone therapy. Among the medications, there may be gestagens, antigonadotropins and combined hormonal preparations. Often, multivitamin complexes 2 are prescribed.
For moderate to severe overgrowth, the most effective way is surgery, in which the largest foci of overgrowth are removed. The most commonly used method is laparoscopy - today, the most sparing type of surgical intervention.
As a preventive measure, especially women planning pregnancy, it is recommended to undergo gynecological examinations as often as possible and report any signs of endometriosis. It is almost impossible to prevent the development of a pathology such as endometriosis, so early diagnosis of the problem comes to the fore. The onset of pregnancy with uterine endometriosis requires particularly high-quality monitoring by the expectant mother and doctors.
- 1. Unanyan, A. Endometriosis and reproductive health of women / A.L. Unanyan // Obstetrics. Gynecology. Reproduction. - 2010 - Volume 4 - No. 3 - P. 6-11.
- 2. Tikhomirov, A. Is endometriosis a purely surgical pathology? / A.L. Tikhomirov // Gynecology - 2012 - Volume 15 - No. 2 - P. 74-77.
- 3. Martynova, N. Complications of pregnancy and childbirth in women with genital endometriosis / N.V. Martynova, I.S. Lipatov, Yu.V. Tezikov, M.A. Ovchinnikov, S.A. Ryabova // FSBEI HE "Samara State Medical University" of the Ministry of Health of Russia - 2014 - P. 8.
- 4. Yarmolinskaya, M. Features of planning and management of pregnancy in women with genital endometriosis / M.I. Yarmolinskaya, S.A. Selkov // Journal of Obstetrics and Women's Diseases - 2011 - No. 3 - P. 176-182.
Among the medical problems of women's reproductive health, endometriosis and pregnancy occupy a special place. That is, the likelihood of pregnancy with endometriosis - a gynecological pathology that appears in the abnormal proliferation of cells of the glandular inner layer of the uterus (endometrium) outside its cavity.
This problem is relevant, since endometriosis is considered not only one of the main reasons for gynecological operations, but also the leading cause of female infertility and chronic pelvic pain.
But, despite the fact that up to 30-35% of women with endometriosis have problems conceiving, the question is - is pregnancy possible with endometriosis? - gynecologists give an affirmative answer.
Why Can't I Get Pregnant With Endometriosis?
Experts do not recommend identifying endometriosis with infertility: in women with this disease, a pregnancy test for endometriosis can be positive, because the possibility of getting pregnant depends on the type and location of dyshormonal endometrial heteropy, as well as on the degree of cicatricial adhesions characteristic of endometriosis. However, the negative impact of this disease on fertility should not be ignored either.
It should be noted that the types of pathology in the form of genital and extragenital endometriosis differ in localization: either on the organs of the reproductive system, or on the structures and organs of the small pelvis and abdominal cavity. But in any case, they are shifted relative to their normal position with various functional disorders. Clinical varieties of genital endometriosis are damage to the ovaries, fallopian tubes, uterine ligaments, and then a problem arises - external endometriosis and pregnancy, with a level of secondary infertility up to 25% of cases.
With endometroid heteropy of the cervix, cervical canal and myometrium (muscular membrane), the problem is formulated as internal endometriosis of the uterus and pregnancy. Because myometrial endometriosis is adenomyosis of the uterus- can occur in parallel with uterine fibroids, women face such a double problem as pregnancy with fibroids and endometriosis, when the chances of motherhood are minimal. In addition, if pregnancy does occur, then the fibroid nodes begin to grow, which increases the risk of its interruption.
With extragenital spread of tissues similar to the inner lining of the uterine cavity, for the most part, the bladder and urethra, the navel and anterior abdominal wall are affected, especially in the presence of postoperative scars.
But why does not pregnancy occur with endometriosis? Here are some examples.
Endometriosis of the cervix and pregnancy: problems with conception occur due to the formation of a cyst (one or more) in the cervical canal, which leads to its deformation and narrowing.
Retrocervical endometriosis and pregnancy: in this rather rare pathology, endometrial tissues are found on the back of the cervix with spread to the posterior fornix of the vagina, the septum between the vagina and the rectum, intestines, urinary tract, and also to the muscular walls of the uterus. And, according to experts, this complicates conception, and treatment of this clinical problem can be solved in isolated cases.
Ovarian endometriosis and pregnancy: Due to the proximity of the ovaries to the uterus, this is one of the most common sites for endometriosis to develop. Due to the appearance of endometrioid ovarian cysts, there are violations of the functions of their follicular apparatus, that is, the ability to form eggs and synthesize hormones. See details - Endometrial cyst. Ovarian endometriosis is the most likely cause of infertility.
Fallopian tube endometriosis and pregnancy: The formation of external (peritubal) adhesions can lead to stenosis or complete obstruction of the fallopian tubes. In such cases, a fertilized egg simply cannot enter the uterine cavity, and with this localization of the pathology, an ectopic (ectopic) pregnancy often occurs.
ICD-10 code
N80 Endometriosis
Epidemiology
The number of women with this pathology is estimated by the experts of the American Journal of Obstetrics & Gynecology at 6-10% (that is, up to 145-180 million) - regardless of age and the presence of children. First of all, it is a disease of reproductive age: the typical age at the time of diagnosis is from 25 to 29 years. Endometriosis is more common in women with infertility and chronic pelvic pain (35-50%). The racial trend is towards higher rates of endometriosis in white women.
According to some studies, endometriosis is the cause of 27-45% of cases of infertility in women of childbearing age. In species terms, slightly more than 90% of clinical diagnoses fall on patients with brilliant endometriosis, and no more than 7-8% on diagnosed extragenial endometriosis.
And the probability of restoring the ability to conceive and bear a child after the complex treatment of endometriosis depends on the characteristics of the body of women and the severity of the disease and can be up to 50% in mild cases, and in severe cases - within 10%.
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Risk factors
Endometriosis develops in women of different ages, and the factors contributing to the appearance of pathology, gynecologists and endocrinologists include:
- acute and chronic forms of gynecological inflammatory diseases;
- a history of abortion, complicated childbirth, delivery by caesarean section;
- gynecological operations (laparoscopic and laparotomic), cauterization of the cervix, abdominal operations on the abdominal organs;
- imbalance of endogenous sex hormones with increased levels of estriol and estradiol ( hyperestrogenism), which is associated with changes in regulation in the hypothalamus-pituitary-ovaries system;
- immune disorders;
- genetic predisposition;
- congenital or acquired lesions of the hypothalamus, pituitary gland, adrenal cortex (leading to impaired synthesis of a number of hormones).
Symptoms of endometriosis during pregnancy
Endometriosis is a chronic disease accompanied by intense menstrual flow and severe pain, as well as certain anatomical changes in the pelvic area, although this pathology does not manifest itself in 20-25% of women.
Pregnancy does not cure the disease, and symptoms of endometriosis during pregnancy can range from mild to severe. For most patients with endometriosis, pregnancy - especially after the first weeks - is a period of relief from symptoms. This is mainly caused by an increased level of progesterone associated with pregnancy: if a healthy woman produces up to 20 mg of progesterone per day during the next menstrual cycle, then in a pregnant woman the daily amount of progesterone can reach 400 mg (due to the synthesis of this hormone by the placenta).
The first signs of pregnancy with endometriosis are the absence of menstruation, since progesterone prevents ovulation. In addition, this hormone prevents the lining of the uterus from shedding, slowing down the growth of its cells, so the absence of menstruation during pregnancy can also reduce the symptoms seen with endometriosis, as abnormally located areas of the endometrium stop bleeding.
However, studies have shown that in some women with endometriosis, the response to progesterone is reduced or absent, which may be due to the general low sensitivity of the receptors that interact with this hormone. It is in such cases that there may be endometriosis during pregnancy and discharge (spotting, brown).
Symptoms of endometriosis during gestation may increase. Mostly, these are pains associated with the fact that the rapidly growing uterus stretches the cystic formations and adhesions. And in late pregnancy, estrogen synthesis increases again (also due to its production by the placenta), which provokes increased growth of endometrial cells and more pronounced symptoms of pathology.
How is pregnancy with endometriosis?
So first, how does endometriosis affect pregnancy? And secondly, does pregnancy cure endometriosis?
Let's start with the second. Pregnancy used to be seen as a "cure for endometriosis," but numerous studies have shown that this is not the case. Even if the symptoms of the disease subside during pregnancy (and the reasons for this were named in the previous section), in most women after childbirth or after the cessation of lactation, they resume, sometimes with a vengeance.
Pregnancy with endometriosis can occur in different ways. Obstetricians and gynecologists call the first two months (8 weeks) the most difficult period: according to statistics, it is during these periods - while the placenta is forming - that spontaneous abortion occurs.
Forms
Also in gynecology, there are four degrees of spread of endometriosis, which largely determines the possibility of pregnancy.
Endometriosis of the 1st degree and pregnancy “coexist peacefully” enough: the foci of pathology are small and solitary, located shallowly; affect, as is commonly believed, only the vaginal part of the cervix and the anatomical structures of the small pelvis. Experts estimate the chances of pregnancy at 75-80%.
Grade 2 endometriosis and pregnancy: there are more endometrial growths and they are located deeper in the tissues of the small pelvis surrounding the bladder; in the deepening of the parietal peritoneum there is an accumulation of a bloody character; there is an adhesive process in the area of the fallopian tubes (with their narrowing) and ovaries. The chance of pregnancy is about 50%.
Endometriosis of the 3rd degree and pregnancy: foci of heterotopia in the uterus and fallopian tubes are multiple, their occurrence is deep; the presence of peritoneal adhesions and small unilateral or bilateral endometrioid ovarian cysts. The probability of pregnancy is not more than 30-40%.
Endometriosis 4 degrees and pregnancy: multiple and deep foci of endometrial growth in the bladder and pelvic peritoneum; multiple dense adhesions of the abdominal organs; bilateral endometrioid ovarian cysts of considerable size. The chances of getting pregnant do not exceed 15%, since changes in the pelvis and uterus negatively affect the implantation of the egg and the development of the placenta.
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Complications and consequences
In addition, the most likely consequences and complications include:
- bleeding after the 24th week of pregnancy, which, as a rule, occurs due to placenta previa or abruption;
- fading of the fetus for a period of about 20 weeks;
- preeclampsia in the second and third trimester of pregnancy;
- premature birth;
- low weight of the newborn;
- weakness of labor activity and delivery through caesarean section.
Complications of pregnancy in the presence of internal endometriosis, in particular, endometriosis of the myometrium, are associated with increased stress on the muscular membrane of the uterus as the period increases, which is fraught with uterine rupture in the second half of gestation.
A rare, but severe and life-threatening complication of endometriosis during pregnancy is intra-abdominal bleeding (hemoperitoneum), associated either with rupture of the vessels of the uterus or ovaries, or with bleeding of endometrial heteropy zones.
Diagnosis of endometriosis during pregnancy
Doctors will not establish the causes of endometriosis during pregnancy, since there are several versions of the etiology of this disease, including: the embryonic theory of the development of pathology from the glandular elements of the Müllerian ducts and wolf bodies; retrograde menstruation; mutations in genes that regulate the estrogen-induced endometrial cell cycle in the proliferative and menstrual phases, etc. More information in the article - endometriosis
Endometriosis is difficult to diagnose. The only definitive way to make an accurate diagnosis is to perform a laparoscopy and examine the tissue sample (biopsy) that is obtained from this examination. But the diagnosis of endometriosis during pregnancy in this way is not carried out because of the potential risks associated with perforation of the uterus, a decrease in uteroplacental blood flow and the development of fetal hypoxia, as well as the threat of intrauterine fetal injury.
Instrumental diagnosis in the form of hysteroscopy is also impossible. Therefore, a routine examination is carried out, an ultrasound scan (which, according to ultrasound diagnosticians, does not give a picture of endometroid heteropy), all the necessary blood tests are taken, including the level of hormones.
A special diagnostic role is played by the collection of anamnesis (with the obligatory consideration of a family history in the female line). Based on the patient's complaints - pain during menstruation (their duration and intensity), pain during or after sex, spotting outside of menstruation, chronic pain not associated with menstruation in the lower abdomen and in the pelvis and lower back, bowel problems - an experienced doctor may suspect the presence of endometriosis.
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Treatment of endometriosis during pregnancy
They do not treat endometriosis during pregnancy, but expectant mothers with endometriosis are on special account in antenatal clinics - with increased attention to their condition, fetal development and additional monitoring of the course of pregnancy. At the same time, pregnant women with this pathology should be warned about the full risks of such a pregnancy.
In non-pregnant women, hormonal medications are a key component of conservative treatment for endometriosis. Used outside the gestation period, the hormonal drug Visanne for endometriosis during pregnancy is contraindicated.
A hormonal drug containing goserelin (an analogue of GnRH - gonadotropin-releasing hormone), Zoladex for endometriosis during pregnancy is also contraindicated due to embryotoxic effects and an increased threat of abortion. For the same reason, similar drugs are prohibited during pregnancy: Triptorelin, Diferelin (Decapeptyl), Buselerin, Leuprorelin.
Pregnant women with endometriosis should not use the drug Danazol (Danol, Danoval, etc.), which inhibits the synthesis of pituitary hormones.
With endometriosis, pregnancy is associated with certain problems, for example, the risk of miscarriage in this disease increases by 76% (compared to healthy women), therefore, neither alternative treatment, nor any herbal treatment, and, moreover, homeopathy can not be used!
Planning for pregnancy with endometriosis
Women in general are much more likely to get pregnant when they are in their 30s (that is, in their 20s or 30s) than when they are in their 30s. So, if endometriosis is diagnosed, start planning pregnancy with endometriosis in advance.
There is no cure for this disease, but there is a treatment that can help women deal with its symptoms, and in case of problems with pregnancy, create the most favorable conditions for the realization of the dream of becoming a mother.
Today, gynecologists use hormone therapy, including oral contraceptives, progesterone preparations, and GnRH analogues. But most of these remedies can only be used for a limited period of time, and the side effects can cause problems for some women.
Experts call the best means of planning pregnancy for endometriosis a complete examination and, if necessary, surgical treatment - removal of foci of endometriosis and excision of cysts, nodules and adhesions by laparoscopic or any other intervention.
If treatment fails, reproductive specialists suggest in vitro fertilization(ECO). However, before resorting to this method, it is necessary to properly treat endometriosis, since preparation for IVF includes an increase in estrogen levels, which will stimulate the development of this pathology.
Endometriosis is a pathological process, the essence of which is a benign growth of tissue, morphologically and functionally similar to the endometrium (this is the inner mucous membrane of the uterine cavity). The disease provokes its growth outside the uterus (in the ovaries, bladder, intestines, lungs). Most often, endometriosis is diagnosed in women of reproductive age. It is dangerous because it inhibits the work of the ovaries (which means the absence of ovulation) and provokes the appearance of cysts, neoplasms. Therefore, endometriosis and pregnancy is a rather dangerous combination.
Causes of endometriosis
Unfortunately, modern medicine cannot name the reasons for the development of this disease with full confidence. But the risk factors are precisely known:
- genetic propensity;
- menstrual irregularities;
- at risk are nulliparous girls and women who have had one birth;
- frequent abortions, diagnostic curettage of the uterus;
- hormonal imbalance;
- prolonged use of intrauterine contraceptives.
Also considered risk factors are dysmenorrhea, sexual intercourse and sports during menstruation, the constant use of tampons. All this complicates the free outflow of blood from the uterus during menstruation and can cause it to enter the fallopian tubes, the abdominal cavity, which contributes to the development of the pathological process.
Symptoms of endometriosis
Quite often, the disease is asymptomatic, and it is determined only by ultrasound or during laparoscopy. Most women do not even realize that their unsystematic pain in the lower abdomen or fatigue can somehow relate to the health of the reproductive system. But there are symptoms that should not be ignored. It:
- chronic pain in the lower abdomen;
- pain during ovulation, sexual intercourse;
- painful urination during menstruation;
- bowel problems and painful bowel movements;
- bloody issues;
- chronic weakness;
- problems with conception.
The most important clinical symptoms of the disease are pelvic pain, menstrual irregularities, infertility, dysfunction of the pelvic organs.
Stages of development of endometriosis
This process occurs against the background of a violation of hormonal, immunological balances or in the case of a genetic predisposition to the disease. The frequency of endometriosis in women of reproductive age reaches 59%, and in operated women 27%.
The stages of the development of the disease depend on the depth of damage to healthy tissue. The American Fertility Society has developed its own classification of the external form of the endometrium, according to which this disease has 4 stages:
- minimal (estimated at 1-5 points);
- easy (6-15 points);
- moderate (16-40 points);
- severe (more than 40 points).
Diagnosis of endometriosis
How to treat endometriosis? First you need: diagnosis and in-depth analysis of the clinical picture, a bimanual gynecological examination (palpation of the internal organs of the pelvis).
- Bimanual gynecological examination. This research method will help the doctor evaluate the size of the uterus, its density, shape, identify seals in the retrocervical region, and the presence of tumors.
- Colposcopy and cervicoscopy. These procedures will clarify the place and form of endometriosis lesions of the vaginal part of the cervix and the mucous membrane of the cervical canal (in this case, an additional examination will be carried out using a fibrohysteroscope).
- ultrasound. Ultrasound is the optimal and widely available screening method for examining women with different stages of endometriosis.
- The method of spiral computed tomography. It will allow you to accurately determine the nature of the pathological process, its localization, the relationship with other organs. It will also help to clarify the condition of the pelvic organs, the presence of neoplasms.
- Hysteroscopy. Using a hysteroscope (optical system), you can examine the walls of the uterine cavity and assess the patient's condition. The method will help the doctor to identify and evaluate changes in the relief of the uterus, the presence of scars, crypts.
- Laparoscopy. With it, you can assess the condition of the tissues and the degree of their damage. Through a small incision in the abdomen, the doctor introduces a special device with a powerful optical system, which allows you to examine all the organs of the abdominal cavity, the uterus, and diagnose pathological processes.
Endometriosis and conception
Endometriosis and pregnancy during this disease have been studied by doctors for a long time. According to research by the American Fertility Society, laparoscopy data states that 20-50% of infertility cases are recorded in women suffering from endometriosis.
Although endometriosis is considered one of the causes of problems with conception, spontaneous pregnancy is possible even with a severe stage of the disease. Although usually the disease provokes anatomical changes in the mucous membrane of the uterus or other pelvic organs, which often leads to damage to the fallopian tubes, adhesions, lack of ovulation, and the formation of cysts. In addition, endometriosis has a tendency to relapse, and this negatively affects the reproductive system and conception.
Pregnancy with endometriosis of the uterus: what is the danger and how to avoid it
It is possible to get pregnant during endometriosis, although the chances of success are not very high. After the course of treatment, the most favorable period for conception lasts a year. After this time, the risk of relapse increases. Pregnancy after endometriosis is quite real, but the expectant mother needs to carefully monitor her well-being and visit the doctor regularly.
The fact is that endometriosis provokes a violation of blood circulation in the walls of the mucous membrane of the uterus, a lack of progesterone, which prevents the normal fixation of the embryo. Therefore, there is a possibility of miscarriage in the early stages. Later, a placenta that is not affected by endometriosis will form, and the risk will decrease. Taking progesterone medications and being closely monitored by your doctor will save you a lot of trouble during pregnancy with endometriosis.
Treatment of the disease by pregnancy: myth or truth?
If you have been diagnosed with this pathology, and you cannot, but want to get pregnant, then the sooner you see a doctor, the better. Treatment of endometriosis by pregnancy, contrary to popular belief, is impossible. Of course, the hormonal background of the expectant mother changes a lot, and due to the increased production of estrogen and progesterone, endometriosis foci are likely to be suppressed. But, unfortunately, there can be no talk of a complete recovery. Endometriosis and pregnancy are incompatible with each other in more than half of the cases.
Management of endometriosis before and after pregnancy
Unfortunately, so far there is no unified treatment strategy. A gynecologist in a situation of "endometriosis and pregnancy" develops an individual scheme of examination and treatment, focusing on the stage and localization of the lesion, clinical manifestations, and tolerance to hormonal drugs.
Usually, conservative treatment is used for patients of reproductive age with an asymptomatic form of the disease, infertility. In especially severe cases (when surgical and medical methods do not help), the foci of endometrial lesions are treated surgically.
In the event that the symptoms of the disease do not cause discomfort and it does not progress, then the doctor will most likely suggest that you be monitored regularly and not take drastic measures. Especially since endometriosis usually goes away after menopause. If something worries you, but the problem of the inability to conceive is not relevant, then the doctor will develop an individual drug treatment regimen for you.
Treatment options for endometriosis
One of the barriers to motherhood and health can be endometriosis. Treatment of this disease is carried out using the following methods.
- Laparoscopy (surgery). How to treat endometriosis? Laparoscopy involves the destruction of adhesions and endometrioid nodes, tissue lesions that reduce the patency of the fallopian tubes. The percentage of the effectiveness of the procedure reaches 84%, especially in the case of a mild form of the disease.
- Medical treatment. Drug therapy provokes the absence of ovulation and can negatively affect the embryo, so for women who want to get pregnant, it is not advisable (except for the hormone gonadotropin - it improves ovulation).
Most often, combined oral contraceptives (progesterone preparations) are recommended. The mechanism of action of drugs is that their components provoke inhibition of ovarian function, lack of ovulation and menstruation. Tissues affected by endometriosis stop bleeding, which prevents the formation of adhesions, cysts, and inflammation. The negative side is the presence of side effects.
If all methods have been exhausted, and pregnancy does not occur, there is an alternative option - assisted reproductive technologies.
Although endometriosis in almost 50% of cases provokes infertility, but this is not a sentence. With timely treatment and qualified treatment, the success rate is quite high. In addition, there is an alternative to classical treatment - assisted reproductive technologies. Medical care and self-confidence will certainly help to defeat the disease. Remember that pregnancy with endometriosis is possible!