Endometriosis( or endometriosis disease) is called pathology, which is characterized by the growth of endometrial tissue outside the uterine lining. This focus is capable of infiltrative growth and penetration into various tissues, causing their destruction, ingrowth is possible in any organ, with metastasis occurring through blood or lymph fluid. Endometrial cells can grow in the wall of the intestine, urinary bladder, ureter, peritoneum, skin integument. Also, often foci of the disease can be found in remote areas: in lymph nodes, in the subcutaneous fat layer, in the navel, in the mucous membrane of the eye. The difference between endometriosis and real tumor lies in the fact that there is no violation of the cellular composition and the clinical manifestations depend on the hormonal background and menstrual function.
- 1 disease classification
- 2 Epidemiology
- 3 cause of endometriosis and pathogenesis
- 4 Contributing factors
- 5 Clinical endometriosis, uterine body symptoms( adenomyosis)
- 6 Clinical signs of cervical endometriosis
- 7 Symptoms of vaginal endometriosis
- 8 Signs ovarian endometriosis
- 9 Symptoms of endometriosis fallopian tube
- 10 Symptoms lesion peritoneum in the pelvis
- 11 Signs of retrocervical endometriosis
Classification of the disease
Depending onThere are:
Genital endometriosis , which is located in the genitals. It is divided into:
- Internal localization, when endometriotic foci are found in the body of the uterus, the isthmus, in the fallopian tubes( their interstitial part);
- Outer - foci localize on the external genitalia, vaginal mucosa, vaginal part of the uterine neck, in the ovaries, fallopian tubes, peritoneum that lining the organs of the small pelvis;
Extragenital - endometrioid inclusions are found in the tissues of other organs( lungs, intestines, navel, postoperative wounds, etc.).
This pathology occurs quite often in women aged 20 to 40 years .In the climacteric period, the frequency of its detection decreases sharply. Endometriosis is detected in about 10% of gynecological patients, and in girls with infertility, the disease is diagnosed with a frequency of up to 45%.Genital endometriosis occupies a larger percentage in the pathology structure( up to 93%), extragenital is much less frequently detected.
Causes of endometriosis and the pathogenesis of
To date, there is no precise evidence of the etiology of this disease .There are many hypotheses of its occurrence:
- Implantation theory, which suggests that foci of endometriosis arise from the cells of the uterine mucosa that enter with excreta during menstruation into the abdominal cavity and into various organs. Moreover, their introduction and further reproduction is possible only if the cells have a high capacity for implantation into the wall of the organ and there is a concomitant disruption of the function of the hormonal system and immunity;
- Endometrial theory, according to which the development of foci of endometriosis is assumed from endometrial cells embedded in the thickness of the muscular layer of the uterus. This can be due to various medical manipulations in the uterine cavity: abortion, diagnostic cramping, manual examinations, caesarean sections, etc., which contribute to the germination of the mucosa in the wall thickness and the development of endometriosis of the uterus. As a result of gynecological operations, the proliferation of endometrial cells through the blood and lymph to other organs is possible, and the emergence of foci in the lungs, skin and muscles;
- The embryonic theory, which says that the development of endometriosis comes from displaced germ cells, from which the uterus and its mucosa subsequently form. This concept is confirmed by the frequent detection of a combination of foci of disease and abnormalities in the structure of the genital organs;
- A metaplastic hypothesis according to which signs of endometriosis of appear as a result of the degeneration of the epithelium covering the peritoneum;endothelium of vessels;cells lining the renal tubules and other tissues.
There are many reasons that contribute to the development and further spread of pathology. Among them there are two main factors:
- Breaking the hormonal background. In patients with endometriosis, a decrease in the level of prolactin, a significant increase in estrone, which leads to stimulation of growth of the uterine mucosa and endometrial foci;
- The change in immunity, which is manifested by activation of autoimmune reactions, decreased activity of natural killer cells, suppression of the natural mechanism of cell death.
Clinical symptoms of the endometriosis of the uterus( adenomyosis) body
Adenomyosis is a type of genital endometriosis in which foci are found in the thickness of the muscular layer of the uterus. Internal endometriosis of the uterus is divided into:
- 1 stage, in which the mucosa grows into the submucosa, only reaching the muscles;
- 2 stage - the lesion occurs to the middle of the muscle layer;
- Stage 3 - germination of the mucosa across the entire muscle layer to the peritoneum;
- Stage 4 - the transition of the pathological process to the peritoneum, which covers the walls of the abdomen, the small pelvis and their organs.
The most important clinical symptom for this form of pathology will be the violation of the menstrual cycle: the discharge becomes abundant, their duration increases, and smearing dark bloody discharge can appear a couple of days before and after the menstruation .With a significant spread of the process, bleeding from the uterus may occur during the intermenstrual period. For such patients is characterized by the development of chronic blood loss and anemic syndrome. The appearance of pain in adenomyosis occurs gradually, its pronounced character is observed in the first days of menstrual flow, and after their cessation the pain syndrome most often disappears. On irradiation of painful sensations it is possible to judge the affected area: if the foci are located in the corners of the uterus, the pain gives to the groin area, with the defeat of the uterine isthmus - in the straight gut and vagina. With a two-handed gynecological examination, an increase in the size of the uterus, corresponding to 8 weeks of pregnancy, is detected.
After menstruation, the organ in the volume is often reduced. If the uterine isthmus is affected, then it is enlarged, compacted, painful, with reduced mobility when palpated. Also for the detection of foci of endometriosis, ultrasound is used, the accuracy of which is about 90%.It reveals an increase in the uterus in size, an uneven thickening of its walls, the structure of the muscle layer changes like "honeycomb"( alternation of densified areas with small cavities filled with liquid).
Clinical signs of endometriosis of the cervix
The appearance of endometriotic foci in the cervix is associated with its damage during various manipulations, trauma in childbirth, abortion, which facilitates the introduction of cells of the uterine mucosa into the damaged tissue of the cervix. It is also possible to spread endometrial cells from other foci through blood and lymph.
The main complaint for this pathology will be spotting spotting that occurs on the eve of menstruation or after sexual contact and is caused by the narrowing of the cervical canal .Quite often, this form of endometriosis is not manifested and is diagnosed only with a preventive examination, when the foci are visually detected. They are characterized by a strong increase on the eve or during the process of menstruation, as well as opening and emptying. After the end of discharge from the uterus, the foci on the cervix decrease and turn pale.
Symptoms of vaginal endometriosis
Vaginal involvement occurs most often with the introduction of endometrial cells during labor. The main complaint is the appearance of pain in the vagina, the degree of severity of which varies: from minor to extremely strong .
For the pain syndrome is typical of a cyclic character, strengthening before and during menstruation, as well as during sexual intercourse. The most pronounced pains are when the perineum and anus are affected, the act of defecation is very painful. When examining the thickness of the vaginal wall, dense scars and knots can be palpated, visually on the mucosa there are dark blue spots that on the eve of the menstruation increase and begin to bleed.
Symptoms of endometriosis of the ovaries
The most common endometriotic foci occur in the cortical layer of organs, are cysts up to 1 cm in diameter filled with brown contents.
The clinical signs of this form may not be long enough. Later, when cystic contents get into the abdomen, involvement of the peritoneum in the process, the appearance of foci in it and the initiation of the process of formation of adhesions. There are aching pains of a dull character in the lower abdomen, which intensify at the beginning of menstruation. Because of the development of the adhesion process and the spread of foci over the surface of the peritoneum, pain syndrome increases with exercise and sexual intercourse. In 70% of sick women there is a violation of menstrual flow, they become more abundant and prolonged.
Signs of endometriosis of the fallopian tube
The incidence of pathology is about 10%.Foci occur on the surface of the uterine tube. Complications of the course of the disease formed spikes, which lead to a violation of the function of the organ. The main method of diagnosis of this type of endometriosis is laparoscopic examination.
Symptoms of peritoneal injury in the small pelvis
This form of pathology proceeds in two ways:
- Only the peritoneum covering the small pelvis is affected;
- The ovaries, uterus, fallopian tubes and peritoneum, on which foci of lesion are formed, are also involved in the process.
With small endometriosis foci of clinical signs, there will not be a long enough time. Later, when the process spreads to the muscles of the rectum and the surrounding cellulose, there are pains in the pelvic region, which intensify the day before and after menstruation. The main method of diagnosing this form is also laparoscopy.
Signs of retrocervical endometriosis
The posterior surface of the cervix and its isthmus is affected, the foci are capable of infiltrative growth in the direction of the rectum. Patients complain of aching pain in the lower abdomen and in its depth, which are strengthened during menstruation and are given to the vagina, pelvis and leg. Constipation and mucus secretion from the rectum are also possible.