Endometriosis
Summary/Definition
Endometriosis is a condition in which endometrial tissue (uterine glands and stroma) grows beyond the uterus, causing the disease. This is a common disease that occurs in about 10-15% of women of childbearing age. The disease can occur in women during menstruation, that is, at any age, from menarche to menopause, and the main symptoms include severe menstrual pain, abdominal pain and infertility. The cause of endometriosis has not yet been precisely determined, but it is estimated that it is caused by menstrual blood reflux, immunological factors, genetic factors, etc.
Symptoms
The most commonly observed symptoms associated with endometriosis are severe menstrual pain, chronic pelvic pain and pain during sexual intercourse (dyspareunia). Pelvic pain observed in endometriosis is characterized by dysmenorrhea, which begins before menstruation and continues throughout the menstrual period. Non-specific symptoms may include premenstrual syndrome, diarrhea, difficulty urinating, or severe pelvic pain. In addition, many patients who go to hospitals because of difficulties with conception are diagnosed with endometriosis.
Diagnostics
During the survey, you can find out when symptoms appear and how pronounced they are, and if there are menstrual cramps, when they begin and how pronounced they are. General information should be checked, including medical history, medications taken (painkillers, contraceptives, hormones, etc.) and general health status. Endometriosis can be suspected if local pain occurs during examination in the uterus, fallopian tubes or utero-sacral ligaments (ligaments in the back of the uterus), or if there is a thickening (thickening) of these organs or nodules (small lumps) painful when touched. If endometriosis is suspected, a blood test called CA-125 can be performed, and if its indicators exceed the normal range, the presence of endometriosis can be assumed. Imaging studies may include ultrasound and magnetic resonance imaging, and transvaginal ultrasound is the most common study in gynecology, since it is painless and safe, and will also help identify tumors filled with blood in the uterus or ovaries. Magnetic resonance imaging is a research method that provides additional information for monitoring endometriosis, adhesions on the ovaries, extraperitoneal endometriosis and changes in the size of endometriosis foci. Diagnostic laparoscopy is currently a modern method of diagnosing endometriosis.
<Table: Symptoms of endometriosis>
| 1. The main symptoms associated with endometriosis |
| Do you have menstrual cramps? (yes, no)Do you have pelvic pain? (yes, no)Do you have dyspareunia? (yes, no) |
| 2. Symptoms associated with endometriosis |
| 1) Infertility 2) Sacral (hip) pain 3) Pain when emptying the intestines immediately before or during menstruation 4) Pain in the groin and lower extremities 5) Pain between the right upper abdomen and the side 6) Pain in the left lower abdomen and between the pelvic bones 7) General fatigue and weakness 8) Premenstrual chills 9) Pain in the right shoulder 10) Blood test, CA – 125 level above 35 (units omitted) 11) Hypermenorrhea – calculated by the method of calculating the menstrual cycle |
| If there is one sign from point 1 and two or more signs from point 2, then there is a possibility of developing endometriosis, which can be confirmed by visiting a doctor for examination and by diagnostic laparoscopy. |
Treatment and course of the disease
Endometriosis is a disease that spreads throughout the abdominal cavity. Visible foci can be surgically removed, but early ones that are not visible can be difficult to remove surgically. Even with medical treatment, the lesion does not disappear completely. Surgical intervention and additional drug therapy, which are currently widely used methods of treatment, are effective for preventing relapses, but they are difficult to completely suppress. Drug treatment includes taking gonadotropin-releasing hormone analogues (GnRH agonists), oral contraceptives, progesterone, danazol, gestrinone and nonsteroidal anti-inflammatory drugs. Surgical treatment includes conservative treatment and radical treatment. Conservative treatment — surgery to remove foci of endometriosis, and in the presence of adhesions due to endometriosis — the creation of a normal anatomical structure. Radical treatment is surgery to remove the uterus, fallopian tubes and ovaries. Non-pharmacological treatments include a pain management clinic, biofeedback therapy, and therapeutic exercises such as aerobics.
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