Endometriosis is the most common disease in women of childbearing age, in which particles of the uterine lining called the endometrium are located outside the uterine cavity. Their location is very diverse, and they can be on the peritoneum, ovaries, the septum between the vagina and rectum, and uterine wall (adenomyosis); they can be practically anywhere except the heart muscle and spleen.
The most easily recognized endometriosis is on the peritoneum. The bearings can reach several millimeters. The appearance of foci develops from microscopic foci invisible to the naked eye to red foci, which undergo the same hormonal cycle as the uterine mucosa. The deposits separate during menstruation, and they gradually turn blue, which heals with a scar and finally has a white color.
Endometriosis on the ovaries can occur in up to several centimeters of cysts, which have a brownish content, so they are called chocolate cysts. At the septum between the vagina and rectum, endometriosis occurs in the form of fibrous nodules, which cause persistent pain. Endometriosis in the uterine muscle often co-occurs with uterine fibroids and manifests as a painfully enlarged uterus and other typical symptoms of endometriosis.
SYMPTOMS
The most common symptoms of endometriosis are pelvic pain, pain during sexual intercourse (dyspareunia), and painful menstruation. The pain is caused by adhesions and irritation of the nerve endings by substances that release endometriotic foci. Endometriosis is widespread in infertile women. About 50% of infertile women have endometriosis, and about 50% of endometriosis women are bare. The cause of infertility is extensive adhesions that prevent the egg from coming loose, prevent the fallopian tubes from moving, or they can close the fallopian tube completely.
Endometriosis can cause an ectopic pregnancy when the egg settles on the uterine lining in the fallopian tube or ovary. Endometriosis in the uterine wall can affect labor and cause placental dysfunction after delivery.
CAUSES
The onset of endometriosis is not yet fully understood. The oldest implantation theory is based on reverse menstruation. During menstruation, the blood is flushed out through the vagina, but at the same time, the particles of the uterine lining can get into the fallopian tubes in the abdomen, where they nest. This theory is supported by the fact that endometriosis mainly affects women who have heavy and frequent menstruation that lasts longer than seven days. It also often occurs in girls who have no or limited ability to drain menstrual blood.
Another theory is the so-called metaplastic theory. The development of endometriosis is explained by the transformation of peritoneal cells into uterine lining cells in the field of recurrent pelvic inflammation or high levels of estrogens in a woman’s blood. Immunological theory suggests that women with reduced immunity or produce antibodies to the endometrium have endometriosis. Several factors contribute to the development of endometriosis – immunological, hormonal, and genetic.
DIAGNOSIS
The diagnosis of endometriosis is based on a carefully taken history and gynecological examination, which may not show any abnormality in milder forms. Ultrasound examination may reveal cystic structures in the ovaries. It is also advisable to take blood samples and determine the level of the tumor marker CA 125, elevated in endometriosis. Laparoscopy or hysteroscopy is required to confirm the diagnosis definitively. Laparoscopy is currently the most widely used method in the surgical field. With the help of laparoscopy, can image all organs of the pelvis and abdominal cavity can image all organs of the pelvis, and abdominal cavity and the necessary surgery can be performed simultaneously. Hysteroscopy allows the gynecologist to examine the cervix and cavity of the uterus, identify fibroids, polyps, developmental defects of the uterus, and uterine adhesions, and take a sample of the mucosa for microscopic examination.
THERAPY
The treatment of endometriosis is individual, depending on whether the woman is planning a pregnancy or a woman who is not planning to become pregnant and needs to be treated for pelvic pain. There are two primary treatment options – hormonal and surgical. The basic principle of hormonal treatment is to affect the patient’s natural hormonal axis. The woman is given hormones that block the release of hormones from the cerebral cortex, thus not releasing the ovarian hormones (Estrogens). There is no cyclical transformation of the uterine mucosa.
