Endometriosis: Symptoms and Treatment
Endometriosis is a gynecological neoplastic disease, accompanied by the proliferation of the inner shell of the uterus (endometrium) beyond the limits of its cavity. Simply put, tissues that are in the uterus in healthy women, with endometriosis grow in other organs. Endometriosis, whose symptoms are experienced by women, develops for vague reasons, although there are some grounds for identifying immune, hormonal, hereditary and some other factors.
So, in order to better understand what is at issue in considering this disease, it is necessary to dwell on what, in fact, is the endometrium, and also to penetrate into the peculiarities of the organs of the reproductive system of a woman.
Women in the small pelvis have a uterus — a muscular organ, connected to the uterine tubes opening to the abdominal cavity on both sides. The uterus covers the three main layers, this is the inner layer of the endometrium, the median (muscle) layer myometrium, and perimetry — the outer serous thin shell of the organ protruding into the As a continuation for the leaflets of the peritoneum from the bladder.
The layer of interest, the endometrium, includes two more layers, it is a functional layer and a basal layer. The functional layer includes a layer of cells that resemble cylinders in their own structure, which, in fact, determines their name — it is a cylindrical epithelium. Between these cells are glandular cells — due to them, the required mucus is produced, and also there are a lot of terminal branches belonging to small spiral arteries.
Throughout the menstrual cycle, the functional layer is subject to constant changes due to the effect of female sex hormones. When the menstrual period comes, then its rejection occurs, and finally, the outward excretion. Then, where the functional layer in the uterus has been torn away, the process of dividing the cells of the basal layer begins. As a result, new cells are formed replacing the rejected layer and forming a new layer.
Specialists note that endometriosis is the third most common among gynecological diseases, following uterine myoma and inflammatory processes affecting the female genital organs. Most often, endometriosis is diagnosed in women of the reproductive age group, mainly between the ages of 40 and 44 years. According to various data, the incidence of endometriosis is about 12% on average in middle-aged women. In infertile women, endometriosis is diagnosed more often — about 30-40% of them occur, while multiparous women face this disease more rarely — about 27%.
What is remarkable, teenage girls can also develop this disease. For example, it is known that about 50% of patients in this group who have undergone surgical intervention due to pelvic pain are diagnosed with endometriosis. The premenopausal period also does not exclude for women the possibility of developing this disease — here its frequency on average is about 2-5%. We add that after menopause in women, similar to the listed age groups, endometriosis may also develop, which, however, occurs less frequently.
At the same time, it is impossible to determine the true rates of the disease in question, due to the difficulties associated with its diagnosis, as well as the fact that in some cases, endometriosis occurs without symptoms at all. On average, about 70% of cases of treatment of patients for medical help due to pain in the pelvic region ends with the diagnosis of «endometriosis.»
These data, with the due approach of the readers to them, are a weighty argument in favor of regular preventive visits by such a doctor as a gynecologist. In particular, this applies to those women who are experiencing certain constraints associated with the admission of this specialist, as well as those women who completely ignore such recommendations and in general do not visit the gynecologist.
The disease we are considering is polyethological, which, in turn, indicates the presence of a variety of possible causes that cause it. At the same time, as has already been identified, the true cause of endometriosis has not yet been determined. Let us dwell on some variants, which are considered to be basic at the moment.
- Retrograde menstruation. Or, as it stands, «reverse» menstruation. This phenomenon determines the following process: a certain amount of menstrual blood released during menstruation, is sent to the abdominal cavity through the fallopian tubes. Menstruation for a similar «scenario» — not uncommon, moreover, it is often found in healthy women. The only difference from patients with endometriosis is that in healthy women, the immune system restrains the endometrium, not allowing it to expand in the area in which it appears, that is, in the abdominal cavity.
- Heredity. This factor is relevant for many diseases that a person has to deal with, and endometriosis can also be considered as a disease, with this factor associated. Accordingly, it is believed that the risk of developing the disease in question is increased if it is available to the next of kin.
- Immune system disorders. This reason is also seen as a presumed factor leading to the development of endometriosis. If the immunity is weakened, then in the abdominal cavity, when the variant of the «reverse» menstruation has already been considered, endometrial cells not only do not collapse, but also attach to the tissues and organs located here, thereby forming foci of endometriosis.
- Surgical intervention in the area of gynecology. Any kind of surgical treatment, and this is curettage (ablation), abortion, cesarean section, cauterization of erosion, etc. — As significant predisposing factors to the development of endometriosis.
- Hormonal changes. This factor is also believed to contribute to the development of endometriosis. The fact that the endometrium is quite sensitive to the effects of female sex hormones, the foci of endometriosis react to them in a similar way. The growth of such foci, for example, contributes to female sex hormones, estrogens.
- Metaplasia of the endometrium. This factor implies a transformation in which one tissue is transformed into another. There is a theory according to which the endometrium, being outside the uterus, can similarly transform into another tissue. Meanwhile, the causes of metaplasia are not clear at the moment, moreover, any assumptions on her account give rise to a lot of controversy among researchers.
In addition to the factors listed, there are some other factors, and they are also not excluded when considering the relationship with endometriosis. In particular, they include:
- iron deficiency;
- environmental impact
- urinary tract infections, as well as STDs
- impaired liver function
- use of an intrauterine device, etc.
Endometriosis: forms and species
Classification of endometriosis is performed in gynecology in accordance with the localization of its foci. In particular, genital and extragenital endometriosis are isolated. Genital endometriosis can be internal (this is adenomyosis) or external, extragenital, in turn, can be extraperitoneal or peritoneal.
By internal genital endometriosis is meant the proliferation of foci of the endometrium in the area of the muscular uterine layer, namely in the cervix and uterus.
As for extragenital endometriosis, it mainly develops in the environment of the kidneys, bladder, intestine, lungs, in the field of some post-operative scars.
Extragenital peritoneal endometriosis primarily affects the fallopian tubes, ovaries and pelvic peritoneum.
Localization of extraperitoneal endometriosis is concentrated from the external genitalia. The main forms of this variant of the disease is endometriosis of the vaginal part of the cervix, endometriosis of the vagina, zadachoshechny endometriosis, endometriosis rectovaginal septum.
Endometriosis can occur in so-called «small» forms or in severe forms. In the latter variant, the localization of foci may correspond to a mixed form, because of which a clear classification of endometriosis is sometimes not at all. In addition, severe forms of endometriosis, according to experts, develop as a result of ignoring the curative and preventive measures at the necessary stages for this.
Based on the depth of lesions by the foci, the corresponding stages of endometriosis are isolated. In particular, this is the minimal stage, the stage is mild, the stage is moderate and the stage is heavy. The severe stage, as is not hard to guess, is the most painful for patients, and also the most difficult to implement measures aimed at treating endometriosis. With internal endometriosis, the lesion in accordance with specific stages is as follows:
- Stage 1 — the mucous membrane is afflicted to the myometrium layer (to the middle, muscle layer, as indicated above)
- Stage 2 — the layer of the myometrium is affected to the middle;
- Stage 3 — the lesion reaches the serous (peritoneal) cover of the uterus;
- Stage 4 — here the parietal peritoneum is affected.
Thus, we can distinguish a group of organs of the abdominal cavity and small pelvis (namely, they are most often affected by foci), which will determine the types of endometriosis:
- Endometriosis of the uterus (also called adenomyosis)
- Endometriosis of the ovaries;
- Peritoneal endometriosis (also known as peritoneal endometriosis)
- Vaginal endometriosis;
- Endometriosis of the cervix
- Rectovaginal endometriosis
- Bladder endometriosis;
- Endometriosis, affecting other organs (the disease is much less common in this item): diaphragm, pleura of lungs, lungs, intestines, eyes, stomach, skin, etc.
Endometriosis of the uterus: symptoms
Endometriosis of the body of the uterus, or, as we previously indicated, adenomyosis, is one of the main forms of endometriosis, in which the myometrium is affected by foci of endometrioid tissue. The symptomatology of this form of the disease is as follows:
- Painful menstruation. This symptom also has its own medical definition — aldysmenorrhea. The intensity of pain in the severity of pain, in general, does not match. The appearance of pain is caused by the fact that the liquid begins to accumulate in the tissues, which is due to the actual adhesive process affecting the uterine cavity, congestion in the menstrual blood, inflammatory process.
- Violations of the cycle. This symptom is quite typical for adenomyosis, although, indeed, not only for him — many gynecological diseases and disorders in the body are accompanied, as is known, by similar «failures». With adenomyosis, most of the cycle disorders are reduced to bleeding. As an important enough symptom for this case is the appearance of brownish or bloody discharge, they appear 1-2 days before the start of menstruation and last the same way, 1-2 days after it. An important signal is also a change in the nature of menstrual flow. So, if earlier menstruation proceeded normally, with adenomyosis they can become, for example, excessively abundant. This is often accompanied by a severe depletion of the patient.
- Dark color of menstrual flow. A characteristic feature of the manifestation of endometriosis during menstruation, there are also blood clots.
- Prolonged menstrual flow. Often menstruation with endometriosis lasts longer, exceeding average duration.
- Infertility. Infertility is due to two main reasons, namely, that there is no possibility of implantation of the fetal egg and its subsequent gestation as a result of the prevalence of the process, as well as the fact that the adhesive process is developed in a pronounced form, Which is accompanied by a lesion of the uterine cavity. In both cases, the result is the same — all this leads to infertility. At the same time, this is not the final verdict in the disease, because at least 20% of cases in practice fix the onset of pregnancy among patients, even with a severe form of the disease in question.
- Miscarriage of pregnancy, that is, in this case it is a spontaneous abortion / miscarriage. The reasons for this outcome are associated with a general picture of the changes against which infertility is developing.
- Endocrine Disorders. In general, this symptom is relevant for extragenital endometriosis, although it may be present during adenomyosis. It manifests itself in the hypothalamic-pituitary insufficiency of the ovarian system. Because of hormonal imbalance, bloody discharge can appear in women between menstruation, which occurs fairly often with endometriosis
In most cases, the disease progresses. In the absence of treatment for about half a year, about 47% of patients face deterioration, while spontaneous improvement occurs in about 30%. It is noteworthy that during pregnancy, some regression of the disease is observed in the patients, or even a significant improvement in the general condition. The fact is that pregnancy is a condition in which the decidual reaction begins to develop in the formed foci, as a result of which they begin to decrease.
Decidualization consists of such changes in the endometrium during pregnancy, in which a special type of cell layer of the endometrium — decidual tissue — is formed. During pregnancy, decidual changes occur quite intensively: the cells accumulate fats and glycogen, the size of these cells increase. Simultaneously with this enhancement, vascular growth in the endometrium is susceptible.
As for the role of this decidual tissue, its role is not completely determined. Meanwhile, it is commonly believed that this tissue controls the insertion of the fetal egg into the uterine wall, where it acts as a kind of interlayer first between the trophoblast, and afterwards — the wall of the uterus and placenta. Also we add that the decidual reaction acts as an integral stage of implantation.
Ovarian Endometriosis: Symptoms
Ovaries in endometriosis can be affected by the entry of endometrial cells in them through the lumen of the uterine tube, which occurs with the flow of lymph and blood. The causes of endometriosis of the ovaries are also not fully understood at the moment, the foci of endometriosis can be located both outside the ovary and directly in it. Symptoms of endometriosis of the ovaries in each case can be manifested in different ways, this depends on the size of the foci and on the specific area of their localization. Let us single out the general symptomatology:
- Pain in the lower abdomen. Such pain is not necessarily associated with a particular period of the menstrual cycle, that is, it can appear at any time. Constant pain in the abdomen can be caused by inflammation of the peritoneum due to irritation on the soil of the formation of endometriosis foci.
- Pain in the lower abdomen during exercise, during sexual intercourse.
- Increased pain in the period before menstruation, especially severe pain on her first day.
- Pain spreading to the inguinal or to the lumbar region, to the rectum.
Peritoneal endometriosis: symptoms
Peritoneal endometriosis (peritoneal endometriosis) is characterized by the fact that in its development an important role is assigned to the interaction of endometrial elements with peritoneal mesotheliocytes. To contribute to the development of this form of the disease, the «reverse» casting of menstrual blood can already be considered, which is caused by certain disturbances in the work of the immune and endocrine systems.
Peritoneal endometriosis can be of two types. So, the first type is characterized by a limited scale of damage — only the peritoneum is affected. The second type, respectively, is characterized by the fact that the lesion of the endometriotic foci occurs not only within the peritoneum, but also behind them, that is, the uterus, ovaries and fallopian tubes are affected.
With small forms of endometriosis, there may be no long-term clinical symptomatology — the disease proceeds in a latent form. At the same time, infertility in such a course of the disease, even in a small form, often exceeds 90%. If the foci of endometriosis have spread beyond the peritoneum and have «settled down» in the rectum and its muscle layer, affecting also the pararectal tissue, then the similar course is accompanied by the appearance of pelvic pain, soreness of sexual contact (which is more pronounced on the eve of the onset of menstruation, and after it) .
Vaginal and perineal endometriosis: symptoms
Basically, the perineum and vagina are affected by endometriosis as a result of germination from the side of the retrocervical focus, somewhat less often due to the appearance of endometrial foci in the area of the site that was affected during delivery.
As the leading complaint for this form of the disease are painful sensations arising both in the vagina and in the back of the pelvis, and the severity of pain in this case varies from moderate to severe enough, often painful, exhausting. Strengthening pain is noted during sexual intercourse, as well as a week before and after menstruation. Severe pain occurs particularly when the front crotch is involved, as well as the external sphincter of the rectum.
There is also a certain kind of difficulty in the act of defecation, which is accompanied by excruciating painfulness in those periods on which the exacerbation of endometriosis occurs. By the nature of the manifestation, the pain is pulsating and burning (analogy with an abscess). When menstruation occurs, the patients will detect swelling, knots or cystic type of formation during palpation.
After the completion of menstruation, the detected lesions either shrink in size or completely disappear, after which the scars remain in their place, they are painful and have brownish pigmentation. If in this case the diagnosis is established erroneously and unreasonably (sphincteritis, rectitis) on the basis of lesion of the external sphincter of the rectum, and thermal procedures (including warm sedentary baths) are appointed, the pain becomes worse.
Pain in the vagina can also be combined with local itching. Some patients find brownish and bloody discharge, emanating from the vagina both spontaneously and during sexual intercourse. There are such discharges in almost standard for endometriosis period for this symptom — a few days before menstruation and within a few days after it.
Cervical Endometriosis: Symptoms
This form of the disease is also quite common, and the reason for this is the location of the affected area — the cervix most often «falls under the shock» during various manipulations in gynecology (abortion, scraping, etc.).
Some symptoms of cervical endometriosis, in general, can be called common with other areas of damage in this disease. These are:
- smearing brownish discharge that appears before menstruation
- pain and discomfort during sexual contact
- the appearance of brownish discharge during sexual intercourse (this symptom mostly occurs in the second half of the cycle).
As for other painful sensations (in the lower abdomen, for example), they are not so characteristic of the general clinical picture for this form of the disease.
Rectovaginal endometriosis: symptoms
Rectovaginal endometriosis can be deep (or internal), which is accompanied by the development of endometriosis-specific pathological foci in the uterus, as well as external, which is accompanied by damage to the fallopian tubes, wide uterine and intestinal uterine ligaments, ovaries, Douglas space and peritoneum.
Symptoms of this form of the disease are similar to the other forms: here, too, are pain sensations that occur during sexual intercourse, as well as pain in the abdomen before and after menstruation.
Bladder Endometriosis: Symptoms
Still some time ago in this form, endometriosis was considered a rare disease, any information about this disease in the medical literature flashed in a rather meager amount. Meanwhile, now the cases of this disease are diagnosed more often, and rather the fault of the past is a lack of familiarization of urologists and gynecologists with it, and not the rarity of its occurrence. His role in this is played by the fact that often specialists in attempts to establish a diagnosis such as endometriosis of the bladder adhere to the direction to another pathology — cyclic hematuria, which in any case is incorrect, moreover, the latter diagnosis is rarely relevant for patients with whom he Was delivered.
The bladder in endometriosis can be affected in different ways. For example, it is possible to hit on its surface the contents that are in the endometrioid cysts of the ovary, as well as the ingress of menstrual blood (according to the «scenario» of retrograde casting), which includes viable endometrial particles, or the proliferation of the endometrium from the isthmus and the frontal uterine wall To the bladder. An important role is played by the isthmus affected by endometriosis, left behind in supravaginal amputation of the uterus, as well as sparing surgical influence on the uterus during this or that manipulation. Cesarean section plays a role. Admissible is the variant of hematogenous entry of endometrial elements into the wall of the bladder organ.
The features of the clinical picture of endometriosis in this case are determined by the features of its genesis. Thus, the foci of endometriosis, formed during the implantation of particles of the endometrium, on the surface of the organ of the bladder, for a long time may not manifest themselves in any way, in other words, there are no symptoms. The detection of foci occurs by chance, for example, in the process of trunking with actual diseases of certain organs of the pelvis, as well as in the lower abdominal cavity. Naturally, the detection of pathology is allowed by those specialists who are familiar with it.
With the spread of endometriosis to the posterior wall of the bladder from the uterus or from the isthmus, severe enough dysuric phenomena develop in patients. If it is a pathology such as congenital endometriosis of the bladder, in which the location of the lesion focuses from the ureteral orifices, the picture of the disease can also be quite severe.
The most common symptoms of bladder endometriosis include complaints of a feeling of heaviness arising in the back of the pelvis and in the lower abdomen. It increases before menstruation, and also after it. At the same time, urination in patients is becoming more frequent, in some cases it is accompanied by soreness. The degree of pain can vary, respectively, they can be both moderate and strong enough, up to a loss of normal working capacity in this period. With urological examinations and repeated urine tests, the causes explaining the sufferings of patients are not detected, due to which the diagnosis of «cystalgia» is established. Therapy applied to the manifestations of symptoms determines the lack of sufficient effectiveness. With thermal procedures, pain intensifies. At the same time, specialists do not attach due importance to the dependence determined between the menstrual cycle and complaints.
Gradually painful urination is supplemented during menstruation with hematuria (blood in the urine), the degree of manifestation of its manifestation can vary. At the stage of progression of the disease, a diagnosis such as recurrent hemorrhagic cystitis can be established. Therapy against manifestations of actual symptoms is still ineffective at the same time.
Soon the disease becomes chronic. According to some data, it takes 3-5 years from the moment of appearance of such a symptom as painful urination before the onset of hematuria. What is noteworthy, many patients face a certain relief of pain when urinating from the time that hematuria began to manifest. In most cases, this symptomatology leads to fear in patients that they may have a tumor in the bladder.
We add that the blood in the urine with bladder endometriosis is, according to some observations, a symptom that occurs in this disease in 25% of patients. If it is a question of extensive endometriosis, in which the neck of the bladder is captured by the lesion, then such a symptom as the problem of urinary retention (incontinence) may also occur.
Endometriosis and Pregnancy
If you consider this disease in combination with infertility, then you can not say unequivocally on the equality between them. In other words, with endometriosis, pregnancy is not impossible. Another thing is that pregnancy with endometriosis significantly reduces the chances of pregnancy. In practice, there are cases of conception in this disease, but it is important to understand that the percentage of success of conception is lower in this case, and, of course, that there is a certain risk for the fetus in endometriosis, which is a spontaneous abortion. If the child was still conceived, then it is mandatory to observe the doctor strictly following recommendations from his side.
As for the cause-and-effect mechanism in the «endometriosis-infertility» scheme, there is still no clear clarity. Meanwhile, there are certain assumptions regarding the factors provoking infertility in endometriosis:
- Immunological and endocrine disorders, topical in parallel with endometriosis. These factors adversely affect ovulation, fertilization and subsequent implantation in the uterus of the egg.
- Mechanical abnormalities that cause obstruction of the fallopian tubes; Pathology of the anatomy of the ovaries; Adhesive processes that make it difficult to release the egg.
- The processes that accompany local inflammations.
- Luteinized follicle syndrome.
- Frequent miscarriages in the early stages.
- Pathology of the uterine tube transport function due to the increase in prostaglandins against the background of endometriosis
In its own interesting and, at the same time, important, is such a factor as unfavorable conditions for the future fetus in the body (womb). More precisely, the essence of this is the following: the body independently decides whether a woman can take out (and after giving birth) a healthy baby right now.
At the same time, new studies show that most women with endometriosis, regardless of the nature of the menstrual cycle (even normal and regular), true ovulation is not present as such, that is, it is about anovulation. We add that without ovulation pregnancy in principle is impossible.
The data of some sources indicate that after treatment and organ-preserving surgical interventions pregnancy occurs on average in 15-56% of cases — such a significant gap in the parameters is due to the peculiarities of the pathological process and the severity of the course of the disease. Basically, gynecologists note that after the treatment in the desired direction pregnancy occurs after six months or a year. Accordingly, the expectation of pregnancy can last from 6 to 14 months.
At the same time (although rarely), there are cases in which successful treatment of endometriosis does not end with the onset of a long-awaited pregnancy in six months or more. In this case, you will need to undergo an additional examination, which will highlight other factors involved in the problem of infertility.
Complications of endometriosis
If the treatment of endometriosis is ignored as a necessity or it is initially implemented illiterately, then you can later face a number of complications:
- development in the abdominal cavity and in a small pelvis of adhesive processes
- development of posthemorrhagic anemia in patients with abundant chronic blood loss, concomitant menstruation
- neurological disorders caused by compression of nerve trunks
- formation of endometrioid cysts of the ovaries
- transformation of endometrioid tissues into malignant tumor formation
In order to establish the diagnosis of «endomectriosis,» you need to obtain results for certain studies, among them are:
- ultrasound of the pelvic area using a special vaginal sensor
- hysterosalpingography is a method in which a contrast medium is used, which can be used to assess how widespread the process of foci formation has been, and also to understand how much the tubal patency has suffered from this, which is especially important in case of infertility, which is actual for the patient,
- Hysteroscopy — this method makes it possible to investigate the features of the uterine surface, endometrioid passages and tubal ostium (on the pale pink mucous membrane they look like dark red dots)
- Laparoscopy is a microsurgical treatment that allows you to diagnose any of the forms of the disease, and — with the simultaneous possibility of treatment during it
- blood test for the detection of an endometriosis marker
In general, the need for this or that variant of the study is determined by the attending physician, depending on the characteristics of the pathological process, the diagnostic scheme may vary.
Treatment of endometriosis is carried out in two main directions, and this is the surgical removal of foci in the areas of endometriosis damage (or removal of organs with them completely), as well as medical treatment aimed at providing hormonal correction of the activity inherent in endometrium.
Surgical treatment often has no alternatives due to the fact that the condition of patients is often rapidly deteriorating and there is a threat for subsequent infertility. In many cases, the pain accompanying endometriosis becomes almost unbearable, in addition to this pain, the rapid growth of foci also accompanies the unfavorable prognosis.
Surgery can be performed in different ways, it is determined on the basis of the location of the foci, the possibility of access to them due to some technique of the required impact. If it is a question of endometriosis of the vagina, cervix or perineum, the preferred option is endoscopy (excision of foci and their cauterization is carried out either through the vaginal cavity, or outside). If the foci are located in the uterine cavity, then the option of removing the uterus (the question of whether to remove or not remove the appendages) or a hysteroscopic operation that provides access through the vagina to the affected uterus organ can be considered.
If endometriotic foci are in the area of the fallopian tubes, ovaries or peritoneum, laparoscopy can be performed — several small holes are made on the abdomen in certain areas for subsequent access to the affected areas.
With regard to drug treatment, it is focused on suppressing the growth / reproduction of endometrial cells. In general, the following groups of drugs are used (only the attending physician can decide on their appointment!):
- oral contraceptives combined action (marvelon, femoden, diane-35, etc.)
- drugs representing the group of antigonadotropins (gestrinone, danazol, etc.)
- drugs representing a group of progestins (depostat, dyufaston, etc.)
- preparations of the agonist group (decapeptil-depot, zoladex, etc.)
- anti-estrogens (tamoxifen, etc.).
Information on these groups of drugs is provided for general information only! Self-treatment by them is unacceptable, the application is possible only on the basis of the testimony of the treating gynecologist!
Endometriosis: prevention measures
Prophylaxis of endometriosis is an equally topical issue for both women who have suffered this disease and recovered from it, and for those women who have experienced this disease only through information sources. Recommendations for prevention include the following:
- regular visit to the treating gynecologist, at least once every 6 months;
- sexual abstinence during menstruation
- timely treatment of gynecological diseases;
- fight against excess weight (exercise, diet, etc.)
- Avoidance of stressful situations as such, as much as possible
- elimination of abortions, selection of optimal solutions for contraception
Endometriosis: Some facts about this disease
Some women ignore this disease, believing that it will pass by itself, some believe that this is only «their problem», some even believe that it will not affect them in any way. Is it so? Let’s look at some established facts related to endometriosis.
- Endometriosis is a disease of active and business women
A number of studies in this area and their results in particular indicate that endometriosis is more often diagnosed in women in large cities, as well as in women whose professional activity is associated with increased mental stress. Basically, we are talking about socially prosperous business women, as well as women whose activities are supplemented by a systematic change in climatic conditions due to business trips, etc. Here we are talking about the desire for self-realization when we postpone motherhood for «later». In the high-risk group, there are also those women whose sex life is «overly active», especially when it comes to the combination with frequent changes in sexual partners (which is not very rare, as you know). It is quite possible that, in addition to treating endometriosis, some kind of restructuring of consciousness will have to be taken care of, which is also an important part in this matter.
- Endometriosis negatively affects the sexual partners of women with this disease
Relatively recently it became known that the problem of endometriosis is not only a purely female problem, but also the problem of a woman’s sexual partner. On this account, there are two valid statements:
— The seminal fluid contains certain molecules (such as estradiol, prostaglandins, etc.), through which the endometrium provokes a stimulating effect. Seed fluid in the process of sexual intercourse is found in the uterine cavity or in the abdominal cavity through the posterior and anterior vaginal arches. Prostoglandins enhance cell proliferation, and also lead to suppression of apoptosis (i.e., a protective mechanism that operates within the framework of endometriosis), inducing the production of certain enzymes, through which endometriosis develops with greater intensity. Accordingly, it can be summarized that when a sperm enters the patient’s body with endometriosis, it acts as a factor supporting the development of this disease.
— Endometriosis negatively affects the qualitative characteristics of sperm. Proved is the fact that hypoxia acts as one of the variants of triggers for endometriosis. In other words, women with endometriosis are always in a state of oxidative stress, in which cells are affected by oxidation. Simultaneously, there is an accumulation in the body of free radicals of oxygen, they, as it became known, are characterized by a toxic effect on the sperm cell — cell membranes, in particular, are subject to damage in particular. And DNA, and apoptosis (cell death) is triggered. That is, those processes that «control» the disease in women, negatively affect the general state of sperm. Accordingly, when infertility is extremely important to begin treatment, thereby eliminating the negative impact for both partners, leading to this result.
- Endometriosis and IVF
In particular, on this item, patients are interested in whether the procedure for IVF is effective in endometriosis. On this account, there are also certain facts:
— common forms of the disease have a negative effect on the ovarian reserve, reducing the number of eggs obtained during stimulation, why this occurs is still unclear;
— Endometriosis itself is the basis for introducing patients into the appropriate risk group regarding the possibility of developing an ectopic pregnancy after embryo transfer has been performed;
— internal endometriosis (i.e., adenomyosis) helps to reduce the possibility of successful implantation of the embryo within the framework of the implementation of PBT programs similarly, as with the usual (natural) mode of conception.
To sum up, the only true solution in the treatment of endometriosis is laparoscopy (surgical treatment) with the addition in the form of certain drugs of conservative therapy.
If you have any symptoms that may indicate endometriosis, you need to visit a treating gynecologist.