Treatment of endometriosis

Endometriosis of the uterus is a condition in which cells of the inner uterine lining (endometrium) grow beyond its natural boundaries. In some cases, they may extend beyond the reproductive organs (vagina, ovaries), and endometrial foci can then be found in the bladder, on the walls of the abdominal cavity, the intestinal mucosa, and other organs.

The condition of the endometrium depends on the level of sex hormones. Each month, if pregnancy does not occur, its cells are shed, and the woman experiences menstruation. Abnormally proliferated endometrial tissue undergoes the same cycles as the uterine lining. It menstruates monthly, which causes a feeling of fullness, pain, and other symptoms of the disease.

The symptoms of endometriosis may vary depending on the location of the condition and the degree of tissue proliferation.

Most often, uterine endometriosis causes:

• severe cramping pain during menstruation;

• pain in the pelvic area (aching, sharp, constant, or periodic);

• heavy menstrual bleeding;

• longer menstrual periods;

• spotting or bleeding at the beginning and middle of the cycle;

• irregular cycles;

• discomfort or pain during and after sexual intercourse;

• pain during bowel movements, rectal bleeding, constipation (when the rectum is affected);

• general weakness, mood swings.

Not all, but some of these symptoms may occur with endometriosis. Abnormally growing endometrial tissue can cause both pronounced and mild symptoms. In rare cases, the disease is nearly asymptomatic.

Endometriosis symptoms are also characteristic of other gynecological diseases. For example, endometriosis may cause more profuse discharge, especially during menstruation, but this symptom is common to many female conditions. Therefore, proper diagnosis under medical supervision is required.

Endometriosis can develop not only in the area of the reproductive organs but also in other parts of the body. Based on this, it is classified as genital and extragenital. In extragenital endometriosis, lesions may appear on the walls of the bladder, intestines, kidneys, lungs, and other organs.

Genital endometriosis can be internal or external. In internal endometriosis, endometrial cells grow into the muscular layer of the uterus. This condition is called adenomyosis or endometriosis of the uterine body. External endometriosis is further divided into two subtypes: peritoneal and extraperitoneal. The first includes endometriosis of the fallopian tubes, ovaries, and peritoneum; the second includes endometriosis of the vagina and cervix.

In a simplified classification, endometriosis is referred to by the affected organ, such as cervical endometriosis, ovarian endometriosis, peritoneal endometriosis, bladder endometriosis, etc.

Based on the spread of endometrial foci and the depth of tissue invasion, four stages of the disease are identified:

• 1st stage – single, shallow endometrial foci;
• 2nd stage – multiple foci with deeper tissue invasion;
• 3rd stage – numerous deep foci, small cysts, and a few adhesions;
• 4th stage – many deep foci, large cysts in both ovaries, and extensive adhesions in the abdominal cavity.

Several theories explain the development of endometriosis in different organs. The most widely accepted is the theory of retrograde flow. It suggests that during menstruation, endometrial cells can travel through the fallopian tubes into the ovaries and spread via the bloodstream or lymph to the abdominal cavity and other organs. Normally, the immune system should destroy these cells, but if local immunity is impaired, this does not happen—cells implant, and the disease develops.

According to another theory, certain cells of the peritoneum can transform into endometrial tissue.

The influence of genetic factors is also proven. Endometriosis is more common in women whose mothers also suffered from the disease.

Risk factors for developing endometriosis include:

• hereditary predisposition;

• absence of childbirth;

• childbirth at middle or older age;

• late onset of menopause;

• menstrual cycles shorter than 27 days;

• menstruation lasting longer than 8 days;

• congenital defects in reproductive organ development.

The symptoms of endometriosis are nonspecific, meaning they can appear in other female conditions. Accurate diagnosis requires instrumental examinations.

During the initial consultation, the gynecologist reviews the patient's complaints and medical history, performs an examination, and collects smears and scrapings for cytological and histological analysis.

To diagnose endometriosis, the doctor may also prescribe:

• ultrasound, CT, or MRI of the pelvic and abdominal organs;

• colposcopy (examination of the cervical mucosa);

• hysterosalpingography (X-ray of the uterus and fallopian tubes with contrast);

• hysteroscopy (endoscopic examination of the uterus);

• laparoscopy (endoscopic examination of the abdominal cavity).

The scope of the examination depends on the symptoms and results of the initial tests and ultrasound. CT, MRI, and endoscopic examinations are prescribed when other methods are not informative enough to determine the exact location, number of lesions, depth of invasion, and other features. In most cases, ultrasound is sufficient to diagnose endometriosis; less often, CT or MRI is required additionally.

Endometriosis is primarily treated surgically. Endometrial foci are removed during hysteroscopy, laparoscopy, or laparotomy. In most cases, endoscopic surgeries are performed. They are minimally traumatic and safe. Modern methods allow the removal of pathological tissues with minimal damage to healthy ones. As a result, for example, in ovarian endometriosis, it is possible to preserve the woman’s follicular reserve and reproductive function.

The type of surgery depends on the location and number of endometrial foci, the depth of invasion, and the presence of cysts and adhesions. In stages 3 and 4, laparotomy (open surgery) may be necessary. In other cases, endoscopic procedures can be performed via the vagina and uterus or the abdominal cavity through small punctures.

In mild cases, the gynecologist may prescribe medication. Hormonal drugs are used to stop menstruation in pathological endometrial foci and prevent their growth. Medications are also prescribed to reduce pain and other symptoms. If the patient has contraindications to hormones or other medications, surgery may be recommended immediately.

In some cases, both treatments are combined—for example, hormonal therapy first, followed by surgery. It depends on the individual patient.

At Oxford Medical, you can undergo diagnosis and treatment of endometriosis by gynecologists with many years of experience. The clinic’s branches are located in the center of Kyiv, on both banks of the Dnipro, and in Irpin. They are equipped with new equipment from leading global brands, allowing accurate diagnosis and minimally invasive outpatient surgeries.

Endometriosis is a complex condition that must be treated. Chronic forms can lead to serious complications.

With endometriosis, the risk increases for:

• anemia due to heavy blood loss;

• formation of adhesions and scar tissue in the pelvis;

• peritonitis;

• premature ovarian failure;

• infertility;

• pregnancy complications;

• chronic pain syndrome.

Endometriosis does not always lead to infertility or other complications. However, among women with infertility, this diagnosis is present in 25–50% of cases, according to various data. This is due to the formation of pelvic adhesions, ovarian depletion, and reduced follicular reserve.

Endometriosis also often causes severe pain and frequent uterine bleeding, reducing quality of life.

Women with a hereditary predisposition are at higher risk of developing endometriosis. If the disease occurred in the mother or other close relatives, the woman should be especially attentive to her health. In this case, it is recommended to avoid hormonal contraceptives or use them only under strict medical supervision, as endometriosis is a hormone-dependent disease.

It is also advisable to undergo preventive checkups with your obstetrician-gynecologist once or twice a year and to treat all illnesses promptly. Maintaining hormonal balance is equally important.

It is believed that the likelihood of developing endometriosis decreases in women after multiple births, extended breastfeeding, late menarche, and regular physical activity.