Endometriosis of the uterus - what is it and how to treat it?
Endometriosis of the uterus: what is it in accessible language?
The problem of endometriosis of the uterus is very relevant for modern medicine. This is due to the fact that the incidence of the disease is increasing from year to year. According to statistics, from 5 to 10% of young women worldwide suffer from endometriosis. Among patients diagnosed with infertility, endometriosis occurs much more often: in 20-30% of cases.
Endometriosis is a pathological proliferation of the glandular tissues of the uterus, which is benign. The newly formed cells are similar in structure and function to the cells of the endometrium of the uterus, but they are able to exist outside of it. The growths (heterotopias) that have appeared are constantly undergoing cyclical changes, similar to those changes that occur every month with the endometrium in the uterus. They have the ability to penetrate into adjacent healthy tissues and form adhesions there. Often, endometriosis is accompanied by other diseases of hormonal etiology, for example, uterine fibroids, HPE, etc.
- Reasons for the development of endometriosis
Symptoms of endometriosis in women
- Symptoms of different forms of endometriosis
- Signs of endometriosis in older women
- Signs of internal endometriosis
- Symptoms of the disease after a cesarean section
- Endometriosis, endometritis and uterine fibroids - what's the difference?
- Are endometriosis and adenomyosis the same?
- Why is uterine endometriosis dangerous?
- Can the stomach hurt with endometriosis?
- Endometriosis diagnosis
Treatment of endometriosis of the uterus
- Antiprogestins (Danazol and its analogues)
- GnRH agonists
- Combined oral contraceptives
- Duphaston with endometriosis
- Other medicines
- Surgical treatment of endometriosis
- Which doctor treats endometriosis?
Endometriosis is a gynecological disease accompanied by the formation of benign nodules that have a similar structure to the inner lining of the uterus. These nodes can be located both in the uterus itself and outside the organ. Particles of the endometrium, which every month are rejected by the inner wall of the uterus during menstrual bleeding, may not come out completely. Under certain conditions, some of them linger in the fallopian tubes, as well as other organs and begin to grow, which leads to endometriosis. The disease is more susceptible to women who experience frequent stress.
With a disease, the endometrium grows where it should not normally be. Moreover, the cells outside the uterus continue to function in the same way as in its cavity, that is, increase during menstruation. Most often, endometriosis affects the ovaries, fallopian tubes, fixing the ligamentous apparatus of the uterus, and the bladder. But sometimes endometriosis is detected even in the lungs and on the mucous membranes of the nasal cavity.
Reasons for the development of endometriosis
Endometriosis can be called a disease with an unexplained etiology. Until now, doctors have not been able to find the exact cause of its occurrence. On this score, there are only scientific theories, but none of them is proven. It is assumed that the risk factors for the development of endometriosis are frequent infections in childhood, hormonal imbalance in the body, inflammation of the ovaries. As it was said, uterine myoma is often a companion of endometriosis.
The theory of retrograde menstruation has today found the greatest response among specialists studying the problem of endometriosis. The hypothesis boils down to the fact that during menstrual bleeding, particles of the mucous membrane of the uterus with the blood flow enter the peritoneal cavity and the fallopian tubes, settle there and begin to function. While from the uterus menstrual blood flows through the vagina into the external environment, the blood that is secreted by endometrial particles that have taken root in other organs does not find a way out. As a result, microbleeds occur every month in the area of endometriosis foci, which entail inflammatory processes.
Other theories that highlight the causes of endometriosis are as follows:
- Implant hypothesis. It boils down to the fact that endometrial particles are implanted into the tissues of organs, getting there with menstrual blood.
- Metaplastic hypothesis. It boils down to the fact that endometrial cells do not themselves take root in areas unusual for them, but only stimulate tissues to pathological changes (to metaplasias).
However, to date, there is no answer to the main question: why endometriosis develops only in some women, and not in all of the fairer sex. After all, retrograde menstruation is observed in each of them.
Scientists suggest that endometriosis develops only when the following risk factors are present:
- Immune disorders in the body.
- Hereditary predisposition to the development of the disease.
- A certain structure of the appendages, which leads to the ingress of too much blood into the peritoneal cavity during menstruation.
- High levels of estrogen in the blood.
- Age from 30 to 45 years old.
- Excessive consumption of alcohol and drinks containing caffeine.
Taking certain medications.
- Metabolic disorders leading to obesity.
- Shortening of the menstrual cycle.
When the immune system is working properly, it monitors and stops all pathological cell division in the body. Fragments of tissue that enter the peritoneal cavity along with menstrual blood are also destroyed by the immune system. They are destroyed by lymphocytes and macrophages. When the immune system fails, tiny particles of the endometrium linger in the abdominal cavity and begin to take root. Thus, endometriosis develops.
Previous surgery on the uterus increases the risk of developing the disease. This can also include scraping, abortion, cauterization of the erosion of the cervix, etc.
As for the hereditary predisposition to endometriosis, science knows cases when in one family all female representatives suffered from the disease, from grandmother to granddaughter.
Despite the fact that there are many theories of the development of endometriosis, none of them can explain 100% why the disease still manifests. However, it is scientifically proven that the risk of developing endometriosis is increased in those women who have undergone an abortion. Artificial termination of pregnancy is stress for the body, which affects all systems, without exception: the nervous, hormonal, and sexual.
In general, those women who often experience emotional overload (stress, nervous shocks, depression) are susceptible to endometriosis. Against their background, immunity fails, which makes it easier for endometrial cells to germinate in other organs and tissues. As gynecological practice shows, the diagnosis of endometriosis is more often encountered by those women whose professional activities are associated with increased nervous tension.
Another risk factor for the development of the disease is living in an unfavorable ecological environment. Scientists have established that dioxin is one of the most dangerous substances present in the air. It is thrown away in significant quantities by industrial enterprises. It has been proven that women who constantly breathe air with a high content of dioxin are more likely to suffer from endometriosis even at a young age.
The following endogenous and exogenous factors can increase the risks of developing endometriosis:
- Installation of an intrauterine device.
- Taking hormonal contraceptives.
- Tobacco smoking.
Symptoms of endometriosis in women
Endometriosis symptoms do not form a vivid clinical picture. Therefore, until the moment when a woman undergoes a high-quality diagnostic examination, she does not find out about her disease. Often, even an examination on a gynecological chair using mirrors does not allow a diagnosis to be made. Therefore, it is worth paying close attention to the symptoms of endometriosis. Moreover, every woman suffering from this disease always has a combination of several characteristic signs.
First, it is the impossibility of conceiving a child. Infertility should be talked about when a woman is not able to get pregnant if she has regular sexual activity without contraception for a year. Endometriosis prevents the egg from being fertilized by the sperm or from being viable. The pathological proliferation of endometrial cells leads to hormonal disruptions, prevents the production of hormones that are necessary for the normal course of pregnancy.
When endometriotic adhesions grow in the appendages, in the cervical region, this will lead to fusion of organs and their walls together. As a result, obstruction of the fallopian tubes is formed, which is the main cause of infertility in women against the background of endometriosis.
The chronic course of the disease negatively affects the state of the immune system. Therefore, even when pregnancy occurs, the woman cannot bear it. As a result, the pregnancy is either terminated or the fetus freezes. This happens 65% of the time.
Secondly, pain. The nature of painful sensations in women suffering from endometriosis is different. Pains can be pulling and dull, present on an ongoing basis. Sometimes they are sharp and cutting and occur in the lower abdomen only periodically.
As a rule, pain against the background of endometriosis is not so pronounced that a woman seeks a doctor because of their occurrence. In most cases, they are considered PMS symptoms or the result of exercise.
Therefore, it is important to pay attention precisely to the chronic nature of the pain that regularly occurs during sexual intercourse, during the next menstruation and when lifting weights.
It is very easy to get rid of pain against the background of chronic endometriosis by taking an anesthetic medicine. Therefore, most women simply do not pay attention to discomfort. However, it is imperative to show concern with the appearance of regular painful sensations in the lower abdomen of varying intensity. Typically, pain returns after the pain medication wears off.
Third, bleeding. The appearance of bloody discharge after intercourse is one of the signs of endometriosis, regardless of the location of the nodes. When adhesions have formed in the area of the urinary system or intestines, then drops of blood will be present in the feces or urine.
Typically, blood appears several days before the start of the next menstrual cycle. Its discharge is accompanied by the onset of pain. After 1-3 days, the blood stops appearing, and after 1-2 days the woman begins another menstruation.
During menstrual bleeding, blood clots are released from the vagina. Their appearance resembles pieces of raw liver. Therefore, if a woman observes this kind of discharge and she has other signs of endometriosis, then it is necessary to report her problem to the doctor.
Fourthly, menstrual irregularities. He with endometriosis is almost always irregular.
A woman should be alerted to the following points:
- The cycle is constantly changing.
- Menses may be absent for several months.
- Menses are long and are accompanied by profuse bleeding.
In case of such failures, you should not hesitate to see a doctor. Otherwise, the woman runs the risk of acquiring serious health problems. If endometriosis is not treated, it can provoke the formation of benign tumors, infertility and inflammation of internal organs.
Symptoms of different forms of endometriosis
Endometriosis of the vagina and cervix
Pain and bleeding before your next period
Disruptions in the menstrual cycle
The appearance of spotting during or after intercourse
Menses last more than a week
The stomach hurts during menstruation and after intimacy
Pregnancy does not occur after a year of regular sex life without using contraceptive methods
Signs of endometriosis in older women
Endometriosis develops not only in young, but also in older women over the age of 50. Moreover, after menopause, the risk of the disease increases, which is due to a lack of progesterone in the body.
The following factors can provoke the development of endometriosis in old age:
- Diseases of the thyroid gland;
- Frequent infectious diseases carried by a woman throughout her life;
- Multiple surgical interventions, and the place of their localization does not matter.
Endometriosis in women over 50 years old may be indicated by symptoms such as:
- Sometimes vomiting occurs;
- Increased irritability, tearfulness, aggressiveness.
Lower abdominal pains rarely bother older women.
If endometriosis of the uterus develops during menopause, then the woman will be disturbed by bloody discharge, both abundant and insignificant.
Signs of internal endometriosis
The following symptoms will indicate internal endometriosis:
- Soreness of the affected area on palpation.
- Sharp pain during menstrual bleeding, which is localized in the lower abdomen.
- Increased pain during intimacy, after heavy lifting.
The ultrasound diagnostician visualizes on the screen characteristic nodes located on the wall of the uterus.
The clinical picture of the blood test is characterized by anemia, which is explained by regular bleeding.
Symptoms of the disease after a cesarean section
Endometriosis develops in women who have undergone caesarean section in 20% of cases. Cells begin to grow in the area of the scar and suture.
The following symptoms will indicate the disease:
- The appearance of bloody discharge from the seam;
- Slow scar overgrowth;
- Itching in the seam area;
- The appearance of knotty growths under the seam;
- Drawing pains in the lower abdomen.
If a woman discovers similar symptoms, she should consult a gynecologist and undergo an examination. In some cases, inpatient treatment is required.
Endometriosis, endometritis and uterine fibroids - what's the difference?
Endometriosis, endometritis and uterine fibroids are different diseases.
Endometritis is an inflammation of the inner layer of the uterus, which develops against the background of penetration of pathogenic microorganisms into its cavity. Endometritis is caused by viruses, bacteria, fungi, parasites. Endometritis does not affect other organs, only the uterus. The disease begins acutely, accompanied by an increase in body temperature, pain in the lower abdomen, discharge from the genital tract. Chronic endometritis resembles the symptoms of endometriosis.
A uterine fibroid is a benign tumor of the smooth muscle and connective layer of the uterus. Myoma develops against the background of hormonal disorders.
Are endometriosis and adenomyosis the same thing?
Adenomyosis is a type of endometriosis. With adenomyosis, the endometrium grows into the muscle tissue of the uterus. This disease affects women of reproductive age, and after the onset of menopause it goes away on its own. Adenomyosis can be called internal endometriosis. It is possible that these two pathologies will be combined with each other.
Why is uterine endometriosis dangerous?
Endometriosis of the uterus is dangerous for its complications, including:
- Formation of ovarian cysts that will be filled with menstrual blood.
- Infertility, miscarriage (frozen pregnancy, miscarriage).
- Neurological disorders due to compression of the nerve trunks by the overgrown endometrium.
- Anemia, which leads to weakness, irritability, increased fatigue, and other negative manifestations.
- Endometriosis foci can degenerate into malignant tumors. Although this does not happen more often than 3% of cases, nevertheless, such a risk exists.
In addition, the chronic pain syndrome that follows a woman affects her well-being and worsens the quality of life. Therefore, endometriosis is a disease that must be treated.
Can the stomach hurt with endometriosis?
The stomach with endometriosis can hurt. And sometimes the painful sensations are quite intense. As mentioned above, the pain increases after intercourse, during intimacy, after physical exertion, when lifting weights.
Pelvic pain occurs in 16-24% of all women. It can have a spilled character, or it can have a clear localization. Pain often worsens before the onset of the next menstrual period, but may also be present on an ongoing basis.
Almost 60% of women with endometriosis report painful periods. The pain is most intense in the first 2 days from the beginning of menstruation.
Endometriosis diagnosis begins with a visit to the doctor. The doctor listens to the patient's complaints and takes anamnesis. The woman is then examined in a gynecological chair. During the examination, it is possible to detect an enlarged uterus, and it will be the larger, the closer the next menstruation. The uterus is shaped like a ball. If uterine adhesions have already formed, then its mobility will be limited. It is possible to detect individual nodules, while the walls of the organ will have a bumpy and uneven surface.
To clarify the diagnosis, the following examinations may be required:
Ultrasound examination of the pelvic organs. The following signs indicate endometriosis:
- Anechoic formations up to 6 mm in diameter;
- The presence of a zone of increased echogenicity;
- Increase in the size of the uterus;
- The presence of cavities with liquid;
- The presence of nodes that have blurry shapes, resembling an oval (with a nodular form of the disease), which reach 6 mm in diameter;
- The presence of saccular formations up to 15 mm in diameter, if the disease is focal.
Hysteroscopy of the uterus. The following signs indicate endometriosis:
- The presence of holes in the form of burgundy dots, which stand out against the background of the pale mucous membrane of the uterus;
- Extended uterine cavity;
- The basal layer of the uterus has a relief contour resembling a toothed comb.
Metrosalpingography. The study must be carried out immediately after the completion of the next menstruation. Signs of endometriosis:
- Increased size of the uterus
- The location of the contrast agent outside of it.
- MRI. This study is 90% informative. But due to the high cost, tomography is rarely performed.
- Colposcopy. The doctor examines the cervix using binoculars and a lighting device.
- Identification of markers of endometriosis in the blood. Indirect signs of the disease are an increase in CA-125 and PP-12. It should be borne in mind that a jump in protein-125 is observed not only against the background of endometriosis, but also in the presence of malignant neoplasms of the ovaries, with uterine fibroids, with inflammation, and also in early pregnancy. If a woman has endometriosis, then her CA-125 will be elevated during menstruation and in the second phase of the cycle.
Treatment of endometriosis of the uterus
Only a comprehensive treatment of endometriosis will achieve a positive effect.
With the timely detection of the disease, there is every chance to get rid of it without involving a surgeon in the treatment. In the event that a woman ignores the signs of the disease and does not visit the gynecologist, this will lead to the fact that every month new foci of endometriosis will appear in her body, cystic cavities will begin to form, tissue will scar, and adhesions will form. All this will lead to blockage of the appendages and infertility.
Modern medicine considers several ways to treat endometriosis:
- Operation. Doctors try to resort to surgical intervention extremely rarely, when drug treatment has not yielded a positive result. The fact is that after the operation, a woman's chance of conceiving a child will be low. Although the latest advances in medicine and the introduction of laparoscopes into surgical practice allow for interventions with minimal injury to the body. Therefore, the likelihood of subsequent conception still remains.
- Medication correction. Taking medications for the treatment of endometriosis is one of the most effective treatments. A woman is prescribed hormones that contribute to the normalization of the ovaries and prevent the formation of foci of endometriosis.
The drugs that are used to treat the disease have a similar composition with oral hormonal contraceptives from the Decapeptyl and Danazol group. The treatment for a woman will be long, as a rule, it is not limited to several months.
To reduce the severity of painful sensations, the patient is prescribed pain relievers.
Until the early 80s of the last century, contraceptive drugs were used to treat endometriosis, which acted as an alternative to surgical intervention. They were prescribed for a period from six months to a year, 1 tablet per day. Then the dose was increased to 2 tablets, which avoided the development of bleeding. After the completion of such medical correction, the probability of conceiving a child was 40-50%.
Antiprogestins (Danazol and its analogues)
Danazol is one of the most effective drugs for the treatment of endometriosis. Its action is aimed at suppressing the production of gonadotropins, which causes the cessation of the menstrual cycle. After discontinuation of the drug, menstruation resumes. During treatment, the ovaries do not produce estradiol, which leads to the extinction of the foci of endometriosis.
Antiprogestins have several disadvantages, as they cause side effects in 85% of women who take them.
Among such undesirable phenomena:
- Weight gain;
- Decrease in the size of the mammary glands;
- Depression tendency;
- Excessive growth of facial and body hair.
Side effects of Danazol are explained by its androgenic action and impaired glucose tolerance.
The antiprogestin Mifepristone does not have sufficient clinical experience to judge its effectiveness.
GnRH agonists suppress the work of the hypothalamic-pituitary system, which leads to a decrease in the production of gonadotropins, and then affects the secretion of the ovaries. As a result, the foci of endometriosis die off.
Side effects of treatment with GnRB agonists are:
- Disruption of bone metabolism with possible bone resorption;
- Prolonged menopause, which can persist even after discontinuation of drugs in this group, which requires the appointment of hormone replacement therapy.
Drugs from the group of gonadoliberin agonists have been used in the treatment of endometriosis for over 20 years. They affect the course of the menstrual cycle. The action of all drugs in this group is similar, however, they have a different form of release. There are injections that need to be injected once every 3 months, there are means for monthly administration, and there are those that need to be injected every day. In addition, gonadoliberin agonists are available in the form of nasal sprays.
Bleeding in women with endometriosis during treatment with gonadoliberin agonists stops 2 months after the start of therapy. Vaginal bleeding may occur 3-5 days after the first dose of the drug. This bleeding continues for 2 weeks or less.
It is possible that in the first 14 days from the start of treatment, a woman will notice a worsening of her condition. However, after 1-2 months, all symptoms of endometriosis decrease, or disappear altogether. The reason for the deterioration of well-being is that the body stops producing some hormones. The level of estrogen increases, but only until the stabilizing effect of the drugs comes.
As for the recovery period after the abolition of gonadoliberin agonists, after 4-6 weeks in women the menstrual cycle resumes (for Burselin and Nafarelin in the form of a nasal spray), or after 6-10 weeks (for Goselerin, Triptorelin and Leiprorelin in the form of injections).
Combined oral contraceptives (COCs)
In 1950, scientists were able to establish the fact that oral administration of estrogens and gestagens in large doses helps to stop menstruation and prevents endometrial metamorphosis. After another 6 years, Dr. R. Kistner concluded that these hormones can be used to treat endometriosis. However, he prescribed to women too large doses of drugs by modern standards, which caused severe side effects against the background of prolonged use. In addition, women could not completely get rid of the androgenic effect of hormone treatment in the future (they took 40 mg of Norethinodrel and 0.6 mg of Ethinylestradiol per day).
After new progestogens were introduced into practice, and the dosage of drugs was reduced, the effect of COC treatment improved. If adverse reactions occur, they are reversible. Therefore, it is the combined oral contraceptives that have become the drugs of choice for the treatment of young women suffering from endometriosis.
Subsequently, additional studies were carried out, during which it was possible to establish that side effects after taking COCs appear in those 7 days during which a woman is menstruating and she does not take drugs. Therefore, it was decided to use a prolonged oral contraceptive regimen for the treatment of endometriosis. Currently, long-term use of COCs is prescribed for women with endometriosis as maintenance therapy after treatment with GnRH agonists. COCs are used in low doses (20 μg Ethinylestradiol). Doctors recommend this treatment regimen for women who plan to conceive a child in the future, but need long-term therapy for endometriosis. A similar therapeutic program is prescribed for patients with chronic pain in the pelvic area that occurs after surgery for endometriosis.
If patients take combined contraceptives according to the classical scheme (21 days of admission, 7 days off), then they have certain problems with menstruation. While long-term use of COCs (63 days of taking and 7 days off) can get rid of these problems. Complaints and negative symptoms disappear in 74% of women, which has been proven in numerous clinical studies.
If you use only gestagens for the treatment of endometriosis for a long time and in high doses, then this will necessarily lead to massive and prolonged bleeding. Another complication of this therapeutic regimen is the occurrence of metabolic disorders. In this regard, the appointment of only gestagens to get rid of endometriosis is not advisable.
Modern progestogens are much more advanced drugs than COCs of the last century. So, from the progestogen Dienogest, such a modern and effective drug for the treatment of endometriosis, like Janine, was synthesized.
Dienogest is the first progestogen that, in combination with ethinyl estradiol, has powerful gestagenic properties, allows quality control of the menstrual cycle, does not provoke intermenstrual breakthrough bleeding. In its structure, it is close to 19-nortestosterone, which makes its bioavailability high and makes it possible for the drug not to affect lipid metabolism. Dienogest also has similar properties with progesterone derivatives, which boil down to a slight antigonadotropic effect and a pronounced peripheral effect, which is manifested in the absence of androgenic activity, but in a pronounced antiandrogenic effect.
Clinical studies have established that Dienogest eliminates the manifestations of endometriosis, but has practically no effect on metabolic processes, suppressing the production of estradiol by the ovaries. Moreover, compared with other drugs, very small doses are required to get rid of endometriosis with the help of Dienogest.
Numerous clinical studies of Dienogest made it possible to establish that this particular drug is the most promising in the treatment of endometriosis in young women (in comparison with other analogues of gonadoliberin).
Studies that were conducted in 1999 with the participation of 267 patients suffering from endometriosis, made it possible to establish that the safety and tolerance of Dienogest is higher compared to Danazol and GnRH agonists, and the effectiveness of the drugs is almost the same. After six months of treatment with Danazol, the women were referred for endoscopy, according to the results of which they were completely cured. Relapses in the next six months occurred only in 7.7% of patients. In terms of side effects, headaches, nausea and depression were reported in 10.5% of cases. At the same time, the overwhelming majority of women noted that their skin condition became much better. The weight of the patients did not change, there were no jumps in blood pressure, liver dysfunctions.
In further studies, it was found that Dienogest promotes the reverse development of endometriosis.
In the composition of the drug Janine, the content of Dienogest is equal to 2 mg, and Ethinylestradiol - to 30 μg. Treatment with Janine very rarely leads to "breakthrough" bleeding, but amenorrhea and hypomenorrhea develop on the background of taking it more often. A large-scale study was conducted with the participation of 11 thousand women who took Janine for six months. In 73% of them, the condition of the skin has significantly improved, the symptoms of acne have disappeared. In addition, it has been proven that Janine does not interfere with lipid metabolism, does not affect hemostasis.
Modern gynecology is revising the dosage regimens of COCs. Increasingly, the interval between pill-taking cycles is shortened to minimize side effects. Doctors practice long-term contraceptive regimens, which consist of 60-80 days (naturally, as part of the treatment of endometriosis). Even now, we can say with 100% certainty that Janine is an effective drug for the treatment of endometriosis with its prolonged use. The interval between cycles should not exceed 4 days (modern standard of treatment), and the duration of the course is determined on an individual basis.
Studies were carried out, during which 59 women with adenomyosis were treated with the help of Janine's drug (in 29 of them, before the start of the course, an operation was performed to remove endometriotic adhesions).
The course of treatment lasted for 63 days with an interval of 7 days. The results of this treatment:
- Elimination of dysmenorrhea, reduction of menstrual blood loss, reduction of pain;
- Excellent tolerability of the drug by patients from both groups;
- Reduction of adenomyosis and the size of foci of endometriosis (ultrasound data);
- The effectiveness of the treatment - in women without surgery: 94.6%, in women after surgery: 89.7%.
Side effects that women have noted are bloody spotting. They were observed during the first 3 months of taking Janine. However, not a single patient refused to take the drug for this reason.
Also, a large-scale survey of gynecologists was carried out about their attitude and personal experience of prolonged use of COCs. 365 doctors filled out the questionnaires, and 58% of them noted that they had practiced a similar treatment regimen for endometriosis, and it was very successful.
So, Janine can be prescribed to women in the following cases:
- As an independent method of treating endometriosis without surgery.
- As a preparation for the patient before the upcoming surgery for the removal of endometriosis.
- To exclude a relapse of the disease after surgery.
As for the possibility of prolonged treatment, this issue should be resolved on an individual basis, taking into account all the nuances.
Endometriosis can be treated with a variety of drug groups, but COCs are the drugs of choice. There are also prospects for the treatment of endometriosis with synthetic progestins in combination with gonadotropin agonists. On this occasion, modern scientists are conducting research that already makes it possible to judge the upcoming success.
Duphaston with endometriosis
Duphaston is an analogue of a natural progestin that allows you to correct various diseases in women caused by progestin deficiency.
Taking Duphaston replenishes the deficiency of progestin, and also facilitates the course of various pathologies of the genital area. Duphaston can be safely attributed to the drugs of the last generation, since the dydrogesterone included in its composition does not give those undesirable reactions that lead to the intake of androgenic progesterones.
Duphaston is prescribed for the treatment of endometriosis, with the threat of miscarriage, with dysmenorrhea, against the background of PMS, with the impossibility of conception (infertility), etc.
Reception of Duphaston allows you to balance the effect of estrogens on the body, and therefore, suppress endometriosis and reverse development of already existing foci. Dufaston can be prescribed in combination therapy with laparoscopy.
Despite the positive effects from the use of Duphaston, it has a number of contraindications, including:
- Dabin-Johnson syndrome.
- Individual intolerance to the components of the drug.
- Rotor Syndrome.
- Cardiovascular diseases.
- Kidney pathology.
In the treatment of endometriosis, agents such as:
- Visanne with endometriosis
- Janine with endometriosis
- Silhouette with endometriosis
- Klayra with endometriosis
- Spiral Mirena with endometriosis
Surgical treatment of endometriosis
Surgical treatment of endometriosis guarantees the removal of its foci, but does not exclude a recurrence of the disease. Often, women with this pathology have to undergo several interventions. The risk of developing a relapse varies between 15-45%, which largely depends on the degree of spread of endometriosis in the body, as well as on the location of the pathological process. Affects the likelihood of relapse and how radical the first intervention was.
Laparoscopy is the gold standard of modern surgery for the treatment of endometriosis. With the help of a laparoscope inserted into the abdominal cavity, it is possible to remove even the most minimal pathological foci, remove cysts and adhesions, and dissect the nerve pathways that provoke persistent pain. It is worth noting that cysts that are provoked by endometriosis must be removed without fail. Otherwise, the risk of disease recurrence remains high.
Self-treatment of endometriosis is unacceptable. The therapeutic tactics must be determined by a doctor.
If endometriosis is difficult, then removal of the affected organ is necessary. This is also possible using a laparoscope.
Doctors consider a woman cured of endometriosis if she is not worried about pain and has not relapsed 5 years after the therapy.
If endometriosis is diagnosed in a woman of childbearing age, then doctors do their best to preserve her reproductive function. It should be noted that the level of modern surgery is quite high and allows women 20-36 years old to bear and give birth to a healthy child in 60% of cases.
The use of endoscopes during surgery allows you to remove even the smallest foci of endometriosis. Further hormonal treatment makes it possible to avoid a relapse of the disease. If endometriosis leads to infertility, then endoscopic treatment is practically the only chance a woman has for successful motherhood.
Endometriosis is a disease that is dangerous for its complications. Therefore, it is so important to diagnose and treat it in a timely manner. The complex application of all modern technologies of surgical intervention: the combination of cryocoagulation, laser removal, electrocoagulation makes it possible to carry out the operation with the maximum chances of successful completion.
The most effective way to treat endometriosis is considered to be carrying out laparoscopy (of course, if conservative treatment fails) with further hormonal therapy. The use of GTRG after surgery increases its effectiveness by 50%.
Which doctor treats endometriosis?
Endometriosis is treated by an obstetrician-gynecologist.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.