Ovarian endometriosis
The cells of the inner mucous membrane of the uterus with endometriosis migrate to the fallopian tubes, ovaries, intestines, bladder, kidneys, lungs, eyes. These are hormone-dependent formations, so during menstruation they begin to bleed in the same way as the endometrium of the uterus. In many pathological foci of endometriosis, blood cannot find a way out, it accumulates and forms a cavity - a cyst. The contents of this cavity decompose, the cyst enlarges with each menstruation, causing severe pain to the woman.
Ovarian endometriosis is the most common type of this disease. It is recorded in 35% of patients who visit a doctor with complaints of gynecological problems. The main age group of cases is women 22-45 years old. A latent (latent) form of pathology is found even in adolescent girls 10-14 years old - in about 5-10% of cases. The absence of symptoms significantly complicates the diagnosis of ovarian endometriosis.
Content:
- Classification of disease stages
- Clinical symptoms of ovarian endometriosis
- Diagnosis of ovarian endometriosis
- Ovarian endometriosis causes
- Ovarian endometriosis treatment
- Ovarian endometriosis and pregnancy
- Prevention
Classification of disease stages
Endometriosis is mentioned in the papyri of the ancient Egyptian priests. At the present historical stage, there is an increase in the incidence of endometriosis. Every third woman undergoing a diagnostic examination for infertility has ovarian endometriosis. Over time, pathological foci transform into endometrioid cysts.
This form of the disease belongs to the group of genital endometriosis, since it affects the reproductive organs. A similar dysfunction of the ovaries is caused by a violation of the contractility of the fallopian tubes, an imbalance in the functioning of the endocrine glands.
Ovarian endometriosis grades:
- I. On the surface of the ovaries, as well as on the peritoneum, small flat single foci are found.
- II. On the walls of the ovaries, endometrioid plaques and small cysts 3-4 cm in diameter are formed.
- III. Adhesions appear that interfere with the patency of the fallopian tubes.
- IV. The cysts on the ovary increase in size (up to 5 cm in diameter), adhesions spread to the intestines and bladder.
A characteristic feature of ovarian endometriosis is “chocolate cysts”. They got their name for the color and consistency of the inner contents, similar to liquid melted chocolate. This form is acquired by coagulated blood that has entered the cyst from the vessels damaged by endometriosis. Cyst replenishment occurs during menstruation, so the growth of formations and the menstrual cycle are closely related.
In the later stages of endometriosis, pathological foci fill a vast area of the ovary. Cysts merge into nests or nodes on the surface of the gland, they have an irregular shape, filled with a tarry thick liquid.
Find out more: Endometrioid Ovarian Cyst
Clinical symptoms of ovarian endometriosis
For a long time, pathology may not give itself out. The first signs of the disease appear as the endometrioid cyst grows, as well as due to micro-ruptures in the foci of the disease. Depending on the stage of the disease, the phase of the menstrual cycle and the age of the patient, the symptoms of ovarian endometriosis may differ from woman to woman.
The most typical manifestations:
- Pain of a different nature. The symptom appears in 2/3 of women with a similar diagnosis. These are aching pulling pains in the lower abdomen, their frequent localization is 3-4 cm below the pelvic bones. With the spread of the disease, pain is felt in the lower back and sacrum. With the onset of menstruation, the pain intensifies, acquires a cutting character, radiates into the vagina, into the rectum. In the later stages of ovarian endometriosis, the pain is so strong that the woman's well-being is noticeably deteriorating, and vomiting appears. Sometimes the pain is felt during exercise or sexual intercourse. If the cyst ruptures, the woman feels sudden, sharp pain. In this case, the muscles of the anterior abdominal wall are tense. This situation requires immediate hospitalization.
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Pelvic pain. The symptom is specific only to ovarian endometriosis. Unpleasant painful sensations in the pelvic area may persist even after treatment. A woman cannot work, realize sexual contacts, socially adapt. If the pain is not relieved by specific therapy, the patient may be assigned a disability.
- Infertility. In 50% of cases of infertility, it occurs against the background of ovarian endometriosis due to hormonal imbalance or due to a mechanical obstacle to fertilization of the egg. Inflammation causes a violation of the secretion of hormones by the ovaries, that is, reproductive dysfunction. Mechanical infertility is provoked by adhesions and cysts, which prevent fertilization and the advancement of the egg through the tubes to the uterus.
- Dysmenorrhea. About a third of women with ovarian endometriosis have a pathological course of the menstrual cycle: sharp pain, dizziness, weakness, low-grade fever, chills, nausea, vomiting (for more details: primary and secondary dysmenorrhea - causes, symptoms, treatment).
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Dyspareunia. This term refers to discomfort during sexual intercourse, manifested by pain or discomfort in the external genitals, in the small pelvis. This symptom manifests itself in 75% of women with ovarian endometriosis. If the process has gone too far, during intimate contact, the woman may pass out from intense pain.
- Dyschezia (dyschezia). Due to muscle tension during bowel movements, the pressure on the ovaries affected by endometrioid cysts increases. The woman experiences pain in the rectum and abdomen.
- Constipation. This symptom most often manifests itself in endometriosis of the left ovary, marked by the formation of a large cyst. It limits bowel movements, causing constipation.
- Bloating, frequent urge to urinate. Symptoms appear if the peritoneum is involved in the pathological process simultaneously with the ovaries.
- Menstrual irregularities. Menstruation becomes longer and the volume of discharge increases. Sometimes, a few days before menstruation and 2-7 days after it, dark spotting appears. They are caused by an increase in estrogen concentration with a decrease in progesterone production.
Due to hormonal imbalance, women become whiny, irritable, their skin condition worsens, it becomes flabby, dry, or, conversely, acne appears. Sleep disturbances, depression, depression are observed.
Diagnosis of ovarian endometriosis
It is very difficult to make an accurate diagnosis by visual examination. The only thing that can be noticed is the dense and immobile ovaries, which can be fused with the uterus and peritoneum into a single whole.
Laboratory diagnostic methods:
- Complete blood count - leukocyte count may be increased;
- Biochemical blood test for oncogenes (the norm can be exceeded by one and a half times - up to 45 units);
- Vaginal smear for genital infections.
Instrumental diagnostic methods:
- Ultrasound examination to diagnose an endometrioid cyst;
- Hysterosalpingography - X-ray of the uterus and ovaries;
- Diagnostic laparoscopy to detect adhesions, determine the degree of damage;
- CT, MRI to differentiate endometriosis from a malignant tumor.
When diagnosing endometriosis on the ultrasound monitor, the following signs are noted:
- The ovarian contour is deformed;
- Its capsule is thickened and compacted;
- The foci of the endometrium on the surface of the ovary have a homogeneous structure, clear boundaries;
- Their shape is oval or round;
- The cyst has a doubled contour, increased echogenicity, up to 5-6 cm in diameter;
- Intra-abdominal fluid accumulates in the small pelvis;
- There are large numbers of adhesions around the ovary.
Ovarian endometriosis causes
Normally, when endometrial cells enter the pelvis through the fallopian tubes, the macrophages of the immune system immediately destroy them. If this does not happen, the glandular cells are implanted into the ovarian tissue and grow.
The reasons:
- Genetic predisposition;
- Lowered immunity;
- Physical and mental overload;
- Excessive sun exposure;
- Postponed operations of the organs of the reproductive system (abortion, cauterization of cervical erosion, cesarean section);
- Obesity;
- Sedentary lifestyle;
- Long-term use of an intrauterine device;
- Hormonal imbalance.
There are two theories for the development of endometriosis. According to one of them, endometrial cells are thrown out during menstruation not into the cervical canal, but into the fallopian tubes, and from there into the peritoneum. They take root, multiply, forming separate formations. According to another theory, these cells die, but they manage to transfer their properties to the cells of the surrounding tissues.
Ovarian endometriosis treatment
There are three treatments for ovarian endometriosis:
- Surgery;
- Conservative therapy;
- Combined method.
Conservative therapy is used in the early stages of the disease in young women in the treatment of infertility. The main drugs are hormones used to suppress estrogen production:
- COCs (Diane-35, Zhanin, Logest, Regulon) - the course of treatment lasts up to 9 months;
- Gonadotropin antagonists (Buserelin, Zoladex) - the course lasts up to six months;
- Levonorgestrel - the introduction of the Mirena intrauterine device, which produces microdoses of progesterone;
- Medroxyprogesterone (Depo-Provera) - the course lasts up to 9 months;
- Androgens for causing amenorrhea (Gestrinone, Danazol) - the course lasts up to 6 months, there are side effects.
Additionally, the woman takes painkillers, NSAIDs, analgesics, absorbents and desensitizers.
With the ineffectiveness of conservative therapy, contraindications to the use of hormones, large formations, a diagnosed endometrioid ovarian cyst, dysfunction of neighboring organs, surgical treatment is performed.
Surgical methods:
- Enucleation - laparoscopic removal of small foci using a special probe that delaminates the cyst membrane;
- Laser or electrical coagulation - cauterization of foci of endometriosis;
- Laparotomy - removal of formations after dissection of the abdominal wall.
If there is oncological alertness, or the disease progresses rapidly, the ovaries or uterus are removed together with the ovaries. The combined approach is a combination of two methods, when hormonal correction is performed after surgery. This is the gold standard for endometriosis treatment.
To consolidate the result, physiotherapeutic procedures are used (electrophoresis, radon baths, magnetotherapy, electroneurostimulation), as well as treatment with leeches. It is desirable that the woman receive the help of a psychotherapist. Mud, massage, paraffin wax are contraindicated, as these methods stimulate the production of estrogen.
If the treatment does not end with the removal of the reproductive organs, as a result, the woman's fertility is restored, she gets rid of the symptoms of endometriosis. Within a year after therapy, it is necessary to monitor the state of the ovaries, donate blood for markers of the disease, undergo an ultrasound scan.
Ovarian endometriosis and pregnancy
With this form of the disease, there is still a considerable chance to restore fertility, although there is a risk of an ectopic pregnancy due to adhesions in the fallopian tubes. If conception occurs, the disease will not affect the bearing of the child and his health. With a large size of the endometrioid cyst, it is likely to rupture, so it is advisable to remove the cyst before planning pregnancy.
Prevention
Distinguish between primary and secondary prevention. To prevent the development of ovarian endometriosis, you should visit your doctor if you experience menstrual irregularities, discomfort or pain, severe premenstrual syndrome.
Measures to prevent ovarian endometriosis:
- Regular doctor visits;
- Timely treatment of diseases of the reproductive organs;
- Physical activity, exercise, physical education;
- Maintaining optimal body weight, combating obesity;
- Eating enough vegetables and fruits;
- Prohibition of sexual intercourse during menstruation;
- Refusal of abortion, use of hormonal contraception;
- Prevention of stressful situations.
An interesting fact is that those women who use oral contraceptives to prevent unwanted pregnancies almost never get endometriosis.
The most effective treatment strategy for ovarian endometriosis is to treat the disease in its early stages. It is important to timely diagnose the appearance of endometrioid cysts and formations in order to successfully get rid of them.
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.
