Symptoms of endometriosis in women. The fourth degree of endometriosis: symptoms and treatments Stages of uterine endometriosis

Endometriosis is a common non-tumor disease in women. Its varieties: internal and external. They differ in the affected organs. Internal endometriosis is a painful change in its muscle tissues. Otherwise it is called adenomyosis. External endometriosis refers to tissues outside the uterus. It affects the perineum and ovaries.

Internal endometriosis of the uterus is a diffuse or focal change in the myometrium. If the endometrial tissue grows into knots, the form of endometriosis is called nodular. Adenomyosis often occurs as a result of abortion, curettage of the uterus for diagnostic purposes. During scraping, there is a violation of the connective tissue of the endometrium in its basal layer and adjacent muscles.

In this case, prerequisites arise for the ingress of endometrial particles into the muscular layer of the uterus with the development of painful foci in it. Chronic endometriosis - caused by the growth of the endometrium, inflammation of the uterus.

Symptoms

One of the main signs of the disease is prolonged heavy menstruation, accompanied by pain. At the same time, the uterus grows, and menstruation is preceded by pain in the lower abdomen, which stops only a few days after it begins. Adenomyosis is characterized by a diffuse process, while the nodular form leads to local growth of endometrial tissue.

The knotty variety of endometriosis causes, in addition to the described signs, disorders of the autonomic system, including nausea, vomiting, accompanied by pain in the head up to loss of consciousness.

The disease is often complicated by tumor diseases of the uterus and ovaries. An ovarian cyst may develop. This is how endometriosis manifests itself.

Classification

As already mentioned, adenomyosis is accompanied by focal endometrioid lesions of the muscular layer of the uterus, called the myometrium. According to the depth of penetration, adenomyosis includes several stages.

Degrees of endometriosis.

The first degree, if the focus of endometrial growth is the only one. At this stage, the size of the myometrial lesion reaches a depth of 1 cm.

Second degree: a series of small lesions affecting the myometrium to the middle.

Third degree, when the lesion extends to the outer serous layer of the uterine membrane.

Endometriosis of the 4th degree, when a complete lesion of all uterine layers develops, up to the parietal peritoneum.

Diagnostics

Only in very rare cases, internal endometriosis of the body of the uterus is diagnosed during examination by a gynecologist. A change in the shape of the uterus to a round one and an increase in its size are not sufficient for a confident diagnosis. Especially if the patient has endometriosis of the 1st degree.

A dynamic ultrasound examination can confirm the suspicion of the presence of endometriosis. It is able, especially in the presence of a vaginal sensor, to identify the localization of the disease. Cases of focal forms of the disease can be found less frequently than diffuse lesions. It can sometimes be confused with newly appeared foci of fibromyomas. Differential diagnosis is aided by a test for internal endometriosis. An increase in the activity of this marker usually occurs in severe cases of the disease.

An accurate diagnosis allows you to put a comprehensive examination of the blood of patients for markers of endometriosis, ultrasound diagnostics, computed tomography. In this case, it is necessary to take into account the complaints of patients about menstrual irregularities and specific pains that occur periodically.

Colposcopy helps to make the diagnosis much easier. Hysterosalpingography, performed on the 5th day of menstruation, is widely used. At this time, the mucosa does not interfere with the appearance of contrast material in the foci of endometriosis accessible from the uterine cavity.

A lot of information can be given by hysteroscopy performed on the 5th day of menstruation. If the menstrual cycle is disturbed, the analysis is carried out after curettage. Hysteroscopy shows in detail the inside of the uterus, the exits of the fallopian tubes, the endometrial passages leading into the uterine cavity.

Especially informative laparoscopy, which allows to detect endometriosis at the beginning of its development.

Treatment

The treatment process aims to limit the development of the disease, reduce its manifestations and restore lost functions. Treatment options can be conservative or surgical. Conservative therapy is divided into hormone replacement and non-hormonal. The specific treatment strategy is determined by the location of the focus of endometriosis, its size, the severity of symptoms of endocrine and immune abnormalities. The age of the patient and her plans for pregnancy also matter.

Conservative treatment can give an effect if internal endometriosis of the 1st degree occurs.

Serious help is provided by anti-endometrioid drugs. As a rule, these are hormone antagonists that are capable of suppressing the female reproductive system.

Antihormones for the treatment of endometriosis:

progestins;
estrogen antagonists;
progestin antagonists;
complex estrogen-gestagenic drugs;
antigonadotropins;
antigonadoliberins.

With a diffuse spread of internal endometriosis, a hysterectomy is resorted to; in the case of a nodular form of the disease, it is permissible to perform an operation that preserves the reproductive organs.

Surgery

Nowadays, methods of conservative treatment with hormone therapy give good results in the fight against the disease.

However, a number of forms of endometriosis require surgical intervention:

in the case of a retrocervical form of the disease;
if there is an endometrioid ovarian cyst;
if conservative therapy does not work;
with a combination of adenomyosis with fibroids and uterine bleeding;
if there is a suspicion of an ovarian tumor;
with a nodular form of the disease;
with a diffuse variety of adenomyosis (high stage);
if the functions of other organs are impaired.

Surgical intervention usually consists of laparoscopy, which involves a minimally invasive operation. More rarely, in difficult cases, a laparotomy is performed, requiring dissection of the peritoneal wall. Laparoscopy is performed by electrocoagulation or by means of a laser. Foci of endometriosis are cauterized or removed.

The results of treatment are determined by the volume of surgical intervention and the correct choice of hormonal treatment. Rehab usually goes without a hitch. As a result, it is possible to restore the reproductive function, significantly reducing pain during menstruation. In the future, the patient should be observed by a gynecologist, regularly conducting ultrasound and monitoring the CA-125 marker in the blood.

- This is a benign invasion and proliferation of endometrial elements in the muscular layer of the uterus.

Traditionally, internal endometriosis is considered a local case of endometrioid disease -. At the same time, many authors describe it as an independent disease - adenomyosis.

Internal endometriosis: ICD-10 code

N80 Endometriosis
N80.0 Uterine endometriosis (adenomyosis, internal endometriosis)

Reasons for the development of internal endometriosis

Destruction intermediate zone myometrium during instrumental or surgical interventions on the uterus (abortion, caesarean section, "blind" curettage of the endometrium, intrauterine device, etc.)
Hereditary predisposition to tumor diseases, genetically determined failure of the intermediate zone of the myometrium.
Chronic inflammatory diseases of the uterus and appendages.
Immune and hormonal disorders.

Factors that increase the risk of developing adenomyosis:

Frequent instrumental intrauterine interventions (abortions, diagnostic curettage, etc.)
High infectious index.
Chronic somatic diseases: hypertension, obesity, diabetes, gastrointestinal diseases, allergies, etc.
endocrine disorders.
High frequency of transferred gynecological diseases.
Shortened (less than 27 days) menstrual cycle, heavy long periods.
Senior reproductive age.

Symptoms of internal endometriosis

Profuse prolonged menstruation.
Algomenorrhea.
pain different intensity: lower abdomen, chronic pain in the pelvic area, in the lower back.

Other Clinical Signs of Internal Endometriosis

Enlargement of the uterus. Sensation of a "big belly" during menstruation.
Smearing blood-brown ("chocolate") discharge from the uterus a few days before and after menstruation.
Secondary anemia.
Acyclic smearing "chocolate" discharge after intercourse, heavy lifting.
Painful intercourse.
Miscarriage: early miscarriage, premature birth.
Infertility.

The main symptoms of internal endometriosis

Diagnosis of internal endometriosis

Objective gynecological examination

An experienced gynecologist will notice the classic signs of internal endometriosis during a routine bimanual examination:

Enlargement of the uterus.
Change in the shape of the uterus (spherical or tuberous).
Rough surface of the uterus in the second phase of the menstrual cycle.
Painful uterus.

Ultrasonography Transvaginal echography (ultrasound) is the initial method of instrumental diagnosis of internal endometriosis.

Despite the rather high (up to 80-90%) diagnostic accuracy of ultrasound, the detection of internal endometriosis of 1-2 degrees by this method is associated with certain difficulties and is not always possible. When adenomyosis is combined with multiple fibroids, the prognostic value of ultrasound is significantly reduced.

For a more accurate diagnosis of adenomyosis, ultrasound should be performed in the second half of the menstrual cycle, closer to the onset of menstruation.

Echo-signs of internal endometriosis

The uterus is round.
In the myometrium, hyperechoic zones of various sizes are determined, more often rounded.
Inside areas of increased echogenicity, anechoic (cystic) cavities can be detected, sometimes large up to 3 cm, filled with a fine suspension (symptom of "honeycomb").
The anteroposterior dimensions of the uterus are enlarged or one of the walls of the uterus is unevenly thickened.
Defects in the basal layer of the endometrium: jaggedness, uneven thickening or thinning. The boundaries between the endometrium and myometrium are indistinct.
Hypo- and hyperechoic bands in the myometrium, located close to each other, perpendicular to the scanning plane (echogenic linear striation).

Echogram. Diffuse internal endometriosis Magnetic resonance imaging

MRI of the uterus is a more accurate (compared to ultrasound) method of instrumental diagnosis of adenomyosis. Due to the high cost, this study is optional. However, many authors believe that MRI should become the standard diagnostic procedure in cases of high-grade algomenorrhea because this symptom always suggests internal endometriosis.

In addition, MRI can detect the disease at an early 1st stage of its development. An important diagnostic MRI sign of adenomyosis is a thickening of the intermediate zone of the myometrium of more than 12 mm (at a norm of 2-8 mm).

MRI of the pelvis - internal endometriosis Hysteroscopy

This method of diagnosing adenomyosis is based on a visual examination of the inner surface of the uterus using endoscopic equipment.

Signs of internal endometriosis with hysteroscopy:

Deformation, expansion of the uterine cavity.
Against the background of a pale pink uterine mucosa, the orifices of bleeding endometrioid passages are visible.
The walls of the uterus have an uneven rocky relief - the phenomenon of "waves" or ridge formation.

Hysteroscopy is used to diagnose internal endometriosis.
on the 6th-9th day of the menstrual cycle.

In the case of adenomyosis, the most informative is hysteroscopy with mandatory targeted biopsy suspicious area of the myometrium.

After diagnostic hysteroscopy and biopsy is always carried out separate diagnostic curettage mucous membrane of the uterus and cervical canal (under the mandatory control of hysteroscopy). All removed endometrial tissues and myometrial biopsy are sent for histological examination.

The final diagnosis of internal endometriosis is made after confirmation by a histological conclusion.

Internal endometriosis in 31-56% of cases is combined with another pathological transformation of the endometrium (including malignant). But most often - from the uterus (up to 85% of cases).

Degrees of internal endometriosis

The severity of the diffuse form of internal endometriosis is determined by the degree of damage to the uterus:

Ι degree - invasion of the endometrium into the myometrium is limited to the intermediate zone (submucosal layer of the myometrium).
ΙΙ degree - the depth of endometrioid ectopia does not exceed half of the myometrium (up to the middle of the thickness of the muscular layer of the uterine wall).
ΙΙΙ degree - the defeat of the largest part or the entire muscular layer of the uterus up to the outer serous membrane.
ΙV degree - the pathological process goes beyond the uterus and spreads to the parietal peritoneum of organs adjacent to the uterus.

Internal endometriosis 1 degree

It proceeds, as a rule, asymptomatically, often becomes an accidental histological finding or is predicted by MRI results.

Asymptomatic grade 1 adenomyosis does not require special treatment. The patient is recommended a healthy lifestyle and dynamic observation by a gynecologist once every 6 months.

Internal endometriosis 2 degrees

And at this stage of the disease, the symptoms of internal endometriosis are not always noticeable. Therefore, the disease can be detected by chance (on a planned ultrasound, during an examination of a patient with complaints of infertility).

But more often, the 2nd degree of adenomyosis is accompanied by algomenorrhea, polymenorrhea, pelvic pain, "chocolate" spotting, dyspareunia.

In some cases, the only sign of pathology is infertility or miscarriage.

The uterus at this stage of the disease is of normal size or slightly enlarged (does not exceed 5-6 weeks of pregnancy).

In asymptomatic forms of grade 2 adenomyosis, treatment is not carried out - dynamic observation is recommended.

With a mild symptomatic course, it is permissible to prescribe monophasic COCs, for example, progestins, including intrauterine ones. Evaluation of the effectiveness of hormonal treatment - every 3-6 months.

For pelvic pain or algomenorrhea, short courses of NSAIDs are also prescribed.

Read more about the medical treatment of internal endometriosis below.

Internal endometriosis 2-3 degrees

Accompanied by pain hyperpolymenorrhea, an increase in the size of the uterus, infertility (in 50% of cases) and other signs characteristic of adenomyosis.

The choice of treatment - hormonal or surgical - is individual. It depends on the severity of the course of the disease, the age and reproductive plan of the woman, the gynecological and somatic pathology associated with adenomyosis.

Internal endometriosis 3-4 degrees

This advanced stage of the disease is accompanied by vivid symptoms and requires surgical treatment.

The volume and access of surgical intervention, postoperative hormone replacement or anti-relapse therapy is prescribed strictly individually, if necessary and according to indications.

Endometriosis of any localization is similar to a tumor with a chronic course and autonomous growth of pathological foci.

Therefore, a true cure for this disease is possible only with the most complete surgical removal of absolutely all endometrioid ectopia. In the case of internal endometriosis, this effect is achieved total removal of the uterus.

But if the disease affects young women, those interested in preserving childbearing function have to look for other, less radical, organ-preserving methods of treatment.

Medical hormonal treatment of internal endometriosis

No drug cures internal endometriosis completely. Hormone therapy only temporarily suppresses the disease.

Drug therapy of internal endometriosis is justified in young nulliparous women.

In other cases, hormonal agents, if necessary, are prescribed after surgical treatment as anti-relapse therapy.

According to many clinicians, a truly effective hormonal-suppressive treatment of adenomyosis is possible only with 1-2 degrees of spread of the disease.

Today, the following groups of hormonal drugs are used in the treatment of internal endometriosis:

A-GnRH - analogues of gonadotropin-releasing hormone: Nafarelin, Buserilin, Leuprorelin, Triptorelin.
Antigonadotropins: Danazol, Gestrinone.
Progestins: Medroxyprogesterone, Dienogest (), Levonorgestrel.

Modern preparations of A-GnRH are recognized as the most effective. They are called the "gold standard" of conservative treatment of endometriosis of any localization.

Some hormonal treatment regimens for internal endometriosis

/doctor's consultation required/

A drug	Trade Name	Routes of administration and doses
Triptorelin	Decapeptyl Depot Diferelin
Goserilin	Zoladex	3.6 mg intramuscularly 1 time in 28 days. Only 3-6 injections
Leuprorelin acetate	Lucrin Depot	3.75 mg intramuscularly 1 time in 28 days. Only 3-6 injections
Nafarelin	Sinarel	Nasal spray. 400 mcg daily for 3-6 months
Danazol	Danoval Danol	1 capsule (200 mg) orally, 2 times a day, daily, continuously for 6 months
Gestrinone	Nemestra	1 capsule (2.5 mg) orally, 2 times a week, continuously for 6 months
Medroxy- progesterone acetate	Provera	10 mg 3 times a day, orally, for 6 months continuously
Dienogest	Bysanne	2 mg once a day, orally, continuously, no more than 15 months
Levonorgestrel	Hormonal intrauterine spiral LNG-Navy Mirena	It is installed inside the uterus for up to 5 years. It is used to treat stage 1-2 adenomyosis in women who are not interested in pregnancy

Both antigonadotropins and A-GnRH suppress menstrual function - they create a state of "medicated menopause" or pseudomenopause. Despite the high efficiency in relation to adenomyosis, treatment with these drugs is accompanied by many undesirable side effects, symptoms of menopause. Therefore, the duration of their application is strictly limited to six months.

After the abolition of A-GnRH, menstrual and reproductive function is restored independently within 6-12-36 months. Remission of the desired disease lasts up to 5 years or more. During this period, a woman manages to give birth to a child or approach natural menopause with the reverse development (involution) of the disease.

Recurrence of internal endometriosis after conservative therapy is an indication for surgical treatment.

Surgical treatment of internal endometriosis

Even taking into account all the complexity and imperfection of the medical treatment of adenomyosis, radical surgical treatment of internal endometriosis - removal of the uterus - is carried out exclusively according to strict indications.

Indications for surgical treatment of adenomyosis:

There is no positive effect from hormone therapy during the first 3 months of treatment.
Adenomyosis grade 2-3 in combination with ovarian tumors, fibroids, endometrial hyperplasia or other uterine pathology requiring surgical treatment.
Adenomyosis 2-3 degree with symptoms of hyperplastic transformation of the muscular layer of the uterine wall.
Adenomyosis resistant to conservative treatment, accompanied by uterine bleeding and secondary anemia.
Cystic form of adenomyosis.

The volume of surgical intervention in the diffuse form of internal endometriosis:

Supravaginal amputation of the uterus - supracervical or subtotal hysterectomy (with or without appendages).
Complete removal or extirpation of the uterus - total hysterectomy (with or without appendages).

Hysterectomy. The volume of surgical intervention for adenomyosis

A supravaginal hysterectomy is less dangerous than total hysterectomy. Therefore, when choosing the volume of surgical intervention, it is extremely important to adequately assess the feasibility of preserving the cervix and ovaries. Oncologists recommend unequivocally removing the fallopian tubes.

Operative access options in surgery for internal endometriosis:

Laparoscopy.
Laparotomy.
Vaginal access in combination with laparoscopy.

Hysterectomy. Online Access Paths

The priority place in the surgical treatment of internal endometriosis is traditionally occupied by laparoscopy.

Advantages of laparoscopy:

Minimal injury.
Significant reduction in postoperative rehabilitation.

In the case of an intact (not involved in the disease) vaginal part of the cervix, a laparoscopic supracervical hysterectomy (LSH) is recommended. Otherwise, a total laparoscopic hysterectomy (TLH) is performed.

Contraindications to laparoscopy for adenomyosis:

Suspicion of advanced malignancy.
The combination of internal endometriosis with extensive distribution of endometriosis of other localization.
Severe extragenital pathology.
Pronounced adhesive process of the abdominal cavity.
Relative contraindication: the size of the affected uterus is more than 12 weeks of pregnancy.

Scheme for the detection and treatment of internal endometriosis

Complications of the disease

Patients with internal endometriosis should undergo regular examination by a gynecologist at least once every 3-6 months. Timely therapy will prevent the progression of the disease.

Severe consequences of a long course of adenomyosis:

Uterine bleeding.
Severe secondary anemia.
damage to adjacent organs.
Infertility.
Severe pain syndrome, severe limitation of physical activity, inability to have sexual activity.
Malignancy.

According to oncologists, patients with internal endometriosis are at high risk for developing endometrial, ovarian, and breast cancer.

To avoid serious complications, it is important to understand what factors can provoke the development of grade 4 endometriosis, and what methods are used to treat it.

Reasons for the development of pathology

Endometriosis 3-4 degrees is a very insidious and dangerous pathology. Its danger lies in the fact that the transition from stage 1-2 to a more difficult phase of development can occur quite quickly. That is why you need to act immediately to prevent complications. In addition, grade 4 endometriosis is also dangerous for pregnancy, since it can provoke its spontaneous interruption, or premature birth. To prevent this, you should know what are the factors that contribute to the development of stage 4 endometriosis.

immunodeficiency states.
Hormonal disruptions.
Unfavorable heredity.
Anemia.
Displacement of the intrauterine device.
Frequent surgical abortions.
Inflammatory diseases of the mucous membranes of the uterus and appendages.
Liver dysfunction.
Surgical intervention in the pelvic organs.
Too early or too late.

In addition, grade 4 endometriosis can be caused by severe stress, an unhealthy lifestyle, mechanical damage to the pelvic organs, diseases of the thyroid gland, the endocrine system, and circulatory disorders in the cervical canal.

Diagnostic measures

To confirm or refute the presence of endometriosis of 3 or 4 degrees in patients, gynecologists often resort to the following research methods.

Ultrasound is a universal diagnostic procedure, during which it is possible to accurately determine the degree of progression of endometriosis. Based on the results obtained, the subsequent development of a treatment regimen is based. In addition, the doctor will be able to assess the risks and threats to a woman's health during pregnancy.
Blood test for endometriosis marker CA-125. The higher its level, the more severe the degree of the disease.
Hysterosalpingography is another highly effective method for examining the pelvic organs, which allows you to accurately determine the stage of development of the pathology.
Laparoscopy is one of the most commonly used methods for diagnosing and treating grade 4 endometriosis of the uterus. During the procedure, a special device is inserted into the patient's abdominal cavity, equipped with sensors and devices that allow you to thoroughly study the state of the cavity of the reproductive organ.

Which method of diagnosing the disease will be appropriate in your case, only a gynecologist can decide. Your task is to consult a doctor in a timely manner after detecting the alarming symptoms of endometriosis.

Clinical picture of pathology

To force a woman to urgently visit the gynecologist's office should be such dangerous anomalies:

pale skin and mucous membranes;
hypotension;
dizziness;
weakness, fatigue (a clear sign of endometriosis, which is at stage 4 of development);
drowsiness;
irregular and excessively heavy menstruation;
severe pain during menstruation, accompanied by nausea, and sometimes vomiting;
foliation of nails;
dyspnea;
infectious or viral diseases of the respiratory tract, often arising due to reduced immunity, etc.

In addition, grade 4 endometriosis is often accompanied by severe pain in the lower abdomen, as well as in the lumbar region, so it is very difficult not to notice it.

Methods for the treatment of endometriosis stage 4

If the appeal to the gynecologist was timely, then the treatment of developed endometriosis of the uterus of the 4th degree may well be limited to long-term use of hormonal medications:

Estrogen-gestagens.
Progestogens.
Antiprogestins.
Antiestrogens.
Gonadotropin inhibitors.
Gonadotropin-releasing hormone agonists.

In addition, many women noted a positive effect in the treatment of grade 4 endometriosis with the help of such folk remedies:

Hirudotherapy.
Acupuncture.

As for surgical intervention for endometriosis, which is at stage 4 of development, it is carried out only as a last resort, when conservative and alternative medicine is powerless. The indications for the operation are:

combination of endometriosis and endometrial hyperplasia;
adenomyosis proceeds in a nodular form;
endometriosis develops in combination with uterine fibroids;
endometriosis 3, 4 degrees proceeds in a severe form;
the effect of hormonal treatment is absent for more than 3 months;
for some reason, hormone therapy is contraindicated for a woman.

Surgery is not performed immediately after the discovery of the disease. Before this serious procedure, the patient needs to prepare the body. For this purpose, she may be prescribed a course of taking danazol or progestogens. They will help relieve the inflammatory process in the pelvic organs, as well as help reduce adhesions in the affected areas.

It is important to know!

Endometriosis grade 4 is a pathology that can recur even after undergoing a full course of treatment. The more time has passed since the operation or taking hormonal drugs, the higher the risk of a relapse of the disease. That is why it is so important to undergo preventive examinations at the gynecologist on time.

The impact of pathology on the fetus

Endometriosis of the 4th degree and pregnancy is one of the main issues of interest to patients of reproductive age. Of course, the disease affects the functioning of the reproductive organs, and often in patients who have had it, infertility is diagnosed.

In expectant mothers, there is a huge risk of miscarriage or the birth of a premature baby. Termination of pregnancy, in turn, causes a severe hormonal failure, due to which the disease begins to progress, and the woman's condition, accordingly, worsens.

As for the birth process in expectant mothers with such a diagnosis, then, as a rule, it goes well, and nothing threatens the baby. However, after the end of pregnancy, a woman has an increased risk of opening heavy uterine bleeding and further progression of the pathology.

Remember: before planning motherhood, you should definitely pass all the necessary medical examinations for the presence of diseases of the reproductive organs. If the disease was detected already during the gestation of the fetus, this should be a strong argument for regular visits to the gynecologist and the implementation of all the instructions prescribed by him!

As a rule, endometriosis, as in the case of pathology at the first stage of development, is detected during the diagnosis of infertility. After a comprehensive examination, treatment is indicated, usually medication. This stage passes for the present without surgical intervention. The right tactics will help provide all the conditions for the onset of the desired pregnancy and prevent the development of the pathological process.

Symptoms

What is it: endometriosis 1-2 degrees? The initial degree usually either does not manifest itself, or makes itself felt with the following three symptoms:

pain during menstruation,
changes in the menstrual cycle,
lack of conception.

Internal endometriosis 1-2 stages is not always so pronounced. It happens that a woman only has discomfort in the lower abdomen, just before menstruation. Few can suspect that this is how it manifests itself. Usually, patients associate such symptoms with the onset of critical days, consider it a variant of the norm.

The initial degree of the disease can also be manifested by such violations in the cycle:

its shortening up to 25-26 days,
slight increase in total blood loss,
a small daub a day or two before menstruation.

It is noteworthy that the first degree of endometriosis is not always associated with infertility. Sometimes it is possible to become pregnant, endure and give birth to a child. That is why at the earliest stages of the development of pathology, not everyone begins to sound the alarm.

Internal endometriosis of the 2nd degree: what is it and what symptoms are different? Compared with the initial stage, this one is already more pronounced.

2nd degree manifests itself:

pain 3-5 days before the onset of critical days,
pulling sensations in the lower abdomen, in the lumbar region,
pain, the intensity of which increases day by day as critical days come,
severe pain on the first day of the cycle, after which relief comes.

Endometriosis - namely its second degree - is also manifested in unusual menstruation. It lasts less, but the blood loss is more significant. The occurrence of intermenstrual discharge from the genitals is likely. Concerned about difficulties with conception.

Endometriosis, which has developed to grade 2, differs not only in symptoms, but also (the uterus is scanned - its body, appendages), biochemical markers. Changes are also detected during endoscopic methods, such as laparoscopy and hysteroscopy.

So, endometriosis of the body of the uterus at the 2nd degree of development of the pathology is characterized by the following:

mild symptoms,
the uterus (its walls) becomes thicker, the endometrium changes, small brushes of the myometrium are diagnosed on ultrasound,
biochemical markers CA-125 and CA-199 moderately increase,
hysteroscopy reveals single endometrioid passages.

The second degree is characterized by the fact that the uterus is affected in the deep layers, but there is only one affected focus. However, in each specific clinical case, the picture may not be the same. So, stage 2 endometriosis is also manifested by the fact that the epithelial cells that have begun to germinate go even deeper or there are more and more of them. As noted above, so far only one area is affected, with rare exceptions. But in those places where the uterus is affected, where the endometrium has grown most deeply, pain may occur.

How is endometriosis treated in stage 2?

Treatment of endometriosis of the 2nd degree is desirable to start as early as possible. Especially if you are concerned about infertility, and there is a desire to give birth to a healthy child. When endometriosis is at the initial stage: stage 1 or 2, surgical methods are not required. In this case, the main tasks of therapy are the restoration of the menstrual cycle, the elimination of pain.

Treatment is carried out with the help of gestagens. They are taken by injection or in tablet form. It is best to administer the drug by injection, so it will be more likely to achieve results.
Treatment can be carried out with combined hormonal drugs. They are designed to restore the functioning of the ovaries. By taking these funds, it is possible to achieve an imitation of the natural endocrine background. As a rule, this method is shown to young women who want to experience the joy of motherhood in the very near future.
Use of intrauterine contraceptive "Mirena". This is a hormonal drug that allows you to suppress the development of the disease. Internal endometriosis does not progress. The method is suitable for those who do not want to start endometriosis so that a later degree of its development occurs, and at the same time, they are not yet ready to conceive a child.

Usually,

The initial stage, first or second, does not require the use of strong hormonal agents that could seriously suppress the functioning of the female body.

For those who have developed endometriosis of the uterus to the 2nd degree, doctors usually strongly recommend pregnancy and childbirth. This does not mean that the disease will pass after the reproductive process of lactation - moreover, after childbirth, an examination is mandatory. The doctor looks at the body of the uterus, etc., according to the results of a comprehensive diagnosis, prescribes a scheme for further actions.

Prevention

As mentioned above, endometriosis may not manifest itself in any way, even already at the second stage of its development. Therefore, preventive measures are important.

If the uterus has undergone surgery, there is a history of abortion, it is important to undergo regular monitoring.
With complaints of pain during menstruation, dysmenorrhea, it is important to undergo specific diagnostic measures.
According to indications, it is worth taking oral contraceptives - hormonal. Often women are afraid to use them, as they believe that this can harm their health, lead to obesity and hair growth in unwanted areas. However, all these consequences occur only in cases where hormonal drugs are taken without a doctor's prescription. A competent specialist selects drugs taking into account individual characteristics.
In chronic, acute pathologies of the reproductive organs, it is important to undergo timely and complete treatment.

Who is most at risk of developing endometriosis?

Those who have:

obesity, while the body is full because metabolic processes are disturbed,
shortened menstrual cycle,
age - over 30-35 years old,
the preferred method of protection is intrauterine contraceptives,
have immunosuppression,
elevated estrogen levels
had uterine surgery
bad heredity,
have bad habits such as smoking.

Taking care of your reproductive health is very important for every woman. The "insidiousness" of endometriosis lies in the fact that even after treatment, relapses can occur. Therefore, it is important to undergo preventive examinations after the course of therapy.

The main criteria for cure are satisfactory health, normalization of the cycle, absence of pain, desired pregnancy.

Today it is the third most common gynecological disease, after inflammation or a pathology such as. It can occur in women during the period of reproductive functioning of the body, usually the age is from 25 to 45 years.

Symptoms of endometriosis can appear almost immediately after the onset of pathological processes in the female body. If left untreated, it threatens infertility.

More often, the pathology under consideration is treated with the help of or other drugs that are included in the drug treatment program. During the first stage of the disease, almost no surgical intervention is used. When choosing the right treatment tactics, a woman will be able to become pregnant, that is, infertility does not occur.

The first degree of endometriosis is manifested in the form and constant small secretions of blood from the woman's vagina. The secretions consist mainly of particles of the endometrium. If the affected area increases, then the amount of discharge also increases. It is worth noting that with endometriosis at the very beginning there is a violation of the menstrual cycle.

What is the danger of endometriosis?

Endometriosis is treated, but you should not start all the pathological processes of the body, since the disease is accompanied by a lot of complications. They include cancer and infertility, which is not treated. It is worth noting that with the appearance of oncological formations, cancer can appear anywhere in the genital organs.

During the first degree, additional unpleasant symptoms appear, such as:

the appearance of discomfort during urination, this happens when endometrial cells grow into the tissues of the bladder;
pain during intercourse and increased bleeding;
the occurrence of unpredictable bleeding, regardless of menstruation;
severe pain in the lower abdomen (this occurs before and after menstruation).
The appearance of tearfulness and an increased level of irritability.

The difficulty is that it is not possible to accurately detect the disease at the beginning of its manifestation, only under assumptions. It is recommended at the first suspicion to consult a doctor for a more thorough examination.

Depending on the spread of the focus of the disease, four degrees of endometriosis are distinguished from focal growths.

Features of the manifestation of the first degree of endometriosis

The ailment in question is not initially very dangerous, but it is important to determine it in advance. The foci have a shallow distribution in the tissues. At the first stage of the disease, the manifestation of these processes occurs secretly. An exception is a delay in menstruation and discharge from the mammary glands, a strong increase in blood volume in the period when menstruation should be.

With the timely detection of this disease (of the first degree), the treatment is quite simple. But, it is important to follow all the requirements and recommendations of doctors. During the first stage, specialists do not refer patients to, or other studies, since visually the disease is almost impossible to notice.

But, if there is a serious suspicion of endometriosis of the 2nd degree or milder, many gynecologists recommend doing a Pap test. This procedure is called histological examination. It helps to establish the foci of the disease and their size.

To date, the treatment of the disease in question is due to hormonal drugs, or other drugs.

Diagnosis of endometriosis

Many diagnostic actions are aimed at detecting and differentiating pathological processes that belong specifically to endometriosis from other diseases. Many experts are aware of the similarity of manifestations of other diseases.

In research, gynecologists and other specialists try to collect all the indicators. A thorough examination of women is also carried out using a gynecological chair.

The most common research methods that give highly accurate results are:

the appointment of a colposcopy;
the use of hysterosalpingography (the results are more accurate by establishing the exact location of the formations);
the appointment of an ultrasound of the abdominal cavity, as well as a qualitative examination of organs that may be exposed to the pathological effects of the disease;
performing computed tomography;
the use of MRI has proven itself well;
using it, you can make a visual assessment of the size and nature of the growth of the disease;
X-ray of the uterus and fallopian tubes makes it possible to more accurately establish the diagnosis;
blood tests for the presence of cancer markers.

There are a number of other research methods, for example, with the use of ultrasound technologies, with which you can get the desired results.

Treatment

Treatment of endometriosis of the first degree occurs without any problems, but with the condition that all the requirements of the doctors are met. At the same time, during the initial degree, no surgical intervention is used - only drugs.

Surgical intervention is used exclusively for advanced forms, when there is no other way out. Often, this happens when a woman has grade 4 endometriosis. At this time, the uterus is removed completely or only the foci of the disease.

It is worth remembering that all efforts should be directed not only to reducing the symptoms, but also to removing the causes that provoke the growth of mucous membrane tissues in the woman's uterus.

Features of the preventive period

So that the disease does not appear in the future or does not begin to progress if it is present, it is important to engage in careful monitoring of health. This includes:

nutrition;
hygiene;
way of life;
avoidance of casual sexual contacts.

It is important to pay attention to what pathologies were previously (they can give complications). If even grade 3 endometriosis is found in a woman, then there is a possibility that with the right treatment, the disease can be eliminated even without the intervention of surgeons.

Before and after treatment, it is important to pay attention to the advice of specialists, observing all their requirements. If you visit a gynecologist regularly, then the process can be detected in advance. With quality treatment, there will be no problems.