Endometriosis of the uterus: what it is, why it is dangerous, symptoms, signs and treatment in accessible language. Symptoms and treatment regimen for uterine endometriosis in women How endometriosis is detected

Endometriosis can cause painful periods, persistent pelvic pain, infertility and other symptoms. Symptoms of endometriosis can range from mild to severe.

Treatment options mainly include painkillers, hormonal treatments, and surgery.

It is worth explaining what it is in an accessible language and why it is dangerous, how the pathology develops, what methods have been developed for its detection and treatment is acceptable in various clinical situations.

What is endometriosis?

Photo of endometriosis

The endometrium is the tissue lining the inner mucous membrane of the uterine body (mucosal layer).

Uterine endometriosis is a condition in which endometrial tissue is found outside the uterus. It is "trapped" in the pelvis and lower abdomen, and, less commonly, in other areas of the body.

Foci of the spread of the disease

Endometriosis is a hormonally dependent pathological condition, accompanied by the growth of the glandular lining of the uterus in the fallopian tubes, ovaries, bladder, in the thickness of the uterus, on the peritoneum, in the intestines and on some other organs (see photo above).

Endometriosis is a common gynecological pathology, ranking third in frequency of occurrence after inflammation and uterine fibroids. Most often, uterine endometriosis is detected in women of reproductive age - from 25 to 40 years. Also, pathology can manifest itself in girls during the formation of menstrual function and in women. It should be borne in mind that difficulties in identifying pathology and the asymptomatic course of the disease allow us to conclude that the endometrioid process is more common.

Causes of endometriosis development

In medicine, there is not yet a unified theory about the causes of endometriosis. There are, the most common of which is retrograde menstruation (meaning the reverse flow of menstrual blood). She explains the origin of endometriosis by the involvement of endometrial particles with menstrual blood in the fallopian tubes and abdominal cavity during retrograde menstruation.

When a number of conditions are combined, endometrioid cells attach to various organs and resume their ability to function cyclically. During menstruation, the presence of endometrium, localized on uncharacteristic organs, provokes microbleeding and inflammation.

Thus, those women who have retrograde menstruation may develop endometriosis, but not in all situations. The likelihood of developing pathology increases due to the following features:

hereditary predisposition;
disturbances in the functioning of the immune system;
surgical interventions;
environmental factors (properties of the environment that affect your body).

Progression of endometriosis is also possible with surgical interventions on the uterus. For this reason, after any surgery, it is important to be observed by a doctor for timely diagnosis of possible pathologies.

There are also a number of other theories about the causes of endometriosis, which include:

theory of gene mutations;
deviations in the interaction of receptor molecules with hormones;
dysfunction of cellular enzymes;
embryonic theory.

Risk factors for developing endometriosis

There are several main groups of women predisposed to the progression of endometriosis:

women with shortening;
women with metabolic disorders (obesity);
using intrauterine contraceptives;
age over 30-35 years;
women with pathologically high levels of estrogen;
women with pathologies that suppress the immune system;
have undergone surgery on the uterus;
smoking women.

Classification and degree of development of endometriosis

The exact answer to the question “what is uterine endometriosis” is determined by the localization and prevalence of the pathological process. For this reason, a classification of pathology has been developed according to location.

There are two main groups of the disease – extragenital and genital.

In the case of the genital form of pathology, areas of heterotopia are located on the genital organs, and in the case of extragenital pathology, they are located outside the reproductive organs. The genital form of the disease is divided into several conditions:

peritoneal form of endometriosis – involvement of the pelvic peritoneum, ovaries and fallopian tubes in the pathological process;
extraperitoneal form of endometriosis - foci of ectopia are localized in the lower part of the woman’s reproductive system (cervix, vagina, external genitalia);
The internal form of endometriosis (uterine endometriosis or adenomyosis) can develop in the myometrium.

In the absence of proper treatment, the pathological process is mixed.

In the case of extragenital localization, the foci of the endometrium include the intestines, lungs, kidneys, and postoperative scars.

Based on the prevalence and depth of the pathological focus, there are 4 main degrees of development of endometriosis:

First: single foci are localized on the surface.
Second: a larger number of deep foci.
Third: multiple deep foci, the presence of endometriotic lesions, adhesions.
Fourth: a large number of deep foci of pathology, large endometrioid cysts, severe, endometrium grows into the thickness of the rectum and vagina.

In addition, the following degrees of internal endometriosis are distinguished according to the degree of involvement of the muscular layer of the uterus in the pathological process:

First: the beginning of myometrial damage.
Second: foci of pathology grow into half the myometrial layer.
Third: damage to the entire thickness of the muscle layer of the organ.
Fourth: damage to the walls of the organ, spread of the pathological process to the peritoneal tissue.

Endometrioid lesions differ from each other in shape and size: they can be small, round or shapeless and spread up to several centimeters in diameter.

Most often, they are characterized by a dark cherry color and delimitation from adjacent tissues by whitish scars. As a result of cyclical maturation, endometrioid lesions are more visible immediately before the onset of menstruation.

Clinical symptoms of endometriosis

The clinical picture of the condition can be varied, depending on the location of the pathological process and its severity. Timely detection of the disease is possible with regular visits to the gynecologist for a preventive examination.

There is a spectrum of symptoms that characterize the progression of endometriosis:

Pain in the pelvic area. The pain syndrome can be both diffuse and localized. The pain may be constant or worsen during menstruation. Soreness is most often triggered by the inflammatory process that accompanies endometriosis.
Dysmenorrhea. Menstrual irregularities.
Dyspareunia, or painful sexual intercourse.
Pain during urination and defecation.
Menorrhagia is an increase in the volume and duration of menstrual bleeding.
Posthemorrhagic. The condition is caused by the chronic nature of blood loss. It manifests itself in the form of increasing weakness, jaundice or pallor of the skin, fatigue, drowsiness, and dizziness.
Infertility. Develops in 25-40% of patients with endometriosis. In this case, we are talking about a low probability of pregnancy, and not about its complete impossibility.

Possible complications of endometriosis

Due to hemorrhages and scar formation in endometriosis, adhesions are provoked in the abdominal organs and pelvis. Quite often, as a result of pathology, cysts are formed on the ovaries, which are filled with menstrual blood. Both adhesions and endometrioid cysts can cause infertility.

Also, with endometriosis, compression of the nerve trunks can be observed, which leads to the development of neurological symptoms. Due to significant blood loss, manifestations such as:

anemization;
irritability;
constant weakness.

Foci of endometriosis in some cases undergo malignancy (malignancy).

Diagnosis of uterine endometriosis

When identifying endometriosis, it is important to exclude other gynecological pathologies that occur with similar symptoms. Diagnostic search includes the following activities:

Anamnesis collection. It is important to take into account not only the patient’s clinical symptoms and complaints, but also family history, that is, cases of pathology among family members. It is also necessary to clarify whether gynecological operations were performed.
Gynecological examination. Can be vaginal, rectovaginal, or in speculum. The most informative is to carry it out a few days before the start of menstruation.
Colposcopy and hysterosalpingoscopy. They are carried out to clarify the location and parameters of the lesion, as well as to obtain a biopsy sample.
Ultrasound examination. It is necessary to clarify the location of foci of pathology and the dynamics of the condition during therapy.
Spiral computed tomography or magnetic resonance imaging. These methods make it possible to clarify the nature and localization of endometriotic lesions.
Laparoscopy. The method allows you to visually assess the number, maturity, and activity of endometriotic lesions.
Hysterosalpingography is an examination of the uterus and fallopian tubes using x-rays.
Hysteroscopy is an endoscopic examination of the uterus to identify.
Laboratory tests: identifying tumor markers CEA, CA-125, CA 19-9 and performing a RO test. These indicators increase significantly in the case of endometriosis. Laboratory diagnostics are also carried out to detect anemia in patients with endometriosis.

Some diagnostic techniques are worth considering in more detail.

Hysterosalpingography

This technique is important for identifying internal endometriosis (adenomyosis or endometriosis of the uterus). The study is carried out with a water-soluble contrast agent on days 5, 6 or 7 of the cycle. The presence of contour shadows is noted on the x-ray.

Tomography

Computed tomography can provide information about the boundaries of the pathological process. Magnetic resonance imaging is more informative for endometriosis.

Ultrasound examination

Ultrasound image of an illness

This technique allows you to characterize the pathology according to clear criteria. Endometriotic origin is characterized by the presence of a dense capsule and hyperechoic contents.

In the case of adenomyosis, examination can reveal areas with increased echogenicity, unevenness and jaggedness of the border areas of the endometrium and myometrium, and round inclusions about 5 mm in diameter. Nodular variants of adenomyosis are accompanied by the formation of cavities with fluid with a diameter of about 30 mm.

Hysteroscopy

This technique makes it possible to accurately identify endometriotic ducts and the roughness of the relief of the uterine walls in the form of crypts or ridges. In 1997 V.G. Breusenko and co-authors developed a hysteroscopic classification of the prevalence of the endometrioid process:

The first stage: unchanged relief of the walls of the uterus, endometriotic ducts in the form of “eyes” of a blue hue or bleeding foci are detected. The uterine wall is characterized by unchanged density.
Second stage: uneven relief of the uterine wall in the form of ridges or disintegrated muscle tissue. Endometriotic ducts are identified. The uterine cavity does not stretch well. The wall has a higher density.
Third stage: the inner surface of the uterus includes many protrusions of different sizes that do not have clear boundaries. Sometimes endometriotic tracts are noted on the upper part of the bulges. The uterine wall is very dense.

Differential diagnosis

Differential diagnosis is necessary to distinguish between endometrioid cysts and ovarian tumors. The final diagnosis is made based on medical history and ultrasound examination. With ovarian endometriosis, there may be no pain, but with an oncological process, non-localized pain may appear.

In cancer and endometriosis, there is an increase in the level of CA-125. Therefore, an increase in the concentration of this substance does not confirm only one diagnosis. In some cases, a definitive diagnosis is only possible during laparoscopic surgery.

In the case of rectovaginal localization of endometrioid lesions, a differential diagnosis with metastases of chorionic carcinoma is required. To make a final diagnosis in this case, a correct medical history and a study of the hCG concentration are required (in this case, signs of pregnancy are also determined).

The tubo-ovarian inflammatory process in the form of an abscess is difficult to diagnose due to the erased clinical inflammation (for example, chlamydial etiology) and the difficulty of distinguishing the process from a benign tumor or cyst of endometrioid origin.

If the formations on the ovary do not regress within two months, surgery is prescribed. Often the final diagnosis is made after surgery and examination of the biopsy specimen.

Also, in the case of endometriosis, differential diagnosis with endometrial hyperplastic process may be required. With the retrovaginal nature of the lesion and endometriosis of the ligamentous apparatus of the uterus, it is imperative to exclude malignant neoplasms in the organs of the digestive system.

Treatment of uterine endometriosis

The tactics of therapeutic correction are determined by the following parameters:

age;
number of pregnancies;
number of births;
prevalence of the pathological process;
location of lesions;
clinic intensity;
associated diseases.

There are the following treatment methods for endometriosis:

Medication.
Surgical - laparoscopy with elimination of endometriotic lesions or radical removal of the uterus and ovaries.
Combined.

The goals of therapeutic correction of endometriosis are not only to eliminate symptoms, but also to prevent unfavorable processes in the form of adhesions, cysts and other pathologies.

Non-surgical treatment of uterine endometriosis with drugs

Conservative treatment (non-surgical) of the disease is carried out if endometriosis is asymptomatic, the patient is young or premenopausal, and there is a need to preserve reproductive functions.

The basis of conservative treatment is hormonal therapy with the following groups of medications:

Combined estrogen-progestin drugs. These include Nonovlon, Silest, Marvelon. These medications contain small doses of gestagens and suppress estrogen synthesis and the ovulatory process. They are prescribed in the initial stages of endometriosis, since combination drugs do not have an effect in the case of widespread endometriosis or the presence of cysts. Possible side effects if used: nausea and vomiting, pain in the mammary glands, spotting during the intermenstrual period.
Gestagens. These include Duphaston, Nemestran, Utrozhestan, Norkoput. Prescription is possible at all stages of the endometrioid process. Treatment with these drugs is carried out over a period of six months to 8 months. Possible side effects: intermenstrual bleeding, depression, pain in the mammary glands.
Antigonadotropic drugs. These include Danol, Danogen, Danazol. The mechanism of action is to suppress the synthesis of gonadotropic hormones in the hypothalamic-pituitary system. A continuous course lasting from six months to 8 months is prescribed. Not used in case of hyperandrogenism. The following side effects are possible: hot flashes, sweating, fluctuations in body weight, roughness of voice, increased oily skin, increased hair growth.
Gonadotropin releasing hormone agonists. These include goserepine, triptorelin and some other drugs. The advantages of taking medications from this group include the possibility of short-term use and the absence of significant side effects. These drugs suppress the ovulatory process, reduce the concentration of estrogen, which together suppresses the prevalence of endometriotic lesions.
Auxiliary medications: immunostimulating drugs, antispasmodic, analgesic, anti-inflammatory drugs.

A specific regimen for drug correction of the endometrioid process is prescribed by the attending physician, based on the characteristics of the clinical situation. Treatment for the condition must be comprehensive; it is important to strictly follow medical recommendations to maximize the effectiveness of the chosen treatment tactics for endometriosis.

A detailed table of how to treat uterine endometriosis with medication, including drugs, their mechanism of action, dosages and side effects:

Medicines	Main mechanisms of action	Dosage and regimen	Possible side effects
Gonadotropin releasing hormone agonists, prolonged, deposited forms	Blocking the production of gonadotropic hormones	Injection form of administration, once every 28 days, from 4 to 6 times	Vegetative-vascular symptoms, in physiological conditions characteristic of menopause, decreased bone density
Antigonadotropic drugs: danazol, gestrinone	Blocking of gonadotropins, endometrial atrophy	Danazol: 600–800 mg per day for six months, Gestrinone: 2.5 mg 2 times a week for six months	Androgen-dependent dermatopathy, dyslipidemia, increased blood pressure, increased body weight
Progesterone analogs: dydrogesterone	Reduced proliferation intensity, decidualization	10–20 mg per day from the 5th to the 25th day of the menstrual cycle or continuously for six months	Not identified
Synthetic gestagens: norethisterone	Decreased proliferation intensity, decidualization, atrophic changes in the endometrium	5 mg per day for six months	Weight gain, hyperlipidemia, fluid retention
Combined monophasic, estrogen-progestogen drugs	Reduced intensity of endometrial proliferation and ovulatory peak of gonadotropic hormones	Continuous use for 6–9 months	Hypercoagulability, fluid retention

Surgical treatment of endometriosis

With moderate and severe degrees of development of the endometrioid process, organ-preserving surgery on the uterus is indicated. In this case, fragments of heterotopias in organs, endometrioid cysts are removed, and adhesions are dissected.

Video on how to perform surgery on the uterus for endometriosis:

The operation is prescribed if conservative treatment does not bring the desired effect, there are contraindications to taking medications, there are lesions more than 3 cm in diameter, and the function of the organs of the excretory system and intestines is impaired. Quite often, operational measures are combined with conservative ones. Surgical intervention is carried out through laparotomy or laparoscopy.

Radical surgery, that is, removal of the appendages and extirpation of the uterus itself, can be prescribed if the patient is over 40 years old, the pathological process has progressed, or there is no effect from less radical correction methods.

In some cases, endometriosis is prone to relapsing, which may require repeated surgery. It is important to undergo preventive examinations with a specialist at least once every six months for the earliest possible detection of pathology and the effectiveness of conservative correction measures.

The criteria for the effectiveness of pathology treatment are:

good health;
absence of pain and other subjective complaints;
no cases of recurrence of the process over five years after a full therapeutic course.

If a woman is of reproductive age, then the effectiveness of therapy is determined by the preservation of reproductive function. In most patients, even surgical correction does not cause complications in the form of infertility due to the use of modern laparoscopic methods.

In the case of radical operations, resumption of the pathological process does not occur.

Treating symptoms at home

Complementary and alternative treatments may include acupuncture, chiropractic, and herbal medicine, but there is no evidence that they are effective.

According to many reviews found on forums, it helps some people cope with their illness.
Quitting caffeine may help reduce pain, as caffeine can worsen symptoms.
Exercise, such as walking, can reduce pain and slow the progression of the condition by lowering estrogen levels.

It is important to monitor symptoms due to the long-term complications of endometriosis. Severe pain or unexpected bleeding should be reported to your doctor.

Although there is currently no cure for endometriosis, most women can find relief by reducing symptoms and still having children.

Measures to prevent endometriosis

The sooner a woman visits a gynecologist when the initial signs of a pathological process appear, the greater the likelihood of recovery and the lower the likelihood of prescribing surgery.

Self-medication or neglect of therapy only worsens the condition: with new menstruation, the appearance of new endometrioid lesions, the formation of cysts, the progression of the formation of adhesions and scars are observed, and the patency of the fallopian tubes decreases.

Basic preventive measures regarding the endometriotic process include:

Examination of patients with complaints of dysmenorrhea. Women of any age when symptoms of dysmenorrhea appear are examined for a tendency to develop the endometrioid process.
Observation of women who have undergone gynecological operations for timely detection of pathological foci. Any surgical intervention in the area of the reproductive system can provoke the progression of endometriosis, so after surgery it is necessary to regularly see a specialist.
Timely diagnosis and treatment of acute, chronic inflammatory processes of the reproductive system. Inflammatory diseases can also lead to the development of the endometrioid process, so it is important to treat pathologies in a timely manner and not neglect the prescribed methods of therapy.

Higher education (Cardiology). Cardiologist, therapist, functional diagnostics doctor. I am well versed in the diagnosis and treatment of diseases of the respiratory system, gastrointestinal tract and cardiovascular system. Graduated from the academy (full-time), with extensive work experience behind her.

Specialty: Cardiologist, Therapist, Functional diagnostics doctor.

A woman's health depends on many factors. What is endometriosis? What are the symptoms and treatment of the disease? What are the main signs of pathology? What are the causes of the disease, and what first aid is needed? In this article you will learn everything about endometriosis.

What kind of disease

Endometriosis is a gynecological disease characterized by the growth of glandular tissue of the uterus beyond the boundaries of this organ. The epithelium can grow in the peritoneum, intestines, ovaries and other, even more distant systems.

Regardless of in which part of the body the endometrium has grown, it undergoes the same changes as the epithelium in the uterus.

This female disease is very common. In adult women, it occurs more often during reproductive age, only in 2% of cases among the elderly. In girls, endometriosis is possible during the formation of the reproductive system. The greatest prevalence of the disease is observed in women after 40 years of age to 44. In women after 50 years of age, the disease occurs less frequently. Determining the disease can be difficult, since the pathology often occurs in an asymptomatic or hidden form.

Endometriosis can be classified according to the etiology of the pathology and the location of the process. There are two types of the disease:

genital;
extragenital form.

With genital endometriosis, the process of growth of the endometrium extends exclusively to the genitals. The extragenital type of disease implies that the process involves organs located outside the reproductive system.

The genital type of pathology can be divided into the following subtypes:

peritoneal;
extraperitoneal (retrocervical);
interior.

With peritoneal endometriosis, the following organs are involved in the process of epithelial proliferation:

ovaries;
pelvic peritoneum;
fallopian tubes.

With retrocervical endometriosis, the lower layers of the genital tract are affected - the vagina, cervix, and rectovaginal septum.

When internal endometriosis develops, a significant enlargement of the uterus occurs, as the organ itself is involved in the process. Tissue proliferation occurs within the muscle layer. The body of the uterus takes on a spherical shape and in size it can reach volumes that are observed in the second month of pregnancy.

The location of external endometriosis largely depends on the stage of the disease. Focal endometriosis of the bladder, endometriosis of the ovary and other organs is possible. Even the lungs and kidneys can be affected.

Depending on the stage of the disease, the following features can be distinguished:

stage 1 disease – foci of cervical endometriosis are superficial and isolated;
with endometriosis stage 2, the affected areas are larger and deeper;
grade 3 is characterized by the appearance of many lesions, cysts on the ovaries, and adhesions in the peritoneum;
Stage 4 is difficult to cure, there are many foci, the cysts are large, bilateral, the epithelium grows into the vagina and intestines.

Internal endometriosis (which affects the uterus itself) is also called adenomyosis. It is divided into several stages depending on the degree of organ damage:

Foci of endometriosis can vary in size and shape. In diameter they can reach from several millimeters to 2-4 cm. As menstruation approaches, they become more pronounced.

Among other things, endometriosis is classified into:

diffuse;
nodal;
focal.

With the diffuse type of pathology, the endometrium grows over the entire surface of the mucous membrane. In nodular cases, the lesions are distributed locally. Focal lesions are characterized by the involvement of only some parts of the uterine wall in the process. All this can be seen in the photographs taken during the examination.

Note! If the disease is not treated, a complication develops in the form of chronic endometriosis.

Causes of endometriosis

The reasons why endometriosis of the vagina, uterus or bladder develops are not known for certain. Long research has helped to compile a list of assumptions, but there is still no exact answer.

There are several versions:

During menstruation, endometrial cells enter the abdominal cavity, take root and begin to grow;
the development of the disease is caused by a surge in hormones - an increase in follicle-stimulating hormone against the background of a decrease in progesterone;
hereditary predisposition to pathology;
decreased immune defense, since with normal indicators the endometrium cannot take root outside the uterus;
degeneration of one tissue into another - metaplasia.

Regardless of which organ is affected by pathology, be it endometriosis of the intestine or ovary, the reasons for the development of the disease are the same.

Risk group

To notice the first signs of the disease, women at risk should be especially attentive to their feelings and well-being. If unusual phenomena occur, you should consult a doctor. If endometriosis is not treated with effective methods, it leads to unpleasant consequences, including infertility.

There is a risk of problems arising in the following situations:

To get rid of the disease, it is important to recognize the signs of the disease in time. Knowing the symptoms of pathology will help with this.

Symptoms of endometriosis

A doctor can diagnose pathology and prescribe treatment. However, only the woman herself can note the main complaints that are worth paying attention to. The main symptoms include the following:

dysmenorrhea;
discharge before menstruation;
infertility;
signs of intoxication.

Much depends on the stage of the pathology and the location of endometriosis. Thus, dysmenorrhea occurs in almost all forms of the disease. Women experience severe pain, both before menstruation and during bleeding, and for several days after its completion. Attacks of pain are cramping, sharp, radiating to the lower back and pelvic area.

Note! In patients with endometriosis, the signs of premenstrual syndrome are very pronounced.

A few days before the expected start of menstruation, women may experience spotting brown discharge. The duration of bleeding increases, and the menstrual cycle itself becomes shorter. When the pathology is complicated by fibroids, bleeding is possible at any time during the cycle, including during ovulation.

With endometriosis, sexual intercourse becomes painful, regardless of the day of the cycle. The pain is acute, radiating to the perineum, peritoneum and rectum.

Infertility is usually the main symptom of the “asymptomatic” course of the disease. Due to endometriosis, adhesions form in the fallopian tubes and ovaries. All this makes the paths impassable and the mature egg does not have time to enter the uterine cavity for fertilization.

Intoxication occurs infrequently, but the following manifestations are possible:

nausea;
vomit;
increase in temperature;
itching on the skin and in the vagina;
fever.

During diagnosis, altered erythrocyte sedimentation rate and leukocyte levels may be detected.

Symptoms may appear from organs in which the epithelium has grown. Thus, with exacerbation of intestinal endometriosis, increased peristalsis is observed. If the bladder is involved in the process, there will be problems with urination and pain of this nature.

Diagnostic measures

In order for the doctor to make a diagnosis and write an effective prescription, it is necessary to undergo some examinations.

First, the doctor will examine the patient. With some forms of endometriosis, a gynecological examination may be painful. The uterus can be enlarged for up to 6-8 weeks, depending on the stage of the disease. Shortly before the onset of menstruation, the organ becomes especially dense and enlarged.

For endometriosis, the following instrumental studies are performed:

Ultrasound of the uterus and genital tract;
blood test;
laparoscopy;
hysteroscopy;

MRI is performed extremely rarely, although this technique is very accurate. The point is the high cost and the availability of other alternative methods. During laparoscopy, altered lesions can be seen. Upon examination, you can see that the affected areas are brown.

The doctor will carefully examine not only the uterus, but also adjacent organs in order to identify the growth of the endometrium there. The necessary diagnostic techniques are determined by the doctor after a visual examination and collection of symptoms.

Important! When going to see a gynecologist, a woman should have a menstrual calendar with her, which will help the doctor get an idea of her cycle.

Endometriosis can be treated at home using a conservative method, or surgical intervention can also be used. Unfortunately, even surgical removal of formations does not always guarantee a favorable prognosis.

Which therapy is chosen largely depends on the patient's condition and her desire to have children in the future. Treatment with medication does not increase the likelihood of restoration of fertility. After the examination, the doctor may recommend both hormonal and non-hormonal treatment.

However, just taking the medications prescribed by the doctor is not enough. It is important to follow a diet. Food should be high in calories, but not contain large amounts of salt and pepper. Physical exercise and daily walks at an average pace are also important. It is important to create a balance between existing stress and rest.

The entire treatment regimen is aimed at:

elimination of psychological causes using sedatives;
strengthening the immune defense to prevent the formation of new foci of endometriosis (for example, using Genferon);
anesthesia;
maintaining the functioning of the liver and pancreas.

During the recovery phase after endometriosis, the doctor decides whether physical therapy is needed or not. In practice, this technique is rarely used.

Treatment for menopause and in cases where a woman no longer plans to have children consists of removing the uterus along with endometrial lesions. In more than half of the cases this gives long-term remission.

For endometriosis, hormonal therapy can be prescribed by an experienced doctor. It is forbidden to do this on your own, since it is possible to clearly determine the dosage only after studying the test results. Using such drugs without a prescription from a specialist can be dangerous.

Hormonal therapy for endometriosis includes:

Surgical intervention is performed in the following cases:

If it is decided to undergo surgery, the patient is prepared. She is taking some hormonal medications. Then, after excision, electrophoresis with iodine and zinc is performed; a course of antibiotics can be prescribed to prevent the addition of a secondary bacterial infection.

Treatment with folk remedies is not prohibited, but it can be carried out along with drug therapy. Otherwise, the effectiveness of folk methods will be minimal. In addition, some methods can be harmful to the body.

What are the consequences

When endometriosis is diagnosed in women of childbearing age, pregnancy is ruled out in most cases. As a rule, it is not possible to completely cure the pathology. Even with a combination of surgical and drug treatment, periods of remission are not very long and sooner or later an exacerbation occurs.

A more successful prognosis for the course of the disease is made in cases where a woman is in. Then, as the production of sex hormones decreases, endometriosis gradually fades away.

After long-term clinical treatment (at least three years), some women were able to conceive. However, during pregnancy against the background of remission of endometriosis, the risk of miscarriage is high, especially in the first weeks.

Preventive measures

Every woman should take preventive measures. This also applies to those who have achieved some success in treating the disease. Preventive measures include the following:

abstaining from sexual intercourse during menstruation;
maintaining an active lifestyle;
regular visits to the gynecologist;
immediate treatment of all inflammatory diseases of the genital area;
refusal to perform abortions, including medical ones;
minimizing emotional experiences and stress;
maintaining normal body weight.

If a woman carefully follows these recommendations, the risk of suffering from endometriosis is significantly reduced.

When the first unpleasant signs of the disease appear, you should consult a doctor as soon as possible. An ultrasound examination will make it possible to diagnose the pathology at the initial stage and apply only drug therapy without surgical intervention.

Watch the video:

Why is endometriosis so often mentioned in connection with infertility? How to “catch” the symptoms of endometriosis, which are almost indistinguishable from menstrual symptoms? And is there a non-surgical treatment for endometriosis? We will answer these and other questions related to endometriosis with the help of leading experts!

Menstruation accompanied by severe pain should alert a woman, as this may be one of the signs of the development of endometriosis. True, the disease can be asymptomatic. As a result, the woman does not receive the necessary treatment, endometriosis progresses and can cause infertility.

Endometriosis: causes of the disease and main symptoms

Today, and this data is absolutely reliable, in the world about 16% of women of reproductive age suffer from endometriosis. A terrifying number! Among all gynecological pathologies, this disease is one of the top three, along with inflammatory diseases and uterine fibroids, leading to significant reproductive dysfunction, persistent pain syndrome, etc.

Endometriosis used to be called the disease of nuns because the disease most often occurred in women who had never been sexually active. And now symptoms of endometriosis are diagnosed even in very young girls. According to the results of a study by the International Endometriosis Association, which involved 40,000 sick women, 50% of respondents showed the first signs of the disease before the age of 24 years, in 21% before the age of 15, in 17% between 15–19 years.

At its core, endometriosis is a benign growth of tissue, similar in properties to the endometrium - the layer lining the uterine cavity.

Alexander Popov, Doctor of Medical Sciences, Professor, Director of the Moskvorechye Medical Center, Head of the Department of Endoscopic Surgery at the Moscow Regional Research Institute of Obstetrics and Gynecology: “During menstruation, in almost the majority of healthy women, menstrual blood comes out not only through the vagina. Blood also flows into the abdominal cavity through the fallopian tubes. Normally, these introduced endometrioid cells must be killed by killer cells, which are found in the body of every person. But for some reason this doesn't happen. This is how endometriosis begins.”

Having attached to an atypical place, endometrial cells begin to perform the same functions as in the uterus, that is, to menstruate. These bleedings lead to inflammation in the surrounding tissues and the formation of adhesions, which contributes to the appearance of the main symptoms of endometriosis:

nagging pain in the lower abdomen and lumbar region throughout the month, intensifying on the eve of menstruation;
pain during sexual intercourse (dyspaurenia);
bloody spotting of a dark “chocolate” color before and after menstruation;
prolonged and heavy bleeding during menstruation;
insomnia, headaches, nervousness, worsening mood, decreased performance.

In some cases, the first and only symptom of endometriosis is infertility. About a third of women with endometriosis cannot become pregnant. The resulting adhesions disrupt the patency of the fallopian tubes and the anatomy of the small pelvis, and also interfere with normal ovulation of the ovaries.

There are many theories about the occurrence of endometriosis, but none of them are proven. The background for the development of the disease can be frequent infectious diseases in childhood, hormonal disorders, etc. The “trigger moment” for the development of pathology can be diagnostic curettage. Recently, genetic factors have become increasingly important.

According to Alexandra Popova, science has proven that the development of endometriosis can be provoked by unfavorable environmental factors, for example, poor ecology. That is, the pathological process has not yet started, and if there were no harmful effects, and this enhances the proliferative activity of endometrioid cells (their reproduction by division), then the woman would not have developed endometriosis.

Endometriosis: diagnostic methods

The tricky thing about endometriosis is that it still needs to be detected. There are many forms of the disease, the manifestations are varied, which makes diagnosis difficult. A gynecological examination and questioning of a woman at a doctor’s appointment can only suggest the presence of the disease. It is also not always possible to diagnose the disease using ultrasound. For example, with the initial stage of endometriosis, when there are few foci of the disease.

The most reliable method for diagnosing endometriosis is laparoscopy - examination of the pelvic organs using a special instrument - a laparoscope, which is inserted through a small incision on the anterior abdominal wall. During the examination, the surgeon may remove a section of tissue and send it to the laboratory for further analysis.

To date, surgery remains the main treatment for endometriosis. Laparoscopy is most often used to remove foci of the disease. As a rule, the operation is performed for chronic pelvic pain (pain in the lower abdomen) and infertility, as well as for the formation of endometrioid ovarian cysts.

So, the main thing that should alert a woman if she suspects endometriosis is cyclicality. In severe cases of the disease, pain can also be chronic. And here both the activity of the woman herself and the professionalism and attentiveness of the doctor are important.

According to an international survey in which 14,000 women aged 16-45 years from 13 countries took part, 80% of the fair sex suffering from painful menstruation do not associate the discomfort with any disease and simply take painkillers. While endometriosis is detected in 75% of women who consult specialists for pain in the lower abdomen.

Surprisingly, doctors sometimes do not attach much importance to this main symptom of endometriosis and do not prescribe adequate treatment in a timely manner.

Endometriosis: treatment simple and complex

To date, surgery remains the main treatment for endometriosis. As a rule, laparoscopy is used to remove foci of the disease.

Other types of technologies are also used (laser, electrical, cryo-, ultrasound and plasma). However, during surgery, especially with widespread endometriosis, only visible and accessible lesions are removed, while microscopic ones may go unnoticed. This can lead to further relapses of endometriosis.

As a rule, the operation is performed for chronic pelvic pain () and infertility, as well as one of the most dangerous types of disease for women. The fact is that several surgical interventions on the ovaries reduce the number of eggs in a woman that can be used for fertilization. This reduces the chances of getting pregnant on your own and giving birth to a biological child.

When sending for surgery, not all doctors, unfortunately, show concern for a woman’s reproductive potential. But several operations on the ovaries may well lead to the fact that at the age of 30 a woman develops. She is infertile because her entire supply of eggs was destroyed during surgery. That is why before surgery it is very important to consult with a fertility specialist who can “preserve” eggs for use (if necessary).

The good news is that if the disease is detected in the early stages, surgery may not be necessary. You can stop the development of endometriosis and relieve pain with medications. For example, as is widespread in France, where hormonal contraceptives are prescribed as the first line of treatment for endometriosis, which introduce the body into a state of pseudo-pregnancy.

One of the effective methods of drug treatment for endometriosis is the prescription of hormonal contraceptives, which suppress a woman’s menstrual function, as a result of which the growth and spread of endometriotic lesions stops. The disease does not develop.

The largest number of women suffering from endometriosis are between the ages of 25 and 35 years. It is during this period that most families decide to plan a pregnancy.

About 25 - 40% of female infertility is due to this disease. This pathology can become a significant obstacle, preventing the fertilized egg from remaining in the uterine cavity or leading to miscarriages. Moreover, endometriosis can affect the entire female body, leading to disruption of the functioning of many internal organs and systems.

Endometriosis is a disease of the female reproductive system, in which the tissue of the inner lining of the uterus (endometrium) begins to penetrate into the underlying structures (myometrium), neighboring organs (fallopian tubes, ovaries, bladder) and even affecting distant parts of the body (lungs, liver, etc.). d.). At the same time, endometrial foci outside the uterus are also subject to the menstrual cycle, periodically contributing to the development of bleeding. The initial manifestations of the pathology are painful, heavy and prolonged menstruation.

Why does endometriosis develop and its classification?

Despite the many studies conducted to identify the reliable causes of the development of endometriosis, a consensus among the scientific community has not yet been achieved. There are many genetic, immune and other less common theories. The following is considered the most reliable.

There are two main forms of endometriosis, different in their causes and manifestations:

Genital. Affects the internal genital organs: uterus, fallopian tubes, ovaries, vagina. Due to the presence of a chronic inflammatory process (endometritis of any nature), abortion, injury, the presence of an intrauterine device, or spontaneously, endometrial cells begin to grow into the muscular layer of the uterus. There are also two subspecies:

External genital. It affects only the ovaries and peritoneum of the small pelvis.
Internal genital (adenomyosis or endometriosis of the uterus). Grows into the muscle layer, leading to an increase in the body of the uterus. Often combined with fibroids.

Extragenital. Foci of endometriosis occur in the pelvic organs, abdominal cavity, lungs, intestines, skin, etc. During menstruation, blood with rejected endometrial cells, for various reasons, first enters the fallopian tubes, and then into the abdominal cavity. On the surface of the peritoneum, endometrial cells take root, gradually increase in number, menstruate and, subsequently, spread further throughout the body.

There are known cases of a combination of genital and extragenital endometriosis.

There are 4 stages of development of this pathology, based on the prevalence and depth of the lesions:

Stage I - Lesions of small size, superficial (affect only the uterine mucosa) - minimal endometriosis.
Stage II - Some lesions penetrate the muscular layer - mild endometriosis.
Stage III - deep, transmural (through the entire wall of the uterus) foci of endometriosis appear. Small endometriotic ovarian cysts develop.
Stage IV - there are many deep foci, cysts reach significant sizes. Foci of endometriosis grow into neighboring organs (vagina, rectum, bladder), and adhesions develop in the pelvis - severe endometriosis.

How does the disease manifest itself?

Depending on the form of the disease (genital, extragenital) and the stage of the process, manifestations may be different. And if in the extragenital form the symptoms depend on the affected organs, then genital endometriosis has a number of characteristic signs:

Pain syndrome. Pain is felt in the pelvic area, it can either intensify before the onset of menstruation or be constant (chronic pelvic pain). Pain often occurs during sexual intercourse. In stage IV of the disease, pain may occur during urination or defecation. In case of damage to other internal organs, pain may also occur in their area, which is usually cyclical in nature.
Bleeding. In the initial stages of endometriosis, excessive bleeding develops only during menstruation. They become long-lasting, profuse, and after they end, the characteristic brown discharge may continue. In late stages of the disease, blood appears in the stool and urine. The extragenital form can cause the discharge of bloody sputum and the occurrence of subcutaneous hemorrhages. These manifestations occur synchronously with the onset of menstruation.
A rather rare manifestation of extragenital endometriosis is a bloody tear. The presence of this symptom gave rise to many myths and legends in ancient times and the Middle Ages.
Dysmenorrhea. It manifests itself as painful, prolonged and profuse cyclic discharge. It may be combined with anemia that develops at the end of menstruation.
Infertility. Due to changes occurring in the endometrium and ovaries, constant anemia due to bleeding, the onset and normal course of pregnancy becomes quite problematic.
Adhesive disease. Due to the constant flow of menstrual blood into the abdominal cavity, especially in the pelvic area, adhesions gradually develop. They reduce the mobility of internal organs, fallopian tubes, and the body of the uterus, which can further reduce the chance of pregnancy. In severe cases, acute or chronic intestinal obstruction may develop.
Extragenital lesion. Perhaps this group of symptoms is the most diverse. This is due to the polymorphism of symptoms inherent in damage to a particular organ. Signs of neoplasm of the liver, lungs, respiratory failure, jaundice, gastrointestinal bleeding, hematuria (blood in the urine), etc. may develop.

What are the dangers of endometriosis?

The development of complications of this pathology is closely related to its manifestations and symptoms. The most serious consequences of endometriosis are:

Adhesive disease.
Anemia.
Damage to the central nervous system.
Malignancy of endometriosis foci.

If pregnancy nevertheless occurs against the background of endometriosis, its course may be complicated by the threat of miscarriage, improper attachment of the placenta, and fetal hypoxia. The adhesive process can lead to the development of an ectopic pregnancy.

Diagnostics

If the patient is bothered by abdominal pain and attempts to become pregnant are unsuccessful, the question arises about the presence or absence of endometriosis.

What are the symptoms associated with endometriosis?

painful menstruation
painful intercourse
chronic pelvic pain
pain in the lumbosacral region
painful urination
painful bowel movement.

Studying the patient’s complaints, her medical history, and a gynecological examination are only the initial stages in diagnosing endometriosis. To clarify the diagnosis, ultrasound, computed tomography or MRI (magnetic resonance imaging) and other research methods are performed.

But the “gold standard” in diagnosing this pathology is laparoscopy with biopsy.

Treatment of endometriosis

Today, there are three main methods of treating endometriosis: medication, surgery and combination. Each method has its own positive and negative sides and scope of application. When choosing treatment, the doctor is guided by age, stage and form of the disease.

Drug treatment

Conservative treatment is used if it is necessary to preserve the reproductive function of a woman at a young age or premenopause and in preparation for surgical treatment. When carrying out drug therapy for endometriosis, treatment is carried out in two directions: eliminating pain (analgesics, NSAIDs) and suppressing the activity of pathological foci with the help of hormonal drugs. It should be clearly understood that conservative treatment of endometriosis without hormones is impossible.

Combined oral contraceptives (COCs) or progestins are prescribed as first-line therapy.

To reduce pain symptoms, analgesics and non-steroidal anti-inflammatory drugs are prescribed.

Hormone therapy is aimed at suppressing the activity and reducing the size of endometrial lesions. The selection of a treatment regimen is based on the maximum reduction in the occurrence of side effects from medications. The most widely used means are:

Progestins (gestagens). Taken in a course of 6–8 months for any form and stage of endometriosis. They help normalize endometrial secretion, slow down its growth and reduce the volume of menstrual bleeding until it is completely absent. Dienogest, dydrogesterone, progesterone, norethisterone are used. Side effects may include the development of depression, intermenstrual bleeding, and pain in the mammary glands.
Monophasic COCs. Oral contraceptives completely block cyclic mechanisms in the female body, which prevents the growth and subsequent rejection of the endometrium and the development of menstrual bleeding. This leads to complete or almost complete elimination of the manifestations of endometriosis. The use of COCs can cause headaches, depression, insomnia, increased blood pressure, and decreased libido. Rigevidon, Novinet, Diane-35, Regulon and others are used.
Gonadotropin-releasing hormone agonists, hormonal releasing systems: vaginal and transdermal combined hormonal contraceptives, subcutaneous and intramuscular depot forms of progestins, intrauterine levonorgestrel releasing system (LNG-IUD) are used when COCs and gestagens are ineffective or before laparoscopic surgery for endometriosis.
Gonadotropin-releasing hormone agonists are taken once a month and are the “heavy artillery” in hormonal therapy. Indicated for stages III – IV of endometriosis. They block the production of specific releasing factors in the hypothalamus, which prevents further production of sex hormones according to the female cycle. These drugs can cause hot flashes, decreased libido, vaginal dryness, menopause symptoms, osteoporosis, headaches and muscle pain.

Surgical treatment

Currently, more and more preference is given to organ-preserving operations that exclude resection of the uterus and its appendages. This trend is due to great progress in minimally invasive surgery over the past 10–15 years. The main goal of surgical treatment of endometriosis today is the removal of lesions and maximum restoration of the functionality of the female reproductive system.

Excision of endometrioid lesions is recommended where possible, especially deep endometrioid lesions, and laparoscopic cystectomy for endometrioid cysts (endometriomas). This helps avoid recurrence of symptoms and endometrioma.

The level of professionalism of the operating doctor plays a significant role during the postoperative period and the possibility of developing complications. The Mother and Child clinics employ world-famous specialists who have techniques for conducting modern surgical interventions to remove endometriotic lesions.

Prevention

In order to prevent the development of endometriosis, the following provoking factors should be avoided: acute or chronic inflammatory processes in the uterus, uterine injuries, medical abortions.

If you suspect the first manifestations of this disease, do not delay diagnosis and treatment. Identification and elimination of endometriosis at stages I – II contributes to maximum preservation of all functions of the female reproductive system.

Article outline

Endometriosis is a common pathological process that affects the lining of the uterus. This disease is characterized by the proliferation of endometrial cells. Endometriosis is most often associated with your ovaries, fallopian tubes, and the tissue lining your pelvis. In fairly rare cases, endometrial tissue can move outside the pelvic organs. The development of such a pathological process can lead to serious consequences. Diagnosis of uterine endometriosis is usually carried out in women aged 25 years and older.

With endometriosis, tissue displacement and growth into the uterine wall are observed, especially during the menstrual cycle. The endometrium continues to act as usual—it thickens and bleeds with each menstrual cycle. Since this tissue is unable to leave the body, it is localized in the pelvic organs. This disease spreads throughout all organs of the female body and includes:

the ovaries, where cysts called endometriomas can form;
intestines;
urinary system;
fallopian tube

Typically, the surface of the uterus becomes irritated, eventually promoting the development of scar tissue. They are abnormal bands of fibrous tissue that can cause pelvic tissues and organs to move towards each other. Endometriosis can cause pain—sometimes severe—especially during your menstrual period. Fortunately, there are effective treatments that are available to every woman.

What are the symptoms of endometriosis?

The primary symptom of endometriosis is pelvic pain, often associated with the menstrual period. Although many women often experience cramps during their menstrual cycle, endometriosis is much easier to recognize. Since in this case the pain intensifies over time and causes enormous discomfort. Typically, women complain of pain when:

menstruation;
sexual intercourse;
uterine bleeding;
infertility;
emptying the bladder or bowel.

Doctors say that during retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and goes directly into the pelvic cavity. These displaced cells adhere to the pelvic walls and surfaces of the pelvic organs, where they begin to actively grow and appear as clots. After which the displaced cells begin to bleed throughout the menstrual cycle.

The reasons for the formation of this unfavorable disease are not yet known. Despite the fact that doctors and doctors of science conduct numerous studies, no one can carefully study the problem of the development of the above symptoms. Basically, experts name several factors that can cause pain in the uterus:

genetic predisposition;
metaplasia;
weakened immune system;
hormonal imbalance.

The severity of pain is not a mandatory factor in recognizing the disease. In most cases, women with mild endometriosis may experience severe pain, while others with more severe symptoms may only feel a slight tingling sensation in the uterine area.

Endometriosis is sometimes misdiagnosed by doctors due to a visual examination. Therefore, in order to make an accurate diagnosis, it is necessary to conduct a comprehensive study and identify the cause.

This type of condition can be confused with irritable bowel syndrome, which causes bouts of diarrhea, constipation, and abdominal cramps. To diagnose endometriosis and the nature of the disease that may cause pelvic pain, your doctor will ask you to initially describe your symptoms.

How to identify uterine endometriosis

When uterine endomitriosis develops, the gynecologist can conduct a visual examination using a vaginal speculum. When diagnosing the disease in a serious form, the doctor decides to perform surgery. But surgery is required only in very rare cases. Basically, after identifying an accurate diagnosis, the patient is given a combination of treatment. In this article, you can consider the methods by which the disease is diagnosed.

The most common way to detect the disease is cytological examination. The material for such a study is obtained during an aspiration biopsy. Thanks to this method, a blunt-ended needle is inserted into the uterine cavity to aspirate a fragment of the endometrium. This procedure is performed on an outpatient basis and is less traumatic. Doctors usually use an anesthetic to reduce sensitivity.

This technique uses high-frequency sound waves to create images inside your body. To capture images, a device called a transducer is either pressed against the abdomen or inserted into the vagina (transvaginal ultrasound). Both types of ultrasound may be performed to provide the best view of the reproductive organs. Ultrasound of the indometrium will allow us to study the uterine mucosa and identify all possible changes.

Which day of your cycle should you choose?

In order to diagnose the disease, doctors resort to internal and transvaginal ultrasound examination. Many gynecologists do not recommend examining changes in pathology using the transabdominal method, since it is difficult to identify the first signs of the disease. The choice of diagnostics depends on the possible diagnosis. To examine the endometrium and obtain accurate information about the disease, it is advisable to select the second half of the cycle. Constant changes in the inner layer of the uterus are observed in the structure of the endometrium. During this period, the pathological area increases, so after completion of the cycle, it is necessary to carry out a diagnosis.

Ultrasound diagnostics

Ultrasound imaging will not definitively tell you whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas). Using ultrasound, you can recognize the pathology of the female body and make an accurate diagnosis. Therefore, if more serious diseases are suspected, doctors resort to a biopsy method.

Colposcopy

In order to investigate the disease in the second phase of menstruation, doctors perform colposcopy. During this pronounced period, it is possible to study the formation of the disease and the focus of endometriosis. The lesion becomes covered with epithelial tissue and begins to bleed excessively.

Colcoscopy is considered the most informative method for obtaining accurate results.

The painless procedure takes approximately 15 minutes.

This diagnostic method is the most important in modern gynecology. With a biopsy, doctors perform a microscopic examination to obtain tissue samples.

The result obtained in the laboratory will determine the morphological change in the uterine mucosa. This procedure is performed with local anesthesia.

In modern clinics, several biopsy methods are practiced:

pipel biopsy;
scraping;
vacuum;

This type of biopsy is considered the most modern option for aspiration of the uterine mucosa. In order to reduce the risk of trauma to the uterine cavity and sensitivity, doctors use a special instrument. This medical device resembles a flexible suction tube, otherwise called a pipel. After carrying out diagnostic measures and obtaining tests in the laboratory, doctors can identify the following diseases:

atrophy or hypoplasia;
local hyperplasia;
simple diffuse hyperplasia;
atypical hyperplasia;
malignant tissue degeneration;
endometritis.

CT

The most accessible and safe method for research is spiral computed tomography. This method was developed to determine the nature of endometriosis and its degree of development.

To identify the first signs of the disease and carefully examine the condition of the pelvic cavity, doctors do a CT scan.

The magnetic resonance method allows for visualization of the internal pelvic organ. This diagnostic method perfectly recognizes the structure of tissues and their development. This type of diagnosis is especially widely practiced for ovarian endometriosis.

Laparoscopy

From a medical point of view, laparoscopic examination usually reveals signs of the disease at an early stage. But to be sure whether you have endometriosis or not, your doctor can refer you to a gynecological surgeon. After performing a visual examination, your doctor will be able to identify signs of endometriosis using a surgical procedure called laparoscopy. It can provide information about the location, volume, and size of endometrial implants to help determine the best treatment options.

Chronic endometriosis most often occurs in women aged 25 to 50 years. To examine the surface of the uterus, gynecologists use a special instrument. Using a hysteroscope, you can examine the image that is displayed on the monitor after inserting a tube into the cervical area. Thus, the gynecologist is given the opportunity to determine the condition of the uterine cavity and the condition of the ovaries.

Tests for tumor markers

After testing for tumor markers, the doctor can identify the important marker CA 125, which is localized in the ovarian region. Cancer cells can change their levels regularly.

If you donate blood for tumor markers in a timely manner, then you can avoid serious consequences.

The obtained laboratory result reflects the picture of the CA 125 antigen, which is predominant in the patient’s body. In the absence of pathology, the analysis will display from ten to fifteen U/ml CA 125 in the blood.