Endometriosis of the uterus - what it is, causes, signs, symptoms and treatment of endometriosis in women. Main causes of internal adenomyosis

For a long time, little-studied endometriosis was considered a mysterious disease. However, at present, the aura of mystery has disappeared: the disease has been sufficiently well researched, its causes have been found, and effective ways to get rid of the disease have been proposed...

What is endometriosis

Endometriosis- chronic, long-term disease. It takes its name from the word “endometrium”. However, not everyone knows; what it is.

The endometrium is located in the uterus (in the pelvis, at the very bottom of the abdomen) and lines its inner part with a “soft feather bed”. This “featherwing” was created by nature for the attachment of the fertilized egg, that is, pregnancy. Otherwise, at the end of a month’s wait, the “feather feather” peels off from the body of the uterus and rushes out - this is how menstruation begins. To replace the departed “featherbread”, a new layer of endometrium begins to grow inside. And so on until the woman is able to conceive a child.

Causes of the disease

What happens with endometriosis? Single endometrial cells or even entire groups of them begin to “travel” and go beyond the boundaries of their “home”. Sometimes it’s close, and often it’s very far. Migrating, they even take root in other organs, disrupting their usual functioning.

Depending on where the cells reside, there are two forms of endometriosis - genital(it is divided into interior and external) and extragenital. With genital internal endometriosis, the cells do not go far; they are located within the body of the uterus, its isthmus and the nearby parts of the fallopian tubes. With genital external endometriosis, they are removed much further - into the ovaries, the outer parts of the fallopian tubes, the peritoneum, the vagina, the cervix, and the external genitalia. With the extragenital form, endometrial cells migrate over long distances - to the bladder, intestines, navel, kidneys, lungs, eyes, postoperative scars. Having taken root there, they bring a lot of trouble.

It must be said that in healthy women, endometrial cells can also extend beyond the uterine cavity, but the body recognizes the “fugitives” in time and destroys them. Thus, the disease does not develop. For the development of endometriosis, two conditions must coincide. The first is when endometrial cells have an increased ability to survive in an “unnatural habitat.” And secondly, when the body’s defenses are not able to destroy cells that have taken root incorrectly. This happens for a variety of reasons. Genetic predisposition, hormonal disorders, and malfunctions of local and general immunity are also affected... Chronic inflammation, uterine injuries (artificial abortion, operations, curettage), and situations leading to increased pressure inside also play a negative role in disrupting the proper functioning of endometrial cells. uterus (strength loads, active sports during menstruation).

It shows itself endometriosis very diverse. It depends on his “place of residence” and the degree of spread of the disease. The most common complaints from patients: in the lumbar region, sacrum, worsening the day before and during menstruation. This kind of pain is understandable. It is associated with the accumulation of menstrual blood in the foci of endometriosis and the inflammation and adhesive process that inevitably follows. As for the intensity of pain, it must be said that it does not always correspond to the severity of endometriosis. The pain can be mild with widespread endometriosis and very severe with its minimal manifestations. Other “identifying signs” of endometriosis are pain, and sometimes bloody discharge during sexual intercourse, disturbances in the nature of menstruation (long, heavy, painful, with spotting bloody discharge before and after menstruation), pain in the rectum during emptying. However, the most pressing problem with endometriosis is infertility...

Many manifestations of endometriosis are characteristic of other common gynecological diseases, for example. As well as diseases of the intestines and kidneys (depending on the location of the foci of endometriosis). Often patients undergo repeated courses of treatment for other diseases, they experience psychosomatic disorders, which is partly true: chronic pain is debilitating and leads to.

To make a correct diagnosis, you need to do a lot of research. The doctor asks the patient in detail how long the pain has been bothering her, what kind of pain it was, whether there were abortions, operations, uterine curettage, complicated childbirth, how menstruation proceeds. Next, a gynecological examination is carried out, during which the doctor looks to see if there is an increase in the size of the uterus, ovaries (especially on the eve of menstruation), and whether these organs are painful... A smear prescribed by the doctor will help determine the presence of infection. If necessary, a smear may need to be examined for cancer cells, and a blood test for cancer markers will be required. Blood tests for hormones, coagulation, as well as ultrasound of the pelvic organs also help to recognize the cause of the disease.

Ultrasound examination is considered the most accessible method of examining patients with various forms of endometriosis. As a rule, for comparison, doctors recommend doing two ultrasounds: at the end of the menstrual cycle (with a 30-day cycle on the 26-28th day) and immediately after menstruation (no later than 5-7 days from the start of the cycle). If endometrial cells have taken root on the cervix and walls of the genital tract, the doctor performs a colposcopy, during which the condition of the disease is assessed using an optical device with 10-20x magnification. There is no need to be afraid of this examination; it is painless.

Another thing is hysteroscopy - examination of the inside of the uterus, when a thin tube with a special optical system is inserted into its cavity. The procedure is performed under anesthesia. In this case, the “eye” from the inside will give the most complete picture of the development of the disease.

Other diagnostic tests

However, that's not all. To clarify the spread of the disease to neighboring organs, an examination of the urinary organs (cystoscopy, urography) and colon (colonoscopy, irrigoscopy) may be prescribed. For more complex variants of the disease, computed tomography with a contrast agent or magnetic resonance imaging (MRI) cannot be excluded, which will help determine the choice of treatment - surgical or non-surgical.

The “gold standard” for diagnosing endometriosis is laparoscopy, when a thin tube with a video camera is inserted into the abdominal cavity under anesthesia, through which the image is transmitted to the monitor screen. This study allows not only to detect foci of endometriosis and distinguish them from tumor processes with maximum accuracy, but also to establish the cause of chronic pelvic pain, as well as infertility.

Well, the final chord in recognizing the disease is a histological examination, when during colposcopy, hysteroscopy and laparoscopy, the doctor performs a biopsy of “suspicious” formations, that is, takes a piece of tissue and sends it to the laboratory for examination.

As a rule, treatment of internal endometriosis is long-term and very individual. A lot is taken into account: the places of “residence” of the “travelling” cells, the degree of their spread, the severity of the disease, the condition of neighboring organs and, finally, the age of the patient, as well as the woman’s desire to have children.

Of course, the fastest and most effective method of treating endometriosis is surgery. During the operation, excision, cauterization of foci of internal endometriosis, or even removal of the affected organ is performed. Surgical treatment actually leads to the elimination or reduction of pain and other manifestations of the disease, and in case of infertility, it increases the likelihood of pregnancy. However, surgery can only provide temporary relief. Where is the guarantee that tomorrow the endometrial cells will not want to go on a new journey? There is no such guarantee, which means that the likelihood of repeated surgical interventions is quite real. Even after a well-performed operation, drug treatment is necessary, aimed at eliminating existing disorders in the body and controlling the disease.

Drug treatment is divided into two types. First: medications are used that act directly on the “traveling” cells, causing them to “calm down.” Second: drugs are used that normalize hormonal, immune, and inflammatory disorders of the body.

The most important and effective are hormonal drugs. There is no need to be afraid of them; in the fight against endometriosis, they are our greatest and most reliable friends. Because “like cures like.” The choice of medications is very individual and is prescribed only by a doctor. The goal of hormonal treatment for internal endometriosis is to cause atrophy, the drying out of the traveling cells. And here the following drugs can help: silhouette, bonade, janine. Their advantage is also that, along with the therapeutic effect, they reliably protect against unwanted pregnancy, that is, they have a contraceptive effect. These drugs are taken strictly according to the following regimen:

From the first day of menstruation, 1 tablet. 1 time a day, preferably at night, for 21 days.

This is followed by a seven-day break, and from the 8th day the drugs are taken from a new package. The duration of treatment is determined by the doctor, but on average it ranges from 3 to 6 months.

To pacify traveling endometriosis cells, it is also quite suitable duphaston in the form of tablets of 10 mg.

It is taken twice a day - morning and evening, usually from the 16th to the 25th day of the menstrual cycle (counted from the first day of menstruation), on average also from 3 to 6 months. At the same time, I emphasize that duphaston is an exclusively therapeutic drug and does not provide protection against unwanted pregnancy.

It is taken from 2-3 tablets 3 times a day for a month, and sometimes, depending on the characteristics of the course of the disease, for a longer period.

We often recommend an intrauterine hormonal system (IUD) to our patients to treat endometriosis. By releasing a medicinal substance into the uterus, it leads to a gradual “drying out” of endometriosis cells. This system is used for 3-5 years under the constant supervision of a gynecologist.

If endometriosis is accompanied by pain, we prescribe ibuprofen at a dosage of 200 mg, 1 tablet 2-3 times a day, drotaverine 40 mg - 1 tablet 2-3 times a day, indomethacin in the form of 100 mg suppositories (introduced into the rectum, according to the instructions. However, they are contraindicated for erosive diseases of the stomach and intestines).

An alternative to them for pain relief may be:

Candles with belladonna extract in a dosage of 0.015 g. Inserted into the rectum at night once a day for 3-5 days.

Will help with heavy and prolonged menstruation tranex 250 mg - 1 tablet 3 times a day, ethamsylate 250 mg - 1 tablet 3 times a day.

Losing a large amount of blood during heavy menstruation, women often suffer from anemia. If you have low hemoglobin in your blood, you can take phenyuls, sorbifer- 1 capsule (tablet) 1 time per day. To relieve anxiety, Afobazole 10 mg will not hurt - 1 tablet 3 times a day.

Don't forget about physical therapy. These are electrophoresis with potassium iodide, magnesium sulfate, electroanalgesia, magnetic laser therapy.

Vitamins, exercise

When treating endometriosis, it is important to exclude physical and emotional stress, you should spend more time in the fresh air, provide good nutrition with a limit on hot and spicy foods, include vitamins A, B1, B6, C, K in your diet. It’s good if they are present on your table , pineapple, seaweed, asparagus, bananas, eggplant, carrots, figs, strawberries, raspberries, pomegranate, watercress, spinach, parsley, rhubarb, oranges, pear, grapes, melon, apples, tomatoes. Spa treatment with radon baths is effective.

As for physical activity, you need to be careful here. With endometriosis, any physical activity during menstruation is strictly prohibited. Sports and exercises that increase blood circulation in the pelvic area are also contraindicated, which can contribute to the further spread of endometrial cells outside the uterus. Additionally, vibrating movements such as jogging are not recommended.

However, some therapeutic exercises will help reduce pain due to endometriosis, but they should not be performed during menstruation.

Lying on your back, bend your knees. On the count of “one-two” - spread your knees to the sides, on the count of “three-four” - return to the starting position.
Lying on your back, lean on your elbows. On the count of “one-two” - lift your pelvis 15-20 cm from the floor, on the count of “three-four” - return to the starting position.
Lying on your back, engage in deep diaphragmatic breathing for a few seconds*
Lying on your stomach, on the count of “one-two” - move the bent leg to the side, on the count of “three-four” - return to the starting position. Do the same with the second leg.
Standing on all fours, stretch your torso, like a cat stretches. Change “cat” poses, connecting your arms, legs, and spine.

Traditional medicine can also be used in the fight against endometriosis. So, to regulate menstruation, use a collection of blackberry, birch leaves, yarrow herb, and valerian root. Mix the raw materials taken in equal parts by weight.

1 tbsp. Pour 1 cup of boiling water over a spoonful of the mixture, wrap it up and leave for 1 hour. After straining, drink in small sips throughout the day.

For heavy menstruation, as a hemostatic agent, a recipe for another collection, which will consist of wild strawberry leaves, raspberries, cinquefoil herb, shepherd's purse, oak bark. All components must be taken in equal parts and mixed,

After which 1 tbsp. Pour 1 cup of boiling water over a spoonful of the mixture and leave for at least 2-3 hours. After straining, drink in 3-4 doses throughout the day.

A new-fangled method of treating endometriosis is aromatherapy

Properly selected essential oils improve blood circulation, increase the body's resistance to harmful environmental factors, normalize mental state, and help activate the body's defenses. Essential oils of lavender, chamomile, dill, sage, eucalyptus, and peppermint have an analgesic and antispasmodic effect. Essential oils of geranium, cinnamon, lemon, and cumin can help stop heavy menstruation.

So there are not so few methods for treating endometriosis. The main thing is to choose the most optimal one and not allow “traveller” cells to wander around your body in the future.

Internal endometriosis is a disease associated with changes in the lining of the uterus, the growth of the endometrium beyond its limits due to hormonal imbalance in the body.

This disease affects more than 15% of women of childbearing age who cannot give birth to a child due to infertility. Those who give birth are subject to changes in the endometrium much less often.

The endometrium is the layer of the uterus that lines the inside of the uterus. A fertilized egg attaches to it and pregnancy occurs. If this does not occur, then the inner layer of the uterus is torn away and comes out together with the egg. Menstruation begins, and a new layer forms in the organ. This happens as long as the ovaries function and the woman can conceive and give birth to a child.

When you have endometriosis, the cells do not leave the uterus, but begin to move within it (or internally) or to other organs. The intestines, bladder, kidneys, eyes are affected (extragenital form or external).

This happens due to hormonal disorders, when the immune system cannot cope with its functions of destroying foreign tissue, and endometrioid cells have increased survival.

The consequences of chronic inflammatory diseases of the female sphere, surgeries, and heavy loads (active sports during menstruation) play a certain role.

Internal endometriosis

It differs from the external one in that it affects the female organs:

body of the uterus (nodular, diffuse, focal);
neck;
ovaries (pseudocysts);
fallopian tubes (adhesions, obstruction).

In ICD-10, internal endometriosis is included in the list of diseases of the genitourinary system.

It is difficult to establish the true causes of the pathology. There is an opinion that in addition to hormonal imbalances, a number of factors can lead to it:

timing of menstruation (too early or late);
late onset of sexual activity;
intrauterine device;
severe allergic reaction;
taking contraceptives;
excess weight, lack of physical activity;
stress;
polluted environment.

Symptoms and manifestations

Signs of the disease:

Dark red discharge, not during menstruation, but before or after it.
during long periods.
Manifested (irritability, tearfulness, headaches).
Pain in the pelvic area, radiating to the rectum, groin, vagina.
Pain during sexual intercourse, accompanied by bleeding.
With large blood losses, anemia occurs.

The intensity of pain is not related to the severity of the pathology. With minor discomfort, a large part of the endometrium may be affected, but severe pain can be caused by a small lesion.

Possible complications

These symptoms are also common to other diseases, such as:

inflammation of the appendages;
diseases of the intestines, stomach, bladder.

It depends on the location of the endometriosis lesions. It is necessary to conduct a comprehensive examination before starting treatment and preventing the development of a chronic form.

Let's consider what complications a protracted illness can lead to:

Anemia. Large blood losses lead to anemia. Weakness, pallor of the skin and mucous membranes, dizziness, and shortness of breath are observed.
Infertility. It can be caused by adhesions that subsequently lead to.
Risk of growth of malignant neoplasms.
Disease of neighboring organs. The ability of the endometrium to move and enter them causes their dysfunction. Endometrial cells penetrate through the lymph and blood vessels even into organs such as the diaphragm, lungs, kidneys, and nerve plexuses.

Carrying out diagnostics

If discomfort lasts more than a week, you need to undergo examinations:

examination by a gynecologist;
Ultrasound of the genitourinary area;
colonoscopy;
laparoscopy (to find out if there is a tumor).

And only after conducting an examination and establishing an accurate diagnosis, the doctor will determine how to treat endometriosis. Contacting a specialist at the first symptoms of inflammatory and infectious diseases of the genitourinary area will help to avoid serious consequences.

Watch the video about the causes and treatment:

Treatment

For endometriosis, both surgical and conservative methods are indicated. The goal is to restore reproductive function, remove pathological tissue, and improve a woman’s quality of life.

At the initial stage, hormone-containing drugs are used. Don't be afraid of them; they help fight endometriosis very well.

Drugs for treatment:

synthetic progestogens (Depo Provera, Duphaston, Ingesta);
contraceptives in tablets containing small doses of hormones (Lindinet, Novinet, Jess);
gonadotropin-releasing hormone antagonists;
hormones that cause amenorrhea (Leuprorelin);
symptomatic drugs (painkillers Ibuprofen, Indomethacin), anti-inflammatory, antioxidant, vitamins.

At home, you can use folk remedies: for heavy periods, collections of birch leaves, mint, and valerian root. Has proven itself well.

Physiotherapy is indicated. Electrophoresis with magnesium sulfate, potassium iodide, and magnetic laser therapy are prescribed.

If conservative treatment methods are not effective, the pathological cells are removed surgically. Laparoscopic operations are performed more often. A laparoscope is inserted into small incisions, endometriotic lesions are excised, and coagulated.

If the inner layer is severely damaged and drug therapy is insufficient, sometimes in the presence of fibroids, the uterus and appendages are removed.

Prevention measures

Endometriosis occurs at any age. Prevention measures have not been fully developed, but the following principles exist:

timely treatment of menstrual disorders in teenage girls;
restoration of normal hormonal levels;
prevention of instrumental abortions;
healthy eating;
active lifestyle with reasonable hardening;
rejection of bad habits;
use of contraceptives to exclude unwanted pregnancy;
regular visits to the gynecologist (2 times a year);
Seeing a doctor if symptoms of inflammation and infectious diseases of the genital area appear, and their treatment.

All this will help prevent the destruction of the endometrium of the uterus and its entry into other organs, inflammation, and will not interfere with the normal functioning of the woman’s reproductive system.

Endometriosis is a non-neoplastic gynecological disease. Based on localization, it is divided into genital (92-94%) and extragenital (6-8%). Genital endometriosis is the second most common disease of the female genital organs (the first place is occupied by inflammatory processes). It is divided into internal and external. Internal is endometriosis of the muscular lining of the uterine body (endometriosis of the uterine body, or adenomyosis), external is endometriosis of the cervix, vagina, retrocervical tissue, perineum, ovaries, fallopian tubes, peritoneum of the rectal uterine cavity and sacrouterine ligaments.

In the case of internal endometriosis of the uterus, damage to the myometrium occurs (diffuse and focal forms). The growth of endometrioid tissue in the form of a node is called the nodular form. Depending on the depth of penetration of endometrioid tissue into the myometrium, three degrees of diffuse form are distinguished: the first - to a depth of 1 cm, the second - to the middle of the thickness of the myometrium, and the third - to the serous uterine membrane. Individual small foci of endometrioid tissue on the surface of the ovaries or peritoneum of the small ovaries are called small forms of endometriosis. The occurrence of adenomyosis, or endometriosis of the uterine body, is also facilitated by diagnostic uterine curettage, abortions and other intrauterine interventions. During curettage, the connective tissue basis of the basal layer of the endometrium and the adjacent muscle elements are disrupted, which creates conditions for the penetration of endometrial cells into the myometrium and the further development of foci of endometriosis.

The pathognomonic symptom of internal endometriosis is the appearance of heavy and painful menstruation that continues for a long time, as well as an increase in the size of the uterus, pain in the lower abdomen immediately before menstruation and in the first days after its onset. Internal endometriosis of the uterine body is usually characterized by a diffuse process, and the nodular form is characterized by local proliferation of endometrioid tissue, reminiscent of a fibroid node on palpation.

In the nodular form, the listed symptoms are supplemented by vegetative disorders during menstruation, including headache, nausea, vomiting and even loss of consciousness. A rare form of internal endometriosis is endometriosis of the isthmic part of the uterus and the isthmic-cervical region.

Internal endometriosis is often combined with uterine fibroids, and in some cases with ovarian tumors and chronic inflammation of the uterine appendages. It can also be accompanied by endometriosis of other organs - for example, endometriotic ovarian cysts.

The diagnosis is made by determining markers of endometriosis, using ultrasound diagnostics, X-ray computed tomography, colposcopy, hysteroscopy, laparoscopy, as well as studying the hemodynamics of the pelvic organs through Doppler ultrasound and angiography. Patients usually complain of menstrual irregularities and a characteristic cyclic pain syndrome.

Diagnostics

Internal endometriosis of the uterus and vagina is diagnosed using colposcopy. Ultrasound diagnostics using vaginal sensors allows identifying adenomyosis, endometrioid ovarian cysts and retrocervical endometriosis.

A frequently used diagnostic method is hysterosalpingography, which is done on days 5-7 of the menstrual cycle so that the thin mucous membrane does not prevent the penetration of the contrast agent into the endometriotic lesions communicating with the uterine cavity.

An informative diagnostic method is hysteroscopy, which is performed on the 5-6th day of the menstrual cycle, and in case of its violations - after diagnostic curettage. Hysteroscopy makes it possible to examine in detail the inner surface of the uterus, the mouth of the fallopian tubes and the endometriotic ducts that open into the uterine cavity.

Laparoscopy has the greatest diagnostic value. When used, it is possible to examine foci of endometriosis at the earliest stages of its development and carry out differentiated treatment.

The determination of endometriosis markers – CA-125 proteins – in the blood plasma is also of no small diagnostic importance. An increase in their activity is observed, as a rule, in severe forms of the disease.

Treatment of internal endometriosis of the uterus

Treatment is aimed primarily at limiting the progression of the disease, reducing its symptoms and restoring reproductive function. Treatment methods are divided into conservative and surgical. Conservative ones, in turn, are divided into hormonal and non-hormonal. The choice of a specific treatment method depends on the location of the endometriotic lesion, the degree of its spread, the severity of manifestations, the nature and level of endocrine-immune disorders, as well as the woman’s age and her interest in pregnancy.

Antiendometrioid drugs are antihormones that inhibit the reproductive function regulation system at various levels (from the hypothalamus to target organs).

Hormonal agents for the treatment of endometriosis are as follows:

progestins;
antiestrogens;
antiprogestins;
combined estrogen-gestagen drugs (oral contraceptives);
gonadotropin inhibitors;
GnRH antagonists.

Indications for surgical treatment:

adenomyosis nodular form;
adenomyosis, combined with fibroids and uterine bleeding;
diffuse form of adenomyosis (with 3-4 degrees of spread);
lack of positive effect from hormonal therapy;
retrocervical endometriosis;
endometriosis of postoperative scars, navel, perineum;
concomitant ovarian tumors.

In the case of a diffuse form of internal endometriosis, hysterectomy is used, and in the case of a nodular form of adenomyosis, an operation involving preservation of organs is allowed.

Content

Focal adenomyosis in the uterine cavity is a localized, locally widespread proliferation of the endometrium, which has clear boundaries, in contrast to. The focal form of adenomyosis is an internal type of endometriosis, which means exclusive damage to the uterine body. Depending on the degree of germination of the endometrium into the thickness of the myometrium, there are three degrees of severity of the disease: mild, moderate and severe.

Features of focal adenomyosis

The endometrial layer completely lines the inside of the uterus. It is regularly renewed through the menstrual cycle to prepare a woman to fertilize an egg and carry a child. The focal form of uterine adenomyosis appears mainly in patients who are already 40 years old and have the first signs of menopause.

Women who are approaching premenopausal age experience regular surges and falls in estrogen. They experience hot flashes, increased sweating, and often feel dizzy. When such surges are present for a long time, a focal form of adenomyosis may develop against their background.

Focal adenomyosis is a type of internal endometriosis, which can also be diffuse, affecting the entire uterine body. The focal variety is described by the specific location of endometrial areas in atypical places.

The main difficulty in diagnosis and treatment lies in determining the stage of development of the disease. There are several forms of the disease, two of which can be cured, and the rest require prompt surgical intervention.

Stages

Features of the formation of internal focal adenomyosis:

formed lesions do not form a capsule;
elements are characterized by so-called infiltrative growth and can penetrate into neighboring tissues;
endometrioid cells provoke destruction of affected tissues;
Like malignant cells, endometriotic elements spread through the lymph and blood.

Gynecologists note that internal endometriosis of the uterus is a fairly serious disease that needs to be treated. Without treatment, complications such as infertility may develop. In addition, it usually involves the occurrence of severe pain, which can interfere with a woman’s daily activities and significantly worsen her well-being.

There are several stages of focal adenomyosis.

At the first stage the depth of germination of endometrial foci into the muscular layers of the uterus is about 1/3. If the pathology is detected early, the formation can be easily treated.
In the second, the endometrium in the uterus grows by 1/2 of the part, so the gynecologist prescribes hormonal medications and appropriate therapy.
At the third stage The endometrium in the form of several sections spreads to the outer walls of the muscular layer of the uterus, thereby provoking more serious problems and disorders in the woman’s body.
At the fourth stage The endometrium extends beyond the uterine cavity, so neoplasms develop on neighboring organs. In this case, the doctor insists on surgical intervention. This form is difficult to distinguish from diffuse.

Main causes of internal adenomyosis

Scientists have not yet fully identified the main reasons that influence the development of focal forms of uterine adenomyosis. They noticed that the pathology is diagnosed in patients whose hormonal background has serious disturbances. Such women are at risk, so it is important to monitor their health.

Factors provoking the focal form of adenomyosis in the uterine cavity, include: frequent pregnancies, medical interventions, installation of a spiral, curettage and abortion.

Women with the following problems are at increased risk:

high probability of a hereditary factor. Such patients may develop not only focal adenomyosis, but also other types of endometriosis;
hormonal disorders, namely excess estrogen and lack of progesterone;
frequent stress, overexertion, fatigue and irregular rhythm of life;
heavy physical activity;
the presence of bad habits, uncontrolled use of medications that are not prescribed by a doctor.

Experts describe the mechanism of development of internal endometriosis using the following theories.

Quite rarely, adenomyosis is diagnosed in girls before the onset of puberty. It is believed that under the influence of intrauterine disorders, foci of endometriosis appear in neighboring tissues, which progress after puberty.
During menstruation, some of the bloody discharge containing endometrial cells is thrown into the peritoneal cavity. This phenomenon is called retrograde menstruation. However, not all women are able to engraft endometriotic elements. This requires special conditions, including immune and hormonal disorders, and the characteristics of endometrial cells.
Many diseases in gynecology have to be treated surgically. Adenomyosis often occurs after surgical procedures accompanied by a violation of the integrity of the inner layer of the uterus. Thus, the necessary conditions are created for the penetration of endometrioid cells into the myometrium and deeper tissues.

Internal endometriosis can be triggered by the adverse effects of certain factors. Women should remember that if inflammation in the pelvic organs is not treated, it can negatively affect not only reproductive function. Infections and stress have the ability to increase the risk of developing adenomyosis by disrupting the functioning of cellular immunity.

Signs and diagnosis

The main symptom of a focal form of adenomyosis in the uterine cavity is pain in the pelvis and abundant.

During the development of pathology, general malaise and anemia are felt. In most cases, the first two forms of the disease occur without symptoms, so it is important to regularly visit your gynecologist.

To detect focal adenomyosis, you need to undergo an ultrasound examination to identify specific ones. A transvaginal scan will allow you to determine the diagnosis with maximum accuracy.

If the disease is not treated, women may face infertility, complete or partial removal of the uterine cavity.

Internal endometriosis of the uterine body can progress without any symptoms. The absence of symptoms is typical for the initial stage. This is due to the slight spread of pathology to the tissues of the uterine body.

In general, symptoms are associated with menstruation. It is known that foci of adenomyosis menstruate simultaneously with the correctly positioned endometrium. The inability to remove endometrial cells from the lesions leads to subsequent irritation and inflammation. Experts identify symptoms that distinguish adenomyosis.

Pain. It has been noted that the pain syndrome in focal adenomyosis is characterized by cyclicity. As a rule, there is an increase in pain before and during critical days. The pain is concentrated in the lower abdomen, sacrum, with possible irradiation to the lower extremities. The pain can be so severe that a woman often has to call an ambulance and be hospitalized in the gynecological department.
Heavy discharge during menstruation. In most cases, a woman notices an increase in the volume of bloody discharge, which may be accompanied by spotting before and after menstruation. Sometimes the appearance of heavy discharge is a symptom of uterine fibroids, which often appears with adenomyosis. Internal endometriosis and fibroids occur due to hormonal disorders based on hyperestrogenism.
Bleeding. This sign, like heavy menstruation, indicates the progression of the disease. Bleeding contributes to the development of anemia due to regular blood loss.
Infertility, spontaneous abortion. As a result of hormonal abnormalities in internal endometriosis, anovulation often appears. Degenerative processes in the body of the uterus do not contribute to the implantation of a fertilized egg. With adenomyosis, an inflammatory process in the uterine body can be observed, which disrupts natural contractility and provokes miscarriages at different stages of pregnancy.

Signs of adenomyosis can be determined during a gynecological examination. The doctor determines the soreness of the uterine body and its enlargement. It is also possible to diagnose changes regarding the shape and consistency of the uterine body. As a rule, with internal endometriosis, the body of the uterus is spherical and dense.

If such treatment does not bring a positive effect, then doctors insist on surgical intervention. internal forms differ depending on the degree of germination of the lesions and the reproductive plans of the patient.

A popular technique is uterine artery embolization. Other operations, in particular curettage and ablation, can or lead to infertility.

To prescribe an effective treatment method for focal adenomyosis, the doctor takes into account several important factors:

patient's age,
presence of children and desire to have children in the future,
absence of childbirth,
stage of the disease,
severe symptoms.

If the patient has problems with the kidneys, blood vessels, liver or diabetes mellitus, then gynecologists do not prescribe treatment with hormones. Surgical intervention is decided only on an individual basis. The doctor will examine the patient’s medical history and determine the absence of asthma and obesity. Internal endometriosis is subject to treatment with serious hormonal drugs, accompanied by a number of side effects.

The principle of treatment of internal endometriosis is based on introducing the patient into a medicated menopause.

During treatment, it is important to adhere to a special diet and internal form. Your diet should include eating foods that are rich in proteins and vitamins. Additionally, immunotherapy and physiotherapy procedures are prescribed. With a focal form of adenomyosis in the uterine cavity, women often encounter neurotic problems, so in severe cases, qualified assistance from a psychotherapist will be required.

Drug treatment of focal adenomyosis can be combined with non-traditional methods of therapy. This includes hirudotherapy or homeopathy, as well as treatment with medicinal herbs. Such complex treatment always brings positive results.

Homeopathic medicines, when selected correctly, will help enhance the effects of medications. Many patients have tried the effect of leeches, which thin the blood and reduce inflammatory internal processes.

In clinical settings, new methods of treating focal forms of adenomyosis in the uterine cavity are used.

Electrocoagulation. Pathological neoplasms are affected by an electric discharge, which gently destroys focal formations.
Embolization.
The presented method of treatment is based on blocking the blood flow that flows to all formations. They are destroyed due to lack of oxygen.

Ablation helps destroy the lining of the uterus.

To avoid the appearance and development of focal forms of adenomyosis in the uterine cavity, you must be careful about your health. It is recommended to lead a healthy lifestyle, eat right, exercise and have a measured sex life. If you experience regular menstrual irregularities, you should immediately seek help from a doctor.

One of the most mysterious and insidious diseases in gynecology is endometriosis. Experts still do not fully understand the mechanisms of its occurrence. One of the varieties of this pathology is internal endometriosis of the uterus. It is interesting that for some women it does not manifest itself, while for others it causes a lot of suffering and deprives them of the joy of motherhood.

When a gynecologist discovers this pathology in a woman, she usually has a question: What is uterine endometriosis and what are its consequences? With adenomyosis, cells from the endometrium (lining) of the uterus penetrate into the myometrium (muscle layer). During the cycle, under the influence of hormones, they undergo changes and are rejected during menstruation.

However, the myometrium is not adapted for this, so hemorrhages, swelling and inflammation occur. In this case, its functioning is disrupted. The internal one is accompanied by an increase in its size, in addition, it acquires a spherical shape.

Symptoms of adenomyosis:

painful, prolonged and heavy menstruation;

severe premenstrual syndrome;

miscarriage;

spotting before and after menstruation;

infertility.

However, internal endometriosis is a disease that may not manifest itself, then it does not require treatment. Many women live with it all their lives without even realizing it, nothing bothers them, and they give birth to healthy children.

Quite often, adenomyosis is accidentally diagnosed during a routine ultrasound. It is advisable for women with this pathology to plan a pregnancy after consulting a gynecologist-endocrinologist and to be observed by him.

Experts believe that the main cause of adenomyosis is an imbalance of key female hormones. This pathology occurs with high levels of estrogen or low concentrations of progesterone. Therefore, hormonal therapy is used to treat it.

Doctors are also confident that heredity, surgical manipulation of the uterus, constant stress, inflammation, mud baths, prolonged exposure to the sun, immune disorders and a number of other factors play a certain role in the occurrence of adenomyosis. Women with this disease are advised not to overheat, as this may contribute to its progression.

Internal endometriosis of the uterus is diagnosed using a gynecological examination, ultrasound, hysterosalpingography and hysteroscopy. A doctor may detect an enlarged uterus before menstruation and a decrease in its size after.

During an ultrasound scan for adenomyosis, the specialist sees diffuse thickening of the myometrium and a heterogeneous cellular structure of the affected wall. In the nodular form of the disease, he detects a node with a heterogeneous structure.

Hysterosalpingography to diagnose adenomyosis is performed from 7 to 9 days of the cycle. During this period, the rejected endometrium does not prevent the penetration of the radiopaque substance introduced into the uterus through the vagina into the endometriotic ducts. This manipulation also allows you to check the patency of the fallopian tubes.

During hysteroscopy for adenomyosis, the gynecologist sees multiple or single holes of linear, oval or round shape in the area of the side walls and bottom. During this study, a special optical device is inserted into the uterine cavity through the cervical canal.

Hormonal drugs are used to treat adenomyosis. In preparation for pregnancy and in the initial stages of the disease, gestagens are used. If the patient does not plan to have a child in the near future, then she is offered oral contraceptives or the Mirena intrauterine system.

In more severe forms and in premenopause, drugs that cause artificial menopause are more often prescribed. If hormonal therapy does not produce results, then surgical intervention is resorted to.

A very good treatment for adenomyosis is pregnancy. This is due to hormonal changes in the body and at this time, foci of endometriosis regress.

So, internal endometriosis of the uterus may not manifest itself, but some women are seriously worried about it, and then require treatment. This disease can prevent conception and bearing a child. In addition, periods can become very painful, heavy and prolonged, causing anemia and reducing quality of life.