Update: October 2018
The uterus is a hollow organ, which is represented by three layers:
the inner lining of its cavity is the endometrium or mucous
the shell, medium, thickest – myometrium or muscle layer and
external – this is the peritoneum, enveloping the uterus or the serous membrane.
Endometrium, in turn, is divided into 2 layers: functional,
retracted during menstruation and basal
(sprout), which gives rise to a new growth of the functional
Endometriosis of the uterus, or adenomyosis is a
hormone-dependent disease that is characterized
the distribution of inclusions very similar in structure to the cells
endometrium, beyond the mucous membrane of the uterus. Respectively,
that all monthly changes inherent in the functional layer
endometrium will also occur in endometrioid heterotopies
(foci) that causes the clinical picture, symptoms
endometriosis of the uterus. The treatment of this disease can be as
conservative and surgical.
The prevalence of endometriosis is 40–70%, such
a wide range is due to the asymptomatic course of the disease,
therefore, adenomyosis is detected by chance when a woman visits a doctor
with other problems, usually about infertility (see all
the reasons бесплодия и методы лечения).
Types and degrees of uterine adenomyosis
There are 3 forms of endometriosis of the uterus:
- diffuse adenomyosis – proliferation of endometrioid heterotopias
over the entire surface of the lining of the uterus with the formation of cavities in
- nodular adenomyosis – the proliferation of endometrial foci locally
with the formation of nodes that do not have a capsule;
- focal endometriosis – only certain areas are affected
By the depth of involvement in the pathological process of the uterine wall
there are four degrees:
- 1 degree – the germination of endometrioid foci on a small
depth, no more than the muscle layer;
- 2 degree – involvement in the process of half the thickness of the myometrium;
- 3 degree – the disease spreads to the whole muscular
- 4 degree – neighboring organs and peritoneum are involved in the process,
which covers them, while in the uterus moves-fistula with
exit into the pelvis.
Withчины эндометриоза матки
The exact causes of endometriosis is not installed.
There are several theories of the development of this disease, but each
individually does not fully explain the mechanism of the disease, but only
- Implant theory. Throwing endometrial cells into others
organs during menstruation, operations and other things where they
survive and form foci of endometriosis.
- Theory of embryonic origin. Endometrial foci
arise from the remnants of the germ material from which
genitals are formed.
- Metaplastic theory. Endometriosis lesions are formed from
mesothelium of the peritoneum, subjected to metaplasia.
Predisposing factors for uterine adenomyosis:
- traumatic injuries of the uterus – abortions (complications),
diagnostic curettage, the introduction of the intrauterine device,
manual separation of the placenta, surgery on the uterus;
- genetic predisposition;
- menstrual problems – early or late
- late childbirth, late onset of sexual activity;
- long insolation;
- stress, physical exertion;
- genital inflammatory and hormonal diseases
- endocrine pathology – diseases of the thyroid gland, sugar
diabetes, autoimmune processes, obesity;
- allergic reactions, weakening of the immune system;
- unfavorable ecology;
- low income;
- stenosis of the cervical canal (difficult blood evacuation during
time of menstruation contributes to its retrograde casting in the uterine
tubes and abdominal cavity).
TOлиническая картина эндометриоза
Withмерно у половины женщин с эндометриозом матки, симптомы
no diseases. Adenomyosis in asymptomatic
is a random finding on the pelvic ultrasound. But this
applies only to patients with endometriosis of the uterus 1
Pathognomic sign of adenomyosis is a violation
menstrual cycle. Characteristic spotting 2 to 3 days before
menstruation and for several days after it. Are possible
metrorrhagia (acyclic bleeding), which, as a rule,
возникают в середине menstrual cycle. Sometimes uterine
bleeding can be so pronounced that the doctor has to
urgently carry out surgery, right up to
before uterus removal.
Menstruation with endometriosis become profuse, with clots,
leading to the development of chronic post-hemorrhagic anemia:
- pallor of the skin and mucous membranes,
- low blood pressure
- brittle nails,
- weakness, drowsiness
- frequent colds and stuff.
Also at эндометриозе отмечается укорочение менструального
cycle. About 50% of patients develop pronounced premenstrual
TOроме того, симптомом эндометриоза является альгоменорея или
dysmenorrhea. Menstruation becomes very painful, the pain has
Pains appear before menstruation, intensified during them and
persists a few days after the end of the menstrual
Pain syndrome is associated with infiltration of uterine tissue with fluid,
accumulation of blood in endometrial foci, as well as adhesions
pelvic disease that inevitably accompanies
Localization of pain depends on the location of endometrioid
heterotopy. For example, with the involvement of the angle in the pathological process
uterine pain will occur in the corresponding groin area, with
damage to the isthmus pain radiating to the rectum, lower back and
in the vagina (see painful periods – causes). Also at
adenomyosis occurs pain during intercourse (dyspareunia).
Endometriosis of the uterus causes the development of infertility, which is connected
with two factors.
- First, egg implantation and gestation
becomes impossible in the altered uterus
- Secondly, adhesions in the pelvis prevents
penetration of the egg into the fallopian tube.
Diagnosis of Endometriosis
Diagnosis of adenomyosis begins with a thorough history taking and
complaints, then a gynecological examination is carried out, during
which is determined by the enlarged (up to 6 – 8 weeks) uterus, especially
on the eve of menstruation, spherical shape. Its mobility may be
limited to small pelvic adhesions. When the nodular form of adenomyosis
separate knots are defined, the uterus has uneven, hilly
surface. Additional methods include:
- Pelvic ultrasound
Echo signs of adenomyosis: an increase in anteroposterior size,
the appearance in the muscle layer of increased echogenicity, the presence
anechoic inclusions with a diameter of 2 – 6 mm or cavities with a liquid,
which contain minor impurities. For the nodular form of adenomyosis
characterized by the presence of 2 to 6 mm diameter inclusions in the form of a circle or
oval and fuzzy contour knot. Focal form of adenomyosis
characterized by the discovery of saccate formations of size 2 –
The main hysteroscopic symptom of the disease is considered
detection of endometrial holes in the form of burgundy points,
while the uterine lining retains a pale pink color. TO
additional signs of diffuse adenomyosis include
enlarged uterine cavity and the “toothed” contour of the basal layer
Metrosalpingography is performed in the first phase of the menstrual cycle.
immediately after the end of menstruation. On the radiograph, it is noticeable that
a contrast agent located outside the boundaries of the cavity
uterus, and its size increased.
- Magnetic resonance imaging
Allows you to diagnose adenomyosis in 90% of cases, but
rarely used due to the high cost of research.
- Endometriosis markers
Increased cancer protein-125 (CA-125) and
placental protein-14 (PP-14) in the blood indirectly indicates
endometriosis. It should be noted that the increase in CA-125 is not observed
only with endometriosis, but also with malignant tumors
ovaries, uterine fibroids, inflammatory diseases and
small term pregnancy. In patients suffering from adenomyosis,
The increased content of CA-125 is observed throughout the second
phases of the menstrual cycle and during menstruation.
- TOольпоскопия — осмотр шейки матки специальным прибором.
Endometriosis treatment может быть как консервативным, так и
operational. When conservative therapy prescribed hormonal and
non-hormonal drugs. TOонсервативная терапия должна быть
complex, and include in addition to the appointment of hormonal
drugs special diet high in calories and
limiting spices, salt and pepper, walking in the fresh air,
physical therapy, limiting physical and mental stress.
The selection of treatment method in each case is individual and depends on
many factors (the age of the patient, the desire to preserve childbearing
function, severity of disease, presence / absence
concomitant pathology and other things). TOроме того, при таком
The following drugs are indicated in the disease:
- immunity correction is carried out,
- relief of pain syndrome (see anti-inflammatory suppositories
- drugs are prescribed to normalize the functions of the liver and
Hormonal drugs for the treatment of endometriosis of the uterus
- Estrogen-progestin drugs
Oral estrogen-progestin contraceptives suppress secretion
gonadotropin-releasing factor and the synthesis of FSH and LH inhibit production
hormones in the ovaries and proliferative processes in the endometrium. Under their
influence stops the processes in the endometrium and endometrioid
growths associated with the change of phases of the menstrual cycle, and
prolonged use occurs endometrial involution, in
as a result, endometrial foci are sclerosed and overgrown.
Oral contraceptives are administered continuously for a period of 6
– 12 months.
Progestogens обладают антиэстрогенным и антипрогестероновым
actions by binding them to estrogen-induced target cells
and progesterone receptors. Duphaston, Norkolut, Premolut
it is recommended to take 5 to 10 mg from 5 to 25 day menstrual
cycle or from 16 to 25 days, the duration of treatment is 6 –
12 months. Medroxyprogesterone acetate is administered at 30-50 mg per
day oral or 150 mg every 2 weeks intramuscularly.
Gestrinon – a new derivative of 19-nortestosterone has
antiestrogenic, antiandrogenic and progestinomimeticheskie effects
and causes atrophy of the glandular endometrium. Appointed by 2.5 – 5.0
mg twice a week. TO атрофическим изменениям эндометрия и
artificial menopause leads and the appointment of mifepristone (dose
100 – 200 mg / day) for six months.
Tamoxifen blocks estrogen receptors in target tissues and
inhibits the production of prostaglandins (source of pain). TOурс лечения
is 6 months at a dose of 10 mg twice a day.
- Gonadotropin inhibitors
Danazol blocks the release of gonadotropins (FSH and LH), inhibits
secretion of sex hormones in the ovaries. It is appointed in a dosage of 200
mg 2 times a week with a gradual increase in dose to 800 mg / day to
onset of amenorrhea. During treatment with danazol, pain is relieved.
syndrome, spotting and pains disappear during
- Gonadotropin-releasing hormone agonists
Use of synthetic gonadotropin-releasing agonists
hormone (zoladex, buserilin, nafarelin) causes the development
drug amenorrhea. For example, zoladex is injected subcutaneously into
the front wall of the abdomen at a dosage of 3.6 mg once every 4 weeks. TOурс
The treatment is 6 months.
Indications for surgical treatment of adenomyosis:
- adenomyosis in combination with endometrial hyperplasia;
- nodular form of adenomyosis;
- combination of endometriosis of the uterus with myoma;
- endometriosis 3 and 4 degrees;
- the presence of endometrioid ovarian cysts or common
- lack of therapeutic effect from hormonal treatment,
lasting 3 months or more;
- contraindications to the appointment of hormonal drugs
(thromboembolism, marked varicose veins of the lower
limbs, thrombophlebitis, liver disease, migraine, tendency
to depressions, endocrine disorders, arterial hypertension and
Before surgical treatment of endometriosis of the uterus patients are shown
taking danazol or progestogens for 1 to 2 months (with the aim of
reduce endometrioid heterotopias, local inflammation and adhesions
in the pelvis). After surgery is performed
rehabilitation (electrophoresis of iodine and zinc, ultrasound, radon water
in the form of baths, vaginal douches or microclysters). In our
The article can learn about the treatment of endometriosis boron uterus.
Is it possible to cure endometriosis of the uterus?
Uterine endometriosis is a recurrent chronic disease.
Relapse after conservative therapy or organ-preserving
operations during the year occur in 20% of cases, after 5 years
disease development the number of relapses increases to 75%. With
combined treatment (conservative and operative
effect, but aggravation is still unavoidable. Most optimistic
prognosis of adenomyosis in premenopausal women, since
disease activity subsides with physiological extinction
ovaries (see hormonal and non-hormonal drugs for
Is it possible to get pregnant with endometriosis of the uterus and give birth to a healthy
Endometriosis of the uterus is the 2nd cause of infertility in women
after chronic salpingitis, salpingoophoritis. TO тому же часть
chronically recurrent inflammatory processes in the ovaries may
also be caused by internal endometriosis, rather than infectious
diseases. Therefore, the link between infertility and
endometriosis in women of childbearing age, as evidenced in
every 2-3 cases of infertility.
Since the mechanisms of infertility in endometriosis
different patients are different, respectively, and the tactics of therapy and
The forecast will be different. In women with internal endometriosis
causes of infertility may be as follows:
- Adhesions in the pelvis, disrupting the transport function
and motor activity of the fallopian tubes
- Infertility in endometriosis of the uterus caused by pathological
changes in hormonal levels, in consequence of which does not occur
the maturation of the egg and its release from the follicle.
- Inflammatory processes in the uterine muscle layer can
provoke increased contractile activity of myometrium and
lead to spontaneous abortion in early
- With аутоиммунных процессах в организме женщины возможно
decreased sperm activity in the uterus, or
impossibility of implantation of a fertilized egg.
- Pain during intercourse on the background of endometriosis, adhesions
– complicate a full-fledged regular sex life.
Infertility in this pathology is usually caused simultaneously.
several reasons. Restoration of the ability of women to conceive
and childbearing should be a comprehensive treatment.
It is very important that the duration of the disease does not exceed 3 years,
then the chances of a successful pregnancy are rising.
TOакова вероятность у женщины с эндометриозом родить здорового
baby? Modern medicine today has enough
extensive material in the field of observation of the flow
pregnancy, childbirth and period after childbirth in women with
this disease. And the basic facts of these studies point to
- With наличии эндометриоза у беременной женщины достаточно высок
риск угрозы прерывания беременности, особенно на малых deadlines.
Modern methods of therapy are carried out according to standard schemes and
able to stabilize the condition of the woman and the fetus.
- It is very important to carry out diagnostics and adequate treatment in time.
endometriosis, as with age the risk of developing
persistent infertility (according to various sources in 40-80% of cases).
- Abortions or miscarriage exacerbate endometriosis,
worsening the prognosis and accelerating the development of the pathological process.
Women should strive to preserve as much as possible
pregnancy on the background of adenomyosis. In the case of spontaneous or
artificial termination of pregnancy the patient needs
complex anti-relapse treatment – antioxidants,
immunomodulators, hormonal drugs, etc.
- In most cases, childbirth in women with adenomyosis occurs without
complications, however, in the sequential period, the risk of uterine
bleeding or recurrent endometriosis of the uterus.