In the structure of gynecological pathology, endometriosis occupies one of the leading places. About 10% of all disorders of the reproductive female sphere are associated with this pathology. With this disease, the endometrium, the inner layer of the uterus, grows beyond its normal localization. The exact causes of the disease have not yet been clarified, but doctors assign a role to an imbalance of sex hormones, impaired immune function, inflammatory processes, and many other factors. The course of endometriosis is individual: in some women, its presence is not determined for a long time, in others, severe pain and severe malaise associated with cyclic changes are typical.

The role of hormones in the formation of pathology

The role of hormones in the formation of pathology

The development of endometriosis is based on a combination of several influencing factors at once, but to date it has not been possible to find out the true leading cause of the pathology. The formation of endometriosis falls on the period of reproductive age, with a peak at 30-45 years. One of the factors of its occurrence is considered pathological menstruation with copious bleeding. Against the background of an imbalance of hormones and increased secretions during menstruation, cells of the exfoliating endometrium may be thrown into the abdominal cavity along with blood. This can lead to the formation of ectopic foci outside the uterine cavity with their functioning in the same rhythm as the true endometrium.

Today, it is hormones that are often “accused” of provoking endometriosis. It is noted that in almost all women with this pathology, one way or another, violations of the ratio of hormones are detected. The hormones FSH (follicle-stimulating) and LH (luteinizing) undergo particular changes, while the level of progesterone is reduced. In addition, the concentrations of prolactin change and a violation of the production of hormones of the adrenal cortex is detected.

Genetic predisposition and the role of immunity

There is evidence from researchers that endometriosis has a genetic predisposition. The studies described family cases when several daughters had different forms of pathology. This is associated with the presence of specific genes that form a woman’s predisposition to the development of endometriosis. Along with this, it is assumed that immunity features can also be inherited, due to which endometrial cells atypical for extragenital localizations are not destroyed by the immune system.

Acquired immune disorders are also possible, which allow the development of endometriosis. Under normal conditions, endometrial cells should be only inside the uterine cavity. In other localizations, they simply do not survive. They are actively recognized and destroyed by their own immunity, preventing the formation of atypical foci of tissue growth. If immunity is impaired due to the influence of various reasons, endometrial cells, penetrating beyond the uterine cavity, take root and begin to actively grow, forming foci of endometriosis on the genitals or in the abdominal cavity. All theories are being actively studied, but at the moment there is no consensus regarding the origin of the pathology.

What factors predispose to the formation of endometriosis?

Conducting global studies among women who suffer from endometriosis has allowed scientists to identify a number of conditions that affect the development of pathology. So, among the leading factors that can cause endometriosis is the presence of abortions, especially several in a row, a deficiency in the body of iron and some other minerals. There is evidence of the adverse effects of the environment and bad habits. Doctors consider surgeries and invasive interventions in the genital area as a risk factor — caesarean section, effects on the cervix, inflammation in the uterus and ovaries, setting an intrauterine device. There is evidence of the influence of obesity and liver pathologies, which leads to an imbalance in hormones.

What organs can be affected: uterus, ovaries, abdominal cavity

Depending on which organs are affected in endometriosis, there are several clinical forms of pathology. So, the genital form is the most common — it affects the uterus itself and the tubes, the space behind the cervix, the vagina or the external genitalia. With damage to the uterus, endometrial tissue is typically found in the muscular and serous layers, as well as foci on the outer surface of the organ. The progression of the pathology leads to the formation of new foci that affect the ovaries and tubes.

An extragenital form is also possible — with foci of endometriosis in the area of ​​the urinary system or intestines, lungs, or in the area of ​​scars after operations. There is also a mixed form, when it is affected as the uterus itself or the ovaries in combination with extragenital foci.

Gynecologists most often encounter adenomyosis, a lesion of the uterus within its muscular layer. The depth of the lesion can be different, from a slight germination of the endometrium into the muscle layer to the defeat of the peritoneum.

Manifestations of the disease: pain, discharge, malaise

Manifestations of the disease: pain, discharge, malaise

The symptoms of endometriosis are varied, and often the manifestations can simulate other gynecological pathologies or an acute abdomen. Sometimes the symptoms are barely perceptible, and the woman does not even pay attention to them, and there are times when sleep and performance suffer due to pain and malaise. When evaluating clinical symptoms, the form of the pathology and the degree of spread of the focus of endometriosis, the existing concomitant diseases, and even the psycho-emotional state of the woman are important.

The leading complaint of all patients is pain localized in the lower abdomen or in the lower back, which can be from slight aching to acute. Against the background of menstruation, the pain increases dramatically, can become unbearable, and requires the use of painkillers. Sexual intimacy and defecation can also cause discomfort, with straining or straining, pain can be felt in the perineum or rectum.

In addition, a typical disorder of menstrual function, spotting, preceding menstruation and occurring after their completion. Against the background of endometriosis, infertility is often formed, especially with damage to the ovaries and fallopian tubes, the formation of adhesions in the small pelvis.

Against the background of the pain syndrome, weakness, fever and nausea, chills are typical, working capacity suffers, which forces the patients to stay on sick leave.

Obstetrics / Ed. Savelieva G.M. 2000

Endometriosis and contraceptive hormones: opportunities and perspectives / Prilepskaya V.N. // breast 2007 T. 15 No. 3