Endometriosis is a pathological condition accompanied by hyperplasia of the inner layer of the uterus, which is called the endometrium. As a result of such a violation, the glandular tissue extends beyond the uterus and may even end up in fairly distant organs.

Depending on where the pathological foci are localized, endometriosis is genital and extragenital. The genital variant implies the presence of pathological changes only within the organs of the reproductive system. With the extragenital variant, the endometrium extends beyond the reproductive system.

In this article, we will talk in more detail about such a variety of endometriosis as internal. It is called adenomyosis and is characterized by the germination of endometrial glandular tissue within the muscular layer of the uterus. Most often, this disease is diagnosed in women aged twenty-seven to thirty years. However, sometimes it can be found in very young female representatives. Among all gynecological pathologies, this disease ranks third in terms of frequency of occurrence.

Depending on the accompanying changes, endometriosis is focal, nodular, diffuse and diffuse-nodular. In the focal variant, the glandular tissue is introduced into the muscular layer of the uterus with the formation of separately located pathological foci. The nodal variant implies the formation of single or multiple nodular formations, inside of which there is a cavity filled with bloody masses. The diffuse variant is established if the cells of the glandular epithelium are located randomly in the thickness of the myometrium, without any grouping. Diffuse-nodular variant includes features of both nodal and diffuse variant.

In addition, there are four stages in the development of this disease:

  • The first stage is characterized by pathological changes only in the submucosal layer of the uterus;
  • The second stage is accompanied by a lesion of the myometrium to its middle;
  • The third stage — more than half of the thickness of the myometrium is involved in the pathological process;
  • The fourth stage — the glandular tissue has grown through the entire thickness of the muscle layer with spread to neighboring tissues and organs.

Reasons for the development of endometriosis

Reasons for the development of endometriosis

Currently, opinions about why internal endometriosis occurs differ. It has only been established that the emerging disorders directly depend on the hormonal background of the body. It is assumed that various traumatic effects on the inner layer of the uterus, for example, during surgical abortions, play their role in the development of this pathology.

Inflammation of the gynecological organs, promiscuous sex life or its too late onset, oral contraceptives — all this can also lead to the occurrence of such a violation. In addition, predisposing factors include a decrease in the level of immune protection and hereditary burden for gynecological pathologies.

The main symptoms of internal endometriosis

The most characteristic clinical manifestation in this pathological process is excessively long and heavy menstruation. Too long menstruation is said if its duration exceeds seven days. In addition, a sick woman complains of symptoms such as the periodic occurrence of spotting or severe bleeding in the intermenstrual period.

In addition, another specific symptom is pain. Its intensity directly depends on the degree of morphological changes in the muscular layer of the uterus and their localization. Most often, the pain syndrome appears a few days before the onset of menstruation and ends about two or three days after it began. Often the patient pays attention to increased pain during sexual intercourse. It can be localized not only in the lower abdomen, but also radiate to the perineum. A gynecological examination reveals an increase in the size of the uterus, unevenness and tuberosity of its wall.

Due to the fact that menstruation becomes too long and plentiful, there is a high probability of developing anemia. In this case, symptoms such as periodic dizziness, increased weakness, shortness of breath and pallor of the skin appear.

Adenomyosis, in the absence of the necessary treatment, often causes various complications. The most dangerous of them are difficulties with conceiving and bearing a child. This is directly related to the fact that the structure of the endometrium is broken, which entails the inability of the fetal egg to attach to the wall of the uterus.

Principles of diagnosis and treatment of the disease

Principles of diagnosis and treatment of the disease

First of all, the diagnosis of internal endometriosis is carried out on the basis of a gynecological examination. However, the most accurate data can be obtained by performing a transvaginal ultrasound scan. It is this method that will fully assess the existing violations in the structure of the uterine wall. In the event that the disease occurs in a diffuse variant, hysteroscopy is a more effective method.

Treatment of this disease is carried out with the help of hormonal and anti-inflammatory drugs, as well as immunomodulators and vitamins. With the ineffectiveness of conservative measures, surgical intervention is possible. Surgical treatment can mean both the removal of pathological foci and the uterus itself. Removal of the uterus, as a rule, is prescribed for those women who are over the age of forty or they have very pronounced and rapidly progressive changes in the myometrium.

Prevention of adenomyosis

To prevent such a disease, surgical termination of pregnancy should be avoided, a full sexual life should be maintained and inflammatory gynecological pathologies should be treated in a timely manner. In addition, it is recommended to regularly undergo examinations by a gynecologist for preventive purposes.

Published on 03/20/2018 21:05, updated on 04/17/2020 17:06

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Used sources

Gynecology. National leadership / Ed. G. M. Savelyeva, G. T. Sukhikh, I.B. Manukhin 2013

Endometriosis, adenomyosis, chronic endometritis: clinical and pathogenetic relationships and reproductive failures / Unanyan A.L., Sidorova I.S., Kogan E.A., Belogubova S.Yu., Demura T.A., Elisavetskaya A.M., Sizova N.M. // obstetrics and gynecology 2018 ten

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