Endometriosis is one of the strange and mysterious gynecological diseases. Mostly young women (30-40 years old) are ill, which negatively affects their reproductive and sexual functions, and also causes suffering in the form of chronic pain syndrome.

Endometriosis in the structure of women’s diseases

Endometriosis is a chronic disease in which areas of tissue similar in structure and function to the endometrium are found outside the uterine mucosa (where the endometrium should be normal). Moreover, such endometriotic foci are found not only in the organs of the female reproductive system, but also far beyond them — the respiratory organs, the organs of the urinary system, the intestines, the abdominal cavity, the skin, etc.

How does endometrial tissue get to other organs? The exact causes and mechanisms of endometriosis development have not been established to date. But there are a number of theories, each of which has the right to exist.

  • implantation theory

The development of the disease is associated with «retrograde menstruation», when menstrual tissue is thrown into the abdominal cavity through the fallopian tubes. And hormonal and immune system disorders contribute to the attachment and further development of endometrioid heterotopias.

  • Embryonic

It suggests that there is a displacement of the germinal material from which the female reproductive system develops, in particular, the endometrium. As a result, the endometrial tissue is not in the place where it should be, but in completely different organs.

  • metaplastic

There is an assumption that the epithelium of some organs, such as the pleura, lymph nodes, kidney tubules, can turn into a tissue similar in structure to the endometrium.

In the structure of women’s diseases, endometriosis ranks third in terms of frequency of occurrence, second only to inflammatory diseases and uterine myoma.

This pathology has much in common with tumors — it has the ability to infiltrative growth with the destruction of tissues and organs, it can metastasize through the blood and lymphatic vessels. But at the same time it is considered a benign disease.

Typical symptoms of «dys-» in endometriosis

The clinical picture of endometriosis in most cases proceeds with characteristic symptoms in a larger number of women. Common and persistent symptoms include pain and infertility. It is infertility that leads a woman to a doctor.

The menstrual cycle is also disrupted — a lot of unpleasant symptoms appear that “fall down” during menstruation.

Pain occurs in almost 80% of cases with endometriosis. In a detailed study of pain sensations, the so-called four “dys-syndrome” was identified, which include such symptoms as dysmenorrhea, dyspareunia, dysuria and dyschezia.

1. Dysmenorrhea — violation of the menstrual cycle

1. Dysmenorrhea - violation of the menstrual cycle

The menstrual cycle with endometriosis has its own characteristic features: it is usually shortened, blood loss becomes abundant and is accompanied by pain. Dysmenorrhea refers to pain in the lower abdomen that occurs during menstruation. The pain symptom is especially pronounced in the first three days of the menstrual cycle. This phenomenon may be associated with an increase and blood filling of endometrioid foci, as well as with irritation of the peritoneum with blood secreted by pathological foci.

The nature of such pain can be different — aching, arching, twitching. However, a woman may be disturbed by symptoms such as nausea, dizziness, general weakness, heaviness in the legs, and fainting. Some women are not able to work at all these days.

The pain disappears with the end of menstruation, but with the next onset of «critical days» everything repeats again.

2. Dyspareunia — pain during sexual intercourse

Women suffering from endometriosis note disorders in the sexual sphere of their lives. Not everyone is ready to come to the hospital with such complaints, but with a trusting relationship with the doctor, sooner or later this symptom is detected.

Dyspareunia is the occurrence of pain associated with sexual intercourse. Moreover, pain in the genital area can appear before the moment of copulation, as well as during or after sexual intercourse. Naturally, intimacy for a woman becomes unbearable. She is forced to avoid sexual contact, nullifying the relationship with her man. At the same time, family life is under threat of disintegration, and women’s physical and mental health deviate from the norm.

Most often, the symptom occurs with endometrioid ovarian cysts and the infiltrative form of endometriosis of the uterus.

3. Dysuria — urination disorder

The close proximity of the uterus and bladder leads to the fact that endometriosis can spread to its walls, as well as the kidneys and urethra. Then join and dysuric disorders — pain during urination, the appearance of blood in the urine, frequent urge.

Dysuria is accompanied by infiltrative endometriosis, as well as endometriosis of the bladder, which occurs most often with metastatic lesions of the urinary system.

4. Dyschezia — violation of the act of defecation

4. Dyschezia - violation of the act of defecation

There are also problems with the stool, denoted by the term dyschezia. This concept includes the following symptoms:

  • Diarrhea;
  • Constipation;
  • Tenesmus (false urge to defecate);
  • Sharp pain in the rectum;
  • Blood, mucus in stool.

Disorders of the act of defecation are often observed with retrocervical localization of endometriosis, when the pathological process is located on the posterior surface of the cervix. Retrocervical endometriosis grows in the direction of the rectum and the posterior fornix of the vagina, so violations of the act of defecation are clearly manifested precisely in this localization. Also, the rectum can be affected metastatically, with any other localization of endometrioid disease.

Dyschezia is also cyclic in nature, manifests itself only during menstruation, disappears with their end.

The above symptoms related to the syndrome of four «dys-» depend on the degree of prevalence of endometriosis — the larger the area of ​​​​the lesion, the more pronounced they are.

Obstetrics / Ed. Savelieva G.M. 2000

Rare localization of genital endometriosis (case report) / Sazonova EO, Digaeva MA, Vysotski? MM, Ovakimian MA // Reproduction problems 2009 T. 15 No. 3