What happens with endometriosis
Foci of endometriosis are structured like the tissue of the inner lining of the uterus and obey the same hormonal signals. Each cycle they grow and are rejected, but the blood from them does not come out.
As a result, chronic inflammation develops in the tissues, adhesions form, and cysts filled with dark, thick contents form in the ovaries - they are called endometriotic, or “chocolate” cysts. Adhesions disrupt the anatomy of the pelvis and the mobility of organs, which causes pain and infertility.
The exact cause of the disease has not been established. The most well-known hypothesis explains it by the reflux of menstrual blood through the fallopian tubes into the abdominal cavity, but in most women such reflux occurs without consequences - which means that both the characteristics of the immune system and genetic predisposition play a role.
Symptoms
- Severe pain during menstruation, increasing with age
- Chronic pelvic pain outside of menstruation
- Pain during intercourse, especially with deep penetration
- Pain during bowel movements and urination during menstruation
- Spotting dark discharge before and after menstruation
- Heavy menstruation
- Infertility is sometimes the only manifestation
- Severe fatigue
- Bloating, bowel movements
- Blood in the urine or stool due to damage to the bladder and intestines
Forms and stages
- Peritoneal endometriosis - lesions on the pelvic peritoneum
- Endometrioid ovarian cysts - endometriomas
- Deep infiltrative endometriosis - damage to the uterosacral ligaments, intestinal wall, bladder; most painful form
- Adenomyosis - endometriosis of the uterine body; often considered separately
- Extragenital endometriosis - rare localizations outside the pelvis
- Stages from I to IV are determined during laparoscopy by the prevalence of lesions and adhesions
An important feature: the stage of endometriosis does not correlate well with the severity of pain. A woman with minimal lesions can experience severe pain, and with a widespread process, sometimes there are almost no complaints. Therefore, treatment is selected according to symptoms and reproductive plans, and not just according to stage.
Endometriosis and infertility
- Adhesions disrupt the patency and mobility of the fallopian tubes
- The anatomy of the pelvis changes, making it difficult to capture the egg
- Chronic inflammation impairs egg quality and implantation conditions
- Endometrioid cysts reduce ovarian reserve - both on their own and after surgery
- In mild forms, laparoscopic removal of lesions increases the likelihood of natural conception
- In severe forms and reduced reserve, it is often more rational to immediately discuss IVF
Diagnostics
- Examination by a gynecologist with assessment of pain in the vaults and uterosacral ligaments
- Transvaginal ultrasound - detects endometrioid cysts and adenomyosis well, but does not see peritoneal lesions
- MRI of the pelvis - if deep infiltrative endometriosis is suspected
- Ovarian reserve assessment: AMH, antral follicle count
- Tumor marker CA-125 - may be elevated, but is not specific for diagnosis
- Laparoscopy with biopsy of lesions is the gold standard for confirming the diagnosis
- Colonoscopy and cystoscopy for suspected damage to the intestines and bladder
- Pain diary - helps to objectively assess the dynamics of treatment
Treatment
- Pain therapy - non-steroidal anti-inflammatory drugs
- Combined hormonal contraceptives in continuous mode
- Progesterone preparations are one of the basis of long-term therapy
- Intrauterine hormonal system
- GnRH agonists - short course, usually before surgery or in severe forms
- Laparoscopy with excision or electrical destruction of lesions
- Laparoscopic cystectomy for endometrioid cyst
- Separation of adhesions - salpingo-ovariolysis
- Introduction of anti-adhesive barriers during surgery
- IVF for infertility associated with endometriosis
- Comprehensive work with chronic pain, including pelvic floor physiotherapy and psychological support
Endometriosis is a chronic disease prone to relapse. The realistic goals of treatment are pain control, preservation of fertility, and a normal quality of life, not a one-time “permanent removal.” After surgery, hormonal therapy is usually prescribed specifically to prevent the lesions from returning.
Where is endometriosis treated in Tashkent
We need high-quality transvaginal ultrasound, access to MRI and a surgical service that is proficient in laparoscopy with gentle techniques for working on the ovaries.
In Tashkent, examination and treatment of endometriosis, including laparoscopic removal of cysts and lesions, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you are planning a pregnancy, be sure to discuss an ovarian reserve assessment with your doctor BEFORE ovarian surgery. This is a case where the order of actions directly affects future chances. Clinic contacts are below.
