Endometrial Hyperplasia – Symptoms, Causes, Treatments

Endometrial hyperplasia is an excessive or abnormal thickening of the lining of the uterus. This lining, called the endometrium, grows and thickens every month in preparation for pregnancy. If pregnancy does not occur, the lining is shed. This shedding process, known as a menstrual period, is controlled by two hormones: estrogen and progesterone.

Estrogen is responsible for building up the uterine lining, and progesterone maintains and controls this buildup. Too much estrogen and not enough progesterone can cause overgrowth of the cells that line the uterus, along with excessive thickening of the endometrium. Women who take estrogen hormone therapy without taking any form of progesterone to balance the effects of estrogen are at risk for the development of endometrial hyperplasia and cancer.

Endometrial hyperplasia may also occur because of chronic diseases, such as diabetes, obesity, and polycystic ovarian syndrome. Polycystic ovarian syndrome is a disorder that involves hormone disturbances and may or may not involve multiple small cysts in one or both ovaries.

What are the risk factors for endometrial hyperplasia?

A number of factors increase the risk of developing endometrial hyperplasia. Not all women with risk factors will get endometrial hyperplasia. Risk factors for hyperplasia include:

• Diabetes
• Estrogen therapy without taking progesterone
• Menopause or the years around menopause
• Missed menstrual periods
• Obesity
• Polycystic ovarian syndrome

Reducing your risk of endometrial hyperplasia

Most cases of endometrial hyperplasia are benign (noncancerous). Because of the associated hormonal shifts, this condition is most common among women who are nearing menopause or have reached menopause. Endometrial hyperplasia also may occur because of chronic disorders, such as diabetes, obesity, and polycystic ovarian syndrome.

You may be able to lower your risk of endometrial hyperplasia by:

• Consulting with your health care provider about hormone replacement therapy

• Keeping track of your menstrual periods

• Maintaining a healthy weight, or losing weight, if advised to do so by your health care provider

• Managing your diabetes

• Taking contraceptives to help regulate your menstrual periods

Endometrial Cancer | Johns Hopkins Medicine

Endometrial cancer is the most commonly diagnosed gynecologic cancer. About 50,000 American women are diagnosed with the disease every year. Endometrial cancer is also the most common form of uterine cancer, so it is frequently referred to as uterine cancer.

What is endometrial cancer? 

The lining of the uterus is called the endometrium. Cancer of the endometrium is the most common cancer of the female reproductive organs.

Cancer of the endometrium is different from cancer of the connective tissue or muscle of the uterus, which is called uterine sarcoma. About 80 percent of all endometrial cancers are adenocarcinomas. This means the cancer occurs in the cells that develop the glands in the endometrium. Endometrial cancer is highly curable when found early.

Uterine carcinosarcoma is a very rare type of uterine cancer, with characteristics of both endometrial cancer and uterine sarcoma. It is also known as a malignant mixed mesodermal tumor.

Types of Endometrial Cancer

Endometrial cancers are usually grouped into one of four categories:

• p53 mutation

• POLE mutation

• Copy number high

• Copy number low

Clinical trials are being used to assess treatments for cancers found within each of these groups, including novel immunotherapy trials.

Endometrial Cancer Prevention

The exact cause of endometrial cancer is not known. However, doctors believe that avoiding the known risk factors when possible, using oral contraceptives or other forms of hormonal birth control, controlling obesity and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

Endometrial Cancer Causes and Risk Factors

The following factors may increase a woman’s risk of developing endometrial cancer:

• Obesity

• Diet high in animal fat

• Family history of endometrial, ovarian and/or colon cancers (hereditary nonpolyposis colorectal cancer)

• Starting monthly periods before age 12

• Late menopause

• Infertility (inability to become pregnant)

• Never having children

• Being treated with tamoxifen for breast cancer

• Hormonal imbalance — having too much estrogen and not enough progesterone in the body

• Estrogen replacement therapy for treatment of effects of menopause

• Diabetes

• Personal history of breast cancer

• Personal history of ovarian cancer

• Prior radiation therapy for pelvic cancer

• Personal history of polycystic ovary syndrome or atypical endometrial hyperplasia

The risk for endometrial cancer increases as women get older, and it is most common in white women.

Endometrial Cancer Symptoms

Consult a doctor if you experience any/all of the following symptoms:

• Bleeding or discharge not related to your periods (menstruation) — over 90 percent of women diagnosed with endometrial cancer have abnormal vaginal bleeding

• Postmenopausal bleeding

• Difficult or painful urination

• Pain during intercourse

• Pain and/or mass in the pelvic area

Endometrial Cancer Diagnosis

Diagnosis of endometrial cancer includes a review of your medical history and a general physical exam. It may also include one or more of the following.

• Internal pelvic exam: This is done to feel for any lumps or changes in the shape of the uterus.

• Pap test (also called Pap smear): This test involves microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer and to show noncancerous conditions, such as infection or inflammation. However, the Pap test does not detect endometrial cancer.

• Endometrial biopsy: This procedure uses a small, flexible tube that is put into the uterus to collect an endometrial tissue sample. The sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.

• Dilation and curettage (also called D&C): Your doctor may recommend a D&C if an endometrial biopsy is not possible or if further diagnostic information is needed. This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.

• Transvaginal ultrasound (also called ultrasonography): This ultrasound test uses a small instrument, called a transducer, which is placed in the vagina. The doctor may do a biopsy if the endometrium looks too thick.

Endometrial Cancer Treatment

Specific treatment for endometrial cancer will be determined by your doctor(s) based on:

• Your overall health and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures or therapies

• Expectations for the course of the disease

• Your opinion or preference

The choice of treatment depends on the stage of cancer — whether it is only in the endometrium, or if it has spread to other parts of the uterus or body. Most people will be treated with surgery first. Some may need additional therapy. Generally, treatment for people with cancer of the endometrium includes one or more of the following.

• Surgery:

  • Hysterectomy — surgical removal of the uterus

  • Salpingo-oophorectomy — surgery to remove the fallopian tubes and ovaries

  • Pelvic lymph node dissection — removal of some lymph nodes from the pelvis

  • Para-aortic lymphadenectomy — removal of lymph nodes that surround the aorta, the main artery of the heart

  • Laparoscopic lymph node sampling — removal of lymph nodes through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly)

  • Sentinel lymph node mapping — use of fluorescent imaging to identify potentially cancerous lymph nodes that would otherwise go undetected

• Radiation therapy: the use of X-rays, gamma rays and charged particles to fight cancer. Brachytherapy and external beam radiation are the most common radiation therapies used to treat endometrial cancer. Novel techniques in image-based brachytherapy with directed magnetic resonance (MR) guidance offer better patient outcomes and fewer side effects.

• Chemotherapy: the use of anticancer drugs to treat cancerous cells

• Immunotherapy: the process of activating the immune system’s natural ability to fight cancer

• Hormone therapy: medication or surgical procedures that interfere with hormone activity

How Pregnancy (Conception) Occurs | Michigan Medicine

Topic Overview

Most women are able to become pregnant from puberty, when their menstrual cycles begin, until menopause, when their cycles stop. A pregnancy starts with fertilization, when a woman’s egg joins with a man’s sperm. Fertilization usually takes place in a fallopian tube that links an ovary to the uterus. If the fertilized egg successfully travels down the fallopian tube and implants in the uterus, an embryo starts growing.

Ovulation, fertilization, implantation

All the eggs for a woman’s lifetime are stored in her ovaries. Women do not keep producing eggs. This is different from men, who continuously make more sperm.

About once a month, an egg is released from one of a woman’s two ovaries. This is called ovulation. The egg then enters the nearby fallopian tube that leads to the uterus.

If a woman and a man have unprotected sexual intercourse, sperm that is ejaculated from the man’s penis may reach the egg in the fallopian tube. If one of the sperm cells penetrates the egg, the egg is fertilized and begins developing.

The egg takes several days to travel down the fallopian tube into the uterus. After it is in the uterus, a fertilized egg usually attaches to (implants in) the lining of the uterus (endometrium). But not all fertilized eggs successfully implant. If the egg is not fertilized or does not implant, the woman’s body sheds the egg and the endometrium. This shedding causes the bleeding in a woman’s menstrual period.

When a fertilized egg does implant, a hormone called human chorionic gonadotropin (hCG) begins to be produced in the uterus. This is the hormone that a pregnancy test measures. It prevents the uterine lining from being shed, so the woman does not have a period. Other signs such as breast changes and nausea occur in a woman’s body, also meaning that pregnancy has begun.

Credits

Current as of:
October 8, 2020

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD – Family Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
Femi Olatunbosun MB, FRCSC – Obstetrics and Gynecology

Current as of: October 8, 2020

Author:
Healthwise Staff

Medical Review:Sarah Marshall MD – Family Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & Femi Olatunbosun MB, FRCSC – Obstetrics and Gynecology

The inner mucous membrane lining of the uterus is called the: a. perimetrium. b. endometrium. c. myometrium. d. perineum.

The Uterine Cycle: Proliferative Phase

The proliferative phase of the uterine cycle is where the endometrium of the uterus is rebuilt. Learn about the uterine cycle, endometrial zones, and the proliferative phase.

Cervix: Definition, Anatomy & Function

The cervix is the part of the female reproductive system that connects the uterus and vagina. Learn about the definition, anatomy, and function of the cervix, and discover how it serves as a protective mechanism for the reproductive system.

What Are Ovaries? – Definition, Functions & Size

An essential part of the female reproductive system is the ovary, or female gonad. Learn the definition of ovaries, their size, and their many functions, such as producing eggs and sex hormones.

Polyuria: Definition, Causes & Symptoms

Polyuria is a condition of having frequent and excessive urination. Learn about the definition of polyuria, explore the roles of water, kidneys, and electrolytes in this condition, and understand the causes and symptoms of polyuria.

Functions & Structures of the Male Reproductive System

The male reproductive system is a network of structures that contribute to the production and distribution of genetic material through sperm. Learn the function of structures involved in the testicles, associated ducts, and the penis.

Follicular Phase of the Ovarian Cycle

What is the follicular phase of the ovarian cycle? Learn the stages of ovarian follicle development and where the follicular phase fits in the ovarian cycle.

Pancreas: Structure & Function

The pancreas produces enzymes that break down and convert food molecules into nutrients and help regulate blood sugar. Learn about the structure and function of the pancreas, and explore hormones produced by the pancreas such as insulin and glucagon.

Ureter: Definition & Function

Ureters are the biomechanics tubes and valves that transfer waste from the kidneys to be expelled from the body. Identify how they function to remove waste without accidentally encountering backflow.

What Is the Uterine Cavity? – Size & Definition

The uterine cavity is the space inside the uterus, and plays a key role in sexual activity, fertilization of the egg by sperm, and the growth of the fetus during pregnancy. Learn about the structure of the uterine cavity and its essential function in reproduction.

The Uterine Cycle: Secretory Phase

The secretory phase of the uterine cycle (menses) is when a suitable environment is created for an incoming embryo. Discover more about the secretory phase and its relationship to the uterine glands, progesterone, and fertilization.

Fetal Development in the First Trimester: Stages & Timeline

Fetal development in the first trimester occurs in stages with new organs forming about every four weeks. Explore the first trimester timeline and learn about embryogenesis, cell differentiation, organogenesis, and the growth progression of an embryo.

What Is a Blastocyst? – Definition & Development Stages

The blastocyst, a phase of a fertilized egg, is a major part of an organism that makes change and growth possible. Learn what happens at this stage of development, the function of the zona pellucida and how blastocysts move into the uterus.

Endometriosis – HealthyWomen

Overview

What Is It?
Endometriosis is a condition in which tissue similar to your uterine lining grows outside your uterus and gets stuck to other organs or structures, often resulting in pain or infertility.

Endometriosis is a noncancerous condition in which tissue similar to the Endometriosis is a condition in which tissue similar to your uterine lining grows outside your uterus and gets stuck to other organs or structures, often resulting in pain or infertility.(uterine lining) grows outside your uterus and adheres to other structures, most commonly in the pelvis, such as on the ovaries, bowel, fallopian tubes or bladder. Rarely it implants in other places, such as the liver, lungs, diaphragm and surgical sites.

It is a common cause of pelvic pain and infertility. It affects about 5 million women in the United States.

Historically thought of as a disease that affects adult women, endometriosis is increasingly being diagnosed in adolescents, as well.

The most common symptoms are painful menstrual periods and/or chronic pelvic pain.

Others include:

• Diarrhea and painful bowel movements, especially during menstruation
• Intestinal pain
• Painful intercourse
• Abdominal tenderness
• Backache
• Severe menstrual cramps
• Excessive menstrual bleeding
• Painful urination
• Pain in the pelvic region with exercise
• Painful pelvic examinations
• Infertility

It is important to understand that other conditions aside from endometriosis can cause any or all of these symptoms and other causes may need to be ruled out. These include, but are not limited to, interstitial cystitis, irritable bowel syndrome, inflammatory bowel disease, pelvic adhesions (scar tissue), ovarian masses, uterine abnormalities, fibromyalgia, malabsorption syndromes and, very rarely, malignancies.

When endometriosis tissue grows outside of the uterus, it continues to respond to hormonal signals—specifically estrogen—from the ovaries telling it to grow. Estrogen is the hormone that causes your uterine lining to thicken each month. When estrogen levels drop, the lining is expelled from the uterus, resulting in menstrual flow (you get your period). But unlike the tissue lining the uterus, which leaves your body during menstruation, endometriosis tissue is essentially trapped.

With no place to go, the tissue bleeds internally. Your body reacts to the internal bleeding with inflammation, a process that can lead to the formation of scar tissue, also called adhesions. This inflammation and the resulting scar tissue may cause pain and other symptoms.

Recent research also finds that this misplaced endometrial tissue may develop its own blood supply to help it proliferate and nerve supply to communicate with the brain, one reason for the condition’s severe pain and the other chronic pain conditions so many women with endometriosis suffer from.

The type and intensity of symptoms range from completely disabling to mild. Sometimes, there aren’t any symptoms at all, particularly in women with so-called “unexplained infertility.”

If your endometriosis results in scarring of the reproductive organs, it may affect your ability to get pregnant. In fact, 30 to 40 percent of women with endometriosis are infertile. Even mild endometriosis can result in infertility.

Researchers don’t know what causes endometriosis, but many theories exist. One suggests that retrograde menstruation—or “reverse menstruation”—may be the main cause. In this condition, menstrual blood doesn’t flow out of the cervix (the opening of the uterus to the vagina), but, instead, is pushed backward out of the uterus through the fallopian tubes into the pelvic cavity.

But because most women experience some amount of retrograde menstruation without developing endometriosis, researchers believe something else may contribute to its development.

For example, endometriosis could be an immune system problem or local hormonal imbalance that enables the endometrial tissue to take root and grow after it is pushed out of the uterus.

Other researchers believe that in some women, certain abdominal cells mistakenly turn into endometrial cells. These same cells are the ones responsible for the growth of a woman’s reproductive organs in the embryonic stage. It’s believed that something in the woman’s genetic makeup or something she’s exposed to in the environment in later life changes those cells so they turn into endometrial tissue outside the uterus. There’s also some thinking that damage to cells that line the pelvis from a previous infection can lead to endometriosis.

Some studies show that environmental factors may play a role in the development of endometriosis. Toxins in the environment such as dioxin seem to affect reproductive hormones and immune system responses, but this theory has not been proven and is controversial in the medical community.

Other researchers believe the endometrium itself is abnormal, which allows the tissue to break away and attach elsewhere in the body.

Endometriosis may have a genetic link, with studies finding an increase in risk if your mother or sister had the disorder. No specific genetic mutation has been clearly linked with the disease.

Diagnosis

Gynecologists and reproductive endocrinologists, gynecologists who specialize in infertility and hormonal conditions, have the most experience in evaluating and treating endometriosis.

The condition can be very difficult to diagnose, however, because symptoms vary so widely and may be caused by other conditions.

Among the ways doctors diagnose the disease are:

Laparoscopy. Currently, laparoscopy is the gold standard for the diagnosis of endometriosis and is commonly used for both diagnosis and treatment. Performed under general anesthesia, the surgeon inserts a miniature telescope called a laparoscope through a small incision in the navel to view the location, size and extent of abnormalities (such as adhesions) in the pelvic region.

However, merely looking through the laparoscope can’t diagnose deep endometriosis disease, in which the endometrial tissue is hidden inside adhesions or underneath the lining of the abdominal cavity. More extensive dissection is needed to diagnose and treat this type of disease.

Many women have a combination of both deep and superficial (in which the endometrial tissue can be easily seen) endometrial disease.

Peritoneal tissue biopsy. During the laparoscopy, the doctor may remove a tiny piece of peritoneal tissue (the inner layer of the lining of the abdominal cavity) or other suspicious areas to help establish the diagnosis of endometriosis. This is recommended by the American College of Obstetricians and Gynecologists (ACOG), which notes that only an experienced surgeon familiar with the appearance of endometriosis should rely on visual inspection alone to make the diagnosis. A biopsy, however, is not mandatory to diagnose endometriosis, and a negative biopsy does not rule out the presence of this disease in other areas within the abdomen.

Ultrasonography, MRI and CT scan. An ultrasound uses sound waves to visualize the inside of your pelvic region, while an MRI uses magnets and a CT scan uses radiation. While these tests can occasionally suggest endometriosis, particularly ovarian endometriotic cysts called “endometrioma,” or rule out other conditions, none can definitively confirm the condition.

At this point, there is no established noninvasive method to diagnosis endometriosis, which is frustrating for both women and their health care providers.

Pelvic exam. Your doctor will perform a physical examination, including a pelvic exam, to aid in the evaluation. The examination will not diagnose endometriosis but may allow your doctor to feel nodules, areas of tenderness or masses on the ovaries that may suggest endometriosis.

Medical history. A detailed medical history may offer your health care professional the earliest clues in making the correct diagnosis.

Treatment

There is no universal cure for endometriosis. However, there are a number of options available for treating and managing the disease after diagnosis. They fall into four categories: medical, surgical, alternative treatments and pregnancy.

1. Medical. The most common medical therapies for endometriosis are nonsteroidal anti-inflammatories (NSAIDs), hormonal contraceptives (in oral, patch, and intrauterine or injectable applications) and other hormonal regimens, such as GnRH agonists (gonadotropin-releasing hormone drugs).
   • Non-steroidal anti-inflammatories (NSAIDs). These drugs, such as ibuprofen, naproxen and aspirin, are often the first step in controlling endometriosis-related symptoms. They may be used long-term in a non-pregnant patient to manage symptoms, in part because they are effective at reducing implantation, are cheaper and easier to use than other options and have fewer side effects than hormonal treatments. However, some patients may experience severe gastrointestinal upset from these agents, particularly if they are administered for prolonged periods and at high doses. They are more effective when taken before pain starts.
   • Contraceptive hormones (birth control pills). This option also costs less and has fewer side effects than other hormonal treatment options and may be recommended soon after diagnosis. Birth control pills stop ovulation, thus suppressing the effects of estrogen on endometrial tissue. In most cases, women taking hormonal contraceptives have a lighter and shorter period than they did before taking them. Often physicians will recommend using birth control pills continuously as opposed to cyclically to eliminate regular menstrual flow, which can be the cause of increased pain in some women with endometriosis.
   • Medroxyprogesterone (Depo-Provera). This injectable drug, usually used as birth control, effectively halts menstruation and the growth of endometrial tissue, relieving the signs and symptoms of endometriosis. Side effects include weight gain, depressed mood and abnormal uterine bleeding (breakthrough bleeding and spotting), as well as a prolonged delay in returning to regular menstrual cycles, which can be of concern to women who want to conceive.
   • Gonadotropin Releasing Hormone Drugs (GnRH agonists). These drugs block the production of ovarian-stimulating hormones, which prevents menstruation and lowers estrogen levels, thus causing endometrial implants to shrink. GnRH agonists usually lead to endometriosis remission during treatment and sometimes for months or years afterward. However, GnRH agonists have side effects, including menopausal symptoms like hot flashes, vaginal dryness and reversible loss of bone density. Add-back hormone therapy, which typically consists of a synthetic progesterone (progestin) administered alone or in combination with a low-dose estrogen, is typically prescribed along with GnRH agonists to alleviate these side effects.
   • Danazol. This reproductive hormone is a synthetic form of a male hormone (androgen) and is available as Danocrine. It is used to treat endometriosis and works by directly suppressing endometrial tissue and suppressing ovarian hormone production. A woman taking danazol will typically not ovulate or get regular periods. Side effects may include weight gain, hair growth and acne, among others. Some of the side effects are reversible. Danazol is typically given for six to nine months at a time. Danazol is not a contraceptive agent, and it is critical that any woman taking this drug also use a barrier contraceptive (condoms, diaphragm, IUD) if she is sexually active.
   • Progestin-containing intrauterine device. Several studies have shown that an intrauterine device (IUD) containing a synthetic type of progesterone (progestin) can also reduce the painful symptoms and extent of disease associated with endometriosis. If effective, the IUD can be left in the uterus for three to five years and can be removed if a woman wants to conceive. There are currently three FDA-approved brands—Mirena, Skyla, and Liletta—and each has different characteristics; Mirena can be left in place the longest. It should not be used in women with multiple sexual partners, those with an abnormal uterus (fibroids) or those with prior sexually transmitted disease. Side effects include cramping and breakthrough bleeding.
   • Aromatase inhibitors. This class of drugs inhibits the actions of one of the enzymes that forms estrogen in the body and can block the growth of endometriosis. It is important to understand that this class of drugs is not approved for use in the treatment of endometriosis by the U.S. Food and Drug Administration; it is under investigation. Side effects include hot flushes, bone loss and the potential for increased risk of birth defects if a woman conceives while taking these medications and remains on them. Their use should be limited to women participating in research trials or after obtaining written consent from a physician who is thoroughly familiar with this class of drugs.
2. Surgical. The goal of any surgical procedure should be to remove endometriotic tissue and scar tissue. Hormonal therapies may be prescribed together with the more conservative surgical procedures.

   Surgical treatments range from removing the endometrial tissues via laparoscopy to removing the uterus, called a hysterectomy, often with the ovaries (called an oophorectomy). Surgery classified as “conservative” removes the endometrial growths, adhesions and scar tissue associated with endometriosis without removing any organs. Conservative surgery may be done with a laparoscope or, if necessary, through an abdominal incision.

   • Laparoscopy. During a laparoscopy, an outpatient surgery also referred to as “belly-button surgery,” the surgeon views the inside of the abdomen through a tiny lighted telescope inserted through one or more small incisions in the abdomen. From there, the surgeon may destroy endometrial tissue with electrical, ultrasound-generated or laser energy or by cutting it out. There is a risk of scar tissue, which could lead to infertility, making pain worse, or damaging other pelvic structures. Surgery to remove endometriosis involving the ureters and bowel can be especially complex and requires a high degree of surgical skill.
   • Laparotomy. A laparotomy is similar to a laparoscopy but is more extensive, involving a full abdominal incision and a longer recovery period.
   • Hysterectomy. During a hysterectomy, your uterus is removed. This leaves you infertile. Hysterectomy alone may not eliminate all endometrial tissue, however, because it can’t remove tissue outside of the uterus or ovaries. Additionally, surgery to remove the uterus may not relieve the pain associated with endometriosis.
   • Oophorectomy. Removing the ovaries with the uterus improves the likelihood of successful treatment with hysterectomy because the ovaries secrete estrogen, which can stimulate growth of endometriosis. It also renders you infertile, however.

   If you wish to preserve your fertility, discuss other treatment options with your health care professional and consider seeking a second opinion.There has only been one comparative study of medical and surgical therapies to see which approach is better. This trial demonstrated improved outcomes with GnRH agonist and add-back therapy alone or after surgery in comparison to surgery alone. Each approach has advantages and disadvantages. Often, your plan of care will be a combination of treatments with medical therapy recommended either before or after surgery.

3. Alternative treatments. Alternative treatments for relieving the painful symptoms of endometriosis include traditional Chinese medicine, nutritional approaches, exercise, yoga, homeopathy, acupuncture, allergy management and immune therapy.

   While some health care professionals may tell you these alternative paths to seeking pain relief from endometriosis are a waste of time, others may encourage you to try alternative methods of pain relief as long as they are not harmful to your condition. Either way, discuss any options you want to try with your health care professional. Also keep in mind that while these options may help relieve the pain of endometriosis, they won’t cure the condition. Few if any alternative treatments have undergone rigorous scientific evaluation.

4. Pregnancy. While it can’t be considered a “treatment” for endometriosis, pregnancy may relieve endometriosis-related pain, an improvement that may continue after the pregnancy ends.

   Health care professionals attribute this pregnancy-related relief to the hormonal changes of pregnancy. For example, ovulation and menstruation stop during pregnancy, and it’s menstruation that triggers the pain of endometriosis.

   Plus, endometrial tissue typically becomes less active during pregnancy and may not be as painful or large without hormonal stimulation. However, in many cases, once the pregnancy and breastfeeding end and menstruation returns, symptoms also return.

If endometriosis has caused infertility, you have several treatment options, including surgery, drugs to stimulate ovulation, typically administered with intrauterine insemination or in vitro fertilization. The appropriate approach would be based on the results of a complete evaluation including an assessment of the male partner. In general, medicines that suppress the painful symptoms of endometriosis, such as GnRH agonists, oral contraceptives and danazol, do not improve the likelihood of pregnancy. The only possible exception would be that the use of a course of GnRH agonists before in vitro fertilization may improve outcomes in certain endometriosis patients, according to several recent studies.

Prevention

There is no known way to prevent endometriosis. However, some health care professionals believe there might be a certain level of protection against the disease if you begin having children early in life and have more than one child.

Additionally, you may prevent or delay the development of endometriosis with an early diagnosis and treatment of any menstrual obstruction, a condition in which a vaginal cyst, vaginal tumor or other growth or lesion prevents endometrial tissue from leaving your body during menstruation.

There also is some evidence that long-term birth control pill users are less likely to develop endometriosis.

Facts to Know

1. Endometriosis is a noncancerous condition that affects about 5 percent of reproductive-age women.
2. About 5 million women in the United States have been diagnosed with endometriosis.
3. Endometriosis develops when cells similar to the endometrium—or uterine lining—grow outside the uterus and stick to other structures, most commonly the ovaries, bowel, fallopian tubes or bladder. Endometrial tissue may migrate outside of the pelvic cavity to distant parts of the body. Researchers aren’t sure what causes this condition.
4. Symptoms of endometriosis can range from mild pain to pain severe enough to interfere with a woman’s ability to lead a normal life. Other symptoms include heavy menstrual bleeding, cramping, diarrhea and painful bowel movements during menstruation, and painful intercourse. However, you may have the disease and experience none of these symptoms.
5. A laparoscope is commonly used to diagnose and treat endometriosis. Laparoscopy allows a surgeon to view abnormalities in the pelvic region via a miniature telescope inserted through the abdominal wall, usually through the navel. While this is the best method of diagnosis available, it doesn’t rule out endometriosis just because the doctor doesn’t see any endometrial tissue.
6. Hormonal changes that occur during pregnancy can temporarily halt the painful symptoms of endometriosis since menstruation stops and estrogen levels drop.
7. There is no cure for endometriosis. Treatment options include minor and major surgery and medical therapies, including hormonal contraceptives and other hormonal drugs, such as GnRH (gonadotropin-releasing hormone) agonists, that limit the estrogen release that stimulates endometrial tissue growth.
8. There is some evidence that a family history of endometriosis may contribute to your likelihood of developing this disease. If you have a mother or sister who is battling endometriosis or has been diagnosed with it, your risk of developing the disease is higher than someone with no family history.

Questions to Ask

Review the following Questions to Ask about endometriosis so you’re prepared to discuss this important health issue with your health care professional:

1. How many cases of endometriosis do you treat per month?
2. How do you make the diagnosis?
3. How many laparoscopic and/or laparotomy procedures do you perform each month for endometriosis and how do you typically treat the disease during surgery?
4. Do you always use medical therapy before surgical therapy? If so, what therapies do you use?
5. Do you recommend medical therapy after surgical therapy? If so, what therapies do you use?
6. Do you use GnRH agonists? If so, when? Before or after surgery?
7. What kinds of hormonal drug therapies have you used for patients with endometriosis?
8. Do you prescribe add-back therapy with GnRH agonist therapy? What add-back hormones do you use and why? Are there other options I can consider?
9. What side effects might I experience with the different hormonal therapies? How long do I have to be on these drugs for them to work effectively? Will my endometriosis come back when drug treatment ends?
10. Does endometriosis affect my ability to have children?
11. Do you think that alternative treatments—such as traditional Chinese medicines, changes in diet, homeopathy or allergy management—may help reduce the pain associated with endometriosis? Can you refer me to any practitioners who specialize in these areas and might be helpful to me?
12. When you perform laparoscopy for endometriosis, are you prepared to treat any disease that you see at that time or do you perform a diagnostic procedure only? What surgical approaches do you typically employ to treat endometriosis (for example, ablation, excision, laser, ultrasound energy, coagulation)?
13. If I want to conceive or am having trouble getting pregnant and have a diagnosis of endometriosis, how would this change your treatment plan? What treatments for infertility do you offer and what are the success rates in my circumstance?

Key Q&A

1. What causes endometriosis?

   The most widely accepted cause of endometriosis is retrograde menstruation. This occurs when tissue from the uterine lining, called endometrial tissue, flows backward through your fallopian tubes while you’re menstruating and implants in various sites, most commonly in the pelvis. The tissue gets trapped and can’t leave the body.

   However, no matter where it is in the body, endometrial tissue still responds to your hormones each month. This tissue can become inflamed, bleed and develop into scar tissue. When the tissue is attached to organs in the pelvic and abdominal cavities, it may cause severe pain, infertility and other problems.

   Other theories suggest that alterations in the immune system response, hormonal imbalances or environmental causes may be related to the development of endometriosis. Experts find strong evidence suggesting a genetic link.

2. What does endometriosis feel like?

   Pain in the pelvic region ranging from very mild to severe is the most common symptom, but you may not experience any symptoms. Some women describe the pain as sharp and burning. It may last all month long, but is usually worse during menstruation, deep penetration during intercourse or bowel movements. Other symptoms may include:

   • Diarrhea and painful bowel movements especially during menstruation
   • Abdominal tenderness
   • Intestinal pain
   • Abnormal menstrual bleeding
   • Severe menstrual cramps
   • Pelvic pain distinct from menstrual cramps
   • Backache
   • Pain during or after sexual penetration
   • Painful bowel movements
   • Pain with exercise
   • Pain with urination
   • Painful pelvic examination
   • Infertility
3. How can I be sure I’m being diagnosed correctly if pain associated with the disease can often be confused with other medical problems?

   Even without a definitive diagnosis, your health care professional may still prescribe hormonal treatments. If the pain decreases, there is an assumption that endometriosis was the cause of the pain. However, endometriosis cannot be definitively diagnosed without laparoscopy and biopsy.

4. Can I get pregnant if I have endometriosis?

   Yes, you can. The majority of women who have endometriosis are fertile, and there are many who have the disease and go on to have children. However, the likelihood of infertility does increase in women with endometriosis of all stages.

5. Is there any way I can prevent endometriosis?

   No. Experts don’t know definitively what causes the condition so they don’t know how to prevent it. Research suggests that having children early, having more than one child and long-term use of oral contraceptives may reduce the risk. However, many other factors determine if and when a woman should have children.

6. What options are available to treat endometriosis?

   The most common medical therapies for endometriosis are hormonal contraceptives and other hormonal regimens, such as GnRH agonists (gonadotropin-releasing hormone drugs), which reduce estrogen release, limiting the effects of hormones on the endometrial tissue. Danazol, a synthetic androgen, is also used, but it can cause some undesirable side effects, including weight gain, hirsutism (hair growth) and lowering of the voice. Surgical treatments range from removing only the endometrial implants via laparoscopy to removing the uterus and ovaries.

7. How do I know which is the best treatment option for my case of endometriosis?

   It’s tough to know which treatment is best for you, especially since very few comparative studies have been conducted to determine which approach is better. There are pros and cons for all treatments. Most women with the disease can find relief via medical therapies, and birth control pills may be used indefinitely to manage symptoms. Other women turn to surgery. However, many women try to avoid surgery to remove the uterus because it’s a serious procedure that will leave them infertile and carries no guarantee of banishing endometriosis forever.

   Because of the risks associated with surgery, the usual course of treatment is to proceed from the least invasive or risky to the more invasive treatment. That means medical treatment first.

   If that doesn’t work, your doctor may recommend laparoscopy, with surgery to remove the uterus as a last resort.

Lifestyle Tips

1. Eliminate trans fats
   Some research shows a link between high dietary intakes of trans fats from hydrogenated oils and increased risk of endometriosis—another good reason to substitute healthful omega-3s for trans fats.
2. Block prostaglandin to relieve pain
   Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are enough to benefit many women with pain from endometriosis and may be the most helpful choice for you as well—check with your health care professional. Ibuprofen (Advil, Motrin, Rufen) and naproxen (Aleve, Anaprox, Naprosyn) are all examples. These drugs block prostaglandins. Prostaglandins are natural body substances that promote inflammation, uterine contractions and pain and are thought to be linked to endometriosis.
3. What to do when pain remedies don’t work
   Make sure your body is best able to withstand pain by getting enough sleep at night, eating right and taking recommended doses of vitamins and minerals—some studies suggest good results with magnesium or thiamine. A heating pad or hot bath may help ease painful cramps. Relaxation techniques, meditation and even acupuncture have helped some women—see a pain management specialist or visit a pain center. Other possibilities include prescription pain control drugs, hormone therapy, trancutaneous electrical stimulation (TENS) and surgery to remove endometriosis lesions or to cut nerves transmitting pain.
4. Get help for painful intercourse
   Tell your health care professional and ask for help, as painful intercourse is a symptom of endometriosis. Women typically feel pain during deep penetration and some feel pain as if something has been “bumped into.” Your health care professional will need to ask questions and perform a pelvic examination to find abnormalities and the source of tenderness. Ultimately, you may need a laparoscopy to document the presence of endometriosis lesions, and medication or surgery to relieve pain.
5. Prepare for Laparoscopy
   Schedule your procedure at the end of the week, to take advantage of the weekend as part of your recovery time. The procedure is typically performed during the first half of the menstrual cycle before ovulation but after the menstrual flow has stopped. Clear your schedule for a few weeks afterward to allow as much time as possible for rest. Clean and take care of errands in advance, and plan ahead with a supply of convenience meals. Arrange with your partner or an adult friend to help you with transportation on the day of surgery. Don’t eat anything heavy or fatty the evening before, follow your doctor’s preoperative instructions, leave jewelry and valuables at home and arrive early to fill out forms.

Organizations and Support

For information and support on coping with Endometriosis, please see the recommended organizations, books and Spanish-language resources listed below.

American Association of Gynecologic Laparoscopists (AAGL)
Website: http://www.aagl.org
Address: 6757 Katella Avenue
Cypress, CA 90630
Hotline: 1-800-554-AAGL (1-800-554-2245)
Phone: 714-503-6200

American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: [email protected]

American Society for Reproductive Medicine (ASRM)
Website: http://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: [email protected]

Center for Endometriosis Care
Website: http://www.centerforendo.com
Address: 1140 Hammond Drive
Building F, Suite 6220
Atlanta, GA 30328
Hotline: 1-866-733-5540

Endometriosis Association (EA)
Website: http://www.endometriosisassn.org
Address: 8585 N. 76th Place
Milwaulkee, WI 53223
Phone: 414-355-2200

Endometriosis Research Center
Website: http://www.endocenter.org
Address: 630 Ibis Drive
Delray Beach, FL 33444
Hotline: 1-800-239-7280
Phone: 561-274-7442

Books

A Gynecologist’s Second Opinion: The Questions & Answers You Need to Take Charge of Your Health
by William H. Parker, Rachel L. Parker

Coping With Endometriosis
by Robert Phillips, Glenda Motta

Endometriosis: One Woman’s Journey
by Jennifer Marie Lewis

Endometriosis Survival Guide: Your Guide to the Latest Treatment Options and the Best Coping Strategies
by Margot Fromer

Endometriosis: The Complete Reference for Taking Charge of Your Health
by Mary Lou Ballweg

Living Well with Endometriosis: What Your Doctor Doesn’t Tell You…That You Need to Know
by Kerry-ann Morris

100 Questions & Answers About Endometriosis
by David B. Redwine

Yale Guide to Women’s Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin, Carol V. Wright

Spanish-language resources

American Academy of Family Physicians, Family Doctor: Endometriosis
Website: http://familydoctor.org/online/famdoces/home/women/reproductive/gynecologic/476.html
Email: http://familydoctor.org/online/famdoces/home/about…

The Difference Between Endometriosis and Adenomyosis

Few women may know what the endometrium is. But they all probably have seen it. It’s the tissue inside the uterus that your body peels off and sheds during your menstrual periods.

When this lining spreads to places it shouldn’t, you can have similar but separate conditions called endometriosis and adenomyosis. They affect different parts of your body, share some symptoms, and may require different treatments.

You can have both of these problems at the same time. Doctors don’t know exactly what causes them.

Inside vs. Outside

In endometriosis, the same type of cells that line the uterus, or womb, also grows outside of it. The growth can breach nearby organs like your ovaries, fallopian tubes, and bladder. It can make it hard for you to get pregnant.

Adenomyosis, on the other hand, happens when the same kind of cells that line the uterus also grows deep in the muscular wall of the uterus and thickens it.” It doesn’t go past the uterus itself. 

Symptoms

Even when the uterine lining grows where it doesn’t belong, it still carries on as usual. It gets thicker and thicker as your monthly cycle nears and then bleeds when your hormones signal that you’re not pregnant. That causes problems.

With endometriosis, it irritates and swells nearby tissues and can lead to scarring. You may notice:

• Belly pain. This is the most common symptom. It may be worse around the time of your period.
• Pain in your back or leg, or pain during or after sex
• Heavy or painful menstrual bleeding
• Pain while you pee or poop
• Nausea, vomiting, or feeling tired

With adenomyosis, the inside of your womb gets thicker and bigger, which doesn’t usually happen with endometriosis. The enlarged uterus may:

• Put pressure on your bladder and rectum
• Change the way your uterine muscles tighten (contract)
• Cause heavy and painful periods

Both conditions can lead to anemia from menstrual bleeding. This means you don’t have enough iron in your blood. Iron supplements may help.

Causes

Doctors don’t know what causes either endometriosis or adenomyosis. But some things can make them more likely to happen.

Your chances for endometriosis go up if:

• You’re in your 30s or 40s.
• Your mother, sister, or daughter has it.
• You have heavy periods that last more than 7 days.
• Your periods are less than 27 days apart.
• You started your period before you were 11 years old.

Your risk of adenomyosis goes up if you:

• Are in your 40s or older; women diagnosed with adenomyosis tend to be older than those who have endometriosis.
• Have given birth at least once
• Started your periods at age 10 or younger
• Have menstrual cycles that last 24 days or less

Diagnosis

It can be hard to tell if you have endometriosis or adenomyosis, or both, or something else like fibroids or cysts. Pelvic pain can be caused by many other conditions, including pelvic floor muscle spasm, pelvic infections, and irritable bowel syndrome.

Endometriosis. Sometimes ultrasound can show endometriosis. An MRI also can show larger areas of endometrial tissue outside the uterus, but it could miss smaller patches. The only way to know for sure you have it is with surgery. That way, your doctor can look for endometrial tissue in your belly (outside your uterus). If they see any, small pieces can be taken out for a lab test to confirm the diagnosis.

Adenomyosis. Your uterus may feel bigger than normal and be tender when you push on your belly. An ultrasound or an MRI might diagnose adenomyosis. Sometimes you might not know you have until after a hysterectomy, when your uterine tissue is tested in a lab.

Treatments

Endometriosis and adenomyosis usually don’t require treatment unless they cause you problems.

Both may be managed with pain medicines, like non-steroidal anti-inflammatory drugs (NSAIDs).

Hormone medicines, such as birth control pills, progestin and progesterone, and gonadotropin-releasing hormone agonists might also be used. These control the way your hormones cycle and can help slow the growth of the endometrial tissue, no matter where it is, but they don’t make it go away. With endometriosis, hormone medicines may help keep new scar tissue from forming.

Gonadotropin-releasing hormone (GnRH) receptor antagonists are another class of hormonal treatments that can be used to treat endometriosis pain. Elagolix (Orilissa) is the only GnRH receptor antagonist approved for pain, but other drugs are being used off-label to treat endometriosis. Thy include cetrorelix (Cetrotide) and ganirelix acetate (Antagon).

Several treatments may help control the heavy bleeding from adenomyosis. A special kind of IUD, a birth control device, is one option. Others include a procedure to block the supply of blood to the uterus (uterine artery embolization) or surgery to scar the uterine lining to make your periods lighter (endometrial ablation).

But the only sure cure is a hysterectomy to remove your uterus. You have to be sure you don’t want anymore pregnancies before you decide to have a hysterectomy, embolization, or ablation.

For endometriosis, surgery might be an option. It can take out the tissue that’s outside your uterus. Scar tissue can be removed, too. If you don’t plan to have more children, your uterus, fallopian tubes, and ovaries can be taken out in a surgery called a hysterectomy with bilateral salpingo-oophorectomy. But even after surgery, there’s a small chance that the pain will come back.

Female reproductive system: The Histology Guide

Uterus

The uterus is made up of an external layer of smooth muscle called
the myometrium, and an internal layer called the endometrium.

The endometrium has three layers: stratum
compactum, stratum spongiosum (which make
up the stratum functionalis) and stratum basalis.

The Stratum compactum and stratum spongialis
develop into the stratum functionalis during the first half of the
menstrual cycle (proliferative phase)

The wall of the uterus changes during the menstrual cycle, as shown
diagramatically here.

Proliferative Phase

In the proliferative phase, facilitated by FSH,
the endometrium thickens, connective tissue is renewed, along
with glandular structures and ehlicrine arteries. Oestrogen causes
the endometrial stroma to become deep and richly vascularised.

Simple tubular glands in the stratum functionalis
open out onto the surface, and the endometrium thickens.

Can you recognise the lumen, stratum
compactum, stratum spongiosum stratum basalis and myometrium
in this photograph?

Secretory Phase

In the secretory phase, facilitated by LH, the
endometrial glands become cork-screw shaped,
and filled with glycogen. They secrete a glycogen rich secretion
during the secretory phase (after ovulation).

You should be able to recognise the glands,
and glycogen secretions in this high magnification
photo of a secretory phase uterus.

Menses

Decreased levels of LH and progesterone result in the menstrual
phase, or menses. During menses
(shedding of the uterine lining, which occurs if the egg is not
fertilised) the spiral arterioles in the stratum
functionalis layer contract, resulting in ischaemia,
and degeneration of the functionalis layer. The arteries rupture,
and the rapid blood flow dislodges the necrotic functional layer,
which is lost. (The basal layer is unaffected, because it is supplied
by straight arteries).

You should be able to recognise the lumen, degenerating
endometrium, and areas of blood leakage in this photo.

Endometrial biopsy | Memorial Sloan Kettering Cancer Center

This information will help you know what to expect during and after your endometrial biopsy.

to come back to the beginning

About endometrial biopsy

During an endometrial biopsy, your doctor will remove a small piece of tissue from the lining of your uterus. The lining of your uterus is called the endometrium.

This tissue sample will be sent to the Pathology Department for microscopic examination.A pathologist examines the sample for abnormal cells or signs of cancer.

to come back to the beginning

Before procedure

Tell your doctor or nurse if:

• you are allergic to iodine;
• you are allergic to latex;
• There is a possibility that you are pregnant. If your period has not yet stopped and you are 11 to 50 years old, you will need to have a urine pregnancy test to rule out the possibility of pregnancy.

You do not need to prepare specifically for this procedure.

to come back to the beginning

During procedure

Endometrial biopsy is performed in the examination room. You will lie on your back, as in a normal pelvic exam.
You will be awake during the procedure.

First, the doctor will insert a medical speculum into your vagina. A speculum is a tool that allows you to gently pull apart the walls of your vagina so your doctor can see the cervix (the lower part of the uterus).

The doctor will then cleanse the cervix with a cool brown solution of povidone-iodine (Betadine ^® ). The doctor will then insert a thin, flexible instrument called a pipe through the cervix and into the uterus to extract a small amount of tissue from the endometrium. When the doctor takes a tissue sample, you will feel cramping. After obtaining a tissue sample, the doctor will remove the mirror.

The procedure usually takes about 5 minutes.

to come back to the beginning

After procedure

• You may have some vaginal bleeding or vaginal bleeding.This can continue for several days after the procedure. You can use sanitary towels if needed. Don’t use tampons.
• You may experience cramping after the procedure. You can take medications such as ibuprofen (Advil ^® ) or acetaminophen (Tylenol ^® ) to fix them.
• Do not insert anything into your vagina for 48 hours (2 days) unless your doctor has approved it. This also applies to syringes and tampons.
• Talk to your doctor or nurse about when it is safe for you to have vaginal sex again.
• Your doctor’s office will give you the biopsy results in about 1 week.

to come back to the beginning

Call your doctor or nurse if you have:

• Temperature 101 ° F (38.3 ° C) or higher
• Vaginal bleeding more profuse than normal menstrual bleeding;

90,015 pain that does not go away with cramps medicine;

• Foul odor or purulent vaginal discharge;

to come back to the beginning

90,000 symptoms and treatments for the disease

Endometriosis: symptoms and treatments for the disease

Endometriosis is by definition a hormone-dependent disease.The endometrium is the lining of the uterus that thickens during the last phase of the menstrual cycle, and the outer part of which is removed from the body during menstruation.

The essence of endometriosis is the proliferation of the endometrium in other parts of the body, and due to the fact that its cells respond to monthly hormonal changes in the same way throughout the body – bleeding.

Since endometriosis is inextricably linked with menstruation, it happens most often in women of reproductive, but not young age (40-45 years), although the presence of the disease in the postmenopausal period is also possible.It also occurs in many very young girls who were operated on for pain in the pelvic area.

Among the interesting facts is that in women with many children, this disease occurs much less frequently than in infertile women.

In some cases, endometriosis is asymptomatic, so no one can give the true statistics of diseases yet. Due to the shyness of women who rarely, or have never visited a gynecologist, difficulties arise in calculating the frequency of occurrence of pathologies.

By the way, 70% of women complaining of pain in the small pelvis turned out to be sick with endometriosis, which is an excellent reason for a preventive visit to a gynecologist.

Types of endometriosis

• The classification of this disease occurs according to the place of growth of the endometrium, that is, they are distinguished:
• genital internal
• adenomyosis;
• extragenital;
• peritoneal;
• extraperitoneal endometriosis.

Internal genital endometriosis, or endometriosis of the uterus, occurs in the canal and cervix. This type is also known as adenomyosis and is considered an independent disease.

The extragenital type is characterized by foci in the kidneys, intestines, bladder and even lungs.

Peritoneal affects the pelvis, abdominal cavity, ovaries, fallopian tubes.

Extraperitoneal is also called external, as it is localized in the cervix, rectovaginal septum, vagina.

Four stages of development of endometriosis characterize the severity of the lesion and treatment: minimal, mild, moderate and severe. At the last stage, it is impossible to clearly diagnose the type of endometriosis, since the proliferation occurs in all directions and has very painful consequences.

Symptoms of the disease

Unfortunately, the symptoms of endometriosis are almost entirely dependent on the individual characteristics of the organism. Sometimes it does not appear at all for a long time, so you can only protect yourself with a regular medical examination by a gynecologist.

However, it is possible to distinguish characteristic signs of the presence of the disease in the patient, which may indicate the need for more thorough research.

For example:

• Pain syndrome. Present in 50-60% of women with endometriosis.
• Dysmenorrhea. It usually accompanies endometriosis and is associated with an increase in pressure and menstrual bleeding into the cyst, irritation of the peritoneum, as well as increased production of prostaglandins, which causes vasospasm, increased uterine contractions, and impaired uterine activity.
• Pelvic pain that cannot be associated with the menstrual cycle. It is observed in 15-25% of patients.
• Pain during intercourse.
• Infertility. The second most frequent symptom, which is characteristic of 25-40% of patients.
• Menorrhagia. Present in only 2-15% of cases. In this case, most often there is a concomitant pathology such as uterine fibroids, PCOS.

How is the treatment of endometriosis

At different stages, the treatment of endometriosis can be operative, conservative and combined.

Conservative method

It is believed that in the early stages of development, the disease can be treated with hormone therapy. A long course of drugs is complemented by antispasmodics, anti-inflammatory and sedative drugs, as well as enzymes and vitamins.

Operational method

When the effect of hormonal drugs is recognized as useless, surgical intervention is prescribed. The gold standard for diagnosing endometriosis is laparoscopy, which is necessary to 100% guarantee the presence of a disease that requires surgical treatment.

During the operation, the foci of proliferation of the endometrium are removed in any way: they are cauterized with a laser, electrocoagulation is performed, resection. Both before and after the operation, a course of hormonal drugs can be prescribed for a period of 3 to 6 months, then the treatment is called combined.

In the postoperative period, the patient is under the regular supervision of a gynecologist.

90,000 Uterine bleeding – causes, symptoms, treatment in Kaluga

Uterine bleeding can be a manifestation of gynecological diseases.

Uterine fibroids are the most common cause of bleeding, especially with a submucous node and large tumor sizes. The presence of submucous fibroids requires surgical treatment. Optimally, this is hysteroresectoscopy or embolization of the uterine arteries.

Polyp and endometrial hyperplasia is an overgrowth of the endometrium in one area or throughout its entire length, manifested by profuse prolonged bleeding. The removal of the polyp and endometrial hyperplasia during hysteroscopy or hysteroresectoscopy is indicated.

Adenomyosis (endometriosis of the uterus) is a condition when the elements of the endometrium fall into an uncharacteristic place for them – the myometrium. Prolonged, heavy menstruation appears, turning into bleeding. Endometriosis is treated conservatively and promptly. Hysteroscopy helps to diagnose it.

Ovarian cysts are also a common cause of bleeding.

Complications of pregnancy – miscarriage, non-developing pregnancy, ectopic pregnancy, complications of abortion, postpartum hemorrhage.

Malignant tumors of the uterus and cervix may manifest as bleeding.

If there is a bleeding clinic, a woman should immediately consult a doctor. An important auxiliary diagnostic method is ultrasound – it allows you to assess the thickness of the endometrium, the presence of nodes in the uterus.