Uterus neck endometriosis
The Uterus Neck Endometriosis (UNE) — a form of external genital endometriosis at which the endometrioidny centers strike mucous a vaginal part of a neck of a uterus and the tservikalny channel. Usually the disease proceeds asymptomatically or is shown by the smearing bloody allocations after intimate proximity, before and after monthly. Extremely seldom patients have a pain in the bottom of a stomach and morbidity during sex. For diagnostics use gynecologic survey in mirrors, a kolposkopiya, cytomorphological methods. Treatment provides purpose of hormonal medicines and expeditious removal of the pathological centers.
Uterus neck endometriosis
According to different authors, the endometrioidny geterotopiya of a neck of a uterus comes to light at every fourth woman having endometriosis. Over the last 50 years prevalence of pathology increased on average for 1,0-7,0%. As well as other forms of a disease, EShM differs in a gormonozavisimost and in the majority of observations arises at women of reproductive age. Cases of developing of endometriosis at girls prior to puberty are not recorded. In the period of a postmenopause the disease is exposed to regress. Taking into account an arrangement of the centers distinguish the superficial endometriosis affecting a vaginal part of a neck, and deep, developing in disteel departments of the tservikalny channel.
Uterus neck endometriosis reasons
According to most of experts in the sphere of gynecology, the main reason for emergence of endometrioidny growths on mucous uterus necks — introduction of the cells of endometrium which are contained in menstrual blood in damaged ekzo-or . The risk of development of endometriosis is increased:
- Uterus neck diseases. It is easier for cells of endometrium to be attached to pathologically changed mucous. Endometriosis can develop against the background of erosion and pseudo-erosion of a neck of a uterus, ekzo-and endotservitsit.
- Invasive interventions. Emergence of endometrioidny geterotopiya is promoted by abortions, installation of Naval Forces, a scraping, hysteroscopy and a gisterosalpingografiya, other medical and diagnostic manipulations on a uterus and its neck.
- Pathological or frequent childbirth. Travmatization of an epithelium in the course of patrimonial activity promotes an invasion of cells of endometrium in endo-and .
An important role in developing of a disease is played by the contributing factors. So, endometriosis is revealed more often at women with the weakened immunity and disgormonalny states which are followed by a giperestrogenemiya. The hereditary otyagoshchennost is of great importance: in close relatives of patients with endometriosis the endometrium geterotopiya on the surface of a neck of a uterus is found by 5 times more often than in the general population of women.
The cells of endometrium which took root into an epitelialny layer of a neck of a uterus react to cyclic hormonal changes in a female body. In them there are same transformations, as in an inside layer of a uterus. At first under the influence of estrogen of a cage proliferirut, and then under the influence of progesterone blood supply of fabrics and secretion of glands amplifies. The cycle comes to the end with the aseptic inflammation and rejection of geterotopichesky endometrium coinciding on time with periods. The endometrialny cages growing in the atypical place are more subject to risk of damage at contact influences, as forms a typical clinical picture of a disease.
Uterus neck endometriosis symptoms
Often endometriosis of a neck of a uterus proceeds without the expressed clinical manifestations. The bloody smearing allocations on the eve of and after periods, and also after sexual intercourse are most characteristic. As in the most part of cases of growth of endometrium are located on an ekzotserviksa, the pain syndrome is not expressed. If in pathological process it is involved and bodies of a small pelvis, the patient is disturbed by a nagging pain in the lower part of a stomach which intensity changes in different phases of a menstrual cycle. The dispareuniya bringing discomfort in sexual life of the woman is possible.
Unlike other forms of a disease, endometrioidny damage of a neck of a uterus becomes complicated extremely seldom. At a large number and the area of pathological growths with the raised bleeding iron deficiency anemia can develop. Involvement in process of a mucous neck of the channel of a uterus breaks its protective function and promotes more bystry distribution of an inflammation on above the located departments of a reproductive system. In some cases endometriosis becomes one of the reasons of cervical infertility. By results of researches, the provocative role of EShM in development of malignant new growths of a neck of a uterus is not excluded.
Taking into account scarcity of clinical symptomatology in diagnosis of endometriosis of a neck of a uterus a key role is played by data of objective researches. In the diagnostic plan are most informative:
- Survey on a chair in mirrors. Against the background of a light pink healthy epithelium the small reddish centers with a diameter of 2,0-5,0 mm are clearly visible. Before periods of a geterotopiya become blue-crimson and increase in sizes a little.
- Kolposkopiya. Under a microscope characteristic endometrioidny fabric which volume and color change depending on a phase of a menstrual cycle comes to light. Examination is recommended to be conducted in the last week before monthly.
- Cytomorphological diagnostics. The histologic research of the materials received at an aim biopsy of a neck of a uterus reveals typical cells of endometrium. If necessary to receive mucous the tservikalny channel its diagnostic scraping is carried out.
Ultrasonography of pelvic bodies, endoscopic and radiological techniques in diagnostics of an endometrioidny geterotopiya of a neck of a uterus play a supporting role and allow to reveal the endometriosis centers in other bodies. Differential diagnosis of a disease is carried out with a chronic specific and nonspecific tservitsit, nabotovy cysts with hemorrhagic contents, teleangiektaziya, ekstravazata, uterus neck cancer. If necessary to the patient appoint consultation of an onkoginekolog and the dermatovenerologist.
Treatment of endometriosis of a neck of a uterus
The choice of methods of therapy has to consider the amount of geterotopichesky growths, prevalence of endometrioidny process, existence of complications, age and reproductive plans of the woman. Dynamic observation with survey of the gynecologist of times in half a year is shown to patients with the small centers of endometriosis in the absence of clinical manifestations and complications. At the considerable volume of geterotopiya, existence of complaints to bloody allocations and a pain syndrome appoint medicamentous therapy which includes:
- Hormonal means. Growth of cells of endometrium the medicines suppressing endocrine function of ovaries oppress. For this purpose apply the combined or gestagenny oral contraceptives, agonists and antagonists of gonadoliberin, androgens. Hormonal therapy is carried out as independently, so by preparation for surgical treatment.
- Symptomatic medicines. Complex treatment is directed to immunocorrection, reduction of symptomatology and complications of a disease. For removal of pain use nonsteroid resolvents. At decrease in level of hemoglobin and erythrocytes iron medicines are shown.
At inefficiency of 3-4-month conservative treatment endometriodny growths are recommended to be deleted quickly. For this purpose usually carry out laser coagulation, cryodestruction or radio wave destruction of the centers of endometriosis. Radical approach with an extirpation of a uterus and appendages is shown only at considerable prevalence of process with involvement of other bodies and the expressed pain syndrome at women who do not plan pregnancy.
Forecast and prevention
At timely detection and adequate therapy forecast favorable. After removal of the centers of endometriodny fabric the disease recurs seldom. Results of treatment even more improve at purpose of hormonal therapy before surgical intervention and after its carrying out. Frequency of absolute clinical recovery increases in such cases by 8 times. In prevention of endometriosis an important role is played by regular survey at the gynecologist for identification and treatment of diseases of a neck of a uterus. It is recommended to abstain from unreasonable purpose of invasive procedures and is mindful of planning of a family, having refused abortions.