Endometriosis and pregnancy - is it possible to save and give birth to a baby? Is it possible to get pregnant with endometriosis - the opinion of experts Second pregnancy after endometriosis

Many women endure some specific pains, accepting them as normal, getting used to them, and do not even consider them a complaint that is worth mentioning at a gynecologist's appointment. And someone does not go to scheduled examinations at all, while nothing disturbs, not thinking about the fact that there are diseases that occur without clearly expressed sensations, and at the same time they cause significant harm to your body and, sometimes, lead to irreversible consequences. It is to such a latent pernicious illness that endometriosis belongs.

What is endometriosis, degrees and types of the disease

At its core, endometriosis is the growth of endometrial tissue (the lining of the uterus) beyond its "legitimate" location. Areas of cells with characteristic properties begin to deploy where they should not be. Moreover, these places are not limited only to the genitourinary system and the nearby cavity, but can also be in the lungs, in the eyes, in postoperative scars. In accordance with their function to bleed once a month (menstruation), these stray foci of foreign tissue perform such an action even in unnatural conditions for themselves, which causes inflammation of these places. As a result of such an anomaly, the activity of the organism is disturbed both at individual points and as a whole. There are also known cases of degeneration of endometrioid tissue into a malignant tumor.

There are endometriosis genital internal (), in which the mucous membrane from the uterine cavity begins to grow into the muscles of this organ. Genital external endometriosis (in 92–94% of cases) implies the location of the endometrium on the genitals. There is also extragenital endometriosis (6-8% of cases) in the organs of the gastrointestinal tract, bladder, and so on.
Endometriosis has been described in medical treatises as early as 2000 BC. and is still a mystery. In terms of prevalence, it is in 3rd place and affected up to 20% of women around the world.

The following degrees of this benign systemic disease are distinguished:

1. In the first degree, one or more lesions are found on the surface of the uterus.
2. In the second degree, the deep layers of the uterus are affected - as a rule, this is one focus.
3. In the third degree, there is a large number of foci penetrating more than 50% into the thickness of the uterus, on the ovaries - small cysts, in the peritoneum - thin adhesions.
4. With the fourth degree of formation of pathological foci, they are very deep, large, there is an fusion of organs with each other (most often the vagina and rectum).

As can be seen, at stages III–IV, the so-called endometrioid or “chocolate” cysts are formed. These are accumulations of menstrual blood in the region of the ovaries, surrounded by membranes of endometrial cells. Moreover, these cysts are functioning and dependent on hormones, as they are cyclically menstruated. The constant blood supply and the lack of blood outlet leads to the growth and association of such cysts with each other, their size can reach 10–12 cm.

Video: doctors' opinion about endometriosis

Reasons for the development of endometriosis

Endometriosis most often occurs in women of reproductive age 20-45 years. The exact causes of its occurrence are unknown. But there are a number of hypotheses that explain the likelihood of this phenomenon as follows:

• in the process of menstruation, exfoliated endometrial cells (normal) migrate along with the reverse blood flow (not the norm - retrograde menstruation) get anywhere and take root there;
• during inaccurate surgical interventions (operations on the uterus, curettage, etc.), parts of the endometrium are transferred randomly from place to place;
• metaplasia (change in structure) of the remains of embryonic tissue (after childbirth, miscarriages, abortions);
• genetic defects (hereditary forms of endometriosis);
• poor immunity and unfavorable ecology;
• hormonal dysfunction;
• long-term unrealized reproductive function;
• chronic inflammatory processes in the pelvic organs.

I had fibroids and adenomyosis stage I-II. After laparoscopy and 4 months of artificial menopause, a long-awaited pregnancy began. There was an accreta of the placenta, and I lay on conservation for the last 2 months. After a successful CS on ultrasound, 1.5 years later, the picture with adenomyosis returned. According to my attending gynecologist, it occurs in 90% of cases after CS, and many people live with it only by observation. And no one forbids getting pregnant and giving birth.

Video: perhaps endometriosis is a psychological problem

Symptoms

In 70% of cases, when a woman has painful periods (dysmenorrhea) - this is a reason to be examined for the presence of endometriosis. Although for the majority in I-II degree this disease is asymptomatic. For those who experience bleeding in the middle and at the end of the cycle, that is, before and after the end of menstruation, and with severe pain in the pelvis, you should not postpone going to the gynecologist. If in the dark times such a condition was considered common, now it is curable. Often pain occurs before / during / after intercourse (dyspareunia). Episodes of pain occur in 60% of women, but most of them do not go to the doctor with this problem. Also, pain can be given to the lower back and abdomen, up to painful sensations during the act of defecation (dyschezia) or urination (dysuria). Thus, pain is the main companion of endometriosis.

With adenomyosis, in addition to pain, menstrual flow is distinguished by its excessive abundance. Suspicion of this disease can also fall with long unsuccessful attempts by a woman to become pregnant. The World Health Organization has listed 22 established causes of infertility, one of which is this one.

Endometriosis draws adjacent tissues and organs into inflammatory processes, which disrupts their normal functioning and the patient's well-being

Endometriosis and pregnancy

Some believe that endometriosis is cured by pregnancy. This fact is not substantiated in any way, but miracles happen, so it cannot be denied. Indeed, during the period of expectation of the child and for some time after the menstrual effusions are absent, in connection with which there is a temporary stoppage of the growth of the endometrium, which can resume after the onset of ovulation.

Why is endometriosis dangerous during pregnancy?

It can be extremely difficult to get pregnant and bear a child with such a diagnosis. If endometriosis spreads to the placenta ("children's place"), then the chance to save the baby is sharply reduced. Therefore, it is advisable to eliminate endometriosis before conception or carefully protect yourself in the absence of children in the plans, since abortion against the background of this disease aggravates its course. The foci may increase, and a woman may even die when the uterine wall is perforated (the formation of a through hole) and unstoppable bleeding.

Taking into account the achievements of medicine to date, the pregnancy that has occurred with endometriosis in most cases can be saved. A woman is prescribed hormonal drugs that support the uterus in the necessary condition for the harmonious development of the fetus. They don't need to be afraid. Modern pharmacology offers effective and safe drugs.

It happens that pregnancy with endometriosis turns out to be ectopic - then an urgent endoscopic (without incisions, but through natural routes) operation is performed and the embryo is removed. The advantage of this intervention is that adhesions are cut in the fallopian tube, as a result of which a woman has an increased chance of becoming a mother in the future.

If pregnancy coexists with adenomyosis, then in the third trimester the risk of uterine rupture increases, so the woman goes to the hospital for observation and emergency care if necessary, as well as possible delivery with the help of a CS.

Planning pregnancy, is it possible to conceive with endometriosis, does endometriosis lead to infertility? How to quickly build up the endometrium for conception?

It is worth getting rid of endometriosis even at the stage of pregnancy planning, especially if it has reached the III-IV degree. But statistics say that every second woman can become pregnant on her own with this disease. This is possible with a small lesion with endometriosis, the absence of other pathologies and in the presence of ovulation. Then the egg will be able to pass into the abdominal cavity and gain a foothold.

Video: is it possible to get pregnant with endometriosis

Infertility in endometriosis occurs under the following objective circumstances:

• violation of the transport function of the fallopian tubes, namely peristalsis (it is difficult for the sperm to pass to the egg, the egg is difficult to pass to the uterus);
• adhesions block patency (peritoneal infertility);
• violation of the interaction between the hypothalamus, pituitary gland and ovaries - organs that produce the correct ratio of hormones;
• the development of an autoimmune reaction, as a result of which, in places of inflammation, the body begins to produce antibodies and can interfere with the implantation of the fetal egg;
• due to inflammation, spermatozoa are deactivated by protective cells (macrophages);
• when a woman experiences severe pain during intimacy, she avoids it.

Additionally, there may be complications in the insufficiency of the development of the endometrium. In other words, it can be thinned. In this case, it becomes unsuitable for conception. The ideal thickness for this action on fertile days (mid-cycle) is 10-12 mm, on average it is 7 mm. If it is below 5 mm, we are talking about hypoplasia, and a thin mucous layer prevents the embryo from fixing. And even with such a complication, pregnancy can occur in 15% of cases - only this increases the risk of miscarriage in the early stages. Thus, the question is no longer in the ability to become pregnant, but in the ability to bear a child.
With an underdeveloped endometrium, even the procedure of artificial insemination is not recommended, since the chances of the embryo being successfully implanted in the uterus are negligible

To normalize the state of the endometrium, find out the cause of the deviation. Most often it turns out to be chaos in the hormonal circuit. Therefore, the doctor prescribes hormone therapy with drugs containing progesterone (for example, Duphaston). This hormone suppresses estrogens (female hormones), which cause the endometrium to grow outside the uterus, and maintains the second phase of the cycle at the proper level to create favorable conditions for conception.

Hypoplasia can also arise due to inflammatory processes in the genital organs - then drug therapy is used. Sometimes they resort to surgical treatment - they remove the endometrium and further increase it with the help of hormone therapy. These methods are designed to renew the inner layer of the uterus and normalize its thickness.

It happens that the problem lies in improper blood circulation - then the effect is achieved by conservative methods: massage, physiotherapy (natural factors), hirudotherapy (leeches), acupuncture, exercise therapy (physiotherapy exercises).

Of no small importance are folk remedies, but not as an independent treatment, but in combination with medication and in agreement with the attending physician. Here are some well-known drugs that can help:

• sage infusion (1 tsp per 200 ml of boiling water for 4 months in the first half of the cycle);
• infusion of the boron uterus (2-3 tsp per 250 ml of boiling water, take daily);
• pineapples and pumpkin, as well as juices from them (in unlimited quantities in the absence of allergies);

Of course, I don’t know about canned pineapples, but from live ones it really grows by leaps and bounds! Checked on myself! On the 14th day of the cycle, it was 8 mm, but on the 17th day of the cycle it became 12 mm (I have never had this in my life) ... But before that, I ate 1 live pineapple a day for 2 days (I read it on the Internet). So give it a try, it's still useful.

Lemurrchik

https://www.nn.ru/community/user/be_mother/tonkiy_endometriy_zlobnaya_bolyachka_endometrioz_chto_delat.html

• tea from raspberry leaves (in small quantities several times a day);
• a decoction of the collection of elderberry inflorescences, yarrow herbs, mint, chamomile, nettle, medicinal drop cap (half an hour before meals 3-4 times a day).

Features of childbirth with endometriosis

Childbirth with this diagnosis in a woman requires close attention from the medical staff. Difficulties that may arise at this moment are associated with the risk of heavy bleeding, fusion of the placenta with the uterus, insufficient tone after the birth of the child and afterbirth. Before childbirth, an ultrasound scan is mandatory to determine the final problem areas and prepare for a suitable obstetric technique. If necessary, CS physicians make efforts to prevent fragments of tissue modified by endometriosis from entering the abdominal cavity. To do this, the uterus is covered with a sterile dressing before dissection. After the end of the birth process, the woman in labor is injected with oxytocin or its analogues intramuscularly to contract the uterus.

Pregnancy after treatment, what to do if pregnancy does not occur?

Six months to a year after treatment, you can start trying to get pregnant. If conception does not occur after the complete elimination of the disease, then you and your partner need to undergo additional examinations. In the absence of obvious deviations, it is worth considering assisted reproductive technologies, in particular in vitro fertilization.
IVF is a method of creating an embryo and introducing it into the uterine cavity in the laboratory, often used for infertility

Diagnostics

Recognizing endometriosis is challenging. It should be suspected in women with a long-term pain syndrome, unsuccessful treatment of inflammatory processes of the appendages, and the absence of pregnancy. In the past, these women often have intrauterine interventions, but sometimes this disease develops even in adolescents.

Obstetrician-gynecologist of the highest category, DMN, Professor M.V. Medvedev

http://www.medvedev.ua/knowledge-base/articles/2016/Endometriosis_article.html

To confirm the diagnosis, the following procedures are used:

• examination of the cervix in the mirrors and two-handed gynecological examination;
• colposcopy;
• gynecological ultrasound;
• hysteroscopy;
• hysterosalpinography;
• Computed tomography and MRI (magnetic resonance imaging) of the pelvic organs;
• diagnostic laparoscopy;
• radiography of the fallopian tubes and the body of the uterus;
• blood test for cancer markers.

First of all, I would like to say that the diagnosis of endometriosis, which was made to a woman only on the basis of a single ultrasound examination, can be safely questioned. Endometriosis is a disease whose symptoms are very obvious and it is impossible to confuse them with something else, but ultrasound examination alone is not enough to make this diagnosis.

However, the question of whether it is possible to get pregnant with endometriosis is being asked by an increasing number of women due to the fact that this diagnosis has become more common, and not always right. There is a reasonable opinion that the diagnosis of "endometriosis" has acquired a commercial connotation and the appointment of hormonal contraceptives for every second woman under the pretext of detecting endometriosis cannot be considered reasonable and reasonable.

Obstetrician of the highest category Lyudmila Barakova

http://babynar.ru/topmenu/baza/kak_zaberemenet_pri_endometrioze/

Treatment

Methods of treatment depend on the age of the woman, the anamnesis of her labor activity, the duration and degree of the course of the disease. Young nulliparous women with asymptomatic course of the disease are trying to prescribe a sparing course of treatment. And in the postmenopausal period (menopause) and with a progressive disease, they can resort to radical abdominal surgery with the complete removal of the uterus and its appendages.

There are the following practices for the treatment of endometriosis:

• Hormone therapy (similar to the method described above for thickening the endometrial layer, productive for grades I-II), as well as using oral contraceptives (COCs).
• Surgical intervention (the most effective and currently available in the form of minimally invasive laparoscopy, supplemented by hormone therapy).
• Expectant tactics (if there is no question of childbearing, there are no pains, it remains only to regularly monitor the condition of the pelvic organs with the help of ultrasound and donate blood for CA-125, a marker of epithelial ovarian cancer).

Modern method of cauterization of endometriosis foci through 2–3 minimal holes

After laparoscopy, a woman is discharged after 1-3 days, and she becomes fully capable on the 3-5th day. From unpleasant sensations, a swollen stomach and aching pain in the collarbone remain for some time - this is how the gas used during the operation comes out. Also, after this intervention, as well as after all types of operations, it is recommended to move and walk more so that connective tissues (strands) do not form between organs in the area of ​​fresh wound surfaces.

Every woman, sooner or later, thinks about the issues of motherhood. One of the obstacles that can stand in her way is endometriosis. This is a pathological condition characterized by abnormal growth of the endometrium. The danger of violation lies in the high probability of developing infertility.

What is endometriosis

The endometrium lines the inside of the uterus. Its growth is influenced by the hormone estradiol. The endometrium includes 2 layers - functional and basal. The functional layer is shed along with menstrual blood if conception has not occurred.

In the first half of the cycle, the thickness of the endometrium increases in size. By the time of conception, it reaches the desired value. This is necessary so that the embryo can easily attach to the uterus. The process of implantation is influenced by such factors as:

• structure of the endometrium;
• quality of blood circulation;
• layer thickness;
• arterial lumen.

Endometriosis is characterized by a pathological condition of the endometrium. In medicine, 2 types of the disease are distinguished - external and internal endometriosis. External is characterized by the growth of endometrial tissue outside the uterus. This group includes retrocervical endometriosis, extragenital and genital.

Internal endometriosis is characterized by excessive thickness of the layers of the endometrium in the uterus. The disease is difficult to diagnose. Very often, women learn about it only during pregnancy planning.

The causes of pathology include:

• long-term use of intrauterine contraceptives;
• genetic disposition;
• hormonal abnormalities;
• violations in the implantation of a fertilized egg;
• disorders in the endocrine system;
• endometriosis after a missed pregnancy;
• inflammatory diseases of the pelvic organs;
• diagnostic curettage of the uterus or abortion.

Diagnosis of the disease is possible in the process of laparoscopy or ultrasound. The severity of symptoms depends on the severity of the disease.

In the presence of endometriosis, a woman notices the following symptoms:

• severe pain during critical days;
• discomfort in the pelvic area during defecation and urination;
• the presence of bloody intermenstrual discharge;
• pain during sexual intercourse;
• the presence of blood in the urine;
• lack of ovulation.

An indirect sign of endometriosis is prolonged infertility. Getting pregnant without treatment is extremely problematic.

The final diagnosis is made only after a diagnostic operation - laparoscopy. It is not always possible to see the disease within the framework of an ultrasound scan.

Is it possible to conceive

Pregnancy with endometriosis of the uterus is possible only after treatment. The embryo is attached to the uterus when the thickness of the endometrium is from 10 to 16 millimeters. With artificial insemination - not less than 8 millimeters.

There are 4 degrees of the disease. Each of them is characterized by a number of features. At an early stage of the disease, infertility can be prevented.

Characteristics of the degrees of endometriosis:

1. At the first stage of the disease, a woman does not notice significant changes. The only sign is an increase in the amount of menstrual flow. Diagnosis at this stage is difficult. If endometriosis is suspected, a histological examination is prescribed. Endometriosis 1 degree and pregnancy are compatible. The disease does not have a strong effect on reproduction.
2. The second degree of the disease manifests itself brighter. Endometrial tissues are firmly rooted in their places and increase in size. This condition is treated with hormonal drugs. Sometimes surgery is used. Grade 2 endometriosis and pregnancy can coexist, provided that the doctor's recommendations are followed.
3. Endometriosis of the third degree is dangerous for the reproductive function of a woman. The serous layer of the uterus is damaged. Foci of endometriosis extend to the peritoneum and fallopian tubes. Spikes appear. Cysts form on the ovaries. The menstrual cycle of a woman is disrupted. Due to the adhesive process, the embryo cannot enter the uterus. For this reason, the likelihood of an ectopic pregnancy increases. Endometriosis 3 degrees and pregnancy are mutually exclusive concepts. The woman will need surgery.
4. The fourth stage of the disease is the most dangerous. The situation is aggravated by the fusion of the reproductive organs. The patient needs immediate medical attention. The question arises of saving a woman's life. Endometriosis 4 degrees and pregnancy are incompatible. The female body after such a state is restored slowly.

Often the question arises as to whether it is possible to confuse endometriosis and pregnancy. This is possible with insufficient qualifications of the doctor and deviations in the operation of the ultrasound machine. The probability of error is especially high in the early stages of pregnancy. To avoid unpleasant situations, doctors recommend conducting a pregnancy test for any deviation in the reproductive system.

The course of endometriosis of the ovaries and pregnancy is quite possible. Sometimes the foci of the disease are localized only on one ovary. The second continues to function. Pathology does not greatly affect the course of pregnancy. The exception is those cases when the endometrial layer is too thin.

Features of pregnancy with endometriosis

Pregnancy after endometriosis is possible, but the presence of this disease increases the likelihood of a miscarriage.

The features of such a pregnancy include:

• the likelihood of spontaneous abortion in the early stages;
• placental insufficiency;
• low attachment of the embryo;
• risk of placental abruption ahead of time;
• premature labor activity.

Conception does not occur immediately, but after prolonged treatment. Pregnancy with endometriosis is problematic, as there are difficulties with bearing a child. The reproductive system of a woman who has had endometriosis becomes vulnerable.

To save pregnancy with endometriosis, prescribe:

Endometriosis and pregnancy after 40 years is a rather complicated combination. In addition to the fact that the body is exhausted by the disease, there are age-related problems. Doctors in this case pay special attention to the patient. The dosage of drugs is increased. In the early stages of pregnancy, placement in a hospital is possible.

There is some truth to the fact that pregnancy cures endometriosis. According to statistics, after a successful delivery, the disease stops progressing.

Treatment

It is much more difficult to get rid of chronic endometriosis, so it is very important not to start the disease. There are several ways to treat endometriosis:

• laparoscopic surgery;
• medications;
• physiotherapy.

Laparoscopy

Most often, pregnancy occurs after laparoscopy of endometriosis. The operation is considered diagnostic. It is performed under general anesthesia. 3 holes are made in the abdominal cavity - in the region of the ovaries and in the region of the navel. A special tool is placed in these holes, with the help of which the doctor determines the local location of the endometriotic focus. Excess tissue is removed. If there are adhesions, they are dissected.

Planning for pregnancy after surgery is not prohibited. The recovery period is short. After 3-5 days, the woman completely returns to her usual life. The operation is a good way to stimulate the activity of the ovaries. In the absence of male factor infertility, the likelihood of a successful pregnancy increases significantly.

Medicines

It is undesirable to combine endometriosis and pregnancy planning. It is recommended to completely get rid of the disease before conception. In order to prevent pregnancy during the treatment period, oral contraceptives are prescribed. They inhibit ovarian function. Against this background, the likelihood of new foci of endometriosis is reduced. The course of treatment with oral contraceptives is from 3 to 6 months. When you stop taking the pills, a rebound effect occurs. The ovaries begin active work. Side effects of this treatment include multiple pregnancies.

Anti-inflammatory and vitamin therapy is also prescribed to eliminate endometriosis. This is necessary to soften the adhesions that often occur when endometriosis is external. Endometriosis, both during pregnancy and in its absence, requires an integrated approach. Hormone support is a must. When planning, it affects the regularity of the menstrual cycle. During early pregnancy, endometriosis and its manifestations are muted by progesterone.

Physiotherapy

Physiotherapy is an additional method of complex therapy. Regular procedures reduce pain in the pelvis, soften adhesions and improve blood circulation. This favorably affects the growth of the endometrium. There are the following procedures:

• magnetotherapy;
• electric shock;
• laser radiation;
• hydrotherapy;
• balneotherapy.

To prevent endometriosis, a woman should avoid hypothermia and visit a gynecologist regularly. It is also recommended to monitor the level of hormones. Hormonal abnormalities are indicated by violations of the periodicity of the menstrual cycle.

Endometriosis is the appearance of cells of the inner layer of the uterus (endometrium) in atypical places: on the peritoneum, in the ovaries, fallopian tubes, wall and cervix, in the bladder, rectum and other organs and tissues.

Why is this happening? Causes of endometriosis

Doctors do not have a definite answer to this question. In general, the picture looks like this.

The inside of the uterus is lined with a mucous membrane called the endometrium. This mucosa consists of two layers - basal and functional. The functional layer is shed every month during menstruation, unless pregnancy occurs. The next month, the endometrium grows again due to the multiplication of cells of the basal layer, under the influence of ovarian hormones, in particular, estrogen and progesterone.

Estrogens (hormones of the first half of the menstrual cycle) contribute to the growth of the inner layer of the uterus and the maturation of the egg. After ovulation, the amount of estrogens decreases, the ovaries begin to secrete progesterone, which inhibits the growth of the endometrium and promotes the development of glands in it, preparing it for the introduction of a fertilized egg. If pregnancy does not occur, then the level of estrogen and progesterone falls, the endometrium is rejected by the uterus, and this is externally manifested by menstruation. Discharge during menstruation is a mixture of blood and fragments of exfoliating endometrium.

So, for the occurrence of endometriosis, at least two factors are necessary: ​​a violation of the hormonal background and a decrease in immunity.

Hormones in endometriosis: an imbalance is provided

Endometriosis does not develop in a woman's body if she does not have a malfunction in the hormonal system. The regulation of the female reproductive system is controlled by many hormones produced by the glands of the brain (hypothalamus, pituitary gland) and ovaries. Moreover, the ovaries themselves are under the control of the hypothalamus. Hormones in endometriosis behave “wrongly”: the ratio of estrogen and progesterone is disturbed in the body. This leads to the suppression of ovulation and the growth of the endometrium, which is then rejected, causing bleeding. Individual cells of the immature endometrium are thrown into atypical places - and foci of endometriosis are formed.

Immune dysfunction and endometriosis

Another cause of endometriosis is a violation of the immune system. The human immune system is designed in such a way that it protects the body from any "unusual" proteins, destroying "foreign" proteins of infections, foreign bodies or tumor cells. In the same way, it destroys cells that are not characteristic of a particular tissue, in particular, endometrial cells that have fallen into “inappropriate” places for them. In almost all women, during menstruation, the discharge not only goes out (through the vagina), but is partially thrown through the pipes into the abdominal cavity, uterine wall, ovaries, and also into the blood and spread throughout the body. Normally, menstrual flow that enters the abdominal cavity is quickly destroyed by special protective cells. Endometriosis occurs when the immune system stops recognizing endometrial cells in other tissues, allowing them to multiply freely anywhere.

After the endometrial cells take root in a new place, they continue to exist according to the laws of the menstrual cycle as they did while in the uterine cavity - in the first half of the cycle they actively multiply and grow, and when menstruation comes, they are rejected into the abdominal cavity, leading to the formation of new foci of endometriosis. If endometrial tissue enters the ovary, then endometrioid benign cysts can form in it. Endometriosis of the body of the uterus (adenomyosis) occurs when endometrial cells are introduced into the muscular layer of the uterus. In rare cases, foci of endometriosis can be found in a wide variety of organs and tissues of the body. So, there is endometriosis of the kidneys, ureters, bladder, lungs, intestines. This is due to the fact that fragments of endometrial tissue are carried throughout the body by the lymphatic or circulatory system.

During pregnancy, menopause and menopause, endometriosis foci undergo a reverse process, which leads to an improvement in the woman's condition.

Symptoms of endometriosis: if the stomach hurts ...

In rare cases, a woman does not even suspect that she has endometriosis, since it can proceed without showing itself at all. But much more often this disease seriously disturbs well-being. One of the main symptoms of endometriosis is pain in the lower abdomen associated with the menstrual cycle. They subside at the beginning of the cycle, grow towards its end, becoming especially strong during menstruation. The pain is most often bilateral, sometimes accompanied by a feeling of pressure in the rectal area and can be given to the back and leg. Discomfort and pain can also occur during sexual contact, as well as during bowel movements. Sometimes the pains are so pronounced that sexual life becomes impossible. Their cause lies in the irritation of the “menstruating” endometrial foci of the nerve endings of the peritoneum. This causes the formation of adhesions (connective tissue strands) in the abdominal cavity, which, in turn, lead to constipation up to intestinal obstruction, as well as frequent, painful urination. Almost all women with genital endometriosis complain of pain during sexual intercourse. Another sign of this disease is prolonged periods, dark spotting before and after menstruation, as well as bleeding between periods. The cycle becomes irregular or shortened, and menstruation is profuse, clotted, and painful. The woman constantly suffers from blood loss, which leads to anemia. And endometriosis of the uterus is manifested by bloody discharge after sexual contact.

Often this insidious disease is also reflected in the emotional state of a woman: constant pain, violations in the sexual sphere, difficulties with conception lead to irritability, imbalance and depression.

Planning for pregnancy with endometriosis

It is believed that endometriosis and pregnancy are not very compatible. Endometriosis can interfere with the maturation of the egg and its release into the fallopian tube (ovulation). It is clear that all this cannot but affect the possibility of conception, and the chances of getting pregnant with endometriosis, unfortunately, decrease. In addition, with a long course of endometriosis, adhesions often form in the genitals, which increases the risk of infertility. Especially dangerous in this regard are adhesions in the fallopian tubes and ovaries, which create an obstacle to the advancement of the egg, which makes it impossible for it to meet with the sperm and conceive.

However, endometriosis is not a "guarantee" of absolute infertility. There are proven facts of the accidental discovery of this disease in women who have never had problems conceiving. Also, many women manage to finally get pregnant after endometriosis.

How is the diagnosis made?

The doctor is able to suggest a diagnosis of endometriosis during a routine gynecological examination: for example, he can see its focus on the cervix or feel painful seals in the vagina. The doctor also draws attention to pain, their connection with menstruation and sexual life. To confirm or clarify the diagnosis, pelvic ultrasound, magnetic resonance imaging, colposcopy (examination of the vagina and cervix using a microscope), hysteroscopy (examination of the uterine cavity using a special hysteroscope device) and laparoscopy are used. The latter method is the "gold standard" for diagnosing endometriosis. This is a gentle surgical operation that allows you to examine the abdominal cavity under magnification (using a special device - a laparoscope) through small holes in the abdominal wall. In fact, only with the help of this method it is possible to see the foci of endometriosis and take a biopsy (pieces of tissue) from them to confirm the diagnosis. Without laparoscopy, the presence of endometriosis can only be assumed.

Treatment and planning of pregnancy after endometriosis

It should be noted right away that the treatment of endometriosis is a long process. Conservative, operative and complex methods can be used. When choosing a method of treatment, the specialist takes into account the age of the patient, the severity of the course of the disease, whether the woman is planning a pregnancy after endometriosis.

With the conservative treatment of endometriosis, hormonal drugs are prescribed in the first place.

Depending on which part of the hormonal regulation was found to fail, the doctor will select the appropriate medication to correct the violation.

Be sure to treat iron deficiency anemia with iron supplements and a special diet. Immunostimulating, analgesic and hemostatic drugs are also prescribed. It is almost impossible to eliminate endometriotic lesions, but treatment allows you to cope with pain and put your menstrual cycle in order, which increases the chances of a woman becoming pregnant after endometriosis.

In some cases, for example, when adhesions form due to endometriosis, one has to resort to surgical treatment. Most often, laparoscopy is used, which allows the least traumatic removal of foci of affected tissue and adhesive formations.

In the treatment of endometriosis, conservative and surgical treatment is often combined. Unfortunately, it is rarely possible to completely get rid of this disease, treatment only allows you to stop the disease, which gives a temporary head start for pregnancy.

Endometriosis and pregnancy

After conservative treatment, it is recommended to plan conception no earlier than 3 months after the course of therapy, so that the body of the expectant mother can fully recover.

Operative intervention, on the contrary, suggests an early onset of pregnancy after endometriosis (unless a combined course is prescribed - a combination of surgical and hormonal treatment). Many doctors advise that before performing surgical treatment of endometriosis, make sure that infertility is not caused by other disorders. If there are several possible causes of infertility, it is recommended to first eliminate all other problems and only then perform surgery for endometriosis. This is due to the fact that the effect of the operation does not last long - the chances of pregnancy after endometriosis increase only in the first 6-12 months after surgery.

On average, 90% of women treated conservatively for mild to moderate endometriosis manage to conceive without surgery within 5 years.

The course of pregnancy with endometriosis

Although it is believed that pregnancy and endometriosis are not very compatible, it is still possible to get pregnant with this disease, and even without treatment for the disease. During pregnancy, endometriosis, as a rule, is not treated, but is dealt with after the birth of the baby.

The only exceptions are cases when an endometrioid ovarian cyst is found in a future mother: if there is a danger of its rupture or torsion, then an operation is planned, which is usually performed at a period of 16–20 weeks of pregnancy (this period is the safest for the fetus).

The combination of pregnancy with endometriosis requires special attention of doctors. Pregnancy often has to be supported with hormones to prevent miscarriage. The threat of interruption may occur in the first and second trimesters due to a lack of the female sex hormone progesterone in the body, which is necessary during this period for the proper development of pregnancy and suppression of uterine muscle contraction. After the formation of the placenta, the likelihood of a miscarriage decreases. By itself, endometriosis no longer threatens the fetus and does not affect its development in any way.

The mechanism of the complex "device" of the female reproductive system is aimed at procreation. Any failure causes problems with the menstrual cycle, on which conception directly depends. One such disorder is endometriosis. Despite the fact that it is diagnosed in 35-40% of women, doctors cannot yet name the exact causes of the pathology. What are the symptoms and consequences of the disease, how "compatible" endometriosis and pregnancy, we will understand in this article.

The essence of the disease

Endometriosis gets its name from the inner lining of the uterus, the endometrium. It consists of two layers: basal and functional. The latter is “renewed” monthly, being rejected along with the egg during menstruation, if conception has not occurred. Then it grows again due to the cellular reproduction of the basal layer, preparing the uterine wall for reliable implantation of a fertilized egg.

Hormones (estrogens and progesterone) regulate the growth of the endometrium. Estrogens come to the fore at the beginning of the menstrual cycle. They stimulate the growth of endometrial cells and the maturity of the egg. After the completion of the ovulation process, estrogens "transfer leadership" to progesterone. The task of this hormone is to reduce the growth of the endometrium and synthesize the glands necessary for the implantation of the egg. If conception does not occur, the concentration of both hormones decreases, and the endometrium "leaves" the uterus - menstruation begins.

Violations in the body of a woman begin during menstruation. During the period of “output” of material unnecessary for the body, endometrioid cells migrate, getting to the internal organs and muscle tissue. There begins the pathological growth of the endometrium, which forms whole foci of the uterine tissue. She, increasing in size, under the influence of changing hormones, bleeds during the menstrual cycle. That is, it behaves as if it grows on its “natural” organ - the uterus. However, there is no outlet for blood and parts of the endometrium, so they turn into adhesions or cysts. development of endometriosis.

Under the influence of a changing hormonal background, a woman experiences pain and discomfort during menstruation. And after a decrease in the concentration of estrogen in the blood, the symptoms decrease or disappear. However, as the disease progresses, the symptoms increase so much that the woman experiences pain all the time.

Depending on where the endometrial cells “gathered”, the following forms of endometriosis are distinguished:

• Genital;
• Extragenital.
• Genital endometriosis is further divided into three groups:
• Internal (endometrioid cells are embedded in deep traces of uterine tissue);
• Peritoneal (endometrial tissues develop in other organs of the genital area: ovaries, tubes, uterine cervix);
• Extraperitoneal (the disease is localized in the external organs of the genital area: vagina, rectovaginal septum).

Extragenital endometriosis develops in organs not related to the genital area:

• bladder;
• Intestines;
• Lungs;
• Navel;
• eyes.

What affects the incorrect "distribution" of the endometrium is still unknown. However, doctors believe that the “erroneous” distribution of hormones during the menstrual cycle and a woman’s weakened immunity provoke the disease.

Increase the “chance” of getting endometriosis and such factors:

• Constant processes of inflammation of the genital area;
• Difficult childbirth;
• Frequent artificial termination of pregnancy;
• Surgical intervention on the pelvic organs;
• Excessive alcohol, caffeine, smoking.

Also, the disease can be caused by unfavorable environmental conditions and prolonged stress.

Symptoms and consequences

The initial stage of endometriosis is asymptomatic. As it develops, a woman may feel slight pain before the onset of menstruation and deviations in the menstrual cycle.

Then the symptoms of the disease appear brighter:

• Pain occurs during intimacy;
• The menstrual cycle is disturbed;
• Dysmenorrhea;
• Menstruation is always accompanied by pain;
• Bloody discharge from the vagina appears between menstruation (the more neglected the process, the longer and more abundant they pass);
• Discomfort during urination and defecation;
• Drops of blood appear in the urine.

Confirmation of developing endometriosis is a long absence of pregnancy with an active unprotected sex life.

It will reveal violations in the body with endometriosis and a graph of basal temperature. , pathology can be recognized at the earliest stages of its development.

Endometriosis can progress quickly. If you do not take measures to eliminate it, the following complications may develop:

• Adhesions in the pelvis (cause pain during intimacy and menstruation, are the cause of infertility);
• Posthemorrhagic anemia develops due to prolonged bleeding;
• The supply of eggs laid since birth is reduced;
• Malignant formations appear when endometrial cells turn into cancerous tumors;
• Nervous disorders are manifested due to pinched nerve endings.

Early diagnosed endometriosis can be treated quickly. However, in advanced stages it leads to infertility.

Treatment Methods

The choice of treatment method depends on:

• From the degree of the disease;
• The woman's age;
• The specifics of her hormonal background.

After diagnostic measures that confirm the diagnosis, the gynecologist prescribes one of the types of treatment: conservative or surgical. Sometimes they are combined to achieve a better result.

Conservative

Conservative treatment includes taking medications that regulate and restore natural hormonal levels. Therapy is always long. With the help of drugs, a woman is introduced into an artificial menopause, that is, she has no menstruation for the entire period of taking the drugs. After their cancellation, the menstrual cycle resumes.

For the treatment of endometriosis, the following groups of drugs are used:

• Combined contraceptives ("Janine") reduce the amount of estrogen produced;
• Gestagens ("Visanna") - analogues of progesterone do not allow the endometrium to grow;
• Antigonadotropic drugs ("Danogen") do not allow ovulation to occur, "destroy" endometrial cells;
• Gonadotropin-releasing hormone agonists ("Diferelin") do not allow the ovaries to "work", stop menstruation.

Since endometriosis is a polysystemic disease, drugs are used to treat inflammation, pain, and allergic reactions. Also at this time, medications that stimulate the immune system are indicated.

Surgical

If the medication has not become effective, the pathological growth of endometrial cells is surgically eliminated.

Laparoscopy for endometriosis is the most popular type of surgery. This is the name of the operation, which is performed through a small incision. Through it, the doctor passes a laser or power tools. With their help, sections of the "unnecessary" endometrium are cauterized. Laparotomy is also used to treat endometriosis. This intervention of surgeons requires an incision in the wall of the peritoneum to carry out the necessary medical manipulations.

After surgery, treatment with hormonal drugs is prescribed to consolidate the results.

Is it possible to get pregnant with endometriosis of the uterus

If endometrial tissue penetrates deep into the muscular layer of the uterus, this disease is called adenomyosis. There is a possibility. Rather, nothing will prevent the sperm from fertilizing the egg. However, in this case, a violation of implantation will occur: the egg will not “hook” for that, because the uterine layer will be broken. It is possible to successfully become pregnant with endometriosis only at the very initial stages of the disease, when the combined germ cells have room to be reliably implanted in the uterus. However, even in this case, difficulties will arise: in order to bear the baby in the first trimester, a woman will need the help of medications.

In addition, pregnancy with endometriosis of the uterus can become dangerous for a woman. The endometrioid tissue in the uterus prevents the egg from penetrating into its layers, so it begins to “look” for another place to attach: tubes, peritoneum, cervical canal. An ectopic pregnancy requires termination in any case, regardless of the place of attachment of the fetal egg.

Therefore, you should not attempt to become pregnant with hyperplasia (a disease in which the uterine mucosa pathologically increases in size). It is better to plan conception after the treatment of pathology.

Advanced endometriosis and infertility is a frightening but very real combination. Sometimes the disease affects the tissues so much that only artificial insemination can help a woman.

Is it possible to get pregnant with ovarian endometriosis

In the presence of pathological growths on the ovaries, ovulation is impossible. Therefore, in this case, endometriosis and conception are incompatible concepts. If the problem is "located" on one ovary, the chances of conception remain.

Pregnancy treatment

Despite the fact that the combination of external endometriosis and pregnancy is not very successful, it occurs even if the woman has not been treated. When a woman's hormonal background changes: the rapidly increasing progesterone prevents further growth of the endometrium. However, the entire first trimester, the expectant mother will need medication "support", with the help of which it is possible to maintain hormonal balance and prevent a miscarriage. After the placenta has formed in the fetus, endometriosis will not be able to “harm” the baby.

If conception has successfully occurred, no action is taken to eliminate pathologically growing tissues until the birth of the child. An exception is endometrioid cysts on the ovaries. In this case, the woman undergoes surgery at 16-20 weeks of pregnancy.

conception after treatment

The age of the woman and the stage of the disease are the main criteria for choosing treatment. Before the appointments, the obstetrician-gynecologist will tell you about when you need to plan a pregnancy. After hormone therapy, a woman should refrain from plans to become a mother for 2-3 months. This time is enough for the body to fully recover from potent drugs.

Laparoscopy for endometriosis - the ability to plan conception as early as possible (if after it no hormone treatment was carried out). This is due to the fact that the effect of surgical intervention lasts no more than a year. Then relapses are possible. Pregnancy after laparoscopy occurs in 80% of cases.

There are many diseases that are passive in the human body. It is possible to learn about them only when difficulties arise in the functioning of a particular system. Within the framework of this article, the problem of pregnancy and conception will be considered with such a mysterious and incomprehensible disease to many doctors as endometriosis. Is pregnancy possible with endometriosis? Can endometriosis and pregnancy coexist?

About the disease

The endometrium is the inner lining of the uterus, designed for the implantation of a fertilized egg into it. Endometriosis is a dyshormonal immune-dependent disease characterized by the spread of endometrial cells beyond its own layer and is accompanied by pain. According to the area of ​​localization, the disease is divided into three forms:

1. Genital - damage to the cavity and cervix, ovaries, fallopian tubes, external genitalia, vagina, etc.
2. Extragenital - manifests itself in the tissues of the bladder, intestines, kidneys, lungs, and even affects skin cells and postoperative scars.
3. Mixed - a combination of genital and extragenital forms of the disease.

Is conception possible?

Many couples ask the question: "Is it possible to get pregnant with endometriosis?". It is this disease that often causes failure in conception. The foci of the spread of the disease in every way impede the normal course of fertilization. The main reasons for the inability to conceive are:

1. No ovulatory phase. There can be no conception without ovulation - a well-known physiological fact. Ovulation can be prevented by endometriosis of the fallopian tubes or ovaries. The egg cannot be released from the ovary or its movement through the cavity of the fallopian tubes is difficult due to overgrown endometrial cells in these places.
2. Adenomyosis. Here, the difficulty of implantation and fixation of the fetal egg in the uterine cavity is monitored. It prevents the implantation of the egg into the lining layer, the same pathologically overgrown endometrium. Embryo fixation can occur, but its further development and gestation is questioned. After a while, a miscarriage can occur - this is a frequent termination of pregnancy with adenomyosis.


3. Endometriosis of the cervix. The distribution area of ​​pathogenic endometrial cells is concentrated on the neck itself. The main problem of conception is that spermatozoa are not able to penetrate the uterine cavity to fulfill their purpose due to the growth of disease foci along the surface of the external pharynx and cervical canal.
4. Disorders in the work of the endocrine and immune systems. It is the hormonal component that plays a primary role in the development of the disease.

It is difficult to figure out how to get pregnant with endometriosis, when this disease puts so many obstacles in the way.

If endometriosis has not been diagnosed in time and already has a large extent of tissue damage, then pregnancy in a natural way may become impossible.

How to get pregnant with endometriosis in such conditions? The only way to conceive is in vitro fertilization (IVF).

Endometriosis and pregnancy

With such a pathology, it is difficult to get pregnant, but it is possible if the fertilized egg manages to bypass all the foci of the disease and find a place for implantation in the uterine cavity. It turns out that you can get pregnant with endometriosis, but what's next? How will the childbearing proceed?

Possible development options:

• Impact of endometriosis on pregnancy. The greatest threat to conception and future pregnancy is the genital type of lesion. The main danger of the disease is the threat of miscarriage due to nutritional problems and fetal development, especially in the early stages (up to 8 weeks of pregnancy), when the placenta has not yet formed. From week 9, the risk of interruption decreases and the effect of endometriosis on pregnancy is minimized. Before asking the question: is it possible to get pregnant with endometriosis, ask yourself if you are ready for a possible spontaneous abortion?
• Impact of pregnancy on endometriosis. Pregnancy with this disease can be useful and even curative. All changes in the hormonal background have a beneficial effect on the development of endometriosis - they slow it down. The fact is that endometriosis is estrogen-dependent, and during pregnancy, the main hormone is progesterone. It is this hormone during childbearing that suppresses the production of estrogen and stops or reverses the development of foci, until they disappear.

Pregnancy after endometriosis

A complete cure for the disease does not give a 100% guarantee that pregnancy will come easily and in the near future. The main consequence of the disease is infertility caused by adhesions in the tissues of the organs of the reproductive system (cervix, tubes or ovaries). Adhesions are connective tissue fibrous strands (unions). Outwardly, they resemble a web or tangled threads that envelop the surface of an organ. Adhesions can form on the walls of the fallopian tubes, pulling them and thereby disrupting the patency, on the surface of the ovary, preventing the egg from leaving it during the ovulatory phase or on the cervix, blocking the path to the uterus for sperm.

To cure adhesive disease, a surgical method is used - laparoscopy. During the operation, the surgeon cuts the adhesive bands, restoring the normal functioning of the organs.

Ways to treat endometriosis

You should not run this problem, especially if you are planning a pregnancy. The tactics of treatment is chosen by the attending physician based on the specific situation and the individual characteristics of the patient's body. Treatment usually consists of three stages:

• Surgical intervention. This method is the most efficient among those available. Surgically, you can completely get rid of the growing foci of the disease and completely eliminate recurrence. The operation is called laparoscopy and involves the removal of an excess layer of overgrown endometrium and dissection of adhesions. After the operation, the doctor prescribes medication.
• Medical therapy. The method is based on the suppression of estrogen production, which provokes the growth of the endometrium beyond its boundaries, and the normalization of the functioning of the ovaries. To block the formation of new foci, hormonal, anti-inflammatory and immunomodulatory drugs are used. The combination of laparoscopy and hormonal therapy achieves the best result.


• Preventive measures. To prevent the onset or further development of the disease, you must carefully monitor your health and pay attention to the slightest warning signs. Regular visits to the gynecologist are mandatory, especially if there are complaints of pain, menstrual irregularities, there were abortions or any surgical interventions in the small pelvis.

Timely seeking help is the key to successful treatment.

A group of researchers led by Professor Serdar Bulun, for a long time, namely 15 years, conducted experiments and experiments on the issue of endometriosis and came to several conclusions:

• The disease has a hereditary predisposition.
• With endometriosis, a specific enzyme, aromatase, is produced.

Normally, this enzyme is absent in the human body. It is the activity of aromatase that increases the production of estrogen, which is a provoking factor for the development of endometriosis.

Based on the data obtained, the researchers concluded that for the treatment of pathological growth of the endometrium, aromatase inhibitors are needed, which would inactivate estrogen receptors, i.e., reduce the production of the hormone estrogen.

Risk group

Certain conditions are necessary for the occurrence of any pathology. The following factors influence the development of endometriosis, as a result of which the development of the disease is possible:

• Women of reproductive years (average 20–40 years). Endometrioid cysts occur at the age of 30 years. Internal endometriosis affects the organs of women 40 years of age. Endometriosis of the uterus often manifests itself in menopause - 40-50 years.
• The risk of endometriosis increases after surgical interventions: laparoscopy, laparectomy, sterilization, etc.
• Environmental pollution. High concentrations of dioxin in the air are especially dangerous.
• Pathologies and malformations of reproductive development: early menarche (7–9 years), heavy and prolonged menstrual bleeding, hyperestrogenism (excess estrogen), etc.

It may take a long time to treat this disease, up to several years. The main thing is that as a result you will be able to carry the child safely without fear for his life. Having cured, you do not have to wonder: is it possible to get pregnant with endometriosis? Moreover, the chances of conceiving and enduring pregnancy with untimely treatment during such a disease are small.