Endometriosis of female reproductive organs. Pathomorphology, diagnosis, treatment and prevention

Abstract

Inflammatory diseases, metrofibroma and endometriosis refer to gynecological diseases, most often causing female infertility. International statistics indicate that endometriosis affects from 5 to 50% of women and it ranks third among the most widespread gynecologic pathologies. Despite the centuries-old history of using diagnostic methods in medicine, it is one of the main unresolved problems of modern gynecology. It has been proven that endometriosis leads to a significant impairment of reproductive function, steady pain syndrome (71–87%) and infertility (21–47%). If over twenty years ago the above-mentioned disease was diagnosed at the age of about 40, then nowadays even a teenager may hear this diagnosis. The objective of this research is to analyze the basics of pathomorphology of genital endometriosis, as well as the principles of diagnosis, prevention and treatment that will help to combat the infertility. The analysis is based on the review of articles and research for 2010-2018, using the PubMed databases, eLIBRARY.RU, Web of Science. Endometriosis is a disease of the most active young women in the social life that may be of hereditary nature. When speaking about the mechanisms of disease progression, there are about 10 theories of its origin, and at the present time none of them explain the diversity of forms and types of this pathology. A distinction is made between genital endometriosis, developing in the genital area, and extragenital endometriosis, developing outside of it. The latter is less common (occurs in 6–8. %) in comparison with genital endometriosis (92–94. %). Genital endometriosis is divided into internal and external, their mechanisms of occurrence are slightly different. But the benign nature of formation is common to both of them. Morphological confirmation of the diagnosis is an important task, as far as endometriosis does not refer either to tumour pathology, or to inflammation, or to pathological regeneration. Accordingly, the treatment will be of a specific nature. This pathology manifests itself in a specific triad of symptoms: dysmenorrhea, dyspareunia and dyschezia. The “golden” standard for the disease diagnosis is a direct visualization of endometrioid heterotopias in the course of laparoscopy and histological examination of biopsy materials of endometriosis. In case of disease detection, the main therapeutic goals are the removal of foci of heterotopias, pain relief and restoration of reproductive function. The main objectives of prevention are strengthening of the immune system, prevention of frequent operations and interventions in pelvic organs, the correct approach to the use of oral contraceptives and women's awareness of the necessity of regular visits to gynecologists. So, a comprehensive approach to the study of pathomorphology and diagnosis of endometriosis allows to determine the expansion degree of heterotopias and to prescribe the correct treatment that will further improve the mental and social life of women and help in restoring the reproductive function.