Surprisingly, but true: the best treatment for endometriosis is pregnancy. Is it possible to get pregnant with endometriosis of the uterus: is it possible to conceive and how does pregnancy proceed in this case? Endometriosis and pregnancy after 40

Abnormal growth of endometrioid tissue is a common female disease, often leading to infertility. With its development, pathological foci form in the area of ​​the uterus, appendages and other organs of the genitourinary system. Due to this, getting pregnant with endometriosis turns out to be problematic. The reproductive system cannot function fully, the menstrual cycle is disrupted, and ovulation is often not observed at all. There is still a chance of pregnancy at an early stage of the disease.

Many women are convinced that pregnancy with endometriosis is impossible. Actually this is not true.

The disease often leads to the formation of adhesions that interfere with the passage of the fertilized egg through the tubes. In addition, the process of egg maturation itself is disrupted. Due to this, the likelihood of becoming pregnant with endometriosis of the uterus becomes significantly less.

Another reason for difficulties with fertilization is that with the pathological proliferation of endometrial cells (the mucous layer of the uterus), there is not enough space for the fertilized egg to attach. Nevertheless, at the initial stage of development of the pathology, when endometrioid lesions are just forming, it is quite possible to become pregnant.

With ovarian endometriosis, an obstacle to follicle maturation is created, hormonal imbalance is noted, and ovulation is not observed. At the same time, the development of infertility begins. If only one appendage is affected, the fertilized egg will be released only once every two months.

In addition, this pathology provokes pain during sexual intercourse. If they are expressed excessively, then intimacy is completely excluded.

Is it possible to get pregnant

Doctors unequivocally say that it is quite possible to become pregnant with endometriosis and uterine fibroids. Another thing is that carrying a child in this condition turns out to be problematic.

The reasons for the development of this disease are not reliably known. There are only assumptions that the pathology is inherited; its appearance is provoked by hormonal fluctuations, poor environmental conditions, frequent abortive measures and many other factors.

At stage 1, when the chances of getting pregnant are greatest, the disease is asymptomatic, making it difficult to diagnose endometriosis during this period. There are many cases where a woman was already carrying a child, and during a routine examination, this disease was detected in her.

The likelihood of successful fertilization also exists with the 2nd degree of pathology, when the adhesive process in the cervix and tubes is just beginning. At the same time, endometriosis stops progressing during pregnancy, and a decrease in lesions is noted. In this case, the woman is under constant medical supervision. This is due to the fact that the disease can negatively affect pregnancy.

Complications of pregnancy

It is possible to become pregnant with endometriosis, especially in cases where the disease is still asymptomatic, the tissue grows only in the uterine cavity, and the endometrium has not yet affected the mucous membranes of the fallopian tubes and ovaries. In the early stages of pregnancy, the risk of miscarriage increases.

If external endometriosis has been diagnosed, and pregnancy still occurs, then you need to be under constant medical supervision. Any changes should not be ignored.

The appearance of bloody discharge often indicates a threat of spontaneous abortion. The pregnant woman is urgently hospitalized.

The danger is represented by cystic formations in the ovarian area, the growth of which is noted as a result of damage to the appendages by endometrial cells. During pregnancy, the risk of rupture of these growths increases. Often they resort to surgical intervention.

If a woman manages to become pregnant with endometriosis, the pathological process may stop, but after childbirth it often begins to progress even more intensely.

How to cure the disease

Pregnancy with endometriosis of the uterus, although possible, is extremely undesirable. It is recommended to plan conception only after treatment has been completed.

The symptoms of the disease are easy to eliminate. The main task is to stop the pathological process. In this case, they most often resort to surgical intervention. Drug therapy is also effective. After treatment for endometriosis, a woman will be able to bear a child.

Medication

Due to the fact that hormonal medications are used during therapy, it is impossible to become pregnant with endometriosis during treatment. To normalize hormone levels and stop the pathological process, the following tablets are prescribed:

• oral contraception;
• progestins;
• suppressing the activity of the gonads;
• gonadotropin-releasing hormone agonists.

With this disease, there is discharge between menstruation, pain in the abdomen and heavy periods. For this reason, hemostatics and antispasmodics are also used. Treatment of endometriosis involves taking immunomodulatory drugs, which activate the body's protective functions. We also recommend reading about.

Operational

Surgical treatment of endometriosis is the most effective method of therapy. The operation to remove pathological areas is most often performed by laparoscopy. The intervention is performed using a special device - a laparoscope equipped with a video camera. Thanks to this, the doctor receives accurate information about what is happening in the internal organs and can visually monitor the progress of the procedure.

Relapses after surgery are quite rare. Accordingly, if it has been cured and does not develop again, pregnancy can occur as soon as possible.

If the disease is in an advanced form, the extent of the damage is quite large and there is a risk of cell malignancy, they resort to complete removal of the reproductive organ and appendages. In this case, infertility due to endometriosis is diagnosed.

Folk

To make pregnancy possible after endometriosis, they often resort to. It will not be possible to cope with the pathology itself in this way. You can only eliminate the symptoms and reduce pain during the menstrual period.

In the process of planning pregnancy, folk remedies turn out to be quite effective. White cinquefoil root, hogweed, St. John's wort and nettle are used. Based on them, decoctions are prepared that are taken orally.

Planning a pregnancy

To give birth to a healthy child, you must first cure the disease that prevents conception. Pregnancy after endometriosis is not only possible, but also desirable. Due to this, the risk of relapse is significantly reduced.

Sometimes you need the help of a fertility specialist, so we advise you to read about the procedure.

Prevention

Despite the fact that it is possible to become pregnant with endometriosis, during the entire period of gestation there is a risk of miscarriage, premature birth and a number of other complications. Therefore, it is so important to prevent the development of the disease and prevent its reappearance after the end of therapy. The result will be a normal pregnancy.

For preventive purposes, you should adhere to the following recommendations:

1. Do not resort to abortion measures.
2. Follow the rules of intimate hygiene.
3. Give proper amount of time to rest.
4. Follow all medical recommendations after surgical intervention in the genitourinary system.
5. Avoid excessive physical activity and stressful situations.
6. Regularly undergo examination by a gynecologist.
7. Treat all developing diseases immediately after the first symptoms appear.
8. Constantly strengthen your immune system.
9. Organize your diet correctly.
10. Enough time to spend in the fresh air.

Conception can occur due to the proliferation of endometrial cells, but bearing a child with this pathology is problematic. Therefore, doctors recommend first of all to cure the disease. After this, you can safely plan your pregnancy. A woman has every chance to give birth to a healthy child.

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 an appointment with a gynecologist. And some people don’t go for routine checkups at all, as long as nothing bothers them, without thinking about the fact that there are diseases that occur without obvious sensations, and at the same time they cause significant harm to your body and, sometimes, lead to irreversible consequences. Endometriosis belongs to precisely such a latently pernicious disease.

What is endometriosis, degrees and types of disease

At its core, endometriosis is the growth of endometrial tissue (the lining of the uterus) beyond its “legal” location. Areas of cells with characteristic properties begin to be located 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 of bleeding once a month (menstruation), these stray foci of foreign tissue perform such an action in unnatural conditions, which causes inflammation of these places. As a result of such an anomaly, the body’s activity is disrupted both at individual points and as a whole. There are also known cases of degeneration of endometrioid tissue into a malignant tumor.

There is a distinction between internal genital endometriosis (), 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) involves the location of the endometrium on the genitals. There is also extragenital endometriosis (6–8% of cases) in the gastrointestinal tract, bladder, and so on.
Endometriosis has been described in medical treatises since 2000 BC. and is still a mystery. In terms of prevalence, it ranks 3rd and affects 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, a large number of lesions are observed, penetrating more than 50% into the thickness of the uterus, small cysts on the ovaries, and thin adhesions in the peritoneum.
4. In the fourth degree, the formation of pathological foci is very deep, large, and fusion of organs occurs (most often the vagina and rectum).

As you can see, at stages III–IV, so-called endometrioid or “chocolate” cysts are formed. These are accumulations of menstrual blood in the area of ​​the ovaries, surrounded by membranes of endometrial cells. Moreover, these cysts are functioning and dependent on hormones, as they cyclically undergo menstruation. Constant blood supply and 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

Causes of endometriosis development

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

• during menstruation, exfoliated endometrial cells (normal) migrate along with the reverse flow of blood (not normal - retrograde menstruation) end up anywhere and take root there;
• during inaccurate surgical interventions (surgery 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 poor ecology;
• hormonal dysfunction;
• long-term unrealized reproductive function;
• chronic inflammatory processes in the pelvic organs.

I had fibroids and grade I–II adenomyosis. After laparoscopy and 4 months of artificial menopause, the long-awaited pregnancy began. I had placenta accreta, and I was in storage for the last 2 months. After a successful CS, the ultrasound picture of adenomyosis returned 1.5 years later. According to my treating gynecologist, it occurs in 90% of cases after a CS, and many live with it, just watching. And no one forbids getting pregnant and giving birth.

Video: endometriosis may be 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 of grades I–II 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 a trip to the gynecologist. If in dark times such a condition was considered common, now it is curable. Pain often occurs before/during/after sexual intercourse (dyspareunia). Episodes of pain occur in 60% of women, but most of them do not go to the doctor with this problem. Also, the pain can radiate 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 if a woman has been unsuccessfully trying to get pregnant for a long time. The World Health Organization has listed 22 established causes of infertility, of which this is one.

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

Endometriosis and pregnancy

Some people believe that endometriosis can be cured by pregnancy. This fact is not substantiated in any way, but miracles happen, so it cannot be denied. Indeed, during the period of waiting for a child and for some time after, there are no menstrual flows, and therefore there is a temporary stop in the growth of the endometrium, which can resume after ovulation.

Why is endometriosis dangerous during pregnancy?

Getting pregnant and bearing a child with such a diagnosis can be extremely difficult. If endometriosis spreads to the placenta (“baby place”), then the chance of saving the baby decreases sharply. Therefore, it is advisable to eliminate endometriosis before conception or carefully protect it if there are no plans for children, since termination of pregnancy against the background of this disease aggravates its course.

The lesions may enlarge, and the woman may even die if the uterine wall is perforated (formation of a through hole) and unstoppable bleeding.

Taking into account the advances in medicine today, pregnancy caused by endometriosis can be saved in most cases. The woman is prescribed hormonal medications that maintain the uterus in the necessary condition for the harmonious development of the fetus. There is no need to be afraid of them. Modern pharmacology offers effective and safe drugs.

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

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

It is worth getting rid of endometriosis at the stage of pregnancy planning, especially if it has reached stage III–IV. But statistics say that every second woman can independently become pregnant with this disease. This is possible with little damage to 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 with 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, it is difficult for the egg to pass to the uterus);
• adhesions block patency (peritoneal infertility);
• disruption 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 the body begins to produce antibodies in places of inflammation and can interfere with the implantation of the fertilized egg;
• due to inflammation, sperm are deactivated by protective cells (macrophages);
• when a woman experiences severe pain during intimacy, she avoids it.

Additionally, there may be complications due to insufficient development of the endometrium. In other words, it may be thinned out. 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 in this case the risk of early miscarriage increases. Thus, the question is no longer about the ability to get pregnant, but about the ability to bear a child.
If the endometrium is underdeveloped, 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 condition of the endometrium, the cause of the deviation is determined. Most often it turns out to be chaos in the hormonal pattern. Therefore, the doctor prescribes hormonal therapy with drugs containing progesterone (for example, Duphaston). This hormone suppresses estrogens (female hormones), which lead to the growth of the endometrium 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 then build it up 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 (physical therapy).

Folk remedies are also of no small importance, but not as an independent treatment, but in combination with medication and in consultation with the attending physician.

• Here are 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 boron uterus (2–3 tsp per 250 ml of boiling water taken 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 live ones really grow by leaps and bounds! Tested it 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’ve never had anything like this in my life)... But before that, I ate 1 live pineapple a day for 2 days (I read it on the Internet). So try it, it's still useful.

Lemurrchik

• https://www.nn.ru/community/user/be_mother/tonkiy_endometriy_zlobnaya_bolyachka_endometrioz_chto_delat.html
• raspberry leaf tea (in small quantities several times a day);

a decoction from a collection of elderberry inflorescences, yarrow herbs, mint, chamomile, nettle, and capitula (half an hour before meals, 3-4 times a day).

Childbirth with this diagnosis in a woman requires close attention from 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 placenta. Before giving birth, an ultrasound is required to definitively identify problem areas and prepare for the appropriate obstetrics technique. If a CS is necessary, doctors 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 material before incision. After the end of the maternity 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 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 a laboratory, often used for infertility

Diagnostics

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

Obstetrician-gynecologist of the highest category, Doctor of Medical Sciences, 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 speculum and two-manual 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 uterine body;
• blood test for cancer markers.

First of all, I would like to say that the diagnosis of “endometriosis”, which is made to a woman only on the basis of a single ultrasound examination, can safely be questioned. Endometriosis is a disease whose symptoms are very obvious and cannot be confused with something else, but an 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 increasingly common, and not always fairly. There is a reasonable opinion that the diagnosis of “endometriosis” has acquired a commercial connotation and the prescription of hormonal contraceptives to every second woman under the pretext of detecting endometriosis cannot be considered justified and reasonable.

Obstetrician of the highest category Lyudmila Barakova

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

Treatment

Treatment methods depend on the woman’s age, her labor history, the duration and severity of the disease. For young nulliparous women with an asymptomatic course of the disease, they try to prescribe a gentle course of treatment. And in the postmenopausal period (menopause) and with a progressive disease, they can resort to radical abdominal surgery with complete removal of the uterus and its appendages.

The following treatment practices for endometriosis are available:

• Hormonal therapy (similar to the method described above for thickening the endometrial layer, productive for degrees I–II), as well as with the help of oral contraceptives (COCs).
• Surgical intervention (the most effective and currently available in the form of minimally invasive laparoscopy, supplemented by hormone therapy).
• Expectant management (if childbirth is not an issue, there is no pain, all that remains is to regularly monitor the condition of the pelvic organs using ultrasound and donate blood for CA-125, a marker of epithelial ovarian cancer).

A modern method of cauterizing foci of endometriosis through 2–3 minimal holes

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

On the entire inner surface of the uterus there is a mucous membrane called the endometrium. With hormonal or menstrual disorders, genetic predisposition and other reasons, the endometrium spreads outside the uterus. This disease is called endometriosis.

You can often come across the statement that endometriosis can be treated by pregnancy. This is partly true, because the period of waiting for a child has a beneficial effect on the condition of the uterus, because during this time the cyclic production of hormones, which led to the growth of the mucous membrane, stops. Endometrial growth activity decreases, and the size of the lesions may even decrease. But in most cases this is a temporary phenomenon that will last until ovulation occurs. Therefore, it is still better to neglect this method of treatment and plan to conceive no earlier than six months after treatment.

Termination of pregnancy is a huge stress for a woman, and with this diagnosis the risk is very high. Therefore, draw conclusions: if you just want a child, then first get rid of endometriosis, and if you are already pregnant, then rely on the experience of specialists and follow all their instructions.

Is it possible to conceive with endometriosis?

Many women cannot conceive a child for a long time in the presence of foci of endometrial spread. Why? There are several reasons:

• Lack of ovulation. Menstruation goes on as usual, spotting is regular, but true ovulation does not occur due to dysfunction of the ovaries or difficulties in the passage of the egg through the fallopian tubes. This problem usually occurs with an endometrioid ovarian cyst.
• Disturbances in the implantation of a fertilized egg. The diagnosis in this case is adenomyosis. In this case, miscarriage occurs rather than infertility as such, and an ectopic pregnancy can also develop.
• Disturbances in the endocrine system of the body. They simultaneously lead to the spread of the endometrium and cause infertility.

Don't despair! Pregnancy and endometriosis can coexist. This will happen if ovulation, fertilization has occurred, and the egg was still able to pass into the abdominal cavity and implant.

It must be remembered that termination of pregnancy can worsen the course of the disease and lead to an increase in lesions. Therefore, with this diagnosis, you need to very carefully monitor contraception in cases where the child is not wanted.

How does endometriosis affect pregnancy?

Experts believe that in this case the likelihood of miscarriage increases. But medicine is now at a fairly high level, so an experienced doctor can help a woman avoid termination of pregnancy. The expectant mother may have to take hormonal medications. Don't be afraid, this is necessary for the safety of your child.

If the uterine mucous tissue has not spread to the placenta, then the chance of saving the baby increases many times over. But in any case, it is necessary to monitor the woman’s condition and, if necessary, prescribe treatment.

Do you have endometriosis and find out you are pregnant?

Contact your gynecologist as soon as possible so that he can give you a referral for an ultrasound. First you need to confirm the fact of intrauterine pregnancy. In the case of an ectopic, an urgent endoscopic operation is performed and the fertilized egg is removed from the tube. An interesting point: after this intervention, the adhesions in the fallopian tube are cut, and in the future the woman’s chance of becoming a mother increases. If everything is in order, then treatment is usually not prescribed in the first trimester.

In the 2-3 trimesters, estrogens suppress the production of progesterone and there is a risk of miscarriage. Therefore, at this stage it is necessary to take progesterone drugs to help reduce the muscle activity of the uterus.

If there is internal endometriosis, then in the last weeks there is a high risk of uterine rupture, so the woman is placed in the prenatal department in order to have an emergency caesarean section if necessary.

Treatment

As we said above, before planning a new addition to the family, you should definitely cure endometriosis, especially if it is stage 3-4. And in six months, or better yet, in a year, you can begin to achieve your goal. If conception does not occur after complete elimination of the disease, then additional studies must be performed to determine the cause of infertility.

The treatment tactics for endometriosis are chosen by the attending physician depending on the individual characteristics of the woman.

• Hormonal therapy. This type of treatment is based on the suppression of estrogens (female hormones), which lead to the growth of the endometrium outside the uterus. Usually this is a synthetic analogue of progesterone () or other similar drugs with a similar effect. This type of treatment is used for stages 1-2.
• Surgical intervention. It’s sad, but at the moment this is the only and most effective method with which you can completely get rid of foci of endometriosis. Now endoscopic operations are being performed, after which the likelihood of the diagnosis returning is minimal. In Russia, almost all such interventions are performed using laparoscopy. In addition to removing excess endometrium, during surgery they can restore the organ affected by it and separate the adhesions that have appeared. After this type of treatment, hormonal drugs are prescribed.
• Waiting tactics. If a woman already has children or is not planning a pregnancy, and her type of endometriosis is not accompanied by pain symptoms, then this therapy is completely justified. In this case, it is necessary to monitor the condition of the pelvic organs using ultrasound, as well as regularly donate blood for the presence of tumor markers, which indicate the early development of a malignant tumor.

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

Why is this happening? Causes of endometriosis

Doctors do not have a clear 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 mucous membrane consists of two layers - basal and functional. The functional layer is shed every month during menstruation, unless pregnancy occurs. Over the next month, the endometrium grows again due to the proliferation of cells in the basal layer, under the influence of ovarian hormones, in particular estrogen and progesterone.

Estrogens (hormones of the first half of the menstrual cycle) promote the growth of the inner layer of the uterus and the maturation of the egg. After ovulation, the amount of estrogen decreases, the ovaries begin to secrete progesterone, which suppresses the growth of the endometrium and promotes the development of glands in it, preparing it for the implantation of a fertilized egg. If pregnancy does not occur, then the level of estrogen and progesterone drops, 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 exfoliated endometrium.

So, for endometriosis to occur, at least two factors are necessary: ​​hormonal imbalance and decreased immunity.

Hormones in endometriosis: imbalance is guaranteed

Endometriosis does not develop in a woman’s body unless she has a malfunction of 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 the ovaries. Moreover, the ovaries themselves are under the control of the hypothalamus. Hormones behave “wrongly” in endometriosis: the ratio of estrogen and progesterone in the body is disrupted. This leads to suppression of ovulation and proliferation of the endometrium, which is then rejected, causing bleeding. Individual cells of the immature endometrium are thrown into atypical places - this is how foci of endometriosis are formed.

Immune dysfunction and endometriosis

Another cause of endometriosis is impaired immunity. 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 uncharacteristic for a particular tissue, in particular, endometrial cells that have ended up in places that are not intended for them. In almost all women, during menstruation, discharge not only comes out (through the vagina), but is partially thrown through the tubes into the abdominal cavity, the wall of the uterus, the ovaries, and also into the blood and spread throughout the body. Normally, menstrual fluid 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 unchecked anywhere.

After the endometrial cells take root in a new place, they continue to exist according to the laws of the menstrual cycle just as they did while in the uterine cavity - in the first half of the cycle they actively multiply and grow, and when menstruation arrives, they are rejected into the abdominal cavity, leading to to the formation of new foci of endometriosis. If endometrial tissue enters the ovary, benign endometriotic cysts can form in it. Endometriosis of the uterine body (adenomyosis) occurs when endometrial cells invade the muscular layer of the uterus. In rare cases, foci of endometriosis can be found in a variety of organs and tissues of the body. So, there is endometriosis of the kidneys, ureters, bladder, lungs, and intestines. This occurs 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, foci of endometriosis undergo a reverse process, which leads to an improvement in the woman’s condition.

Symptoms of endometriosis: if your stomach hurts...

In rare cases, a woman does not even suspect that she has endometriosis, since it can occur without showing itself at all. But much more often, this disease seriously affects one’s 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, increase towards the end, becoming especially strong during menstruation. The pain is most often bilateral, sometimes accompanied by a feeling of pressure in the rectum and can radiate to the back and leg. Discomfort and pain can also occur during sexual intercourse, as well as during bowel movements. Sometimes the pain is so severe that sexual life becomes impossible. Their cause lies in irritation of the nerve endings of the peritoneum by “menstruating” endometriotic foci. This causes the formation of adhesions (connective tissue cords) 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 bloody spotting before and after menstruation, as well as bleeding between periods. The cycle becomes irregular or shortened, and menstruation becomes heavy, with clots, 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 intercourse.

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

Planning pregnancy with endometriosis

It is believed that endometriosis and pregnancy are not very compatible. Endometriosis can disrupt the process of egg maturation 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 long-term endometriosis, adhesions often form in the genitals, which increases the risk of developing infertility. Particularly dangerous in this regard are adhesions in the fallopian tubes and ovaries, which create an obstacle to the advancement of the egg, making it impossible for it to meet the sperm and conceive.

However, endometriosis is not a “guarantee” of absolute infertility. There are proven facts of accidental detection 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?

A doctor can suggest a diagnosis of endometriosis during a routine gynecological examination: for example, he can see its focus on the cervix or feel painful lumps in the vagina. The doctor also pays attention to pain, its connection with menstruation and sex 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 this method can you see 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 treatment of endometriosis is a long process. Conservative, surgical and complex methods can be used. When choosing a treatment method, the specialist takes into account the patient’s age, the severity of the disease, and whether the woman is planning a pregnancy after endometriosis.

In the conservative treatment of endometriosis, hormonal drugs are primarily prescribed.

Depending on which area of ​​hormonal regulation the malfunction was identified, the doctor will select the appropriate medications to correct the disorder.

Iron deficiency anemia must be treated with iron supplements and a special diet. Immunomodulating, analgesic and hemostatic drugs are also prescribed. It is almost impossible to eliminate endometriotic lesions, but treatment can cope with pain and normalize the menstrual cycle, which increases a woman’s chances of becoming pregnant after endometriosis.

In some cases, for example, when adhesions form due to endometriosis, it is necessary to resort to surgical treatment. Most often, laparoscopy is used, which makes it possible to remove foci of affected tissue and adhesions in the least traumatic way.

When treating 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 expectant mother’s body can fully recover.

Surgical intervention, on the contrary, presupposes the rapid onset of pregnancy after endometriosis (unless a combined course is prescribed - a combination of surgical and hormonal treatment). Many doctors advise that before undergoing 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 undergo 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 receiving conservative treatment for mild to moderate endometriosis are able to become pregnant 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 become pregnant with this disease, 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 exception is when an expectant mother is diagnosed with an endometrioid ovarian cyst: if there is a danger of its rupture or torsion, then an operation is planned, which is usually performed at 16–20 weeks of pregnancy (this period is the safest for the fetus).

The combination of pregnancy and endometriosis requires special attention from doctors. Pregnancy often has to be supported with the help of hormones to prevent miscarriage. The threat of miscarriage can arise 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 contraction of the uterine muscles. Once the placenta is formed, the likelihood of miscarriage decreases. Endometriosis itself no longer threatens the fetus and does not affect its development in any way.

No woman is immune from pathology of the reproductive organs. Diseases of the reproductive system inevitably lead to problems with conception.

Endometriosis is considered a common gynecological disease that causes infertility. It complicates the course of the pregnancy and threatens its termination. According to doctors, the disease affects about 30% of women.

How to protect yourself from pathology? How to get pregnant with her and successfully carry a child? Read the answers to these questions in a new article.

What is endometriosis

With the disease, endometrioid tissue grows outside the uterus, affecting other organs. The presence of these cells in other organs and tissues gives rise to painful phenomena, including dangerous ones. During the menstrual cycle, the tissue goes through absolutely all changes, just like the endometrium. Gradually it affects surrounding organs.

The disease occurs in 2 out of 20 women of reproductive age. The development of endometriosis depends on hormonal levels. If the symptoms are ignored, the disease often leads to infertility.

When the pathology affects the genitals, it is called genital.

This form has several types:

• internal - damage to the muscular layer of the uterus;
• peritoneal - proliferation of endometrial tissue into the fallopian tubes, ovaries and pelvic peritoneum;
• extraperitoneal - the appearance of pathology in the external organs of the reproductive system, the vaginal part of the cervix and the retrovaginal septum.

If the disease is severely advanced, endometrioid lesions become diffuse. In this case, pregnancy is highly doubtful.

To make a diagnosis, a specialist performs an ultrasound.

The gravid endometrium, ready for conception, should be loose and three-layered. This structure ensures implantation of the fertilized egg and its subsequent development.

The doctor also evaluates the thickness of the endometrium. Normally it should be 8-10 mm.

If the uterine mucosa is thin, they speak of hypoplasia. Usually its size does not exceed 6-7 mm. If it is lush and thick, the specialist suspects hyperplasia or polyps.

Some women are sure that hyperplasia of the uterine mucosa and endometriosis are the same thing. In fact, these are different concepts. Their main difference is that in the first case, the pathology affects the organ at the morphological level. With endometriosis, changes occur in the uterus itself, not in the cells.

To make a correct diagnosis, laboratory diagnostics are performed. The doctor performs a core biopsy and examines the material under a microscope.

Causes and symptoms of the disease

It is not always possible to determine why the disease appeared. Experts identify the suspected causes of the disease.

These include:

1) Endocrine imbalance

In women, increased concentrations of luteinizing and follicle-stimulating hormones and prolactin are determined. There is a decrease in progesterone levels. Quite often, dysfunction of the adrenal cortex occurs.

2) Genetic predisposition

There is a separate type of illness - familial.

During normal functioning of the body's defenses, endometrioid tissue is destroyed if it extends beyond the uterus. When they are weakened, pathological foci survive in other organs and grow, since immune cells do not recognize foreign ones.

3) Malfunction of the neuroendocrine system

Constant stress, poor nutrition, the development of sexually transmitted infections or somatic diseases can lead to the onset of endometriosis.

4) Exit of endometrial cells outside the uterine cavity.

During menstruation, they are thrown into other genital organs along with bloody discharge.

Eliminating provoking factors will help avoid the disease.

These include:

• age of the woman (more often found in patients over 40 years old than in younger ones);
• C-section;
• frequent abortions (vacuum aspiration and curettage procedures);
• anemia;
• overweight;
• long-term use of an intrauterine device;
• liver diseases;
• chronic inflammation of the genital organs (sluggish endometritis, adnexitis);
• environmental factors - poor ecology.

Severity of endometriosis:

Degree	What does it look like	How it manifests itself	Is it possible to get pregnant
1	Superficial single small foci of proliferation of endometrioid tissue form on the genitals	There are no obvious signs of pathology, the menstrual cycle is not disrupted, before menstruation a mild pain appears in the lower abdomen	If a woman does not use contraception, conception occurs without any problems
2	Pathological foci penetrate deep into the uterine wall and become multiple	In the premenstrual period (3-5 days before menstruation), there is pain in the lower abdomen, a pulling feeling in the lumbar region, the pain is most intense on the first day of the cycle: then there is relief, heavy bleeding during menstruation, shortening of the cycle	Pregnancy is possible in three cases: absence of lesions in at least 1 of the ovaries; patency of the fallopian tube; minor damage to the uterine wall
3	Multiple deep lesions are formed. Multiple endometriotic cysts appear in the ovaries	Heavy blood loss and a long cycle, spotting between periods, intense pain in the lower abdomen and perineum, worsening before menstruation, development of iron deficiency anemia, nausea and vomiting, slight increase in body temperature	Possible after treatment. However, the risk of miscarriage is high
4	Deep multiple areas of proliferation of endometrioid tissue are formed, dense adhesions with large cysts appear on the ovaries, lesions can penetrate into the vaginal wall or rectum	Intensification of all symptoms characteristic of the third degree	Most often impossible: infertility develops

The disease impairs women's fertility, which can cause them to have trouble conceiving. Usually the cause is the growth of pathological tissue in the ovaries.

Ovulation does not occur in the affected organ: the egg is not able to mature and leave the follicle. However, if one ovary continues to function normally and the fallopian tube is patent, conception is possible.

Another obstacle to pregnancy is severe damage to the myometrium by endometriotic lesions. When the zygote reaches the uterus, it cannot attach to the uterine wall.

If the growth is grade 1–2, implantation will most likely occur. However, in case of severe damage, the woman is prescribed medicinal or surgical treatment to increase the chances of normal pregnancy.

With endometriosis, hormonal imbalance develops. It provokes the growth of pathological tissue.

Despite all the difficulties caused by endometriosis, the disease does not mean that pregnancy is impossible or contraindicated. When the disease occurs, gynecologists even advise the patient to conceive a child. It is noted that for those who became pregnant, the course of the disease improved.

The expectant mother is in a state of prolonged anovulation with absence of menstruation. At this time, the female body is under the influence of progesterone. This condition provokes the reverse development of pathological foci.

If you are concerned about whether the disease is affecting your baby, we hasten to reassure you. It has no direct effect on the fetus.

However, the disease often becomes a threat to its gestation. If the uterine wall is severely affected by growths, in the early stages pregnancy often ends with detachment of the fertilized egg - a miscarriage. Sometimes the child stops developing: a frozen pregnancy occurs.

Women suffering from the disease may experience complications (fetoplacental insufficiency). Due to pathology, the functioning of the placenta is disrupted. The baby does not receive normal nutrients from oxygen.

The disease is also dangerous due to the development of uterine bleeding. It is very abundant, and the woman quickly loses blood. The condition threatens not only the fetus, but also the life of the expectant mother.

To prevent tragedy, visit a gynecologist at the stage of planning a child. At this time, you will have to undergo pre-gravid preparation. With the onset of gestation, doctors perform the prevention of miscarriage and fetoplacental insufficiency.

How to treat it

If you have been diagnosed, don't panic. Although the disease cannot be completely cured, its progression can be controlled.

To do this, you need to choose the right therapy. It will eliminate unpleasant consequences and allow you to live a full life.

Methods used to combat endometriosis:

1. Drug therapy: taking hormonal drugs, painkillers, drugs for anemia. Endometriosis, like polyps of the uterine mucosa, is treated with medication: hormone-containing medications are taken. Duphaston, Utrozhestan help to enlarge and build up the endometrium and have a beneficial effect on the course of pregnancy during illness. At the stage of planning a child, oral contraceptives are prescribed (Yarina, Zhanine). They reduce the production of LH and FSH, suppressing ovulation. Due to the lack of hormonal supply, the disease regresses and prepares for pregnancy.
2. Electrocoagulation― cauterization of endometriotic areas of growth with current.
3. Ablation- destruction of pathological foci by cryodestruction and radiomicrowaves.
4. Physiotherapeutic treatment: magnetic therapy, laser and hydrotherapy, balneotherapy. It is carried out as an integrated approach for hormonal or postoperative treatment.
5. Surgical intervention: laparoscopic removal of pathological lesions or excision of areas of growth with a scalpel.
6. Traditional methods.

Herbs help build up the endometrium and eliminate the disease (sage, red brush). Some women use Chinese tampons. They help normalize vaginal microflora and treat chronic gynecological diseases.

Features of childbirth with endometriosis

When pathology develops, doctors use a special approach to delivery. During the passage of the child through the birth canal, uterine bleeding is sometimes provoked.

To protect the expectant mother from a life-threatening condition several days before the expected birth, specialists perform an ultrasound on the woman. Such a study makes it possible to assess the condition of the uterus and placenta.

Often, obstetricians and gynecologists perform a cesarean section on a woman in labor. Such an intervention eliminates the development of severe complications. During the operation, doctors prevent the aspiration of endometrioid cells into the patient’s abdominal cavity.

Preventive measures

Scientists have not identified reliable causes of the disease. It turns out that there is no effective prevention. However, this does not mean at all that you need to give up and do nothing.

List of measures to follow:

1. Come regularly for gynecological examinations.
2. Promptly treat not only “female-specific” diseases, but also general ones.
3. Monitor your weight and follow a diet to avoid high levels.
4. Avoid sexual intercourse during menstruation.
5. Do not use the intrauterine device for a long time. It is better to use other means of contraception - COCs, mini-pills, hormonal patches.
6. Eliminate abortions. To do this, prevent the development of unwanted pregnancy.

In the following video, the doctor explains in detail whether it is possible to bear a child with the disease:

Conclusion

Endometriosis is a serious disease that often causes infertility. However, do not think that its development is a death sentence for a woman.

The compatibility of the disease with pregnancy depends on the course and aggressiveness of the pathological process. Usually, with grade 1-2, the expectant mother carries the child normally, but with one condition: this entire period must proceed under the close attention of a doctor. Do not try to treat the disease yourself.

If you want to have a child, be responsible in your preparation. Depending on the severity of the process, the doctor will prescribe suitable therapy. When the egg matures and is subsequently fertilized, you have a high chance of carrying and giving birth to a healthy baby.