Endometriosis of female reproductive organs. Pathomorphology, diagnosis, treatment and prevention
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.
2. Aldangarova, G. A. & Sulejmanova, A. A. (2017). Optimizaciya diagnostiki i lecheniya endometrioza matki [Optimization of diagnosis and treatment of uterine endometriosis]. Vestnik hirurgii Kazahstana – Bulletin of Surgery of Kazakhstan, 3, 5–10.
3. Baranov, V. S. (2018). Kriticheskie periody razvitiya endometrioza [Critical periods of endometriosis]. Ekologicheskaya genetika – Ecological genetics, 16 (2), 36–39. doi: 10.17816/ecogen16236-39.
4. Gushin, V. A., Bichurina, A. S. & Koryaushkina, A. V. (2017). Genitalnyj endometrioz, diagnostika i lechenie [Genital endometriosis, diagnosis and treatment]. Zhurnal akusherstva i zhenskih boleznej – Journal of Obstetrics and Women's Diseases, 66, 106–107.
5. Evsyukova, L. V., Ryazancev, E. L. & Ryazanceva, M. E. (2015). Naruzhnyj genitalnyj endometrioz [External genital endometriosis]. Zemskij Vrach – Zemsky Doctor, 4 (28), 45–47.
6. Kucherevska, I. Ye., Shulika, Ye. I., Arkhipova, V. S., Pushna, N. M., Proskurnia, N. H., Potoroka, V. V. … Pelipas, R. V. (2012). Suchasni aspekty profilaktyky ta likuvannia endometriozu [Modern aspects of prevention and treatment of endometriosis]. Medytsyna transportu Ukrainy – Medicine of transport of Ukraine, 2, 82–86.
7. Padrul, M. M., Olina, A. A. & Sadykova, G. K. (2017). Klinicheskoe nablyudenie bolnoj s endometriozom kishechnika [Clinical observation of a patient with intestinal endometriosis]. Akusherstvo i ginekologiya – Obstetrics and gynecology, 2, 125–129.
8. Pechenikova, V. A., Akopyan, R. A. & Kvetnoj, I. M. (2015). K voprosu o patogeneticheskih mehanizmah razvitiya i progressii vnutrennego genitalnogo endometrioza – adenomioza [On the issue of pathogenetic mechanisms of development and progression of internal genital endometriosis - adenomyosis]. Zhurnal akusherstva i zhenskih boleznej – Journal of Obstetrics and Women's Diseases, 64 (6), 51–57.
9. Skakova, R. S. (2015). Laboratornye metody diagnostiki genitalnogo endometrioza [Laboratory methods for the diagnosis of genital endometriosis]. Vestnik Kazahskogo Nacionalnogo medicinskogo universiteta – Bulletin of the Kazakh National Medical University, 4, 314–318.
10. Yarmolinskaya, M. I., Rusina, E. I., Hachaturyan, A. R. & Florova, M. S. (2016). Klinika i diagnostika genitalnogo endometrioza [Clinic and diagnosis of genital endometriosis]. Zhurnal akusherstva i zhenskih boleznej – Journal of Obstetrics and Women's Diseases, 65 (5), 4–21.
11. Baranov, V. S., Ivaschenko, T. E., Liehr, T. & Yarmolinskaya, M. I. (2015). Systems genetics view of endometriosis: a common complex disorder. European Journal of Obstetrics & Gynecology and Reproductive Biology, 185, 59–65. doi: 10.1016/j.ejogrb.2014.11.036.
12. Buck Louis, G. M., Peterson, C. M., Chen, Z., Croughan, M., Sundaram, R., Stanford, J. … Kannan, K. (2013). Bisphenol a and phthalates and endometriosis: the endometriosis: natural history, diagnosis and outcomes study. Fertil. Steril., 100, 162–169. doi: 10.1016/j.fertnstert.2013.03.026.
13. Han, X. T., Guo, H. Y., Kong, D. L., Han, J. S. & Zhang, L. F. (2018). Analysis of characteristics and influence factors of diagnostic delay of endometriosis. Zhonghua Fu Chan Ke Za Zhi, 53, 92–98. doi: 10.3760/cma.j.issn.0529-567X.2018.02.005.
14. Hufnagel, D., Li, F., Cosar, E., Krikun, G. & Taylor, H. S. (2015). The role of stem cells in the etiology and pathophysiology of endometriosis. Seminars in Reproductive Medicine, 33, 333–340. doi: 10.1055/s-0035-1564609.
15. Hwang, J. H., Lee, K. S., Joo, J. K. & Lee, H. G. (2014). Identification of biomarkers for endometriosis in plasma from patients with endometriosis using a proteomics approach. Molecular Medicine Reports, 10 (2), 725–730. doi: 10.3892/mmr.2014.2291.
16. Kim, H. S., Kim, T. H., Chung, H. H. & Song, Y. S. (2014). Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis. British Journal of Cancer, 110, 1878–1890. doi: 10.1038/bjc.2014.29.
17. Koukoura, O., Sifakis, S. & Spandidos, D. A. (2016). DNA methylation in endometriosis. Molecular Medicine Reports, 13 (4), 2939–2948. doi: 10.3892/mmr.2016.4925.
18. Lin, W. C., Chang, C. Y. Y., Hsu, Y. A., Chiang, J. H. & Wan, L. (2016). Increased risk of endometriosis in patients with lower genital tract infection. Medicine (Baltimore), 95, e2773. doi: 10.1097/MD.0000000000002773.
19. Matalliotakis, M., Zervou, M. I., Matalliotaki, C., Rahmioglu, N., Koumantakis, G., Kalogiannidis, I. … Goulielmos, G. N. (2017). The role of gene polymorphisms in endometriosis. Molecular Medicine Reports, 16 (5), 5881–5886. doi: 10.3892/mmr.2017.7398.
20. Nisenblat, V., Bossuyt, P., Shaikh, R., Farquhar, C., Jordan, V., Scheffers, C. S. … Hull, M. L. (2016). Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews, 5, CD012179. doi: 10.1002/14651858.
21. Ozhan, E., Kokcu, A., Yanik, K. & Gunaydin, M. (2014) Investigation of diagnostic potentials of nine different biomarkers in endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 178, 128–133. doi: 10.1016/j.ejogrb.2014.04.037.
22. Rosa e Silva, J. C., do Amara, V. F., Mendonca, J. L., Rosa e Silva, A. C., Nakao, L. S., Poli Neto, O. B. & Ferriani, R. A. (2014). Serum markers of oxidative stress and endometriosis. Clinical and Experimental Obstetrics and Gynecology, 41 (4), 371–374.
23. Sapkota, Y., Steinthorsdottir, V., Morris, A. P., Fassbender, A., Rahmioglu, N., De Vivo, I. … Nyholt, D. R. (2017). Meta-analysis identifies five novel loci associated with endometriosis highlighting key genes involved in hormone metabolism. Nature Communications, 8, 15539. doi: 10.1038/ncomms15539.
24. Signorile, P. & Baldi, A. (2014) Serum Biomarker for Diagnosis of Endometriosis. Journal of Cellular Physiology, 229 (11), 1731–1735. doi: 10.1002/jcp.24620.
25. Somigliana, E., Vercellini, P., Vigano, P., Benaglia, L., Busnelli, A. & Fedele, L. (2014). Postoperative medical therapy after surgical treatment of endometriosis: from adjuvant therapy to tertiary prevention. Journal of Minimally Invasive Gynecology, 21, 328–334. doi: 10.1016/j.jmig.2013.10.007.
26. Vercellini, P., Vigano, P., Somigliana, E. & Fedele, L. (2014). Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology, 10, 261–75. doi: 10.1038/nrendo.2013.255.
This work is licensed under a Creative Commons Attribution 4.0 International License.