Ectopic cervix - is one of the most frequent cervical abnormalities. Gynecologists stick to the old-fashioned term "cervical erosion" that is not quite true defines ectopia. Even in 1978 it was decided the term "cervical erosion" is replaced by ectopia of the cervix. This is not only a more accurate display of the diagnosis, but does not cause an adverse reaction in patients.

Normally, the vaginal part of the cervix (which is visible when viewed in the mirror) is covered by stratified squamous epithelium, while the inside of the cervical canal is lined with a cylindrical (cubic epithelium) .  Ectopic cervical (pseudo, cervical erosion) - a displacement of the boundary interface of stratified squamous and columnar epithelium in the vaginal portion of the cervix .  This process is considered physiological in the newborn period, adolescent girls, women who have early sexual initiation and during pregnancy .  The main factors of cervical ectopia is hyperestrogenia - raising the level of female hormones, due to which there are creeping columnar epithelium in the vaginal portion of the cervix .  At the age of 23 to 45 years old border between two epithelia is at the external opening of the cervix, and after 45 years it has shifted towards the cervical canal .  Ectopic cervical cancer, which arose during pregnancy usually resolves itself after delivery .

Causes

The main reasons that lead to the formation of ectopic include:

• hormonal disorders;
• cervical trauma (childbirth, abortion, the use of barrier contraceptives);
• inflammation of the female genital organs.

The clinical picture of cervical ectopia

Often, ectopia of the cervix are asymptomatic. Complaints that are placing patients with ectopia: nagging pain in the abdomen Abdominal pain: when to sound the alarm? The appearance of heavy, yellowish turbid discharge, discomfort in the vulva, itching and burning, menstrual irregularities, uncharacteristic for this disease and are associated with underlying pathological processes (cervicitis, colpitis, adnexitis, etc.). During the inspection in the mirror on the cervix around the external os clearly visible congested (red-faced) portion of different sizes (from a few millimeters to one or two centimeters). Often a patient note contact painless bleeding of varying intensity (often meager) after intercourse, pelvic examination Gynecological examination: an important component of women's health   or douching. Ectopic cervical arose as a result of injuries and scarring, deforms the cervical canal and the cervix itself.

The main method of diagnosis of ectopic cervix is ​​extended colposcopy Colposcopy - how to prepare it properly?   (examination of the cervix by a special device, which increases the apparent picture several times). After treatment of the cervix 3% solution of acetic acid is removed mucus, which is produced in large amounts columnar epithelial glands and acinar visible in a microscope, in the form vinogradinok, cancer. Sample Ljugolja (treatment of cervical iodine solution 5%) negative (section ectopia not stained with iodine).

Additional methods of diagnosing cervical ectopia

Besides inspection of the cervix in the mirrors and colposcopy in the diagnosis of ectopic cervical used:

• cytology (detecting the presence of cancerous cells of the cervix);
• screening for infections, sexually transmitted infections (chlamydia, cytomegalovirus infection, the virus papilommy person);
• a study of hormonal status;
• a biopsy of the cervix with subsequent histological examination of biopsy (if indicated).

Treatment

Treatment of cervical ectopia is to eliminate concomitant cervical inflammation, normalization of hormonal levels and removing diseased tissue.

Methods for the removal of the pathological focus:

• chemical coagulation Solkovagina Solkovagina - help with cervical lesions ;
• cryotherapy (liquid nitrogen treatment);
• lazerovaporizatsiya;
• diathermocoagulation (in recent years almost does not apply);
• processing apparatus "Surgitron."

Anna Sozinova

Endometriosis is diagnosed in the uterus of a large number of patients who go to the doctor in connection with gynecological problems. According to some endometriosis can be observed in up to 50% (from 10% to 50%) of women of reproductive age. The disease is often a diagnostic laparoscopy finding in the survey women for infertility.

Some women suffer from endometriosis for many years, even without knowing it because the disease may be asymptomatic. But it can bring a lot of trouble, especially in the form of heavy and painful menstrual blood loss as a result of developing iron-deficiency anemia.

Why endometriosis uterus begins

Endometriosis is called the development of tissue-like mucous membrane of the uterus (the endometrium) in other organs. In endometriosis uterine such tissue develops in the thickness of the muscular layer of its wall. Endometriosis uterine relates to the internal forms of the disease.

The causes of this disease are currently not fully understood, but it is believed that the main causes are neuroendocrine disorders and immune disorders. In most cases, uterine endometriosis associated with increased secretion of female hormone estrogen, which contribute significantly to the widening of the mucous membrane of the uterus during the first half of the menstrual cycle.

The risk of endometriosis is enhanced during the various manipulations and operations in the uterus, for example, in childbirth, especially if they are accompanied by a manual removal of the placenta, abortions, spontaneous abortions, diagnostic and therapeutic manipulation in the uterus. All this leads to injury of the uterus wall, which may further crosses with blood cells of the endometrium. There they grow and begin to respond to cyclical hormonal changes in a woman's body in the same way as the normal endometrium in the uterus.

But the cells of the endometrium during menstruation, many women fall into the interior of the uterus, endometriosis is developing not all. This happens due to the fact that in the normal cells of the immune system destroys these "stray" endometrial cells, not allowing them to take root where it is not necessary. When violations of the immune system, this protection factor is weakened or absent, which leads to the development of the disease.

In the uterus the disease process may be diffuse (spread evenly) and focal (nodal) form.

What characterizes the uterus endometriosis

By nature Endometriosis is a benign process, the growth of which is shown a tissue having morphological similarity to the endometrium. This tissue is cyclical changes typical of the menstrual cycle, but the tissue is outside the uterus. Scientists who study the nature of the disease, came to the conclusion that there are several theories. The greatest importance is attached to migrated inflammation, disruption of the body's immunological status and hormonal regulation. We must also consider the fact of hereditary predisposition.

As evidence of the role of hormonal imbalance indicates that the earliest cases of endometriosis were found in girls aged 10-11 years. This is the age of formation of hormonal regulation, when the first menstruation. Hormonal dysfunction can be expressed in the development of the syndrome or SNF neovuliruyuschego follicle in a short menstrual cycle, long and heavy menstruation. In a study of patients revealed changes in the level of secretion of sex hormones and central concentration of receptors for sex hormones estrogen Estrogen - the key to bone health   and progesterone Progesterone - norm and pathology . A study of the hormonal profile of women reveals the features of the dynamics of hormone levels, which in the future will greatly assist in the selection of treatment tactics.

Pathological process can have genital and extragenital localization. Endometriosis refers to the uterus and genital localization is called adenomyosis.

There are two clinical forms of the disease:

• diffuse
• nodal

The prevalence of pathological process with internal endometriosis determines the stage of the disease. The most favorable course have initial form. In the case of the first and second stages of the disease process is distributed more muscle and mucosal membranes. The defeat of the body of the uterus until the serous cover is characteristic of the third stage. Endometriosis uterus can occur in isolation in a process involving only the body of the uterus, but may change in adjacent organs and pelvic peritoneum. The fourth stage of the disease is characterized by a complicated one for the flow that causes the development of clinical symptoms.

In rare cases, adenomyosis are asymptomatic. The localization of the pathological process, its prevalence and form lesions determine the main clinical symptoms. The main complaint is pain. Pain can wear intense, with some patients noted the presence of persistent pain in the lower divisions. If adenomyosis lesion of the peritoneum occurs, nearby organs, the pain radiates to the lumbar region, coccyx or anus. There is no scientific proof of the existence of a clear interconnection pain intensity and severity of the disease. In the initial stage of the disease pain can be pronounced with minimal changes.

Besides pain noted the appearance of menstrual disorders in the form of irregular menstruation, prolonged discharge from the genital tract, which appear at different periods of the menstrual cycle and have a dark brown color, therefore such allocation is called "daubs". Adenomyosis may be the cause of disease, discomfort during sexual intercourse. The most negative impact of this disease on the health of the woman and her reproductive function associated with the development of infertility.

In the case of internal endometriosis can be traced to the dependence of clinical symptoms of certain phases of the menstrual cycle. An objective examination of the patient on the gynecological chair size of the uterus will be increased in the second phase, that is, in the days before the expected menstruation. The uterus is enlarged to fill the 6-8 week of pregnancy. This feature also applies to the severity of pain. Shortly before and during the first few days of menstruation pain increases dramatically. In this connection, it is recommended to carry out a dynamic examination on different days of the cycle, so that you can see the difference between symptoms and diagnose adenomyosis Adenomyosis - diagnosis endometrioid lesions of the uterus   and other diseases of the reproductive sphere.

Symptoms

The main symptoms of any kind of genital (sex organs) Endometriosis is a painful menstruation (dysmenorrhea). When the disease of the uterus there are abundant painful menstruation (menorrhagia). Moreover, this disease is characterized by and metrorrhagia - irregular intermenstrual bleeding.

Bleeding these have a long character and tend hardly treatable. They can not stop even scraping Scraping - heavy and unsafe procedure   mucous membrane of the uterus.

But in some cases the disease is asymptomatic and detected incidentally during routine inspections.

Diagnostics

The diagnosis of this disease gynecologist may suspect on the basis of complaints by women. Survey of the gynecologist, if the changes are in the body of the uterus, usually nothing. But nodular form, if the nodes are large enough, they can be felt. During vaginal examination

Ultrasonography (US) of the uterus is the main additional method of identifying this disease is carried out using a vaginal ultrasound probe. To clarify the diagnosis, and apply other methods: X-ray, CT and magnetic resonance imaging, hysteroscopy (endoscopic examination of the uterus using a hysteroscope).

Work is also a blood test for the presence of certain tumor markers characteristic of endometioza (CA-125, CA 19-9) - so you can not only refine diagnosis of the disease, but also to assess the severity of its manifestations, as well as to monitor the effectiveness of therapy. Be sure to explore the female hormones.

Treatment

Treatment begins with conservative methods. Since most women have an increase in estrogen secretion, the activity of these hormones is suppressed by means of individualized hormone replacement therapy (anti-estrogens, progesterone or synthetic analogs agonists Riesling-hypothalamic hormones that suppress the secretion of pituitary gonadotropins).

With the ineffectiveness of conservative treatment is carried out the operation, during which pathological lesions in the muscle layer of the uterus cauterizing different ways. In some cases, surgery is performed supravaginal removal of the body of the uterus (the cervix with preservation). After the operation is also assigned long-term (several months) hormone therapy.