The spread of the endometrium of the uterus beyond this organ can occur both in the reproductive system and beyond - in the intestines, bladder, pelvic peritoneum, lungs, and even in the eyes. Endometrial cells in any part of the female body are subject to the cyclical action of female hormones and bleed during menstruation.
If there is no outlet of blood from damaged vessels, it accumulates, forming cysts, nodes, plaques and other formations. This disease is very common among women of reproductive age who have gynecological problems. Among those who are treated for infertility and undergo a detailed examination (in particular, laparoscopy and laparotomy), from 6 to 44% of women have a similar diagnosis.
Extragenital endometriosis, which includes endometriosis of the pelvic peritoneum, accounts for 6 to 8% of all recorded cases of the disease. Regardless of the location, endometriosis is not a local, but a general disease that causes disruption of the endocrine and nervous system in a woman.
Etiology of the disease
The spread of endometrial cells is based on their spread through the blood and lymph flow to other organs and tissues.
This is facilitated by medical manipulations inside the uterus:
- Diagnostic curettage;
- Abortion;
- C-section;
- Manual examination of her cavity after childbirth.
Among other factors in the development of the disease, experts name injuries to the inner surface of the abdominal cavity, combined with reduced immunity. This could be inflammation, mechanical damage, or surgery. In addition, genetic predisposition plays an important role.
There is an assumption that endometrial cells during menstruation, for some reason, are not excreted through the cervical canal, but are released into the abdominal cavity through the fallopian tubes. Normally, this situation is stopped by immune cells (macrophages), but if there are problems with the endocrine and immune systems, this protection may not work. Peritoneal cells (mesotheliocytes) begin to interact with endometrial cells, forming foci of the disease.
Clinical picture of peritoneal endometriosis
There are two forms of peritoneal endometriosis:
- Heterotopia is diagnosed exclusively in the pelvic peritoneum;
- In addition to the peritoneum, endometriosis affects the uterus, ovaries, fallopian tubes, and intestines.
The severity of the disease depends on the following factors:
- Area of foci of peritoneal endometriosis (from extensive to minimal);
- The presence of adhesions, their severity (from single to complete obliteration);
- Depth of peritoneal lesion (1-3 cm).
The minor form of the disease does not manifest itself for a long time and proceeds latently.
When foci of the disease spread into the deeper layers of tissue before and after menstruation, the following symptoms appear:
- Debilitating pelvic pain, pain in the lower abdomen of a pulling or aching nature;
- Pain during sexual intercourse and physical activity;
- Impaired functioning of the abdominal organs - problems with urination, defecation, bending of the uterus due to adhesions in the peritoneum;
- Lack of normal ovulation due to adhesions, and, as a result, infertility.
Diagnosis of peritoneal endometritis
Most often, abdominal endometritis is detected during laparoscopy. Morphological manifestations of peritoneal endometritis:
- Vesicles are whitish in color and have no pigment;
- Hemorrhagic vesicles are small cysts filled with thick, tarry contents;
- Superficial and deep foci of the endometrium (heterotopia) are blue, purple, black;
- Nodules, tubercles, spots, colored yellow-brown.
Surgery
The only radical remedy to get rid of foci of endometriosis is laparoscopy. This procedure has many positive properties:
- It is low-traumatic;
- A woman does not lose her ability to bear children;
- During laparoscopy, the doctor has the opportunity to objectively assess the condition of the internal organs;
- The very next day, if there are no complications, you can leave the hospital;
- The marks from the operation heal quickly; they consist of 3 small punctures in the anterior wall of the peritoneum.
During laparoscopy, the doctor grabs the endometriosis lesion with a clamp and cuts it off with special scissors. The remaining peritoneal defects heal quickly. To prevent the disease from spreading further, the tissue excised during laparoscopy is removed through the operating channel in a special container.
In addition to surgical intervention, it is possible to perform cryodestruction, laser coagulation, excision of nodes with an electric knife, argon coagulator, or ultrasonic scalpel.
Conservative treatment
In addition to removing foci of the disease, the goal of specialists involved in the treatment of endometriosis is:
- Prevention of disease relapse;
- Protection from complications, consequences of adhesive disease;
- Pain syndrome therapy;
- Treatment of posthemorrhagic anemia;
- Relief of psychoneurological manifestations.
- Hormonal therapy lasts from 2 months to six months.
It includes the following groups of drugs:
- Estrogen-gestagens - Microgynon, Diane-35, Ovidon, Rigevidon, Anovlar, side effect - increased risk of thrombosis;
- Progestins that effectively relieve pain - Norkulot, Depostat, Duphaston, Orgametril, side effects - weight gain, swelling of the extremities, tension in the mammary glands, breakthrough uterine bleeding;
- Gonadotropin-releasing hormone agonists that cause temporary amenorrhea - Suprefect-depot, Zoladex, Decapeptyl-depot, side effect - hot flashes similar to menopausal syndrome;
- Androgens – Testosterone, Sustanon-250;
- Anabolic steroids – Retabolil, Methylandrostenediol;
- Antiestrogens – Tamoxifen, Toremifene.
These drugs require strict monitoring of contraindications and side effects.
Other groups of drugs for symptomatic treatment:
- Immunomodulators – Levamisole, Cycloferon, Thymogen;
- Antioxidants – ascorbic acid, vitamin E, pycnogenol;
- NSAIDs for pain relief, treatment of inflammatory processes - Brufen, Indomethacin;
- Antispasmodics – Analgin, No-spa;
- Tranquilizers to eliminate neurological manifestations - seduxen, Elenium, Phenazepam, Rudotel, Tazepam;
- Iron preparations for the treatment of hemorrhagic anemia (Ferroplex, Fenyuls).
With precise selection of medications and following the doctor’s recommendations, the disease can be effectively treated.
Forecast for the development of the disease
Relapses of the disease occur in 20% of women of reproductive age with a similar diagnosis. In premenopause, the prognosis is more favorable because the production of estrogen by the ovaries gradually decreases. After radical surgery, peritoneal endometritis does not recur, and the ability to bear children is restored.
Endometriosis of the abdominal cavity is a pathological proliferation of endometrial cells outside the uterus, their growth into the soft tissue of neighboring internal organs located in the pelvis. The process of cell germination in the abdominal cavity is benign, but without timely treatment, in the presence of concomitant diseases, the possibility of degeneration of endometriosis foci into a malignant tumor cannot be ruled out.
Scientists still have not been able to figure out why endometrial cells grow into the abdominal cavity. However, there are a number of factors that can significantly increase the risk of endometriosis in the peritoneum:
- depressed immune system – weak immunity is observed in women who have suffered severe infectious or viral diseases, which is why the body cannot cope with the growing endometrial cells;
- failure of the menstrual cycle, leading to incorrect and untimely maturation and increase in the thickness of the epithelial uterine layer;
- injuries to the cervix and the organ itself - cases of medical termination of pregnancy, undergoing a curettage procedure for therapeutic or diagnostic purposes, other types of surgical interventions;
- chronic inflammation of the pelvic organs;
- lack of hemoglobin - this pathological condition is observed in diseases of the circulatory system, anemia, and poor nutrition;
- overweight, obesity;
- liver diseases;
- poor environmental conditions in the region of residence;
- Hormonal imbalance is a common cause of the disease;
- heredity.
If a woman has had cases of peritoneal endometriosis among her blood relatives, the risk of developing the disease increases significantly, especially in the presence of provoking factors. The likelihood of pathological proliferation of epithelial cells increases in girls with an early onset of menstruation. This refers to situations where a teenager’s periods began before the age of 14-15.
The etiology of the disease is due to the fact that during menstruation, for unknown reasons, the cells of the uterine layer of the endometrium do not penetrate the cervical canal, but leak into the peritoneum through the passages of the fallopian tubes. In normal health, the immune system itself copes with pathogenic cells by producing antibodies to them - macrophages. But with weak immunity, this process occurs too slowly or is absent altogether. Then peritoneal endometriosis begins to develop. Endometriosis of the pelvic peritoneum is more often diagnosed in women aged 35 to 40 years.
Symptoms
Endometriosis of the pelvic peritoneum in the early stages of development may not have a pronounced symptomatic picture. Signs of the disease appear gradually. Their nature and intensity depend on the tissue of which organ the endometrial cells grow.
Common signs of pathology include:
- severe pain in the lower abdomen;
- increased pain during menstruation, heavy periods;
- constant feeling of discomfort in the abdomen, bloating;
- discomfort in the groin area during sexual intercourse;
- bleeding not associated with menstruation.
If there is damage to the tissues of the bladder, cervical canal, endometriosis of the anterior abdominal wall (see photo) or rectum, the woman experiences stool disturbances, frequent constipation is replaced by prolonged diarrhea, and there are blood clots in the stool and urine. Over time, endometrial cells affect an increasing amount of tissue, which leads to blockage of the fallopian tubes and the inability to conceive a child.
The disease has a negative impact on the emotional background. Knowing that every sexual intercourse will cause abdominal pain, a woman deliberately refuses sex. Each arrival of menstruation causes a feeling of panic; heavy discharge, which occurs even in the middle of the cycle, depresses a woman and prevents her from leading an active life.
Diagnostics
Damage to soft tissues by endometriosis is a serious disease that, without timely treatment, can lead to serious consequences. The specificity of endometriosis is that it very quickly becomes chronic, and even surgical treatment does not guarantee a complete recovery.
A woman should immediately consult a doctor as soon as she discovers that, in addition to menstruation, she has discharge, and bleeding during menstruation has become heavy, and her stomach has begun to hurt frequently. The diagnosis of abdominal endometriosis is made after the doctor conducts a gynecological examination of the woman in a chair, takes a thorough medical history, and analyzes complaints.
To clarify the primary diagnosis, determine the degree of development of the disease and the presence of complications, a medical examination is carried out, including the following methods:
- Ultrasound of the pelvic organs– carried out transvaginally. The insertion of a special sensor into the vagina makes it possible to obtain an accurate image of the condition of the cervix and uterine cavity.
- Hysteroscopy– carried out to analyze the condition of the uterine fundus, the degree of patency of the fallopian tubes is analyzed.
- Laparoscopy– minimally invasive surgical intervention is performed for both therapeutic and diagnostic purposes. This examination method is used if complications from the pelvic organs are suspected.
To assess the general health of a woman, a general and detailed blood test is performed. If blood clots are present in the urine or stool, they are tested in a laboratory. Based on the data obtained during the medical examination, the doctor selects a treatment method.
Treatment of abdominal endometriosis
In the early stages of the development of the pathological process, when pathogenic cells have not yet completely grown into the soft tissues of the abdominal organs, conservative treatment is prescribed. It consists of taking medications aimed at normalizing the hormonal levels of the reproductive system, relieving signs of endometriosis and stopping the further spread of the pathological process.
At a severe stage, when the disease has become chronic and provoked a number of complications, there is no point in drug therapy. A positive result can only be achieved through surgical intervention.
Drug treatment
To stop the process of pathological proliferation of endometrial cells, hormonal drugs are prescribed. As a rule, women are prescribed oral contraceptives, long-term use of which helps normalize hormonal levels and inhibit the production of large amounts of the female hormone estrogen.
What does this give? When estrogen concentration decreases, there is no ovulation. The organs of the reproductive system cease to prepare monthly for the possible fertilization of the egg, and the endometrium stops growing. Hormonal therapy includes the use of certain drug groups to alleviate the general condition of a woman:
- Antigestagens– medications quickly reduce the pain symptoms of the disease. Drugs in this group trigger the process of atrophy of the uterine layer of the endometrium, preventing further growth of pathogenic cells. Despite the effectiveness of this therapy, it is used only if a woman has contraindications to surgery and the disease is rapidly developing. The disadvantage of this treatment is that hormonal drugs from the antigestagen group often cause side symptoms - weight gain, hot flashes, acne.
- Agonists– drugs in this group slow down the production of hormones in the female reproductive system. These medications need to be taken in a short course, since their long-term use creates an artificial menopause. It is not recommended for patients planning pregnancy.
- Preparations of the estrogen-progestogen group– are prescribed for an intense symptomatic picture, when endometrial cells have grown deep into the tissue of the pelvic organs, and the woman has severe pain in the pelvic area.
- Progestogens– cause endometrial atrophy. Effective for symptomatic therapy. Medicines relieve severe pain in a short time. The disadvantage of treatment is the high risk of complications such as rapid weight gain and extensive soft tissue swelling. Hormonal drugs from the progestogen group are taken over a long course of 6 to 12 months.
In addition to hormonal treatment, symptomatic therapy is carried out. To relieve attacks of abdominal pain, painkillers and non-steroidal anti-inflammatory drugs are prescribed.
To restore the protective functions of the immune system, immunomodulators are prescribed. It is allowed to use traditional medicine methods - taking decoctions of medicinal herbs (chamomile, St. John's wort, celandine). Decoctions are also used for douching. The traditional method of treatment helps to normalize the functioning of the reproductive system and reduce the intensity of pain.
Doctors allot 6 months for conservative treatment; ultrasound is periodically performed to monitor the condition of the endometrium. If after six months there is no positive dynamics, surgery is prescribed.
Surgery
Surgery to treat endometriosis is carried out in two ways - laparoscopy and classical surgery. Depending on the severity of the clinical case, during the operation the uterus and appendages are preserved or partially or completely removed.
Preference is given laparoscopy. This method of operation is characterized by minimal trauma, and the rehabilitation period is short. Complications after laparoscopy are quite rare. Due to the absence of an abdominal incision, the woman does not need to stay in the hospital for a long time. Discharge from the hospital is carried out the next day.
During laparoscopy, the doctor makes several punctures in the abdominal cavity, through which surgical instruments and a device - an endoscope - are inserted, through which the doctor receives an image from the peritoneum on the screen.
The foci of endometriosis themselves are removed by cauterization. The following methods are used for this:
- cryodestruction – destruction of pathogenic cells with liquid nitrogen;
- electrocoagulation – exposure to high-frequency current;
- laser vaporization - a method of evaporating pathogenic tissues with a laser;
- radiocoagulation - exposure of lesions to radio waves.
During laparoscopy, the removed tissue from endometriosis lesions is sent to the laboratory for histological examination, which determines the nature of the formations. Such an examination is carried out for the reason that there is a risk of the lesions degenerating into malignant neoplasms.
After surgery, a woman needs to undergo a course of hormonal therapy to restore the functioning of the reproductive system, normalize the menstrual cycle, and prevent the re-growth of endometrial cells.
Possible complications
Ascites is dropsy in the abdominal cavity that occurs due to inflammation of tissues damaged by endometriosis cells.
Ascites is manifested by an increase in abdominal volume, severe pain, and signs of intoxication of the body. The disease can only be treated through surgery. If the operation is not performed in a timely manner, the fluid-filled dropsy will burst, leading to peritonitis.
Despite the fact that during surgical treatment of abdominal endometriosis the foci of the disease are removed, there is still a risk of relapse of the disease. Recurrence of lesions occurs if the cause of endometriosis has not been treated.
Another complication after surgery is endometriosis of the postoperative scar. The pathology develops gradually and may manifest itself after a few years. With the development of this disease, endometrial cells begin to rapidly grow outside the uterine cavity and grow into the postoperative scar. Symptoms and treatment are identical to the general clinic of endometriosis.
A woman experiences severe abdominal pain and the cyclicity of menstruation is disrupted. Therapy is conservative if the disease was diagnosed early, or surgery is prescribed when medications do not help, the pathology is advanced and there are complications.
Pregnancy and pathology
It is possible to become pregnant with abdominal endometriosis in the early stages of the development of the pathological process, when there are still no extensive adhesions blocking the passages of the fallopian tubes. If laparoscopy was performed, it is recommended to become pregnant immediately after completion of restorative hormonal therapy. Under the influence of natural changes in hormonal levels, there is a possibility that the pathological process will stop.
Medical interest in endometriosis has grown over the past two decades. And there was something to show it off from! Gynecologists began to diagnose the disease en masse. Any compaction immediately raises suspicions and concerns - what is its nature, whether there are malignant cells in it. After a detailed study, endometriosis nodules no longer raise such questions, but no one has been able to fully understand the mystery of the female illness. There are theories and concepts, but they are all controversial.
However, the disease is not as young as it seems. Descriptions of its symptoms were found in Egyptian manuscripts dating back to 1855 BC. Later, Hippocrates dedicated his research to her. Several millennia have passed, and there is still no clarity, despite the fact that modern science has technical capabilities at the highest level.
Ancient scientists, of course, did not have at their disposal the equipment and instruments that are available to modern doctors. As a result of long-term research and observation, it was found that the nodules consist of pieces of endometrial tissue. Their source is located in the uterine cavity, the inner lining of which is covered with a layer of endometrium. During menstruation, it is periodically rejected.
The process of the menstrual cycle is controlled by the pituitary gland, which gives the female body the necessary commands. First, it stimulates the maturation of the egg. Then it promotes its movement to the uterus. If fertilization has occurred, then the next stage is the attachment of the fertilized egg in the uterine cavity to the nutrient soil of the endometrium. If not, then it is removed from it. Menstruation is precisely the endometrial tissue that, along with blood, exits through the vagina.
All this happens with the participation of several hormones produced in the female body. The action of each of them is aimed at achieving a specific goal. Their level at different periods of the cycle either increases or decreases, reacting to changes occurring in the woman.
Why is the endometrium outside the uterus?
If medicine could answer this question, then perhaps the topic of endometriosis would be closed. Proponents of the hormonal and metaplastic theories put forward various assumptions regarding the occurrence of foci of endometrial tissue outside the uterine cavity. Until now, they still remain only hypotheses.
Abdominal endometriosis - foci of inflammation outside the uterine cavity Whatever the reasons for the development of pathology, scientists have no disagreement about their prerequisites. They are unanimous in their opinion that endometriosis is provoked and aggravated by:
- Disruptions in the hormonal system, weakened immunity;
- Retrograde menstruation, in which menstrual blood moves in an unusual reverse direction and enters the peritoneum;
- Abortions, cesarean sections, diagnostic uterine curettages;
- Other interventions in the uterus - operations, cauterization of erosions, installation of intrauterine devices;
- Sexual intercourse during menstruation;
- Hereditary predisposition;
- Inflammatory processes in the genitourinary system;
- Anomalies in the structure of the genital organs.
What forms does endometriosis exist in?
There are three groups of forms of endometriosis:
- Genital. Foci of endometriosis with it develop inside the genital organs;
- Extragenital, in which endometrial tissue is found outside the genital organs;
- Combined, combining the two previous ones.
In the extragenital form, endometriosis spreads far beyond the uterus. The intestines, lungs, and urinary system are attacked. If there are postoperative scars, then they also serve as an object for consolidation for endometriosis. In some cases, the organs of vision are affected, and then such a characteristic phenomenon as bleeding through the eyes is observed.
The genital form is more common. When leaving the uterine cavity, endometrial tissue settles on its outer wall, moves towards the fallopian tubes and reaches the ovaries. Damage to the peritoneal walls by endometriosis is a common occurrence. The external genitalia, cervix and cervical canal are also affected.
The longer endometriosis goes untreated, the more lesions it forms. Gradually, from the 1st and 2nd stages, when relatively small areas are affected, endometriosis develops into a chronic disease with 3-4 degrees of development.
Endometriosis of the pelvic peritoneum
Endometrial nodules are capable of increasing in size (and quite quickly) and affecting one organ after another. The process resembles metastasis, which is characteristic of cancer. But endometriosis forms benign formations, and its degeneration into a malignant form occurs relatively rarely.
The internal organs located in the pelvic cavity are in close proximity to the walls of the peritoneum. Over time, foci of endometriosis form on them as well. In such cases, endometriosis of the peritoneum is diagnosed, which in medicine is called peritoneal.
The similarity of the symptoms of this type of disease with signs of the inflammatory process is so great that an incorrect diagnosis is often made. Treatment in this case is with antibiotics and does not bring a positive result. A new round of examination begins, which takes some time. But you can’t hesitate, because endometrial tissue grows deeper and deeper into the affected organs, not excluding the peritoneum.
Symptoms indicating endometriosis
The first thing to suspect endometriosis is changes in vaginal discharge. In inflammatory processes, they are purulent and have an unpleasant odor. In the case of endometriosis, they bother a woman in the intervals between menstruation. Their color is brown, turning to reddish. Menstrual bleeding at the same time becomes too heavy and also painful.
Pain not only accompanies menstruation, but also appears on other days of the cycle. They radiate down the abdomen, and their strength is so great that the woman is forced to take painkillers. Together with bleeding, this leads to significant blood loss. Anemia develops. A woman complains of weakness and dizziness. Her appearance is unhealthy, her skin becomes pale.
Pain syndrome is also observed during sexual intercourse, but to a lesser extent. If endometriosis affects the rectum, blood is released during bowel movements, and the process itself causes pain. With endometriosis of the abdominal cavity, a woman experiences discomfort when examined by a gynecologist. Sometimes during this procedure it is possible to palpate lumps indicating the presence of a disease.
How is endometriosis determined?
A woman cannot determine that she has endometriosis based on her symptoms. The gynecologist will not do this until the examination results are in front of him. To do this, use one of the methods: ultrasound, hysterosalpingography (HSG) or laparoscopy. Typically, examination of organs in the pelvic area is performed. If foci of endometriosis cannot be identified during the procedure, then the area of research is expanded.
Due to its prevalence, ultrasound is available in most medical institutions. The report form is a graphic image obtained after a transvaginal examination. The presence of endometriosis is reflected in the form of circles and ellipses.
The set of equipment for HSG includes a fluoroscope, an X-ray tube and a monitor on which the image is received. After administration of the contrast agent, an x-ray is taken and its description is made.
The most accurate data is obtained during laparoscopy. The technique is reliable and gives comprehensive results. It is used for both diagnosis and treatment of endometriosis. Moreover, the operation is often performed without removing the patient from anesthesia after suspicions of endometriosis are confirmed.
How is the treatment carried out?
It takes a long time to get rid of endometriosis, even if this involves surgical intervention. After removing foci of the disease using a laser or electrocoagulation, it is necessary to take hormonal medications for six months or more. They are designed to restore hormonal balance and thus stop the formation of new endometrial lesions.
When peritoneal endometriosis is diagnosed, surgical treatment can eliminate adhesions. They form in the area of the fallopian tubes and ovaries, thereby preventing natural conception.
Drug therapy in some cases is possible without surgery, but it is effective only in the early stages. It is based on taking hormonal drugs that change the ratio of hormones in the body and at the same time have a contraceptive effect. Therefore, it is impossible to get pregnant during the treatment period, but as soon as it ends, doctors strongly recommend conceiving a child. In this way, two problems are solved at once: it is possible to avoid a relapse of the disease and give birth to a healthy baby.
What are the advantages of laparoscopy
By giving consent to the operation, a woman can expect that all her genitals will be preserved. This opportunity is provided by laparoscopy, a minimally invasive and gentle method used to treat endometriosis. You won’t be able to do without anesthesia, but it is quite possible to reduce the time you spend under it to half an hour and get rid of huge stitches and postoperative scars. There are only three small puncture wounds left on the body, which heal quickly and are almost invisible over time.
The recovery process is much faster. The fact that on the day of the operation or, in extreme cases, the next day the woman leaves the hospital speaks for itself. It is also important that during laparoscopy the chances of damage to other organs located in close proximity to the peritoneum are minimized. It is not always possible to avoid this during open abdominal surgery.
Since endometrioid nodules can degenerate into oncological tumors, it is advisable to send the removed areas for histological examination. With laparoscopy this is possible, except in cases where thermal effects are used.
Traditional medicine experience
Since endometriosis was known to ancient doctors, then there must be some methods that have come down to us from those times. Unfortunately, for a long time the disease was considered to be the possession of the devil in a woman, hysteria. The reason was the woman’s behavior during attacks. She was forced to writhe in unbearable pain, which bewildered those around her.
From the heritage of doctors and healers, which has survived to this day, treatment with leeches, acupuncture, and medicinal herbs is successfully used.
Herbal medicine has a greater analgesic and hemostatic effect and does not lead to the disappearance of endometrial lesions. But hirudotherapy is considered a fairly effective technique and has become widespread. It has been approved by the Ministry of Health of the Russian Federation and has been experiencing another surge in its use since the end of the last century. Leeches bite at biologically active points and inject their saliva. The enzymes it contains help thin the blood, restore hormonal balance, and improve blood circulation.
One of the methods of traditional medicine is treatment with leeches. Despite all the positive properties of folk remedies, it is not recommended to use them without consulting a gynecologist.
The connection between endometriosis and pregnancy
Endometriosis and pregnancy can be at opposite poles, or they can maintain a friendly relationship. The hostility between them arises due to infertility, which is caused by endometriosis. In exceptional cases, a woman with endometriosis is able to conceive a child. If she does not know that she is sick, then the diagnosis is made after childbirth or during curettage required after a frozen or ectopic pregnancy. Often such a pregnancy ends in miscarriage.
At the same time, pregnancy that occurs after treatment of endometriosis contributes to final recovery. This happens because menstruation stops and hormonal levels change. Foci of endometriosis destroy themselves and after at least 10-12 months the disease does not recur. After this period, which covers the period of gestation and feeding the child, there may be no relapse. Of course, for this it is necessary to take care to exclude the causes that led to the development of endometriosis.
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