Cervical endometriosis (CE) is a form of external genital endometriosis in which endometrioid foci affect the mucous membrane of the vaginal part of the cervix and the cervical canal. Usually the disease is asymptomatic or manifests itself with spotting spotting after intimacy, before and after menstruation. It is extremely rare for patients to experience pain in the lower abdomen and soreness during sex. Gynecological examination in mirrors, colposcopy, cytomorphological methods are used for diagnosis. Treatment involves the appointment of hormonal drugs and surgical removal of pathological foci.
ICD 10
N80.0 Uterine endometriosis
General information
According to various authors, endometrioid heterotopia of the cervix is detected in every fourth woman suffering from endometriosis. Over the past 50 years, the prevalence of pathology has increased by an average of 1.0-7.0%. Like other forms of the disease, CE is hormone-dependent and in the vast majority of cases occurs in women of reproductive age. Cases of endometriosis in girls before puberty have not been recorded. During the postmenopausal period, the disease undergoes regression. Taking into account the location of the foci, superficial endometriosis is distinguished, affecting the vaginal part of the cervix, and deep, developing in the distal parts of the cervical canal.
Causes
According to most specialists in the field of gynecology, the main cause of endometrioid growths on the mucous membrane of the cervix is the introduction of endometrial cells contained in menstrual blood into the damaged exo- or endocervix. The risk of developing endometriosis increases:
- Diseases of the cervix. It is easier for endometrial cells to attach to a pathologically altered mucosa. Endometriosis can develop against the background of erosions and pseudoerosions of the cervix, exo- and endocervicitis.
- Invasive interventions. The occurrence of endometrioid heterotopias is facilitated by abortions, IUD insertion, curettage, hysteroscopy and hysterosalpingography, and other therapeutic and diagnostic manipulations on the uterus and its neck.
- Pathological or frequent childbirth. Traumatization of the epithelium during labor contributes to the invasion of endometrial cells into the endo- and exocervix.
Predisposing factors play an important role in the occurrence of the disease. Thus, endometriosis is more often detected in women with weakened immunity and dishormonal conditions, which are accompanied by hyperestrogenemia. Hereditary burden is of great importance: in close relatives of patients with endometriosis, endometrial heterotopia on the surface of the cervix is detected 5 times more often than in the general population of women.
Pathogenesis
Endometrial cells embedded in the epithelial layer of the cervix respond to cyclic hormonal changes in the female body. The same transformations occur in them as in the inner layer of the uterus. First, under the action of estrogens, cells proliferate, and then under the influence of progesterone, blood supply to tissues and secretion of glands increases. The cycle ends with aseptic inflammation and rejection of the heterotopic endometrium, coinciding with menstruation. Endometrial cells growing in an atypical place are more at risk of damage during contact, which forms a typical clinical picture of the disease.
Symptoms of cervical endometriosis
Often endometriosis of the cervix proceeds without pronounced clinical manifestations. The most characteristic spotting spotting on the eve and after menstruation, as well as after sexual intercourse. Since in most cases the endometrial growths are located on the exocervix, the pain syndrome is not pronounced. If the endocervix and pelvic organs are involved in the pathological process, the patient is concerned about pulling pain in the lower abdomen, the intensity of which varies in different phases of the menstrual cycle. Dyspareunia is possible, which causes discomfort in a woman’s sex life.
Complications
Unlike other forms of the disease, endometrioid lesions of the cervix are extremely rarely complicated. With a large number and area of pathological growths with increased bleeding, iron deficiency anemia may develop. Involvement in the process of the mucous membrane of the cervical canal violates its protective function and contributes to a faster spread of inflammation to the higher parts of the reproductive system. In some cases, endometriosis becomes one of the causes of cervical infertility. According to the research results, the provoking role of CE in the development of malignant neoplasms of the cervix is not excluded.
Diagnostics
Taking into account the scarcity of clinical symptoms, objective research data play a key role in the diagnosis of cervical endometriosis. In diagnostic terms, the most informative are:
- Examination on a chair in mirrors. Against the background of pale pink healthy epithelium, small reddish foci with a diameter of 2.0-5.0 mm are clearly visible. Before menstruation, heterotopias become blue-purple and slightly increase in size.
- Colposcopy. Under the microscope, a characteristic endometrioid tissue is revealed, the volume and color of which vary depending on the phase of the menstrual cycle. The examination is recommended to be carried out in the last week before menstruation.
- Cytomorphological diagnostics. Histological examination of materials obtained by targeted cervical biopsy reveals typical endometrial cells. If it is necessary to obtain the mucous membrane of the cervical canal, its diagnostic curettage is performed.
Ultrasound of the pelvic organs, endoscopic and radiological techniques in the diagnosis of endometrioid heterotopia of the cervix play an auxiliary role and allow to identify foci of endometriosis in other organs. Differential diagnosis of the disease is carried out with chronic specific and nonspecific cervicitis, nabotovye cysts with hemorrhagic contents, telangiectasias, extravasates, cervical cancer. If necessary, the patient is prescribed a consultation with an oncogynecologist and a dermatovenerologist.
Treatment of cervical endometriosis
The choice of therapy methods should take into account the size of heterotopic growths, the prevalence of the endometrioid process, the presence of complications, the age and reproductive plans of the woman. Patients with small foci of endometriosis in the absence of clinical manifestations and complications are shown dynamic follow-up with a gynecologist’s examination every six months. With a significant volume of heterotopias, the presence of complaints of spotting and pain syndrome, drug therapy is prescribed, which includes:
- Hormonal agents. The growth of endometrial cells is inhibited by drugs that suppress the endocrine function of the ovaries. To do this, combined or gestagenic oral contraceptives, gonadoliberin agonists and antagonists, androgens are used. Hormone therapy is performed both independently and in preparation for surgical treatment.
- Symptomatic drugs. Complex treatment is aimed at immunocorrection, reduction of symptoms and complications of the disease. Nonsteroidal anti-inflammatory drugs are used to relieve pain. With a decrease in the level of hemoglobin and erythrocytes, iron preparations are indicated.
If the 3-4-month conservative treatment is ineffective, endometriodic growths are recommended to be removed promptly. For this purpose, laser coagulation, cryodestruction or radio wave destruction of endometriosis foci is usually performed. A radical approach with extirpation of the uterus and appendages is indicated only with a significant prevalence of the process involving other organs and severe pain syndrome in women who do not plan pregnancy.
Prognosis and prevention
With timely detection and adequate therapy, the prognosis is favorable. After removal of foci of endometriodic tissue, the disease rarely recurs. Treatment results are further improved when hormone therapy is prescribed before and after surgery. In such cases, the frequency of complete clinical recovery increases by 8 times. In the prevention of endometriosis, an important role is played by a regular examination by a gynecologist to identify and treat diseases of the cervix. It is recommended to refrain from unjustified appointment of invasive procedures and consciously refers to family planning, refusing abortions.
