For the diagnosis of various diseases in women in gynecology often used ultrasound, including transvaginal. Endometriosis on ultrasound imaging is visualized as tissue that has grown beyond the inner limits of the uterus. Pathological foci may be located in the ovaries, tubes, partially in the abdominal cavity, the upper part of the neck, in rare cases - in the rectum.
Indications for ultrasound
The examination is prescribed for any suspicion of abnormal growth of endometrial cells, which the doctor notices during a routine examination. However, the diagnosis of endometriosis in the first and second stages of ultrasound is almost never used. At these phases of the development of the disease, the foci are isolated, weakly expressed, it is impossible to visualize them, to determine a clear localization.
The only informative study is MRI of the pelvic organs, allowing even single growths of the endometrial tissue beyond the uterus to be detected.
With extensive tissue growth, a physician can determine the exact location and structure of the pathological focus. In this case, the diagnosis of endometriosis on ultrasound allows you to make the correct diagnosis.
More often, the study is carried out transvaginally, and the usual ultrasound of the pelvic organs is resorted to only when the endometrial cells grow into the rectum and the organs adjacent to the uterus.
Ultrasound if one suspects this pathology is appointed one of the first in the survey. Endometriosis is a hormone-dependent disease, therefore, in parallel with it, fibroids, polyps, cysts can develop. Timely ultrasound diagnostics allows you to identify these formations and begin treatment.
The main stage of preparation for ultrasound is filling the bladder. This is necessary for maximum diagnostic information. A few hours before the manipulation, the woman should drink at least 0.5 liters of fluid. Before the procedure, empty the bladder can not.
On which day of the cycle is better to do ultrasound
Ultrasound in endometriosis is optimally done on the 12–15th day (from the beginning of the menstrual period) with a duration of about 30 days. That is, on the 5–7th day after the end of menstruation, the study will give the most accurate information about the location and structure of endometriotic foci.
Visualization of foci of endometriosis on ultrasound and information content of the whole study are directly related to the period of menstruation. Starting from the moment of ovulation, that is, from the middle of the cycle, the mucous inner lining of the uterus swells under the action of the hormones necessary for conception. Lots of overgrown endometrium look like clear foci of a darker shade. Also during this period you can see cysts, polyps, myoma in the initial phase of growth.
Echo signs of endometriosis
To determine the type of pathology is extremely important the early appointment of ultrasound. There is external endometriosis and pathology of the internal type. In addition, the disease is divided into focal, nodular and diffuse forms. The latter is diagnosed with an internal variant. About diffuse type speak such signs of endometriosis on ultrasound:
- the tissue lining the inner walls of the uterus, often the posterior, thickens
- the body of the uterus is oval or rounded,
- uterine myometrium is characterized by increased echogenicity, has a fuzzy uneven contour,
- It is possible to visualize various inclusions up to 0.05 mm in diameter - polyps, myoma, foci of endometriosis, calcium deposits, malignant tumors in the initial stage of growth.
With the nodal form of pathology during the examination will be visible such changes:
- violation of the structure of the uterine walls,
- interstitial (within the uterus) endometrial node.
Possible detection of tumors, similar to cysts, with a diameter up to 3 cm, without clear contours.
Focal endometriosis is determined by the following features:
- increased echogenicity of certain areas of the myometrium in the absence of even clear contours,
- cystic formations up to 1.6 cm in diameter
- uneven thickening of the walls of the uterus.
In general, the following results indicate the pathology: any nodal structures, fuzzy uneven contours of the endometrium, irregular symmetry of the uterine walls.
The most difficult to diagnose nodal and focal types of endometriosis. Symptoms and echo signs of these diseases are separately diagnosed rarely, often accompanying uterine myoma and some other pathologies.
See endometriosis on ultrasound is not immediately. If the disease is at the initial stage of development, repeated examinations are appointed - once a month on the 5th to 7th day of the monthly cycle.
Additionally, the doctor can determine by ultrasound:
- changes in the tubes and neck,
- appendage condition
- the structure of internal tissues - nodular inclusions, heterogeneity, thickening,
- echogenicity of the myometrium and the body of the uterus, its size,
- any neoplasms and nodular seals.
The presence of pathological processes is indicated primarily by changes in the size of the uterus. Normally, its length is 7 cm, width - 6 cm, and thickness - up to 42 mm. The contours should be clear, uniform, without foreign inclusions. If the thickness of the endometrium is higher than normal, they say about the beginning of the development of endometriosis.
Detection of hyperechoic inclusions suggests pathological tissue growth. Also indicates a violation of the structure of the cervix and cervical canal.
Additionally, an internal view of the uterus, the localization of all pathological foci is visualized. Today, women most often detect ovarian endometriosis. When conducting a differential diagnosis revealed cysts and polyps.
Also, the study by ultrasound is used to monitor the effectiveness of therapy, especially when conducting conservative treatment. In this case, the survey is best done every three months to assess the degree of tissue growth.
Treatment and Prevention
Depending on the stage of development of the disease, one or several foci are visualized on ultrasound. In the 3-4th degree, cysts on the ovaries are additionally formed, there may be adhesions.
In advanced cases, in addition to the transvaginal, a pelvic ultrasound is prescribed to identify endometrial foci in the intestine, less often in the tissues of the lungs.
Conservative treatment - installation of intrauterine systems releasing, hormonal drugs. The combined course uses estrogen-progestin, antigonadotropic drugs. As a symptomatic therapy, anti-inflammatory, desensitizing, and anesthetics are prescribed.
If this treatment does not bring positive results within 6–9 months, stenosis of the lumen of the ureters or intestine is observed, the woman has been diagnosed with individual intolerance to hormonal drugs, or there are contraindications to receive, surgical removal of endometriotic foci is used.
The cyst is removed during laparoscopy, laparotomy or with direct access through the vagina.
In modern surgery, cyst laparoscopy is most often used, which implies a low-impact invasive access to growths through small incisions.
Prevention of the disease consists in timely examination of the cervix and uterus, the choice of modern hormonal methods of contraception, strict control over the cycle, minimization of abortions and scraping, as well as injuries of the uterus.
Women's health requires constant monitoring. Signs of endometriosis consider discharge of a bloody nature, acyclic menstrual bleeding, the inability to get pregnant or bear a child. In advanced cases, when lesions are present in the muscle layers of the uterus and in adjacent organs, the period may be scarce, and the adhesions begin.
All of these clinical manifestations are an indication for the study. According to its results, conservative treatment methods are applied or a decision is made to remove the formation surgically. If endometriosis was detected during the gestational period, hormonal or operative therapy is resorted to only after delivery.
Table of contents
Endometriosis is a disease of the female pelvic organs, which is characterized by a strong proliferation of the tissues of the inner layer of the uterine wall into other structures (beyond the limits of this organ). Such cells enter the ovaries, vagina and other areas through the fallopian tubes, blood and other means. They can form cysts, which will lead to violations of the urinary system.
Symptoms of this disease often coincide with signs of other ailments of the urogenital system. In some cases, it may not appear at all, or a woman may not pay attention to the symptoms, considering it unimportant or normal. Therefore, it is worth to consult a doctor if such phenomena are recorded:
- Long and painful menstruation
- The presence of dark discharge for a few days before or after periods
- The presence of discomfort during intercourse
- Unstable cycle
- Painful urination
- Weakness, frequent dizziness, fatigue, the appearance of skin defects
- Increased temperature over time
Timing for study
Single pelvic ultrasound in endometriosis is often not enough. But this type of examination can also be useful if it is carried out in the correct period of time.
For the diagnosis of other diseases - fibroids and the like - it is recommended to do an ultrasound examination in the first week after the end of menstruation (from the fifth to the seventh day), when the intrauterine tissue is the thinnest.
In the case of endometriosis, this principle does not work, since its formations are best seen with the thickest inner layer of the uterine walls. Therefore, for the best result, it is necessary to do this examination from the twenty-fifth to the twenty-eighth day, if the cycle of the woman is thirty days long. During this period, the endometrium becomes the most thick, and, accordingly, the disease foci grow.
Since it is not always possible to unambiguously determine the presence of this ailment, it is recommended to undergo an ultrasound scan for several menstrual cycles and preferably on the same cyclic days. This helps to reveal the signs characteristic of such a disease.
Endometrial structural changes
There are three main stages of changes in the state of the inner layer of the uterine walls, which are divided into several shorter mini-stages:
- Period of menstruation - the thickness of the endometrium is minimal, but a number of areas may be hyperechoic
- Fifth to seventh days - a thin layer of the endometrium up to seven millimeters thick, having a low echogenicity
- Eighth-tenth days - thickness grows to ten millimeters
- Eleventh-fourteenth days - the layer grows to fifteen millimeters
- Fifteenth to eighteenth days - the echo is growing, the layer reaches seventeen millimeters
- Nineteenth to twenty-fourth days - the envelope thickens, the echogenicity is increased, and the structure of tissues becomes heterogeneous
- Twenty-fourth to twenty-eighth days - the thickness can be reduced to 11-17 mm, the echogenicity and structure indices remain the same
What will the ultrasound show?
On pelvic ultrasound, endometriosis is not always obvious, but ultrasound helps determine its presence by some signs:
- The presence of endometrial cells in the perineum, vagina and vulva
- The presence of formations on the cervix
- Enlarged uterus, change its shape (becomes spherical)
- The presence of cysts in the ovaries
- Thickening of the walls of organs
If the focus of the development of the disease in the ovaries, the examination will show that:
- There are various types of nodules in the tissues.
- There is a round growth behind the uterus or to the side of it.
- Tissue heterogeneity
If the disease is localized in the uterus, then an ultrasound will reveal the following changes:
- Blurry endometrial tissue layer
- Asymmetry of the walls of the uterus
- The presence of nodules
Types of Disease
As endometriosis grows, its four degrees are determined:
- The first - the spread point
- The second - foci gradually grow
- Third - cysts are formed, which gradually increase in size.
- Fourth - extensive damage to organs and tissues
There is also a classification by its localization:
- Internal - foci in the uterus and its neck
- Outer - endometrial cells in the abdominal cavity, vagina, ovaries, etc.
Distinguish types of the disease in the form and structure of tumors:
- Focal - cyst with increased echogenicity of up to 16 mm, uterine walls are asymmetric
- Nodular - round neoplasms up to 30 mm in size, not having clear outlines and localized in a specific organ
- Diffuse - the uterus acquires rounded outlines with calcium inclusions, its inner layer has blurry borders, the back wall is enlarged, and echogenicity is increased
On pelvic ultrasound, endometriosis can be detected, but doctors recommend several types of examinations to be performed so that the diagnosis is more accurate.
To determine the presence of this disease, use such types of ultrasound as:
- Abdominal - is carried out by the sensor through the abdominal wall
- Transvaginal - examination by inserting a sensor into the vagina
- Transrectal - with this type of device is placed in the patient's anus
For a more accurate identification of the type of neoplasm, the second and third type of examination are more suitable. They also allow you to take tissue samples for analysis.
As an additional method to clarify the diagnosis, colposcopy can be used (examination of the vagina and cervix with a device that includes a binocular).
When do ultrasound for endometriosis?
The need for an extraordinary visit to the doctor indicates the following symptoms:
- acute pain during menstruation,
- pain in the pelvic area,
- selections preceding the cycle and continuing to alarm after it ends,
- pain during bowel movements and intimate intimacy.
Types of research
If you suspect endometriosis, the doctor, in addition to taking a history, may prescribe the following tests and studies:
Such a wide range of available methods of instrumental diagnostics does not always allow to identify the main cause of the disease, including ultrasound, which is characterized by its effectiveness. Such a method does not literally cause any harm to the patient's health, which means that it can be used to assess the state of the fair sex, to detect the pathologies present and to choose the most appropriate treatment method.
Determine the cycle
If you are looking for the answer to the question when it is better to do ultrasound, then you should know that the ultrasound examination will provide maximum accuracy and information, provided that it will be held not earlier than 7 days from the beginning of menstruation. If there is such an opportunity, then it is better to go to the hospital on day 10 from the beginning of the cycle. A later diagnosis may not be accurate, so it is not worth delaying a visit to an appointment with a specialist. Ultrasound in endometriosis will not provide a reliable picture, if carried out arbitrarily, without reference to the monthly schedule. The most accurate signal that it is time for an ultrasound is residual spotting.
So, the answer to the question on which day of the cycle to do ultrasound is 7-10 days from the beginning of the cycle.
Chances are that it will be necessary to evaluate the state of the body over time, that is, to conduct several surveys at different times.
What does training include?
This procedure does not imply lengthy preparation. All that is required of the patient is to drink 500 ml of water a couple of hours before the examination, since it is carried out with a full bladder.
Contrary to popular belief, endometriosis can affect not only the uterus and ovaries. In addition to these bodies, the places of localization of the disease are:
The disease under consideration may be localized in other organs, but in practice such cases are almost never encountered.
Summing up, I would like to say the following: endometriosis is a serious chronic disease that, in the absence of due attention from the medical profession, has every chance of changing the chronic form of the course to acute. In addition, this ailment adversely affects the quality of life and it is not worth delaying its treatment.
What kind of pathology is this?
The uterus has several layers.
Internal-endometrium, medium - myometrium, and serous membrane, which is located as superficially as possible. Endometriosis is the proliferation of the endometrium outside the uterine cavity. The disease is benign, but this does not mean that it should not be treated. On the contrary, very often the cause of female infertility is endometriosis.
Therefore, many doctors and recommend to perform ultrasound every 1-2 years. And it is desirable to conduct it from the age of 25 years, and after 40 to increase the frequency of research to at least 1 per year.
The endometrium can grow into the body of the uterus, cervix, ovaries, vagina, peritoneum and other organs located in close proximity to the uterus. Еще одна проблема, по которой УЗИ стоит выполнять даже при отсутствии симптомов — скрытое течение. Эндометриоз одно из тех заболеваний, которое медленно и скрытно развивается, но последствия, которого могут быть весьма серьезны.
If, for any reason, prophylactic ultrasound was not performed, then the woman may develop symptoms indicating the need for an ultrasound diagnosis to verify the diagnosis. It should be understood that if symptoms have already appeared, the disease is clearly not in the initial stages of its development. The indications include:
- painful intercourse,
- pain a few days before menstruation, which stop 1-2 after the end of menstruation,
- pain when urinating and stool,
- increase or decrease in the menstrual cycle,
- changing the color of the discharge to brown or darker,
- bleeding a few days before menstruation.
All these indications do not necessarily indicate endometriosis, but only suggest its presence. More accurate diagnosis without ultrasound does not perform.
Features of ultrasound and its effectiveness
On the ultrasound, the endometrium is seen quite well, which will prevent other pathologies from escaping, and not just endometriosis. A study in the course of which diseases of the female reproductive system can be revealed is called pelvic ultrasound. It includes examination of the uterus, ovaries, vagina, etc. But with the fallopian tubes everything is not so simple - the tube cannot be seen on the ultrasound due to its structure and small diameter, but if there is a pathology that will lead to its increase, then it will be possible to see it.
As for the timeliness of detection of endometriosis on ultrasound, then everything is not so simple and straightforward, but it should be understood that as a method for preventive examinations and the method that will be applied first, it is the best.
Accurately endometriosis on ultrasound can be seen only from the second stage, when there are already any pronounced changes. Before the second stage, one can only suspect the presence of the disease.
But why is it used ultrasound? There are a lot of reasons for this, but only in a complex way they can answer this question. First of all, the main question is presented to any diagnostic method - accuracy and safety. Moreover, these two factors must be in balance with each other. No one will use a non-informative or extremely harmful diagnostic method.
Ultrasound is quite successful here. Ultrasound is completely harmless to the human body and can be performed as many times as necessary. The same goes for quality. Such a diagnosis, although not always absolutely accurate and much depends on the specialist performing, but gives all the necessary information.
It will not be superfluous to make an ultrasound of the female organs, it will allow you to be more confident in your health and if there is such a pathology as endometriosis, it will be detected as soon as possible, and therefore treatment will be started much earlier. This will lead to faster recovery and minimal complications and consequences of the course of endometriosis.
How will ultrasound see endometriosis in the first stage?
Although it was mentioned above that it is possible to detect endometriosis with the help of ultrasound from the second stage, there may be signs indicating the development of the disease. But for a start, it is worth figuring out what stages there are and how they are characterized.
- So, the first is the germination of the endometrium by 2-3 mm in the myometrium.
- The second stage is characterized by germination of the endometrium by half in the myometrium.
- At the third endometrium reaches the serous membrane.
As can be seen from the classification, the minimum first stage can be seen only if there is an increase in the uterus or a change in the contours of the myometrium. But still it is impossible to establish the presence of endometriosis at the first stage using ultrasound.
When endometriosis has already developed enough to be diagnosed by ultrasound, it can be seen on the characteristic signs:
- an increase in the uterus in size and change in its shape, it becomes round,
- clearly visible irregularity of the contours of the myometrium.
Endometriosis is very diverse in its manifestations. It can manifest itself as a formation in the uterine cavity, and in the form of endometrial cysts. They are formed as a result of the growth of the endometrium and are easily detected. Their size and wall thickness depends on the duration of the process.
How is such a diagnosis performed?
- This diagnosis is often carried out transvaginally, that is, by inserting a sensor into the vagina. Other methods are not suitable enough and will not give the necessary picture.
- However, if the virgin is being examined, then everything will be transabdominal (through the abdominal wall).
- Rarely transrectally, using a sensor that is inserted into the rectum.
Ultrasound for endometriosis, on what day?
Most diseases of the female reproductive system require diagnostics in the first days of the cycle, almost immediately after menstrual bleeding. However, with endometriosis, everything is different. Endometriosis cannot be seen on the 5-7 day of the cycle, and if something is found, the gynecologist is unlikely to trust it.
In the later periods of the menstrual cycle, all pathological areas that were formed as a result of the growth of the endometrial layer increase. In addition to the cysts already mentioned, there are also endometrial nodes.
On which day of the cycle you need to do ultrasoundchosen by the doctor, together with the patient. As a rule, it falls out right before the onset of menstruation.
How to prepare for an ultrasound scan of the female organs depends on the method by which the study will be conducted. For transvaginal pretreatment is not required and it will be enough just to empty the bladder before the examination.
If it is necessary to lead transabdominal, then everything is a little more complicated, because ultrasound will be performed through several layers of tissues, including through the intestines, then you should follow a diet before the diagnosis. Diet is to eliminate from the diet of all gas-forming products, such as cabbage, peas, dairy products, fresh pastries, bananas, etc. When it is impossible to get rid of gases, you should drink carminatives, such as Espumizan.
About the results
As a result of the pelvic ultrasound, the conclusion of an ultrasound should still be disassembled by the attending physician, namely the obstetrician gynecologist. Diagnosis is not just a comparison with norms, but a comprehensive comparison of the data obtained from all diagnostic methods, including interviewing and inspection.
Although in the study of the endometrium do ultrasound, it is only part of the complex of diagnostic measures. But its value is extremely high, because to consider pathology from different angles, not every type of diagnosis can allow.
Where to do the research
Places where pelvic ultrasound can be performed to identify endometriosis are quite a lot. First of all, there are many state clinics where diagnostics can be performed absolutely free of charge. If the patient prefers private medical institutions, then there should be no problems.
When a woman chooses the location of the ultrasound, she must take into account the level of qualification of specialists and modern equipment. Optimal will be the places where the diagnosis is performed by doctors who are gynecologists or have experience in this field. In some cases, the diagnosis may be dealt with at all by the attending physician, which would be the best option, but perhaps this is not always the case.
The price of such a study is not high and is available to almost every patient, and there are devices in a variety of medical institutions. The great advantage is also the presence of many devices that are mobile enough, and you can bring them anywhere.
Ultrasound signs of endometriosis in adult patients
It should be noted that with ultrasound it is possible to identify the local and diffuse form of this disease. In this case, the study is recommended to perform on the fifth or seventh day of the cycle (in this case, you can get more objective data).
Echographic symptoms of diffuse endometriosis:
- the uterus undergoes changes (as a rule, there is an increase in it, sometimes up to 5–8 weeks of gestation),
- the shape of the body becomes spherical,
- contours - smooth and clear,
- the myometrium may be normal or heterogeneous structure (then areas of hyperechoic inclusions are visualized),
- the walls of the uterus are asymmetrical,
- Ultrasound using a transvaginal sensor can show the presence of diffusely dilated convoluted vessels in the uterine wall,
- the endometrium is thickened due to glandular hyperplasia (depends on the day of the cycle),
- the ovaries are not changed (no signs of inflammation),
- the bladder is either not changed, but more often it is deformed due to the pressure of the enlarged uterus.
Along with this, in the process and after the treatment it is imperative to carry out a control ultrasound (on which day of the cycle it is better to do it with your doctor).
The hormonal drug buserelin is highly effective in the treatment of endometriosis of the uterus. It should be said that this drug, being a synthetic analogue of gonadotropin-releasing hormone, suppresses the production of endrogens, on which, in fact, its therapeutic effect is based.
Echographic manifestations in diffuse endometriosis of adolescents
During this age period, the most characteristic feature in endometriosis on ultrasound is the spherical shape of the uterus. The size of the body is not changed or increased slightly. Myometrium may also not be changed. The echo density of the walls of the uterus may be heterogeneous (or diffuse) increased. Inflammation of the ovaries is not visible.
The main thing is that if at this time there is no special (hormonal) treatment, then the consequences may be irreversible. Very often, endometriosis threatens the development of infertility. Therefore, laparoscopy of the genitals is often performed to clarify the diagnosis.
Along with this, during the period of menopause, the uterus is reduced in size, but its spherical shape remains. At the same time, endometriosis, as a rule, undergoes reverse development.
It should be said that endometriosis must be differentiated from inflammation, uterine fibroids, since with these processes the size of the organ is increased, as well as with endometrial pathology.
Ultrasound for local endometriosis
Pathological changes in local endometriosis can manifest itself as follows:
- visualization in the myometrium of hyperechoic round inclusions, up to four,
- the uterus in size is usually not enlarged,
- endometrium is not changed (depending on the day of the cycle).
Sometimes the signs of endometrial pathology may not be visible with ultrasound, so a negative echographic result does not guarantee the complete absence of the disease. In this case, laparoscopy is recommended to rule out or confirm the diagnosis.
The fact is that it is very important to choose the day of the cycle, when it is better to do an ultrasound scan of the genitals, especially to evaluate the control of endometriosis after treatment.
It should be said that if after the treatment of endometriosis there is a positive trend, which consists in relieving the painful symptom and signs of inflammation, then only medical treatment is sufficient. Laparoscopy is recommended as a control.
So, if the manifestations of endometriosis have not disappeared during drug therapy with buserelin, but are only progressing, signs of inflammation of the appendages increase, then surgical intervention should be done. At the preoperative stage, laparoscopy is recommended to clarify the prevalence of the pathological process and assess the state of the endometrium.
As practice has shown, after treatment with buserelin, recurrences of endometriosis are possible. Therefore, for best results, you should combine the use of this hormonal drug with surgery, as well as carry out laparoscopy for early detection of disease recurrence. At the same time, after surgery, buserelin suppresses the remaining small foci of endometriosis, which helps prevent the development of relapse of the disease.
Summing up, it is worth saying that endometriosis is a terrible disease that can lead to infertility. For a more accurate result of echography, you need to determine in advance on which day of the cycle to conduct an examination. At the same time, signs of endometriosis, tumors or inflammation of the genitals can be detected. It is imperative to conduct a follow-up study after treatment (medication, surgery, or a combination of these methods), as well as laparoscopy of the genitals to clarify the diagnosis.
Types of endometriosis
Medical statistics is relentless - about a third of all women of reproductive age suffer from endometriosis in one form or another. Moreover, in 80% of cases of female infertility this pathology is the main cause. What is endometriosis and how is it?
The uterine wall consists of three layers: endometrium (internal), myometrium (middle) and a thin outer serous membrane. This is perimetry. Endometriosis is called benign proliferation of the endometrium that extends beyond the uterine cavity.
There are 2 main forms of the disease - internal genital and external, extragenital. The peculiarity of internal endometriosis is that the endometrium grows only in the uterus, cervix and uterus. He does not go into other organs. There are 3 degrees of this pathology:
- Stage 1 - myometrial layer is affected 2-3 mm in depth,
- Stage 2 - the disease reaches half the uterine wall,
- Stage 3 - tissues have grown to the outer serous membrane.
In general, the growth of the endometrium is divided into several types, depending on localization. Endometriosis occurs:
- the body of the uterus (diagnosis of "adenomyosis"),
- other organs (bladder, intestines, mesentery, postoperative scars, etc.).
The latter form is fixed extremely rarely.
Indications for ultrasound in endometriosis
The cunning of endometriosis is that it often occurs with almost no symptoms, in about one third of the patients. At the same time, the severity of the disease and the volume of affected tissues are completely independent of the presence of external signs.
Therefore, doctors advise all women 25-40 years to do preventive ultrasound 1-2 times a year. After 40 years - one ultrasound once a year.
There are a number of common signs of endometriosis, in which the doctor will send the patient to an ultrasound. The main ones are:
- regular pains that begin 2-3 days before menstruation and disappear a day or two after they end,
- pain during intercourse, urination, defecation,
- failures of the menstrual cycle (menstruation can increase up to 8 days, the cycle itself is reduced to 27 days or less),
- menstruation becomes more abundant
- spotting appears a few days before menstruation and within a week after,
- the color of the discharge changes to dark red or brownish.
Inability to get pregnant for a long time, miscarriages, hormonal failure will also tell about the possible endometriosis.
How to choose a day for an ultrasound?
In the diagnosis of endometriosis using transvaginal, internal ultrasound. In rare cases (for example, when the patient does not live sexually) - transrectal. External ultrasound (transabdominal) in this case is not recommended, it does not give the most clear picture.
Ultrasound scanning of the pelvic organs should always be done by women at a certain time of the menstrual cycle. What day to choose for the procedure depends primarily on the possible diagnosis. So, the second half of the cycle is ideal for the study of the endometrium.
This is because the structure of the endometrium changes every few days of the cycle, and possible pathology can only be seen at the end of the second phase. All changes in the inner layer of the uterus are presented in the table.
Forms of endometriosis
- Adenomyosis - endometriosis of the muscular layer of the body of the uterus. Depending on the depth of penetration of the endometrium into the layers of the uterus, four stages are distinguished: the first is characterized by the beginning of the penetration of the endometrium into the muscular layer, with all subsequent endometria going deeper into the serous (outer) membrane, during the fourth stage it affects serosis.
- Cervical endometriosis is characterized by minimal symptoms, since endometriotic foci are located in the cervix. The most characteristic symptom is bleeding and pain during sexual contact.
- Vaginal and perineal endometriosis - endometrial foci migrate from the uterus into the vagina or perineum. At the end of the cycle, these lesions can be detected by routine gynecological examination.
- Ovarian endometriosis - endometrial foci located on the ovaries can imitate ovarian cysts.
- Pipe endometriosis - leads to obstruction of the tubes and the impossibility of conception. The overlap of the lumen of the tube by a thickening endometrium, the development of adhesions leads to the development of such a state as hydrosalpinx. On ultrasound to determine the cause of this condition is not always possible, in this case, laparoscopy is performed.
Symptoms of endometriosis to some extent recur in all forms of endometriosis:
- Painful prolonged menstruation, discharge of blood clots during menstruation.
- The appearance of smearing brown discharge in the middle of the cycle, a few days before and within a few days after menstruation.
- Discomfort, pain during sexual contact, gynecological examination, physical exertion.
- Боли в нижней части живота, которые начинаются со средины цикла, достигают апогея к первому дню цикла, а затем постепенно снижаются.
- Бесплодие неясного генеза.
How to detect endometriosis? Ultrasound diagnostics is the simplest and safest method for detecting endometrial foci, but it cannot always provide all the necessary answers. Erroneous setting or removal of this diagnosis may be the wrong answer to the question: when to do an ultrasound for endometriosis?
To understand when to do ultrasound for endometriosis, you need to remember what happens to the endometrium during the cycle. On the first day of the cycle, it is rejected, which is accompanied by menstrual bleeding. Immediately after the end of menstruation, the endometrium of any location has the smallest thickness. That is why the detection of foci of endometriosis with ultrasound diagnosis for 3-5 days, as is customary, is almost impossible due to their small size. So when to do an ultrasound for endometriosis, so that the diagnosis is set correctly? It is best to carry out this study before menstruation, on the 23-25 day of the cycle - at this time the thickness of the endometrium is maximum, and the lesions will be clearly visible.
Of course, it is not always the diagnosis of endometriosis, ultrasound diagnosis of which was carried out according to the rules, it is possible to detect. Some forms of endometriosis are not visible on ultrasound, even if you found out from your doctor when to do an ultrasound for endometriosis and conducted a study on the desired day of the cycle. In this case, additional methods of research will help: laparoscopy, hysteroscopy, separate curettage, analysis for endometriosis markers.
If you cannot become pregnant for a long time, you are worried about these symptoms, hydrosalpinxes are detected on ultrasound - the likelihood of endometriosis is high, ultrasound diagnostics and a thorough examination will help you to make an accurate diagnosis. In this case, you should not despair - the current level of development of medicine can successfully treat endometriosis using conservative and minimally invasive methods, which often leads to success when trying to get pregnant.
Endometriosis is not a sentence! Even if you suspect this disease, a competent doctor will prescribe a full course of examination, tell you when to do an ultrasound for endometriosis, and if you confirm the diagnosis, will conduct a full course of treatment. This necessarily takes into account the age and family situation of the patient, the desire to have children and many other factors. And remember - during pregnancy and menopause, the hormonal background of a woman changes, making it possible to significantly regress endometriosis up to complete cure. So do not despair and do not give up trying to get pregnant, and the disease will recede!
The advantages of ultrasound in the diagnosis of endometriosis
Ultrasound examination has several advantages over other methods, therefore it is widely used in gynecological practice. The main advantages are as follows:
- does not require special skills and expensive equipment,
- information content.
However, the conclusion of doctors after ultrasound diagnosis may vary, and this is a minus method. It all depends on the experience, qualification of the specialist, his observation, and, of course, on the quality of the equipment used.
However, compared with, for example, laparoscopy, ultrasound does not require anesthesia, preliminary examination, hospitalization and does not carry such risks to the health of a woman. Ultrasound examination with a high probability can indicate the foci of endometriosis, which allows the doctor to prescribe the necessary treatment.
However, it should be understood that only pathological areas in the body of the uterus, on the ovaries are visible, indirectly, endometriosis of the rectovaginal tissue can be judged. For more detailed consideration it is recommended to use special rectal sensors.
And here is more about when to do ultrasound with myoma.
When you need to do an ultrasound
Ultrasound examination has recently been routine for the detection of gynecological diseases. Suspected endometriosis can be on the clinical picture when viewed from a woman, as well as on the basis of complaints that she will make. An approximate list of indications for performing ultrasound may look like this:
- painful periods,
- copious menstruation,
- spotting in any phase of the cycle, but especially before and after critical days,
- problems conceiving for over a year
- complaints of discomfort in the lower abdomen or in the vagina during exercise, intimacy,
- if endometriosis was with close relatives,
- when viewed on the gynecological chair revealed an enlarged body of the uterus, education in the ovaries, foci of endometriosis on the cervix or in any place accessible to visual inspection.
Carefully review and evaluate all parts of the reproductive system, since endometriotic ectopia can be located anywhere:
- in the cervical canal,
- in the endometrium,
- among the muscle layer of the uterus,
- on the ovaries,
- in the field of rectovaginal tissue.
In other places, ultrasound does not help to identify pathology due to the small size of the lesions on the fallopian tubes, peritoneum.
It is also possible diagnostic search for foci of endometriosis in the detection of even small areas in areas accessible to gaze. For example, if there is endometriosis of the cervix or vagina, it is likely that foci will be found in other parts of the reproductive system.
See this video for what endometriosis is:
What are the foci and what are visible
An ultrasound can detect diffuse tissue damage and individual local foci. However, in some cases, especially in young girls with a vivid clinical picture of endometriosis, ultrasonic signs may not be detected.
In the majority, the diffuse form is characterized by the following criteria:
- the body of the uterus is increased to 5-9 weeks of pregnancy and has a spherical shape,
- with dynamic ultrasound on the eve of menstruation and in the middle of the cycle, it is noticeable that the uterus increases before critical days,
- outlines of the uterus are always smooth, without suspicion of nodes.
By a detailed examination of the myometrium, its normal structure or heterogeneity can be detected due to inclusions, which can be in the form of points or longitudinal cords. In terms of echo density, the muscular layer of the body of the uterus must be compared with the neck. If it is enlarged, this is another sign of “for” endometriosis, especially if such changes are observed on the eve of menstruation.
Focal form of endometriosis
Examination of the endometrium often reveals hyperplasia that accompanies endometriosis. Moreover, polyposis is rare.
Ovaries, if they do not have endometrial cysts, are not changed. In the opposite case, they reveal the formation of increased echogenicity with dense uniform content. The size of cysts can vary from a few millimeters to tens of centimeters.
If the uterus is enlarged, it can squeeze the bladder and change its shape, which is also ascertained by ultrasound.
The use of a rectal probe allows to investigate rectovaginal fiber in detail and identify foci here, as well as the prevalence of the process.
It should also be noted that the round shape of the body of the uterus with endometriosis remains in menopausal women, even if other symptoms do not bother them anymore.
Local foci of endometriosis can be seen with ultrasound as single or nearby areas of inclusions of irregular shape (less often oval or clumpy). Their sizes are from 2-3 to 6-10 mm. The shape of the uterus and its dimensions while not changing. Such foci in the myometrium may be surrounded by fibrous tissue and resemble myomatous nodes. Their main difference is that they can change their shape depending on the day of the cycle and treatment.
See in this video about ultrasound diagnosis of endometriosis:
Which day of the cycle is best to analyze
Usually gynecological ultrasound is recommended for 3-7th days of the menstrual cycle. However, this time is not suitable for the detection of endometriosis, since immediately after menstruation the foci decrease in size and their signs become barely noticeable.
However, at the beginning of the cycle, significant foci of endometriosis can be identified, especially if it is ovarian cysts. The body of the uterus is also enlarged and spherical. The endometrium thickness is also important for diagnostics at this time.
The best time to confirm endometriosis is the time before menstruation аций for 23-25 days. Foci in this case have maximum sizes, will be clearer delimited from the surrounding tissues.
In some cases, the most reliable information can be obtained only with a dynamic examination of the genitals during the cycle. And the ultrasound should be carried out by the same doctor on his apparatus, so statistical errors can be avoided. If, as a result of observation, it is revealed that suspicious lesions tend to increase by the term of menstruation, this will be a criterion for endometriosis.
Do I need training
Ultrasound for the diagnosis of endometriosis It is carried out by abdominal, vaginal and rectal sensors. The preparation features are as follows:
- it is necessary to exclude gaseous food on the eve so that the swollen intestinal loops do not interfere with the visualization of tissues,
- it makes no sense to do an ultrasound during menstruation, you need to wait for their completion or approach,
- when using a rectal probe, clean the intestines the day before, carry out basic hygienic procedures, and even better, make a microlax microclyster to prevent unpleasant surprises.
And here more about how the vagina changes during menstruation.
Endometriosis, an insidious disease, is not always easy to identify and reliably confirm. Examination of the pelvic organs with the help of ultrasound makes it possible to assume the presence of a pathology with a high degree of probability, which makes it possible to prescribe a suitable treatment. For research used vaginal, rectal and abdominal sensors.
It is believed that ultrasound can be done on any given day. However, the quality of the result depends on when you do an ultrasound for uterine myoma. So when should you come for an examination?
Not all tests can be taken during menstruation. For example, total blood smears from the cervix will be uninformative. Ultrasound in the first 5 days is also undesirable.
There are bloody discharge in ovulation, even in absolutely healthy women. So the body can react to stress, flights and other factors. However, if they become regular, accompanied by additional symptoms, it is necessary to see a doctor.
Sometimes quite by accident, sometimes an ultrasound of the endometrium is detected in the uterus. The main reason - hormonal failure. By species it can be glandular, fibrous, etc. It can be both in unborn and in the age of 40. Treatment is possible without surgery, but more often hysteroscopy is required. What is dangerous polyp? Can I get pregnant? What are the consequences for a woman?
The concept of endometriosis
Endometriosis in gynecology refers to a chronic disease that causes a benign growth of the endometrial cap in various atypical places of the female body.
This disease ranks second among the causes of female infertility.
This disease is insidious in that it does not manifest itself for many years. And the many forms of endometriosis and the types of its manifestations seriously complicate the diagnosis of this pathology.
The fact that it may be the cause of endometriosis has not yet been fully clarified. It is believed that the basis of the disease are immune and endocrine disorders of the body. However, the main impetus for its development are the various consequences of endometrial trauma due to the following reasons:
- use of intrauterine contraceptives.
All of the above factors seriously affect the female hormones and the cyclical nature of its development.
In endometriosis, foci of endometrial growth are periodically rejected (in accordance with the phases of the woman's menstrual cycle). At the beginning of the cycle, the endometrium expands, reaching its maximum thickness by the end of the cycle and rejecting during menstruation.
It is with the cyclical behavior of endometriotic foci that the timing of the ultrasound is associated with this disease.
The main forms and symptoms of endometriosis
Endometriosis usually affects women of reproductive age. Often this ailment is revealed in them unexpectedly, for example, during the passage of a routine examination.
It is the transvaginal ultrasound that is considered the main method for detecting this pathology.
From the location of foci of tissue growth and distinguish the types of this disease:
- perineal, cervical and vaginal,
Women suffering from endometriosis, most often can be bothered by the following unpleasant symptoms:
- duration of menstruation and their pain,
- the appearance of clots during menstruation,
- chronic lower abdominal pain, starting from the middle of the cycle,
- smearing brown discharge outside the menstrual cycle (in its middle, for several days and after the cycle),
- pain during sexual intimacy, urination, defecation, exercise,
- infertility for unexplained reasons.
When you need to undergo an ultrasound
In case of endometriosis, it is extremely important that the pathology is detected as early as possible. However, the asymptomatic nature of this disease or its minor manifestations lead to the fact that the diagnosis is diagnosed in an already advanced stage.
The diagnosis of endometriosis is not easy to recognize: it is often set with a gap of 10-12 years.
Therefore, there are a number of symptoms in which it is necessary to suspect that something was wrong and get a referral to an ultrasound:
- duration, profusion and pain of menstruation,
- cycle violations
- frequent brown discharge,
- urination soreness
- excessive emotionality
- increased body temperature
- the appearance of anemia in the analysis of blood or its signs (weakness, pallor, yellowness of the skin, fatigue, dizziness).
Analyzes for the diagnosis of endometriosis
Endometriosis diagnosis is a difficult issue.
The complexity of the course of this pathology often leads to difficulties in identifying it with ultrasound diagnostics. In this case, other additional research methods are prescribed to patients with unclear symptoms.
Only the specialist can decide what types of tests to prescribe at this ailment. In some cases, only a laparoscopic method (low-traumatic surgical method) can establish the final conclusion.
Diagnostic methods for the detection of endometriosis
- Cytological examination: used for screening diagnostics of many uterine pathologies, however, this method is not able to reveal the full picture of the disease.
- Research on onco-markers: with endometriosis is significant, since their number is increased here. It is possible to assess the severity of the disease and the effect of the treatment. Typically, this method is used in parallel with the analysis of hormones (progesterone, prolactin, testosterone).
- Colposcopy: a colposcope is inserted through the vagina using special solutions (acetic acid, iodine, Lugol solution). However, the method has contraindications (not earlier than 1 month after an abortion and 2 months after childbirth or surgery on the uterus, intolerance of the drugs used).
- Biopsy: A sample of tissue is taken for examination. It is used immediately after menstruation. It requires highly qualified specialists: a surgeon and pathologist. Otherwise, the disease can be skipped. After local anesthesia, a tube with a piston is inserted to collect tissue. After 10-14 days, the result is ready. With this method, diagnostic accuracy is about 98%.
- Computed tomography: allows you to determine the pathology, its appearance and connection with other female organs.
- Magnetic resonance imaging: has high resolution and diagnostic accuracy up to 96%. It uses nuclear magnetic resonance. This method is associated with the preservation of immobility of the patient, so it is contraindicated in claustrophobia, patients with pacemakers and hearing aids, seriously ill patients. This is a painless method, it is only accompanied by noise.
- Laparoscopy: diagnoses with high accuracy - up to 96%. Endometriosis is diagnosed in the uterus and outside of it. A laparoscope with a flexible cable and lenses connected to a video camera is inserted through a small puncture in the abdominal wall. The device distributes the foci of pathologies in color and shape, determining their size and degree of maturity. This is a progressive low-traumatic method, without complications in the form of scars or any pain. The recovery of patients after it is rapid: laparoscopy is considered the “gold standard” among all types of examinations.
- Hysteroscopy: with this method, a hysteroscope is inserted through the uterine neck. It is also used to treat pathology. Anesthesia is necessary for the procedure (local or general). Carbon dioxide or liquid (saline or saline) is injected into the uterus beforehand to unstuck it. This study is conducted on the 8-10 day cycle. Hysteroscopy has several "advantages": the absence of adhesions due to low trauma, excellent viewing of the walls of the uterus, a minimum of complications.
However, none of the survey methods provides 100% confirmation of the diagnosis of endometriosis. For any method, an important factor is the professionalism and qualifications of the doctor.
The manifestation of endometriosis on ultrasound
What can show the ultrasound examination for endometriosis?
УЗИ диагностика может показывать различные результаты в зависимости от типа недуга. Известно о следующих формах эндометриоза:
- диффузная (внутреннего вида).
On ultrasound diffuse endometriosis is manifested:
- structural metamorphosis of the uterine wall (oval or rounded),
- non-contoured structure
- cystic areas (up to 30 mm),
- nodes interstitial type (without going beyond the body).
Focal form of endometriosis on ultrasound can manifest itself:
- different thickness of uterine walls,
- cystic cavity (from 2 to 16 mm),
- increased echogenicity of the muscular wall of the uterus with smooth, clear contours.
With endometriosis, the uterus will be detected:
- blurring and unevenness of endometrial tissues,
- nodal structures
- asymmetry of uterine walls.
Ovarian endometriosis is often manifested:
- the punctate tissue with heterogeneous structure,
- rounded neoplasms (lateral or posterior uterus),
- interspersed foci of various shapes, structures and sizes.
The accuracy of ultrasound diagnostics in endometriosis is about 80%. With normal female health, gynecologists usually refer the patient to an ultrasound at least 1 time per year. With confirmed endometriosis, ultrasound is usually prescribed every six months. It is especially important that women with “aggravated” gynecological history (severe childbirth, infections, abortions, miscarriages, etc.) go to a gynecologist. Maintaining their own women's health depends largely on the woman herself.