Adhesions on the ovaries

Adhesions on the ovaries are formations of connective tissue. This is a common problem that leads to a pain syndrome in gynecology, the cause of which is often difficult to determine. More often spikes can be the cause of infertility, which requires serious treatment and timely diagnosis. This pathology occurs in women of childbearing age and therefore, despite its small spread, it can be a serious pathology that prevents the onset of a normal pregnancy. Therefore, it is necessary to know the main symptoms of the disease and possible ways of correction.

[1], [2], [3], [4], [5], [6], [7],

Epidemiology

The epidemiology of this problem is such that ovarian adhesions stand in the first place in terms of prevalence, as the cause of infertility in women of reproductive age. This is due to the fact that recently the incidence of chronic inflammatory infections of the ovaries has progressively increased and their recognizability has decreased. Speaking about the structure of the causes that are priority in the development of adhesions, then on the first place - surgical interventions, and on the second - inflammatory pathologies. The cause of the painful syndrome of unexplained etiology in 45% of cases are precisely the adhesions on the ovaries, which are difficult to diagnose.

[8], [9], [10], [11], [12], [13], [14]

Causes of the ovarian adhesions

Talking about how important it is to pay attention to one's health, it is necessary to know that any diseases can be the reason for the subsequent development of the following pathologies. Therefore it is very important to know what causes to this can lead.

Most often, the cause of the formation of adhesions on the ovary is a process that breaks their integrity, that is, most often this is an operative intervention. Any operation concerning a caesarean section or removal of a cyst always passes with a violation of normal processes of blood coagulation and processes of cell regeneration. When there is any tissue damage, the body tries to restore the structure of this damaged tissue. And in normal this process of regeneration is due to the intensive division of cellular structures. If the process of cellular regeneration does not have time to recover, then the body replaces the tissue defect due to the intensive synthesis of fibroblasts and the formation of connective tissue. So there are spikes on the ovaries, which in their structure are connective tissue. Therefore, when the peritoneum of the small pelvis and the ovary tissue are affected, the regeneration process starts, and spikes are formed which can involve not only the ovary itself, but also the adhesions to the peritoneum of the small pelvis and adjacent organs. Thus, the topic of the ovary itself is violated because of the possible tension of its adhesion processes.

[15], [16]

Risk factors

First of all, it is necessary to identify a risk group in which spikes are formed most often. This group includes:

1. women who suffered an induced abortion;
2. women after cesarean section;
3. inflammatory diseases of the ovaries - chronic or transferred acute adnexitis, oophoritis;
4. ovarian cyst, mainly operated;
5. apoplexy of the ovary;
6. ovarian hypoplasia of congenital or acquired etiology;
7. ovarian endometritis;

[17], [18], [19], [20], [21], [22]

Pathogenesis

The pathogenesis of adhesions on the ovaries lies in the mechanisms that trigger the reactions of active synthesis of connective tissue. At the same time, damage is caused by activation of cell synthesis and stimulation of regeneration by attracting mediators, which in turn lead to the activation of fibroblasts. As a result of these processes, fibrin synthesis is intensified, which can accumulate on the surface of the ovaries at the sites of regeneration, and further deepening of these changes takes place.

Chronic inflammatory processes of the ovaries and tubes are the second most common cause of the formation of adhesive processes. This creates very favorable conditions for maintaining a flaccid inflammatory process, which is supported by many cells. Thus, chronic inflammation in the ovary is accompanied by a constant presence of neutrophilic leukocytes, granulocytes, monocytes and fibroblasts - all these cells damage the cell membrane of the ovary stroma, which is a condition for the constant process of proliferation and regeneration. Such favorable conditions are the cause of the formation of adhesive processes.

Spikes on the ovaries after cesarean section are very common, since this operation is very common, and it also leads to the above described processes. Therefore, it is possible to identify a risk group from women who underwent surgery on the uterus or ovaries, and such women should be monitored for adhesions. This will help reduce not only the problem with violations of the ovario-menstrual cycle, but also reduce female infertility, which can still be cured at this stage of fibroplastic changes.

[23], [24], [25], [26], [27], [28], [29]

Symptoms of the ovarian adhesions

Very often this pathology develops asymptomatically and the changes progress to the extent of the absence of therapeutic measures. Sometimes after surgery on the ovary, compensatory initial synthesis of connective tissue takes place, and in time, this synthesis progresses so much that symptoms appear several years after the operation.

The first signs of adhesions on the ovaries can first manifest when a woman tries to become pregnant. At the same time, numerous attempts become unsuccessful and after many tests and examinations by the method of elimination they come to the diagnosis of ovarian adhesions. This is due to the fact that the connective tissue that forms on the ovary interferes with the release of the oocyte from the follicle, so the ovulation process is inadequate. In this case, the egg simply does not reach the uterine cavity and fertilization does not occur. Therefore, adhesions on the ovaries can have clinical manifestations in the form of infertility, which happens most often.

Also, the clinical symptoms of the formation of adhesions can be pain syndrome. The pains associated with ovarian adhesions have their characteristics: pain is blunt, permanent, localized on one side of the abdomen. They can intensify, in connection with menstruation, which can be due to compression of nerve endings with an increase in the uterus. Such a pain syndrome is not intensive and can be treated with spasmolytics. The peculiarity of such pain is that they are of the same type and do not increase, do not have a progressive character. If the nature of the pain has changed or if the localization has changed, then it is worthwhile to think about it, because this can be a sign of complications.

Also, the symptoms of adhesions can be manifested as problems with patency of the fallopian tubes. There are symptoms of a chronic inflammatory process of the tubes or ovaries, which is due to the maintenance of a chronic foci of infection. In this case, there are symptoms of a chronic intoxication process in the form of periodic or constant maintenance of subfebrile body temperature, lethargy and weakness, decreased efficiency, periodic or persistent weak pain syndrome. These symptoms should also be paid attention, since they can be indicative of such pathology.

Sometimes spiky on the ovaries can disrupt their normal work so much that the structure of the stroma and the glandular structure of the organ changes and a disruption of function occurs. This is manifested in the first place by violations of the ovario-menstrual cycle. Often these two pathologies do not bind together, but it must be remembered that such reasons can also be. In this case, there is a violation in the form of failure of the function of the ovaries and it passes by the type of amenorrhea. Such delays can be up to two to three months, and then, when the amount of hormones is restored, normal menstruation can resume.

Symptoms of adhesions on the ovaries can be manifested in the form of pathological discharge. Such discharge can be green or yellow, in a small amount when the same ovary is inflamed. There may be bloody discharge, if the adhesions are accompanied by a change in the topic of the fallopian tubes and secondary traumatization. Then there may be minor bleeding after active physical exertion.

Complications and consequences

What are dangerous spikes on the ovaries? This question does not have an unambiguous answer, since all changes depend on the woman's age and the severity of the symptoms. The most important complication of such adhesions in women of reproductive age is infertility. This happens in case the process has spread to the fallopian tubes and caused a change in the topic of the organs. This raises the question of whether it is possible to become pregnant with ovaries spikes. Despite the process of irreversibility of changes, nature in this case provided the woman with two ovaries and two fallopian tubes, therefore, considering that the process is mainly one-sided and the changes are asymmetrical, then you can get pregnant, in extreme cases, there are alternative methods.

[30], [31], [32], [33], [34]

Diagnostics of the ovarian adhesions

It is very important to diagnose the adhesion process in the small pelvis until it becomes the cause of infertility. Therefore, it is important when examining a woman with any pathology, do not exclude such a process in the ovaries with the help of not only general data, but also, if necessary, conduct additional research methods.

First of all, the consultation should begin with the clarification of the history of the patient - it is important to establish and detail the complaints, as well as to find out the patient's life history. It is necessary to learn about the nature of pain, localization, duration, reaction to analgesics, as well as to find out the dynamics of symptoms and whether they have changed in recent times. Such details of complaints are also needed for further differential diagnosis. From the history of life you need to find out what surgical interventions were in the woman, whether there were pregnancies and how the delivery was, as well as the presence of diseases of the ovaries and uterus. It is important to find out the time of the last menstruation, their regularity and character. Further, upon examination, it is possible to identify the indirect signs of the adhesion process. In bimanual palpation of the uterus, its insufficient mobility can be determined, and also with large sizes of adhesions it is possible to determine a unilateral infiltrate that is not painful or moderately painful in the projection of the ovaries. This can be the initial step for further diagnosis and differential diagnosis of such a process. But also when examining a woman in mirrors, there can be no specific changes, so more research is needed.

Analyzes that need to be performed to identify adhesions are not specific and they can only be performed for the purpose of differential diagnosis. In case of a chronic inflammatory process in the ovary and the resulting adhesions, it is possible to determine changes in the general blood test - leukocytosis with a neutrophil shift of the formula to the left, acceleration of the ESR. This should lead to the thought of a chronic inflammatory process. It is also necessary to carry out a study of the smear from the vagina to the bacterial flora - this will make it possible to identify the causative agent of this chronic infection.

Be sure to conduct a histological examination of the cervical smear for the presence of dysplasia.

Instrumental diagnosis of ovarian adhesions is not the most informative method, but it is used at the first stage of the examination. There are no specific symptoms, and the nature of the changes depends on the size of the adhesive conglomerates. Spikes on the ovaries on ultrasound have the form of inhomogeneous echoes of different intensity, but it is difficult to differentiate and confirm these changes. Therefore, preference is given to more informative methods.

Hysterosalpingography is a method in which a cavity of the uterus and tubes is filled with a contrast substance and an X-ray examination is performed. In this case, you can see any defects in the filling of pipes in the ampullar part and the degree of filling with contrast, which can be taken as a basis for diagnosing the adhesive process. It is possible to determine the degree of violation of the tubal and ovarian topic in connection with the development of connective tissue and to become the stage of the disease. There are three main stages of this process:

1. Adhesive process is limited only to the ovaries without serious processes on the pipes and there are no barriers to the release of the egg;
2. Adhesions pass from the ovaries to the tubes, and the capture of the egg by the pili;
3. Adhesive process deforms the uterine tube with the formation of its bends or a change in the topic.

The stage of the process is important to clarify the diagnosis and choice of treatment tactics.

The "gold standard" for diagnosis of ovarian adhesions is laparoscopy. This is a visual method of diagnosis, which is that a camera is inserted into the cavity of the small pelvis through a special conductor, which allows you to directly see the nature of the changes and their prevalence. The diagnostic value of this method is increased due to the fact that it is possible to conduct simultaneous and operative intervention, in which the revision of the pelvic cavity is carried out. This is an affordable and minimally invasive method that can also be used to diagnose the adhesive process and differential diagnosis of the volumetric process in the small pelvis.

[35], [36]

Differential diagnosis

Differential diagnosis of adhesions on the ovaries should be carried out with many pathologies if the woman is infertile for this reason. Then, in the second and third stages of the adhesion process, it is necessary to exclude, in the first place, those pathologies that may be accompanied by ovulation disorders. If the luteal phase is not sufficient, ovulation may not occur, which should be taken into account in the differential diagnosis of adhesions, which may be accompanied by a violation of the egg's yield. Therefore, to exclude the hormonal causes of ovulation disturbance, hormonal screening should be performed, and only then think about mechanical factors.

When identifying a significant conglomerate on the ovary adhesive nature of the etiology during palpation, differential diagnosis should be carried out with tumor processes. In this case, the ovarian tumor is more often painless, does not shift and has no precise contours. Sometimes, in order to differentiate these two processes, it is necessary to perform magnetic resonance imaging, which allows us to clarify the nature of the process and its infiltration growth, in the case of a tumor.

It often happens that there is a need to differentiate ovarian adhesions with a cyst. The main thing is ultrasound, which can accurately determine the changes characteristic for the cyst in the form of a cavity with clear edges and echo-negative contents. Sometimes an exact differentiation can be made only visually, having seen changes during laparoscopy.

It is very important to conduct the whole complex of diagnostic studies because of not only the diagnosis, but also for the purpose of differential diagnosis.

Treatment of the ovarian adhesions

Treatment of adhesions on the ovaries must necessarily take into account the etiological, pathogenetic principle and severity of symptoms. If this pathology is asymptomatic and does not affect reproductive function, then the treatment should not be active.

Drug treatment should be conducted in an acute period, taking into account the cause that led to spikes. If the cause of such changes is chronic inflammation of the ovary, then it is necessary to eliminate this inflammation, as it supports the synthesis of connective tissue. Therefore, the treatment should use a complex of antibiotics and anti-inflammatory drugs. The advantage belongs to an antibiotic, to which there is a sensitivity of the flora isolated from the vagina.

1. Vilprafen is an antibacterial agent that has available forms for the treatment of gynecological pathology, from the group of macrolides. The active substance of this drug is josamycin, a drug that is especially effective in intracellular forms of infection. These forms often cause a chronic inflammatory process, since microorganisms within the cell are not easily treatable. This drug acts by inhibiting the synthesis of protein fragments of the cell wall, which leads to a bacteriostatic effect. Dosage of the drug in the form of vaginal tablets of 500 milligrams. The method of applying suppositories for the treatment of chronic inflammation of the ovaries is a coursework of two vaginal suppositories per day. In this suppository should be put after hygiene procedures. Side effects are possible in the form of dyspepsia, dysbiosis, as well as increased liver transaminases and jaundice. Precautions - Do not exceed the course of treatment because of possible local changes in the form of candidiasis. It is necessary to take into account the possible influence on hearing when the dose is raised.
2. Flamax is an anti-inflammatory drug that is used in complex therapy with an antibacterial drug in severe pain syndrome, as well as to accelerate the resolution of adhesions. This is achieved by activating the immune defense cells in the focus of inflammation and reducing edema. The active substance of this drug is ketoprofen (a non-steroidal anti-inflammatory non-narcotic drug). The drug is available in the form of vaginal tablets, the dosage of the drug is 100 milligrams of the active substance in one tablet. Method of application - one suppository per day should be used vaginally, after hygienic measures, you also need to withstand an hour after using other vaginal suppositories. Adverse events are possible on the part of the gastrointestinal tract in the form of glossitis, lesions of the esophagus, stomach, intestines with dyspepsia, violation of evacuation function of the intestine. Also possible allergic manifestations of varying severity. When the drug acts on the hematopoietic system, anemia, a decrease in the number of platelets and granulocyte neutrophils may occur. When acting on the heart and the vascular system, there may be an increased heart rate, pain in the heart, heart rhythm disturbances, lability of blood pressure, and edematous syndrome. Precautionary measures - in pregnancy it is not necessary to apply in the early stages.
3. Longidase is an enzyme preparation that can be used in the second stage of treatment, when the inflammatory process is treated. The enzyme preparation has a directed effect on the connective tissue, since it cleaves glycopeptide bonds. Due to this directional action helps to conduct specific proteolytic therapy. The active substance of the drug is hyaluronidase (a natural proteolytic enzyme). The drug is available in ampoules for intramuscular injection and dosage of the drug for 1500 and 3000 international units. The method of application of the drug is intramuscular, with 3000 units of action per day, the course of treatment from ten days to three weeks. You can repeat the course of treatment if necessary. Side effects are possible only in the form of allergic manifestations and irritations at the injection site. Precautions - during pregnancy and breast-feeding the drug is undesirable to use. It is not recommended to combine this medication with loop diuretics.
4. Trypsin - a proteolytic agent, which includes a natural enzyme trypsin. This agent has proteolytic activity in relation to connective tissue, so it can be successfully used to improve the dynamics of resorption of ovarian adhesions as a combination therapy. The drug is issued in ampoules and its dosage is 10 milligrams. The method of application of the drug can be intramuscular, but in combination with parenteral treatment, local treatment can be used. It is necessary to make a tampon from a solution of trypsin from the ampoule and insert it into the vagina for two hours before bedtime. Possible side effects in the form of burning or unpleasant sensations in the vagina. From systemic side effects it is possible to strengthen the heartbeat and a sensation of hot flush to the face. Precautions - Do not use tampons with the remedy in the event of damage to the uterus or after recent surgery.
5. Acylact is a drug from the group of probiotics, the main active ingredient of which is lactobacilli. This tool is recommended to use at the final stage of treatment of ovarian adhesions, when the normal microflora of the vagina is being restored. After treatment with antibiotics, anti-inflammatory drugs and proteolytic enzymes, this tool will help to restore the endometrium faster and normalize the bacterial composition. The drug is available in the form of vaginal tablets and dosage - one tablet per day. The way of application - vaginally it is necessary to introduce a candle not too deeply into the vagina after all hygienic measures and outside the reception of other local remedies. Side effects are rare, allergic reactions to the components of the drug are possible. Precautions - tablets should be used for the entire course and everything, long-term storage and incomplete course reduces the effectiveness of the drug.

These are the main medications that should be used only according to the scheme, as the complex of drugs is directed at different parts of the process and it is necessary to carry out treatment alternately.

Physiotherapeutic treatment of ovarian adhesions is very important, since a purposeful influence on the pathological process is carried out using physical methods. A prerequisite for physiotherapy is the absence of acute and chronic inflammation in the ovary, so it is better to use such treatment in remission. The most common method of physiotherapy is electrophoresis with enzymes - lidase, trypsin, chymotrypsin. These enzymes with the help of ions are able to penetrate deep into the adhesions and better to break their bonds. A course of seven to ten sessions of electrophoresis is recommended. Also, a good effect is revealed by magnetic therapy, which enhances the ionization of cells and also reduces the severity of the process.

Vitamins in the treatment of adhesions do not have a specific effect, but as a complex therapy they improve blood circulation and normalize the immune status, including local.

Surgical treatment of ovarian adhesions is used in the second and third stages of the disease, when the follicle is drawn into the process and ovulation is disturbed. In this case, women who plan pregnancy, surgical intervention is recommended. Treatment can be minimally invasive when using alternative methods to a scalpel. Very often during the diagnostic laparoscopy, when it is possible to visually see the adhesions and assess the prevalence of the process, then immediately conduct and surgical treatment. The most accessible method is dissection of adhesions with a scalpel. But such surgery has a drawback, because after this spikes often re-form. There are also alternative methods - the use of an electric knife or laser excision. In addition to removing the adhesions, the "cauterization" of the cells of the connective tissue takes place in parallel, so the process of further synthesis is not so significant. This is the advantage of laser surgery - spikes are formed very slowly, but this method is not available everywhere. In the course of such an operation, special resorptives can be applied to the ovaries, which can permanently prevent further changes.

Speaking about medical and surgical treatment, it is necessary to take into account in this case the main sign - this is the stage of the disease, and also take into account age and individual characteristics.

Alternative treatment of ovarian adhesions

Priority in the use of alternative treatment methods belongs only to the first stage of the disease, when the process is not yet widespread. Herbs and alternative methods are used that increase blood circulation and lymph circulation and thus normal blood flow is restored, which reduces the severity of dysplastic processes and the synthesis of connective tissue. The main alternative methods are as follows:

1. Flax is a natural remedy that possesses a good anti-inflammatory property and has a proteolytic ability. To prepare the medicine, flax seeds must be boiled in hot water for three minutes, then soak the solution and allow it to cool. In such a solution, you need to moisten the gauze swab and insert it into the vagina for the whole night. Such procedures should be done daily for at least a week, then recommend switching to sessile baths from the same solution - this will improve the effect of treatment.
2. St. John's Wort reveals its effect by increasing the outflow of lymph, which improves the trophism of the ovary and reduces the severity of the adhesion process. For a medical solution, take a liter of hot water and pour five tablespoons of leaves of dried St. John's wort with this water. Such a solution is infused for three hours, and then douching should be performed. It is better to do this at night with the help of a small pear. The course of treatment is three weeks.
3. Compresses from medicinal herbs are very useful and effective in treating adhesions of the pelvic organs. For such compresses, you need to take the leaves of yarrow and morinda, pour them with hot water and make a compress of gauze tissue. Such a compress should be placed on the lower abdomen and covered with warm woolen cloth on top. The duration of action of such a compress should be at least two days. The course of treatment is ten days.
4. Aloe contains natural proteolytic enzymes in its composition, so aloe juice has a good effect on the dissolution of the adhesive process. To treat the juice of a young aloe plant, you need to squeeze about 20 milliliters into a glass jar, then add a teaspoon of honey and five drops of vitamin A. This solution strengthens the proteolysis of the adhesions a few days after the start of treatment. Take a teaspoon of an empty stomach once a day, the course of treatment - five days.

Very good treatment gives a combination of different methods of alternative medicine, for example douches and compresses - this enhances the effect of these substances.

The use of herbs is also widely used:

1. The use of the maria root, as a perennial plant, has a very good effect on the female reproductive system, especially when it comes to adhesions. For treatment use alcoholic tincture - for 300 grams of vodka you need to take two small roots of this plant and insist for at least a week, then take two times a day after eating a teaspoon of this medication.
2. Boron uterus is a plant that is widely used in gynecology, as it has many properties - antitumor, resorptive, anti-inflammatory. For the treatment use the water infusion of this herb, which is prepared according to the standard rules - for three tablespoons of dry herbs you need to take a liter of boiled water. You need to use half a cup of this tea twice a day, the course of treatment - seven days.
3. Birch buds are also very effective for the treatment of adhesions of any etiology, and as regards ovarian adhesions, in this case they use a local form. To do this, make a decoction of birch buds, filling them with a glass of water. After half an hour after the broth is consumed, it is necessary to make a gauze swab and insert it into the vagina for two hours. The course of treatment is two weeks.

Homeopathic treatments for ovarian adhesions are also widely used:

1. Acidum fluoride is a homeopathic remedy of inorganic origin (phosphoric acid). This agent improves the metabolism of cells of connective tissue and promotes their resorption with pronounced tropism to the ovaries. This drug is released in the pharmacological form of homeopathic granules and is dosed seven granules twice a day. This is a very powerful tool in its operation, which promotes the proteolysis of adhesions even the most pronounced ones. Precautions - when treating pregnant women you need to consult a doctor. Side effects of the drug are possible in the form of a grinding of teeth and a metallic taste in the mouth.
2. Silicea is a homeopathic preparation of natural inorganic origin, which is recommended to be taken in conjunction with Acidum Fluoricum, which increases the effectiveness of both drugs. Dosage of the drug - seven granules three times a day. Method of application - you need to dissolve the granules until they are completely dissolved. Precautions - do not break the reception time, it affects the effect of treatment. Adverse events were not detected.
3. Thuya is a homeopathic remedy of plant origin, which is effective with concomitant inflammatory diseases of the ovary. Dosage and the way of application of the preparation - seven granules three times a day, keep in the mouth until complete resorption. Side effects are possible in the idea of a cough that has a dry character. Precautions - patients with bronchial asthma need to use the drug with caution.
4. Graphite is a homeopathic remedy based on inorganic material. Used to treat adhesions in patients with a pronounced exudative component. Method of application - under the tongue, dosage - ten drops of solution three times a day. Adverse events occur rarely, allergic manifestations are possible.

Homeopathic remedies should be used for a long time - in case of treatment for at least six months, positive dynamics are possible, up to complete recovery.

[37], [38]

Prevention

Prevention of ovarian adhesions nonspecific:

• regular check-ups with the doctor;
• diagnosis and treatment of ovarian cysts, inflammatory processes;
• hygiene of sexual life, avoiding promiscuous connections and reducing the level of infection with intracellular organisms;
• family planning and regular sexual relations;
• avoidance of unplanned surgical interventions and artificial termination of pregnancy.

[39], [40], [41], [42], [43], [44], [45], [46]

Forecast

The prognosis of ovarian adhesions in terms of life is favorable, but if a young woman has such a problem, and in case of untimely treatment, complications can be expected, given that this process is irreversible. Therefore, it is necessary to deal not only with primary prevention, but also secondary - it is better to treat spikes in the initial first stage.

Adhesions on the ovaries is a common problem among women who want to have children. This is due to the fact that the incidence rate is increasing and the clinical manifestation and timely diagnosis of chronic ovarian diseases, as the main element in the formation of adhesions, is reduced. Postoperative adhesions have more severe treatment and are less treatable, especially conservative. Given this, it is necessary to protect your health from an early age to fulfill your role as a mother.

[47], [48], [49]