RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015
Erosion and ectropion of the cervix (N86)
obstetrics and gynecology
general information
Short description
Recommended
Expert Council
RSE on PVC "Republican Center for Health Development"
Ministry of Health
and social development
dated November 20, 2015
Protocol #16
Protocol name: Erosion, ectopia and ectropion of the cervix
Erosion (true erosion) - cervical disease, in which there is a defect in the epithelium covering the vaginal part of the cervix.
Ectopia (pseudo-erosion)- a disease of the cervix, in which there is a displacement of the boundaries of the high cylindrical epithelium of the endocervix beyond the external os to the vaginal part of the cervix.
Ectropion is an eversion of the mucous membrane of the cervical canal.
Protocol code:
ICD-10 code(s):
N86 Cervical erosion and ectropion
Abbreviations used in the protocol:
|
HPV-
human papillomavirus STI- sexually transmitted infections pap test- pap test PHC- primary health care PCR- polymerase chain reaction RShM- Cervical cancer HSIL- high quality squamous epithelial lesion AGC- atypical glandular epithelium ASC- atypical squamous cells ASC US- atypical squamous cells of unknown significance LSIL- low-grade squamous epithelial lesion LEEP- loop electrosurgical excision procedure LLETZ- large loop excision of transformation zone |
Protocol development date: 2015
Protocol Users: general practitioners, obstetrician-gynecologists
Criteria developed by the Canadian Task Force on Preventive Health Care to assess the evidence of recommendations
| Levels of Evidence | Recommendation levels |
|
I: Evidence based on at least one randomized controlled trial II-1: Evidence based on evidence from a well-designed controlled trial but not randomized II-2: Evidence based on evidence from a well-designed cohort study (prospective or retrospective) or a case-control study, preferably a multicentre or multi-study study II-3: Evidence based on comparative study with or without intervention. Convincing results obtained from uncontrolled experimental trials (such as the results of penicillin treatment in the 1940s, for example) could also be included in this category. III: Evidence based on the opinions of reputable experts based on their clinical experience, data from descriptive studies or reports from expert committees |
A. Evidence to recommend clinical preventive intervention B. Strong Evidence Supports Recommendations for Clinical Preventive Intervention C. Existing evidence is conflicting and does not allow recommendations for or against the use of clinical prophylaxis; however, other factors may influence the decision D. There is good evidence to recommend no clinical preventive effect. E. There is evidence to recommend against clinical preventive action L. There is insufficient evidence (either quantitatively or qualitatively) to make a recommendation; however, other factors may influence the decision |
Classification
Clinical classification
Erosion classification (true erosion):
· inflammatory;
· traumatic;
Trophic (in the presence of prolapse and prolapse of the cervix).
Ectopia classification:
According to etiopathogenesis:
Congenital (influence of high levels of hormones in the mother's body);
Acquired (during puberty, there is a rapid growth of the muscular structures of the cervix with a lag in the proliferative process in the stratified squamous epithelium).
By clinical course:
uncomplicated form;
Complicated form (combination with cervicitis, vaginitis);
According to the histological structure:
glandular (follicular) - many glandular passages;
papillary (papillary) - proliferation of stroma;
epidermis (healing) - sections of the cylindrical epithelium are replaced by stratified squamous as a result of metaplasia of reserve cells or "crawling" of squamous epithelium cells from the periphery to the ectopic zone.
Clinical picture
Symptoms, course
Diagnostic criteria:
Complaints and anamnesis (the nature of the occurrence and manifestation of pain syndrome):
Complaints:
mucous discharge from the genital tract;
purulent discharge from the genital tract;
intermenstrual bleeding from the genital tract;
contact bleeding from the genital tract.
Anamnesis:
the presence of cancer in close relatives;
childbearing function (number of births, abortions, the nature of contraception);
Past gynecological diseases (term and duration of detection of cervical pathology).
Physical examination:
During a gynecological examination:
Erosion: a defect in the mucous membrane of the external pharynx is bright red, irregular in shape, with relatively clear boundaries, easily injured, bleeds.
ectopia: a defect in the mucous membrane of the external pharynx with irregular outlines from bright red to pale pink. Significant hyperemia, natal glands, and edema are possible.
Ectropion: characterized by eversion of the mucous membrane of the cervical canal. The cervix may be hypertrophied with scarring.
Diagnostics
The list of basic and additional diagnostic measures:
The main (mandatory) diagnostic examinations carried out at the outpatient level:
collection of complaints and anamnesis;
physical examination - general gynecological examination;
a smear for the degree of purity of the vagina;
Cytological examination of smears from the cervix (PAP - test);
colposcopy.
Additional diagnostic examinations carried out at the outpatient level:
KLA with the determination of the time of blood clotting;
microreaction;
HIV (in preparation for surgical treatment);
liquid cytological examination of scrapings of the cervix and cervical canal;
PCR for chlamydia (HPV 16, HPV 18, HSV 2 - to determine the oncogenic risk of human papillomavirus) (UD - IIIC);
targeted biopsy (to verify the diagnosis if intraepithelial neoplasia is suspected, it is recommended to take tissue from the pathological site under colposcopy control) (LE - IA);
scraping of the cervical canal followed by a scraping examination (required in cases where the junction of the cylindrical and stratified squamous epithelium is not visualized, with the result of the PAP - AGC test, and in women over 45 years old) (UD - IIB).
Instrumental research:
Extended colposcopy/video colposcopy :
Erosion:
A defect in the epithelium with a naked subepithelial stroma with clear edges, in which signs of an inflammatory reaction are found: expansion of capillaries, impaired microcirculation, swelling. After applying a solution of acetic acid, the bottom of the erosion turns pale, after Lugol's solution, the bottom does not stain.
Ectopia:
There is a displacement of the columnar epithelium to the exocervix with a transformation zone (transformation zone), which is characterized by the presence of metaplastic epithelium of varying degrees of maturity, open and closed glands, islands of columnar epithelium with fuzzy contours, sometimes with a vascular network.
Ectropion:
Eversion and exposure of the mucous membrane of the cervical canal is detected, in which the boundary between the stratified squamous and cylindrical epithelium of the cervix can be violated.
Target biopsy:
erosion:
There is a defect in the stratified squamous epithelium infiltrated by leukocytes. At the bottom of the erosion, there is an increase in granulation tissue and infiltration from polymorphonuclear leukocytes, histiocytes, as well as vascular plethora and swelling of the endothelium.
Ectopia:
Distinguish glandular, papillary and immature squamous metaplasia. Glandular is characterized by the presence of glandular structures in the subepithelial tissue, a high cylindrical epithelium lines branching glandular passages - erosive glands, around which an inflammatory reaction is noted. Papillary - characterized by the growth of the stroma with the formation of papillae of various sizes, covered with a cylindrical epithelium.
Ectropion:
Metaplasia of the columnar epithelium of the cervical canal by stratified squamous, possibly proliferation of connective tissue;
scraping of the cervical canal with subsequent examination of the scraping - the absence of atypical cells.
Indications for consultation of narrow specialists:
Consultation with an oncologist in case of severe cervical intraepithelial neoplasia, atypical glandular cells and suspected cervical cancer.
Laboratory diagnostics
Laboratory research:
Main:
smear on the degree of purity of the vagina (the presence of an inflammatory process in the vagina);
Cytological examination of cervical smears / Pap test (absence of atypical cells and intraepithelial neoplasia) see Appendix 1. Interpretation of the results of cytological examination according to the Bethesda terminology system, see Appendix 2.
liquid cytological examination of scrapings of the cervix and cervical canal - the absence of intraepithelial neoplasia from the mucous membrane of the cervical canal and the vaginal part of the cervix;
PCR diagnostics for chlamydia, HPV 16, HPV 18, HSV 2 (determining the presence or absence of human papillomavirus);
bacteriological examination to identify the microflora (determines the presence of an infectious agent and its sensitivity to antimicrobial agents).
Differential Diagnosis
Differential Diagnosis:
Table - 1. Differential diagnosis of erosion, ectopia and ectropion of the cervix.
| Pathology | Features | Verification survey |
| Dysplasia | In history, an unsatisfactory result of the Pap test. |
Targeted biopsy: intraepithelial neoplasia. |
| Cervical cancer |
In history, an unsatisfactory result of the Pap test. There may be complaints of metrorrhagia (heavy and irregular vaginal bleeding). |
-PAP test: atypical changes in the cytological examination of cervical scraping; - colposcopy: acetowhite epithelium, atypical vessels, puncture and mosaic; Targeted biopsy: confirms the diagnosis and determines the stage of the disease. |
| cervicitis | Complaints of discomfort, pain in the vagina, purulent discharge from the genital tract, itching and burning. On examination, there are signs of an inflammatory process in the vagina. |
-Smear on the degree of purity: detection of the inflammatory process; -PCR: detection of Chlamydia trachomatis or other STIs; -bacteriological examination: detection of pathological flora. |
Treatment
Treatment Goals: improvement of the cervix.
Treatment tactics:
There is no routine treatment for erosion, ectopia and ectropion of the cervix.
If there are no complaints and the pathology is detected during the examination, with satisfactory results of the examination, then there is no need for treatment (LE - 1A).
If there are complaints from the patient, treatment is necessary, the purpose of which is to remove the pathologically altered tissue area and restore the normal structure.
Non-drug treatment- No
Medical treatment:
There is no specific drug treatment (LE: 1A);
Drug therapy is possible with complicated ectopia, including anti-inflammatory therapy of the concomitant inflammatory process of the cervix and vagina according to the results of bacteriological and bacterioscopic studies.
Other types of treatment:
Cryodestruction
Indications:
Contraindications:
oncological diseases of the cervix;
Chemical coagulation (solkovagin)
Indications:
ectopia.
Contraindications:
acute inflammatory diseases of the genital organs;
The presence of an atypical histological picture;
The presence of an atypical histological picture.
Laser coagulation
Indications:
ectopia (pseudo-erosion);
Erosed ectropion.
Contraindications:
acute inflammatory diseases of the genital organs;
spread of the pathological process above the lower third of the cervical canal;
The presence of an atypical histological picture.
Surgical intervention
Surgical intervention provided on an outpatient basis:
Electroradiosurgical coagulation of the cervix:
Indications:
Ectopia (pseudo-erosion of the cervix).
Contraindications:
acute inflammatory diseases of the genital organs;
The patient has a pacemaker and cardiac arrhythmias of organic origin;
The presence of an atypical histological picture.
Electroradiosurgical loop excision (conization) of the cervix (LEEP,
LLETZ):
Indications:
ectropion;
Ectopia (pseudo-erosion of the cervix) with an abnormal colposcopic picture and cytogram at the age of over 35 years.
Contraindications:
acute inflammatory diseases of the genital organs;
The patient has a pacemaker and cardiac arrhythmias of organic origin.
NB! Radio wave surgery is an atraumatic treatment for cervical pathology (IA). Based on a meta-analysis, after this procedure, the risk of preterm birth in a subsequent pregnancy was 1 in 143 cases. In addition, 42 groups of researchers believe that a low risk is associated with a depth of exposure to radio waves less than 10 mm.
Indicators of treatment efficacy and safety of diagnostic and treatment methods described in the protocol:
timely detection of pre-invasive diseases of the cervix with subsequent recovery.
Hospitalization
Indications for hospitalization indicating the type of hospitalization: No
Prevention
Preventive actions:
Primary prevention (healthy lifestyle with the exclusion of possible risk factors, HPV vaccination of certain population groups);
secondary prevention (high-quality and well-organized screening of the female population, including a cytological examination of a smear from the cervix (traditional and liquid cytology) - Pap test.
Further management:
· in case of negative results of the Pap test, the next examination is carried out within the time limits established by the screening program;
In case of inadequacy of the material, it is necessary to repeat its sampling;
· with ASCUS cytological conclusion - observation and repeated cytological examination after 6 and 12 months is recommended; if ASC-US or weighting persists in dynamics, colposcopy and targeted biopsy of all suspicious lesions are necessary;
if an ASC-US/LSIL or more severe lesion is detected at follow-up, colposcopy and targeted biopsy should be performed (LE III-B);
· with a cytological conclusion HSIL - obligatory colposcopy and targeted biopsy. In the absence of a transformation zone, it is necessary to perform curettage of the cervical canal. If HSIL is confirmed at review, therapeutic cervical excision is required (LE III-B);
· with a cytological conclusion of AGC, colposcopy is necessary in combination with a biopsy from the cervical canal. In women with appropriate symptoms and in women over 35 years of age, the study should include the collection of material from the uterine cavity. Loop excision is required when AGC is confirmed (LE II-B).
· pregnancy, if the test is positive and there is a visible cervical lesion, a colposcopy within 4 weeks (LE III-B) and cytological examination of cervical smears is necessary. For ASC-US or LSIL, cytology can be repeated 3 months postpartum (LE III-B). Biopsy during pregnancy is not recommended and may be associated with significant bleeding (LE III-D).
· ASC-US/LSIL cytology in women younger than 24 years requires HPV testing, colposcopy, and repeat cytology at 12 months (LE II-B). With a positive test for HPV - follow-up in dynamics after 12 months. With a negative HPV test - routine cytological screening once every 3 years. If ASC-US/LSIL persists or worsens - there is no need for immediate treatment, repeat cytology after 6 months and colposcopy after 24 months. If high-quality epithelial lesions persist, loop excision is recommended (LE III-B).
Information
Sources and literature
- Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
- List of references: 1) Prilepskaya V.N., Rudakova E.B., Kononov A.V. Ectopia and erosion of the cervix - M.: MEDpress-inform, 2002. 2) Early diagnosis of cervical cancer at the level of primary health care. cytological screening. Guidelines - Edited by Nurgaziev K.Sh. – Almaty, 2012. 3) Khmelnitsky, O. K. Cytological and histological diagnosis of diseases of the cervix and body of the uterus / O. K. Khmelnitsky. SPb. : SOTIS, 2000. 4) Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287:2114Y9. 5) Davey DD, Austin RM, Birdsong G, Buck HW, Cox JT, Darragh TM, et al. ASCCP patient management guidelines: Pap test specimen adequacy and quality indicators. J Low Genit Tract Dis 2002;6:195Y9.. 6) Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D; 2006 ASCCP-Sponsored Consensus Conference. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007;11:201Y22. 7) Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012;62:147Y72.
Information
List of protocol developers with qualification data:
1) Tuletova Ainur Serikbaevna PhD, JSC "Astana Medical University", assistant of the department of obstetrics and gynecology, doctor of the first category.
2) Korkan Anuar Ivanovich Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology of the Kazakh Medical University of Continuing Education, obstetrician-gynecologist of the highest category.
3) Sarmuldaeva Sholpan Kuanyshbekovna candidate of medical sciences, acting Head of the Department of Obstetrics and Gynecology of the Kazakh Medical University of Continuing Education, obstetrician-gynecologist of the highest category.
4) Sadvakasova Shynar Muratovna Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology No. 1 of the Republican State Enterprise on the REM of the Kazakh National Medical University named after S.D. Asfendiyarova, obstetrician-gynecologist of the highest category.
5) Gurtskaya Gulnar Marsovna Candidate of Medical Sciences JSC "Astana Medical University" Associate Professor of the Department of General Pharmacology, Clinical Pharmacologist.
Indication of no conflict of interest: no.
Reviewers: Ryzhkova Svetlana Nikolaevna - doctor of medical sciences, professor, doctor of the highest category, head of the course in obstetrics and gynecology of the faculty of advanced training of doctors of the State Enterprise "West Kazakhstan State Medical University named after Marat Ospanov".
Indication of the conditions for revising the protocol: Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.
Attached files
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Among the diseases with an asymptomatic course that can lead to serious consequences - the inability to become pregnant, complications of childbirth, miscarriages, and also cancer, ectopia in the cervix is distinguished. This is a serious pathology that affects more than 30% of girls of reproductive age. Rarely, pseudo-erosion is accompanied by symptoms (itching in the perineum, discomfort, menstrual disorders. More often it is hidden. The disease is treated, the main thing is to identify it in time and start therapy.
What is an ectopia?
Pathology is also called false or pseudo-erosion, endocervicosis. It is characterized by a displacement of the cylindrical epithelium from the cervical canal to the vaginal part of the cervix (normally covered with a flat one). Ectopia is represented by a bright red focus. Unlike erosion, endocervicosis does not bleed, since the pathology is not accompanied by ulceration of the mucosa.
Ideally, the part of the cervix (which is closer to the vagina) is covered with a squamous epithelium. The area where cylindrical or prismatic is also found is called the transformation zone. The second type of cells is very thin, therefore, in the transition area, the appearance of deformation of the mucous neck can be created. Because of this, an incorrect diagnosis is made - erosion and the wrong treatment tactics are selected.
The danger of pathology
Ectopia of the neck, if it proceeds without symptoms, is not complicated by other diseases (cervicitis, colpitis), does not affect the quality of life of the girl, is not dangerous. When endocervicosis is accompanied by inflammation, progresses rapidly, affects the woman's condition, you need to sound the alarm and start therapy.
Penetration into the changed area of the cervix of pathogenic flora is fraught with damage not only to the cervix, but also to neighboring organs, in particular the ovaries. Due to the strong growth of the epithelium, problems arise with conception and pregnancy.
Cervical ectopia with a long course leads to dysplasia (prerequisites for oncology). The disease is characterized by exacerbations (when conservative methods are used for its treatment).
The greatest danger is such a consequence as transformation into cancer. A tumor of the cervix is often fatal.
Classification
A classification has been developed for ectopic or columnar epithelium growth in the cervix.
Table 1 - What is pseudo-erosion
| Kinds | Characteristic |
| Origin |
|
| With the flow |
|
| According to the composition of tissues |
|
What provokes?
In adolescence, endocervical pseudo-erosion is regarded as a functional feature of the uterus. Ectopia of the neck during pregnancy also refers to the physiological conditions provoked by hormonal imbalance. Changes in the uterus are due to:
- previously transferred, chronic diseases (endocervicitis, chlamydia, vaginitis, colpitis, endometriosis);
- promiscuous sexual life;
- damage to the cervix during childbirth, abortion, diagnostic curettage;
- hormonal imbalance;
- ovarian dysfunction;
- decrease in the protective properties of the body;
- early sexual life;
- frequent change of partners;
- multiple births;
- the presence of bad habits;
- improper use of the uterine spiral;
- infections (herpes, syphilis);
- genetic predisposition.
Only a doctor can determine the exact cause of cervical lesions. If women's health worsens, you need to consult a doctor and undergo an examination. Delay in therapy, ignoring the warning signs is fraught with the development of complications.
Symptoms
Ectopia of the neck is rarely accompanied by symptoms. More often it goes unnoticed, does not affect well-being. An uncomplicated form is detected during examination. Complicated cervical ectopia on the cervix with chronic cervicitis, colpitis or other pathology is accompanied by a vivid clinical picture.
The disease is characterized by:
- profuse leucorrhoea or serous discharge;
- disruptions of the menstrual cycle;
- itching, burning in the genital area;
- contact bleeding;
- discomfort during intimacy;
- painful periods.
Diagnostics
The main task of the examination is to differentiate ectopia from cervical erosion, infectious processes, polyps, endometriosis, ectopic pregnancy, dysplasia, cancer and establish an accurate diagnosis. For this, the doctor, in addition to a survey, an examination, prescribes the following:
- Pap test - allows you to detect precancerous and oncological processes.
- Colposcopy - to study foci, differentiate normal cells from atypical ones.
- Extended colposcopy (Schiller's test, chromoscopy, use of 3% acetic acid).
- Biopsy - taking a piece of tissue for further examination under a microscope.
Additionally, blood tests are prescribed for hepatitis B, mycoplasma, chlamydia, HIV.
Therapy Methods
The method of treating pathology is selected by the doctor after a thorough diagnosis, clarification of the cause. Cervical ectopia, which is asymptomatic, especially in nulliparous, does not require action. The girl needs to be observed by a gynecologist. Complicated pseudo-erosion, when there are extensive cervical lesions and pronounced signs, is treated taking into account the existing changes.
To combat pathogenic microflora, antimicrobial, antifungal, antiviral drugs are prescribed. After eliminating concomitant diseases, the use of eubiotics is indicated to increase local immunity. Only after stopping the inflammation, the destruction of the foci of ectopia is performed.
Used for complicated endocervicosis with cervical deformity. It consists in a cone-shaped excision of the tissue. Improper execution is fraught with stenosis of the cervical canal. The procedure is not recommended for ectopia in nulliparous.
Cryosurgery
A widely used method of therapy for pseudo-erosion of the uterus, which consists in exposing the focus to low temperatures (freon, nitric oxide, carbon dioxide). The method is safe, painless, does not involve the risk of damage to healthy cells of the cervix. The minus of manipulation is abundant vaginal discharge and loss of K.
Laser destruction
An effective method for the treatment of ectopia, cervicitis, dysplasia. It consists in exposing the problem areas of the neck with a carbon dioxide laser beam. Advantages of cauterization: accuracy, no infectious consequences, quick recovery. The disadvantage of vaporization is the high cost.
Radio wave therapy is safe, accurate, painless. After the manipulation, no scars remain on the uterus, healthy tissue does not change. It consists in the use of low-frequency electric current (a thin wire loop is used). Treatment with radio waves is associated with the appearance of convulsions (several hours after the intervention), brown discharge.
Thermocoagulation
The hearth is exposed to high temperatures. Thermal influence destroys the cylindrical epithelium and covers the exposed area of the neck with a flat one. The technique ensures the destruction of the infection, so complications are rare. The advantages of treating ectopic uterus include:
- security;
- precise control;
- availability.
Among the minuses: discomfort, possible re-conduction.
Surgical methods
The most common method of therapy for erosion, cervical ectopia with squamous metaplasia is recognized as conization of the cervix. Intervention is indicated for the ineffectiveness of other methods, large-scale damage to the uterine mucosa. It is performed using general anesthesia. The tissues are excised with a “cold knife”, a laser. Loop excision is rarely performed.
Chemical coagulation
It implies the use of a mixture of acids (solkovagin preparation). The technique is safe, it can be applied to young girls. The procedure is simple and not expensive. But the method will not work if the lesions are extensive.
Alternative treatment
Folk remedies for ectopia on the cervix are used carefully and rarely. Before using the composition, you should consult a doctor. Not always after the use of alternative methods, the effect is positive.
Sitz baths are ineffective for pseudo-erosion of the uterus. The medicine is not able to overcome the resistance of the vaginal walls and reach the cervix. The technique is effective in inflammation of the external genital organs.
Table 2 - Recipes for the treatment of endocervicosis
Drinks from medicinal plants are not able to eliminate the defect in the uterus. They only provide an increase in protective forces, relief of inflammation in concomitant diseases. Harm, as well as special benefit in the treatment of ectopia, the funds will not bring.
Postoperative treatment
During the recovery period after cauterization or excision of the problem area, antibiotics may be prescribed to prevent a secondary infection. With unpleasant sensations, painkillers are used, and vitamins and immunomodulators are used to strengthen immunity.
Precautions after surgery
For a woman who underwent cauterization or excision, for the speedy recovery of the cervix, it is recommended:
- exclusion of sexual intercourse (2 months);
- refusal to use tampons;
- minimization of loads.
You can also not visit the sauna, bath, drink alcohol.
If you find heavy bleeding, severe soreness, fetid discharge, you should consult a doctor.
Ectopia and gestation
Conception with endocervicosis is possible. But only with a slight lesion of the mucosa. Ectopia or erosion of the cervix during pregnancy will not affect the process of laying, organs, fetal development, however, ruptures are possible during deformation. Inflammation, deep scars - a hindrance to conception.
Extensive ectopia during pregnancy is fraught with negative consequences, in particular, premature birth, miscarriage.
False erosion with menopause
During menopause, cervical pathology is rarely detected, but if it is found, it is caused by a surge of hormones. The disease often subsides and then disappears altogether. With progression, a radical method is used.
Prevention
Disease of the uterus is easier to prevent than to treat. For this you need:
- undergo an inspection once a year;
- treat comorbidities;
- use contraceptives;
- to refuse from bad habits;
- strengthen immunity.
Women with erosion on the neck are shown an annual examination. This measure helps to avoid the development of cancer.
Does it need to be burned?
Doctors do not always resort to a radical method of treatment. If endocervicosis in the cervix is hidden, the girl has no complaints, observation is indicated. With the progression of the disease, an effective method for removing the altered tissue is selected. Women planning a pregnancy for the treatment of ectopia use sparing methods that are not associated with the likelihood of scarring.
Forecast
If the treatment is carried out on time, using the correct method, the prognosis will be favorable. Ignoring the symptoms, refusing to visit a doctor is fraught with complications - dysplasia, malignancy, infertility.
findings
Ectopia on the neck is a common phenomenon that everyone can experience. If the pathology of the cervix is pronounced, this is a reason for urgent treatment. Refusal of therapy is fraught with the development of cancer, malfunctions of the reproductive system. It is possible to prevent the occurrence of uterine disease. To do this, you need to be examined by a gynecologist.
Ectopia of the cervix - displacement of the boundaries of the cylindrical epithelium on the vaginal part of the cervix.
SYNONYMS
False erosion, pseudo-erosion, endocervicosis, glandular erosion, glandular muscle hyperplasia.
ICD-10 CODE The ectopia of the cervix is not included in the ICD-10.
EPIDEMIOLOGY
Ectopia of the cervix is detected in 38.8% of the female population and in 49% of gynecological patients. The congenital form of cervical ectopia (including ectropion) is observed in 11.3% of women with this pathology. The maximum frequency (more than 50%) of the incidence of cervical ectopia is observed in nulliparous women under 25 years of age.
PREVENTION
To prevent the development of cervical ectopia, you need:
prevention, timely diagnosis and treatment of inflammatory processes of the genital organs;
timely correction of hormonal and immune homeostasis disorders;
promotion of a culture of sexual relations;
abortion prevention (rational contraception).
SCREENING
They don't carry out.
CLASSIFICATION
In the modern colposcopic nomenclature adopted at the VII International Congress in Rome (1990), ectopia (columnar epithelium) is referred to point I: “normal findings of a colposcopic examination”. The absence of cervical ectopia as a pathology in the ICD-10 and its classification as normal data in the colposcopic nomenclature implies uncomplicated forms of cervical ectopia, which is a physiological condition.
ETIOLOGY
In adolescents and patients of early reproductive age, cervical ectopia is considered as a physiological condition associated with relative hyperestrogenism. The appearance of cervical ectopia during pregnancy is also considered a physiological condition associated with changes in ovarian function.
Acquired ectopia of the cervix is considered as a polyetiological disease due to the influence of a number of factors.
There are exogenous and endogenous factors that contribute to the development of cervical ectopia. The exogenous factors include: infectious, viral (early onset of sexual activity, a large number of sexual partners, a history of inflammatory processes in the genital organs) and traumatic (cervical injuries during childbirth and abortion, the use of barrier methods of contraception).
Endogenous factors include: violation of hormonal homeostasis (menarche earlier than 12 years, menstrual cycle and reproductive function disorders), changes in the immune status (presence of chronic extragenital and gynecological diseases, occupational hazards).
The factor of hereditary predisposition, the possible influence of COCs and smoking on the development of cervical ectopia is still being discussed.
PATHOGENESIS
The pathogenesis of cervical ectopia is not well understood.
In the prenatal period, the process of displacement of the cylindrical epithelium behind the internal os is considered a normal stage in the development of the cervix. As a rule, when a woman reaches reproductive age, the border of the cylindrical and stratified squamous epithelium is not visible during a gynecological examination. However, ectopia can persist in early reproductive age, especially in women with menstrual irregularities (against the background of relative hyperestrogenism).
Ectopia of the cervix is considered a congenital, as a rule, a temporary physiological condition, they are not dangerous in terms of malignancy and do not require treatment.
The formation of acquired ectopia of the cervix occurs under the influence of endogenous and exogenous etiological factors, which include mechanisms that support the pathological differentiation of the reserve cells of the cervix into the cylindrical epithelium.
CLINICAL PICTURE
The diagnosis of congenital ectopia of the cervix is established at the first visit to the gynecologist of a woman who has recently begun sexual activity.
When making a diagnosis of acquired ectopia of the cervix, its appearance on a previously unchanged cervix is taken into account.
Colposcopic manifestations of early recurrent ectopia of the cervix are detected 2-3 months after treatment, late - after 6 or more months. Early recurrent ectopia of the cervix is considered the result of inadequate treatment. However, if this is an uncomplicated form, is it worth talking about relapse and inadequacy of therapy?
The uncomplicated form of cervical ectopia does not have specific clinical manifestations, and most often it is diagnosed during a preventive gynecological examination.
A complicated form of cervical ectopia is observed in more than 80% of cases. In a complicated form, ectopia is combined with inflammatory, precancerous processes of the cervix. When combined with a violation of the epithelial-stromal relationship of the cervix, cervical ectopia is interpreted as an ectropion. In the presence of concomitant inflammatory processes of the lower genital tract, patients complain of leucorrhea, itching, dyspareunia, and rarely contact bleeding. Often the reason for contacting a gynecologist is menstrual irregularities, infertility.
DIAGNOSTICS
PHYSICAL EXAMINATION
To diagnose ectopia, an examination of the cervix using mirrors is used. Around the external pharynx, in the presence of this pathology, an ectopia is detected, which has the appearance of a spot with irregular outlines from pale pink to bright red.
LABORATORY RESEARCH
Apply cytological examination. For ectopia of the cervix, the following variants of cytological conclusions are most characteristic:
cytogram without features (cells of the squamous epithelium of the surface and intermediate layers);
proliferation of cylindrical epithelium;
cytogram of endocervicosis (corresponds to the clinical diagnosis of cervical ectopia). With a complicated form of cervical ectopia, the following variants of cytological conclusions are most characteristic:
inflammation cytogram;
cytogram of leukoplakia (dyskeratosis) or dysplasia (CIN) of varying severity.
Bacterioscopic, bacteriological methods, PCR are also used.
They study the functions of the ovaries: conduct tests of functional diagnostics, examine the hormonal status (according to indications).
Make an immunogram (according to indications).
INSTRUMENTAL STUDIES
To diagnose cervical ectopia, an extended colposcopy is performed. Congenital ectopia of the cervix is represented by areas of cylindrical epithelium with uneven contours. A feature of physiological ectopia (the physiological location of the junction in young women outward from the external pharynx) is considered to be clear boundaries between the flat and cylindrical epithelium.
Acquired ectopia of the cervix is represented by a cylindrical epithelium in various combinations with a transformation zone. Cylindrical epithelium is a cluster of rounded or oblong papillae of bright red color. The normal transformation zone against the background of the bright surface of the cylindrical epithelium is visible in the form of pale gray tongues of stratified squamous epithelium, while open and closed gland ducts may occur. On the surface of the closed ducts of the glands, a pronounced vascular network is often visible. In more than 40% of patients with acquired ectopia of the cervix, along with the cylindrical epithelium and the normal transformation zone, abnormal colposcopic signs are detected: leukoplakia, puncture, mosaic, iodine-negative zones.
Targeted biopsy of the cervix and curettage of the cervical canal with histological examination are indicated when atypical cells are detected on cytological examination and / or in the presence of abnormal colposcopic signs. The most frequent histological conclusions in congenital ectopia of the cervix: glandular papillary pseudo-erosion, with an uncomplicated form of acquired ectopia of the cervix: glandular pseudo-erosion, epidermizing pseudo-erosion. With a complicated form of cervical ectopia, any variants of histological conclusions are possible, characteristic of CIN of varying degrees against the background of cervical ectopia.
DIFFERENTIAL DIAGNOSTICS
Differential diagnosis is carried out with:
True erosions of the cervix.
INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS
Consultation and treatment with an oncogynecologist is necessary in case of a combination of cervical ectopia with CIN III degree.
A consultation of a gynecologist-endocrinologist is indicated in case of complex hormonal disorders.
EXAMPLE FORMULATION OF THE DIAGNOSIS
Ectopia of the cervix, uncomplicated form.
Uncomplicated forms of cervical ectopia do not require treatment. Dispensary observation is shown in order to timely identify deviations in the clinical course.
The tactics of treating patients with complicated forms of ectopia of the cervix, combined with leukoplakia, CIN I-II degree are described in the sections devoted to these diseases.
Patients with complicated forms of ectopia of the cervix, combined with CIN III degree, are subject to treatment by an oncogynecologist.
GOALS OF TREATMENT
The goals of treatment for cervical ectopia:
elimination of concomitant inflammation;
correction of hormonal and immune disorders;
correction of microbiocenosis of the vagina;
destruction of pathologically altered tissue of the cervix.
INDICATIONS FOR HOSPITALIZATION
Hospitalization is indicated for cervical biopsy.
NON-DRUG TREATMENT
Destructive methods of treatment are necessary for complicated forms of cervical ectopia. For the destruction of pathologically altered tissue of the cervix, cryodestruction, laser coagulation, and radiosurgery are used.
The choice of treatment method corresponds to the pathology with which cervical ectopia is combined.
MEDICAL TREATMENT
It is necessary to carry out etiotropic anti-inflammatory therapy according to the schemes generally accepted in clinical practice, correction of the vaginal microbiocenosis, correction of hormonal disorders, correction of immune disorders.
SURGERY
Surgical methods of treatment are used in cases where ectopia is combined with CIN II-III degree and with cervical deformity.
APPROXIMATE TIMES OF INABILITY TO WORK
Sexual activity after a biopsy of the cervix is possible after 4 weeks, after the use of destructive methods of treatment - after 6-8 weeks.
FURTHER MANAGEMENT
Dispensary observation of patients with uncomplicated form of cervical ectopia: examinations once a year with colpocytological and bacterioscopic studies.
After destructive methods of treatment, examination of the cervix and colposcopy is carried out no earlier than after 6 weeks.
Dispensary observation of treated patients with complicated forms of cervical ectopia, combined with cervical leukoplakia and CIN - see sections "Cervical leukoplakia" and "Cervical dysplasia".
INFORMATION FOR THE PATIENT
Pathological changes in the cervix in most cases are asymptomatic. Regular preventive examinations are required (1 time per year).
The prognosis for cervical ectopia is favorable.
Content
Often, during a vaginal examination, a gynecologist visualizes a small hyperemic area in a woman on the integumentary epithelium of the cervix. Outwardly, this focus resembles erosion, but histological examination establishes an ectopia of the cylindrical epithelium. This disease can occur in women of any age, during pregnancy and while taking oral contraceptives. What is the reason for the ectopia of the cylindrical epithelium of the cervix, and what negative consequences can be obtained without starting treatment on time?
The concept of ectopy
Between the body of the uterus and the vagina is the neck, which unites them together. It is covered from the inside with a special cylindrical epithelium. Very often, a patient can detect changes in the mucous layer of the cervix during a gynecological examination. Doctors immediately diagnose "erosion". Although in fact, true erosion on the neck is very rare, since the duration of the existence of the true form is no more than 2 weeks. It is initiated by infectious inflammation and is a wound - the result of the active action of microorganisms. In the vast majority of cases, hyperemia of the cervical area is pseudo-erosion or ectopia.
Ectopic columnar epithelium - what is it? This process is the transition of a section of the cylindrical epithelium to the vaginal part of the cervix from the cervical canal.
The disease occurs in half of the female population, very often it can be congenital. If treatment is not started on time, then the likelihood of the degeneration of ectopia into cancer increases several times. Ectopia is especially dangerous with the parallel circulation of the human papillomavirus with a high risk of carcinogenesis.
Development process
The cervix, with its normal anatomical structure, is covered with several types of epithelial tissue: flat and cylindrical (glandular) epithelium. They also vary in color from pale pink to red.
As a rule, the columnar epithelium should be located directly in the cervical canal. With ectopic glandular epithelium, it extends beyond the boundaries of the canal region and covers the vaginal part.
Causes
Ectopic columnar epithelium of the cervix can be caused by the following factors:
- Inflammatory processes of the genital organs. In this case, persistent fungal, bacterial or viral infections can provoke ectopia. As a result of inflammation, a true erosion forms in a woman, which heals incorrectly without restoring normal squamous epithelium, and a cylindrical appearance forms at the site of the wound. As a result, the squamous epithelium is replaced by a cylindrical one, and the patient receives a diagnosis of ectopia.
- Injuries of the cervix and vagina. This item includes injuries during childbirth, curettage, operations, indelicate sexual life.
- Imbalance of hormones in a woman's body. This can be caused by taking hormonal contraceptives, which disrupt the full function of the ovaries.
- Low level of local immune response. This can be caused by the onset of sexual activity at an early age, frequent abortions and childbirth, a large number of sexual partners.
- High levels of the hormone estrogen in a woman's body.
- Congenital ectopia occurs in girls before sexual activity and is considered the norm among gynecologists, but is subject to careful observation.
Symptoms
This disease occurs without the presence of clear symptoms, in rare cases, a woman may observe bleeding after intercourse or for no reason.
In pregnant women, ectopia of the cylindrical epithelium of the cervix occurs due to changes in the level of hormone production in the body; after delivery, it disappears on its own.
With advanced forms, the following symptoms may occur:
- discharge of the former color and constant itching (in the case of a concomitant inflammatory process);
- burning, discomfort;
- infertility.
As a rule, the more pronounced the symptoms of the disease, the more extensive the area of the neck is involved in the pathological process. If ectopia is accompanied by an infectious process, the discharge becomes mucopurulent in nature and is often abundant.
Diagnosis of the disease
A doctor can diagnose ectopia during a gynecological examination. In the case of a congenital form of the disease, the diagnosis is made at the first visit to the gynecologist. With the acquired form of ectopia of the cylindrical epithelium, the doctor may note the formation of a small area of various shapes, bright red in color, when pressed on it, blood appears. In this case, an additional examination using a colposcope is performed.
Mandatory analyzes are:
- Schiller's test;
- taking a smear for bacteriological culture;
- PCR diagnostics of discharge and cervical smear, including HPV spectrum;
- Pap test or cytological analysis of a smear from the vagina and cervix.
Without fail, the doctor takes a scraping for cytology to identify possible atypical or inflammatory process, as well as for the identification of squamous and columnar epithelial cells.
If, after a series of studies, an abnormal developmental process or ectopia was diagnosed, then a biopsy is taken from the patient from the affected area on the neck for further study by specialists of the histological laboratory.
At the same time, the doctor may prescribe blood donation for the level of sex hormones in the body, with an increased content of them, a consultation with a gynecologist-endocrinologist is mandatory.
Treatment
With a congenital form of ectopia of the cylindrical epithelium of the cervix, treatment is not carried out, but the girl is observed in dynamics.
If an abnormal process is detected, they immediately begin combined treatment. With complex forms of ectopia of the cylindrical epithelium, a woman is given complex therapy with the appointment of drugs that relieve inflammation, suppress a viral infection, the correct contraceptives are selected, the correct hormonal background is established, and a course of immunomodulators is prescribed.
After taking the course of the necessary drugs, doctors destroy the affected area on the neck using the following methods:
- laser destruction;
- action of liquid nitrogen;
- destruction by substances of chemical origin;
- radiosurgical methods of exposure.
If concomitant pathologies are identified, complex treatment is carried out with surgical intervention and subsequent hormone therapy.
Prevention
To prevent the development of this disease, a woman must definitely visit a gynecologist 1-2 times a year, monitor the level of hormones in the body, have a regular sex life, follow the rules of personal hygiene, exercise regularly, get rid of bad habits and take vitamins to strengthen the immune functions of the body .
To identify the possible onset of the development of a background or precancerous process on the neck, girls and women must take a smear for cytological studies annually (you can take it on any day, except for menstruation).
It must be remembered that ectopia refers to the background state of the patient's reproductive tract. The disease is completely curable and does not leave consequences with timely therapy.
Danger and Consequences
With ectopic columnar epithelium, the patient may be accompanied by unforeseen bleeding. It is always disturbing and scary. Doctors reassure and claim that cervical ectopia may be accompanied by discharge with blood, but such symptoms are eliminated during treatment.
The only possible complication is considered to be the development of dysplasia, leukoplakia and malignancy. But such processes rarely occur. Ectopia can be aggravated by HPV activation or infection. In the presence of local dysbiosis, various inflammatory diseases of the genital organs, violations of the production of hormones by the ovaries, favorable ground is created for the transition of ectopia to dysplasia. Therefore, with any changes in the nature of the discharge, sensations, it is necessary to seek advice from a gynecologist, he will select a quality treatment. It is not recommended to delay this process, and even more so to self-medicate.
Rebirth of ectopia columnar epithelium in cancer is rarely recorded.
It must be remembered that the ectopia of the cylindrical epithelium (pseudo-erosion) is a disease of a benign nature. In most cases, doctors do not perform a radical intervention in the form of excision of the affected area. When ectopia is detected, drugs are prescribed that eliminate the possible cause of the development of the disease (hormones, other types of contraceptives, immunomodulators, antibiotics, antiseptics and antiviral agents). However, if infectious and inflammatory processes join the ectopia, then this should cause concern in a woman. In this case, it is recommended to start timely treatment to prevent deterioration of the patient's condition.
Modern diagnostic equipment makes it possible to identify the smallest pathologies of the female genital organs, which were previously difficult to see visually, and even more difficult to differentiate.
And if a couple of decades ago, patients were diagnosed with erosion, then with the widespread use of colposcopy, it became possible to differentiate the pathology.
As it turned out, in some cases, doctors are faced with ectopia of the cervix, which has rather than erosion.
What is ectopia
Cervical ectopia of the cervix is an abnormal arrangement of cylindrical epithelium that extends beyond the boundaries of the cervical canal.
The disease, in fact, is not an erosion, since the integrity of the tissue is not damaged.
Normally, the epithelium should line the cervical canal from the inside, and not from the outside.
But with this violation, the cervical epithelium extends to the outer part of the neck, going beyond the boundaries of its physiological location.
Ectopic columnar epithelium is quite common among women. Four out of ten patients have some type of disorder, and one in ten it is congenital.
Most often, the disease is diagnosed in women under thirty years of age.
During pregnancy
During the period of bearing a baby, a woman's hormonal background changes significantly, which may well provoke the appearance of violations.
This situation is considered as a variant of the norm, and in the absence of other pathologies of the female genital organs, you should not worry about the presence of this disease.
With cervical ectopia, both pregnancy and childbirth can proceed quite normally, without posing a threat to the health of the mother or fetus.
In addition, the appearance of a red spot on the neck is a consequence of the normal preparation of the body for the birth of a child.
After the baby is born, there will be no trace of the pathology - the tissue of the epithelial layer will return to normal on its own, without medical intervention.
The violation does not cause any specific specific signs in pregnant women. The place does not bleed, does not hurt, does not itch.
It is possible to detect the appearance of a cylindrical epithelium in pregnant women on the surface of the cervix during pregnancy only by a gynecological examination or using colposcopy.
A violation can make itself felt if other deviations join it - inflammatory processes, cancerous degeneration of tissues.
Classification
In medicine, the following types of ectopia of the cylindrical epithelium of the cervix are distinguished:
- The congenital form of cervical ectopia - in fact, is not considered a pathology, it is usually diagnosed in adolescents. This species is not dangerous to health and is able to grow on its own.
- True erosion is a violation of the squamous epithelium, which in an acute form lasts from one to two weeks, and then turns into a kind of pathology. In this case, erosion with cervical ectopia are closely related. The disease can occur along with cervical ectopia of the cervix with chronic cervicitis. The difference - cervical erosion or ectopia - is damage to the mucous layer. With ectopia, it remains intact, and erosive processes contribute to its damage.
- Pseudo-erosion is a disease with a change in the stratified squamous epithelium. Symptoms of the pathology do not appear, so women do not complain about the presence of a deviation. It doesn't go away without treatment.
In addition to this classification, pathology is uncomplicated and complicated.
As for the first type, everything is clear here - the violation is not accompanied by other diseases, but the complicated pathology of the CE (cervical epithelium) is considered more closely - in the presence of cervical ectopia with squamous metaplasia, the risk of cell malignancy is high, and if vaginitis, colpitis, damage to the uterine tissue is diagnosed , then these pathologies are treatable, and you should not worry.
Symptoms
A congenital disorder is diagnosed at the first visit to the doctor, since it does not have specific symptoms.
Such cases are uncomplicated, and apart from the incorrect location of the columnar epithelium, the patient has no other abnormalities.
Signs of a violation appear if the process is complicated by any pathology. Usually, a complicated form of the disease occurs in eight out of ten patients who applied to the antenatal clinic with health complaints.
Most often, comorbidities are inflammation, as well as tissue malignancy, precancerous processes.
This causes pain, itching in women, hematuria is occasionally observed, intimate contact is accompanied by painful sensations.
Women do not think that it is dangerous, and they come for a consultation only when the menstrual cycle is disturbed or pregnancy does not occur for a long time.
Causes
Violation of the arrangement of the cylindrical epithelium in adolescent girls and women of early reproductive age is not considered as a disease provoked by puberty and the production of too much estrogen.
During pregnancy, the causes of cervical ectopia are also not associated with hormonal disorders.
In particular, doctors distinguish such exogenous causes:
- transmission of infectious or viral diseases;
- lack of a permanent sexual partner;
- inflammation of the genital organs;
- traumatic injuries as a result of childbirth or abortion;
- use of barrier methods of contraception.
The endogenous causes of glandular pathology include earlier onset of critical days, the influence of professional factors on the female reproductive system, and changes in the immune status.
Currently, the effect of oral contraceptives on the occurrence of violations is being investigated, but exact data have not yet been obtained.
cervicitis
The inflammatory disease cervicitis can provoke the disease.
The most common cause of the violation is the defeat of pathogenic microflora, such as staphylococci, streptococci, E. coli, Trichomonas. Very often, these two diagnoses are put together, because they are closely related.
An interesting feature is that even with the cure of the underlying disease, ectopia can be diagnosed for a long time.
In this case, a partially destroyed layer of the epithelium is visualized, which indicates the initial stage of erosion.
Diagnostics
You can see the damage to the epithelium of the cervix even with the help of examination with mirrors. Outwardly, pathology is an area of irregular shape near the external uterine os, which has a color from pale pink to bright red.
For a more detailed study, additional analyzes are carried out. First of all, a cytological examination is carried out, which should give a negative answer in terms of the presence of malignant cells.
In the laboratory, the results of the analysis may look like this - detection of cells without any features, signs of proliferation of the cylindrical epithelium, symptoms of endocervicosis.
The disorder is complicated by concomitant diseases, the analysis shows leukoplakia or dysplasia of varying degrees.
In addition to the mirror examination of the uterus, colposcopy, doctors can prescribe a bacteriological examination, a polymerase chain reaction, if necessary, they perform an analysis for hormones, an immunogram is made.
An extended colposcopy plays a decisive role in the diagnosis. With a congenital disorder, sections of the columnar epithelium have uneven edges, but clear boundaries with the squamous epithelium.
The acquired disease is represented by a cylindrical epithelium, transformed into clusters of bright red papillae.
The zone of degeneration of the epithelium is manifested by pale gray formations, and open ducts of the glands can be detected, and the vascular network is clearly visible on the closed ducts.
In almost half of the patients, in addition to these signs, there are also such abnormalities as leukoplakia, mosaic, iodine-negative areas that do not stain.
With complicated ectopia, signs of secondary pathology will be diagnosed. In women with suspected ectopia, the diagnosis of oncology and erosion is differentiated.
Treatment
In uncomplicated forms of ectopia, treatment is not carried out. Such patients are only observed at the dispensary in order to identify possible deviations in time.
Treatment of cervical ectopia with complications is carried out in order to eliminate inflammation, correct immune dysfunctions, restore vaginal biocenosis, and destroy pathologically degenerated tissue.
In nulliparous doctors try to use conservative methods. To eliminate the symptoms of ectopia, it can be treated on an outpatient basis, it will only take a short stay in the hospital to take a biopsy.
Medications
As medicines, doctors advise the use of general strengthening drugs, means for correcting the immune status, hormonal drugs to normalize the functioning of the female genital organs.
Women are prescribed vitamins and minerals.
Conservative therapy
Conservative treatment is used to cauterize the ectopic area. Solkovagin is used as a preparation - a solution of acids and zinc citrate.
As a result of surface treatment, tissue destruction occurs at a depth of 2.5 mm, which allows you to start regeneration processes, and a zone of healthy epithelium is formed in the patient.
Polycresulen solution has a similar effect.
Surgical intervention
With ectopia, surgical treatment of the pathology is also possible. These methods include:
- cryodestruction - exposure to the affected area with low temperatures (about 180 degrees below zero);
- laser vaporization - removal of the affected area using a laser machine;
- radio wave surgery - treatment of a pathologically altered area with thermal energy, resulting in the evaporation of individual areas.
Each of these methods has its advantages and disadvantages, the choice is made depending on the severity of the pathology and the rationality of the use of such treatment.
Complications
Ectopia of the cervical epithelium can provoke health complications in women if the disorder is diagnosed along with serious inflammatory pathologies.
Also, during incomplete treatment, ectopia can present unpleasant surprises. Complications of pathology are:
- the occurrence of flat warts;
- dysplastic disorders;
- leukoplakia;
- cervicitis.
To avoid complications, it is necessary to diagnose the pathology in time and cure it to the fullest. To prevent recurrence, it is important to follow preventive measures.
Prevention
In order to prevent ectopia, it is necessary to promptly identify and treat all inflammations of the female genital organs, to achieve a complete cure for infectious diseases.
It is important to correct the hormonal background, immune status.
It is important for women to be aware and adhere to the culture of sexual relations, to resort to rational contraceptive methods in order to avoid abortions.
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