Gynecologist ectopia. Ectopia of columnar epithelium: main signs and therapy. What is “cervical ectopia”

Cervical ectopia is an atypical localization of cuboidal (cylindrical) epithelium, which lines the inner part of the cervical canal, on the vaginal part of the cervix; during normal development of the body, it is covered with flat epithelium. If ectopia of the uterus is not complicated, then it does not give a clinic; if they are present, then there is a possibility of bleeding, dyspareunia, itching in the genital area, and leucorrhoea. This disease can be diagnosed during a gynecological examination, and the diagnosis is clarified through the use of extended colposcopy, cytological analysis scraping and, if necessary, biopsy.

First of all, you need to find out what cervical ectopia of the cervix is, and only then move on to the specifics of treating this disease. The following terms are used to refer to the disease in gynecology: endocervicosis, false erosion, glandular muscle hyperplasia, pseudo-erosion. In the normal state of the body, the vaginal part of the uterus, which can be examined without the use of electronic equipment, is covered from the outside by a multilayered squamous epithelial layer, but inner part The cervical canal is lined directly with columnar epithelium.

Ectopic cervix

During the development of this disease, the border of the transition of cylindrical to squamous epithelium shifts towards the external pharynx, localizing locally or along its circumference. Ectopia is determined in 40% of the fairer sex, and in 11.3% of patients this feature passes into the congenital stage. The maximum incidence of cervical ectopia (approximately 45%) is diagnosed in women under 30 years of age. The disease is fraught with serious complications, however, ectopia itself can never lead to cervical cancer, although the disease increases the likelihood of such serious consequences.

By origin, acquired and congenital ectopia of the cervix can be distinguished. Pseudo-erosion can have a recurrent course, while the clinical form is complex and significantly complicated. Modern calposcopic nomenclature is able to consider uncomplicated ectopia of the cervix as a normal phenomenon and one of the variants of the physiological condition. If there are complications of ectopia, care should be taken for treatment; ectopia of the cervix in this case will be accompanied by cervicitis and colpitis.

With the loss of the relationship between stromal and epithelial cells, ectopia can be considered as ectropion. Histologically, there are papillary, glandular ectopia of the cervix, as well as pseudo-erosion along with squamous metaplasia. With the glandular variety, the accumulation of glands with fairly branched glandular ducts and manifestations of the inflammatory process are determined. In the presence of papillary ectopia, there is a possibility of proliferation of stromal elements and the formation of papillary structures that are covered by columnar epithelium.

Regeneration of cervical ectopia may be accompanied by reverse pinching of the columnar epithelium by cells of squamous mature epithelium, that is, the formation of a transformation area. Spare cells will be involved in this process; as a result of differentiation, they first turn into immature and then into metaplastic epithelium of the mature type.

The implementation of colcoscopy allows you to find the difference in completed and unfinished areas of transformation. If adverse effects are present, then cellular metaplasia may break off, causing recurrence of cervical ectopia. If there is an overlap of the metaplastic layer of cells at the mouth of the cervical glands, Nabothian cysts are formed, that is, retention-type cervical cysts.

Before starting treatment, it is necessary to determine the reasons for the ectopia of the columnar epithelium of the cervix. This is very important because this information used in the treatment of this disease. Further treatment therapy directly depends on the factor that led to the occurrence of this pathological condition. Let's look at each reason in more detail, they include the following factors:

Hormonal disbalance. This is one of the main causes of ectopia, the fact is that the problem does not occur at all in girls during menopause, and approximately 50% of all women of reproductive age had problems with this pathology. As a result of such observations, it was possible to establish that changes in the cylindrical epithelium are carried out under the influence of various hormones. In this case, it will not lead to a slow inflammatory process, because the mucous membranes of the cervix are not damaged. A prerequisite for the appearance of cancer is only the area of transformation of the epithelium.
Inflammatory process in the cervix area. The presence of sexually transmitted diseases, as well as cystitis in a recurrent form, adnexitis and other stages of inflammation of the elements of the reproductive system, leads to exfoliation of the squamous epithelium on the external os of the cervical canal. Inflammation does not disappear anywhere; on the contrary, the process of its progression continues. This course makes the cervix quite vulnerable to the occurrence of cancer: on the surface you can notice not only the transformation zone, but also a sluggish inflammatory process.
Mechanical injury. A non-healing wound may occur on the surface of the cervical canal, which may be a consequence of violent sexual intercourse, the result of birth injuries, or a consequence of the use of vaginal contraception or candles. In this case, cervical ectopia poses a danger not only due to the degeneration of epithelial cells into cancerous ones, but also due to the lack of protection against various infectious diseases.

There may be several reasons for the appearance of cervical ectopia

Each of the above factors leads to the occurrence of this disease. You first need to determine the exact cause of this condition, and only then move on to treating the problem.

Treatment

Colcoscopy is used as a diagnostic measure for ectopia. There are two types of examination: conventional and extended colposcopy. As a rule, to clarify the exact diagnosis, it is enough to conduct a simple examination using gynecological speculum.

In situations where a specialist needs to determine the type of ectopia, extended type colposcopy is used, in which the pathologically altered area of the cervix is examined under several times magnification using a colposcope.

Modern therapeutic measures include a large number of methods to combat erosion. Some of them do not have scars, so they are suitable for those representatives of the fairer sex who wish to become pregnant in the future. For this reason, you need to choose the method that your doctor recommends, but he needs to know exactly about your future plans. For treatment the following are used:

radio wave surgery;
cryodestruction;
thermocoagulation;
laser destruction.

Each of these methods has a number of positive aspects and shows good results in the treatment of such a complex disease. The choice of a specific method depends on various factors, primarily on the cause of the pathology, the degree of damage to the body, the woman’s age and desire to become pregnant in the future. Ectopia of the cylindrical epithelium of the cervix, like ectopia, is a rather dangerous problem, since at any moment it can acquire a malignant nature, which is fraught with serious consequences. At the same time, a large number of women face this problem; if there are no complications and reproductive functions are realized normally, then there is no reason to worry, and experts do not recommend resorting to radical treatment.

Ectopia is a harmless condition in which the tissue of the cervical canal is shifted towards the vaginal part of the uterus. Bias various types epithelial tissue leads to a characteristic clinical picture, which is immediately visible during a gynecological examination. Synonyms for the disease are pseudo-erosion, endocervicosis, ectopia of the cervical epithelium.

Now let's look at this in more detail.

What is “cervical ectopia”?

The cervical canal of the cervix and its surface, which faces the vagina, are lined different types epithelial tissue. In some cases, the anatomical structure is disrupted and the epithelial layer in the canal moves closer to the vagina. This condition is found in 40% of women. If the patient's age is less than 30 years, ectopia is not considered a pathology. Ectopia itself is harmless and does not cause cervical cancer, but against the background of it, the likelihood of other pathologies, including malignant tumors, increases.

Ectopia is classified according to:

Origin – congenital and acquired.
The course – complicated and uncomplicated.
Histologies – glandular, papillary, metaplastic.

Treatment of ectopia is not always necessary. If it is carried out, then healing of the cervix occurs due to the formation of a transformation zone - the replacement of columnar epithelium with flat epithelium.

During a gynecological examination using a mirror or colposcope, the boundaries of the two types of tissue are clearly visible. The cervical epithelium is like a red spot that is located in the center of the cervix. Its size depends on the severity of ectopia and the area of tissue displacement.

Doctors consider most cases of ectopia to be the normal physiological state of a woman. Treatment is carried out in complicated forms, when tissue displacement is accompanied by infection or inflammatory processes (colpitis, cervicitis).

The exact causes of ectopia are unknown. In some cases, it occurs due to hormonal imbalance, but can also occur in healthy women.

Types of cervical ectopia

It is very important to correctly determine the type of anatomical disorder in order to predict possible consequences and understand whether there is a threat to the woman’s health. Doctors distinguish the following types of ectopia:

Congenital ectopia. Diagnosed in young girls, it is a congenital physiological condition. Such ectopia does not pose a health risk and may disappear on its own over time.
True erosion. The shift of epithelium occurs as a result of the inflammatory process, which appears when the integrity of tissues is violated. True erosion on examination also looks like a red spot, but it has areas of damage and bleeding.
Pseudo-erosion or ectopia itself. Ectopia, in contrast to true erosion, is only a displacement of the epithelial layers and is not accompanied by tissue damage. The absence of inflammation and bleeding causes the latent course of ectopia and the absence of complaints in the woman.

Ectopic cervix during pregnancy

In many pregnant women, the doctor diagnoses ectopia, which usually frightens the expectant mother. In fact, ectopia, unlike erosion, is not dangerous for a pregnant woman and can be considered a variant of the physiological norm. One of the reasons that leads to displacement of the columnar epithelium is a change in hormonal levels. This is exactly what happens during pregnancy, leading to characteristic changes in the cervix. In most cases, after childbirth, the cervical tissue is restored and returns to its place.

Ectopia during pregnancy does not cause uncomfortable symptoms in a woman if it has an uncomplicated course. If there are minor injuries, inflammation or degenerative changes, treatment will be required to ensure a normal birth process and protect the health of the unborn child. Erosion, unlike ectopia, can adversely affect the formation of the fetus, since it has increased likelihood infection.

If a pregnant woman is diagnosed with true ectopia without tissue damage, treatment is not carried out. However, after giving birth, during a routine examination, the doctor assesses the condition of the cervix and if the process turns into erosion, then treatment will be required.

There are no definitive ways to prevent the disease. The likelihood of developing ectopia depends on individual characteristics women. However, in order to avoid more serious pathologies with an inflammatory process, it is recommended to prepare for pregnancy in advance and treat existing diseases before conception.

The first signs of cervical ectopia

True ectopia without an inflammatory process is asymptomatic. During a routine examination with a gynecologist, a woman can find out about the displacement of cervical tissue. Ectopia is often diagnosed in nulliparous women up to 25 years old. This condition does not require treatment and can go away on its own after childbirth.

Under the influence of unfavorable factors, the cervical epithelium can be injured, which will lead to the development of erosion or complicated ectopia. In this case, the woman will experience unpleasant symptoms from the genital organs, and there will be a need to visit a gynecologist.

Symptoms of cervical ectopia

With physiological non-infectious ectopia, symptoms may be absent. If microtraumas, inflammation or infection appear on the cervix, characteristic symptoms. Possible manifestations of ectopia or signs that require contacting a doctor for a more detailed examination:

increased amount of daily discharge;
itching and burning sensation;
bleeding after sexual intercourse;
traces of blood on underwear during the intermenstrual period;
unpleasant odor or change in color of vaginal discharge;
menstrual cycle disorders.

During a gynecological examination, a characteristic clinical picture appears - a red spot in the center of the cervix, which is a cylindrical cervical epithelium.

The difference between ectopia and erosion

Many women believe that ectopia and erosion are the same thing. These are two completely different conditions that require different treatment approaches, so determining which one you are diagnosed with is very important.

With ectopia, the tissue of the cervical canal shifts closer to the vagina, which leads to eversion of the inner layer and its visualization during a gynecological examination. The mechanical shift of the epithelium itself is not dangerous and may not affect the quality Everyday life women.

With erosive lesions, injury to the mucosa and disruption of its integrity are observed. This is accompanied by an inflammatory process, and often infection. Simultaneously with erosion, a woman may be diagnosed with colpitis. Erosion requires treatment and during pregnancy can pose a danger to the health of the fetus; an infection develops at the site of inflammation.

Causes and prevention of cervical ectopia

The exact reasons for the development of ectopia are unknown. The most likely factors that lead to displacement of the columnar epithelium are:

Hormonal disorders. The period of puberty, pregnancy or pathological hormonal imbalances lead to various diseases cervix. In such conditions, the symptoms may not be clearly expressed, which is why the woman consults a doctor in the later stages. To detect changes in a timely manner, it is recommended to undergo preventive examinations once a year. Physiological ectopia can be observed even in young girls who are not sexually active. In some cases, hormonal disorders may occur due to the incorrect selection of oral contraceptives.
Early or multiple sexual contacts. Frequent sexual intercourse or sex at a young age with an immature cervix leads to injury and abrasions. Mechanical damage causes an inflammatory process, then erosion and ectopia. A pathogenic pathogen can enter the wound surface, and with reduced immunity, the own bacterial flora of the genital tract can become active, which will lead to infection and the need for treatment.
Inflammatory processes in other areas of a woman’s genital area can spread to the cervix and eventually lead to ectopia.
Mechanical damage. These include abortions, diagnostic measures, experiments during sex, and childbirth.

To preventive measures that will help avoid the appearance of ectopia or identify it on early stages, relate:

annual visit to the gynecologist;
maintaining personal hygiene;
protected sexual intercourse (condoms are the method of protection);
absence of abortions;
no sexual intercourse under 18 years of age;
intimate relationships with a regular partner.

The general prognosis for cervical ectopia is favorable. The disease does not threaten the patient’s life, but should not be ignored in order to prevent complications.

Diagnostics

If the ectopia is congenital, the patient will learn about it at her first visit to the gynecologist. In the future, she only needs to undergo annual examinations to monitor the dynamics of the condition.

During a gynecological examination, a bright red focus of ectopia is discovered on the woman’s cervix. The area may bleed slightly when touched. The diameter of the redness can vary, up to completely covering the surface of the cervix.

A mandatory test is colposcopy. This is a visual gynecological examination using a special device that has multiple magnification. It allows you to examine in detail the condition of the cervical tissue, determine the affected area and structural changes. It is colposcopy that makes it possible to distinguish columnar epithelium from squamous epithelium, and, accordingly, to distinguish erosion from ectopia.

The doctor always asks the patient about the presence of complaints and prescribes several studies in order to understand the full clinical picture. The duration of the onset of symptoms or its absence also has important diagnostic significance.

In addition to a visual examination, the doctor prescribes the following studies:

A smear to check for infection. This will allow you to find out whether the ectopia is complicated, and what line of therapy should be the main one. The smear determines the amount of opportunistic flora, as well as pathogens that cause sexually transmitted diseases.
Smear for cytology. It is used to examine columnar and squamous epithelial cells and identify signs of inflammation.
Biopsy. If pathological structural changes in the tissue are suspected, for example, destructive or malignant formations, the doctor submits a piece of cervical tissue for analysis.
Scraping from the surface of the cervix for oncocytology.

If, during diagnosis, abnormalities are detected in the patient (unstained areas, mosaic, leukoplakia), further detailed studies are required to exclude oncology.

Treatment of cervical ectopia

For uncomplicated ectopia, treatment is not carried out. The patient needs to visit a gynecologist 1 or 2 times a year to monitor the dynamics of changes in the cervix. At negative tests You can visit a doctor less frequently for atypia – once every two years.

If ectopia is accompanied by inflammation or infection, treatment is necessary. Therapy in this case will be aimed at eliminating inflammation, restoring immune defense and regenerating cervical tissue.

Treatment can be conservative or surgical. In nulliparous women, preference is given to the first methods. Medications that can be used include:

Antibiotics. The drug is selected depending on the isolated pathogen and its sensitivity.
Immunostimulants. They increase the body’s overall resistance to infection and prevent relapse after treatment.
Vitamins. Accelerate tissue restoration, normalize trophic processes.
Hormones. Hormonal therapy allows you to correct the female background and improve the functioning of the genital organs and the body as a whole.
Local remedies. One of the most widely used is Solkovagin. This is a solution that leads to the destruction of the affected tissue area and initiates regeneration processes to produce new healthy epithelium of the correct type. For mild lesions, other drugs that promote cell renewal may be prescribed.

If conservative treatment is ineffective or complicated ectopia is severe, the doctor may prescribe surgical intervention. It is based on the necrosis of the pathological area, which will lead to the removal of the affected cells and the appearance of a new healthy layer of tissue. Surgical techniques are carried out after eliminating the main cause of ectopia - infection, hormonal imbalance or another. First, the woman is prescribed antiviral therapy, hormonal contraception, antibiotics, and then one of the following methods can be used:

Electrocoagulation. A method that is now practically not used. It is based on cauterization of the cervix with electric current, which leads to deep burns and necrosis of the affected area of ectopia. The disadvantage of the method is that the effect of the current is quite strong and affects not only superficial tissues, but also deeper ones, which may be healthy. The degree of tissue heating under the action of current is almost impossible to control, which makes electrocoagulation an inaccurate and unpromising method. After charring of the epithelium, a rough scar is formed, which takes a long time to heal. This method is not recommended for women who are still planning a pregnancy.
Cryotherapy. The essence of the method is the same - the affected tissues are killed for subsequent natural restoration. Here they are exposed to liquid nitrogen. Cold injury affects several layers of the epithelium, and the degree of exposure cannot be controlled. The method is gradually becoming a thing of the past and is now used quite rarely. Not recommended for women who are still planning pregnancy.
Argon plasma coagulation. Using high-frequency current, the doctor acts on the affected tissue using a non-contact method. This makes it safer and also allows it to be used by nulliparous women. In this case, tissue charring does not occur, and the depth of the lesion is no more than 3 mm. The crust that remains after treatment is very thin and elastic, so healing and tissue restoration occurs quickly.
Radiofrequency electrosurgery. Tissue excision also occurs under the influence electric current, however, the principle of operation is slightly different. With this method, the cellular fluid evaporates, rather than the cells themselves being destroyed. Thermal destruction of surrounding tissues does not occur, due to which the area heals without scar formation and quite quickly. This is the method used by the well-known Surgitron device, which is offered for treatment in many medical clinics.

Complications

Advanced ectopia can lead to erosion and inflammation. They, in turn, will spread to neighboring areas, causing other diseases of the woman’s genital area. Complications include:

the appearance of condylomas in the presence of human papillomavirus infection;
leukoplakia;
tissue atrophy;
development of the epithelium into a malignant formation;

Quite often, women turn to a gynecologist with complaints about the diseases described above. This occurs due to inattention to one’s health, lack of regular medical examinations and neglect of ectopia.

Although doctors are trying to replace the term “pseudo-erosion” with the more modern “endocervicosis” or “ectopia of the columnar epithelium of the cervix,” the disease is still often called in the old fashioned way, which gives rise to excessive fears and negativity among patients.

There is no need to be afraid; often the disease does not even need to be treated.

What is endocervicosis?

The term “ectopia” is used when an organ or tissue is displaced to an unusual location.

Normally, the cervix of the uterus (cervix) faces the vagina with a surface covered with squamous epithelium, but with ectopia, areas around the pharynx are replaced by columnar epithelium, which belongs in the channel and not on the surface.

Outwardly, it looks like a red spot.

Increasingly, modern medicine is inclined to consider such physiological manifestations as a normal physical condition, since around the cervical cervix canal the cylindrical and squamous epithelium periodically shift each other in one direction or in the opposite direction.

Pseudo-erosion up to 25 years of age:

girls during puberty;
young women using hormonal contraception;
during pregnancy.

In the following video clip, the gynecologist talks in detail about cervical ectopia:

Differences between true and pseudo-erosion of CMM

True and pseudo-erosion of cervix are different diseases.

If, with endocervicosis, there is a displacement of the position of the cylindrical epithelium (the inner lining of the cervical canal extends beyond its limits without symptoms of inflammation and disruption of tissue integrity), Erosion causes thinning of the squamous epithelium, lining the cervix from the outside, i.e. in the vaginal part of the organ.

Later, cracks and sores appear in these areas.

Endocervicosis can be located not only around the external pharynx of the cervical canal, but also on the anterior or posterior lip of the cervical cavity, manifesting itself there in various sizes and shapes.

The real one appears only around the external pharynx of the cervix, and is the result of inflammation caused by pathogenic microorganisms such as staphylococci, gonococci, etc.

Prevalence in women

The spread of prevalence rates of cervical pseudo-erosion is wide - from 10 to 25 percent.

Some sources indicate the appearance of pathology in almost every 2nd woman under 40 years of age.

After this age, endocervicosis does not develop. In 40% of cases, the problem occurs in completely healthy women.

Causes

Information about the disease is contradictory.

It is classified as dishormonal, but the role of estrogens, hormones that promote the development of women’s reproductive abilities, is not fully understood.

The roles of birth injuries and inflammatory diseases of the genitals are also poorly studied.

It is noted that The disease can be either congenital or acquired:

the acquired form has many causes, external and internal; they are conventionally divided into the consequences of injuries and hormonal dysfunction;
associated with abnormalities in the hormonal function of the ovaries.

Uncomplicated pseudo-erosion develops when the mechanism of hormone synthesis in the ovaries changes. The epithelium reacts to this with pseudo-erosion.

The cause may also be any irritation of the cervix or infection.

Symptoms

Uncomplicated endocervicosis, if it forms on the unchanged surface of the cervical cervix, does not bother women, is asymptomatic, and is detected only upon examination.

But if inflammation develops in parallel, it may be accompanied not only by discharge, but also other signs corresponding to the disease that caused the inflammation.

Occasionally, contact bleeding occurs (appearing after vaginal intercourse).

Upon examination, cervical ectopia appears as a red area located around the exit of the cervical canal. The epithelium in this place appears velvety.

If the problem is accompanied by inflammation, cloudy yellowish mucus is visible in the vagina or cervical canal. But in front of everyone external signs the final diagnosis is made on the basis of cytological examination.

Treatment methods for cervical epithelial lesions

If endocervicosis is small in size and proceeds without complications, it is not classified as a gynecological disease, but is considered a physiological condition not associated with pathology.

In this case, no treatment is required; it is enough to visit a doctor for an examination once a year. The pathology may disappear as soon as the cause that caused it disappears.

The complicated version of the disease does not go away on its own and there are many ways to do it.

The choice of scheme and method depends on the type of pseudo-erosion, the cause that caused it, and the type of complications.

If the therapy is chosen correctly, the disease is completely eliminated.

At the core existing methods treatment lies elimination of abnormally growing epithelial cells so that their place is subsequently taken by cells typical of a given area of the organ.

helps in 75–90% of cases, but complications occur in 6–40% of cases. This is a disruption of the menstrual cycle, exacerbation of inflammation, bleeding at the site of intervention, fusion of surfaces.
affects the focus of pathology with low temperatures, the session is carried out painlessly and bloodlessly on an outpatient basis. Recovery is up to 80–95% of cases, but regeneration is long-term.
does not affect menstrual and reproductive function, therefore it is most often used to treat nulliparous women. The efficiency of application reaches 98%.
(use of an electromagnetic field of ultrahigh frequencies) is an expensive method and is therefore rarely used.
Thermocoagulation allows you to obtain complete epithelization within a month without complications. Efficiency - 92%.
Chemical coagulation: electrophoresis with zinc, use of other drugs as indicated.

Is the development of the disease dangerous?

The lower part of the cervix, protruding into the vagina (ectocervix), is normally covered with stratified squamous epithelium, protecting the tissue from the contents of the vagina, which (even its conditionally pathogenic part) is aggressive in the microbiological sense.

If, during pseudo-erosion, any area is replaced by single-layer epithelium, protection decreases significantly or disappears completely.

This gradually leads to chronic inflammation of the cervix of varying severity, affecting not only the outer part of the canal, but also the space surrounding it or the inner part.

Later, the inflammatory process can spread to the uterus, fallopian tubes, leading to infertility or ectopic pregnancy.

Chronic cervicitis - cause:

miscarriages;
premature birth;
postpartum inflammation.

After all, the cervix is a barrier to infections, and its inflammation opens the way for all kinds of microbes.

conclusions

Pseudo-erosion is not dangerous pathology and goes away over time as soon as the cause that caused it disappears.

If the disease is complicated by inflammation, then self-healing is impossible. Depending on the cause of inflammation, the attending physician draws up an individual treatment regimen and selects the most effective existing treatment method.

The disease can be avoided.

Prevention measures:

refusal of abortion;
choosy sex life;
using safe contraceptives;
non-traumatic sex.

Cervical diseases occur in many women. Some of them are very dangerous, others do not pose a serious threat, but can lead to unpleasant complications. There are no pain receptors in the cervix, so the pathology can be asymptomatic, without causing discomfort or anxiety. What type of disease is cervical ectopia, whether treatment is required and how complex it is - in each case, the issue is resolved individually, taking into account the nature of the manifestations of the pathology and the woman’s plans for motherhood. Prevention of the disease is of great importance.

Normally, the section of the cervix that extends into the vagina is covered with a multilayered mucous membrane consisting of flat cells. The inner part (cervical canal) has a single-layer epithelium of cylindrical cells. Ectopia is a condition in which the cylindrical epithelium moves to the outer part, replacing the flat one.

When examined using gynecological speculum, the doctor sees a red ring around the outlet of the cervix. Such an anomaly in itself does not pose a danger, but a complication may arise such as the reverse proliferation of squamous epithelium, in which it overlaps the overgrown cylindrical cells. In the area of overlap, a so-called transformation zone is formed.

In the cylindrical epithelium of the cervix there are glands that produce mucus necessary to protect the uterine cavity from infection and play other important roles in the functioning of the reproductive organs. In the transformation zone, flat cells are packed into the glands, forming plugs. This prevents mucus from coming out. Cysts form in the membrane, and their contents may suppurate. Such processes provoke the development of atypical cells with a disrupted structure. Over time, if the condition progresses, malignant neoplasms appear against its background.

Cervical ectopia is usually observed in women under 30 years of age, and sometimes it is congenital.

Video: What is ectopia, how does it differ from erosion

Classification of ectopia of the uterine cervix

According to the nature of the development of the pathology, an uncomplicated and complicated form of ectopia is distinguished.

Uncomplicated. There is only a movement of cylindrical cells to the area of flat ones, with no consequences. This condition is not considered a disease and treatment is not required. It is only necessary to periodically conduct gynecological examinations in order not to miss the development of cervical pathologies.

Complicated. An inflammatory process (cervicitis) occurs in the area of cell movement. As a result, the area of ectopia swells and is easily damaged, which leads to true erosion and inflammatory diseases of other organs of the reproductive system.

Depending on the structure of the area to which the pathology extends, ectopia of the cervix is divided into the following types:

Glandular. In the area of ectopia, a large number of inflamed glands of the cylindrical epithelium are observed.
Papillary (papillary) ectopia. Cylindrical cells are grouped into papillae.
Epidermalizing ectopia. Squamous epithelial cells penetrate between the cylindrical ones and displace them. Self-healing of the surface of the cervical pharynx occurs. There is no need for treatment.

Ectopia can be congenital or acquired.

Congenital the anomaly is due to genetic characteristics of the development of the genital organs. It does not cause any painful symptoms. By the age of 20, it usually disappears without any medical intervention. Such cervical ectopia is considered a normal physiological condition.

Acquired Cervical pathology occurs during reproductive age.

Causes of ectopia

The reasons for the development of pseudo-erosion can be:

Significant changes in hormonal levels, an increase in the content of female sex hormones in the blood. This is exactly what happens in a woman’s body at the very beginning of the reproductive period. Therefore, pathology most often occurs at the age of 20-30 years.
Usage hormonal contraceptives(the natural ratio of sex hormones is disrupted), endocrine diseases.
Frequent change of sexual partners. The penetration of foreign microflora contributes to the occurrence of sexually transmitted infectious diseases.
A sharp jump in hormone levels occurs when pregnancy occurs. Therefore, during this period, ectopia is observed in many women.
Injury to the mucous membranes of the cervix during childbirth, abortion, and genital surgery. It leads to disruption of cell development.
Inflammatory and infectious diseases of the genital organs, disruption of the structure of the mucous membranes as a result of their irritation by pathological secretions.
Early onset of sexual activity and childbirth at a young age, when the mucous membranes of the cervix are still immature and easily injured.

The occurrence of ectopia is facilitated by disruptions in the body's immune defense system.

Symptoms of complicated ectopia

A woman cannot recognize cervical ectopia on her own if she does not have concomitant diseases of the genital organs. There are practically no symptoms of an uncomplicated anomaly.

The thing is that it is a rare woman who can boast of ideal reproductive health, especially after the onset of sexual activity, pregnancy, childbirth, or abortions. As a rule, ectopia occurs against the background of an inflammatory process in the vagina, cervix, cavity or uterine appendages. Often, in addition to ectopia, there are diseases of the cervix such as leukoplakia (keratinization of the surface of the cervix), true erosion, dysplasia ( abnormal development cells in individual or all layers of squamous epithelium).

Therefore, most often ectopia is detected in a woman when she comes to the doctor with symptoms such as:

Unusual discharge, indicating the presence of inflammatory processes (colpitis, cervicitis, endometritis, adnexitis) or infectious diseases of the genital organs (thrush, ureaplasmosis, trichomoniasis and others). In this case, the discharge is usually abundant, weakly or brightly colored yellow, green, brown, has an unpleasant odor, and an unusual consistency.
Pain in the lower abdomen, in the sacrum area.
Heavy or scanty periods (a sign of hormonal disorders in the body, inflammatory or hyperplastic processes in the endometrium).
Bloody discharge after sexual intercourse, gynecological examination, douching (evidence that there are wounds on the surface of the mucous membrane of the cervical pharynx, cysts and polyps have formed in the epithelium).

We should be wary and painful sensations during sexual intercourse.

Diagnosis of ectopia and its complications

In the presence of diseases accompanied by cervical ectopia, it is necessary to establish the cause of the appearance of such symptoms. In addition to the usual examination of the vagina and cervix using mirrors, colposcopy is also performed. In this case, the surface of the cervical pharynx is pre-treated with a 3% solution of acetic acid or Lugol's solution containing iodine. Damaged areas remain pale and are clearly visible against the background of healthy tissue. Using a colposcope, you can illuminate the organ cavity and optically enlarge the image.

Transvaginal ultrasound using a vaginal probe can detect deep damage to the mucosa, if any. A microscopic examination of the mucous membrane of the cervix (smear) is carried out to determine its microflora and detect infectious agents. To clarify the type of microorganisms, bacterial culture is done.

A PCR blood test is used to accurately determine the type of infection present in the body based on its DNA. General blood and urine tests show the number of leukocytes, which makes it possible to determine the presence of an inflammatory process.

A scraping is taken from the surface of the cervix to detect squamous and columnar epithelial cells and determine the degree of development of the disease. If cells of an atypical structure are detected, a biopsy and histological examination of cervical tissue is performed.

Video: Use of colposcopy to diagnose ectopia and cervical erosion

Treatment for ectopia

Treatment is carried out only if ectopia is accompanied by complications.

If inflammatory processes are detected, antibiotics and anti-inflammatory drugs are prescribed. For infectious diseases, complex treatment is carried out with antifungal, antiviral drugs. Medicines are prescribed to strengthen the immune system and increase the body's resistance. If vaginal dysbiosis and a lack of beneficial lactobacilli are detected, then drugs are used to restore normal microflora.

If it turns out that the cause of cervical ectopia is hormonal abnormalities, then duphaston or oral contraceptives are prescribed to restore hormonal levels.

If extensive damage to the cervical mucosa is detected, surgical treatment is performed. For example, when cysts are detected in the vaginal part of the cervix, they are opened, the contents are removed and the damaged surface is cauterized.

If it is necessary to remove polyps located in the mucous membrane, as well as to clean the surface of the cervical pharynx from destroyed tissue, methods such as cryodestruction (freezing), diathermocoagulation (cauterization with electric current), laser destruction, and chemical cauterization with a solution of solkovagin are used.

They are especially scrupulous in choosing treatment methods for nulliparous women. It is necessary to use the least traumatic methods so that scars do not remain on the cervix (for example, laser cauterization, radio wave destruction).

Prevention of ectopia and its complications

Since the development of pathology is difficult to notice, preventive gynecological examinations are of great importance. If ectopia is detected, you need to visit a gynecologist once a year to monitor the condition of the cervix, and if complications arise, prescribe timely treatment.

It is important to take care of strengthening the immune system, healthy image life, carefully monitor the hygiene of the genitals.

Of great importance right choice contraceptives. You cannot self-medicate or take any medications(antibiotics, hormonal agents, anticoagulants) without a doctor’s prescription.

This is an atypical position of the cylindrical epithelium covering the inside of the cervical canal of the uterus; the norm is the presence of squamous epithelium. Clinical symptoms appear only in a complicated form: white discharge, discharge mixed with blood, itching and burning of the vulva, dyspareunia. Diagnosis of cervical ectopia of the cervix is carried out using a gynecological examination, colposcopy, and in individual cases - biopsy. Treatment of ectopia is only necessary in a complicated form; the uncomplicated form does not require treatment, but only requires control of the disease.

Cervical ectopia of the cervix: what is it?

Modern medicine uses such definitions as pseudo-erosion, endocervicosis, false erosion to designate the disease ectopia. Ectopic columnar epithelium of the cervix occurs in 40% of women, while more than 11% of all cases are congenital anomalies. Patients of childbearing age are at risk (up to 50% of all cases). A history of ectopia in women increases the risk of the formation of malignant tumors, as well as the development of various inflammations of the vulva.

During a gynecological examination without the presence of ectopia, the cervix is covered with squamous epithelium in several layers. Using mirrors and internal examination, the cervical canal, which is covered with columnar epithelium, is revealed. In the presence of cervical ectopia, the photo demonstrates that the line between the epithelia is deformed and moves closer to the outer cavity of the vagina, being located either locally or in a circle, the picture is completely different.

Classification of cervical ectopia of the cervix

Modern medicine defines several forms of ectopia, both by origin and localization, and by the course of the disease. Ectopia can be either a congenital disease (about 11% of all cases) or acquired. Signs of ectopia may be uncomplicated, which is the norm in individually and does not require treatment; complicated ectopia is often caused by inflammation inside the genital organs, which also involves diseases such as colpitis and cervicitis. These diseases are infectious, their complete cure is necessary first of all. In the future, the prognosis of ectopia may not have any signs and a relapse may occur.

When the structural and skin elements of the cervix change, as well as when their relationship is dysfunctional, cervical ectopia is ectropion.
Based on histological characteristics, they are distinguished:
- pseudo-erosion;
- papillary - structural formations of the cylindrical epithelium of the uterus;
- glandular - ectopia with inflammation, abscess of glands with branching is noted.

Scarring during ectopia is accompanied by the transformation and renovation of the epithelium from cylindrical to flat. The process involves additional cells, which, through division, turn into an immature form, and then acquire a mature stage.

With colposcopy, it is possible to differentiate changes in the skin. Under negative conditions, cellular transformation may not have a logical conclusion. In this case, a relapse of ectopia occurs. It is also possible for a retention cyst of the cervix to appear if the pharynx has a skin growth of a metaplastic type.

Causes of cervical ectopia of the cervix

Cervical ectopia can develop in conditions of changes in the functional systems of the body, including:

hormonal disorders;
inflammatory processes;
presence of injuries and damage to the genital organs;
general decrease in immunity due to chronic diseases.

The causes of ectopia of the uterus are diseases of the reproductive system that occur in the patient’s history and which have relapsed. Such diseases include chlamydia, mycoplasmosis, vaginitis, endocervitis. Changes in the microflora of the vagina, a quantitative increase in opportunistic flora due to bacteria such as streptococcus, staphylococcus, E. coli, etc. - all this can lead to the development of ectopia. In addition, vaginal discharge provokes changes in the squamous epithelium of the cervix, where erosion forms. In the future, erosion is differentiated as ectopia.

Injuries and mechanical damage can cause ectopia. Difficult childbirth, surgical termination of pregnancy, douching, insertion of an IUD also increases the risk of pseudo-erosion and the development of the inflammatory process.

Hormonal imbalance in the body is also one of the causes of ectopia. Very often it is a concomitant disease with ovarian dysfunction, endometriosis, fibroma.

A decrease in the immune system and protective properties of the body can develop as a result of diseases such as diabetes and obesity.

The following conditions play an important role:

early sexual life;
frequent change of partners;
unprotected sex;
multiple births;
multiple abortions.

All this is fertile ground for the occurrence of pseudo-erosion.

Symptoms of cervical ectopia

Symptoms and manifestation of ectopia are observed in a complicated form. As a rule, it is accompanied by diseases such as dysplasia, leukoplakia, and polyps. There may be a discharge that is whitish or mixed with blood in the presence of colpitis or endocirvicitis.

At initial stage complicated form of ectopia, the patient may complain of changes in the nature and timing of the menstrual cycle, as well as the inability to become pregnant for a long time (1 year).

The uncomplicated form of cervical ectopia of the cervix does not have any special signs. During a gynecological examination, it is easily detected by a specialist.

Diagnosis of ectopic columnar epithelium of the cervix

Diagnosis of pseudo-erosion on initial stage includes a primary gynecological examination by a specialist, thanks to which it is possible to identify the nature of ectopia - congenital or acquired. At congenital form and the absence of complaints from the patient, further diagnosis and special treatment are not required. In the acquired form, it is necessary to evaluate the previous nature of the columnar epithelium of the cervix and compare it with changes in the vagina at the time of diagnosis.

Diagnostics using gynecological speculum and instruments reveals a violation of the epithelial line, the presence of a red inflammatory focus of the uterus, which can bleed when pressed.

Colposcopy and Schiller tests are mandatory measures to identify ectopia of the columnar epithelium of the cervix. These methods reveal the following indicators of the disease:

transformation of uterine tissue into new structural compounds;
the presence of a cylindrical zone of skin and a displacement of the connection line closer to the exit of the uterus;
leukoplakia;
punctuation;
mosaic.

With the listed signs of ectopia, further diagnosis consists of:

bacteriological culture;
PCR diagnostics;
microscopy;
cytological examination;
in some cases, a biopsy is indicated.

Additionally, studies of the ovaries are carried out, their functionality and the presence of possible hormonal disorders are determined. If any violations are detected, consultation with a gynecologist-endocrinologist is mandatory.

Treatment of cervical ectopia

The complicated form of pseudo-erosion has several treatment options, depending on the nature of the identified disorders. Anti-inflammatory drugs must be prescribed. An individual contraceptive program is selected together with a gynecologist-endocrinologist. Hormonal imbalances in the body are also treated.

Treatment of cervical ectopia involves the possibility of undergoing various therapies:

laser therapy;
cryotherapy;
radiosurgery;
diathermocoagulation, thanks to which the internal inflammatory process of the cervix stops and ectopia recurs.

When diagnosing diseases of the genital organs, further treatment occurs on an individual basis, depending on the specific disease, nature and location.

Uncomplicated ectopia does not require treatment. A patient with a history of this disease should simply be under the supervision of a doctor and follow his recommendations, which should contribute to the regression of the disease. If signs of ectopia are detected, the woman needs to undergo an examination as soon as possible to identify pseudo-erosion of a complicated form.

Prevention and prognosis of cervical ectopia

Cervical ectopia of the cervix has a positive prognosis when the disease is detected. The disease is monitored through colposcopy every six months, even in the absence of complaints about health.

Carrying out preventive measures consists of timely diagnosis and further treatment of any diseases that the patient has. Women who have endocrine disorders are at risk; they need constant monitoring by a gynecologist-endocrinologist to monitor the condition of the body and timely identify disorders.

Also, to prevent ectopia, constant examination by a gynecologist is necessary to detect infectious diseases of the genital organs.

Correct guidance intimate life, properly selected contraception, avoiding unwanted pregnancy - all these are the main preventive measures that must be followed.