Endometriosis - a disease with unexplained to this day authentic reason for its development.This disease is studied carefully, but many questions remain unanswered.
Endometriosis - a condition characterized by the appearance of ectopic endometrial Tacna regions.This means that the tissue that histologically and functionally similar to the endometrium (the mucous membrane lining the uterus), gets into tissues and organs, for which its presence is not typical.Endometrial tissue undergoes changes that are characteristic of the menstrual cycle.Gradually this tissue invades surroundingtissue.Endometriosis occurs mostly in women of reproductive age.
factors and causes of the disease:
for diagnostic laparoscopy, many women identified endometrioid heterotopias, which disappear on their own without any treatment and does not manifest itself, they are "accidental discovery".However, certain risk factors and a genetic predisposition to endometriosis promote infiltration and formation of endometrioid ovarian cysts.
classified as follows:
There is another classification, according to the stages:
On examination of endometriosis lesions can be found on the perineum and vulva, as well as on the cervix and vagina.The uterus is painful to shift, can be rejected backwards and tightly fixed in this position.Can detect endometrial ovarian cysts.
Endometriosis can affect not only the sexual organs, but also the urinary system: urinary bladder, urethra, ureters, and kidneys.This can lead to serious consequences, such as hydronephrosis, renal blockade and loss of its function.
Infertility is diagnosed in 25-40% of women with endometriosis.
Currently, there are many different theories of development of endometriosis, but none of them has not been proved in full.It determines only the most probable risk factors that may contribute to the disease.It:
First of all, it is the clinical manifestations and patient complaints.Significantly helps in the diagnosis of ultrasound.But the basic method is laparoscopy, during which it is possible with reliable accuracy to diagnose endometriosis.All lesions typically appear and are visualized as red, black or white lesions.Red lesions similar to those of the endometrium, and the black and white lesions are inactive.Classical for endometriosis are black and brown.
During the laparoscopy carried out serial examination of the pelvic cavity, the surface of the ovaries, pelvic peritoneum, uterine ligaments, appendix, sigmoid colon, fallopian tubes.To improve the quality of diagnosis laparoscopy complement biopsy.
Endometrial cysts of the ovary are also called "chocolate" because their content is dark brown.90% of all endometrial cysts - a parovarian cyst.
Endometrial nodes - this is a manifestation of deep endometriosis.Units composed of fibrous tissue and smooth muscle cells, they who are node basis, not endometrial tissue.Most of these components affect the sacro-uterine ligaments, fascia retrotservikalnogo, rectouterine partition and ovarian ligament.These structures form the ligament of the uterus and appendages apparatus with which they are held in the physiological situation in the pelvis.For nodes hardly characteristic of necrosis and bleeding in the 2nd phase of the cycle they undergo secretory changes.Hence endometrial process may spread to the pelvic side wall, ureter and iliac vessels.
long and not always successful.After drug treatment relapse occurs up to 50%, after surgery in 20% of patients experience a recurrence within 5 years.Drug therapy does not eliminate the effect of endometriosis and, unfortunately, temporary.
This drug therapy does not increase the percentage of pregnancy in women who are interested in it.The main objectives of the treatment of endometriosis: reducing the intensity of symptoms, quality of life, an exact diagnosis.The choice of treatment depends on several factors.Taken into account if a woman wants to preserve fertility, the severity of symptoms, from which treatment is preceded and what the effect of it was the location of the endometriosis.
principles of medical therapy for endometriosis
quite high analgesic effect have general therapeutic measures - exercise, psychological support, relaxation, NSAIDs and paracetamol.
most widely used in the treatment of endometriosis received use of combined oral contraceptives, because they have less severe side effects.In this case, the preferred three-phase COCs.
Apply progestogens the schemes, it reduces estradiol levels.
Danazol - synthetic derivative of 17alpha-ethinyl estradiol, its effect is to suppress ovulation and menostaze (cessation of menstruation).This drug causes atrophy of the vaginal mucosa and in the endometrium, decreasing the intensity of pelvic pain, dyspareunia and reduced menstrual pain.Reduces ectopic endometrial lesions, stops the germination foci heterotopias.By reducing blood loss increases the level of hemoglobin.Adverse drug effects: irregular uterine bleeding, manifested light anabolic effect, acne, hirsutism (increased hair growth on the body), swelling, weight gain, changes in voice, decrease in breast.In connection with the phenomena androgenization patients often forgo treatment with danazol, in spite of its high efficiency.
Gestrinone - a synthetic steroid hormone with high antiprogestinovoy activity.It acts on the hypothalamic-pituitary system and inhibits the action of central nervous system hormones (gonadotropins).This drug has and antiestrogenic activity as well.The result is a drastic reduction of LH and FSH production in ovulation and peak occurs.As a consequence less ovaries produce hormones, leading to atrophy of the endometrium and endometriotic heterotopias respectively.Dosage doctor picks.Despite the suppression of ovulation in some women may become pregnant, so reliable contraception during treatment.
Another group of drugs used in treatment of endometriosis - this agonists gonadoliberines. their mechanism of action is suppression of pituitary luteinizing hormone and follicle, leading to reduced production of estrogen by the ovaries.This leads to a state pseudomenopause.These drugs can not be used for more than 6 months due to bone demineralization.Manifestations hypoestrogenism may be significantly expressed, namely, that all the symptoms of menopause: dryness of the vaginal mucosa, hot flashes, palpitations, and others.These drugs are expensive and they are used only as an alternative method, when there is no effect from all other therapies.Agonists produce gonadotropins in various forms, nasal spray, subcutaneous injection, intramuscular injection, depot formulation.Menses resumed after 2-3 months after the end of supplementation.To reduce the pronounced climacteric syndrome permissible purpose of hormone replacement therapy.Agonists can be called gonadotropins rescue with endometriosis stages 2 and 3.
Mifepristone - antiprogesteronovoy drug with activity, when administered within 3 months reduces pain, while a positive effect is observed at the end of the first month.Mechanism of action of mifepristone is that it prevents menstrualnopodobnoe bleeding in endometriotic lesions.
Surgical treatment of endometriosis is to remove the maximum organosohraneniem heterotopias.This is especially important for women who are planning in the future pregnancy and childbirth.Relapses occur after such treatments is not more than 20% within 5 years.Surgical treatment is very effective against persistent pelvic pain syndrome.Ovarian endometrial cysts were removed with their capsule.
is known severe endometriosis can cause infertility.Surgical treatment in this case can play a large role.During operation carried colliotomy, removal of cysts, restoration of anatomic structures and their relationships to each other.But not always the only surgical technique results in restoration of fertility.In some cases, it needs modern technologies of reproduction.
Endometriosis can be oligosymptomatic, and not affect the quality of life of women.On the other hand, the time has not been diagnosed endometriosis lack of adequate treatment and can lead to complications.The most likely complication:
Since significant causes of endometriosis are not known, and there is no effective prevention.However, you can influence the development and outcome of the disease, if you observe a number of recommendations:
violates a woman's fertility, but this does not mean that pregnancy is not possible or is contraindicated.On the contrary, many experts recommend pregnant, as it has a beneficial effect on the disease.The fact is that during a state of prolonged gestation anovulation, menstruation absent, and the body is under the influence of progesterone for 9 months.All these conditions promote the regression of heterotopias.
However, endometriosis itself is a risk factor in pregnancy because it can cause miscarriage threat.Therefore it is recommended to conduct training pregravid women suffering from endometriosis, and during pregnancy to carry out prevention of miscarriage and placental insufficiency.It is recommended to visit a gynecologist before pregnancy, and registration to become as soon as possible.In endometriosis, the child does not have direct effect, so there is no fear for the baby's health.However, indirect effects may be manifested in the development of placental insufficiency, when the child is not getting enough nutrients and oxygen from the placenta for violations of work.
combination endometriosis with uterine myoma often occurs.Diagnosis of today has become more accurate, so this condition has become increasingly apparent.The combination of uterine fibroids with adenomyosis causes more severe clinical manifestations, as a pathology exacerbates the other.Treatment is difficult and often the only way is surgery.This approach to the problem of depriving young women's ability to conceive and successfully endure pregnancy.It leads to early menopause and climacteric syndrome expressed (if you have to remove the ovaries).Currently, there are perfected minimally invasive treatments that are aimed at not only to preserve the body, but also to keep its full functionality.
In some cases, use of progesterone hormone therapy drugs and gonadotropic hormone agonists.They lead to pseudomenopausal and can reduce fibroids and heterotopia half or more.This advantage is used in the preparation of women for surgical treatment for large size fibroids in order to reduce its volume, which in turn will facilitate the technical side of surgery.This method is not used in young women of childbearing age, especially considering pregnancy.
drugs of plant origin and methods of traditional medicine are not effective enough.They are not able to remove fibroids or endometrial lesions.With a view to the prevention of and in conjunction with other treatments they can be used, but as a separate method of treatment effect will not, and vice versa, can delay valuable time.The best option for adenomyosis treatment, combined with uterine myoma any location at node diameter greater than 1 cm in women of childbearing age - a surgical treatment.Moreover, it is the absolute indication for surgery.
If endometriosis lesions cervical endometrioid heterotopias are located on the cervix and are rendered when viewed from a doctor on a gynecological chair.They appear as small red formations.