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Endometriosis - Diagnosis, Treatment
Endometriosis - Diagnosis, Treatment
Elements of the endometrium in endometriosis occur in places not designed for it: deep in the body of the uterus, the cervix, the tubes, ovaries, uterine ligaments. Been able to locate outside the woman's reproductive system. Then talk about endometriosis of the bladder, bowel, postoperative scar, kidneys, lungs, etc. In all these cases, the tissue of endometriosis during the menstrual cycle, there are changes similar to those occurring in normal endometrii.V result of endometriosis is characterized by a variety of symptoms depending on the affected organ, distribution process, concomitant diseases and other conditions, which often makes it a diagnosis and treatment very difficult.
The causes of endometriosis has long occupied the minds of scientists. But so far there is no theory that fully explains its origin. Often, the spread of endometriosis explain skid and engraftment of endometrial particles to other organs and parts of the reproductive system. In the origin and development of the disease play a role of hereditary factors, disturbances in the immune and neuroendocrine system and several other reasons.
The most common complaint of patients with endometriosis are pain, rapidly emerging or worse before and during menstruation. There may be a slight increase in the affected organs before and during menstruation. In addition to painful menstruation is often observed, and other disorders of menstrual function: heavy periods, pre-and postmenstrual spotting. Not uncommon, and infertility, and endometriosis may be the sole cause of infertility, and combined with other factors.
Let us consider briefly the most common forms of endometriosis:
Endometriosis is characterized by the appearance of the cervix in the vaginal part of small (2-5 mm) "holes" reddish color. Before menstruation, these centers will change color and increase in size. Contribute to the emergence of endometriosis of the cervix by cauterization of erosions diathermocoagulation, neck injuries after childbirth, abortion, dilatation and curettage.
Ovarian Endometriosis manifests in the form of endometriosis lesions in the thickness of tissue, or on the surface of the ovary. In a small expression of the disease is manifested infertility. In the process of having a greater incidence of endometrioid cyst (sometimes referred to as "chocolate"). In these cases, except the characteristic pain of infertility. Pain may be constant, with increased before and during menstruation. In this form of endometriosis is observed adhesions in the pelvis, which is an additional cause of infertility, pain, urinary dysfunction, constipation, bloating, etc.
Currently, much attention is paid to "small" forms of endometriosis. This term is small, isolated areas of endometriosis in the utero-peritoneal rectal deepening, sacro-uterine ligaments, on the surface of the ovary. Their only manifestation is usually infertile. Prior to the introduction of laparoscopy, this form of the disease is not detected, and infertility in these cases was considered "unexplained".
Endometriosis of the body of the uterus usually occurs between the ages of 40-50 years. In the event of his significant role played by abnormal births, abortions, diagnostic curettage of the uterine cavity, and inflammatory processes. This form of endometriosis is accompanied by pain of varying intensity, heavy menstrual periods, spotting before and after them. Because of increased blood loss often develop anemia.
Endometriosis is often associated with uterine cancer.
Diagnosis of endometriosis
Diagnosis of endometriosis is based on the characteristic of each form and location of endometriosis patients complaints, gynecological examination on the data and results of special research methods. These include colposcopy, cervical biopsy, hysterosalpingography, hysteroscopy, laparoscopy, and ultrasound.
Treatment of endometriosis
Currently, the best is a comprehensive approach based on a combination of pharmacological and surgical treatments.
For medical treatment of endometriosis using various hormonal treatments, the application of which is observed during the treatment of menstrual function off. It promotes regression of endometriosis lesions of different localization. Duration of the drugs and their choice is individual and depends on the form and stage of disease, age of the patient, the need for infertility treatment, the effectiveness of therapy, and other factors. It is now widely used progestins:
estrogen-progestin preparations (single oral contraceptives) in the continuous and, sometimes, in a cyclic mode, danazol (danol, danoval), gestrinone, and in recent years, the agonist of gonadotropin-releasing hormone (Zoladex, dekapeptil depot, etc.). The last group of drugs produces the best results in treating the disease.
Surgical treatment of endometriosis used in nodal forms of endometriosis, uterine body, with a combination of endometriosis with uterine fibroids, endometrial cysts in the ovaries and in other cases. After surgery, hormonal treatments are appointed for a period of 6 months. In some cases, performed, and preoperative hormonal treatment. It is important to use laparoscopy for infertility and the presence of "small" forms of endometriosis. Endometriosis produce electrocoagulation followed by the appointment of hormone therapy.
In addition to hormonal and surgical treatment after the operation is carried out restorative treatment. It is necessary for the prevention of adhesions, prevention and correction of possible complications of long-term hormone therapy used. Electrophoresis is used iodine and zinc, drugs that affect the function of the gastrointestinal tract, liver and pancreas (Festal, pancreatin, methyluracil, etc.), diet therapy and vitamins. In the complex treatment includes sedatives, analgesics, anti-allergic drugs. Unfortunately, the treatment of endometriosis, especially in conjunction with infertility is not always successful. In such cases, the treatment of infertility using IVF and PE. Frequently observed and relapses of the disease, which contributes to the process of treating the additional complexity.
