About 50 years ago about this woman's disease and no one heard. Today - this is one of the most common diagnoses: gynecologists find endometriosis more often than fibroids or inflammatory diseases of appendages. What is it? Epidemic?
When medical students preparing to take exams, the most favorite among them are the diseases which "has not been studied pathogenesis, etiology is unknown." I mean, do not know the reason, and it turns out so, do not guess. I learn these words - and fairly. Fortunately, fewer and fewer of these off-white spots. Numerous studies allow, if not all find out exactly, but at least we assume with high probability. Endometriosis - one illustration of this situation. Well, we do not know exactly how and why it is taken. But we have a few theories connected.
For a start - what is endometriosis?
Endometriosis - A disease which occurs only in women because only women have a uterus. The uterus is composed of 3 layers - the outer layer of the serous, the average muscle and internal - active. Active inner layer called the endometrium. It was he exposed to the active transformations during the menstrual cycle, preparing to meet the fertilized egg. If the egg is not fertilized it and stuck, the endometrium disappointed rejected - that is, menstruation.
Manage this process many hormones, but today is not about them. Today - on the endometrium. Very well, when he is where he is supposed to, and doing what it is supposed to. But when suspiciously similar to the endometrial foci arise in the thickness of the muscular layer of the uterus, on the ovaries, fallopian tubes inside, on the walls of the pelvis and ligaments - there are problems. And a healthy endometrium and the endometrial foci that's listen to the commands, which are fed hormones. And outbreaks begin to occur changes corresponding to the phases of the menstrual cycle. That is endometrioid pockets swell, too, "preparing for pregnancy," and then menstruate.
Where?
In the surrounding space. The thickness of the muscular layer in the lumen of the fallopian tubes into the peritoneal cavity, etc. It turns out that every month in women occur more microbleeds, that the body is fighting bravely. Only just, more or less mastered the body, here you are, if you please - the next menstruation!
Where it takes the endometrium? How he gets there? There are theories:
- Hereditary predisposition.
- Hormonal disorders.
- Theory of implantation - theoretically endometrium can get "where nonpositive" during abortion, severe and traumatic delivery, installation and removal of the Navy.
I really like the version of the theory of implantation - retrograde menstruation. This is when a certain amount of menstrual blood thrown into the fallopian tubes during uterine contractions and settles on the ovaries, tubes, abdominal cavity, giving rise to the development of the disease.
It is believed that taking muscle relaxants during menstrual pains (in particular, so beloved by Russian women shpy), helps to throw the menstrual blood in the fallopian tubes.
Endometriosis It fades in women who take post-menopausal. No menstruation - no endometriosis.
What bothers women with endometriosis? How does it manifest itself?
It all depends on exactly where and how long the centers started. While pockets of small and their number is small, the complaints can not be. As the disease progresses, there is pain. Why it hurts, it is easy to explain the example of the usual bruise. Blow, burst small blood vessels, there was a slight bleeding in the muscle and under the skin, and here it is - a bruise. Touch - hurts. The body works bruise turning black, green, yellow and disappears.
In endometriosis, the pain usually occur or are worse in the premenstrual days and during menstruation. In severe pain and disturbed after menstruation. With the defeat of the muscle layer of the uterus (adenomyosis), in addition to pain, characterized by heavy menstruation, spotting from the genital tract before and after "critical" days. If endometrial foci are on the back surface of the cervix, there is pain during sexual intercourse. Pain can give to the sacrum, rectum, vagina.
Endometriosis - a common cause of infertility.
Why infertility ? Mainly due to the formation of adhesions. Small pockets of gradually merge into a cyst and tightly fused with the surrounding tissues, impaired patency of the fallopian tubes, the egg can not normally ripen in the affected ovary, endometrium responds poorly to neighboring pockets, and 250 monographs, dissertations, research ...
What to do?
And it will ask the patient. Treatment of endometriosis It depends on the woman's reproductive plans. If pregnancy is very necessary, but it does not work, we go to the operating room. Laparoscopic surgery is done for diagnostic purposes - on the one hand, and on the other - it allows you to immediately produce the removal of the identified endometriosis and adhesions divided structure. Diagnosis of "small forms of endometriosis" (small isolated pockets on the peritoneum, the surface of the ovaries) is only possible with laparoscopy. No complaints, no pain, menstrual regularity, analyzes wonderful, wonderful semen - "sterility of unknown origin" - during laparoscopy often finds it "small forms".
After the operation for 3-6 months is often prescribed hormone therapy. This phase of treatment often causes confusion among our patients and rejection. The fact is that for the treatment of endometriosis, we successfully use the drug, causing "artificial menopause".
Remember, there is no menstruation - no endometriosis.
3-6 months for the repeal hormones of pregnancy. If pregnancy does not occur within one year, it dramatically reduces the chances of recovery of reproductive function of women. Unfortunately, as soon as the return of menstruation and endometriosis returns. In these cases the recommended program of IVF (in vitro fertilization with the use of schemes to stimulate ovulation).
Pregnancy and breast-feeding has a healthy effect. Menstruation is not - there is regression of endometriosis, while the abortion leads to or aggravate the process.
If all the planned children are born to select tactics treatment of endometriosis assess the prevalence and severity of the centers of pain. Good results are obtained combining treatment - a combination of surgery with hormone therapy.
The only BUT: treatment of endometriosis is carried out continuously until the age of natural menopause! After the completion of the main stage, the patient offer a long-term use of combined oral contraceptives or intrauterine system specific "Mirena". Such treatment prevents endometriosis "roam" in full force.
Prevention of endometriosis: how to avoid?
Prevention of endometriosis - Is prevention of intrauterine interventions (abortion, spirals). Informed and proper use of oral contraceptives - the method number 1.
Gold letters dream to write the words of his patient: "I have always been proud of the fact that he had never taken oral contraceptives. But it turned out to be proud of something and nothing ... "
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