The epidemic of endometriosis

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 ... "

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis: known about the unknown

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. This is one of those diseases, which did not really clear - "has not been studied pathogenesis, etiology is unknown," as they say in the exams medical students.

What is endometriosis? I will explain clearly, but unscientific.

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.

Very well, when the endometrium is where it 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!

It endometriotic lesions on the peritoneum. Such harmless and cute. I can not believe that these small ink klyaksochki is the cause of severe, often disabling disease, infertility, and pain.

So beautiful vyglyadt endometriosis during laparoscopic surgery. Consider it with the naked eye is also possible, but to estimate the true prevalence of endometriosis could only after widespread use of laparoscopy.

Pages: 1   2 3 4

• All posts gynecologist

Blog gynecologist

Go back to the main page

Who has the chance of becoming pregnant in the New Year's Eve?

Dear women, I immediately look to their menstrual calendars. Everyone who began menstruating December 15 and later have a higher chance of getting pregnant in the New Year's Eve!

Expectant

The most popular question online consultant in the past year as in other years: "I've had sex such, such and such a number. When I got pregnant?" The real meaning of this question is: "From I still flew? "Very often it is asked in a month or two after the New Year's Eve. Be careful, dear women - holiday atmosphere so dizzy, keep control. Tests to determine paternity before the birth is still far from perfect, in fact - on the brink of fraud and science.

However, not all unwelcome pregnancy. Some of my patients planning to become pregnant is the new 2014. They went pregravid preparation: screened for infection, are taking folate, dentists completed treatment of oral diseases, we have - waiting for a miracle.

- Can I have a glass of champagne on New Year's Eve?
- Of course. There is nothing criminal. A small dose of alcohol is quite acceptable. However, I can not say that it is absolutely safe.

Remind: one unit dose of alcohol - is 340 g of 5% beer 141, 75 g of 11% of the wine or 42, 53 g of 40% vodka or brandy. Drinking 4 or more standard drinks in a week takes us to the high-risk group. At the planning stage of pregnancy and during pregnancy, any dose of alcohol can be fatal.

Those who are already pregnant and ready to give birth, too afraid of the long holidays. All my pregnant, are at term, cross their fingers just would not be dropped to give birth in the New Year ! However, no matter how wanted to celebrate the holiday with their families, there are reasons for unconditional emergency hospitalization, this recall:

• suspected leakage of amniotic fluid. Stock up on a few tests Amni Sure to not go in vain;
• regular contractions every 10 minutes and more - use the online service skhvatkoschitalok or clock with a second hand. Record the duration of the bout and the interval between contractions. With regular labor, the intervals are shortened and lengthened battle;
• sharp pain in the abdomen - Alarm! Go to the hospital immediately, and without hesitation;
• bleeding from the genital tract - a condition that can be life-threatening. Immediately to the expert!

It is important that among the friends and relatives of the pregnant had at least one completely sober person who is able to drive a car. "Alarm suitcase" and documents to be collected, the phone battery charged, all the moves are recorded.

Throughout January, February and even March, we, obstetricians, we uploaded a special work. We will unravel the intricacies of the New Year "miracles" in the form of infections, pregnancies nerazvivaek. We again plunge into the abyss of human happiness and unhappiness. We will rejoice and grieve together with you. We will try to help, heal and save. I know that this year will conjecture the beat of the Kremlin chimes. My dream is to become of the obstetrician-gynecologist specialist in women's health. It will have to work hard, and you - do not get sick, dear women!

I wish I wish and planned pregnancies, safer sexual behavior, and powerful women's health to all my patients - full-time, part-time - and just readers.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Heavy periods when to sound the alarm

One resorted to my teenage doctor, "Oxana, see our girl. 16 years, 72 hemoglobin. " Wow! At the level of hemoglobin 70-90g / L, we are talking about moderate anemia. Less than 70 g / l - severe anemia, it is necessary to solve the issue of blood transfusion.

Periods

The level of hemoglobin found by chance a girl on the eve of donated blood to get help at the school after SARS. Account time in such a situation is on the clock, day and already lost. The situation is alarming.

- Lena, all tell the doctor! What have you done? Abortion? Tablets saw? I do not hide anything.

Lena - beautiful tall girl, long hair, brown eyes. Few spoils greenish yellow complexion.

- Yes, nothing that I did not do ...

Lena is sexually active for a year. Well lives ... The two partners, two of sexual contact. Last 5 months ago. Both contacts are protected by a condom. Relationship failed. Sometimes.

- Lena, what's bothering you?

- I'm very plentiful monthly .
- Always plentiful?
- Always. From the very beginning.

From history

The first menstruation came at age 13. Menses are 5-6 days after 28 of them for 3-4 days very much.

Unfortunately, "very much" everyone understands in his own way. It is believed that if a single woman loses menstruation less than 50 ml of blood   - everything is fine. Loss of 50-80 ml   It can lead to iron deficiency, particularly if the intake of iron from food is reduced or absorption.

80-120 ml of blood and   per menstrual bleeding - a profuse blood loss leading to iron deficiency anemia. Blood loss over 120 ml per cycle - life-threatening.

The problem of objectification of blood loss volume is quite complicated. And the patient and the doctor is difficult to estimate the amount of lost blood. Today, there are special plates, believes based, but in Russia this counting method is not widely used.

Calculation of blood loss during menstruation

Doctors define special test questions that help identify heavy blood loss.

• At night the proceeds? We have to change the gasket at night?
• It happens that a pad is not enough for one hour?
• It happens that you take with you extra clothes?

Lena is the way it is.

- Good. Come on a chair, let's see how it looks.

While the girl undresses, I estimate the thickness of the corner of my eye pads and the number of bleeding. Well, very well for 10 am.

- Oh, and I still have a tampon ...

- Another swab ?! It is through the pad so many passed ?!

Security question "Do you use tampons and pads at the same time? Whether there are thus leak? "Too, but it is usually necessary to ask very adult aunt.

From history

Uterus corresponds to the age, firm, mobile, painless. In the appendages nothing special found.

It's really common Lenochkina menstruation.

This girl, we was hospitalized. She certainly help - examine, restore blood loss. Then we will find a long-term treatment, and of menstrual bleeding will be gone.

Since 2011, the whole world uses the new classification of the causes of uterine bleeding PALM-COEIN .
PALM   (Eng. - palm)
P olyp - endometrial polyp
A denomyosis - adenomyosis
L eiomyoma - leiomyoma, uterine fibroids
M alignancy and hyperplasia - ozlokachestvlnie (cancer) and hyperplasia
COEIN   (in consonance with English. Coin - coin)
C oagulopathy - coagulopathy, violation of blood coagulation
O vulatory dysfunction - ovulation disorders
E ndometrial - disease of the endometrium
I atrogenic - iatrogenic injury (medicinal use hormones, intrauterine devices, and others.)
N ot yet classified - not yet classified

According to the classification PALM-COEIN, the diagnosis of chronic abnormal uterine bleeding set, if unpredictable, overly long, abnormal volume and / or frequency of menstruation continues 3 months.

The doctor should be a clear sequence of actions: detailed inquires about the nature of menstruation, said co-morbidities, take medication, and lifestyle factors potentially contributing to the emergence of abnormal   uterine bleeding .

Further assessment depends on the patient's reproductive plans, but be sure to include a detailed study of the structure of the uterus, the level of hemoglobin and hematocrit, search endocrine causes of ovulatory disorders, markers of blood coagulation disorders.

Highly effective treatment   uterine bleeding   well developed. In our arsenal there are lots of resources, the use of which depends on the age, sex and reproductive history and plans for the patient. For some, the ideal hormonal contraceptives, significantly reduces the amount of blood loss. Someone salvation seem gormonvydelyayuschaya Navy. After elimination of structural anomalies and diseases of the endometrium, requiring surgery, the method of choice for treatment of uterine bleeding associated with ovulatory dysfunction (including juvenile bleeding), according to medical therapy.

Instruction for parents

Dear Parents, look at their younger daughters. Palish not it?

Begin need to worry if:

• Menstrual bleeding lasting more than 10 days.
• From the 1st day of menstruation before the 1st day of menstruation takes place at least another 21 days.
• 1 hour child is using more than one pad.

Dear girls, if each of your menstruation becomes a "glorious sea - sacred Baikal", tell parents about it. Or the doctor.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Terms of missed contraceptive pills

It was in my biography time when I taught a special course "Family Planning", about the methods of contraception: faithfully wrote lectures and seminars developed programs, guidelines drawn to three independent work and are very proud of. My mom, all my life teaches philosophy and others like it, provides technical protection. This experience was interesting. Sometimes it is a pity that this period of my life is over.

I forgot to take a pill

I love public speaking, so that lectures are excitedly and enthusiastically. Students listened spellbound, still, after all contraception - it's interesting. And simple. And it is very clear! But my mother urged not to have illusions:
- Begin to take credit, you'll see.

My mother, as always, was right. Even the girls umnen'kiye never mastered the artless wisdom of protection. Advantages and disadvantages   Contraceptive   They mixed up in their heads in an unimaginable mess. Expose it was almost impossible.
There was a question - what to ask "to three"? It was the 2002 issue "at three" was nominated "rule missed pills." Looking ahead, I will say that over the years "Rule skipped pills" has acquired so many nuances and details that today for the correct answer should be to put a solid "five".

Then all oral contraceptives (COCs) in our market contained 21 active pill. Some had additional 7 inactive pills. Receive Mode "21 days to drink - 7 days off" was considered the only true and immutable.
Rule missed pills COCs, with 21 active pills in a pack

• Skips inactive pills in packages of 21 7 can be ignored. However, the missed inactive tablets should be discarded to avoid accidentally extend the period of receiving the inactive pills.
• Missing less than 12 hours: drink a pill as soon as you remember, even if you have to drink two pills in one day. The rest of the pills are taken at the usual time.
• Missing more than 12 hours: drink the last of missed tablets as soon as you remember. Count how many pills left in the pack because of this tablet.

Hormonal contraceptives

Then he appeared on the market "Jess" ("Dimia"), containing 24 active pills and receive mode 24 +4. The new regime has brought new rules.
Rule missed pills COC mode 24+ 4

• Skipping inactive pills can be ignored. However, the missed inactive tablets should be discarded to avoid accidentally extend the period of receiving the inactive pills.
• Missing less than 12 hours: drink a pill as soon as you remember, even if you have to drink two pills in one day. The rest of the pills are taken at the usual time.
• Missing more than 12 hours: drink the last of missed tablets as soon as you remember. Take a good look, what kind of pill you missed:

Rule missed pills

Notice how all the more complicated. Know this rule - is the answer to solid "four"!

In 2009, it was developed and brought to market a complex contraceptive "Klayra." Here and dynamic dosing regimen of the 26 + 2, and estradiol, identical to endogenous. Every day I say at the reception that "Klayra" - preparation for clever girls, do not miss a pill, the drug is very well thought out and balanced. I'm just sorry for almost 40 years of work of biochemists. But life is life, and passed Klayru.

Rule missed pill "Klayra" dynamically 26 +2

• Skipping inactive (white) tablets can be ignored. However, the missed inactive (white) tablets should be discarded to make sure we do not extend the period of receiving the inactive pills.
• Missing less than 12 hours: drink a pill as soon as you remember, even if you have to drink two pills in one day. The rest of the pills are taken at the usual time.
• Missing more than 12 hours: drink the last of missed tablets as soon as you remember. Take a good look, what kind of pill you missed:

Skip COC

The more tablets (particularly with the combination of two active ingredients on days 3 to 24 minutes) is omitted and the closer they are to the receiving phase inactive pills, the higher the chance of pregnancy. Agree, it is not just "five" and "excellent"!

Why do the wicked teacher forced to cram those stupid rules, if they are in each statement?
First, read the instructions not all taught by rote unit emits most of the trash. Special meanness is in the fact that when skipping pills, instruction rarely at hand.
Secondly, and in-chief, in 2002, the Internet was not as widespread as it is now. Today, even my husband asked how to roast potatoes with mushrooms is not my wife, and at Yandex.
Third, the vast expanses of the Internet you can find an endless number of nonsense. Why go far, http://mygynecologist.ru/content/yaz-dzhes-instruction: «If you missed 2-3 tablets Jess, they should take as soon as remembered about it. If you missed just two pills Jess, you take in a day 2 tablets, and the next day, too, the two tablets. Further prevent even 7 days after admission. If you have missed 3 tablets Jess, you also take them to 2 a day, is not "catch up" on account of the desired tablets. Simultaneous administration of 3 pills can lead to overdose symptoms (nausea, vomiting), but, in principle, is not dangerous. "
This recommendation will not do! No one "catch up" is not necessary. It is necessary to drink the last of the missing pills. The rest of the missed pills are ignored and remain in the package.

It is unacceptable to take more than 2 tablets a day! This does not increase the contraceptive efficacy, but will increase the risk of complications and spotting.

KOK - highly effective and safe method of contraception for a constant properly received. But! If you miss a pill, contraceptive protection is somewhat reduced, even when properly executed algorithm. In the absence of menstrual-like reaction is necessary to exclude pregnancy. Especially if the drug was not perfect.

Unfortunately, medical knowledge are not static. The latest news from the world of "missed pill": preparations for "Jess" ("Dimia") and "Jess Plus" permissible error in the reception doubled. Safe is considered to be late for 24 hours! Now forgotten pill should be taken no later than 48 hours from the last time you drink.

The new rule missed pills COC "Jess" ("Dimia") and "Jess Plus" mode 24+ 4

• Skipping inactive pills can be ignored. However, the missed inactive tablets should be discarded to avoid accidentally extend the period of receiving the inactive pills.
• Missing less than 24 hours: drink a pill as soon as you remember, even if you have to drink two pills in one day. The rest of the pills are taken at the usual time.
• Missing more than 24 hours: drink the last of missed tablets as soon as you remember. Take a good look, what kind of pill you missed:

Contraception

• All posts gynecologist

Blog gynecologist

Go back to the main page

One time - is not considered?

Exactly you know that you can get pregnant at any time. Especially with the first. Where this immutable adolescent confidence that for the first time - do not count, I have no idea.

Getting pregnant on the first try

At the reception, mother and daughter. Girl 14 years old, bright, tall, blonde. "What worries you? "-" Stomach hurts her, "- said the parent.

We find out that stomach hurts a month, not much, occasionally, aching pain, short episodes, urinating more learning, but painless.

- This is an inflammation of her, too, so I was. I chill somewhere - suggests his mother.
- Last month when we started?
- I do not remember - shrugs girl.

- Oh, Doctor, what's the difference when they were menstruating. Normal her monthly. She inflammation Well, you see it?

Good girl, dancing is involved, meets a boy ("Oh, they have there is nothing serious! We need to learn!), Sex life does not live.
When viewed from the uterus, finding fault, slightly increased and the right ovary cyst with the obvious. I think that's the reason for the pain.
- It is urgent to do an ultrasound.
- What for? She w inflammation! And I have to work - lamenting mother.
- I do not understand everything, ultrasound is necessary to make sure, and urgently.

Mom ran to work, going to do ultrasound alone. Girl lying on the couch, frightened little eyes gleaming. On the screen man by 9 weeks of pregnancy.

- Wow, what a great already! Another Mary?
- What is there the Virgin Mary - objection uzist - she already hard lives!
- Twice - squeaked from the couch.
- A birth control, how?
- Nothing.
- Why?
- So after all become pregnant the first time impossible - conviction, tell me reproachfully from the couch.

Exactly you know that you can get pregnant at any time. Especially with the first. Where this immutable adolescent confidence that for the first time - do not count, I have no idea. Practice suggests that pregnancy is often no time is required, relatively innocent enough games and petting.

- Come on, phone, child, will be to call your mom. You have not yet reached the age of "medical confidentiality", so that you will take.

- Hello, this is again Bogdashevskaya. You, above all, do not panic, but we've got to the US, as it were, so a softer, a godsend.
I am often such talk. I try to speak slowly, pausing. If the mother has time to include fantasy, a message will appear on the pregnancy deliverance.

Period 9 weeks does not leave much room for maneuver. Decisions must be made by parents. The girl has not reached the age of consent, criminal prosecution of young men is quite real.

In such stories are always a lot of tears. A mother with three children, this - the eldest. Mom girl walked up to me crying the whole week.

- Doctor, you know, the fourth child of our family is not overeat. But it will bear? And to give birth? She's still a child. Well, let's say I make a child over. The boy's parents agreed to fund all, I have talked with them. The school also decide - go to the externship.

- And she wants that?

- She sobs for several days. He says that he will do as I say.

- It used to such obedience.

- It is on the Internet has just been reading that her baby will get bit by bit, the handle-legs there ... You know, doctor, I am afraid to put pressure on it. She did not forgive me, if that. But if I lose it ... What do you do, Doctor?

On this issue there is no right answer. But he did not need anyone in this family. They made a decision and make it a reality. The fourth child is one "not to overeat," but for pregnant first child should be carefully observed, weighing all the risks.

It is a good mother and a good daughter. They completely trust each other, know how to forgive and overcome difficulties. I believe that this story is a long and mostly happy.

Why am I telling you this? All of the same - once considered! Keep this in mind and tell adolescents.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Female Cancer: the story of one online consultation

She died. I knew that the chances she had neither in Russia, nor in Israel. It took so much time, and I'm there, he reminded the woman he had never seen. Internet - a great hoaxer, we never know who is actually located on the other side of the monitor, but I believe - no, I know - it was just that: a strong, energetic, bright.

A woman crying

The question online consultation:

"I have a bloody discharge from the vagina .  I have put a preliminary diagnosis -Disfunktsionalnoe uterine bleeding menopause .  Hysteromyoma .  Pelvic ultrasound from 02 . 07 . 2011 - 132h92h133 uterus, uterus enlarged to 39 mm infiltration front and rear walls .  The appendages are not clearly visualized .  Right surround education tubo-ovarian volume 102sm3 left 163 cm3 .  Changed parametrium l / nodes .  Conclusion: The pathology of the endometrium, education appendages .  Wedge . blood from 02 . 07 . 2011 Hb 113 g / L, erythrocyte-4, 9, Lake 13, 5, 15 fell, ESR, 15 mm / h .  X-rays of the chest of 02 . 08 . 07- pathology is not revealed .  Common analysis of urine from 02 . 07 . 2011- 1026, acid, protein, 0, 4, sugar-otsuts, Lake 60-64 in sight, erythrocytes 80-85 unchanged .  Coagulation of 02 . 07 . 2011 prothrombin index 83%, INR, 1, 19, PTT-45, 7, 20-thrombin time, 5, fibrogen, 3, 0, fibrinolysis, more than 5 hours .  Biochemical analysis of blood from 02 . 07 . 2011: urinary-8, 6, creative-152, glitch-5, 7, protein-83g / l, albumin 49g / L, AST-16E / L, ALT-9E / l AP-411, Fe-3, 4, total . Bill 14, 1, 8-cholesterol, 18 .  03 . 07 . 2011 attempted WFD, the operation is not technically possible due to severe infiltration of the anterior vaginal wall .  Biopsy tissue from the anterior vaginal wall, the material is sent for histological examination, cytological smears taken .  Histology showed (6 . 07 . 2011): Macro-loose dark brown and grayish convolutions kroshkovidnye tissue fragments .  MICRO: Among individual blood found very small fragments of tumor tissue in its structure the most appropriate stromal sarcoma .  Endometrial stromal sarcoma .  CA125 at a rate of 35 I 94, in addition, I have been suffering from obesity .  What are my chances? "

My answer:
"You have a lot of hard work. In no case do not pull - pull long been nowhere. Much depends on you - your spirit of recovery, how you tolerate the treatment. It ochayannaya disease, and it requires a desperate means - the treatment of cancer pathology requires the mobilization of all the resources of your body, and help loved ones. You will find like-minded people and experts in the Russian Oncological forum. Good luck, stay :)) "

The issue:
"You did not answer me. Approximately what awaits me? At the hospital I was put on the following Monday. Is it true that Jewish susceptible cancer most often and why? I'm just the doctor said, "Oh, my dear, you are a Jew! It's hard you have to. "

Answer:
"No, not associated with Kaposi's nationality, although proven that Jewish women of Ashkenazi in the genotype are common alleles for pathological VDKN, breast cancer and ovarian cancer. I do not want you as a properly orient (by your description, it IIIC), but I hope that you will operate (volume - hysterectomy with appendages, resection of the greater omentum may resection 2/3 of the vagina), and then - chemotherapy. Perhaps a chemo-radiation therapy, or as a separate step - beam. May propose to start with a few courses of chemistry, and then go to surgery. This is a very long and multi-step process. "

The issue:
"Then, doctor, my chest is too problematic. The results of mammography, "skin, nipples, areola not changed. The structure shows a pronounced glandular, fibrous, fatty and connective tissue components. Against this background, both breasts are determined by multiple focal shadows of 0, 3 and 1, 0 cm d, with equal precise contours. The left breast is determined by the formation of 4 cm d, with irregular contours. Conclusion: diffuse fibrocystic breast disease, suspected cancer of the left breast. " Just do not know how to be a mood of eerie "

Answer:
"Bad. It is not clear - whether primary multiple cancer (two different cancers at once), or metastasis. Unfortunately, most first. "

The issue:
"I once again stuck. But what predictions in my case, as I have left? "

Answer:
"Forecasts in oncology - a thankless task. I have too little information to somehow evaluate your chances. A comprehensive survey, the volume of surgical intervention, the results of histological examination of all removed material, comorbidity, tolerance of chemotherapy and radiotherapy - all this seriously affects the prognosis. Most important is your attitude and faith in a favorable outcome. Survival of those who are willing and able to fight. "

The issue:
"Thank you Doctor. You are my ray of light and hope. I'll be happy when your words come true. Let us pray and fight. Two more questions: 1. I was put in the center of Blokhin. Who would you have advised me there of mammalogy oncologist and cancers? Should I be treated there, or go to Israel? 2. How to protect three daughters from this horror? In older have found ovarian cysts, operated on. "

Answer:
"Methane in any case it is not necessary! RCRC - the most solid institution in the Russian Federation. You necessarily look for a consultation and all decisions are made collectively. In relation to girls - the only reasonable method of prevention is regular monitoring. Annually - colposcopy cytology + + + OMT ultrasound mammography / breast ultrasound. Today it is possible to make the molecular genetic study on the carriage of mutations in the genes BRCA 1/2. These mutations are responsible for hereditary ovarian cancers and breast cancers. BUT! In case of detection of mutations, an adequate measure of prevention is prophylactic mastectomy and oophorectomy (removal of the ovaries and mammary glands) immediately after the implementation of the reproductive function. If the mutations have been identified, that does not preclude the likelihood of tumor localization data of a different nature. Hold on, strength, and good luck to you. "

The issue:
"Thanks, I'll try not to limp. My girls I taught youth receptions of self, and launched himself. Jobs such, I have a large construction business. There's no time at all. But preventive operations do very scared, they are too beautiful. Whether it is possible in some other way? Do I have what they have cancer? "

Answer:
"BSE does not improve the early diagnosis of - just an observation with the use of modern equipment: mammography, ultrasound, etc. Prophylactic surgery - a step of despair. This selection is done by women, burying his mother, grandmother, aunt, sister ... "

And again, she again:

• "The terrible thing to say. But the analysis we do, but we'll see. How will they live then as sex life and how to lead their husbands to say? Tomorrow I go to the hospital. Nerves to the limit. Not slept all night, the pressure of 170/90, the head is in a vise, abdominal pain, chest whining. In the brief moments of sleep dreaming about any nonsense. What is that to me it would do. Just to get out for four months at least. Is there anything in an Internet forum where you can chat with people like me? I rummaged everything, one nonsense. Fearfully. I cried all morning. "
• "If I survive, we will meet again, I'll come to you at the reception. You calmed me, gave me hope. Girls adult male around. We love each other. Today, imagine, I terribly wanted sex. Experience the stunning orgasm can last in life, who knows.
• I look forward to our doctors, "...
• "In general, as you said. I looked at a council headed by the manager. Branch. We looked at all of my examination, ultrasound done in two projections, and they decided to carry out an operation on Wednesday. The volume: removal of the uterus, vagina 2/3, omentum appendages and ovaries. When operate chest decide tomorrow. I have been told that the breast can try to preserve. Head. department said it is good that paid doctors to work in a day and not waited for everyday life, we are calm and work productively. So, do not so bad ?! "
• "Today the issue resolved with the breast. I do lumpectomy left breast in the lower outer quadrant with preservation glands. My dignity will be saved. Tell me, please, when you remove 2/3 of the vagina, uterus and ovaries, sex generally is possible? And how much he brings fun? I understand that you're not a sexologist, but just too shy to ask your doctor. It is strange to hear from La Juive questions about sex? I'll probably go to hell. "
• "Thank you for your support. Today I was told that the chances of a long and active life I have more than 70%. Very strong body. Yesterday came a daughter. Walked around the clinic. Prophylactic mastectomy - the removal of the breast completely? And is it possible, after her doing reconstructive plastic ? "

And it is not She wrote:
"Hello! I rose, daughter Myra Isaakovna. My mother had an operation, the state is now stable, moderate. Doctors say that everything went well. Mom just asks me to write to you about this, because you are very cool its support during the difficult days. Almighty bless you. "

I am often asked what I think about the online consultation. Miscellaneous think. Medicine - not an exact science. Not seeing the patient, not knowing the full scope of information that can be such nakonsultirovat that oh-ho-ho. To offend patients. Frustrating that nothing concrete has been said, the treatment is not appointed, the board of given some uncomfortable.
One of the basic tenets of medical ethics - Primum non nocere (first do no harm). It is this correspondence remember consultant, looking at issues of nuggets of information, sifting husks of emotions.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis and infertility: History 1

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about the disease, the National Community of endometriosis throughout the world, doctors and patient volunteers organize events and press reports. The world must know what suffering can bring this disease related to pain. Women should not suffer in silence! MEDIKFORUM contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

Katya came to see me in September 2012. They came together with her husband to be examined together. Very young couple - she 26, he 27, together with the school, married 5 years, three years, "planning" of the child, but the pregnancy does not occur all. The terrible word "infertility" has not yet spoken, but inwardly they are ready to hear it.

Complaints patient there, all very good. But the dialogue does not work, like Katya periodically falls out of the reality: closes his eyes and off for a few seconds, at the most basic questions are answered after a long delay, painfully for something to listen. The pale, listless - I was seriously worried.

From the history of the disease.
Menstruation from 13 years of regular, painful.
The pain takes Nospanum, Nurofen, ketanov, baralgin, pentalgin.
Painkillers do not help.
Nothing helps.
With 17 years treated at the gynecologist from inflammation of the appendages. 5 times was in the hospital. Birth control pills are not prescribed.

From sluggish conversation we find out that the patient came to the reception on the first day of menstruation. Here I understand the cause of her condition.

- So you have today is the first day? That you have such pain ?!

Here breaks husband:

- Yes, today still nothing! It is three days could not get up on the bed rolls and lows! "First," it takes longer - make a shot, that's all.

Dysmenorrhea - cyclical pathological process in which a woman experiences pain during menstruation; and - the secondary, because it is only a symptom of the underlying disease, I suspect PID - inflammatory diseases of the pelvic organs. What could it be? Untreated gonorrhea? Chlamydia?

We carry out complex analyzes and the wife and husband to reveal anything that might interfere with pregnancy.

From history
Sperm fertility hormones in the order of US unremarkable.
On examination, it looks perfect - peaceful isolation, the area of ​​the appendages and vaults in order, no infections, pH 4, 0.
Ovulation is, the second phase of the smart.
Shown diagnostic laparoscopy - it makes it possible to ensure patency of the fallopian tubes, adhesions immediately upon detection remove them. And can detect hidden problems.

The operation was conducted in MONIIAG. Pipes proved passable on both sides, no signs of chronic inflammation and adhesions found. Not far from the ovaries to the peritoneum comfortably settled small unit endometrioid heterotopia. Endometriosis. He became a barrier to pregnancy.

From the history of the disease.
The diagnosis after the operation: external genital endometriosis 1 tbsp. Infertility-1. Secondary dysmenorrhea.

This story has a happy ending. Immediately after surgery, with the patient, we picked up a soft hormonal therapy. After 4 months (it can not be less than) the drug was canceled, and a month later pregnancy. Now Katya is observed in the women's clinic and is preparing to leave.

Experts say - well, what's wrong with that? What's so amazing and magical? All typical. What's to discuss?

Nothing to discuss. Just remember - from the fact that endometriosis is a very common, almost does not depend on the age of the patient's disease, the severity of pain and the risk of infertility is not reduced. Do not suffer in silence! Ask for help!

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis and urethritis history 2

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about the disease,

MEDIKFORUM   It contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

A 41 year-old Elena went from clinic to clinic. The painful burning sensation in the urethra causing it again and again to see a doctor to be tested, to drink antibiotics. It would seem banal urethritis! But somehow nothing pomogalo.Zhzhenie and itchy back with a bang after any treatment, there have been signs of itching and discomfort in the vagina.

Consultation with gynecologist in such situations - is required. When Elena came to me, there were a few, and she did not expect a miracle. Configured I was skeptical, but answers questions with pleasure.

From the history of the disease.
Complaints expressed by burning and tingling in the vagina, the periodic discharge from the genital tract. Symptoms appeared in the summer of 2011.
Patient self-conducting oil processing takes suprastin - does not help.
Menstruation at age 12, regular. At 21, married and happily married for 20 years.
One pregnancy, childbirth prosperous 1993.
Safe interrupted intercourse, condoms. Several times taking oral contraceptives, but, mainly, with the purpose of treatment.

- And what were treated with contraceptives?
- I had endometriosis. I brought all the statements - see.

For years, Elena Vladimirovna bothered painful pelvic pain, in connection with which it has repeatedly called for medical help. In 2001, she conducted a diagnostic laporoskopiyu "cauterized" mass endometriosis and half appointed "Buserelin." The effect was amazing - there was no pain for two years.

By 2007, the renewed pain forced again to lie down on the operating table. All the same - a diagnostic laparoscopy, coagulation endometrioid heterotopias.
Hard to say why, but an anti-hormone therapy is not administered. Whether in the hospital decided that hormones should appoint, in consultation and advice to Elena has not reached., That if someone did not consider it necessary. But the pain came back very quickly. Within two years, doctors have suggested radical surgical treatment.

In 2009, the clinic had a major laparoscopic hysterectomy without appendages. In peritoneal endometriosis multiple coagulated from 2 to 4 mm in diameter.
- Why left ovary?
- So as I was only 38 years old.
- So what. Where is the logic - to remove the uterus and ovaries are left?
- I was told that if you remove the uterus, endometriosis, it can no longer leak.
- A hormone treatment appointed?
- I have cleaned it all! They said that endometriosis is gone.

My bewilderment was great, even though I knew that Elena could see the situation from the perspective of the patient. From the position of the doctor, a volume of operation is extremely neosmotritelen. The ovaries continue to produce estrogen, which stimulates the growth of endometriosis.
- But I have no ovaries began to climax!
- Do you think the ovaries menopause starts? Will necessarily and quickly.

From the history of the disease.
Self-assessment of the severity of menopausal symptoms 14 points (Moderate): hot flashes, palpitations, insomnia, nervousness, fatigue.
When viewed in the mirrors on the walls of the vagina multiple endometrioid pockets. Copious chocolate.
Endometriosis vaginal part of the urethral lesion is rare. Itching, stinging, tingling, a feeling of rawness - typical symptoms of endometriosis for a given location.

We were treated annually. Chocolate allocation stopped quickly, but itching and burning in the urethra remained almost 6 months. We believe in the success seen improvement and I understand that we were able to find the cause of this incurable urethritis. When long-term therapy, it is important to choose the drug well tolerated, and we succeeded.
- I have all passed. Can I stop drinking the drug?
- You understand that the symptoms may come back?
- Yes, but if I start drinking it again, they will pass?

Maybe. Unfortunately, to predict further developments difficult. As ovarian failure, endometriosis cease to behave aggressively. Let us hope for the best. (infertility: History 1)

• All posts gynecologist

Blog gynecologist

Go back to the main page

It's time to the hospital: main features

When to go to the hospital - the issue date for pregnant women and their relatives. Helicopter over the little town, and a lot of cars on the road - especially in Moscow, especially when small maternity wards are closed at CRH (not profitable), while the perinatal center yet to be reached.

when to go to the hospital

I tell this story for 4 years in the classroom to prepare for childbirth.

Elena 34 years. The second pregnancy, the second coming generations. Once graduated from the Moscow Aviation Institute, majoring but never worked with her first husband did not work, his son Mishka 5 years - a great healthy boy. This sudden pregnancy, but desirable, from a loved one, which promises to "help", but does not promise to marry. Counted term births - fell on the 10th September.

- But remember that a woman is at term with 38 minutes on the 42 th week.
- Yeah. The last time I gave birth a week earlier, and then in the September 3rd face. I need to know exactly how to catch Bear parents drive, and then he got scared when labor will begin.
- Lena, what nonsense? Bear in 38-39 weeks, let grandparents take. But even if the birth will begin what he scared? Start fights, you quietly invoke emergency and calmly go to the hospital.

On the morning of September 3, Lena began pohvatyvat stomach.

- Began. I said - a week earlier - said Lena while cleaning the apartment and collecting Bear to her grandmother.

The contractions were quite tolerant, Lena felt fine, but just in case, called her parents:

- Well, Mom, you come?

- Yes, of course, darling, we're going.

"That is great! "- Thought Lena, patting his stomach. It disturbs it not in vain, because she lives in Khimki, and parents in Vykhino. For those who are not in the material: Khimki and Vyhino are in opposite ends of the Moscow and Moscow - the city is not small.

The contractions gradually become tangible, Lena started to glance at the clock, wondering duration of contractions and interval.

- Mom, what are you going?

- Yes, darling, we have come out with my dad.

"From the planar Vyhino to the subway 47 minutes - Lena thought, rubbing his lower back. - Without a direct, straight branch. And even from the subway about 15-20 minutes. Childbirth - business not fast, all have time. "

Some time later, Lena decided to go to the toilet: "Can not enema at the hospital will cost." It was in the toilet Lena was very clear that she wants to "at-large" is not without reason - it clearly has tuzhit!

Here Lena mobilized and developed a storm of activity. First things first, she ran to a neighbor:

- Urgent Call an ambulance! I give birth!

Then I took a bath of warm water and two attempts to successfully gave birth to a girl.

- Oxana, you do not think I have it right away mucus from the nose sucked, and she screamed. I bathed and put it to his chest. And then the ambulance arrived. That is well done all the same, so soon arrived! I pinch the cord doctor, and right on the stretcher I was in the car suffered. I say, "Doctor, I feel myself very well, I'll make it myself. Why did stretcher? "But the doctor does not allow, he said that I had the last in the womb, so only on a stretcher. I honestly prichestno not want to give birth at home, it happened by accident.

Bear did not have time even frightened.

We recommend immediately go to the hospital Where:

• There has been a rupture of membranes and / or suspected of leakage in any stage of pregnancy.

• When regular contractions more often than 10 minutes.

• If there is a sharp pain in the abdomen.

• When the bleeding.

Today, the World Wide Web offers a convenient on-line service - skhvatkoschitalki. They are especially useful for those whose lives have long been inextricably linked with different gadgets, and Internet addiction issue this "break" in places where there is no network and Wi-Fi.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis in adolescents: the history 4

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about this disease, MEDIKFORUM contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

Masha 18 years. At the reception it brought my mother - excited, loud, restless. In Masha painful menstruation. Very painful.

It was hard to talk. My mother tried to present a complaint to evaluate and draw conclusions. Prolix and noisy, she sincerely believes that it can better describe the complaint daughter daughter. Masha - an adult over the age of confidentiality girl. Align mother out of the room it was only after 10 minutes.

From history
Menstruation from 13 years, established immediately.
Regular - every 28-30 days.
Moderate.

In order to assess the severity of pain, we are using your - visual pain scale from "0" to "10", where at "0" no pain, and "10" - this is the most unbearable pain imaginable. Masha assessed pain during menstruation in 9 points.

- Monthly once were so painful?
- No, at first just unpleasant ache. And six months later already well so sick. Mum to me that just does not come on! And Nospanum and baralgin.
- A Nise, Nurofen tried?
- Yes, we all have tried. I already ketanov not help.
- The sexual life of the age to live?
- I do not live.
- Quite quite? No-way?
- No (smiling).

In the days of menstruation Masha does not study, does not meet with friends or hanging "in contact". Three or four days each month lying in Masha "pose sic" and grunts. With meticulous survey it found that in those days, Masha has difficulty with urination and defecation. The severity of constipation is estimated at 10 points on the VAS.

From history
Inspection and productive Vaginoscopy information is brought to - all right.
Pelvic ultrasound - corresponds to the phase of the menstrual cycle. Everything works like clockwork.

Generally, primary dysmenorrhea (painful periods), "normal" for a symptom of adolescence. However, 10% of   dysmenorrhea in adolescents   is secondary, that is associated with other disorders. Endometriosis - not uncommon at this age. According to the World Endometriosis Association, 38% of women, the symptoms of the disease first appear before the age of 15 years.

The presence of secondary dysmenorrhea can be assumed in the following cases:
• in patients who do not respond to commonly used to treat primary dysmenorrhea first-line drugs (NSAIDs and CCO);
• if dysmenorrhea occurs shortly after the menarche (within the first 6 months), because, as a rule, primary dysmenorrhea develops later, from the time of ovulatory cycles (in the middle and late adolescence).

Symptoms of endometriosis in adolescents may differ. Only 9.4% of adolescents complain cyclic pain, but more than 90% of them note acyclic dysmenorrhea pain with or without.
In the case of suspected endometriosis is usually applied a stepwise approach in the selection of medication. First-line drugs are NSAIDs (Nise, Nurofen, ketoprofen, etc.) And the COC in a cyclic or continuous mode.
With the ineffectiveness of these methods is recommended to carry out a diagnostic laparoscopy.

Features laparoscopic diagnosis in adolescents

The question of "to operate - not to operate" very complicated. Clear guidelines for today do not. Laparoscopy may be imposed in order to confirm the diagnosis of endometriosis in adolescents with generalized severe pelvic pain, in case of failure of medical therapy. In young patients often detected atypical endometrial lesions in the form of bubbles and pockets of bright red, extremely rare heterotopia classic color "powder burns".

The recommendations of the Canadian Society of Obstetricians Gynecologists 2010 Endometriosis: Diagnosis and management (Journal of Obstetrics and Gynaecology Canada 2010; 32 (7): 1-28)
1. Endometriosis - the most common cause of secondary   dysmenorrhea in adolescents .
2.   adolescents with endometriosis   are more likely than adult women, there is an acyclic pain.
3. On physical examination of adolescents with endometriosis rarely detected are any deviations, as most of them have the disease at an early stage.
4. Endometriosis in adolescents is often characterized by atypical manifestations. During the laparoscopy revealed atypical endometrial lesions in the form of bubbles and pockets of bright red color.
5. All the available methods of treating endometriosis are acceptable for teenagers, but should take into account the age of the patient and side effect profiles of drugs.

From history
We have put Masha diagnosis of "secondary dysmenorrhea. Suspicion of external genital endometriosis. "
Her mother angrily rejected the proposal to take COCs. The idea of ​​a diagnostic laparoscopy she also did not like. Visan decided to choose as the lesser of two evils.

Against the background of the first package of the drug, bothered spotting and drowsiness. Mom Masha was in a panic. With great difficulty, persuaded to continue receiving, using blackmail and easy voicing average price diagnostic laparoscopy. "Miracle" was already on the second package - the pain is almost gone. Masha assessed their pain by 2 points. Another good news was the complete disappearance of the problems with constipation. She continues treatment for 6 months. It feels great, depression, which so frightened mother reading the instructions, did not come. Masha still does not live sexual life.

We are faced with the question - what do we do next? How long will it take the drug? The unequivocal answer I have. I hope that from day to day priskachet prince on a white horse, and I'm in good conscience translate Masha Kok. We wait-with.

• All posts gynecologist

Blog gynecologist

Go back to the main page

A child with alcohol syndrome can be born in any family

FAS - fetal alcohol syndrome. So called disorder that occurs when the mother used alcohol during pregnancy. It is a combination of mental and physical birth defects that occur shortly after birth and remain for life.

Fetal alcohol syndrome

The most beautiful baby lying in your wheelchair, said to me one day in-law. My most beautiful child 11 years, and all these years I have to agree with her mother in law: mother's eyes look at the world from a certain angle. Maternal instinct, including immediately after the birth, so reconstructs the perception that "mimishnye Lialechka" from magazines, babies, advertising diapers, do not seem so sweet and charming. Because the most charming, so that there is the most beautiful baby in the world, only one - the one that is in your wheelchair.

Unfortunately, or fortunately, becoming a mother, I can not stop looking at the world through the eyes of an obstetrician-gynecologist. Leave to care for a child every mother, I - not the exception - is found with a lot of kids who ride in carriages, leading to the clinic, to the rocker or swing seated mold mud pies in the sandbox. Gliding through the eyes of children face, my brain automatically mutilated medobrazovaniem said: "FAS! And this FAS! ... It is likely, too, FAS! "

In 1973, two groups of scientists: K.L.Dzhones and colleagues (USA) and P.Lemoen et al have described the first time the FAS. The picture is quite diverse: pre- and postnatal degeneration, craniofacial dizmorfiya, brain damage. Children are born with LBW and inadequate length of the body, behind a raise in height and weight. Craniofacial dizmorfiya so common that "a person with alcoholic baby syndrome" you can easily learn in a sandbox and a group of kindergarten:
- Short palpebral fissure,
- Epicanthus,
- Ptosis,
- Strabismus
- Low bridge,
- A thin upper lip,
- Deep-seated ears,
- Microcephaly.

The three-year Maxim Kuzmin, adopted by spouses from Texas, had all the typical features of FAS. 01/21/13 baby died. US forensic experts determined that death occurred from the rupture of arteries as a result of the trauma of Maxim himself.

You can argue long, it was, and who is to blame. But it is known that the biological mother of Maxim was deprived of parental rights for antisocial behavior associated with alcoholism. A child was considered hyperactive and received sedatives.

Signs of damage to the nervous system in patients with FAS may occur immediately after birth:
- Tremor,
- Seizures
- Hypotonia.

In the future, say the development of so-called "hyperactivity and attention deficit", memory impairment, mental retardation.

From malformations common abnormal location of the fingers, hip dysplasia, hypospadias, malformations of the vagina, imperforate anus, heart, pathology of hearing and vision.

These children face serious difficulties in obtaining education. The offenses attract attention or addiction police. Deviation of sexual behavior, alcoholism, inability to live among humans. Unfortunately, the prognosis is poor. FAS - the disease is incurable. Even a mild form of FAS in the fetus leads to serious problems in the child.

- Yes, children from disadvantaged families - this is a problem. Children of alcoholics - this horror, the horror!

No. "The horror, the horror" in another. Children with FAS are born in the most common socio-affluent families.
There is no safe dose of alcohol!
Group risk for the general health of women is the use of 4 or more standard drinks per week. For pregnant women and women planning a pregnancy, the use of any amount of alcohol is risky.

1 dose - 340 g of 5% beer 141, 75 g of 11% of the wine or 42, 53 g of 40% vodka or brandy.

If a woman is pregnant or planning a pregnancy - complete abstinence from alcohol.

If a woman uses contraception regularly, or using ineffective methods of contraception - pregnancy is possible. Make a choice: reliable contraception and / or avoiding alcohol.

- How do you protect yourself?
- Nothing.
- Why?
- Well, if I get pregnant, I'm going to give birth.

It is wonderful. It's wonderful that a woman does not plan to have an abortion. The catastrophe is that she is not planning a healthy baby. Shall we never be able to reach out and explain that elementary folate intake, basic changes in lifestyle and nutrition, minimum training and complete abstinence from alcohol, smoking and drugs are absolutely necessary.

- Well, I already have a child. I did not do this, I drink occasionally, even during pregnancy, some beer or red wine. The baby is fine!

The birth of a healthy baby does not guarantee that subsequent children will also be born healthy.

Look at the children, falling on his back and feet hitting the supermarket. Look at children with difficulty assimilating program of the first year of secondary school. You do not dream about it, right?

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis in postmenopausal women

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about this disease, MEDIKFORUM contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

It is believed that endometriosis is not found in women with menstrual function extinct: no menstruation - no endometriosis. Unfortunately, women with natural menopause, the risk of recurrence of endometriosis is 3, 7% in women with surgical menopause - 2, 7%.

Mercifully left ovary after surgery increases the risk of renewed pain in 6, 1 and 8 times, 1 times increased risk of reoperation compared to women, which was removed and the uterus and ovaries. Therefore, the possible recurrence of the disease should always think of women with a history of hysterectomy and classic symptoms of endometriosis - pain.

The first case of endometriosis in postmenopausal women has been described as early as 1950. Since then, periodically there are similar publications, causing permanent interest.
J.C. Rosa-e-Silva and colleagues presented three cases of histologically confirmed disease in postmenopausal women without a history of endometriosis, never received HRT (hormone replacement therapy):

• A woman aged 62 - endometrioma, pelvic pain

• A woman aged 78 years was found endometriosis in postoperative scar after gistrektomii produced 20 years ago

• A woman of 54 years (from 48 years of menopause) diagnosed endometriosis in the rectovaginal septum

It is interesting that in postmenopausal women are more common extragenital endometriosis (large and small intestine, bladder, urethra, lung, liver and skin) and endometrioma.

Diagnosis in such cases is much more difficult. First of all doctors think the exclusion of cancer. Especially difficult to correct diagnosis patients, without reference to a history of endometriosis. The unequivocal answer to the question, it is primarily caused endometriosis or recurrence of an old undiagnosed, does not exist. In relation to endometriosis is dominated by theories and hypotheses. The absolute is believed that surgical treatment should be the first step in the treatment of patients with endometriosis, revealed for the first time in postmenopausal women.

In practice, gynecologists often worried about whether you can conduct HRT patients with endometriosis? Do not use estrogens provoke relapse? And this question is not idle.
Prolonged use of GnRHa (gonadotropin releasing hormone), repeated surgical interventions help reduce the ovarian reserve and the development of early and premature menopause. On the one hand, the earlier a woman enters menopause, the greater the risk of cardiovascular events, urotroficheskih detection, lower cognitive function and quality of life. On the other hand, possible resumption of relapse of pain, repeated surgeries and even malignancy.

Position EMAS: Keeping menopausal women with a history of endometriosis, 2010

• HRT shows women with early / premature menopause before the average age of menopause, and should be considered in older women with severe vasomotor symptoms.
• Data relating to the use of HRT in women with a history of endometriosis is limited. Apparently, it is necessary to apply a continuous combined regimen regardless of whether or not a hysterectomy. This will help reduce the risk of disease recurrence and malignancy of the remaining endometriosis.
• Alternative therapies and kostnoprotektivnye drugs should be used in women who are not receiving hormone therapy.
• Appointment of drugs produced on the basis of herbs should be used with caution because their effectiveness has not been studied properly and may include estrogen-like components with unpredictable effects in these patients.

• All posts gynecologist

Blog gynecologist

Go back to the main page

Endometriosis and birth control pills: Story 3

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about this disease, MEDIKFORUM contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

Nadenka 33 years. In November 2011 she was first diagnosed with "endometriosis". Almost six years before she complained of abdominal pain.

Nadia married 25 years. Beautiful wedding, beloved husband, a separate apartment. Quickly she became pregnant, and just in time she gave birth to a healthy boy. Milk was slightly, but enough for up to 6 months. Life was good.

Pain began a few years after birth. They then appeared and disappeared, then were quite tolerant, some painful and unbearable. The doctors did not find anything, but tried to help. Nadia conscientiously implement the destination - drank antibiotics, herbs. Several times went to the sanatorium "in the dirt."

My husband also tried to help - drove to the consultation, buy medicines, and even found a good nanny for his son (Nadya sometimes curl so that the care of the growing strength little boy was left). But then anxiety and suspicion gave way to sympathy, coldness. My husband thought that Nadia pretends and plays scene "dying swan" because it does not want to deal with a child, farm, sex. Indeed, the inability to perform "marital duty" irritated him most.

On the next reception at the gynecologist revealed cysts in the ovaries. Cysts were big and suspicious. The doctor strongly recommended surgery. Perhaps it is the need for hospitalization was the last straw for Nadenka husband. A conversation in a raised voice, and her husband filed for divorce.

10 days in the gynecological department of the hospital is very good Nadia spent in a daze. The inspections, procedures, consultation. Strange words frightened Nadenka did not care. Operation since surgery. Before you leave the doctor Nadenka time explaining what is endometriosis, strongly recommended to take birth control pills. What did he know, this strange doctor! What contraceptives, why? Before the trial was two weeks, life is over, who are now required to Nadia 4-year old son in her arms.

But it all goes - the court, the division of property and the rights to participate in the upbringing of the child. Only 3 months Nadia realized that she did not hurt. Menses time, not "poured" and not twisted "letter sic."

Son - cute boy and magic - went to kindergarten. Nadia got pretty dusty diploma and went to work. The salary was modest, but the parents have helped life to normal. Hair, Heels, fresh make-up, bright eyes. It is no wonder that very soon there was a decent man, he offered his hand and heart and all that there still attached. Immediately after the wedding, it was decided to "make a girl".

Nadia came to us after 1, 5 years. Pregnancy does not occur.

- I do not understand! With me no abortion, son, I almost immediately became pregnant, gave birth easily. Husband spermogrammu passed - everything is in order.

From history:
Discovered external genital endometriosis IV degree (endometrioid ovarian cysts 5 and 7 cm, widespread endometriosis Douglas space and vesico-uterine fold.
In the US in both ovaries 3 centimeter education, suspiciously reminiscent of endometrial cysts.

- You prescribed treatment after surgery?

- Yes, I was advised to drink contraceptive, but I was divorced from her husband, and I have a long time did not have sexual relations.

- Now there is no pain?

- What are you, I'm fine. To me in a hospital surgery done about these doctors legends go!

- It is necessary to make diagnostic laparoscopy. Endometriosis often recurs and does not become pregnant. And the pipe will look spaechki disconnected.

From history:
Laparoscopy has been made operational, two-sided conservative cystectomy. Coagulation and excision of endometriosis. Hromogidrotubatsiya - fallopian tubes are passable on both sides.
Histology: Endometrial ovarian cysts.

- Nadia, it is necessary to take hormone preparations 4-6 months. Only then it is possible to get pregnant
- But I was told that I tried right now. What is the best chance to get pregnant immediately after menstruation!

After 4 months there were pain during sexual intercourse, menstruation became more and more painful.

From history:
FSH - 36 3 IU / liter
LH - 8, 8 IU / l
Prolactin - 487 mIU / L
AMG - 0, 5 ng / ml (normal 1-3, 5 ng / ml).
Ovarian reserve is reduced dramatically.

Ovarian reserve - this is a strategic supply of eggs. No suitable eggs - no pregnancy. The examination revealed a regular recurrence of endometriosis.

Nadya sent to the reproductive system. Recommended hormone therapy, which has twice ignored the patient, then IVF with donor eggs.

Does the routine gynecological surgery contribute to early menopause? This is not an idle question. Nothing more carefully than laparoscopy, has not yet been invented. You do not like the answer: laparoscopic surgery disrupts the function of the ovaries and reduce the ovarian reserve .

Electrocoagulation after resection of ovarian cysts lead to disruption of the vascular system of the ovary, and the removal of normal ovarian tissue with endometriotic cyst wall occurs under any surgical technique.

Treatment of Endometriosis exclusively by surgical methods is unacceptable. Implementation of anti-hormone therapy - not a whim and not a fad, it is a necessity.

• All posts gynecologist

Blog gynecologist

Go back to the main page

How to start a sex life: the rules of sexual debut for girls

"Fall off the horse, so to raven" - said my wise mother. For the correct start of sexual activity, it needed. Not just any pretty boyfriend, persistent gentleman, and not even the most beautiful boy in the class, which all the girls dreamed. He - a Romeo for Juliet, Tristan to Isolde, Orpheus for Eurydice.

Start sex life

It happens in our lives only once. That is the only time longing, fear, lust, curiosity create an explosive mixture. First sexual intercourse can become magical and can bring only disappointment and disgust.

Unfortunately, the first sex can not only like it, but to be really dangerous. To obtain gonorrhea, syphilis, or HIV infection, only one times. Do not be fooled by "decent" view of a young man. In order to carry HIV and hepatitis, not have to be a drug addict. Even a nice young man from a good family, it may be a questionable one-time experience of the consequences of which he does not even know.

Rule №1. Take your time. Make sure that it is the person with whom you're ready to share your first time. Ideally - you do not mind to educate children with him and support in grief and joy.

Rule № 2. Do this in good faith, being of sound mind and memory. It is not necessary start having sex While under the influence of alcohol, drugs, coercion and blackmail under the influence ("you love me - prove", "if you do not give, I would be very hurt"). Such situations should be avoided by refusing to questionable companies and entertainment.

Rule № 3. Move from theory to practice. For a successful sexual debut should take some time to enhance their education. Some ideas about human anatomy and physiology can be obtained in high school. On what problems may arise, should know before onset of sexual activity that would take all necessary measures to prevent them.

Actually, the first sexual experience, and for many, many years, there will be two problems: genital infections and unwanted pregnancy.

Explore the possibility of the symptoms, it is necessary knowledge. A condom - the only effective barrier against sexually transmitted infections, use of condoms during each sexual contact from the very beginning to the very end. Take care rules putting condoms on bananas porepetiruyte and carry condoms with them. This good habit could one day save your life.

Be sure to keep a menstrual calendar start. This is not a whim of gynecologists, is a harsh necessity.

Rule № 4. Get rid of illusions.   Remember, the issue of protection from unwanted pregnancy, it is solely a women's issue. Under no circumstances can not be trusted with your life and your future to someone else. Even in the most optimal variant if an unwanted pregnancy ends marriage and childbirth, it is far from a happy ending. Marriages "by aerial" very rarely happy, unplanned births will change not only your life but the lives of your loved ones. Whatever decision was taken, it will affect your life. That woman the risk of infertility, making abortions. This woman may die, nurturing pregnancy and giving birth to an unwanted child. That woman will be a single mother, if the happy family life does not work out. Coitus interruptus does not protect against pregnancy! The younger the woman, the higher her chances of getting pregnant.

Rule № 5. Learn how to separate the wheat from the chaff.   On the Internet you will find a sea of ​​conflicting information. From prevention through "safe days" and slices of lemon to the long and angry opus about the dangers of hormonal contraception. Learn to look for reliable information, do not hesitate to ask questions, to compare the answers, decide whose opinion is trusted. It is possible, you will find many fine doctors who will be able to find a moment or two to share with you the knowledge. Quite possibly, you will begin to recognize the evil trolls from the first line of the message and do not take for granted all that is excavated in the network.

Rule № 6. Prepare a path of retreat.   Take care to advance the search for a physician to whom you can come running on internal reception. Obviously, you may need a gynecologist often - infection, pregnancy diagnosis, selection of a contraceptive method, bursts of "paranoia" doubt. It all starts as soon as the dare "to start."

Rule № 7. Create conditions.   Let your first time to be romantic, tender, memorable. You should have enough time to take the time. The place should be quite secluded and comfortable, what would help you relax. The ability to take a shower is also very important.

If you feel old enough to start adult life - there is no objection. But be prepared for what adulthood - is the adult problems. Ready? Welcome!

• All posts gynecologist

Blog gynecologist

Go back to the main page