New methods of treatment of endometriosis - the topic of the article. This can lead to the development of the following symptoms:
- painful menstruation (dysmenorrhea) - pain usually begins one to two days before the menstrual period and gradually weakens, although sometimes they do not completely disappear;
- pain during sexual intercourse (dyspareunia) can last up to 24 hours;
- a feeling of pressure in the rectum - sometimes there may be urgent urges or pain during defecation;
- pain in the lumbar region can be associated with the ingress of blood into the urine; pain when urinating;
- infertility - up to 40% of women with endometriosis experience difficulty in conceiving a child.
Although some women may not manifest endometriosis at all, many of them suffer from severe pain, which leads to a general deterioration in health and depression. The exact cause of endometriosis is unknown, but there are several theories:
- retrograde menstruation - during the menstrual fragments of the endometrium through the fallopian tubes get from the uterus into the pelvic cavity; if predisposed, these fragments can be attached to the pelvic organs;
- genetic factors - a woman whose close relative is sick with endometriosis, is 6-9 times more likely to develop the disease;
- spreading through the blood or lymphatic system - this theory explains the cases of detection of foci of endometriosis in organs such as the lungs and even the brain;
- abnormal development of reproductive organs - endometrial tissue can develop outside the uterus's mucous membrane during an intrauterine disruption in the formation of genital organs.
Studies show the possibility of the relationship of the development of the disease with such risk factors as:
- frequent, profuse menstruation;
- beginning of menstruation up to 13 years;
- age over 25 years;
- absence of pregnancy;
- consumption of more than 300 mg of coffee a day;
- lack of physical activity;
- irregular menstruation;
- reception of oral contraceptives.
Menstruation and endometriosis
After menstruation, the level of estrogen rises, and the inner lining of the uterus (endometrium) begins to thicken, preparing for the adoption of a fertilized egg. Before ovulation (release of the egg from the ovary), the level of progesterone increases, which promotes the expansion and blood filling of the endometrial glands. If fertilization does not occur, the level of hormones decreases. The endometrium is rejected and, together with the unfertilized ovum, emerges from the uterine cavity in the form of bloody discharge (menstruation). The foci of endometriosis also secrete blood, which, however, does not have an outlet. Instead, the formation of blood-containing cysts occurs, which can compress the surrounding tissues. It is also possible for them to rupture or inflame with subsequent healing and formation of adhesions.
The prevalence of endometriosis is not known reliably, since many sick women do not experience any symptoms. It is believed, however, that at least 10% of all women of reproductive age suffer from endometriosis.
Endometriosis should be suspected in every woman who suffers from painful menstruation, which reduces the quality of life. Diagnosis is based on examining the pelvic cavity through a laparoscope (which is inserted into the abdominal cavity through a small incision) or during an abdominal operation. Massive splices can make laparoscopic examination impossible, in such cases I resort to MR scanning, which, however, is less reliable. Formed endometrioid cysts in the pelvic cavity the doctor can palpate with vaginal examination. There are two main methods for treating endometriosis: drug therapy and surgery. In any case, treatment should be individual. Medications for the treatment of endometriosis include: combined oral contraceptives containing estrogen and progestogen (synthetic progesterone). Duration of treatment is 6-9 months of continuous intake. As an option, an isolated administration of the progestogen, dydrogesterone or medroxy progesterone is possible; danazol - a steroid hormone with an antiestrogenic and antiprogesterone effect; analogues of gonadotropin-releasing hormone (GnRH) affect the pituitary gland and prevent the onset of ovulation; this can lead to the development of menopausal symptoms such as hot flashes and osteoporosis. To reduce these side effects, hormone replacement is possible; Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain; examples of such drugs are mefenamic acid and neurooxene. Hormonal therapy, which blocks ovulation, usually effectively relieves pain, but does not cure the disease. In the absence of treatment, the disease progressively worsens until menstruation stops or before pregnancy, when symptoms usually subside. The patient should discuss in detail with the doctor all the symptoms and draw up a treatment regimen.
Most women manage to take the disease under control with the help of one of the methods of treatment. About 60% of patients with a moderate course of endometriosis after surgical treatment are able to conceive a child. The probability of pregnancy in the severe course of the disease is reduced to 35%. Elimination of foci of endometriosis can relieve pain and cure of endometriosis, and separation of fissures increases the likelihood of pregnancy. For this, laser therapy and cauterization with an electrocoagulant can be used. Young women planning pregnancy are recommended laparoscopic surgery. Removal of the uterus, fallopian tubes and ovaries can be offered only to women over 40 who have fulfilled their reproductive function.