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Endometriosis is an illness of a female reproductive system of gormonalnozavisimy type. Growth of an endometria — a mucous membrane of a uterus – in other departments of a female organism is characteristic of this illness. According to specialists, endometriosis of a uterus is the eurysynusic gynecologic illness taking on prevalence degree the third place after a hysteromyoma and various inflammations of female generative organs. As a rule, this illness affects an organism of women at reproductive age. The peak of incidence of endometriosis is the share of age after forty years. However, this illness is shown also at the girls staying at teenage age today. One more feature of endometriosis consists that at the women who had several childbirth, the disease is shown less often, than at not giving birth patients. The disease can also arise at women after a menstrual pause.
Today specialists state several assumptions concerning the endometriosis reasons. Today there is a so-called theory of retrograde periods. According to this theory, blood, is emitted in the course of periods and containing parts of an endometria, rather often it appears in uterine tubes and an abdominal cavity. It is also the so-called phenomenon of retrograde periods. At hit of cells in these bodies there can be their cauterization. After that cells of a mucous membrane of a uterus begin to function as demands their purpose: they prepare for implantation of an embryo. If conception does not happen, then the main part of a mucous membrane leaves a uterus in the course of periods. But from other bodies an exit of an endometria is impossible. Therefore, in bodies there is small hemorrhage becoming the inflammation reason. So women with retrograde monthly appear in risk group. To learn whether the retrograde periods take place, it is enough to pass survey and consultation of the gynecologist.
However, endometriosis of a uterus affects not each woman with similar feature of monthly. It is considered to be that the main characteristics which considerably increase predisposition to this disease is the following. First, this certain structure of uterine tubes which is easy for revealing in the course of inspection. Secondly, an important role is played by existence of a hereditary factor. Thirdly, emergence of endometriosis is promoted by disturbance of functions of immune system of an organism of the woman.
Started talking about a genetic factor after researches of scientists from Ireland. It is proved that at women whose close relatives have endometriosis, the probability of its manifestation increases five times. So at survey and consultation specialists surely find out whether was cases of this disease among the patient's family.
However, the probability of a disease is increased also by other mentioned factors. So, at disturbances in work of the immune system supporting a normality of fabrics in an organism there can be similar pathology. If the immune system is normal, then it is capable is destructive to affect deviations in functioning of an organism which also growth of an endometria out of a uterus cover is among. At failures in work of immune system there is also a failure in work of other systems. Regular preventive inspections will allow to find development of a disease as soon as possible.
Today the operative measures which ever were carried out in a uterus are considered as one of the most frequent reasons of endometriosis. It is abortion, Cesarean section, cauterization of an erosion and other procedures. So after similar operations it is necessary to pass with an accurate regularity surveys at the doctor.
Classification of endometriosis
Specialists classify endometriosis according to localization of this pathology. Considering this factor, allocate genital endometriosis, an adenomyosis, outside endometriosis, and also peritoneal, extragenital and ekstraperitonealny endometriosis. At internal genital endometriosis the endometria expands in a neck and the channel of a uterus. At extragenital endometriosis of a cell of a mucous uterus grow in kidneys, a bladder, intestines, lungs, and also in hems after operations. At peritoneal extragenital endometriosis there is a damage of ovaries, a pelvic peritoneum, uterine tubes. At an ekstraperitonealny form of an illness endometriosis expands in external genitals. Allocate "small" and severe forms of a disease. In severe forms the illness develops if the patient did not complete a course of the corresponding treatment in time. From that how deep water of the struck places, distinguish four stages of a disease: minimum, easy, moderate, heavy. It is the most difficult to cure the last stage of endometriosis.
It is important to consider that symptoms of endometriosis can be very different. Their manifestations directly depend on specific features of an organism of the patient. Very seldom this disease passes in general asymptomatically, therefore, it is possible to diagnose it only in case of passing of regular survey for the doctor. However, as a rule, certain symptoms of this illness nevertheless take place. Pain is considered as the main symptoms of endometriosis. At the most part of patients of pain are shown in different forms. One more often found symptom of an illness is a dysmenorrhea. The most this symptom is shown for the first-tretiye days of periods. This symptom is connected with menstrual bleeding in a cyst and, respectively, increase of pressure in a cyst. Also the dysmenorrhea can arise because of retrograde periods and emergence of irritation in a peritoneum. It can be shown also as a result of active production of prostaglandins causing a vasospasm and strong reductions in a uterus. Pain in days of monthly is shown also because of a contact with a number of the located bodies with the endometrioid center. In addition to the described symptoms at endometriosis there can be allocations of dark brown color remaining and for several days after periods.
A certain number of women complains of pelvic pain which has no relation to a menstrual cycle. It arises owing to a secondary inflammation in those bodies which were struck with endometriosis. Symptoms of endometriosis can be shown also by painful feelings in the course of sexual intercourse. The most often similar symptom takes place at women with the vagina affected with endometriosis, a rectovaginal partition, rectouterine space. Also there are back pains, periods pass irregularly, however they are especially plentiful.
The second unpleasant symptom of this disease — impossibility of conception. Infertility is shown at 25-40% of sick women. Today up to the end all origins of infertility at endometriosis are not found out. It is obvious that changes in uterine tubes, ovaries which were provoked by endometriosis take place, and pregnancy as a result does not come. Failure in work of immune system is the second reason of impossibility of conception at this disease. Endometriosis can similarly influence a regularity of an ovulation, and pregnancy then will not come because of disturbances in the course of an ovulation which accompany this disease. One more symptom of endometriosis — a menorrhagia. However, this symptom of a disease meets less than the main symptoms.
Diagnosis of endometriosis
In the course of statement of the diagnosis survey and all necessary procedures under the leadership of the doctor of a certain profile is very important. First of all, at diagnosis it is necessary to pass primary survey of the gynecologist. Further the doctor in details interrogates the patient to find out character of pain, to learn what gynecologic diseases she had earlier whether the corresponding surgical interventions were given ever. Also the specialist has to find out information on gynecologic diseases of relatives of the patient.
Further in the course of statement of the diagnosis the following methods are used: gynecologic inspection with use of a mirror, ultrasonic research of bodies in a small pelvis, rectovaginal, rectal inspection, a kolposkopiya, a laparoscopy, hysteroscopy is performed. Two last procedures are the most often applied methods for statement of the diagnosis "uterus endometriosis". They should be seen off only in clinical conditions. Pelvic pains which proceed at the patient more than half a year are the main indication to use of a laparoscopy and hysteroscopy.
At most of the patients with this illness increase in a uterus, as a rule, moderate takes place. Also at a certain part of patients (approximately in 15-20% of cases) define the fixed and unstable bend of a uterus. In the course of diagnosis at some patients existence of the small knots in the back arch provoking morbidity emergence is defined. To estimate whether there are no similar phenomena in a rectovaginal partition, rectal and rectovaginal examination is conducted. During the research directed to survey of uterine tubes and ovaries the specialist defines whether these bodies are increased, whether ona are mobile, and whether there is no morbidity. When carrying out a kolposkopiya and hysteroscopy the specialist receives the material used for carrying out a biopsy. The biopsy and histology are considered as effective addition to endoscopic methods of inspection and promote definition of the correct way of therapy.
Treatment of endometriosis
At selection of an adequate technique of treatment the specialist considers many factors among which — age of the patient, existence of pregnancy in the past, feature of a disease at this stage. The doctor has to estimate, endometriosis symptoms whether this illness is combined with other inflammatory processes, whether it is necessary to work on recovery of reproductive function of the woman are how expressed.
At the moment use several effective methods of treatment of endometriosis. So, depending on the above moments specialists offer use of a conservative medicamentous method of treatment of endometriosis, and also surgical methods. When carrying out operation the organ-preserving method (a laparoscopy and a laparotomy) by means of which delete only the centers of a disease can be used and keep bodies. The radical method at which the uterus and ovaries are removed is in certain cases shown. Also the combination of the specified ways of treatment is used.
So, conservative therapy is applied if the illness proceeds asymptomatically, during the permenopazualny period, at infertility, an adenomyosis, endometriosis for fertility recovery. For this purpose to the patient the course of the hormonal, antiinflammatory, desensibilizing and symptomatic means is appointed. However hormonal therapy is considered the main component of similar treatment. It is important to consider that only the long course of drug treatment guarantees receiving effect of such therapy. During treatment regular supervision at the treating specialist are shown.
Prevention of endometriosis
For prevention of endometriosis it is necessary to pass regular routine inspections of the gynecologist without fail. Especially the women and girls suffering from too severe menstrual pains which can be an endometriosis symptom should show consideration for this rule. It is important to pass routine inspections after abortion or other surgical intervention in a uterus. To prevent developing of endometriosis, it is necessary to cure quickly all inflammatory diseases of generative organs, including chronic. Will help to anticipate a disease also the analyses directed to determination of level of hormones which directly influence work, both immune system, and other systems in an organism.
Women who note reduction of a monthly cycle, failure in a metabolism and, respectively, a sharp set of weight should pay special attention to preventive measures. Also surveys and consultations of the doctor regularly there have to pass those women who use intrauterine contraceptives, those who already were thirty years old, and also regularly smoking.