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Lynoral (Ethinyl Estradiol) is a synthetic estrogen that is used to prevent pregnancy.

Active Ingredient: Ethinylestradiol

Lynoral (Femodeen) as known as: Aethinyloestradiolum, Aida, Aliane, Apri, Aranelle, Arianna, Balanca, Balziva, Belara, Belarina, Bellgyn ratiopharm, Bellissima, Bellune, Bemasive, Binovum, Biviol, Brenda-35 ed, Brevinor, Careza, Carlin, Chariva, Chloe, Ciclidon, Ciclomex, Cileste, Clairette, Claudia, Clevia, Conceplan, Cryselle, Cycléane, Cyclen, Cyclessa, Cypestra-35, Cyprelle, Cyprene-35 ed, Cyprest, Cyproderm, Cyprodiol, Cypromix, Cyproteron, Cyprotérone, Cyproterone-apc, Daphne, Demulen, Desmin, Désobel, Desolett, Desorelle, Desoren, Diacare, Diane mite, Diane-35, Dianette, Dianova mite, Dileva, Diva-35, Dixi 35, Docdonna, Drina, Drosperin, Dueva, Duofem, Duoluton, Edelsin, Edulen, Efézial, Elisamylan, Elleacnelle, Elleogest, Enriqa, Ergalea, Estelle-35, Estinette, Estinyl, Estraceptin, Estrostep, Ethinyl estradiol, Ethinylestradiolum, Ethinyloestradiol, Etinilestradiol, Etinilestradiolo, Eufem, Eugynon, Evalon, Evépar, Evra, Facetix, Fedra, Felixita, Femcon, Femelle, Femhrt, Femiane, Femigen, Femina, Feminac 35, Feminil, Femodeen, Femoden, Femodene, Femodette, Femovan, Gestinyl, Gestodelle, Gestodette, Gestodiol, Gestofeme, Gestonette, Ginera, Ginette, Ginoden, Gracial, Gratiella, Gynelle, Gyneplen, Gynera, Gynofen, Gynovin, Gyselle, Harmonet, Harmonette, Holgyeme, Hormofen, Improvil, Jasminelle, Jeanine, Jenetten, Jennifer, Juliette, Kariva, Katya, Kelnor, Kipling, Lamuna, Laurina, Leena, Libeli, Liberel, Lilia, Lindynette, Linessa, Liofora, Logest, Lovelle, Low-ogestrel, Lucille, Ludeal, Lumalia, Lybella, Mamineurine, Masbell, Meliane, Melodene, Melodia, Microdiol, Microfollin, Microgestin, Midane, Milligest, Milvane, Minero, Minerva, Minesse, Minigeste, Miniphase, Ministat, Minulet, Minulette, Miravelle, Mirelle, Modina, Mona hexal, Moneva, Mononessa, Morea, Myralon, Myvlar, Necon, Nelova, Neo-eunomin, Neocon, Non-ovlon, Norimin, Norinyl, Nortrel, Norvetal, Novial, Novynette, Nuvaring, Ocella, Ogestrel, Oilezz, Ortho, Orthonett novum, Ortrel, Ovcon, Ovestin, Ovidol, Ovral, Perléane, Phaeva, Planak, Planovar, Planum, Practil 21, Pramino, Prefest, Previfem, Primosiston, Progynon c, Prosexol, Prostarin, Ratiopharmeva, Reclipsen, Reginon, Regulon, Remexin, Restovar, Securgin, Suavuret, Sunya, Sylgestrel, Sylvan, Sylvie, Syndi, Synfase, Synphase, Synphasec, Taril, Tri-gynera, Tri-legest, Tri-minulet, Tri-sprintec, Triadene, Triafemi, Tricilest, Triella, Trigynovin, Triminulet, Trimiron, Trinessa, Trinovum, Triodeen, Triodena, Triodene, Trisequens, Valette, Varnoline, Velivet, Visofid, Vivelle, Vreya, Xylia, Yadine, Yarina, Yasminelle, Yax, Yaz, Yira, Yris, Zenchent, Zovia, Zyrona

Endometriosis (endometrial disease)

Endometriosis (endometrial disease)
  • What is Endometriosis (endometrial disease)
  • What triggers / Causes of Endometriosis (endometrial disease)
  • Pathogenesis (what is happening) during Endometriosis (endometrial disease)
  • The symptoms of Endometriosis (endometrial disease)
  • Diagnosis of Endometriosis (endometrial disease)
  • Treatment of Endometriosis (endometrial disease)
  • Prevention of Endometriosis (endometrial disease)
  • Which doctors should be consulted if You have Endometriosis (endometrial disease)
What is Endometriosis (endometrial disease) -

Endometriosis (endometrial disease) - hormonal, immune dependent and genetically determined disease with benign growth of tissue similar in their morphological structure and function of the endometrium, but outside of the uterine cavity.

Endometriosis is one of the most common diseases of the reproductive system in women 20-40 years old, its frequency, its incidence ranges from 7 to 50. Endometriosis occurs in 6-44 women suffering infertility and undergoing laparoscopy and laparotomy. The main part is genital endometriosis (92-94), much less is extragenital endometriosis (6-8). However, regardless of the localization of endometriosis is not local, but General disease with certain neuroendocrine disorders.

Insufficient efficiency of treatment, disability and neuroticism patients, as well as infertility treat endometriosis as a social and public problem.

There are three concepts of biological entity of endometriosis. Some authors consider it a true neoplasm, other - border disease between the hyperplasia and tumor, third - tumor dyshormonal proliferatum able to malignancy.

Endometriosis differs from true tumors by the absence of marked cellular atypia and dependence clinical manifestations of the menstrual function. However, endometriosis is able to infiltrative growth with penetration into surrounding tissue and their destruction. Endometriosis can grow into any tissue or organ: the wall of the intestine, bladder, ureter, peritoneum, skin, can metastasize lymphogenous or hematogenous route. The lesions found in lymph nodes or distant parts of body like face, eyes, subcutaneous tissue of the anterior abdominal wall, etc.

What triggers / Causes of Endometriosis (endometrial disease):

The etiology is not established and remains controversial. Proposed numerous hypotheses endo metrisa, but none have been definitively proven and generally accepted.

The endometrial origin of endometriosis. This theory considers the possibility of developing endometrioid heterotopias of the elements of the endometrium, offset in thickness of the wall of the uterus or migrated with retrograde menstrual secretions into the abdominal cavity and spread to various organs and tissues.

It is proved that intrauterine medical procedures (abortion, diagnostic curettage of the mucous of the uterus, manual examination of the uterus after childbirth, cesarean section, enucleation of fibroids, etc.) contribute to the direct germination of the endometrium into the uterine wall, leading to the development of internal endometriosis of the uterine body.

In addition to direct ingrowth of the endometrium in the thickness of the myometrium at the time of gynecological operations elements of the mucous membrane of the uterus can get into the flow of blood and lymph and spread to other organs and tissues.

Embryonic and dizontogeneticheskie theories consider the development of endometriosis shifted from sections of embryonic material, which in the process of embryogenesis are formed female sex organs and, in particular, the endometrium.

Detection of clinically active endometriosis at a young age and frequent combination of endometriosis with anomalies of the genitals, urinary tract and gastrointestinal tract confirm the validity of embryonic or dysontogenetic-tion of the concept of origin of endometriosis.

Metaplastic concept. According to this hypothesis, endomet-Rios develops as a result of metaplasia of embryonic peritoneum or coelomic epithelium. The possibility of turning into endometriodnoy tissue endothelium of lymphatic vessels, mesothelium of the peritoneum and pleura, the epithelium of the tubules of the kidney and other tissues. Such transformations can be potentiated hormonal disorders, chronic inflammation or mechanical trauma. Metaplastic theory can explain the cases of endometriosis in men, the detection of extragenital lesions of endometriosis and the occurrence of endometriosis in girls before menarche.

Of the many factors that contribute to the development and dissemination of endometriosis, you should allocate hormonal disorders and dysfunction of the immune system.

Changes in the neuroendocrine link of the reproductive system in patients with endometriosis allow to consider that this disease is hormone-dependent. Endometriosis is rare before menarche and rarely occurs after menopause. Endometriosis stabilizes or regresses during physiological pregnancy or artificial hormonal amenorrhea.

Hormones have a significant effect on endometrioid nye implants, as heterotopic endometrium, as well as normal, contains oestrogenic, androgenic and proges-terenowy receptors. Estrogens stimulate growth of the endometrium, their excess leads to endometrial hyperplasia. Excretion of estrogens in patients with endometriosis has no classical cycles, it is messy and creates hyperestrogenic background. In the study of the excretion of estradiol, estrone and estriol was set to a high level of estrone. Estrone, as a weak estrogen in patients with endometriosis, is converted at an elevated enzymatic activity of 17-beta-hydroxysteroiddehydrogenase into a powerful estrogen, namely 17-beta-estradiol. Androgens lead to atrophy of the endometrium. Progesterone supports the growth and secretory changes in the endometrium, exogenously administered progesterone analogs lead to the development of decidual reaction in the endometrial tissues in adequate concentrations of estrogens. At 25-40 patients with endometriosis have normal biphasic menstrual cycle. These patients violated the mechanism of cytoplasmic sequestration of progesterone, which leads to the perversion of the biological activity of hormones. In patients with classic manifestations of severe disease progesterone level-links-linking of receptors in endometriotic lesions in 9 times lower than normal.

Important role in the pathogenesis of endometriosis is owned by autoimmune reactions. When violations of the hormonal status of a dysfunction of the immune system is expressed in T-cell immunodeficiency, inhibition of the function of T-suppressors, activation of delayed-type hypersensitivity.

Pathogenesis (what is happening) during Endometriosis (endometrial disease):

Classification of endometriotic lesions. Allocate genital (localization of the pathological process in the internal and external genitals) and extragenital (development of endometriotic implants in other organs and body systems women) endometriosis. In turn genital endometriosis is divided into internal (body of the uterus, isthmus, interstitial departments of the fallopian tubes) and outside (vulva, vagina and vaginal portion of the cervix, retrotservikalnogo region, ovaries, fallopian tubes, peritoneum lining the pelvic organs).

Clinical forms of endometrial disease (V. P. Baskakov et al. 2002)

  • - Genital form:
    • . cancer
    • . ovaries-
    • . fallopian tubes-
    • . external genitalia-
    • . retrotservikalnogo endometriosis
    • . vagina-
    • . the pelvic peritoneum.
  • - Combined form
  • - Extragenital form:
    • . bowel
    • . urinary tract-
    • . post-surgical scars-
    • . lungs
    • . other organs.

Endometriosis of the uterus (adenomyosis). Adenomyosis is a form of endometriosis in which heterotopia endometrial tissue found in the myometrium.

Macroscopically, the endometriosis of the uterine body is manifested by enlargement of the uterus, hyperplasia of the myometrium by aceitoso wall. In the area of endometriosis may also appearance of cystic cavities with hemorrhagic content or the formation of nodes with prevalence of endometrial stromal tissue.

Endometriosis of the isthmus and uterus (adenomyosis) may be diffuse, focal or nodular in nature. There are 4 phases of the internal endometriosis of the uterus (adenomyosis), depending on the depth of invasion of the endometrium into the thickness of the muscular layer (B. I. Iron, A. N. Strizhakov, 1985 - L. V. Adamyan, V. I. Kulakov, 1998).

Classification of adenomyosis

  • Stage I - the defeat of the mucous membrane to the myometrium.
  • Stage II - the defeat to mid-thickness of the myometrium.
  • Stage III - the defeat of the endometrium to the serous covering.
  • Stage IV - damage to the parietal peritoneum.
The symptoms of Endometriosis (endometrial disease):

The leading symptom of the disease is elitemedia. Pain develops gradually is most pronounced with endometriosis are pain during the first days of menstruation, when there is a rejection of the endometrium (endometrial desquamation). Strong pains occur in lesions of the isthmus of the uterus, uterosacral ligaments with endometriosis and extension of the uterine horn. To determine the localization of endometriosis take into account the radiation of pain: with the defeat of the angles of the uterus give pain in the corresponding groin, endometriosis isthmus of the uterus - in the rectum or vagina. As a rule, with the end of menstruation the pain disappear or greatly diminish.

Menstrual function is disturbed by the type of menometrorrhagia. Menses are profuse and prolonged (hyperpo-limenaria), in addition, the pathognomonic appearance of the first spotting of dark blood discharge for 2-5 days before your period and during 2-5 days after. In common forms of adeno-Misa to menorrhagia can join uterine bleeding in the intermenstrual periods (metrorrhagia).

Due to Meno - and metrorrhagia in patients with adenomyosis develop hemorrhagic anemia and all symptoms associated with chronic blood loss: increasing weakness, paleness or yellowness of the skin and visible mucous, fatigue and drowsiness, loss of critical assessment of their illness.

Endometriosis of the cervix. The prevalence of endometriosis this localization is associated with injuries during gynecological manipulations, determinantal cervix. Trauma during childbirth, abortion and various manipulations can facilitate the implantation of endometrial damaged tissues of the cervix. Possible embryonic path of origin of endometriosis of the uterus - element mullerova primary tubercle of the vaginal plate. In addition, it does not eliminate lymphatic and hematogenous spread of endometriosis on the cervix from other lesions.

Depending on the depth of the lesion distinguish ectocervical and endocervical endometriosis of the vaginal portion of the cervix, rarely endometrioid heterotopias impress the cervical canal.

Diagnosis. In some cases endometriosis cervix clinically without symptoms and diagnosed with gynecological examination. Endometriosis of the cervix may be complaints about the appearance of brown spotting and dark blood discharge before menstruation or during sexual contact. Pain are observed with atresia of the cervical canal or endometriosis isthmus of the uterus.

Gynecology important a thorough inspection of the cervix in the mirrors. Endometriosis is defined as nodular or melkokistosnaya lesions red or dark purple color. Endometrioid heterotopias increase considerably just before or during menstruation. During this period, some pockets can be opened and emptied. After menstruation endometrial heterotopias diminish and fade.

When colposcopy is carried out differential diagnosis between cysts narodowych glands, pseudo, erythroplakia, polyps of the mucous membrane of the cervical canal, ectropion and endometriosis of the cervix.

These cytological examination of prints solidity shell of seikimatsu little information for the diagnosis of endometriosis, but allow you to judge the condition of the stratified squamous epithelium of the cervix and identify cellular atypia.

Servicescope used in a comprehensive study with endometriosis of the cervix and allows you to diagnose paracervical spread of endometriosis for lateral defects of the mucous membrane. In patients with acyclic blood discharge and contact bleeding spend gysterosalpingoscopy and separate diagnostic curettage of the uterine mucosa.

Endometriosis of the vagina and perineum. The vagina and perineum are more affected by endometriosis again during germination of retrotservikalnogo hearth, at least - result in implantation of particles in endometrial damaged area during childbirth.

Leading complaint with endometriosis this localization are pain in the vagina from moderate to very strong and painful. Pain appear cyclically, amplified through sexual contact, before and during menstruation. Severe pain occur with involvement of the perineum and the external sphincter of the rectum. Defecation accompanied by severe pain during periods of exacerbation.

Diagnosis is based on complaints associated with the menstrual cycle, and data on pelvic examination, which includes inspection of cervix and vagina in mirrors, two-handed moisture-limno-abdominal and rectovaginal research. In the thickness of the walls of the vagina or rectovaginal deepening palpable dense painful scars, knots or thickenings. Vaginal mucosa may contain brown or dark blue foci. Before and during menstruation endometrial heterotopias increase and may bleed.

To identify the distribution process use additional methods of research: sigmoidoscopy, ultrasound of the pelvic organs, laparoscopy.

To clarify the nature of the lesion of the vagina a histological study of biopsy material.

Retrotservikalnogo endometriosis. The prevalence retrotservikalnogo of endometriosis among all localizations of endometriosis ranges from 0.5 to 6.5. When retrotservikalnogo endometriosis pathological process is localized in the projection of the posterior surface of the cervix and isthmus at the level of the Sacro-uterine ligaments. Lesions able to infiltrative growth, usually in the direction of the rectum, the posterior fornix of the vagina and vaginal-rectal cavities.

Allocate 4 degree distribution retrotservikalnogo endometriosis (L. V. Adamyan, V. N. Kulakov, 1998)

  • I degree - of endometriotic foci are located within rectovaginal fiber-
  • Grade II - endometrial tissue grows into the cervix and the vaginal wall-
  • III degree - the pathological process extends to the Sacro-uterine ligaments and the rectum to the mucous membrane-
  • IV degree - in the pathological process involved the mucosa of the rectum, the peritoneum rectouterine deepening with the formation of adhesions in the uterus.

The clinical picture. Complaints when retrotservikalnogo endometriosis due to the proximity of the rectum and pelvic nerve plexus. Patients complain of aching pain deep in the pelvis, lower abdomen and lumbosacral region. Before and during menstruation, the pain can become pulsating or jerking, to give into the rectum and vagina. Less pain irradiat in the side wall of the pelvis, in the leg. Patients may complain of constipation, sometimes the mucus and blood from the rectum during menstruation. During germination retrotservikalnogo of endometriosis in the posterior fornix of the vagina appear bluish "eyes" that bleed during sexual intercourse. Severe endometriosis in 83 observations becomes the cause of the periodic disability and a significant number of observations to simulate the diseases of other organs.

Diagnosis. Take into account patients ' complaints and pelvic examination data. When retrotservikalnogo endometriosis is palpated dense formation in rectovaginal tissue behind the cervix. Quite informative ultrasound data, which are determined by heterogeneous ehoplotnosti education under the cervix, the smoothness of the isthmus and fuzzy contour of the rectum. To clarify the extent of the process required sigmoidoscopy, colonoscopy, excretory urography, cystoscopy, magnetic resonance imaging.

Endometriosis of the ovaries. The ovaries may be affected by endometriosis as a result of hematogenous dissemination and lipogen-tion by. It is also possible implantation and embryonic origin of the disease.

Endometrioid heterotopias represent a pseudocyst with a diameter of 5-10 mm, filled brown mass. The most commonly endometriosis ovarian is localized in the cortical layer of the ovary, widespread the endometriosis is and the medulla. Wall heterotopia consist of layers of connective tissue. At the confluence of foci of endometriosis are formed endometriomas ("chocolate cysts"), whose walls are lined with cylindrical or cubic epithelium.

There are several histological types of ovarian endometriosis: glandular, cystic (macro - and microhistory), cystic glandular and stromal. Glandular-cystic endometriosis has the greatest ability to proliferative growth and malignancy. When merging several endometrioid heterotopias on the ovary occurs endometriomas or endometrioid pseudocyst. The walls of the cyst are composed of layers of connective tissue, a large endometrial cyst is lined by cylindrical or cubic epithelium. In cytogenous stroma and tissue of the affected ovary often found endometrial cancer. The contents of the endometrioid pseudocyst represented by dark-brown mass, rich in hemosiderin.

The clinical picture. Endometriosis of the ovaries until a certain time can not be yourself. When the micro perforations in the endometrioid heterotopias or endometrioma involved in a pathological process of the parietal and visceral peritoneum, there is a further spread of foci of endometriosis and the formation of adhesions. There are complaints of a dull aching pain in the abdomen radiating to the rectum and perineum. Pain worse during menstruation. Adhesions and distribution of foci of endometriosis in the peritoneum amplify pain during exercise and sex. In 70 patients with endometriosis of the ovary marked elitemedia and dyspareunia.

Diagnosis. External endometriosis with involvement of the ovaries in the early stages of the disease indicates chronic pain syndrome. Mel-conistone heterotopia of endometriosis does not lead to a significant increase in ovarian and gynecological examination is almost never diagnosed. With the formation of adhesions may limit the mobility of the uterus and ovaries are palpated in a single conglomerate with the uterus. These pelvic examination and additional investigations are more informative when formed endometriomas (endometriotic cysts). Endometrioma characteristic of bilateral lesion, localization posterior to the uterus, restriction of movement and tenderness to palpation. Endometriomas have tugoelasticheskuyu consistency, their diameter varies from 4 to 15 cm. the Volume of endometrium varies depending on the phase of the menstrual cycle before menstruation endometriomas less than after menstruation.

When small the endometrioid heterotopias their ovaries ultrasound imaging is difficult. Indirect signs of endometriosis of the ovary are hypoechoic inclusions on the surface of the ovary, thickening of the tunica albuginea due to the formation periovarian adhesions. In the formation of endometriomas the information content of ultrasound increases to 87-93. Sonographically endometriomas are rounded with a pronounced echo-positive capsule, fine echo-positive suspension on the background of the liquid contents, localization behind the uterus. The lesion is usually bilateral.

The greatest diagnostic value in ovarian endometriosis is laparoscopy. Laparoscopy determine inclusion in the stroma of the ovary small size (2-10 mm) bluish or dark brown, sometimes with dripping dark blood. Endometriomas have a whitish capsule with marked vascular pattern and smooth surface. Capsule endometrium often intimately soldered to the rear surface of the uterus, fallopian tubes, the parietal peritoneum, a serous cover of the rectum.

Endometriosis of the fallopian tube. Endometriosis of the fallopian tubes is from 7 to 10. Endometriotic lesions are mesasal pinks may be placed on the surface of the fallopian tubes. Concomitant adhesions may contribute to the violation of the functional usefulness of the tube.

The main method of diagnosis of endometriosis of the fallopian tubes is laparoscopy.

Endometriosis of pelvic peritoneum. In the development of endometriosis of pelvic peritoneum important role played by the interaction of meso-felicito peritoneal, and endometrial elements. The occurrence of endometriosis of the peritoneum may contribute to retrograde reflux of menstrual blood certain changes to endocrine Noah and immune systems.

There are two main options peritoneal endometriosis. When you first endometriotic lesions limited to the pelvic peritoneum, in the second embodiment, except heterotopia peritoneal endometriosis affects the ovaries, uterus, fallopian tubes.

Small forms of endometriosis long time does not manifest itself clinically. However, the frequency of sterility in isolated small forms of endometriosis can reach 91. When proliferation and invasion foci of endometriosis in the muscular layer of the rectum, adrectal fiber appear pelvic pain, dyspareunia, more pronounced on the eve of menstruation and after it.

Diagnosis. The main method of diagnosis is laparoscopy, which allows to detect pathological changes.

Endometrioid heterotopias on the peritoneum have different morphological manifestations:

  • . atypical (unpigmented, whitish) vesicles-
  • . hemorrhagic vesicles-
  • . pigmented yellow-brown tubercles and spots-
  • . typical (blue, purple, black) superficial and deep infiltrated heterotopia.
Diagnosis of Endometriosis (endometrial disease):

After the history and physical examination performed gynecological examination, which is more informative on the eve of menstruation. Depending on the severity of the ade-nomiza the value of the uterus may be normal or fit 5-8 weeks of pregnancy. On palpation the uterus is dense, in nodular form, its surface may be uneven. Before and during menstruation, painful palpation of the uterus.

With the defeat of the isthmus of the uterus marked its expansion, increased density and tenderness to palpation, especially in the area of attachment of the Sacro-uterine ligaments. Pain expressed before, during and after menstruation. In addition, often with lesions of the isthmus of the uterus there is a limitation of the mobility of the uterus and increased pain when mixing the uterus forward.

Ultrasound sonography. For a detailed evaluation of structural changes of the endometrium and myometrium used ultrasound with the use of transvaginal transducers, the accuracy of diagnosis of endometriosis is greater than 90.

The most informative ultrasound in the second phase of the menstrual cycle (23 to 25 th day of the menstrual cycle).

Common sonographic signs of adenomyosis are increased anteroposterior size of the uterus, areas of increased echogenicity in the myometrium, small (0.2-0.6 cm) rounded anehogennoe inclusion. The nodular form of endometriosis affects anogramma area increased echogenicity round or oval with smooth and indistinct contours, in some cases with small anehogennoe inclusions. Adenomiose node differs from fibroids the lack of a pseudocapsule and indistinct contours. In the form of focal adenomyosis predominant cystic component in the area of the lesion with perifocal seal, unevenness and graininess of the circuits in the affected area.

To improve the informative value of ultrasound in the diagnosis of early forms of endometriosis used hydrosonography. With adenomyosis are determined by a small (1-2 mm) anehogennoe tubular structure extending from the endometrium to the myometrium. In the basal layer of the endometrium are observed are small (1-2 mm) hypoechoic inclusions.

The thickness of the basal layer of the endometrium is uneven, in subepithelial layers of the myometrium identify the individual areas of increased echogenicity (4 mm).

The information content of x-ray hysterosalpingography with endometriosis is 85. Radiographs increased the size of the uterine cavity, determined by the deformation and jagged edge contour of the uterine cavity. To improve the accuracy of the research must scraping the lining of the uterus before menstruation. After removal of the functional layer of the endometrium when contrast fills moves endometrioid heterotopias, which allows to obtain step-out of the shadows with adenomyosis.

The diagnostic value of hysteroscopy varies from 30 to 92. Hysteroscopic signs of adenomyosis depend on its form and severity. V. G. Breusenko et al. (1997) suggested hysteroscopic classification of adenomyosis:

  • Stage I: the relief of the walls is not modified, identifies endometrial moves in the form of "eyes" dark-bluish color or open bleeding. The wall of the uterus during curettage normal density.
  • Stage II: the relief of the walls of the uterus is uneven, has the form of longitudinal or transverse ridges or spongy muscle tissue, visible endometrial moves. The uterine wall rigidly, the uterus is poorly tensile. When scraping the uterine walls are thicker than usual.
  • Stage III: on the inner surface of the uterus are determined vbuhania of various sizes without clear contours. On the surface these wybuchami sometimes visible public or private endometrial moves. When scraping felt uneven surface of the walls, ribbing - the uterine wall is thick, audible squeak.

Signs of cervical adenomyosis: uneven relief of the wall of the uterus at the level of the internal OS and endometrial moves, of which a trickle of blood flows.

This classification allows you to define the tactics of treatment. No endoscopic signs of adenomyosis does not exclude lesions and nodes of adenomyosis in interstitial and subserous departments of the myometrium.

The diagnostic value of MRI is greater than 90. Diagnosis is based on increasing the anteroposterior size of the uterus, revealing the spongy structure of the myometrium in the diffuse form and nodal deformation in focal and nodular forms of adenomyosis.

Treatment of Endometriosis (endometrial disease):

Treatment of patients with endometrioid disease consists not only in the suppression of clinically active endometriosis hormones or remove the lesions surgically. It is necessary to relieve patients from complications and consequences of endometriosis, adhesive disease, pain syndrome, post-hemorrhagic anemia and neuropsychiatric disorders.

In combination therapy of endometriosis is the leading role of surgical treatment. The choice of method and access the surgical treatment depends on the location and extent of the process. For prevention of disease recurrence after surgery for endometriosis the appropriate use of hormone therapy for 3-6 months.

Treatment of cervical cancer is the application of a solution of salvagin on the affected areas, electrical, redicoulously or laser vaporization, and cryoablation ectocervical endometriosis.

When endocervical endometriosis can be applied redicoulously lesions, cervical conization or laser vaporization.

To prevent relapse of the disease is prescribed estrogen-progestin drugs for 2-3 months.

Endometriosis of the vagina shows the excision of endometriosis and the appointment of hormonal drugs based on the severity of the process in the postoperative period. When retrotservikalnogo form of the disease is performed surgery in the amount of extirpation of the uterus with appendages. If necessary perform plastic surgery on the rectum, vagina, urinary tract. The best effect was obtained during surgery after hormone therapy.

Endometriosis of the ovaries, fallopian tubes, and extragenital-forms of endometriosis located on the peritoneum, or coagulated evaporated by the laser during laparoscopy. In the postoperative period prescribed hormonal therapy.

Internal endometriosis of the uterine body requires a differentiated approach to treatment. Endocrine dependence of endometrioid heterotopias is no doubt that hormonal therapy has become a mandatory component of the treatment of endometrial disease. Hormonal therapy patients with adenoma zoom complicated by menometrorrhagia, algomenorrhea or dysparunia. In addition to tablets and injectable forms, is used hormonal intrauterine system containing levonorgestrel (intrauterine device (IUD "Mirena").

In recent years for the treatment of adenomyosis use of organ-preserving endoscopic techniques. In superficial forms of adenomyosis (I stage by hysteroscopic classification) possible resection (ablation) of the endometrium. The effectiveness of the treatment is from 37 to 67. In superficial forms also effective cryoablation of the endometrium. The clinical effect of interstitial laser-induced thermotherapy reaches 88. Uterine artery embolization with adenomyosis effective in 60-90 patients.

Adenomyosis in combination with uterine cancer responds poorly to hormonal correction. Patients recommended surgical treatment in the amount of hysterectomy. Those patients in whom hormonal therapy of adenomyosis has not led to the relief of major symptoms (menometrorrhagia, algodismenorei and anemia), also operative treatment in the volume of hysterectomy.

In common forms of external endometriosis with the formation of adhesions and infiltration of other organs in the preoperative period using hormonal drugs to limit the pathological process and facilitate surgery. In patients with minor forms of endometriosis and external endometriosis is a hormonal therapy before surgery is impractical because it may hinder the complete removal of endometrioid heterotopias because of atrophic changes and partial regression.

For hormonal therapy used:

  • . combined synthetic estrogen-progestin drugs - femoden, mikroginon, Hanover, ovidon, marvelon, rigevidon, Diane-35, etc. -
  • . progestins drugs without estrogenic component is examined, primulator, norcolut, orgametril, gepostet, OK-eprojection kapronat, etc. -
  • . antigestagen - gestrinone (semestral)-
  • . antigonadotropin - danazol (danoval, danol, danogen)-
  • . agonists gonadotropin-releasing hormone - Zoladex, DECA-Patil depot, Deputy prefect depot, etc. -
  • . the antiestrogen is toremifene, leuprorelin, tamoxifen-
  • . anabolic steroids (retabolil, methylandrostan, etc. -
  • . androgens - testosterone, Sustanon-250, methyltestosterone. The most promising in the treatment of endometrial disease are Progestogens, antigonadotropnym drugs and GnRH agonists. Other drugs (estrogen-progestin and progestogen) can be applied for the purpose of prevention of endometriosis, as well as to regulate menstrual function.

Hormone therapy patients with endometrioid disease involves strict account of all side effects and contraindications.

An important component of conservative therapy is to normalize the disturbed immune status. For this purpose, apply the immunomodulators: levamisole (decaris), timalin, timogen, Pentaglobin, cycloferon. Used hardware stimulation of the thymus gland and intravascular laser irradiation of blood.

Participation in the pathogenesis of autoimmune processes makes justified systemic enzyme therapy, as enzymes are the mediators of a complex interaction between endocrine organs and the immune system. Enzyme therapy is used to reduce scar-adhesive changes, prevents the activation of macrophages and some cytokines in the proliferation of endometrio-LiDE implants. Wobenzym and flogènzim have a normalizing effect on blood rheology.

In connection with the failure of the antioxidant system of the organism in patients with endometriosis in therapy include tocopherol acetate (vitamin E), unithiol with ascorbic acid, Pycnogenol, etc.

With the aim of relieving pain and as an anti-inflammatory therapy using inhibitors of endogenous Pro-prostaglandin, which include nonsteroidal anti-inflammatory preparatai (brufen, pluguin, indomethacin, etc.). Perhaps the use of antispasmodics and analgesics (baralgin, halidorum, Nospanum, analgin, etc.).

Neurologist algebraic expression and consequences of endometriosis eliminate reflexology in combination with tranquilizers and lo-dative drugs (tazepam, seduksen, Elenium, phenazepam, anselin, rudotel). The appointment of neurotropic agents should coordinate with the neuropsychiatrist.

Hemorrhagic anemia requires the use of iron supplements (phenols, terrordome, veraplex, etc.).

In the complex treatment of patients with endometrioid disease use physiotherapy techniques: electrophoresis with sodium thiosulfate, potassium iodide, lydasum, trypsin, etc. are also Using radon water in the form General baths, vaginal irrigations and enemas.

Forecast. Endometriosis - relapsing disease, the recurrence rate is 5-20 per year, the cumulative risk over 5 years - 40. The recurrence rate 5 years after treatment with analogs of GnRH in uncommon forms of endometriosis is 37, with heavy - 74. A more favorable prognosis after hormonal treatment of endometriosis in women premenopausal, since the onset of physiological postmenopausal women prevents relapse. Patients who have undergone radical surgery for endometriosis, the process is not resumed.

Prevention of Endometriosis (endometrial disease):

Prevention of endometriosis is to diagnose diseases at early stages. In the surgical treatment of endometriosis should be mindful of the implant distribution of endometrioid heterotopias and avoid contact and endometrial tissues affected by endometriosis, the peritoneum and the operating wound.

Which doctors should be consulted if You have Endometriosis (endometrial disease):

Other articles

Risks of thrombosis with contraception

Risks of thrombosis with contraception

Combined hormonal contraceptives that contain both an oestrogen and a progestagen, such as the Pill, the vaginal ring and the patch, carry a slightly elevated risk of thrombosis. The European Medicines Agency reviewed this risk in 2013. You can offer the users of these products better advice with the results of this review.

What are the risks of hormonal contraception?

Women who use hormonal contraception have a slightly elevated risk of thrombosis. The risk of thrombosis is a known, but rare adverse event, which is described in detail in the patient information leaflet. You can consult the table to determine the extent of the risk of thrombosis. This table was updated following a review by the EMA in early 2013.

The review specifically looked at the differences in the risk of thrombosis between the various products. This revealed that the risk of thrombosis is still low. Therefore, there is no reason for users of contraception to stop using these products. The benefits of combined hormonal contraceptives (protection against unwanted pregnancies) still outweigh the risks. However, it is important for healthcare providers and users to be aware of the risks and symptoms of thrombosis.

Risk of thrombosis Type of contraception

* The substance name is listed on the packaging and in the patient information leaflet.

Women with an increased risk

Some groups of women are at increased risk. Please note: the risk factors for users can change over time. Therefore, you should advise the user to keep reading the patient information leaflet. And give users the information card to take home.

The following groups of women are at increased risk:

  • Women who have previously had a thrombosis
  • Women with a hereditary condition that leads to increased blood clotting
  • Women with family members who suffered thrombosis before the age of 50
  • Women who have recently given birth
  • Women who smoke, are overweight or are older than 35 years

There is a temporary increase in the risk of thrombosis with:

  • pregnancy
  • certain diseases (including cancer)
  • major surgery
  • severe trauma
  • migraine
  • patients who are on bed rest for extended periods
Symptoms of thrombosis

You can recognise thrombosis based on a number of symptoms. These are also listed in the information card for users. You can recognise thrombosis in the leg by:

  • severe pain
  • redness
  • swelling of the leg

A pulmonary embolism (thrombosis in a vein in the lung) can be recognised by:

  • sudden onset of shortness of breath and coughing, sometimes with some blood
  • chest pains linked to breathing
  • rapid breathing
  • increased heartbeat
  • unexplained, severe headache
Risk of various types of hormonal contraceptive skills

Contraceptive pills that contain the substances levonorgestrel, norethisterone or norgestimate have a lower risk of thrombosis than products containing other substances. However, products with a higher risk are still available. These products are allowed because the MEB deems the absolute risk of these pills low, particularly in relation to the benefits.

Furthermore, not all women respond equally well to the contraceptive products with the lowest risk. These women retain the option to switch to a different contraceptive product.

Advice when prescribing the Pill

If you are aware of the user's risk factors, you will know which contraception you can best recommend to her. You can also consult the guidelines for advice to doctors about prescribing the Pill:

These guidelines recommend first using a contraceptive with levonorgestrel, norethisterone or norgestimate. These products have a lower risk of thrombosis. The MEB supports this advice.

Documents Risk of thrombosis with contraception: Patient information card

Combined hormonal contraceptives that contain both an oestogen and a progestagen, such as the Pill, the vaginal ring and the.

Oral contraceptive use is associated with hypoandrogenism

Oral contraceptive use is associated with hypoandrogenism. - GreenMedInfo Summary

The aim of the present study was to compare changes in the endogenous androgen environment in healthy women while on low-dose oral contraceptives (OCs). One-hundred healthy women were randomized to receive one of four OCs during six months: 21 tablets of Cilest, Femodeen, Marvelon, or Mercilon. During the luteal phase of the pretreatment cycle, body weight and blood pressure were recorded and the following parameters were measured: sex hormone-binding globulin (SHBG), corticosteroid-binding globulin (CBG), testosterone (T), free testosterone (FT), 5 alpha-dihydrotestosterone (DHT), androstenedione (A), dehydroepiandrosterone-sulphate (DHEA-S) and 17 alpha-hydroxyprogesterone (170HP) while also the free androgen index (FAI) was calculated. Measurements were repeated during the 3rd week of pill intake in the 4th and the 6th pill month. There were no differences on body mass and blood pressure with the use of the four OCs. The mean serum DHEA-S decreased significantly in all groups though less in the Mercilon group when compared to Cilest and Marvelon (approximately 20% vs 45%). Mean serum SHBG and CBG increased significantly in all four groups approximately 250% and 100%, respectively. In each group CBG also increased significantly but less in women taking Mercilon (-75%) as compared to the others (-100%). Current low-dose OCs were found to have similar impact on the endogenous androgen metabolism with significant decreases of serum testosterone, DHT, A, and DHEA-S. They may be equally beneficial in women with androgen related syndromes such as acne and hirsutism.

Article Published Date. Mar 01, 1996

Study Type. Human Study


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