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Endometriosis

Endometriosis - is a benign disease process, when outside the endometrial tissue proliferation occurs, on the structure and functional properties similar to the endometrium (the mucous membrane of the uterus). The cells of endometrial tissue are sensitive to the monthly hormonal effects and also manifest themselves bleeding as the main uterine tissue. In the tissues in which there are foci of endometriosis developed mikrokrovotecheniya, inflammatory response, neovascularization (formation of new blood vessels), and fibrosis (scarring, adhesions). These changes and determine the characteristic clinical picture of endometriosis.

The disease can have symptoms of pain, occurring before and during menstruation, menstrual dysfunction, dyspareunia (painful intercourse), infertility (due to the pronounced topographic anatomical changes in the pelvis due to adhesions, lesions of the ovaries, hormonal disorders, etc. . d.). It is estimated that the prevalence of endometriosis is about 7-10%. Endometriosis is a hormone-dependent state, and so it occurs in women of reproductive age. Among women, the incidence of infertility is endometroiza ot20% to 50%. About 80% of women with chronic pelvic pain obranuzhen endometriosis.

Depending on the localization of the disease experts distinguish several forms of endometriosis:

• Genital form - generalized organ failure and pelvic peritoneum (endometriosis, uterus, ovaries, pelvic peritoneum).

• Extragenital form - the spread of endometrial tissue outside of the reproductive system. In this case, the affected intestine, stomach wall, urinary organs, and even the lungs;

• Combined form - while simultaneously developing the genital and extragenital form.

 

The exact cause of endometriosis is still unable to establish. There are several theories, none of which does not give an exhaustive answer to the question (retrograde menstruation, immune dysfunction, metaplasia theory, genetic predisposition). The leading theory of endometriosis is a violation of embryonic development in which endometrial cells spread through the blood and lymph circulation to all organs and tissues.

Since the causes and mechanisms of development of endometriosis is still unclear, there is still no treatment that would get rid of this disease. The choice of method by means of which will be the treatment of endometriosis depends on the particular situation and the individual characteristics of the patient.

However, it should objectively determine the goals and objectives of the treatment, which include:

• relief of symptoms of endometriosis;

• improving the quality of life of women;

• increase fertility (ability of pregnancy);

• delay the progression of the disease, delaying its repeated exacerbations.

Today medicine uses the following methods for the treatment of endometriosis:

• Surgical;

• medication;

• combined.

 

Surgery - this is the only method to eliminate the endometriotic lesions. Recently developed sparing endoscopic surgery in which there is minimal injury of tissues and there is practically no risk of further spread of endometrial foci (currently up to 95% of transactions done laparoscopically). During surgery, endometriosis successfully destroyed using a laser, electrostimulation, ultrasonic energy.

After surgery, if necessary, use various types of rehabilitation, hormonal agents administered to prevent relapse.

The indications for surgical treatment of endometriosis are:

• severe degree of diffuse uterine endometriosis (III-IV stage, with severe pain and / or painful menstruation);

• nodal form of endometriosis uterus;

• endometriosis combination with other gynecological pathology (tumor of the uterus, ovary etc.);

• inefficiency of hormone replacement therapy, or contraindications to its implementation;

• ovarian endometriosis (as a stage in the complex therapy);

• Prevalence of external genital endometriosis;

• severe endometriosis of the cervix.

Drugs that provide a complete cure of endometriosis does not exist. The basic principle of hormonal therapy - the suppression of the formation of their own estrogen hormones in women. This effect is achieved by assigning different derivatives of progesterone as well as other, more potent drugs which suppress secretion of ovarian hormones.

Drug therapies include the use of different groups of products:

• Combined estrogen-progestin preparations;

• progestin, progestogens;

• antigonadotropnym drugs.

If you suffer from endometriosis young woman, whose main task of doctors - to do everything possible so that after the operation she recovered (infertility) or preserved reproductive function. Pregnancy with endometriosis is possible, but it depends on the severity of the onset of the disease. I must say that the current level of operative gynecology, including the widespread adoption of laparoscopic, sparing operations can achieve such a result after surgery in 60% of women with endometriosis at age 20-36 years. Approximately one third of women endometriosis can be resolved independently. Despite the fact that approximately 95% of patients respond to medical treatment (reduction of pain), cure infertility is not possible, but potentially pregnancy is still possible. In 50% of women after termination of therapy within 5 years there has been renewed symptoms.

Given the nature of the pathogenesis of ovarian endometriosis, which is based on hardening of the blood vessels with subsequent ovarian tissue fibrosis and massive loss of primordial follicles, in recent years, many researchers have come to the conclusion about the possibility of cryopreservation of oocytes, embryos and ovarian tissue even followed autotransplantation.

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Феськов Александр Михайлович

Alexandr Feskov

Director of Center of Human Reproduction, head physician

Феськова Ирина Анатольевна

Irina Feskova

medical director of the Center of Human Reproduction

Рыжков Артём Вячеславович

Artem Ruzkov

doctor obstetrician-gynecologist

Чумакова Наталья Александровна

Natalia Chumakova

doctor obstetrician-gynecologist

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