In the last decade, notes that the increased role of the fungal flora as the causative agent of infectious diseases that may occur in various organs and systems of the body. This fully refers to diseases of the reproductive system. Thrush in women (or vulvovaginal candidiasis) is considered the most common urogenital infection.

The typical clinical manifestations of thrush

Clinical manifestations depend on the yeast form of the disease. There are the following forms:

• acute
• chronic
• carrier state

They differ in the nature of the flow of infectious process. The most common complaint:

• The first changes the nature of vaginal discharge. In acute disease course selection are abundant, while the color and texture may vary. The most characterized by the appearance of dense (or creamy), white, flaky or filmy discharge, but in some cases they may be watery with the appearance of cheesy-friability inclusions.
• The presence of this type of discharge is accompanied by a merger pronounced itching and burning in the vagina and vulva, as well as a specific smell (not sharp sour smell). Itching may be constant or amplified in certain circumstances. The woman said that in the late afternoon or at night, after a long walk, water treatment, sexual itching becomes more pronounced. In some cases itching acquires such intensity that it becomes a cause of anxiety, sleep.
• The acute form of yeast infection can be accompanied by the development dizuricheskih symptoms (for example, the appearance of discomfort or discomfort when passing urine). In some cases, the clinical symptoms of the disease bright interferes with the normal process of urination and causing urinary retention in women.

During the pelvic exam Gynecological examination: an important component of women's health   an armchair detected changes in the skin and mucosal inflammatory. Dense white discharge cover the vaginal wall in the form of a film, which is difficult to remove with a spatula. Mucosa swollen, inflamed, bleed easily in the study. On mucous genitals rashes can appear in the form of bubbles (or vesicles) that requires a differential diagnosis with other infections whose transmission is possible sexually (eg, herpes virus infection). When inflammation occurs in the acute form, in some cases, a survey will be quite painful procedure.

Symptoms of chronic candidiasis

Chronic forms of candidiasis are characterized by less severe symptoms .  The disease will occur with periods of relapse and remission while for the year could be more than four episodes .  Beyond acute discharge becomes smaller, or they are not available, so a woman can not complain at this time .  Only an exacerbation of infection there is a bright clinical picture, the appearance of which is the reason for the visit to the doctor .  Characteristically, the symptoms tend to occur shortly before the expected menstrual period, and its onset decreases their severity .  Will prevail secondary changes on the skin and mucous membranes, are associated with long-term course of the disease .  Objectively during the inspection is noteworthy that the inflammatory manifestations are less pronounced .  Unlike the acute form of edema and hyperemia of the mucous membranes are not clinically significant symptoms .  May occur with damage to the spread of the surrounding departments (perianal area and thighs) .

Another form of thrush is kandidonositelstvo. In this case, there are no complaints and symptoms, and the diagnosis is established only on the basis of microbiological testing of vaginal secretions Vaginal discharge: normal or disease? .

Diagnosis thrush - practical recommendations

Thrush can be not only a separate disease, but also accompany other urogenital infections. To suspect the presence of Candida infection is possible when a woman has specific complaints. These include the allocation of cheesy nature, itching, local signs of infection. Thrush should be differentiated from infection caused by the herpes virus Herpes - a virus creeping With vaginal vaginosis (bacterial vaginosis) and with various skin diseases Skin diseases - what to do when violated the basic functions of the skin . Some common clinical symptoms can complicate diagnosis. In this situation, conducting a comprehensive laboratory diagnostics allows definitively establish the diagnosis.

Using the culture method of diagnostics provides ample opportunities for the diagnosis:

• Evaluation is not only quantitatively the composition of the microflora, but also to establish the exact species, tribal affiliation yeasts and their sensitivity to commonly used antifungal agents. If cultural studies in the material found yeast-like fungi, it is one of the precise diagnostic criteria candidiasis.
• This study further establish the presence of concomitant bacterial flora that helps assign therapy if thrush occurs not in the form monoinfection. A high percentage of positive results enables detection of fungi in the smears stained Gram or wet in the study drug.
• A comprehensive evaluation of the results of microbiological studies, and proper interpretation of the local symptoms are major moments during the diagnosis of candidiasis. This approach eliminates the presence of diagnostic errors and ensures adequate anti-inflammatory therapy.

Marina Solovyov

Preparations for the treatment of adenomyosis are common among them a choice. What is right for you, the doctor will recommend. What medications can be used to treat adenomyosis?

Nonsteroidal anti-inflammatory drugs, such as aspirin, diclofenac, ibuprofen or

Usually they are the drugs of first choice for the appearance of this symptom of adenomyosis, as painful menstruation. They relieve pain by inhibiting the production of prostaglandins, and also make menstrual bleeding less abundant. Side effects of drugs of this type can be upset stomach, digestive problems and diarrhea.

Analogs of gonadotropin-releasing hormone (GnRH), e.g., leuprorelin

Drugs of this class induce a condition similar to menopause. Leuprorelin prevents ovulation and reduces the level of estrogen Estrogen - the key to bone health . As with menopause neoplasm in uterine tissues are reduced in size, so that they cause fewer problems. Adenomyosis symptoms such as cramping and pain in the lower abdomen, are much less pronounced. The injections of leuprolide do once a month; treatment can last up to six months. Often receiving GnRH analogues administered prior to surgery. They can cause side effects such as hot flashes, mood swings, vaginal dryness Vaginal dryness: Causes and Symptoms , Breast tenderness, insomnia; usually it all goes very quickly. The consequence of the prolonged use of these medications may be a decrease in bone density. Throughout the course of treatment patients are advised to take supplements with calcium, as well as the use of lubricants.

Mirena

Mirena - IUD is, from which the body comes in small doses of levonorgestrel (a progestin). It not only prevents pregnancy, but also makes menstrual bleeding is much less abundant - it's one of the reasons why it is recommended to use when adenomyosis. Over time, the levonorgestrel also thins endometrium. IUD sets doctor and patient, it can last up to five years. Side effects may be bleeding, weight gain, headaches and increased appetite. The most common and unpleasant side effect of Mirena is bleeding - it can take up to three months after the installation of a spiral, and for many women this has to be treated as an inevitability. On the other hand, Mirena can be an alternative way of treating adenomyosis for women wishing to preserve fertility.

Combined hormonal contraceptives

Many doctors prescribe to patients with adenomyosis combined hormonal contraceptives - pills (such as Yasmin or Jeanine), vaginal rings or patches .  They prevent ovulation attenuate the endometrium and thus help normalize menstrual bleeding .  They have a further advantage - for example, they improve skin condition in humans suffering from acne, and reduce the risk of ovarian cancer .  It is believed that the use of hormonal contraceptives is relatively safe until menopause - provided that the woman is examined regularly by a doctor .  Patients taking these drugs, it is necessary every three months to check your blood pressure .  Female smokers over the age of 35 years, as well as those with a history of thrombosis or heart disease, the use of hormonal contraceptives are not recommended .  It also should not be used for those who have a serious surgical procedure and women who have a history of breast cancer Breast cancer: what every woman needs to know   or liver disease.

Hormonal contraception can cause side effects such as headaches, weight gain, high blood pressure, vaginal bleeding between periods.

Danazol

Danazol - is an inhibitor of gonadotropin-releasing hormone production, which is often prescribed for the treatment of adenomyosis. It blocks the production of hormones responsible for ovulation and menstruation. Danazol thins endometrium, and makes it less active.

Typically, the drug effects become apparent after approximately 30 days after initiation of treatment. Finally, after 3-6 months of regular admission danazol patient stops ovulation and menstruation. Impact of danazol on hormone is reversible - the menstrual cycle to normal within two months after the end of treatment.

The lowest effective dose of danazol - 200 mg per day. Acceptance of such doses is indicated for heavy menstrual bleeding; side effects are rare. However, if the patient takes Danazol 400-800 mg a day, there is a greater likelihood of side effects, such as acne, edema, increased hair on various body parts, a decrease in breast size, voice change (it becomes more low - this is due to the fact that Danazol is a derivative of the male sex hormones), increased activity of the sebaceous glands, weight gain. Less frequently occur side effects such as vaginitis (inflammation or irritation of the tissues of the vagina), headaches, hot flashes, nervousness and irritability Irritability - you try to control my temper . In very rare cases, danazol can cause jaundice, pancreatitis (inflammation of the pancreas), thromboembolism, and clitoral enlargement.

Sometimes a good result can be achieved by taking a total of 50-100 mg per day of danazol; the risk of side effects with minimal.

Danazol should not be taken by pregnant or lactating women, as well as patients with disorders of the liver, kidneys and heart. During the course of treatment the patient should see your doctor regularly so that he could celebrate any time change its state.

Depo-Provera

Depo-Provera - is an injectable preparation which is usually used as a contraceptive. It is also indicated for the treatment of adenomyosis. It is a synthetic form of progesterone, which prevent ovulation effects and leads to a thinning of the endometrium. Among the side effects of Depo-Provera - irregular menstrual bleeding, weight gain, headaches, nausea and acne. With prolonged use of Depo-Provera to reduce the risk of bone density. Pregnancy is possible, on average, nine months after a woman stops using this medication.

Use of dydrogesterone treatment of adenomyosis

Oral progestins, which include dydrogesterone, long and effectively used in the treatment of adenomyosis .  Their mechanism of action is still a subject of debate among scholars, but probably the drug slows or stops the progression of the disease, affecting the growth factor receptors, and providing anti-inflammatory effect .  Other drugs such as danazol and gonadotropin-releasing hormone, and effectively improve the symptoms block further germination of endometrial tissue in the myometrium, but they are associated with a high risk of recurrence and of serious side effects .  Didrogesteron, according to research, quickly reduces pain and normalizes the menstrual bleeding and facilitates some other symptoms of adenomyosis .  At the same time, it is well tolerated by most patients, and seldom causes side effects .  Another advantage is the relatively low cost of the drug .  Dydrogesterone is particularly used in the therapy of patients who want to become pregnant in the future .  Various aspects related to the reception of dydrogesterone, are in need of further study, but now it is considered one of the most effective and safe drugs that can be prescribed to patients suffering from adenomyosis .