Currently, constantly increasing the percentage of women suffering from disorders of the cycle (heavy and prolonged menstruation, menses with clots, etc.). Not least in this list are, and endometrial hyperplasia and polyposis. But, unfortunately, it is not always achieved the effect of treatment and diagnostic curettage of the uterus Curettage - how dangerous it is?   and hormone therapy. The woman continued to suffer from massive bleeding, which often threaten her life. As an alternative therapeutic curettage and hormone ablation acts (or endometrial ablation).

What is endometrial ablation

Endometrial ablation is a minimally invasive procedure, which is performed during the removal or destruction (destruction) of the entire thickness of endometrium. Operation endometrial ablation is performed under intravenous anesthesia or epidural anesthesia. The first method of endometrial ablation was proposed Bardenheuer in 1937.

Endometrium relates to gormonalnozavisimym tissues and undergo periodic changes throughout the menstrual cycle. In the second (secretory) phase of the menstrual cycle, the endometrium reaches its maximum thickness (10-15 mm), the glands begin to secrete an active, blood flow to the uterine mucosa is enhanced and increases in blood levels of progesterone Progesterone - norm and pathology   and estrogen Estrogen - the key to bone health . All these changes are aimed at preparing for the introduction (implantation) of a fertilized egg. If neproizoshedshego conception in the endometrium begin necrotic changes and he rejected what is called menstruation. If a woman suffers from recurring major bleeding with clots - endometrial ablation helps to effectively solve this problem by avoiding surgery (removal of the uterus).

Uterine bleeding can occur for the following reasons:

• hormonal imbalance;
• abnormalities in blood coagulation system;
• benign and malignant processes in the uterus (endometrial polyps, uterine and cervical cancer);
• pregnancy (miscarriage, ectopic pregnancy);
• Infectious diseases of the sexual sphere (endometritis).

Necessary inspections before the procedure

Before performing endometrial ablation is necessary to pass the following examinations:

• vaginal smears;
• colposcopy (examination of the cervix under magnification);
• Pelvic ultrasound vaginal and abdominal sensors;
• X-ray of the skull (inspection sella);
• a study of hormonal status;
• thyroid function.

The technique of the procedure

Endometrial ablation is performed under anesthesia on the gynecological chair Gynaecological chair: Take a closer look . After processing, the external genitalia are introduced into the vagina mirror, and the cervix is ​​fixed bullet forceps. Then the probe is measured by the length of the uterine cavity and cervical canal expansion is carried Gegara expanders. Thereafter, the uterus is introduced special optical instrument - hysteroscope, which allows you to explore the mouth of the uterus and tubes. In conclusion, endometrial ablation is performed.

The methods of endometrial ablation:

• by laser radiation;
• RF method;
• Balloon thermoablation;
• diathermocoagulation endometrium;
• endometrial cryoablation;
• microwave method of destruction of the lining of the uterus.

Indications for endometrial ablation

Indications for manipulation include:

• recurring, massive, prolonged and frequent bleeding from the uterus in the absence of effectiveness of conservative treatments and malignancy of the female reproductive organs in patients older than 35 years;
• recurrent endometrial hyperplasia in women premenopausal and postmenopausal periods;
• the presence of endometrial proliferative processes in postmenopausal at impossibility of hormonal treatment.

During the endometrial ablation should consider the following factors:

• reluctance of women to preserve fertility;
• refusal of surgery (removal of the uterus) or failure of its implementation;
• uterine size should not exceed ten to twelve weeks of pregnancy.

Anna Sozinova

Adenomyosis, ovarian - such a diagnosis does not exist. Endometriosis - a proliferation of endometrial tissue in other organs and tissues. Adenomyosis or endometriosis Endometriosis - a serious problem with serious consequences   It called uterine endometrial proliferation tissue on the wall of the uterus. Growth of the same tissue in the ovaries called ovarian endometriosis.

As the disease develops

Ovarian Endometriosis develops in contact with the cells of the mucous membrane of the uterus (endometrium) in the ovaries and the development of areas where endometrial tissue. Most often throw endometrial tissue occurs in the ovaries through the fallopian tubes. This process contribute to hormonal disorders (high blood levels of estrogen), impaired immunity (normal immune cells destroy the "alien"), genetic and hereditary predisposition, various intoxications, external influences, and so on.

Abandoned in the ovary cells of the endometrium initially located on the surface of the ovaries, and then they form areas of endometrial tissue, most often in the form of cysts. Endometrial cysts - a hollow structure filled with endometrioid content. Endometrial cysts may have a different structure. So, cysts containing in glandular cells that produce secret confided similar endometrium, called endometrioid ovarian formations. If the glandular cells inside the cyst is not, it's just endometrioid cyst.

Endometrial education are more often bilateral and cause the formation of adhesions in the ovary and in the pelvis. In addition, it raises a number of endometrioid formation of characteristic symptoms of ovarian endometriosis. Endometrial cysts are often asymptomatic, but dangerous in relation to the cyst rupture.

Ovarian Endometriosis - symptoms

Characteristic symptoms of ovarian endometirioza often occur when endometrial formations. These symptoms develop gradually, beginning endometrioid formation in the ovaries may not manifest itself in any way. Then there are symptoms resemble symptoms of chronic inflammation in the ovaries - aching pain in his side, a feeling of heaviness in the abdomen on one side, malaise, weakness. The pain may be aggravated by sexual contact. During the month (but not every month) can occur paroxysmal severe abdominal pain Abdominal pain: Types and Symptoms Accompanied by nausea, vomiting and fainting.

Endometrial cysts are usually asymptomatic, but only as long as the cyst did not explode. Cyst rupture accompanied by signs of acute abdomen and requires emergency surgery. Endometrial cysts may also fester.

Ovarian endometriosis often accompanied by infertility.

How to identify?

In most cases of ovarian endometriosis is detected by ultrasound (US). Can not distinguish between the type of education for blood flow (Doppler method is used), it is expressed in the endometrial formations and insignificant when endometrial cysts. Maybe detection of ovarian endometriosis and using magnetic resonance imaging.

In some cases, to confirm the diagnosis is performed diagnostic laparoscopy - a study of the ovary using an optical device laparoscope. The study is done under general anesthesia in the anterior abdominal wall is several punctures through which a tube is inserted into the optical transmitting enlarged image on the screen surface of the ovary. During diagnostic laparoscopy Laparoscopy - why is it necessary?   possible biopsy - removal of tissue for research.

The diagnosis of ovarian endometriosis can also indirectly confirmed in the study of blood to the antigen CA-125 - a marker of epithelial ovarian tumors. When endometrial formations, this figure is several times higher than the norm, with inactive endometrial cysts it is only slightly above normal.

A study of blood hormones, endometriosis detected in other organs and tissues, which also need to be treated.

Treatment

Treatment of ovarian endometriosis operative. Endometrial cysts removed by removing endometrioid formation try to remove all possible endometriosis, diseases are not allowed to relapse. The operation is performed using laparoscopic sparing Access. Laparoscopic equipment can remove endometrial cysts even of small size, and then cut the adhesions that prevent normal operation of the ovary and exit from the egg during ovulation Ovulation - How to determine as accurately as possible? . For very large cysts are removed along with the ovary.

After the surgery is usually given a course of hormone therapy, which suppresses the secretion of estrogen - it is the prevention of recurrence of endometriosis.

Diagnosis of adenomyosis ovarian does not exist, there is ovarian endometriosis.

Galina Romanenko