- Endometriosis uterus - one of the most frequent diseases in women
How to conduct a survey and treat
When an internal endometriosis was widespread method of diagnosing an ultrasound scan TVS transvaginal probe. This study has great diagnostic capabilities, allows us to refine the localization process. Can effectively evaluate the treatment on the basis of the dynamic monitoring of the uterus, which is clearly seen using Doppler blood vessels of the uterus.
Confirm the diagnosis of adenomyosis helps hysteroscopy
Hysteroscopy - examination of the uterus inside
. When imaging the uterus can see the characteristic features of adenomyosis:
- endometrium is uneven contours
- the presence of uneven surface of the mucosa as crypts of various cellular structures or irregularities. Even after the removal of a special instrument functional layer is no alignment surface
- the emergence of "points" or "gaps" that resemble cells from which blood flows. This is clearly seen after the test oxytocin, when administered intravenously a solution of oxytocin and pronounced blood flow occurs from "points"
If the pathological process is common, it is important to evaluate the condition of having an anatomical connection with the uterus. It is important to select the further treatment strategy when planning surgery. With high precision allows us to give a description of established pathological process method of computed tomography (CT), MRI technique. Status of the mucous of the uterus is well visualized by MRI, so it is necessary to include in the plan a comprehensive survey.
Typical changes in endometriosis is found during diagnostic laparoscopy.
There laparoscopic diagnostic sign of adenomyosis
Symptoms of adenomyosis - characteristic and recognizable
- "Marble" of the uterus. You can also find other manifestations - specific pockets of white and red color, the presence of glandular bulging or yellow-brown spots of irregular shape. Using endoscopic technology makes it possible not only to confirm or rule out the presence of endometriosis, as well as in the future to restore a woman's reproductive health.
Proven clinical cases of adenomyosis require treatment, which consists of several stages. After the relief of symptoms of the disease to restore a woman's fertility, her menstrual function, to carry out prevention of recurrence. The main method of medical treatment is hormone therapy. While receiving hormonal therapy is the development of atrophic phenomena directly in endometriosis. If the disease is characterized by widespread over, while there is a high risk of subsequent relapse, use combination therapy with hormonal and surgical treatment. It is recommended that hormone therapy as a preoperative preparation, as this will help to reduce the severity of pathological formations and makes maintenance an operation.
Preparations for the treatment of endometriosis uterus
The question of how to approach the selection of a drug, assign the appropriate procedure to be determined not only the clinical picture and age limits and the presence of comorbidities (gynecological diseases combined with adenomyosis
Adenomyosis - avoid constant stress
and somatic disorders). Independent method of treatment is to use oral contraceptives, or COCs. This method is particularly recommended for young women. It confirmed the effectiveness of low-dose preparations of the last generation, "Silest" "Marvelon", "Janine", "Yasmin". The positive results of treatment can be expected only after long-term use of drugs for six months to one year. Receive Mode hormones selected individually, the standard scheme is that the patient must take pills for 21 days followed by seven days to make a break.
Effectively the appointment of hormonal agents from the group of progestogens, which include dydrogesterone, medroxyprogesterone. The daily dose of dydrogesterone may be up to 30 mg per day. In the treatment of adenomyosis
Adenomyosis - treatment should be individualized
mode should be selected taking the drug from 10-11 to 25 day cycle. If injections of medroxyprogesterone deposited, they do once every two weeks at a dose of 150 mg. Optimal treatment progestogen should be at least nine months.
The drugs of choice are considered central agonist of gonadotropin-releasing hormone (or GnRH). These drugs are highly effective, but have a number of negative developments, which may affect their application.
The first is side effects associated with the hypoestrogenic state. The developing shortage of sex hormones should be compensated for conducting hormone replacement therapy. If a woman is appointed for a long period of therapy agonists, it is necessary to pay attention to the appearance of complaints of "hot flashes", palpitations, mood changes, or urogenital disorders. To eliminate the effects hypoestrogenic appointed replacement therapy tibolone (CW one tablet per day).
For the majority of patients is the most convenient mode of application of GnRH agonists. The formulations are produced in the form of injections (intramuscular or subcutaneous injection), which are administered only once every 28 days. Intramuscularly injected "buserelin" at 3, 75 mg. Subcutaneously can be used "goserelin" at 3 and 6 mg. Results of therapy are evaluated not earlier than after 3-6 months. The duration of hormone treatment should be strictly differentiated for each clinical case.
If, after completion of a course of treatment, the patient complaints persist persistent pain, there are symptoms of neighboring organs, it is necessary to appoint a consultation of experts of related disciplines (urologist, gastroenterologist, psychiatrist)
. Severe pain that is not relieved by conservative treatments, is an indication for hospitalization and surgical intervention of
. Even after adequate removal of endometriosis there is a risk of re-development
. In this regard, it is important to promptly appoint a rehabilitation treatment in the postoperative period
. This treatment consists of physical therapy to normalize the circulatory and metabolic processes improve tissue regeneration processes, as well as immunostimulatory therapy, hormonal treatment to restore the two-phase loop
. On the success of combination therapy influences the prevalence of adenomyosis, the severity of changes