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All About Endometriosis

Selasa, 11 Mei 2010

All About Endometriosis

Endometriosis lately becomes very popular term. A disease that affects only women each year shows an increase in the cases although the data certainly can not be known. Women seem to need to be aware that the disease often characterized by severe pain during this period. Because, besides can reduce fertility or fertility potential, this disease is often very difficult to be detected.

According MedicaStore, endometriosis is a disease that triggered the growth of endometrial tissue outside the uterine cavity. The endometrium is the tissue that limits the inside of the uterus. In the menstrual cycle, endometrial thickness will increase as a preparation for pregnancy. If pregnancy does not occur, then this layer will be separated and removed as menstruation.

This disorder is genetically derived allegedly discovered six times more often in women who have a mother or sister with this complaint are not compared. Endometriosis can occur at any time during the reproductive age women and become a big problem because it can cause infertility.

The cause of endometriosis is not known with certainty, but there are several theories proposed so far, namely:

    * Menstruation Retrograde, where most of the flow of menstrual blood from the womb out into the abdominal cavity through the fallopian
    * Impaired immune system that allow endometrial cells attach and grow
    * Genetic Abnormalities
    * Network endometrial spread via lymph system and blood flow
    * Environmental factors, such as exposure to dioxins

Endometriosis can cause infertility due to various circumstances the following:

    * Hormonal Parameters compared with normal cycles, follicular phase of endometriosis patients with a shorter, lower estradiol levels, and the peak value of LH (LH surge) is reduced. Follicles are formed during the LH surge tended to smaller size.
    * Luteinized Unruptured follicle syndrome (LUF) LUF is the failure to release eggs from the ovaries.
    * Effect of peritoneal endometriosis patients found an increase in the number and activity of peritoneal fluid and the peritoneal macrophages.
    * Immune System Endometriosis affects the immune system and can directly lead to infertility.
    * Production of Prostaglandins Prostaglandins allegedly produced by young endometrial cells, causing spasms or
    * Contraction of muscles. Because of the influence of prostaglandins, tuba becomes rigid and can not take the eggs produced by the ovaries and adhesions occur rejection fetus in the womb. Besides the movement of sperm is also reduced thus affecting its ability to penetrate the egg.

Endometriosis can occur in many places and affect the symptoms caused. The most common place is in the back of the uterus, the tissue between the rectum and vagina and rectum surface. But sometimes also found in the valopii tube, ovarian, cervical strap muscles, bladder and pelvic sidewall.

Following the menstrual cycle, each month this tissue outside the uterus has thickened and bleeding. This bleeding does not have exit channels such as menstrual blood, but collect in the pelvic cavity and cause pain. The formation of endometriosis in ovarian is causing chocolate cysts. Due to the chronic tissue inflammation, scar tissue formed and adhesions reproductive organs. The egg itself enmeshed in a thick scar tissue that can not be discharged. A third of patients with endometriosis do not have any symptoms other than infertility.

Other patients are experiencing many symptoms with the primary symptoms of pain. Endometriosis is not related to the degree of pain, severe endometriosis can be caused only mild pain.

Symptoms often arise:

    * Pain, great pain of endometriosis is determined by the location
          o pain during menstruation
          o pain during and after intercourse
          o ovulation pain
            pain on examination by a physician
    * Bleeding
          o bleeding a lot and the old at the time of menstruation
          o spotting before menstruation
          o irregular menstrual
          o dark menstrual blood comes out before the end of menstruation or menstrual
    * Complaints and small bowel
          o pain with defecation
          o blood in feces
          o diarrhea, constipation and colic
          o pain before, during and after urination

A woman with typical symptoms or unexplained infertility is usually suspected of having endometriosis. Additionally certain laboratory examinations can help, such as levels of Ca - 125 in blood and endometrial aromatase activity. But it means the most reliable diagnosis is by laparoscopy, which is done by inserting the laparoscope through a small incision tool below the navel. With this tool the doctor can view the pelvic organs, cysts and endometriosis tissue directly.

Treatment given depends on the symptoms; plan to have children, age and extent of the affected area. Management of endometriosis with drugs do not cure, endometriosis will relapse after treatment is stopped. In women with mild to severe endometriosis, especially in cases of infertility, so needed surgery to remove endometrial tissue and as much as possible to restore reproductive function.

   1. Hormonal treatment
      Hormonal treatment aims to stop ovulation and allow the endometrial deposits to regress and die.
      These drugs are pseudo-pregnancy or pseudo-menopause. Used are:
          * Derivative of testosterone
                o Danazol
                o Gestrinone (Dimetriose)
          * Progestogen
                o Medroxyprogesterone (Provera)
                o Norethisterone (Primolut)
                o Dydrogesterone (Duphaston) ·
          * GnRH (Gonadotropin-Releasing Hormone) analog
                o Leuprorelin (Prostap)
                o Goserelin (Zoladex)
                Nafarelin o (Synarel)
                o Buserelin (Suprecur)
          * Combination contraceptive pill

All of these hormonal treatments through clinical trials have proven the effectiveness of which is roughly the same. Side effects of these drugs differ from one person to another.

Hormonal Treatment Side Effects

Bleeding between periods, mood swings, depression, atropik vaginitis

Weight gain, acne, the sound gets heavier, hair growth, heat flow, vaginal dryness, swelling of ankles, muscle cramps, bleeding between periods, decreased breast size, mood swings, disturbances of liver function, lipid metabolism disorders, carpal tunnel syndrome .

GnRH analogue
Heat flow, vaginal dryness, loss of calcium from bones, mood swings.

Contraception Pills
Stomach swelling, swollen breasts, increased appetite combination, ankle swelling, nausea, bleeding between periods, deep venous thrombosis.

   2. Surgery
      Surgery can be performed by laparoscopy or surgery, depending on the extent of the invasion of endometriosis. In patients with severe endometriosis hormonal therapy followed by surgery. Often the treatment given before surgery to reduce the number and size of the endometriosis tissue. At the time of surgery all visible endometriosis tissue and can be reached must be removed, with no incision or burning by laser beams. Hormone treatment given after surgery to reduce inflammation and clean up the remaining endometrial tissue.
   3. Radical Surgery
      Surgery is done by lifting the uterus and ovaries in addition to cleaning the endometriosis tissue. This is only done on women with severe endometriosis who did not experience improvements with other medications and does not expect a pregnancy. After the surgery is given estrogen replacement therapy, since the appointment of the uterus and ovaries cause the same consequences with menopause. Replacement therapy was given 4-6 months after surgery so that all the remaining endometrial tissue was gone and not re-formed under the influence of estrogen.

Endometriosis cause infertility by many mechanisms of ovulation disorders, tissue adhesions, tubal blockage, ectopic pregnancy and other reasons unknown. Successful pregnancy after treatment with surgery and hormone therapy ranged from 40-70% depending on the severity of endometriosis.

Seeking pregnancy after endometriosis treatment is done by:

   1. Wait
   2. Ovulation induction and intra-uterine insemination
   3. In vitro fertilization (tube baby)

So, from now on do not hesitate to go to the doctor to consult an expert if you experience symptoms of this disease. Although many hospitals (RS) and the clinic has been providing surgical facilities. However, is not it better to detect the earliest stage of the required surgery?

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