(Jrt)
Endometriosis
Endometriosis is the presence of endometrial cells outside the uterine cavity (peritoneal cavity and ovary). Endometriosis is a benign but incurable disease, still very mysterious to the medical community. Neither his home nor his remedy are determined to date, although several hypotheses have been issued (including the role of reflux endometrium by the fallopian tubes into the pelvic cavity during the rules).
80% of endometriosis have ovarian location.
The lesions of endometriosis, in addition to the pelvic area may also be on the digestive organs, including the rectum, the bladder or the kidneys.
Epidemiology
It is estimated that 10% of women suffer from endometriosis. Yet not all are diagnosed as suffering from forms little extended. It is responsible for nearly half of menstrual pain (dysmenorrhoea).
Its frequency increases with age and affects women around the thirties. It may nevertheless meet with the teenager. It is rare when taking a contraceptive oestrogens and progestin. It is more common in cases of late menopause or in women who had their first period early.
Mechanism
It is currently unknown. The hypothesis of "retrograde rules" was mentioned.
Aspect
In most cases, endometriosis is located outside the uterine muscle, but may also lie within it (adenomyosis).
Endometriosis can take different forms:
* Ovarian cysts
* Nodules on the pelvic organs or other organs of the abdominal cavity
* Adhesions between organs (between the annexes and the uterus, between the uterus and intestines, ...)
Clinical signs
Endometriosis can detect different ways, and pain can occur anywhere in the body. His expression varies from person to person, can be manifested by intense pain or be completely asymptomatic contrary to (the patient not complaining of anything).
The first sign to be taken into account are painful (dysmenorrhoea).
The rules are accompanied by gastrointestinal problems (diarrhea, constipation, rectal), urinary difficulties, or abdominal spasms ... These rules are often very abundant.
Women with endometriosis may also experience pain during intercourse (dyspareunies.
In case of damage or digestive bladder or kidney problems, endometriosis is accompanied by painful symptoms, complications and functional (to digest, go to the bathroom, urinate ...).
Endometriosis has important repercussions on the mind and morale, women suffering pain, infertility, effects of surgery or treatment .... Psychological assistance can be beneficial, and groups of words together affected women may be beneficial.
Diagnosis
The diagnosis of certainty can not be raised by the Coelioscopy. This review, requiring surgery, is not offered in the first intention.
It is sometimes but not always, suspected in an examination imaging, ultrasound or magnetic resonance imaging (MRI), MRI is more efficient for diagnosis of endometriosis sub-peritoneal. Ultrasound can be made by trans-vaginal probe by introducing dedicated to this level. It allows us to visualize the presence of small uterine cysts (small cavities fluid). Their absence does not eliminate the diagnosis.
A blood test for the CA125 assay can also be practiced, but this marker is not specific to endometriosis.
The diagnosis is a fundamental step:
* More endometriosis is taken on time, unless it extends, the less it is difficult to treat.
* Only a clear and comprehensive mapping of lesions can choose effective medicine and, where appropriate, a successful surgery.
* Endometriosis can lead to infertility or cause of infertility (ovarian damage and / or annexes).
Evolution
Endometriosis is a disease with a variable spontaneous evolution: Initially limited to the uterus or ovaries, it can extend to bodies of small basin. It can in no way back. At best, it is stabilizing, but the damage already does not reverse, do not heal. More endometriosis is extended, it is more severe and difficult to treat, hence the importance of a diagnosis in time. Whatever happens, it is a disease that is kept for life.
Treatment
In mild forms hormone contraception by oestrogens and progestin sufficient to stop the progression of lesions, even to remove the cyst.
In the more extensive surgery for removal of uterine cysts may be necessary. It can be done by laparoscopy or more conventional way, by opening the abdomen. After surgery, it is imperative to follow a hormonal treatment to prevent recurrences. Unfortunately, surgery is often futile because of the recurrent disease: a cyst removed likely to be reformed sooner or later, the same injury during the cautérisées coelioscopie.Il appears that the surgery had better results about fertility. The surgery gives the best results in the fight against the disease is one that is a "cleaning" of all lesions of endometriosis: removal of cysts, cautery lesions, ablation zones of adhesions and nodules (intestinal wall, ligaments supporting the uterus etc.). If everything was removed, the patient can expect a few months or few years of "tranquility". This option is widely considered for women with a desire for procreation in the very near future.
Nevertheless, leading to consider surgery remains in first place the intensity of pain felt by the patient, quality of life.
It is assumed that removing the rules (hormone) prevents endometrial cells from spreading to outside the uterus, endometriosis and reform.
We must naturally calm the pain:
* Paracetamol, and anti-spasmodic;
* Anti-inflamatoires nonsteroidal;
* Derivatives morphine and morphine.
Read also Menopause
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