Menstrual pain is a condition that normally occurs in patients with menstruation. But not infrequently painful menstruation becomes a sign of a disturbance in the female reproductive organs, endometriosis is one of them. Endometriosis: Tues Endometrium a Switch Endometriosis is a medical condition in women that is characterized by the growth of endometrial cells outside the uterus womb. Bladder uterine endometrial cells coated by a great effect on female hormones. Normally, the cells will thicken the uterine endometrium during the female cycle lasts so will be ready to receive the fertilized egg and sperm cells. If the egg is not fertilized, the thickened endometrial cells would disintegrate and come out as menstrual blood. In endometriosis, endometrial cells that originally were in the womb will move and grow outside the uterus womb. These cells could grow and migrate to the ovary, oviduct (fallopian tube), behind the uterus, uterine ligament can even get to the bowel and bladder. Endometrial cells have the same response as the endometrial cells of the uterus and is very influential on female hormones. At the time of last menstruation, endometrial cells that move it will flake off and cause a feeling of pain around the hip. Figures Genesis Endometriosis Generally, the disease endometriosis appears in reproductive age. The incidence of endometriosis reach 5-10% in women generally, and more than 50% occur in perimenopausal women. Symptoms depend on the location of endometriosis endometrial cells is changed. The most notable is the presence of pain in the pelvis, so that almost 71-87% of cases are diagnosed due to severe chronic pain during menstruation, and only 38% that arise from complaints infertile (infertile). But there was also a reported ever happened to the menopause, and some even reported in 40% of patients hysterectomy (removal of the uterus). Some studies also say that Japanese women have a greater prevalence among women kauskasia. In addition, 10% of endometriosis may appear to those who have a history of endometriosis in the family. Notice Signs and Symptoms Symptoms of endometriosis is varied and unpredictable. Painful menstruation (dysmenorrhoea), chronic low back pain, pain during intercourse (dispareunea), infertility (infertile) is a common symptom. Lots of speculation from various researchers regarding pain arises. Basically, the pain of endometriosis arise as a result of inflammation of the material produced by the active endometriosis. Endometrial cells that move was going to peel off and is localized in one place and stimulate an inflammatory response by releasing cytokines material so that it appears the feeling of pain. In addition, pain can also be caused by moving endemetrium cells causes scar tissue in place will stick and cause perlengkatan organs, such as ovary, ovarian ligament, oviduct (fallopian tube), bowel, bladder, etc.. Adhesions this will damage organs and cause severe pain around the pelvis. Endometriosis was found in 25% of infertile women (barren) and an estimated 50% - 60% of cases of endometriosis will be infertile (infertile). Invasive endometriosis will cause infertility due to reduced function of the womb and the fallopian tubes and ovaries sintering at. However, some theories say that the endometriosis will produce inflammatory prostaglandins and other materials that may interfere with the functioning of the reproductive organs such as contraction or spasm. Also mentioned in endometriosis fallopian tube function in doing taking eggs from the ovaries to be disturbed. It can even damage the epithelial lining of the uterus and cause implantation failure in fertilization outcome (so that patients with endometriosis had a miscarriage 3 times larger than normal). Levels of Endometriosis Broadly speaking, endometriosis is divided into four tiers based on the severity of the disease. Stage 1 Besrsifat superficial lesions, no adhesions on the surface. Stage 2 The existence of sintering up in the cul-de-sac. Stage 3 Just as the stage 2, but with a small endometrioma ovarian adhesions and there are also a lot more. Stage 4 Same as stage 3, but with a large endometriomas and adhesions were very extensive. Knowing the Endometriosis You need to visit a doctor to determine the presence of disease endometriosis. Usually, the interview (history) and physical examination, endometriosis can be known. In patients with endometriosis, when a physical examination, will be found nodules on the ligament of the uterus. In addition, the nodules are also found in uterosacral. The pain experienced by patients during the trial. Laindibutuhkan Investigations to confirm the diagnosis of endometriosis, such as ultrasound (ultrasonography) and MRI (magnetic resonance imaging). In some cases of endometriosis, patients get the negative results of the investigation that required a more accurate examination. A more accurate is that laparoscopy with biopsy and examination of tumor marker CA-125. Patient Handling Endometriosis It must be realized that endometriosis is progressive and repetitive, so pengankatan uterus (hysterectomy) and both fallopian tubes to be the most likely choice to eliminate endemetriosisnya. But this action is not possible at those who still want to have offspring or not married. So the choice to do that is using drugs. Therapy can be done using: Nonsteroidal antiinflammatory drugs (NSAIDs / nonsteroidal antiinflammatory drugs). NSAIDs not only reduce pain, but it can reduce the bleeding that occurs. In severe cases, allowed the use of morphine. Progesterone or progestin Progesterone can be "against" the activity of estrogen and prevent thickening of the endometrium. Progestin is a chemical derivative of progesterone. Avoid any kind of material that is estrogenic. Oral Contraceptives Oral contraceptive therapy can reduce pain associated with endometriosis. Oral contraceptives will suppress LH and FSH to prevent ovulation so that the endometrium is not thickened. Oral contraceptives (birth control pills) may suppress pain by 75% in patients with endometriosis. Birth control pills can be taken continuously or according to the menstrual cycle and may be discontinued after 6 to 12 cycles. Side effects that may occur are headache, nausea, and hypertension. These pills are taken in accordance with the rules, by not taking the pill placebonya. Danazole (steroids) that works by creating an atmosphere of androgenic, can suppress the growth of endometriosis. But there are side effects that arise as hirsutism (excess hair growth in women with a distribution like men), acne, etc.. Lupron (GnRH agonists) work by increasing blood levels of GnRH, LH and FSH levels seingga down, but the side effects that may occur is the appearance of osteoporosis. Can be used only 6 months. The dosage was 11.25 mg for 3 months, then resumed sebukan once for 6 months 3.75 mg. Aromatase inhibitors are the treatment of block peroduksi of estrogen. Surgery Treatment with surgery were divided into 3 groups: Conservative surgery, done if the reproductive organs are still needed, these actions are taken by the mengeksisi, remove tissue endometriosis alone, and keep the pelvic organs remain in good condition. Semi conservative, if ovarian function is still needed. Radical surgery, if the ovaries uterus and ovaries removed in total, was conducted in patients who experience severe pain and is resistant to medikamentosa (drugs), and have no desire anymore offspring. But radical action also does not guarantee the patient will be free from pain. Recurrence Endometriosis Factors that determine recovery of the disease is highly dependent patients. This is because there is no treatment that can completely relieve patients of pain severe endometriosis. Keep in mind, early treatment with laparoscopic surgery is needed to determine the severity of endometriosis that can be used as a reference in the provision of therapy. The desire of patients to be free from pain and the desire to have children requires consideration for physicians in selecting therapies for patients. Recurrence rate of endometriosis is so big that is 5-20%, even up to 40%, except for hysterectomy in patients or patients already entered menopause. Endometriosis is rarely become malignant and has nothing to do with endometrial cancer. Less than 50 cases of ovarian malignancy arising from endometriosis cases and most of these cases have become adenoakantomas. So, do not underestimate the sign of endometriosis menstrual pain when you have felt.
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