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The diagnosis of endometriosis cannot be made solely on the basis of the symptoms that each patient presents. It must always be confirmed with complementary examinations, which allow the existence and severity of each case to be specified. On examination, the gynecologist may find an increase in the size of one or both ovaries, or a certain degree of immobility or fixation of them to the uterine wall or vaginal fundus. But additional tests are necessary to confirm the diagnosis.
Using the results of an ultrasound, a lamparoscopy, a CT scan or the numbers of blood markers, the gynecologist will be able to study the extent of endometriosis.
- Ultrasound. It is the basic technique that serves, initially, for the diagnosis of endometriosis. The image allows the ovarian cysts to be seen with a specific pattern. It is preferable that this test be carried out vaginally, provided that the woman has had sexual intercourse.
- Blood tests. Recent studies indicate an increase in the so-called marker CA-125 in the blood in women suffering from endometriosis. Unfortunately, this marker is highly nonspecific, because not all women with endometriosis suffer alterations in their CA-125 levels, especially in those with mild disease. In addition, other alterations inside the abdomen can modify it (appendicitis, uterine fibroids, pelvic inflammations, functional hemorrhagic cysts, recent surgery, cancer, etc).
- Laparoscopy. It is an operative technique that allows us to observe the inside of the abdomen. It is carried out under anesthesia and is performed in the operating room. Through small incisions in the navel and both sides of the pubis, the optic camera and the working instruments are introduced. The vision of the gynecological structures helps to confirm the existence of endometriosis and to treat it, usually by this same route. In young patients, when the subsequent goal is to achieve fertility, it is about eliminating the disease while preserving as much healthy tissue as possible.
- TAC. CT (computerized axial tomography) or MRI (nuclear magnetic resonance) are complementary tests, which the gynecologist may request when the diagnosis of endometriosis by ultrasound is not clear or when the CA-125 marker is very altered.
Endometriosis treatment is personalized, as the woman's age, symptoms, and desire for fertility must be considered. In some cases, drug treatment may be sufficient, while other patients will benefit from combined medical and surgical treatment.
Antiprostaglandins, which decrease pain and menstrual bleeding; oral contraceptives, which promote ovarian rest, decrease the possibility of progression and relapse of endometriosis; Danazol, which decreases ovarian hormone levels generating pseudomenopause, have been the most widely used so far.
- Gn-RH analogs (gonadotropin-releasing hormone) belong to the newest medication for the control of endometriosis. These are substances that act at the brain level, suppressing, much more intensely, the genesis of hormones from the ovary and causing a state of reversible menopause when leaving them.
Its side effects are like those of physiological menopause (hot flashes, sweating, joint pain, vaginal dryness, fluid retention), but they can be alleviated with other drugs administered simultaneously. Its main function is the healing of microscopic abdominal implants and the cessation of ovarian function and, in some cases, it can facilitate surgical maneuvers. This medication is not helpful in making endometriotic cysts disappear.
- Gn RH antagonists. They are still in the experimental study phase, but they seem to be promising drugs when it comes to achieving a temporary menopause from the first application.
Today, the surgical technique used for endometriosis is laparoscopy. It allows a view of the interior of the abdominal cavity, through small incisions of a few millimeters, through which the working instruments are inserted. It is carried out under general anesthesia and requires previous tests, such as chest x-ray, electrocardiogram and blood tests.
The mission of the laparoscopic gynecologist will be to eliminate all macroscopic active endometriotic substances, trying to minimize damage to healthy tissue. The diseased tissue will be sent for study, the result of which will be provided to the patient a few days later. The hospital stay is usually short, one or two days, and the return to normal activity takes one or two weeks.
Endometriosis is a disorder, often painful, that occurs when the tissue (endometrium) that normally lines the uterus grows somewhere else outside the uterus.
In general, endometriosis affects the fallopian tubes, the ovaries, the tissue that lines the pelvis, making it difficult in many cases for a woman to become pregnant.
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