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103. Лим В.И., Набиева Ш.М., Лим М.В. Влияние этиологического фактора развития на течение гемолитической болезни новорожденных // Вопросы науки и образования, 2020. № 15 (99).
4. Лим В.И., Шавази Н.М., Гарифулина Л.М., Лим М.В., Саидвалиева С.А. Оценка частоты метаболического синдрома среди детей и подростков с ожирением в Самаркандской области // Достижения науки и образования, 2020. № 9 (63).
5. Шавази Н.М., Азимова К.Т., Закирова Б.И., Лим М.В. Прогностическая значимость факторов риска на развитие инфекционно-токсического шока при пневмониях у детей раннего возраста // Тюменский медицинский журнал, 2011. № 2.
6. Шавази Н.М., Лим М.В., Лим В.И., Рузикулов Б.Ш., Азимова К.Т. Применение ингаляций 10% ацетилцистеина у детей с острым обструктивным бронхитом // Вопросы науки и образования, 2020. № 35 (119).
7. Шавази Н.М., Гайбуллаев Ж. Ш., Лим М.В., Рузикулов Б.Ш., Карджавова Г.А., Алланазаров А.Б., Ибрагимова М.Ф. Ингаляции ацетилцистеина в терапии рецидивирующих обструктивных бронхитов у детей // Вопросы науки и образования, 2020. № 29 (113). "
EARLY DIAGNOSIS OF ENDOMETRIOSIS IN WOMEN OF REPRODUCTIVE AGE Bakhriddinova Kh.
Bakhriddinova Khumora - Master's degree Student, DEPARTMENT-2 OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the article under discussion depicts early diagnosis of endometriosis in women of reproductive age. The author concluded that endometriosis is currently a fairly common disease, detected mainly in women of fertile age. The necessity of early diagnosis of endometrioid disease should be emphasized, study of symptoms and possible causes of the disease, and search for effective treatment methods, since this pathological process leads to serious complications, including pain syndrome, development of infertility and depression of psycho-emotional state, which noticeably worsens quality of life of women of different ages. Keywords: endometriosis, reproductive age, morphological and functional properties, common and severe disease, inflammatory, uterine, specific signs of the disease.
Endometriosis is a tumor-like pathological process in which there is a benign growth of tissue outside the uterine cavity, with similar morphological and functional properties to the endometrium. Endometriosis ranks third in the structure of gynecological diseases, following the inflammatory uterine appendage diseases imioma. At the beginning of the 20th century, endometriosis was the leading cause of inflammatory diseases of the uterine appendages. S. Menge and E. Oritz wrote in the "Handbook of Gynecology" (1914) that "...genital endometriosis is of no particular practical importance", then at the end of the century, due to the universal increase in the frequency of this pathology, endometriosis began to be considered as a new disease of civilization. Currently, endometriosis is justifiably recognized as the most common and severe disease of women of reproductive age, which negatively affects the general condition, performance and quality of life of patients [1,2].
In spite of the many studies conducted on the identification of reliable causes of endometriosis, no consensus in the scientific community has been reached so far. There are many genetic, immune, and other less common theories. The following is
considered to be the most reliable. There are two main forms of endometriosis, different in their causes and manifestations:
• Genital. It affects the internal genital organs: uterus, fallopian tubes, ovaries, vagina. Due to the presence of a chronic inflammatory process (endometritis of any nature), abortions, injuries, the presence of an intrauterine device or spontaneously, endometrial cells begin to sprout into the muscular layer of the uterus. There are also two subspecies of it:
• External genital. Affects only the ovaries and peritoneum of the small pelvis.
• Internal genital (adenomyosis or endometriosis of the uterus). It grows into the muscular layer, leading to an enlargement of the uterine body. Often combined with myoma.
• Extragenital. Focus of endometriosis occur in the pelvic organs, abdomen, lungs, intestines, skin, etc. During menstruation, blood with rejected endometrial cells for various reasons enters first the fallopian tubes and then the abdominal cavity. On the surface of the peritoneum, the endometrial cells take root, gradually increase in number, menstruate, and then spread further through the body.
There are cases of combination of genital and extragenital endometriosis.
There are 4 stages of this pathology, based on the prevalence and depth of focus:
Stage I - focus of insignificant size, superficial (affecting only the mucous membrane of the uterus) - minimal endometriosis.
Stage II - some focus penetrate into the muscular lining - mild endometriosis.
Stage III - deep, transmural (through the entire uterine wall) focus of endometriosis appear. Small endometrioid ovarian cysts develop.
Stage IV - there are deep focuses, and the cysts reach significant sizes. Endometriosis focus grow into adjacent organs (vagina, rectum, bladder), adhesions develop in the pelvis -severe endometriosis [3].
There are no specific signs of the disease, but there are some symptoms that should be a reason to visit a gynecologist. First of all, there may be a variety of bleeding - from weak, in the form of smeary discharge, to profuse. Symptoms of endometriosis in women over 40 years: the appearance of a smeary, brownish discharge after intercourse. At the same time, nothing else bothers - the woman notes the regularity of menstruation, the absence of pain in the abdomen and normal vitality. If there is a large and frequent blood loss, there will be symptoms such as general fatigue, sleepiness, sad moods, decreased hemoglobin in the blood [3].
The listed manifestations do not always indicate the development of the disease. But it is necessary to have a preventive check-up and examination by a gynecologist.
Timeliness of diagnosis is extremely important both for the prognosis of the disease and, especially, for the restoration of impaired fertility, where the time factor and age play a decisive role.
If the patient's complaints indicate signs of cervical endometriosis or any other organs, the diagnosis will not be made until the results of laboratory tests are available. Diagnostic measures for the disease in question are varied - gynecologists use both pelvic ultrasound, endometrial biopsy, and laparoscopy.
It is mandatory for a woman to take blood and urine tests and a vaginal smear for the presence or absence of infectious diseases. The cause of pain in endometriosis often lies in the progression of latent infections.
Depending on the degree of endometriosis, the localization of the pathological process and the general health of the woman, a course of treatment is prescribed. Therapy or surgery is selected on a strictly individual basis, but the general principles are as follows:
Treatment of endometriosis of the uterine body begins with a course of hormonal drugs. If the therapy does not give positive results or if a uterine myoma has been diagnosed simultaneously with endometriosis, doctors perform surgical removal of the hollow organ. In the case of early diagnosis and lack of effect after hormonal therapy, doctors perform excision of the specific area of the endometrium exposed to the pathology [3].
Localization of the pathological process in the vagina implies the excision of altered tissues.
How to treat ovarian endometriosis? Today there are three main ways to treat endometriosis: medical, surgical and combined. Each method has its own positive and negative aspects and scope of application. When choosing a treatment, the doctor is guided by the age, stage and form of the disease, the planning of the subsequent pregnancy.
Here, doctors insist on a powerful, somewhat aggressive hormonal therapy. If the woman is over 40 and is not planning a pregnancy, then treatment comes down to surgical removal of the affected ovary. The problem is that along with ovarian endometriosis, it is not uncommon to diagnose endometriosis of the fallopian tube. In this case, a complete removal of all affected organs is performed.
Means of treatment of internal endometriosis are prescribed only by a doctor, since they are from the category of hormonal drugs, in violation of the dosage and duration of the course can cause serious health problems. Also, painkillers are prescribed to patients on an individual basis. If endometriosis pains coincide with menstruation, antispasmodics and analgesics will help to normalize the condition.
In order to prevent the development of endometriosis, the following provoking factors should be avoided: acute or chronic inflammatory processes in the uterus, uterine trauma, medical abortions.
It should be concluded that endometriosis is currently a fairly common disease, detected mainly in women of fertile age. I'd like to emphasize the necessity of early diagnosis of endometrioid disease, study of symptoms and possible causes of the disease, and search for effective treatment methods, since this pathological process leads to serious complications, including pain syndrome, development of infertility and depression of psycho-emotional state, which noticeably worsens quality of life of women of different ages.
References
1. Barbieri R.L. Hormone treatment of endometriosis: the estrogen threshoid hypothesis // Am. J. Obst. Gyn., 1992. Vol. 166. P. 740-745.
2. Cosson M., Querleu D., Donnez J. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscohic surgery // Fertil. Steril., 2002. Vol. 77(4). P. 684692.
3. Goncharova M.A., Petrov S.A., Kislyakova N.N. Genital endometriosis: main directions of diagnosis and treatment // Scientific Review. Medical Sciences, 2020. № 2. P.p. 5-9.
4. Kohler G. Faustmann T.A., Gerlinger C. A dose — randing stady to determine the efficacy and safety of 1,2, and 4 mg of dienogest daily for endometriosis // Int. J. Gyn. Obst.. 2010. Vol. 108. P. 21-25.
5. Seracchioli1 R., MabroukM., Manuzzi et al. Postoperative use of oral contraceptive pills for prevention of anatomical relapse or symptom recurrence after conservative surgery for endometriosis // Hum. Reprod., 2009. Vol. 24(11). P. 2729-2735.
