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Premenstrual syndrome

Premenstrual syndrome PMS - endometriosis   PMS or premenstrual syndrome and endometriosis A recent question by a patient prompted us to review premenstrual syndrome(1-4). The traditional view Premenstrual syndrome is a frequent, well known (4500 hits on pubmed) but poorly understood syndrome, occurring to some extend in most if not all women in the premenstrual period . The symptoms of PMS are variable. Some women have mainly brain symptoms or premenstrual dysphoric disorder with feelings as irritability, depression, mood swings, nervousness, irritation, sleep disturbances, character changes and more severe psychiatric syndromes. Other women mainly complain  of  ‘progesterone’ effects  as abdominal bloating, water retention and breast tenderness. Traditional gynecology and endocrinology consider progesterone concentrations or hormone changes  as the driving motor of PMS. It seems logical since PMS occurs in the luteal phase of an ovulatory menstrual cycle. The ‘classic’ but empirical treatment with progesterone orally or intra-vaginally,  unfortunately is not very effective. Even the suppression of ovulation is not that effective according to a recent Cochrane review (5). What is missing in the literature ? Traditional gynecology and endocrinology do not consider clinical observation as valuable information. When Evidence Based Medicine becomes a religion what is not proven -preferentially in a RCT-  does not exist.  We recently discussed this in detail for surgery(6). After 30 and 40 years of gynecologic endocrinology and endometriosis we consider important for PMS The effect of age : in young women severe PMS is rare; it increases with age and decreases after 45 years The importance of an uterus : severe PMS is extremely rare in the absence of a uterus even in women...

Endometriosis symptoms checklist

Endometriosis symptoms checklist Aim is a simple symptoms check-list to answer the following questions when should I look for help ? which is the probability of typical-cystic-deep endometriosis with my symptoms ? when to doubt/correct my GP or gynecologist and ask for a second opinion ? Endometriosis might be present = diagnosis required depending on the severity of symptoms diagnosis= laparoscopy for cystic ovarian endometriosis diagnosis is laparoscopy for superficial and deep endometriosis No complaints : typical lesions in 5%, occasionally cystic and deep Only dysmenorrhea If severe : typical in 50% if very severe : cystic in 10% ; deep in 5% Chronic pelvic pain If severe ; typical in 50% , cystic ovarian in 10% if very severe : cystic ovarian 15% ; deep 5 % however many other causes that can cause chronic pelvic pain have to be ruled out Only infertility typical lesion will be found in 50% Diagnosis for endometriosis required Radiation of pain to the anterior-inside of the upper leg = ovarian pain perineal pain radiation is pathognomonic for deep endometriosis dyschesia during menstruation and/or diarrea during menstruation suggests deep endometriosis dysuria at the end of micturition can suggest deep endometriosis of the bladder Common mistakes A normal clinical exam or ultrasound or MRI does not rule out even severe endometriosis Menorrhagia or menstrual disturbances might be present in endometriosis, but do not suggest endometriosis Medical therapy for endometriosis without a diagnosis unless for a short period of time Comments A laparoscopy unfortunately is invasive : therefore the indication is finally made by a clinician with experience. this reflects the questions before an...

Surgeons guidelines for cystic ovarian endometriosis

Cystic ovarian endometriosis Guidelines by surgeons Background Retrograde menstruation with extra uterine implantation of endometriotic tissue upon the ovarian surface is seen as the most common cause of ovarian endometriotic cyst. Subsequent inflammation, adhesion formation and further invagination of the ovarian cortex give rise to the formation of the endometriotic pseudo-cyst. The presence of ovarian endometriotic cyst results in an impaired ovarian reserve due to fibrosis (Kitajima et al. Fertil Steril. 2011 ) and diminished ovarian interstitial vascularization (Jun-Jun Qiu et al. AOGS, 2012). These pathological changes are already present in small endometriotic cysts. It is a cause of early ovarian depletion in young women. Intra-cystic endoscopic images obtained at trans-vaginal laparoscopy shows an omnipresent neo-angiogenesis with inflammatory reaction and presence of active endometriotic tissue, indicating the aggressivity of the disease already in a very early stage (Gordts et al. Gynecol Surg (2014.  11:3–7).     Diagnosis Therapy Infertility In absence of markers of the aggressiveness of the disease, and with the available scientific data, surgical treatment in an early stage in patients with infertility causing a minimal trauma is suggested. In case of larger endometriotic cyst a combined technique of cystectomy and ablation at the hilus or a surgery in two steps is recommended to minimize the ovarian damage. Recent data show a better outcome in terms of ovarian reserve and recurrence rates using an ablative surgical procedure compared to cystectomy (Roman 2016,2015; Muzii 2016). In absence of infertility In young patents: use of OC is advisable to stop menstrual bleedings and to decrease pain and slow down the process. In case of no response and increasing size...

Shiny Trinket

Shiny trinkets are shiny.