Gynecology

Urinary incontinence – an involuntary leakage of urine. Condition that woman is unable to control.

Dr. Gil Levy – urogynecology, pelvic surgery, leading expert in the of interstitial cystitis and urinary incontinence treatment.

Incontinence is a very big problem for a women. The problem is not only a medical character but also hygienic, social and emotional as it occupies all aspects of a woman’s life, significantly degrading the quality of life, her self-esteem and sexual function.

Urinary incontinence occurs at a young age is 8% – 20% of women over 40 years of about 25%. Women over 65 years – 40%.

For the diagnosis of urinary urodynamic studies are conducted to help diagnose the type of problem. This method consists in measuring the pressure in the bladder and abdominal pressure. This test provides clear criteria for bladder and its sphincters which helps determine the degree of incontinence.

Many patients believe that there is no solution to this problem and you just need to get used to living with it. In fact it is not. Despite the fact that the incontinence is not defined as “disease”, but to live with the problem is not normal. Our experts have the experience and appropriate qualifications to successfully treat incontinence or even save a woman from this problem.

Urinary incontinence can occur for various reasons:

Stress incontinence

Incontinence during coughing, laughing, sneezing, exercise, running or any other situation that results in intra-abdominal pressure, which in turn causes incontinence.

In this case it may be recommended physical therapy, injections, supporting ring. The last thing may be recommended surgery TVT.

Urinary incontinence due to hyperactive bladder

Incontinence in this case happens when a woman feels the need to urinate spontaneously, but she did not have time to go to the nearest toilet because the interval between feeling needs and urinating very short.

In this case the problem may affect behavioral therapy (restriction in the number of drinking water, going to the toilet every two hours), drug therapy, vaginal stimulation, Botox injections or nerve stimulator.

Mixed incontinence includes stress incontinence and urgency of urination.

Treatment of this problem depends on its severity. This may be drug therapy and surgical methods.

Functional urinary incontinence is caused by other diseases. For example, a woman suffering from Alzheimer’s disease can not always go to the toilet in time and have difficulty with mobility, especially for women in old age.

The method of treatment is determined depending on the type of incontinence.

In some cases, the operation is performed with the installation of surgical tape Ulmsten TVT (tension-free vaginal tape)

Thanks to this operation, the patient may be asked to fast and safe surgical solution that helps her get rid of the problem of incontinence.

The second generation – TVT-O

The operation is performed under local anesthesia through the vagina, and its aim is to install a synthetic film under the urethra to support it during the increase in abdominal pressure and prevent incontinence. This procedure is also characterized by minimal complications.

Mini film is the third generation TVT

This operation is performed through the vagina, takes about 10-20 minutes, can be done under local anesthesia. The method is to install a synthetic polypropylene film under the urethra.

It is a new third generation method allows the surgeon to perform fine tuning, i.e. the film to stretch and to find the position in which it will provide the necessary support to prevent incontinence.

Related:

Benign tumors of the uterus (fibroid)
Endometriosis
Adhesions
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Pelvic prolapse 
Vaginal infections
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Pelvic organs prolapse is a condition in which the vagina and uterus fall outside of the pelvic organs.

Dr. Gil Levy – Urogynecology, pelvic surgery, leading expert in the of interstitial cystitis and urinary incontinence treatment.

Professor Mordechai Goldenberg – specialist in endoscopic surgery. Head of the Department of Gynecologic Surgery, Chaim Sheba (Tel Hashomer). Head of School of endoscopic surgery.

Possible risk factors include vaginal delivery, age and weight gain.

Vaginal delivery is one of the most common risk factors associated with uterine prolapse due to damage to the nerves, connective tissue and muscle structure during childbirth. The pelvic floor muscles are contracting so as to provide a stable platform pelvic organs. The tone of the pelvic floor muscles is needed to maintain the pelvis in place. During natural childbirth contraction of normal muscle tone of the pelvic floor muscles may be reduced due to direct trauma or nerve damage.

Other known risk factors include prior pelvic surgery, intra-abdominal pressure (caused by obesity or chronic constipation), connective tissue disease and genetic factors. Even menopause is considered a risk factor for pelvic prolapse.

In a risk are also women with a rare connective tissue disorders such as Ehlers-Danlos syndrome or Marfan syndrome.

Conditions connected to the uterine prolapse are bladder prolapse (cystocele), prolapse of the rectum or colon (rectocele) and small bowel prolapse (enterocele).

The main clinical symptoms: discomfort, feeling of fullness, heaviness and pressure in the vagina, pelvic pain, urinary incontinence, urinary retention, constipation, sexual dysfunction, pain.

Diagnosis is based on clinical data (age, obesity, vaginal delivery or surgery) and gynecological examination.

Diagnostic tests

Estimated amount of urine after emptying

Urinalysis

Urodynamics test

Treatment

The main treatment of pelvic organ prolapse is a surgery.

In the absence of severe symptoms or mild symptoms some discomfort may be appropriate only observation. A woman may be recommended restoration of pelvic floor muscles.

Conservative treatment of patients with symptomatic

Mechanical support, for example, ring (pessary) used to restore the sagging organs in place. The ring is held by means of the back of the pubic bone and the pelvic floor muscles. This procedure can be offered to women who do not wish or can not be operated due to concomitant diseases or in need of respite due to the omission associated with pregnancy. Approximately – 50% – 70% of women successfully adapt to install pessary. If there is a discomfort pessary can be replaced or reduced in size.

Indications for surgery

Surgery may be recommended in cases where the symptoms continue to harass a woman, despite conservative treatment. When selecting the method of surgical taken into account such factors as age, abdominal approach versus vaginal approach, patient recovery time and possible complications of surgery, lifestyle and related diseases.

The decision is also based on the patient’s wish to preserve her reproductive function.

Types of operations

Sacrocolpopexy. Can be done through the abdomen open surgery, laparoscopy or by using the Da Vinci robot. Synthetic prosthetic mesh in the form of a bag attached to the front and rear wall of the vagina and connected with the anterior longitudinal ligament. It helps to keep the body in its correct anatomical position.

Restoration of the uterosacral ligaments. This procedure has advantages in terms of a fast recovery with no complications caused by a mesh prosthesis. The operation is performed through the abdominal or vaginal cavity. This also recovers the shape of vagina. The probability of success is about 80%.

Restoring sacrospinal ligament. The result of this operation is similar to the result of the restoration uterosacral ligaments. This procedure is typically performed on one side.

Operation must be performed by an experienced physician of urogynecology. Our experts have years of experience and high qualifications in such operations.

The advantages of the laparoscopic technique and precision robotic surgery (Da Vinci) are significant reduction in pain, minimal risk of infection, minimal blood loss, faster recovery and return to normal life, aesthetic, almost invisible scars.

Our doctors

Related:

Benign tumors of the uterus (fibroid)
Endometriosis
Adhesions
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Vaginal infections are a very common problem in women.

Where infections come from?

Lactobacilli bacteria are an integral part of the natural environment of the vaginal mucosa and their role is providing normal vaginal acidity (pH).

Bacteria produce lactic acid and prevent the vagina from infection by other pathogenic bacteria. Under laboratory conditions these bacteria can also destroy HIV. Moreover, in the natural environment of the vagina such bacteria exist as Streptococcus, Gram-negative bacteria, Gardnerella, Anaerobic bacteria, including bacteria of the Candida family.

The hormone estrogen promotes the growth of Lactobacilli by increasing the production of glycogen, which breaks into glucose and used as a nutrient for bacteria.

Acute inflammation of the vagina can be divided into three types:

1. Bacterial vaginosis

2. Vaginal candidiasis

3. Trichomoniasis

Each of the three types due to various causes, and therefore they have different treatments.

Bacterial vaginosis. The most common cause of acute inflammation. Pathogens are lactic acid bacteria, including mycoplasma, gardnerella and anaerobic bacteria.

Risk factors: multiple sexual partners, change sexual partners several times a month, vaginal douches. Bacterial vaginosis is a risk factor for the occurrence of infections of the female reproductive system, including endometritis after delivery or caesarean section and various infections of wounds after pelvic surgery, pelvic infection and preterm labor.

Women with bacterial vaginosis are also in an increased risk of miscarriage and they have lower the chances of success in vitro fertilization.

The infection should be diagnosed by an experienced gynecologist who on the basis of laboratory analysis will determine the exact diagnosis and prescribe the right treatment.

Treatment focuses on actions against anaerobic bacteria: it can be oral antibiotics, suppository or cream prescribed by the doctor.

Vaginal candidiasis. At least 75 percent of women suffer from vaginal candidiasis at least once in their lifetime and at least half of them are experiencing the discomfort of two or more times. In most cases the disease is caused by bacteria Candida Albicans.

Risk factors: pregnancy, menstruation, use of spermicides and young children (especially from 15 to 19). The use of antibiotics is also a risk factor, probably due to changes in the natural vaginal flora (Lactobacillus).

Diagnosis should be done by an experienced doctor and gynecologist. As a rule, women are concerned about white sticky discharge, no odor, similar to cottage cheese. The gynecologist will take a smear and accurate diagnosis by laboratory analysis.

Treatment in this case is the reception of topical antifungal agents.

Trichomoniasis. Trichomonas is an intracellular parasite that is transmitted through sexual contact.

Risk factors: change of sexual partners, frequency of sex with more than twice a week, the presence of three or more sexual partners in the last month.

Trichomoniasis is also associated with infections of the female reproductive system, including infections after delivery, operations and abortion, pelvic infection and preterm labor.

Diagnosis should be done by an experienced doctor and gynecologist. As a rule, women are concerned about yellow sticky discharge with an unpleasant odor, itch and burning. Gynecologist accurately diagnoses by laboratory analysis of the vaginal smear secretion.

Related:

Benign tumors of the uterus (fibroid)
Endometriosis
Adhesions
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Pelvic prolapse
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Menorrhagia is a condition in which the menstrual period takes an abnormally long time.

Professor Mordechai Goldenberg – specialist in endoscopic surgery. Head of gynecological surgery, Chaim Sheba Hospital (Tel Hashomer), Head of the Endoscopic surgery School

Increased menstrual bleeding may be the result of abnormal blood clotting, hormonal regulation of the menstrual cycle or endometrium. Menstrual bleeding can be increased without any other symptoms or in combination with other symptoms such as severe pain (dysmenorrhoea).

The normal menstrual cycle lasts 25-35 days and the bleeding – an average of 5 days. The amount of blood which thus loses female is 25 to 80 ml. Blood loss of more than 80 ml or cycle that lasts more than 7 days can cause menorrhagia. In practice patient or doctor can not measure the amount of blood lost. It is possible to estimate the amount of bleeding on the number of pads or tampons used by women during the menstrual cycle. Well soaked tampon containing 5 ml of blood. In the case of low blood volume, but the length of the cycle for more than seven days, you must consult a doctor for gynecological consultation. This may indicate a manifestation of menorrhagia.

Causes of menorrhagia

Distribution of the endometrium (endometriosis).

In most cases bleeding is the result of natural hormonal changes leading to menopause.

Irritation of the mucosa of the uterus can lead to increased blood flow, for example as a result of infection (acute inflammatory disease or chronic pelvic infection) or intrauterine devices (IUDs).

Fibroids (leiomyomas) on the wall of the uterus sometimes cause the intensity of menstrual loss by increasing the surface of the uterus. Exceptions, such as adenomyosis, endometrial increase the uterus and make it sensitive.

Important note: Endometriosis causes pain but usually does not cause changes in blood loss during menstruation.

Carcinoma of the uterus (endometrial carcinoma) usually causes irregular bleeding, unlike the cyclic pattern of menorrhagia.

Ovarian endocrine disease (uterine bleeding, the most common cause)

Blood clotting problems (rare)

Uterine polyps

Risk factors: obesity, lack of ovulation

Diagnosis of menorrhagia

– Examination of the pelvis and rectum

– Cervical smear

– Ultrasound scan of the pelvis is the first line diagnostic tool to determine the structural anomalies

– Endometrial biopsy to rule out cancer or atypical hyperplasia

– Hysteroscopy

Treatment of menorrhagia

Generally, treatment is directed to a mechanism causing menorrhagia and parallel to the treatment of symptoms.

Often this treatment with hormones. Typically, the patient is recommended to take contraceptive pills or progesterone drugs for several months.

Hormone therapy helps to restore hormonal balance and is effective in reducing bleeding without surgery. This treatment is suitable for women who want to preserve their reproductive function in the future to have a baby. Preparations need to take a long time. During the reception there may be minor side effects such as headaches, breast tenderness and weight gain. Efficacy is relatively limited.

Fibroids can respond to hormonal treatment. If not, then maybe it would have to be surgically removed.

In the treatment may also be used non-steroidal anti-inflammatory drugs (NSAIDs), but they tend to reduce the bleeding intensity by 30% only.

Curettage. Sometimes recommended to women who do not respond to medication. This method consists in a mechanical scraping the mucous membrane of the uterus under general anesthesia. This reduces bleeding. The method is still used in cases of severe bleeding that requires immediate treatment.

Hysteroscopy. Surgical procedure in which you are addressing the causes and treatment of menorrhagia endometrial using an optical device (hysteroscope), which allows the doctor to view the uterus during the procedure. By hysteroscopy can be removed small fibroids is localized out of muscular layer of the uterus. The procedure is performed under general anesthesia and requires a highly qualified doctor as high risk (75-85%), perforation of the uterus, bleeding and infection.

Hysterectomy. Effective treatment for menorrhagia may be a hysterectomy (removal of the uterus surgically by open surgery or laparoscopy under general anesthesia). After surgery 3-4 day hospitalization and recovery within a few weeks.

But hysterectomy performed only in cases where it is impossible to remove fibroids locally and preserve the uterus. Our specialists have appliances conserving surgery and do everything possible to avoid a hysterectomy.

Related:

Benign tumors of the uterus (fibroid)
Endometriosis
Adhesions
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Infertility
Pelvic prolapse 
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Dysmenorrhea is a gynecological problem expressed with severe pain in the abdomen and pelvis during menstruation or a few days before.

Dysmenorrhea often occurs along with excessive bleeding.

Primary dysmenorrhea – severe menstrual pain in women.

Secondary dysmenorrhea – pain as a symptom of other gynecological problems such as endometriosis, infection of the reproductive system (pelvic inflammatory disease), including the uterus, ovaries and fallopian tubes, anatomical configuration of adenomyosis and uterine problems.

Symptoms that accompany dysmenorrhea include headache, nausea and vomiting, diarrhea, chronic fatigue and pain in the lower back and hips.

The prevalence of dysmenorrhea is quite high, ranging between 40% – 90% of women. Primary dysmenorrhea occurs especially among girls and young women under the age of 25 years. Secondary dysmenorrhea is more common in women aged 30 years and older.

Primary dysmenorrhea occurs mostly in young girls and women and usually begins in the first years after the onset of menstruation. Pain can occur a few days before the onset of bleeding and is often accompanied by nausea, vomiting, diarrhea, headache or pain radiates from the pelvis to the back and hips. The pain associated with the release of prostaglandins endometrial tissue, causing muscle contractions. In a study of Swedish scientists in women with severe pain in the menstrual blood was found 20 times more prostaglandins than women who did not experience such pain.

Secondary dysmenorrhea occurs as a symptom of gynecological diseases of the uterus and the reproductive system. The most common of these is endometriosis – the growth of endometrial tissue into the peritoneal cavity. Diagnosis of endometriosis is done by pelvic examination or laparoscopy.

Other factors of secondary dysmenorrhea can be ovarian cysts, fibroids, or bacterial infections, viral, fungal pathogens or parasites.

Treatment of dysmenorrhea

Treatment of non-steroidal anti-inflammatory drugs (NSAIDs) and other drugs may relieve some cases of severe pain, antiprostaglandin drugs to reduce the amount of prostaglandins which are responsible for this phenomenon. A new generation of drugs such as valdecoxib (only directed by a physician), are effective at reducing the side effects associated with the digestive system. These drugs block the production of prostaglandins and the pain becomes less intense.

In some cases the pain can be reduced by using contraceptive drugs.

Surgical treatment. In some women the pain is so strong that the drugs do not help improve the situation. In such cases our specialists can recommend the procedure Presacral neurectomy – removal of the ganglia of the sympathetic presacral trunk to reduce the emission of nerve signals, thereby eliminating a lot of pain.

Another method is the ablation of uterine mucosa (for women who do not plan to have children in the future).

Related:

Benign tumors of the uterus (fibroid)
Endometriosis
Adhesions
Amenorrhea (absence of menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Pelvic prolapse 
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Amenorrhea is a condition of absence of menstrual periods in women or the presence of less than 9 menstrual cycles per year.

Professor Mordechai Goldenberg – expert in endoscopic surgery, Head of gynecological surgery, Chaim Sheba Hospital (Tel Hashomer), Head of Endoscopic surgery School

Primary Menopause is a condition in which a woman does not have a menstrual cycle before the age of 15 (with the presence of secondary sexual characteristics, such as breast growth or the appearance of axillary hair) or the absence of the cycle up to 13 years in the absence of secondary sexual characteristics.

Secondary Menopause is a condition in which a woman with irregular menstrual cycle is terminated for a period of at least six months.

Diagnosis of amenorrhea

Qualified specialists perform a physical examination and study history. The presence of budding breasts indicates exposure to estrogen.

In addition, conducted BHCG to avoid pregnancy (which may be the reason for the absence of menstruation). After a negative pregnancy test analysis of the hormonal profile, including the assessment of the level of FSH (follicle stimulating hormone) and prolactin.

In the normal level of the above hormones are very important to check the anatomical abnormalities, such as: absence of the uterus (Mullerian agenesis: Mayer-Rokitansky-Kuster-Hauser syndrome). This syndrome occurs during the formation of the uterus, fallopian tubes, cervix, and the two outer thirds of the vagina. This syndrome typically occurs in the absence of one kidney, urinary tract defects. Such women, even without a uterus, in the presence of the egg can still have a biological child through a surrogate mother.

Androgen insensitivity syndrome. From the point of view of the karyotype we are talking about a man who looks like a woman with the lack of male traits – without the development of the penis and scrotum, with external female genitalia, but with undescended testicles. This defect is 5% of the initial menopause. Formation begins breast occurs because of transition peripheral testosterone to estrogen. These women can not have biological children. In this case removal of the testes is also important to prevent the degeneration of a malignancy.

Anatomical issues. Imperforated hymen (a condition in which the membrane is completely closed) or transverse vaginal septum. In such cases women complain of pain each month and over time will create a pool of accumulated blood, which can not come out through the vagina.

High FSH levels. This is a problem in the ovaries that are not responsive to FSH and consequently the FSH indicates a positive feedback mechanism. If this is a secondary controller El, it may be early menopause and premature ovarian failure. The cause of this problem related to the function of the ovaries, and in this case women often have no secondary sexual characteristics since the ovary produces estrogen. There are several reasons:

Turner syndrome. This high level of prolactin, hyperprolactinemia in which creates problems in providing estrogen, resulting in serious damage to the hormone GnRH. Hyperprolactinemia violates a provision of GnRH, which causes hypogonadotropic hypogonadism condition. Hyperprolactinemia pituitary adenoma can be detected in approximately 50% of women. There is no direct relationship between the level of prolactin in the blood and the size of the adenoma. In the case of pituitary adenoma must be performed MRI and treatment.

Low levels of FSH. Menopause begins due to a problem in the hypothalamus (hypothalamic amenorrhea) if it starts before puberty. Thus there is a disturbance in the secretion of the hormone GnRH for various reasons: stress, extreme changes in weight, malnutrition (anorexia or Kallmann syndrome).

The enzymatic defect. Defect enzymes that produce estrogen and cholesterol, cortisol, may lead to the fact that estrogen and FSH levels will not be high due to the estrogen negative feedback on the pituitary.

The main causes of secondary menopause (menopause for six consecutive months) are the following reasons:

1. Polycystic ovarian syndrome

2. Menopause due to a problem in the hypothalamus (hypothalamic amenorrhea). If the problem begins after puberty it refers to the secondary menopause. There is a disturbance in the delivery of GnRH, for various reasons: stress, extreme changes in weight, malnutrition (anorexia).

3. Pregnancy after menopause

4. Menopause occurs gradually at the end of the fertile period.

Less common conditions include:

Failure of the ovaries due to the high level of FSH. This may be a result of chemotherapy and radiotherapy, which results in the destruction of the ovary, the situation with Turner syndrome, chromosome translocations and other chromosomal anomalies. When ovarian failure before the age of 40 years old women complain of hot flashes and cessation of the menstrual cycle. In some cases women with primary immune deficiency occur disorders such as diabetes, thyroid disease, and many others.

Asherman’s syndrome. As a result of adhesions of the uterus (after abortion, for example).

Other causes: chronic diseases (such as diabetes and liver disease, adrenal disease, cirrhosis of the liver) and rarely other reasons.

Progestin test – a study on the allocation of the ovary estrogen. If the ovaries to produce estrogen, progesterone when administered (10 mg per day for five days) in women with menstruation. If not, it can be concluded that there is a problem with the production of estrogen, or Asherman’s syndrome. In the absence of a history of induced abortion, Asherman’s syndrome can be excluded. In this case it will be necessary to find out the cause of the lack of estrogen – the reason may be related to the ovaries or hypothalamus.

Highly qualified specialist can determine the cause of amenorrhea and, after a thorough investigation, appoint a suitable patient, an effective method of treatment.

Related:

Endometriosis
Adhesions
Dysmenorrhea (painful menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Pelvic prolapse 
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Endometriosis is a condition in which tissue resembling the mucous membrane of the uterus (the endometrium) grows outside the uterine cavity.

Dr. David Soriano – a leading specialist in the treatment of endometriosis. Head of the Endometriosis Unit, Chaim Sheba Medical Center

The most common areas for the growth of tissue outside of the uterus in the pelvic organs are the ligaments that hold the uterus, pelvic peritoneal membrane and reproductive organs (ovaries and fallopian tubes), as well as the area around the uterus.

Endometrial tissue injury often leads to an increase of anatomically similar to the reproductive organs – bladder and colon. In rare cases, the tissue is detected in muscle tissue of the uterus, and even in distant organs such as the diaphragm, lungs, or brain.

Endometrial tissue reacts to hormonal changes that occur during the menstrual cycle. Also endometrial tissue that are outside of the uterus responds to these hormonal changes. It causes local inflammation, immune activation and inflammation hypersecretion materials that cause pain. It also forms scar tissue or adhesions around the endometriosis and adjacent organs, and the development of ovarian cysts (vesicles filled with liquid brown).

Endometriosis can sometimes cause severe pain during menstruation, nausea and fatigue in young girls, and they need painkillers. Pain and feeling on the verge of losing consciousness require diagnosis. Especially in families where the mother or sister suffered severe dysmenorrhea (pain during menstruation).

The combination of chronic pelvic pain during menstruation and ovulation with particular concern requires careful study. In this case, most likely, this is due to endometriosis, and early diagnosis can significantly help.

Endometriosis can cause a wide variety of symptoms. Its characteristic symptoms: severe back pain before and during menstruation, increased bleeding during menstruation, severe pain in the pelvis or lower abdomen for a few months, severe stomach cramps during menstruation, nausea, vomiting and feeling on the verge of loss of consciousness during menstruation, pain during sex, gastrointestinal disorders such as constipation, painful exit, diarrhea, especially during menstruation, bleeding from the rectum (during menstruation), pain or urgency (especially during menstruation) infertility.

Diagnosis of endometriosis
Suspicion that the woman may suffer from endometriosis usually based on one or more of the features described above. Women with a family history of endometriosis in need of early diagnosis and monitoring.

Doctor examines and performs ultrasound. Upon detection of typical endometriosis doctor takes a sample of tissue for the laboratory examination.

The only way to take a sample of this method of direct internal inspection of laparoscopy (introduction of an optical instrument through a small incision in the navel, through which specialist can examine the abdomen and pelvic organs). Laparoscopy is an invasive surgical procedure that is performed under general anesthesia.

Sometimes the diagnosis of endometriosis is set randomly during laparoscopy performed for another purpose, such as resection of ovarian cysts or check the status of women tubal infertility or severe pain ovaries with suspected ovarian torsion. The advantage of laparoscopy in the opportunity to take a tissue sample (biopsy) for accurate diagnosis of endometriosis, assess the severity of the disease, identify the location, size and number of lesions in the pelvis. The skilled artisan will find the lesion and can assign an effective treatment.

Treatment of Endometriosis
Currently there is no way a complete cure of the disease, but our skilled professionals due to years of experience may recommend medications or surgical techniques that help to significantly alleviate the symptoms and increase a woman’s chances of pregnancy. Effective and proper treatment depends on the type and severity of symptoms, age of the woman and her readiness for operation.

When the main symptom is pain before and during menstruation, primary care, which is needed by a woman, it should be pain relief. The next step could be a long and continuous treatment contraceptive drugs. Tablets inhibit endometriosis, hormone stimulation and tissue structures is reduced uterine bleeding during the menstrual cycle. This treatment, like other hormonal therapies, allows to inhibit ovulation cycles are aimed at reducing the size of the lesions and a decrease in inflammation around them.

In more severe symptoms, absence of response to treatment, infertility, doctor may recommend laparoscopic surgery to remove endometriosis. Especially in cases of women who want to become pregnant, surgical treatment shows better results than drug therapy.

Laparoscopic surgery in the treatment of endometriosis
Laparoscopy is the tool of choice accurate diagnosis of endometriosis, its location and severity, as well as it allows to perform a surgery without opening the abdominal cavity. The doctor performs only a puncture in the navel.

Diagnostic laparoscopy
In the study the abdomen and pelvis expert can assess the condition of the ovaries and fallopian tubes, uterus, check the integrity of the genital organs, find endometriosis, adhesions, cysts, endometrial determine the extent of involvement of the pelvic organs.

Endometriosis is manifested in different ways, with morphology typical for a wide range of glucose lactate introduced for determining the size of endometrial lesions from 1 mm to 10 cm. Since lesions appear in different forms depending on the period of development, there is a chance during surgery miss endometriosis. Therefore, it is important to carry out the operation with the aim of a diagnostic laparoscopy pathological tissue sampling with a view to identifying it.

Laparoscopy surgery
Purpose of the operation in each case individually. This can be a diagnosis, a division of adhesions and removal of ovarian cysts, research into the causes of infertility and infertility treatment because of endometriosis.
The most common reasons for performing laparoscopic surgery in women with endometriosis are the presence of a large ovarian cyst, intense pelvic pain that does not respond to treatment, or repeated unsuccessful attempts to become pregnant.

The advantages of laparoscopy
The main advantages of laparoscopy include:
– Diagnosis and treatment without opening the abdominal cavity
– Smaller damages than after open surgery
– Less chance of infection during surgery
– Quick recovery

In the course of the treatment of women with endometriosis and infertility takes into account such factors as the age of the woman, the duration of infertility, pregnancy last, the presence of ovarian cysts and the degree of endometriosis.

The overall pregnancy rate after laparoscopic procedures in Israel – about 50%.

Our doctors

Related:

Benign tumors of the uterus (fibroid)
Adhesions
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Infertility
Menorrhagia (heavy menstrual periods)
Pelvic prolapse 
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Urinary incontinence
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva

Uterine Fibroids (leiomyomas, fibroids) – benign hormone-dependent tumors of the uterus, which is formed from smooth muscle tissue of the organ and can be located under the mucous membrane of the uterus in its intramuscular layer or on the outside, under the peritoneum.