Endometriosis is a condition in which the lining of the uterine cavity (endometrium) grows outside of the uterus. Endometriosis can be found anywhere in the pelvic cavity, including all the reproductive organs as well as on the bladder, small bowel, colon, rectum, appendix, and vagina. However, endometriosis cannot be considered simply as misplaced endometrium, because it differs in hormonal responses and visual appearance.
The real cause of endometriosis remains unknown. The following theories represent current thinking of the etiology of endometriosis, but none of them can explains all cases of endometriosis. We do know, however, that endometriosis is not caused by anything that the patient has done.
Patients with endometriosis can have symptoms varying from constant excruciating pelvic pain to no symptoms whatsoever. Paradoxically, the extent of endometriosis has no correlation to the amount of pain a women will experience. Some women with severe endometriosis do not have any symptoms and may not know they have endometriosis until a pelvic mass is detected on a routine pelvic examination or a problem with infertility is discovered.
Advances in technologies have allowed conduct of many procedures by laparoscopy and hysteroscopy. These are the essence of our specialty. Most new technologies foster improved performance. In business term, they are called sustaining technologies. In fact, most technological advances in an industry are sustaining in nature.
We are in the cyber-era. Many conventional “snail” mails have been replaced with emails. Electronic mails allow easy, fast and economical communication. It is ideal for short messages, and quick questions and replies. For ISGE with members from around the world, it is a convenient way to communicate; time-zone is not a factor anymore. You send your e-mail and the receiver replies at his or her convenience. It helps us stay connected.
Suppose for instance, that last year, the chair of an organizing committee invites you to lecture at a meeting. You accept. You then assist this chair in organizing the program by inviting other speakers to the meeting. Two months before the meeting, the invitation for you to speak is withdrawn.
In minimally invasive surgery (MIS), complications can occur due to faulty instruments, surgical technique, or inadequate patient election. Surgeons who routinely perform MIS rarely encounter complications. Conversely, practicing gynecologists at large often find that certain procedures or techniques are not as safe as previously reported in the literature by the "experts." One of the reasons is that complications tend to be underreported.
The tragic events of September 11 have, to put it mildly, thrown many people off balance. On a somewhat secondary scale, our Society was affected. The 5th Regional Meeting of ISGE in conjunction with the 2nd Brazilian Congress of Gynecologic Endoscopy took place on September 12-15, 2001.
We are entering a time in the development of the discipline of gynecologic endoscopy where there is an opportunity to build bridges, both ideologically and functionally. The science and practice of endoscopy have progressed to the point where core groups of advanced endoscopic surgeons have organized themselves in every corner of the world, not only to exchange knowledge, but also to set goals and plan for the future of the field.
A fibroid is a benign tumor of the uterus. Various terms are used to refer to the tumor, such as fibromyoma, myofibroma, leiomyofibroma, fibroleiomyoma, myoma, fibroma, and fibroid. Of these, fibroid is the most common term, although myoma is more accurate.
Uterine prolapse or dropped womb is a condition in which the uterus drops downward in the pelvis below its normal position. The uterus may drop slightly and remain above the introitus (vaginal opening, grade 1). It may drop further so that the cervix or lower portion of the uterus reach the region of the introitus (grade 2). In the most severe form, the cervix or even the entire uterus bulges out of the introitus (grade 3). Uterine prolapse is the indication for hysterectomy in 16% of cases in the U.S.
Despite the major public health impact of leiomyomas, little is known about their cause. Until recently, the steroid hormones estrogen and progesterone were considered the most important regulators of leiomyoma growth. There is abundant evidence that estrogen promotes fibroid growth including the clinical observations that fibroids grow in the presence of high levels of estrogen, such as during the reproductive years, and that they regress in the presence of low levels of estrogen, such as following menopause or during gonadotropin releasing hormone (GnRH) agonist therapy.
The first laparoscopic hysterectomy was performed in 1989 by Henry Reich. Nowadays the laparoscopic hysterectomy for a uterus up to 300 grams, without other pathologies that could limit its mobility or without a poor vaginal access, has to be considered a basic well standardized procedure.
GnRH-agonists as analogues of the natural GnRH have gained great importance in gynaecological endocrinology and have proven to be particular useful in clinic and practice being applied to treat a large range of clinical conditions. However, the clinical use is negatively influenced by GnRH-agonist induced side effects due to hypoestrogenism, which is the main type of action to be used for treatment and prevention.
Hormone Replacement Therapy: In most European countries, the actual Guideline on the Evaluation of New Medicinal Products in the Treatment of Primary Osteoporosis is incomplete in that, unlike the previous Note for Guidance on Postmenopausal Osteoporosis in Women (EMEA 2001 Guidance), it fails to address the prevention of osteoporosis indication.
The world of menopausal care is changing. For many years, the scientific community involved in menopause research has been amassing evidence that the menopause is associated with multiple complaints and chronic diseases, and that postmenopausal hormone therapy has the potential to prevent or treat most of them.
What are Uterine Fibroids?The walls of the uterus are made of smooth muscle called myometrium, and the inside lining, with glandular tissue, is called endometrium. “Uterine fibroid” is a slang term for leiomyoma, or often simply myoma. Fibroids are benign tumors made of smooth muscle cells.
Based on the protective effects of intrauterine devices against endometrial cancer, researchers hypothesized that IUDs may also have a protective effect against cervical cancer. However, results from epidemiological and clinical studies to date have been inconclusive.
New research sheds light on vulvodynia, showing that the disorder is under-diagnosed and inadequately treated. Since the chronic pain associated with vulvodynia can make it difficult to sit or participate in sexual activity, the disorder greatly impacts quality of life for women afflicted with it. The research is published online as part of the American Journal of Obstetrics and Gynecology.
Competing for time and being able to provide timely information is one of the challenges of the 21st century. The Internet can help.
Hysterectomy is the most frequently performed operation in women, with a life time risk varying from country to country from less than 20% to more than 40%. Overall these differences reflect more medical practice than differences in pathology between countries.
Principles and Practically
Both types of surgery are complimentary. Each has specific advantages and indications. It is an advantage to have and to be able to use both.
Steroid hormones have a typical chemical structure. Their mechanism of action is through binding to a specific receptor which in the nucleus of the cell will induce effects at the genomic level.
The female reproductive function depends on the healthy ovaries (primary reproductive organ) and genital tract organs. Infertility is one of the main gynecological problems which affect between 10-15% of females in the reproductive age.
Recently a letter was sent to the Women's Health Forum by a patient who had undergone numerous surgeries in an effort to alleviate her pain due to surgical adhesions. Additionally, I recently had a patient whose case demonstrates a rather typical story for post-surgical adhesions, and her management. These two patient cases I hope you will find informative and "food for thought".
Myomectomy is becoming a much more frequently performed procedure certainly it is one that is sought out much more frequently by our patients. Probably the most intimidating form of fibroids is that which occurs in the broad ligament, and particularly one which occurs in the cervical region.
Chronic pelvic pain affects a large number of women, and is not often optimally treated within a single specialty. It is responsible for approximately 40% of laparoscopies and 10-15% of hysterectomies in this country. In one survey of 5300 women, more than 16% noted chronic pelvic pain.
Of the 600,000 hysterectomies performed yearly in the U.S., approximately 300,000 are accompanied by prophylactic bilateral oophorectomy, traditionally suggested as the best strategy to decrease the rate of ovarian cancer.
To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
