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Female urogenital system diseases

Female urogenital system diseases

Dysmenorrhea

What is Dysmenorrhea?

Dysmenorrhoea is defined as the painful menstruation with symptomatology both local (at abdominal level), and general (headache, breast tenderness, tiredness etc.).

What are the causes?

It can be attributed to a psychogenic mechanism, to a hormonal disorder or to spasms of the myometrium (primitive dysmenorrhoea) or to the pelvic inflammation or alteration of the uterine emptying leading to painful contractions (secondary dysmenorrhea).

Can menstrual pains be reduced?

It is usually prescribed the contraceptive pill that "keeping the ovaries resting" reduces the typical symptomatology of the menstrual cycle. In other cases, anti-inflammatory and painkillers are recommendend, but is is well known about their series of side effects especially in the use for long period of time.

The alternative is to take natural preparations with anti-inflammatory properties and among the most common we remember those containing turmeric, quercetin, PEA (palmitoylethanolamide), N-acetylcysteine (NAC), ALA (alpha lipoic acid) or bromelain.

Endometriosis

What is endometriosis?

Endometriosis is a pathology characterized by an ectopic localization of endometrial tissue.

Internal endometriosis (adenomyosis), which is the one characterized by the presence of abnormal islands of tissue in the myometrium of the uterine wall, is different from that called external endometriosis characterized by the presence of outbreaks of tissue in various external body locations to the uterus; therefore, there is the presence of endometriotic tissue in the fallopian tubes, in the ovary, in the uterine ligaments, in the rectal-vaginal septum, in the pelvic peritoneum, in the ureter, in the intestine or even, in rare cases, at the pericardium and pleura levels.

This ectopic tissue is governed by the same hormonal influences as the normal endometrium to have haemorrhages with the same rhythm of the menstrual flow. The blood, because it cannot escape outside through the vagina, is collecting in ectopic outbreaks forming cystic structures and inflaming the affected area. Endometriosis, sometimes silent but for most cases symptomatic, due to the continuous presence of an inflammatory state, manifests itself with one or more of the following symptoms: dysmenorrhea (painful menstruation), chronic pelvic pain, irregular, long-lasting and abundant menstrual flows, dyspareunia (pain during sexual intercourse), dyschezia (pain during defecation) dysuria (pain during urination).

The most frequent type of endometriosis is ovarian with the presence of cysts that contain menstrual blood (produced by ectopic endometrial cells) and therefore also referred to as "chocolate" cysts at the level of the most delicate and important part of the female reproductive system.

How is endometriosis diagnosed?

Firstly, the anamnestic data "interrogating" the patient on the symptomatology and on the characteristics of the menstrual flow are collected, then proceeding with the transvaginal ultrasound. In order to exclude the presence of an ovarian tumour, a blood test may also be required for the determination of the CA-125, a protein present on the epithelial surfaces of the uterine cervix, endometrium and fallopian tubes. In case of endometriosis the value of the CA-125 is moderately high while in case of cancer it is very high.

What are the causes?

It is still unclear the mechanism that regulates the onset of this disease even if the most accredited theory is that of retrograde menstruation i.e. the reflux of menstrual blood within the pelvis leading to implantation of endometrial cells (remember that menstrual blood derives from cyclic exfoliation of the endometrium i.e. the mucosa of simple prismatic epithelium that delimits the inner surface of the uterus by covering the myometrium, the muscular layer of the uterus wall) in the tissues of the organs/structures mentioned above. Other theories suggest that some endometrial cells may be transported through the lymphatic or blood pathway to other organs and then proliferate under the same mechanisms as those at uterine level. Others speak of metaplasia i.e. the transformation of certain differentiated cellular elements of a tissue into elements having the morphologic and functional characteristics of another tissue. Finally, there may be a genetic predisposition to endometriosis or a problem at the level of the immune system that allows the implantation and proliferation of these cells even in abnormal locations for the same.

In Italy about 5% of women are suffering from endometriosis and in total they estimate about 3 million of cases diagnosed between 25 and 35 years (even if the pathology can appear also in younger people).

Can endometriosis be treated?

Endometriosis can be treated or to better understand, it can be controlled because actually you can’t completely heal.

The therapy is usually the pharmacological one which involves the use of estroprogestinic, anti-inflammatory and painkillers drugs that control the symptoms, especially the painful ones, but in some cases,  it must necessarily be combined with the surgical procedure that aims to remove the endometriotic tissue developed in abnormal locations. This is a very delicate intervention especially when it is carried out on an ovarian level because it can lead to a reduction in the reproductive potential of the woman by reducing her ovarian reserve.

Are there natural remedies to keep the symptoms under control?

In case of mild symptomatology or in support of pharmacological therapy, there are today several natural preparations with antioxidant and anti-inflammatory properties. They are often advised by the doctor precisely to try to reduce the use of drugs that in the long run may give problems of side effects (such as anti-inflammatory) or to be used during periods of suspension of therapy.

Among the most common there are food supplements containing turmeric, quercetin, PEA (palmitoylethanolamide), N-acetylcysteine, ALA (alpha lipoic acid) or bromelain

Ovarian polycystosis

What is it?

Most commonly known as polycystic ovary syndrome (PCOS) it presents the following anatomopathological picture: enlarged ovaries with small cysts (which are formed due to the non-release of the oocyte in the ovary), alterations both endocrinological (with a hormonal imbalance towards increased production of male hormones) and metabolic (with accumulation of subcutaneous fat and weight gain) . This syndrome influences in the woman both the reproductive sphere and the metabolic one but also in consequence that aesthetics and psychological.

The causes are not yet well recognized but in fact the clinical picture shows insulin resistance and a hormonal imbalance with greater presence of male hormones that cause hirsutism, irregularities or even disappearance of the menstrual cycle and infertility. A genetic component is probably also involved as women with sisters affected by this syndrome have a double risk of developing it.

How is it diagnosed?

If there is a concomitant presence of overproduction of androgens (typically male hormones), anovulatory cycles (i.e., failure to release the ovule in the ovary) and ultrasound diagnosis of ovaries with the polycystic aspect, a certain diagnosis can be made of this pathology. The insulin resistance also seems to play an important role as it leads to an increase in androgen production by the ovaries and consequently to the polycystic ovary syndrome.

Can the ovarian polycystosis be cured?

The treatment foresees the reduction of symptoms through a proper diet and exercise aimed at weight control and therefore in consequence of a reduction of testosterone, insulin and luteinizing hormone (the hormone that stimulates the gonads). Smoking abstention also helps to reduce androgen levels.

Pharmacological treatment is decided based on the magnitude of the symptoms and the eventual desire for a pregnancy: estroprogestinic (oral contraceptives) may be prescribed to reduce the production of gonadotropins, specific drugs for regularize hormones, oral antidiabetics.

Combined with a healthy lifestyle, food supplements containing myoinositol and alpha lipoic acid may also be recommended.

Cystitis

What is cystitis?

Cystitis is an acute or chronic inflammation of the urinary bladder wall frequently caused by a bacterial infection, but which may also be of viral or fungal origin, from drugs, from toxic chemicals or from a bladder tumour.

In case of cystitis you have difficulty in emitting urine that is eliminated drop by drop, you feel the continuous need to urinate and the burning or even pain during urination (with sometimes even loss of blood).

Why are women mainly affected?

In women there is a higher incidence of bacterial cystitis than in man.

The different anatomic conformation of the urethra (shorter in the woman than the man) in the last excretory tract implies that in the woman the urethra is in the immediate vicinity of the vagina and then to the rectum, with consequent higher risk that the bacteria from the intestine, can reach the urethral duct and from here go back to the bladder. Moreover, their colonization can be favoured by the secretions normally present in the vagina.

How to treat cystitis?

Firstly, it is necessary to make a urine culture in order to identify the presence of an infecting agent. In this case the pharmacological therapy is the antibiotic one. Anti-inflammatory drugs are often used, especially in the most painful acute phase.

In case of non-bacterial cystitis, we proceed where possible to eliminate the factor that triggered it.

Even the use of natural substances can alleviate the disturbances and above all reducing the number of recurrences: Turmeric (Curcuma longa), cranberry (Vaccinium macrocarpon) and the bearberry (Arctostaphylos uva-ursi) are the most recommended.

 

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