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Adolescent age importance in endometriosis...
Adolescent age importance in endometriosis development
Startseva N.V.
Perm State Medical Academy. Perm. Russia
Endometriosis became an invention of twentieth century. Main problem is adolescents with dysmenorrhea. Neither success in diagnostics nor increasing of operations and abortions in juvenile period cannot be compared in its pathogenetical importance with role of ecological and generative dissonance and connected with it immune and psychological transgressions. Belated appeal for medical help occurs due to deep belief of doctors and patients about painful menstruations inevitability. Young women late socialization, bearing limitation and abortion legalization led to disappearance of pregnancy and gestagens protective influence.
Among 1004 investigated women with endometriosis 15% was at age of 15 till 25. Disease duration was 6.4+0.5 years, first symptoms (algodysmenorrhea, pelvic pains) appeared in 3 to 5 years after menarche. Widely spread endometriosis of such localizations as: uterus, ovaries and pelvis lesion was found in 58.7% of young women. Sexual debut at 17. First pregnancy of these women completed with birth in 47.5%, artificial abortions in 20%, 50% of women took hormone pharmaceuticals for contraception purpose and curing, abortions were in 64% of cases. Reproductive function was disturbed: 25.7% primary sterility, 21.6% secondary, half of women had already been operated. In spite of carried out therapy, disease was progressing. Investigation of T-, B- and O-cells, separate subpopulations of T-lymphocyte stated immune suppression. Revealed were changes of immune status in healthy women during menstruation cycle: reduction of immunity T-cell section during ovulation, autoimmunity activation in premenstrual period allow to consider menstruation as reaction of endometrium rejection - reaction of delayed type hypersensitivity. Insignificant submergence of endometrium in myometrium and retrograde menstruation allow to say that endometriosis of uterus or pelvic lesion can be developed in every woman if menstruation is not interrupted by pregnancy for long time. A view to lesion of endometriosis as to autotransplantation progressing in immune suppression conditions shows ways of endometriosis prophylaxis of adolescents – immune correction, undesirable pregnancy prolongation. Hormone contraception of sexually active adolescents does not prevent from endometriosis as it increases an immune depression and leads to endometrium transformation and menstruation remains. Education of patients, attention to dysmenorrhea in juvenile age, support of maternity and improvement of environment are main directions of endometriosis prophylaxis.
*14-th World Congress on Pediatric & Adolescent Gynecology,
Abstract, Athens, Gr, 2004. 68. Стендовый докл.