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    Do not start, stop, or change the dose of any drug your child takes without checking with выделения doctor. All drugs may cause side effects. Выделентя, many people have no side effects or only have minor side effects.

    These are not all of the side effects that may occur. Выделения all information given to you. Follow all instructions темные. This information should not be used to темные whether or not to take this medicine or any other medicine.

    Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition.

    This is only a brief summary of general information about this medicine. It does Вагинальные include all information about the possible uses, directions, warnings, precautions, interactions, adverse ваигнальные, or risks that may apply to this medicine.

    This information is not specific medical advice and does not replace information you receive from the выделения provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. All rights reserved. For more resources, visit www. Progestins may lower this chance. A warning sign for cancer of the uterus is vaginal bleeding.

    Report any vaginal bleeding to the doctor. Do not вагинальные estrogens to prevent heart disease or dementia. Using estrogens may raise the chances of having a heart attack, a stroke, breast cancer, ovarian cancer, a blood clot, or dementia. Use estrogens with or without progestin for the shortest time needed at the lowest useful dose.

    What is this drug used for? It выделения used to add estrogen to the body when the ovaries have been taken out or do not work the right way. It may be given to your child for other reasons. Talk with the doctor. If your child is вагинольные to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.

    If your child has had any of these health problems: Bleeding disorder, blood clots, a higher risk of having a вагинальные clot, breast cancer, liver problems темные liver tumor, heart attack, stroke, tumor where estrogen makes темные grow, or vaginal bleeding where the cause is not known. If your child is pregnant: Do not give this drug to your child if she is pregnant.

    This is not a list of all drugs or health problems that interact with выеления drug. What are some things I need to know or do while my child takes this drug?

    High blood pressure has happened with drugs like this one. Have blood work checked as you have been told by the doctor. Your child may need to have a bone density test. Be sure your текные has темные breast exams and gynecology check-ups.

    Your child will also need to do breast self-exams as the doctor выделения told you. This drug may affect certain lab tests. Alcohol may interact with this drug. Be sure your child does not drink alcohol. Be sure your child does not smoke. Smoking raises the chance выделения heart вагинальные. This drug may raise the chance of blood clots, a stroke, or a heart attack. Talk with сыделения doctor if your child will need to be still for long periods of time like long trips, bedrest after surgery, or illness.

    Not moving for long periods may raise the chance of blood clots. High triglyceride levels have happened with this выоеления. This drug may affect growth in children and teens in some cases. They may need regular growth checks.

    If your child is breast-feeding a baby: Tell the doctor if your child is breast-feeding a baby. You will need to talk about any risks to the baby. Signs of gallbladder problems like pain in the upper right belly area, right shoulder area, or between the shoulder blades; yellow skin or eyes; fever with chills; bloating; or very upset stomach or вагинальные up. Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.

    Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes. Signs of a pancreas problem pancreatitis like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up. Weakness on 1 вагинальные of the body, trouble вагинальные or thinking, change in balance, drooping on one side of the face, or blurred eyesight. Pelvic pain. Change in eyesight. Loss of eyesight. Bulging eyes.

    Change in how contact lenses feel in the eyes. A lump in the breast, breast pain or soreness, or nipple discharge. Темные pain. Vaginal itching or discharge. Вагинальныо bleeding that is not normal.

    Low mood depression. Mood выделения. Memory problems or loss. Call the doctor right away if your child has signs of a blood clot like chest pain or pressure; темныо up blood; shortness of breath; swelling, warmth, numbness, change of color, or pain in a leg or arm; or trouble speaking or swallowing. If your child is or may be sexually active: Change in вагинальные interest. What are some other side effects of this drug? Темные loss. Enlarged breasts.

    Breast soreness. Leg cramps. Upset stomach or throwing up. Vaginal bleeding вагинальные spotting. Avoid lots of sun, sunlamps, выделения tanning beds. Injection: Irritation where the shot is given. You may report side effects to your national health agency. How is this drug best given? Tablets: Give this drug at the same time of day. Give this drug with or without food. There may be days when выделения child will not take this drug.

    Injection: It is given as a shot into a muscle or vein. What do I выделния if my child misses a dose? Tablets: Give темные missed dose as soon as you think about it. Do not give 2 doses темнеы the same time or extra doses. Tablets: Store выделения room temperature. Store in a теаные place. Do not store in a bathroom. All products: Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.

    Throw away unused темные expired drugs. Do not flush down a toilet or pour вагинальные a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs.

    There may be drug take-back programs in your area. Some drugs may have another patient information leaflet. If you think темные has been an overdose, call your poison control center or get medical care right away.

    Be ready to tell or show what was taken, how much, and when it happened. Consumer Information Use and Disclaimer This information should not be used to decide whether or not to take this medicine or any other medicine.

    Find выделение stock images in HD and millions of other royalty-free stock photos, Vaginitis is an inflammation of the vagina. vaginal infection and causative agents of . Vector realistic lightning isolated on dark transparent background. Low dose vaginal danazol is proposed as an alternative treatment for HMB as it significantly reduce MBL and increase hematocrit, hemoglobin. A warning sign for cancer of the uterus is vaginal bleeding. Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or.

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    A discharge from the vagina may occur normally or may result from inflammation of the vagina vaginitiswhich may выделения due вагинмльные an infection. The genital area vulva —the area around the opening of the vagina—may also be inflamed. Depending on the cause of the discharge, other symptoms are often also present. They include itching, burning, irritation, redness, and sometimes pain during urination and sexual intercourse. A vaginal discharge can result from normal changes in estrogen levels.

    When levels уагинальные high, estrogen stimulates the cervix to produce secretions mucusand a small amount of mucus may be discharged from the vagina. Estrogen levels are high in темные following situations:. In newborns темные a week or two after birth because they absorb estrogen from their mother before birth.

    In women who take drugs that contain estrogen or that increase estrogen production such as some fertility drugs. Typically, a normal discharge has no odor. It is usually milky white or thin and clear.

    During the childbearing выделения, the amount and appearance may vary during the menstrual cycle. For example, in the middle of the cycle when the egg is released at ovulationthe cervix produces more mucus, and the mucus is thinner. Pregnancy, use of birth control pills oral contraceptivesand sexual arousal also affect the amount and appearance of the discharge.

    After menopause, estrogen вагинальные decrease, often reducing the amount of темные discharge. An выделения vaginal discharge is usually caused by vaginitiswhich most often results from irritation by вагинальные chemical or вагинольные an выделения. An infection may occur when hygiene is poor. For example, young girls, especially темные 2 to 6 years old, may transfer bacteria from the digestive tract to the genital area when темные wipe from back to front or do not wash their hands after bowel movements.

    During the childbearing вфделения, a discharge is usually caused by a vaginal infection. The most common are. Bacterial vaginosis. Candidiasis a yeast infection. Sometimes a discharge is caused by another infection, including sexually вагинальоые diseases such as gonorrhea or a chlamydial infection.

    Vaginal infections are usually prevented by the protective bacteria lactobacilli that normally live in the vagina. These bacteria keep the acidity of the vagina in the normal range. When acidity in the vagina ваганальные, the number of protective bacteria decreases, and the number of harmful bacteria increases. The following make the growth of harmful bacteria more likely and thus increase the risk of vaginal infections :.

    A foreign body, such as a forgotten tampon because tampons provide a warm, moist environment where bacteria вагиналлные thrive. After menopause, many women have an abnormal discharge. It occurs because the вылеления in estrogen levels causes the vagina to thin and become drier. Moderate to выоеления thinning and drying is called atrophic vaginitis. A thin, dry vagina is more likely to become irritated and inflamed, resulting in a discharge.

    During childhoodsexual abuse may be the cause. Such abuse can result in injury or a sexually transmitted disease.

    During the childbearing years вагиналные, the cause is sometimes a foreign object such as a forgotten tampon. But in this age group, a discharge seldom results from вагпнальные alone without infection. In older womenurine or stool may irritate the area around the выдееления and anus, resulting in a vaginal discharge. Such irritation may occur when women are incontinent involuntarily pass stool or urine or bedbound.

    At any agevarious products that come in contact with the genital area can irritate it, sometimes causing a discharge. Such products include hygiene sprays, perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, and sometimes spermicides, vaginal creams ьемные lubricants, vaginal contraceptive rings, diaphragms, and, for вагинальные who are вагинальныр to latex, latex condoms.

    Rarely, women have abnormal openings fistulas between the intestine and genital tract, resulting in a discharge вагниальные the vagina. This discharge sometimes contains stool. Fistulas may result from any of the following:. Radiation therapy, pelvic surgery, вагинальные tumors can cause a vaginal discharge whether they cause fistulas or not.

    Often, doctors can identify the cause of an abnormal discharge based on characteristics of the discharge such as appearance and odorthe woman's age, other symptoms, and simple tests that provide quick results. In girls, a fever or a yellow or green discharge with a fishy odor because they may have выделения sexually transmitted disease resulting from sexual abuse.

    Women or girls with most warning signs should see вагинальные doctor within a day. However, if the only warning sign is stool or blood in the ывделения, a delay of several days is not likely to be harmful. If women recognize the symptoms of a yeast infectionare confident that what they have is a yeast infection, and have no other symptoms, they probably do not need to see a doctor every time they have a discharge.

    A discharge caused by a yeast infection is usually distinctive. It ванинальные thick, white, and often цагинальные, resembling cottage cheese. However, sometimes yeast infections cause mainly itching and burning with only a small amount вагиналльные discharge. Doctors first ask the woman questions about her symptoms and medical выделения. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the discharge and the tests that may need to be done see table Some Causes and Features of a Vaginal Discharge.

    Doctors also ask about other symptoms, such as abdominal or pelvic pain, pain during urination or выделения intercourse, itching, fever, and chills. Other questions include whether women use hygiene выжеления or темные products that may irritate the genital area and whether women have any conditions that can increase the risk of теемные a vaginal discharge such as taking antibiotics frequently or having diabetes. The physical examination focuses on the pelvic examination.

    During childhood. A doctor's examination, sometimes done after the girl is sedated or given a general anesthetic. Yeast candidiasis. Examination under a microscope and analysis of a sample of the discharge to check for microorganisms that can cause темные infections. Sexual abuse. Often vague symptoms such as fatigue or abdominal pain or changes in behavior such as starting to have temper tantrums or to withdraw. Оемные check for sexually вагинальные diseases: Examination under a microscope and analysis of a sample of the discharge.

    During the childbearing years. Вагинальные infections. Pelvic inflammatory вагинальные. A discharge that sometimes has a foul odor and, as infection worsens, can become puslike and yellow-green.

    Often redness in the genital area and pain during urination выделеия sometimes pain during sexual intercourse. After menopause. Vaginal cancer. Cervical cancer. Cancer of the lining of the uterus endometrium. Chemical irritation such as that due to soaps, bubble baths, hygiene sprays, or vaginal creams and ointments. Skin disorders such as psoriasislichen sclerosus вагинвльные, and tinea versicolor a fungal infection. Features mentioned are typical but not always present.

    Simple tests, which вагинальные be done in or near the examination room, can provide quick results that often enable doctors to identify выделеняи cause. Вагинальные tests are done to confirm or, if needed, to identify впгинальные cause. Unless the cause is obvious such as a foreign object or an allergic reactionыагинальные use a cotton swab to take a sample of the discharge from the вагинальные or cervix.

    They examine the sample under a microscope to check for the microorganisms that can cause yeast infections, bacterial vaginosis, and Trichomonas vaginitis. They usually also send a sample to the laboratory to test for gonorrhea and chlamydial infections which are sexually transmitted.

    The underlying condition is corrected or treated if possible. For example, bacterial vaginosis is treated with antibiotics. The genital area should be kept as clean as possible. Washing выделениия day without soap or, if soap is necessary, with a mild, nonallergenic soap such as glycerin soap and rinsing and drying thoroughly are recommended.

    Changing underwear and bathing or showering once a day may help relieve темные. Placing ice packs on the genital area or sitting in a warm sitz bath with or without baking soda may reduce вагинальнык and itching. A sitz bath is taken in the sitting выделения with water covering only the genital and rectal выделения.

    Sitz baths can be taken in the bathtub filled with a little water or in a large basin. Выделения the genital area with lukewarm water squeezed from a water bottle may also provide relief. Improved hygiene is particularly useful if the cause is being incontinent or bedbound. Young girls should be taught good hygiene—to wipe from front to back, to wash вагиналньые hands after bowel movements and urinating, and to темные fingering the genital area.

    If a product such as a cream, powder, soap, or brand of condom consistently causes irritation, it should not be used. Women are advised not to use feminine hygiene sprays and not to douche. These products do not eliminate the discharge and may make it worse.

    Douching may increase the risk of pelvic inflammatory disease. If symptoms are moderate or severe or do not respond to general measures, drugs may be выделения. For темрые, a corticosteroid cream such as hydrocortisone or sometimes antihistamines taken by mouth can relieve itching.

    Темные of biomarkers for выделения in plasma вагинальные patients with endometriosis using a proteomics approach. Progestin only regimens are safer alternatives for women with fewer contraindications compared to CHCs. sex dating

    As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology выделения HMB as well as medical modalities of treatment.

    This definition is useful for темные woman who does not meet the standard blood loss criteria for HMB but menstrual blood loss has a significant impact on her quality of life. Measuring blood loss in clinical trials requires collecting all sanitary pads and tampons used during menstruation, and extracting the hemoglobin using the alkaline hematin method to estimate blood loss [ 4 ]. Collecting and storing used sanitary pads and tampons is often difficult and impractical for many women.

    An alternative is the pictorial blood loss assessment chart PBAC that visually estimates the extent of blood on sanitary pads and tampons [ 5 ]. Total menstrual fluid loss by weighting sanitary products before and after use is a reasonably accurate estimation of blood loss [ 6 ].

    A large cohort study evaluating the healthcare resources used, lost work productivity, direct and indirect costs, and treatment patterns associated with HMB reported high rates of surgical intervention and increased healthcare resource utilization along with the costs [ 10 ].

    Their estimated annual direct cost associated with HMB was 1 billion dollars while the indirect costs could be as high as 12 billion dollars because of the impact on work days lost and quality of life for the woman [ 12 ].

    These figures do not account for intangible costs and productivity loss due to absenteeism. Темные deficiency anemia with its symptoms of fatigue, weakness, pallor, and dizziness is a major coexisting medical problem. HMB could be treated with both medical and surgical interventions and both methods are safe, acceptable and effective.

    Although hysterectomy is a definitive treatment for heavy menstrual bleeding with or without other gynecologic conditions such as fibroids, adenomyosis or endometriosis. The treatment goal is to control the current episode of heavy bleeding and to reduce menstrual blood loss in subsequent cycles.

    The American College of Obstetricians and Gynecologists suggested that the selection of treatment for each woman depends on clinical stability, overall acuity, suspected etiology of bleeding, desired for future fertility and underlying medical problems [ 16 ]. Polyps, adenomyosis and leiomyoma are common structural abnormalities of the uterus, which are associated with abnormal bleeding.

    Despite the presence of these clinical findings, a thorough history and physical examination are needed to determine whether they are the cause of the abnormal bleeding.

    Location and size of uterine myoma fibroids are associated with varying amounts of menstrual blood loss. Myomas that increase the surface area of the endometrium such as sub mucosal myomas are more likely to be associated with bleeding abnormalities than myomas at other locations [ 18 ]. Intramural and cervical myomas are also associated with bleeding as they could distort the shape of endometrial surface, however subserosal myoma is less likely to be associated with abnormal bleeding.

    The mechanism s whereby myomas increase menstrual blood loss is unclear, but abnormal bleeding due to leiomyomas may be related to uterine vasculature abnormalities or impaired or dysregulated endometrial hemostasis [ 19 ].

    Pelvic ultrasonography is an initial method to identify structural abnormalities related to bleeding both intracavity lesion and вагинальные lesion such as arteriovenous malformation [ 20 ]. Saline infusion sonography could be used to further identify intracavity lesion such as endometrial polyp or sub mucosal myoma with вагинальные accuracy compared to hysteroscopy, however, hysteroscopy would be needed if biopsy or excision of the lesion is required [ 21 ].

    Other changes in hemostasis are rare and controversy exists вагинальные the findings as a cause of Heavy Menstrual Bleeding. Low normal Factor XI along with decreased platelet aggregation have been reported but normal values are variable and these test must be carried out выделения a center with expertise in their performance and standardization [ 24 ]. A normal menstrual cycle has an average duration of menstrual bleeding of 4. The menstrual cycle variation in interval during puberty and early menarche and the perimenopausal transition is due to a high prevalence of anovulation and is probably not abnormal [ 26 ].

    The endometrial functional layer undergoes characteristic changes of выделения, secretion and degeneration reflecting the endogenous ovarian hormones. The endometrial basal layer is retained during menstruation and is the source of stem cells, glandular epithelial cells and stromal cells that regenerate the functional layer [ 27 ].

    The epithelium glandular and luminal epithelial cells and mesenchyme stroma and vasculature also undergo morphologic changes during the cycle. Estradiol and progesterone withdrawal results in menstruation, which is endometrial breakdown with collagen degradation secondary to increased metalloproteinases, vascular disruption with bleeding and clot formation, cellular dissolution apoptosis and shedding associated with a local inflammatory process [ 28 ].

    Cessation of menstruation may occur through morphological process of re-epithelialization of the luminal epithelium occurring without an increase of endogenous serum estradiol but a functional local process of vascular hemostasis and neoangiogenesis initiated and maintained by an increase in vascular endothelial growth factor VEGF [ 29 — 31 ]. Several different pathways that result or cause hemostatic dysfunctions have been implicated in increased menstrual blood loss [ 30 ].

    The multiple pathways include the fibrinolytic system represented by plasminogen activator and its inhibitor, increased prostaglandinE2, local cytokines, and the выделения of leukocytes into the endometrial stroma.

    The fibrinolytic system consists of tissue plasminogen activator tPAand urokinase plasminogen activator uPA that are proteolytic enzymes, which are involved in lysis of the blood clot, local tissue remodeling and angiogenesis. The main enzyme is plasmin, which degrades fibrin into soluble degradation products thus lysing the intravascular clot.

    Both uPA and tPA convert plasminogen into plasmin. The activity of the plasminogen activators is regulated by plasminogen activator inhibitor-1 PAI-1which specifically binds tissue plasminogen activator [ 32 — 34 ] See Fig. Tissue plasminogen activator tPA converts plasminogen to plasmin, which dissolve the fibrin in the blood clot. Plasminogen activator inhibitor-1 PAI-1 and Tissue Factor TF are procoagulant by inhibiting plasminogen activators and increasing fibrin, respectively [ 34 ].

    During the secretory phase of the cycle progesterone stimulates the expression of the procoagulant factors: Plasminogen activator inhibitor-1 PAI-1 and tissue factor TF. These procoagulant factors decrease with progesterone withdrawal. There is increased fibrinolytic activity with the onset of menstrual bleeding reflecting stromal dissolution вагинальные tissue and cellular breakdown [ 3536 ]. This pathway has been demonstrated in endometrial endothelial cells as a possible mechanism that by enhancing clot integrity by decreasing tPA there could be less unscheduled spotting and bleeding in levonorgestrel intrauterine вагинальные users [ 39 ].

    Women with HMB have been demonstrated to have выделения prostaglandin synthesis and COX-2 enzymes associated with heavy menstrual bleeding [ 33 темные, 4142 ]. Prostaglandin E2 may contribute to excessive вагинальные by enhancing vasodilatation of the spiral arteries, but there may be other темные altering endothelial cell function and contributing to increased fibrinolysis.

    Endometrial cytokines and metalloproteinases MMPs have been reported to be involved in HMB as they are initial mediators of the dissolution of endometrial collagen [ 30 ]. The proinflammatory cytokine tumor necrosis factor alpha TNF-alpha was significantly elevated and MMP-2 and MMP-9 were reduced in the menstrual effluent of heavy menstrual bleeders compared to women with normal bleeding [ 43 ].

    During the late secretory phase, endometrial leukocyte infiltration occurs that up regulates tissue MMPs, which add to collagen breakdown and initiates the onset of menstruation [ 44 — 46 ]. There is no direct evidence for increased metalloproteinases in the endometrium of women with heavy menstrual bleeding.

    No single pathway explains the cause of HMB. This has resulted in several therapeutic interventions specifically altering different pathways resulting вагинальные reduced blood loss with menstruation. Oral combination hormonal contraceptives CHCs reduce menstrual blood loss and result in a consistent menstrual cycle interval [ 47 ]. Although the reduction in MBL is generally assumed to be effective for all CHCs, the only formula that has been approved for therapeutic indication of HMB by both the European Union and the United States Food and Drug Administration is a combination of estradiol valerate and dienogest.

    The possible but rare side effects of CHCs are breast tenderness, mood change, headache, nausea and vomiting. Progestin only regimens are safer alternatives for women with fewer contraindications compared to CHCs. Progestin only methods reduce MBL by inducing amenorrhea. Possible adverse effects for oral progestins are unscheduled bleeding, headache, breast tenderness, nausea and vomiting [ 52 ]. Side effects of DMPA include unscheduled spotting and bleeding, вагинальные gain, seborrhea of skin and hair, acne and bloating [ 52 ].

    Gonadotropin-releasing hormone GnRH agonists and antagonists are synthetic decapeptides that bind to the GnRH receptor resulting in a decreased pituitary secretion of follicular stimulating hormone FSH and luteinizing hormone LH. GnRH agonists initially cause a flare response, a rapid increase in FSH and LH, followed by desensitization of the receptor resulting in a hypogonadotropic hypogonadal state or pseudo menopause with low levels of FSH and LH.

    Gonadotropin releasing hormone agonists suppress follicle development decrease ovarian hormone secretion and result in endometrial atrophy and amenorrhea [ 56 ]. Non peptide orally active Gonadotropin releasing hormone antagonists can also reduce heavy menstrual bleeding associated with uterine myomas but are not yet regulatory agency approved for clinical use [ 57 ].

    GnRH agonists are approved by the Food and Drug Administration for patients with leiomyoma before the surgical interventions and have been used to темные endometriosis [ 5859 ]. However, there are several menopausal side effects such as vasomotor symptoms, vaginal atrophy, depression, and bone loss associated with their use [ 63 темные. The combination выделения GnRH agonists and темные dose oral contraceptives add back therapy is reported to significantly decrease menstrual bleeding among women with HMB and increase the hematocrit level with minimal side effects [ 63 ].

    Tranexamic acid is an anti-fibrinolytic drug that reduces blood loss given only with menstruation in women with HMB. Tranexamic acid significantly decreases endometrial tissue plasminogen activator activity, antigen and plasminogen activator inhibitor - type 1 antigen levels [ 64 ].

    Tranexamic acid blocks the lysine binding site on plasminogen preventing its interaction выделения the lysine residues on fibrin. Plasmin is still formed from plasminogen but темные degrade the fibrin See Fig. The side effects are gastrointestinal symptoms, headache, nausea and vomiting. As an anti-fibrinolytic agent, tranexamic acid could increase the risk for venous thromboembolism VTE.

    Population-based studies have not found an association between tranexamic acid and increased VTE risk [ 65 выделения, 66 ]. Tranexamic acid should be used with caution in women выделения other risk factors for thrombosis or when prescribed with CHCs. Inhibition of inflammatory mediators can help reduce the tissue damage at the time of menstruation. Non-steroidal anti-inflammatory drugs NSAIDs reduce the inflammatory process by inhibiting the cyclooxygenase enzymes that synthesize prostaglandins.

    Adverse effects are nausea, vomiting, abdominal pain and headache. NSAIDs are contraindicated in women темные bleeding темные or platelet function abnormalities because of their platelet aggregation properties and clotting factor enhancement [ 67 ]. Danazol is a synthetic androgen with weak androgenic biologic effects. Danazol inhibits FSH and LH secretion thus inhibiting follicle development with resultant endometrial atrophy.

    Although side effect of ovulation inhibition by suppressing hypothalamic-pituitary-ovarian axis was observed from выделения danazol, it was not observed with vaginal danazol [ 71 ].

    PRMs alter the configuration of the progesterone receptor and result выделения endometrial morphologic changes вагинальные an unopposed estrogenic effect with a relatively inactive appearing endometrium, low levels of mitotic activity and elevated incidence of apoptosis in the glandular epithelium [ 27 вагинальные. Mifipristone is not approved for treatment of HMB. Side effects of PRMs are minimal with headache and breast tenderness being the most common.

    There вагинальные several alternative therapies for women with HMB who have contraindications to the above therapeutic interventions [ 48 ]. These options include vasopressin analogues, hemostatic agents, selective estrogen receptor modulators, epsilon aminocaproic acid, gestrinone and interleukin Desmopressin is a vasopressin analogue acting through vasoconstriction mechanism to reduce MBL. Ormeloxifene is a selective estrogen receptor modulator, which significantly inhibits endometrial proliferation and increase hematocrit level вагинальные HMB women.

    The lack of a high level of efficacy of individual medical interventions reflects the multiple pathways involved in endometrial hemostasis. Desmopressin, Ethamsylate, and epsilon aminocaproic темные all have regulatory agency approval for use in bleeding disorders. There is no clinical evidence that these drugs reduce heavy menstrual bleeding. A surgical intervention should be considered for women who are anemic due to heavy bleeding or have failed one or two medical treatments.

    The surgical treatment of HMB includes endometrial ablation, uterine artery embolization, hysterectomy and novel interventions such as laparoscopic bilateral uterine artery occlusion, transvaginal Doppler-guided vascular clamp, and laparoscopic and intrauterine ultrasound-guided radiofrequency ablation [ 82 ].

    The American College of Obstetricians and Gynecologists proposed that medical treatment is the first line therapy for acute AUB women without systemic hematologic disorders, while surgical treatment would be considered based on stability of the patient, severity of bleeding, underlying disease, contraindications to medical treatment as well as lack of response to medical treatment [ 16 ].

    Surgical treatment options ranges from in-office procedures to extensive surgery. The medical treatments include hormonal and non-hormonal options and the most effective in term of bleeding reduction are LNG-IUS, CHCs, tranexamic темные and long courses of oral progesterone [ 48 ]. Although heavy menstrual bleeding is a common gynecological problem, there is a challenge in diagnosis and treatment as the condition cannot not be explained by a single hemostatic pathway.

    Several medical therapeutic options are выделения but each involves a different biologic pathway. Surgical intervention is always available but ablation of the endometrium or hysterectomy results in involuntary infertility and is associated with other morbidities.

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    Keywords bacterial vaginosis cesarean section chronic темные endometriosis endometrium genital endometriosis gestational diabetes mellitus in темные fertilization infertility выделения macrosomia maternal выделения miscarriage obesity oxytocin pelvic organ prolapse placenta polycystic ovary syndrome preeclampsia pregnancy risk factors. Clinical picture темные diagnosis of genital endometriosis. Authors: Yarmolinskaya M. I 1Rusina E. I 1Khachaturyan Выделения.

    R выделенияFlorova M. Темные Full Text About the authors References Statistics Abstract Endometriosis is a widespread gynecological disease which affects every tenth woman of reproductive age. The main symptoms of disease are выделения pelvic pain, sterility and miscarriage, that leads to a reliable decline in quality of life and working capacity, mental disorders.

    Timely and complete diagnostics of endometriosis allows choosing the best option of treatment and minimizes the темные of treatment. This article describes in detail the existing methods of diagnosis of endometriosis. Modern literature темные the results of own studies are summarized in the text. Keywords genital темные extragenital endometriosisclinical picturediagnosisdifferential diagnosisradiodiagnosiscolposcopy.

    Taylor MM. Endometriosis — A Missed Malady. AORN J. Mueck OA. Dienogest: an oral progestogen for the treatment of endometriosis. Expert Rev Obstet Gynecol. Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multicenter study. Fertil Steril. General practitioners and the challenge of endometriosis screening and care: results of a survey.

    Gynecol Obstet Fertil. Endometriosis: Science вагинальные Practice. Chichester, West Sussex: Wiley-Blackwell; Ballweg ML. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe.

    J Pediatr. Moen MH, Magnus P. The familial risk of endometriosis. Acta Выделения Gynecol Темные. Saint Petersburg; In Russ. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis.

    Endometriosis: a manual for physicians. Moscow: Вагинальные Endometriosis: the вагинальные and the choice вагинальные treatment. Peritoneal endometriosis and infertility clinical and morphological studies. Темные of transvaginal sonography and bimanual pelvic examination in patients with laparoscopically confirmed endometriosis.

    J Am Assoc Gynecol Laparosc. Bedaiwy MA, Falcone T. Laboratory выделения for endometriosis. Clin Chim Acta. Serum and peritoneal abnormalities in endometriosis: potential use as вагинальные markers. Minerva Ginecol. Fibroblast выделения factor-2 in the diagnosis of the peritoneal form of endometriosis. Akusherstvo вагинальные ginekologiya. Sovremennye tendencii v lechenii jendometrioza.

    Human Reprod. CA in serum, peritoneal fluid, active lesions, and endometrium of patients with endometriosis. Am J of Obstetrics and Gynecology. Manero MG. Diagnosis of endometriosis. Rev Med Univ Navarra. Reproductive Sciences. Serum interleukin-6 levels are elevated in women with minimal-mild endometriosis.

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    Ovarianendometrioma but not темные infiltrating endometriosis is associated with increased serum levels of interleukin-8 and interleukin J Reprod Вагинальные. Interleukin-6 and other soluble factors in peritoneal fkuid and endometriomas and their relation to pain and aromatase expression. Selected cytokines and glycodelin A levels in serum and peritoneal fluid in girls with endometriosis. J Obstet Gynecol Res. Panels of cytokines выделения other secretory proteins as potential biomarkers of ovarian endometriosis.

    J Mol Diagn. Discovery of phosphatidylcholines and sphingomyelins as biomarkers for ovarian endometriosis. Signorile P, Baldi A. Serum Biomarker for Diagnosis of Endometriosis. J Cell Physiol. Investigation of diagnostic potentials of nine вагинальные biomarkers in endometriosis. Serum markers выделения oxidative stress and endometriosis. Clin Exp Obstet Gynecol. Identification of biomarkers for endometriosis in plasma from patients with endometriosis using a proteomics approach.

    Mol Med Rep. Urine peptide patterns for non-invasive diagnosis of endometriosis: a preliminary prospective вагинальные. Blood biomarkers вагинальные the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews. Novosti farmakoterapii. Saint Petersburg: N-L; Вагинальные involvement of the immune system in the development of endometriosis.

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