Endometrioza w wieku przed- i okołomenopauzalnym – jak leczyć?

Endometriosis, i.e. extragonadal localization of endometrial stroma and glands is predominantly found inreproductive age women, however it is also diagnosed in teenagers and postmenopausal women. Prevalenceof postmenopausal endometriosis is 2-5% of all endometriosis cases, with majority found in patients usingestrogen replacement therapy (ERT). Etiopathogenesis of endometriosis after menopause is related toextragonadal aromatase activity (androstendione to estradiol conversion). The aim of endometriosis therapyis to relief pain. This effect can be achieved either through pharmacological or surgical treatment. Majorityof endometriosis medications relies on reduction of estradiol production. Combined hormonal contraceptivedrugs (oral, transdermal, transvaginal) and gestagens constitute first-line pharmacological therapy. Second-lineconsists of GnRH analogs, intrauterine system releasing levonorgestrel, danazol, and gestrinone. Progressivelymore and more experimental treatments are applied in postmenopausal endometriosis, just to name aromataseinhibitors suppressing local estrogen production. Surgical therapy may be also considered as first-line approach.Depending on the history of illness, pain intensity, and patient expectations surgery can cover wide spectrumfrom local excision of endometriosis through interruption of neural pathways (presacral neurectomy) finishingwith total hysterectomy with or without bilateral salpingoophoorectomy

Cardiovascular Function in Different Phases of the Menstrual Cycle in Healthy Women of Reproductive Age

Background: Sex hormones influence the cardiovascular (CV) function in women. However, it is uncertain whether their physiological variation related to the regular menstrual cycle affects the CV system. We studied changes in the hemodynamic profile and body’s water content and their relation to sex hormone concentration in healthy women during the menstrual cycle. Material and methods: Forty-five adult women were examined during the early follicular, late follicular, and mid-luteal phases of the same menstrual cycle. The hemodynamic profile was estimated non-invasively by cardiac impedance while water content was estimated by total body impedance. Results were compared with repeated measures ANOVA with post-test, if applicable. Results: There were no significant changes in most hemodynamic and water content parameters between the menstrual cycle phases in healthy women. Left ventricular ejection time differed significantly among phases of the menstrual cycle, with shorter values in the mid-luteal phase (308.4 vs. 313.52 ms, p < 0.05) compared to the late follicular phase. However, the clinical relevance of such small differences is negligible. Conclusions: Changes in sex hormones during the physiological menstrual cycle appear to have no considerable effect on healthy women’s hemodynamic function and water accumulation