PREGNANCY TRIMESTERS

DOC I AM PREGNANT 2

Pregnancy is typically broken into three periods, or trimesters, each of about three months.
First Trimester:
The first 12 weeks of pregnancy are considered to make up the first trimester.
The first two weeks are the two weeks before conception.
The third week is the week in which fertilization occurs.
In the 4th week, the fertilized egg reaches the uterus and burrows into its wall which provides it with the nutrients it needs. At this point it is called an embryo which connects via the umbilical cord to the placenta in the wall of the womb.
The 5th week marks the start of the development of the embryo.
This is the time when the embryo's brain, spinal cord, heart and other organs begin to form.

At this point the embryo is made up of three layers,
1.the top one (called the ectoderm) will give to the embryo's layer of skin, central and peripheral nervous systems, eyes, inner ear, and many connective tissues
2.the middle layer (the mesoderm) will give rise to the heart and the beginning of the circulatory system as well as the bones, muscles and kidneys.
3.the inner layer (the endoderm) will give rise to the development of the lungs, intestine and bladder.

In the 6th week, the embryo will be developing basic facial features
Its arms and legs also start to grow.
In the 7th week, the brain, face and arms and legs quickly develop.
In the 8th week, the embryo starts moving
In the next 3 weeks, the embryo's toes, neck and genitals develop as well.
By the end of the first trimester, the fetus will be about 3 inches (76 mm) long and will weigh approximately 1 ounce(28g).

Second trimester
Weeks 13 to 28 of the pregnancy are called the second trimester.
Most women feel more energetic in this period, starting to put on weight as the symptoms of morning sickness fade away.
The movement of the fetus, often referred to as "quickening", typically happens in the fourth month, and can be felt in the 20th to 21st week, or earlier if the woman has been pregnant before.
The placenta fully functions at this time and the fetus makes insulin and urinates.
The reproductive organs differentiate the fetus as male or female.

Third trimester
Final weight gain takes place from the 29 to 40 weeks of pregnancy.
The fetus will be growing the most rapidly gaining up to 28 g per day.
The woman's belly will transform in shape as the belly drops due to the fetus turning in a downward position ready for birth.
Fetal movement can become quite strong and can be uncomfortable to the woman.
This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and backache.
Movement of the fetus becomes stronger and more frequent.
There is head engagement ( the fetal head descends into the pelvic cavity) so that only a small part  can be felt abdominally.
The perenium and cervix are further flattened and the head may be felt vaginally.
Because the head engagement severely reduces bladder capacity, increases pressure on the pelvic floor and the rectum,the
mother may experience the perpetual sensation that the fetus will "fall out" at any moment.

Childbirth
This is the process whereby an infant is born.
It is considered to be the beginning of the infant's life.
A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. There may be waterbag bursting or blood(show)
Most childbirth is widely regarded as painful, some women do report painless labours
Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding.

PREGNANCY

DOC I AM PREGNANT
Pregnancy is the carrying of a fetus or embryo in the womb of a woman. 

The term embryo is used to describe the developing offspring during the first 8 weeks following conception while the term fetus is used from about 2 months of development until birth.

Human pregnancy is divided into three trimester periods:
1.The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).
2.The second trimester, the development of the fetus can be more easily monitored and diagnosed.
3.The third trimester often approximates the ability of the fetus to survive outside of the uterus.

 Fertilization
The process leading to pregnancy occurs earlier usually in the fallopian tube when the female egg is penetrated by the male spermatozoon following the act of sexual intercourse.
This process is referred to as fertilization or conception.
The fertilized egg then travel down the fallopian and implants itself into the inner lining of the womb or uterus.
Once implanted in the uterus the embryo will grow to become a fetus at 2 months before coming out of a normal pregnant mother's womb at 38 weeks from conception to become a newborn baby.
After implantation into the lining of the womb, the embryo secretes a hormone named human chorionic gonadotropin which in turn stimulates the corpus luteum in the woman's ovary to produce progesterone.
The progesterone act to maintain the lining of the uterus so that the embryo will continue to be nourished by the glands in the lining of the uterus.
The capillaries will be stimulated to grow from the wall of the uterus to form the placenta which allow the embryo to receive vital nutrients from the woman's blood supply.The umbilical cord is the connecting cord from the embryo or fetus to the placenta and allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply.

The expected date of delivery is 40 weeks counting from the first day of the last menstrual period and birth usually occurs between 38 and 42 weeks.Even though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period.

Diagnosis of pregnancy:
The beginning of pregnancy may be detected by a pregnant woman without medical testing through a number of symptoms of pregnancy:
1. nausea and vomiting,
2. excessive tiredness and fatigue,
3. cravings for certain foods
4. frequent urination particularly during the night.

Signs of pregnancy include:
1.the presence of human chorionic gonadotropin (hCG) in the blood and urine can be detected as early as 12 days after implantation
2.missed menstrual period,
3.implantation bleeding during the third or fourth week after last menstrual period,
4.increased basal body temperature sustained for over 2 weeks after ovulation,
5.Chadwick's sign (darkening of the cervix, vagina, and vulva),
6.Goodell's sign (softening of the vaginal portion of the cervix),
7.Hegar's sign (softening of the uterus isthmus),
8.pigmentation of linea alba – darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the 22nd week of pregnancy
9.Breast tenderness and darkening of the nipples is common
10.an early obstetric ultrasonography can determine the age of the pregnancy fairly accurately based on the last menstrual period.

A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease II
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What are the Complications of untreated Gastroesophageal reflux disease?
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GERD complications include

1.stricture formation,

2.Barrett's esophagus,

3.esophageal spasms,

4.esophageal ulcers,

5.esophageal cancer, especially in adults over 60 years old.


What is the treatment of Gastroesophageal reflux disease?
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Treatment is aimed at
A. prevention of reflux:
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1.weight loss for the Obese

2.Positional therapy

a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients

b.Elevating the head of the bed is also effective.

The head of the bed can be raised by wooden bed risers that support bed posts or legs.

Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.

c.a bed wedge pillow will also help to raise the patient's body higher

3.Certain foods should be avoided to prevent gastroesophageal reflux:

a.Coffee,

b.alcohol,

c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C

d.Antacids based on calcium carbonate actually increase the acidity of the stomach.

e.Foods high in fats -delay stomach emptying

f.Carbonated soft drinks with or without sugar.

g.Chocolate and peppermint.

h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.

i.Milk and milk-based products containing calcium and fat,

j.Eating within 2 hours before bedtime.

k.Large meals- smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.

4.Smoking reduce lower esophageal sphincter competence, and should be avoided

5. Posture and GERD
Slouching causes a kink between the stomach and esophagus.

The esophageal muscles become twisted in a spasm.

Gas and acid get trapped in the spasm,causing irritation to the throat and the windpipe resulting in cough and asthmatic symptoms.

6.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

B. Neutralizing the Gastric Acid Reflux
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1. Drug treatment

a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)

b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)

c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.

d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.

e.Sucralfate (Carafate) is used to help heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.

2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.

The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:

a.The Endocinch apply stitches in the LES to help strengthen the muscle.

b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.

c.The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fix the fold using a suture-based implant.


What is the prognosis of Gastroesophageal reflux disease?
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It is a chronic disease so treatment is lifelong and recurrences are common.


How is Gastroesophageal reflux disease prevented?
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1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar

2.Spicy foods - Cut down on pepper or chilies.

3.Avoid lying down for two to three hours after meals.

When you are sitting up, gravity helps drain food and stomach acid into your stomach.

4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.

5.Avoid GERD symptom triggers- chocolate, mint, citrus, tomatoes, pepper, vinegar, catsup, and mustard.

6.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.

7.Eat smaller meals to avoid triggering GERD symptoms.

8.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease I
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What is Gastroesophageal reflux disease?
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Gastroesophageal reflux disease (GERD) is a chronic disease of the esophagus whose mucosa is damaged by abnormal reflux of gastric acid from the stomach to the esophagus.


What are the risk factors in Gastroesophageal reflux disease?
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1.Incompetant Lower Esophageal Sphincter(LES) allow the acid and gastric juice to reflux up the esophagus

2.Hiatus hernia - hole in diaphragm separating esophagus from stomach is enlarged allowing the easier flow of acid up the esophagus

3.Obesity and pregnancy: increased body weight cause pressure in the abdomen to push gastric contents upwards towards esophagus

4.Zollinger-Ellison syndrome- this condition typically increase gastric acid

5.Hypercalcemia, increase gastrin production, leading to increased acidity

6.Corticosteroids like prednisolone - can irritate the stomach mucosa and increase gastric acid

7.Scleroderma and Multiple sclerosis with esophageal involvement

Factors which has been associated with GERD :

8.Obstructive sleep apnea

9.Gallstones which can impede the flow of bile and digestion of fats


What are the causes of Gastroesophageal reflux disease?
------------------------------------------------------------------

1.incompetence of the cardia(junction between the stomach and esophagus),

2.transient cardia relaxation,

3.impaired expulsion of gastric reflux from the esophagus

4.hiatus hernia.


What are the Symptoms of Gastroesophageal reflux disease?
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The most common symptoms are

1.Heartburn - there is a burning discomfort behind the breastbone due to acid flow up the esophagus

2.difficulty swallowing (dysphagia)- due to narrowing of the esophagus (persistent implies stricture while intermittent implies spasm)

3.chronic chest pain - pain is behind the central sternum as a result of acid in the esophagus

4.cough - the acid flow up the esophagus can irritate the larynx and spark off the cough reflex

5.hoarseness- due to inflammation of the vocal cords from the acid reflux

6.voice changes- as above

7.chronic ear ache- inflammation of the throat from acid relux an also affect the eustachian tube of the middle ear resulting in pain

8.burning chest pains- again due to the gastric acid in esophagus

9.nausea and belching- too much acid to the throat can cause the nausea and expulsion of air effect

10.sinusitis - acid can also find its way up the throat and into the sinuses.

11.esophagitis (reflux esophagitis)- acid low up the esophagus causing pain
worse on lying down

12.strictures are narrowing of the esophagus resulting from acid in the esophagus

If the reflux affects the throat and larynx, it is called laryngopharyngeal reflux disease.


How do you diagnose Gastroesophageal reflux disease?
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A detailed history of acid reflux into the esophagus.

Useful investigations may include

1.barium swallow X-rays,

2.esophageal manometry - measures the pressure in the esophagus

3.24-hour esophageal pH monitoring - measures the acidity of the esophagus

4.Esophagogastroduodenoscopy (EGD) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach in order to assess the internal surfaces of the esophagus, stomach, and duodenum.

In general, an EGD is done when:
1.the patient does not respond well to treatment,

2.has danger symptoms including:
dysphagia,

anemia,

blood in the stool (detected chemically),

wheezing,

weight loss,

voice changes.

Esophagogastroduodenoscopy can show peptic stricture, or narrowing of the esophagus near the junction with the stomach.
This can cause dysphagia or difficulty in swallowing

Biopsies done during gastroscopy may show:

1.Edema and basal hyperplasia (non-specific)
2.Lymphocytic inflammation (non-specific)
3.Neutrophilic inflammation (usually due to reflux or Helicobacter Gastroesophageal reflux disease)
4.Eosinophilic inflammation (usually due to reflux)
5.Goblet cell intestinal metaplasia or Barretts esophagus.
6.Elongation of the papillae
7.Thinning of the squamous cell layer
8.Dysplasia or pre-cancer.
9.Carcinoma.
10.Reflux changes may be non-erosive in nature, leading to the non-erosive reflux disease.

A Simple Guide to Amenorrhea

A Simple Guide to Amenorrhea
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What is Amenorrhea?
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Amenorrhea is a symptom defined as absence of menstruation.

What are the types of Amenorrhea?
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1.Primary Amenorrhea
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is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.

2.Secondary Amenorrhea
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is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.

What are the causes of Amenorrhea?
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1.Physiological(hormonal):
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pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone

2.Genetic Causes:
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abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis

3.Uterine Pathology:
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adhesions from previous operation
endometriosis
tuberculosis infection
radiation

4.Ovarian:
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Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries

5.Pituitary:
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Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities

6.Psychological:
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Depression
Anorexia nervosa,
starvation

7.Systemic Diseases:
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Hypothyoidism
Cushing syndrome

8.Medical causes:
----------------------

Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs

How to establish a diagnosis of Amenorrhea
-------------------------------------------

History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones

2.Secondary Amenorrhea
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Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity

Pyschologic disorders:
depression
anorexia nervosa

Pelvic examination:
---------------------

vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries

Investigations:
--------------------

Pregnancy test

blood for follicle stimulating hormones, luteinising hormones, prolactin

Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests

Serum testesterone and androsterones

Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours

What is the Treatment of Amenorrhea?
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Medications:
-------------

Specific treatment for amenorrhea depends on:

1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient

Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary

2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.

3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.

4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.

5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility

6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone

Other Treatments:
----------------------

1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,

2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa

3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.

4.Healthy lifestyle for those who are obese

A Simple Guide to Varicose Veins

A Simple Guide to Varicose Veins
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What are Varicose Veins?
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Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.

What are the causes of Varicose Veins?
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The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.

Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.

2.Prolonged standing -causes gravitation of the blood down the veins

3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood

4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.

5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.

6.Tight stockings- constricts the blood vessels mechanically

7.Smoking- constricts the blood vessel through its chemicals

What are the complications of Varicose Veins?
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Varicose Veins reduces the blood flow in the legs and can give rise to
complications:

1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.

2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.

3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.

4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.

What are the symptoms of Varicose Veins?
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1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis

What are the investigations needed in assessment of varicose veins?
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The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:

1.venous doppler,

2.PPG, and

3.color duplex ultrasound.

What is the treatment for Varicose Veins?
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1. No treatment if condition is mild

2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.

3. Medical treatment:

Injection of veins-

a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.

b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.

c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.

d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.

4. Surgical treatment:

a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.

b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.

c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.

d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.

e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves

How can Varicose Veins be prevented?
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1.Reduce weight

2.Exercise

3.Aviod prolonged standing

4.Put your feet up

A Simple Guide to Endometriosis

A Simple Guide to Endometriosis

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What is Endometriosis ?

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Endometriosis is a disorder of the endometrial tissues (which line a woman's uterus) in which these tissues are implanted in places outside the uterus, usually in other parts of the pelvic cavity and abdomen.

However, in women with Endometriosis, blood from the implanted endometrial tissue is trapped inside, becomes inflamed, and develops into scar tissue.

Because of this inflammation, severe pain, infertility and bowel problems occur.

What are the Causes of Endometriosis?

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The cause of endometriosis is still not known.

There are a few theories:

1.during menstruation, some of the menstrual tissue is pushed back through the fallopian tubes into the abdomen where it implants and grows.

2.it may be due to a genetic process

3.certain families are predisposed to endometriosis:

Higher socioeconomic groups

women who marry late and have no or few children

4.Stress may constrict the opening of the uterus .

Some endometrial tissues are pushed backward into the abdominal cavity instead of through the opening of the uterus

What are the Symptoms of Endometriosis?

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Endometriosis occurs usually years after the periods begin.

Symptoms may worsen as the endometrial area increases in size.

However after menopause, the implanted tissue shrinks away and the symptoms subside.

Common symptoms include:

Severe menstrual cramps

Pelvic pain apart from menstrual periods

Diarrhoea or painful bowel movements during menses

Menstrual irreuglarities

Menorrhagia

Painful intercourse

Backache

Pain with exercise

Painful pelvic exams

Painful and frequent urination

Bloating

Constipation

Fatigue

How do you made the Diagnosis of Endometriosis ?

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A diagnosis can only be made via laparoscopy.

A laparoscope is a tube with a light in it which is inserted through a small incision in the navel area. The misplaced endometrial tissue can then be found and the location, extent and size of the endometriosis detected.

What is the Treatment for Endometriosis?

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There is no cure for endometriosis.

If the symptoms are mild, only medication for pain is required.

Treatment depends on the size, extent of the lesions, age of the patient and the desire for pregnancy.

If these women want to be pregnant, the best course of action is to have a trial period of unprotected intercourse for 6 months to 1 year.

Once pregnancy occur, the endometriosis will cleared by itself because there is no menses for nine months. Whether the endometriosis will recur after delivery depends on the patient. Most patients do not have a recurrence.

If the patient is not seeking pregnancy and where specific treatment of the endometriosis is required, hormone suppression treatment may be tried. This prevents ovulation and less endometrial tissue is formed. Because of this the endometriosis may reduced resulting in less symptoms. A course of treatment may last 6 months.

Where hormone suppression therapy do not work, some patients may require surgical treatment to remove the endometriosis tissue in the abdomen.

In severe cases, where the uterus and ovaries are affected, removal by surgery of the uterus and/or ovaries is required especially in those nearing menopause or who do not wish to be pregnant.