Total Messages: 160
Good evening, Dr. Sikirin! My daughter, 13 years old, was diagnosed with apoplexy of the right ovary. Pain in the lower abdomen on the right side and lower back. She is in the hospital for two days, she is observed and made anesthetized. About OK Yarin, I realized that it would be necessary to drink to prevent, and what else, so that the pulling pain is gone, and why the central nervous system and prolactin play such a cruel joke with us, may I be afraid that I will not become a grandmother? Thank!
03/12/2009, Dr. Sikirina
Ovarian apoplexy is the result of explosive ovulation, with a ruptured ovarian tissue and hemorrhage into it. Happiness that your daughter was not operated on about this! Let them do pain relief, it is not harmful. She does not need to take Yarin, it is too high-dosage for her. Now, in March, the microdose "heir" Yarin, OK Jaz (Yaz) should appear on the Russian pharmacy market, with the same anti-prolactin effect and a guarantee that the weight will not increase, because there is a slight diuretic in the composition that imperceptibly removes excess liquid. To reduce the number of adhesions, after hemorrhage in the ovary, I recommend attaching physiotherapy to the treatment. Best of all MILTA or RIKTA devices. This is a quantum therapy that has a pronounced anti-inflammatory and resorbing effect. It is necessary to conduct 10 sessions. On the 2nd place is mud therapy. Moreover, you can not go to the mud resorts. It is enough to use the products of the company "Dr. Nona", a mud mask for the body. Dirt is superimposed in the form of mud "pants" on the lower abdomen, sacrum and lower back. And if the girl is already having sex, then a mud tampon is inserted into the vagina, for 2 hours.
I had ovarian apoplexy 5 years ago. Now constant delays, menstruation is very scanty and very dark in color. It was five doctors. All prescribe a different treatment - from hormone therapy to referral to surgery to remove a cystic formation. I want to get pregnant, does not work. I do not know what to do. They say that a floating cyst is not recommended to operate. What to do, tired of the doctors and tests. There is no infection, slight inflammation.
Hello last month, my lower abdomen acted as if my period should start, but it was still 2 weeks before them. I went to the doctor and immediately made an ultrasound: the right ovary was normal, and on the left there was a heterogeneous formation of 21.0 mm “web” there was no fluid in the pelvis. Conclusion: the picture is not exclusion of the left. She returned to the doctor with the result, she said nothing terrible, prescribed candles with indomethacin and tampons with Veshnevsky ointment. Please explain what is really happening to me?
02.02.2009, Dr. Sikirina
This is not apoplexy (hemorrhage into ovarian tissue), but a follicular cyst. Do not worry, it is not such a cyst that needs to be deleted. This is a temporary, functional education, which will pass by itself, after menstruation. Vishnevsky ointment is not necessary to apply, and Diclofenac candles, better than indomethacin, enter into the anus, at night. They have analgesic and anti-inflammatory effects.
I had apoplexy of the right ovary 2 years ago after intercourse, there was a sharp pain. She stayed home for two days, then she was taken to the hospital by ambulance. At the entrance, she was already losing consciousness, underwent laporoscopy, sanitation, drainage of the abdominal cavity and small pelvis, pumped out about 450ml of fluid. After that, I lay 2 days under a drip and then another week in the hospital. After discharge, she spent a week at home, and then again went to the hospital with acute thrombophlebitis v.cepalica of the left upper extremity (as the doctors said, apparently from a dropper, the drugs burned the walls of the vessels). She lay there for another week, gave anticoagulants, disaggregants, anti-inflammatory therapy and physiotherapy on her left forearm. After discharge, she took warfarin (1 month) and detralex (1 month). After 3 weeks, she was in the hospital again - because pulling pain all this time did not stop, and subsequently intensified. After the ultrasound scan, free fluid was noted in the pelvic cavity (70 ml). Uterine fibroids small size. An anti-inflammatory, symptomatic therapy was carried out in the department: no-shpa, indomethacin.
Oral contraceptives never accepted, due to an enlarged thyroid (standing under the control of an endocrinologist, no nodes, chronic autoimmune thyroiditis (since 1990), moderate hypothyroidism at the stage of medical compensation, I take l-thyroxine 50 μg from 2005).
For the last 2 months I have been feeling constant nagging pains in the lower abdomen, painful menstruation is constant (they always, always drink painkillers), sleep badly, constant fatigue. The right side of the back also began to hurt. Constantly hurts lower back. I try to drink about 2 liters of water per day. Food all seems under-salted.
Tell me - which doctors and what should I check? Thank you in advance.
01/15/2009, Dr. Sikirina
After ovarian apoplexy, laparoscopy, drainage, thrombophlebitis of the cubital vein, in a word, after all the shocks that had been transferred, the shocks of the shock hormone prolactin began. I think that you do not have AIT, simply, prolactin and TSH have one trigger mechanism - stress. The TSH rises, “spur” the thyroid gland, therefore antibodies (immunoglobulins, Ig) are formed to thyroglobulin (TG), which transports thyroid hormones into the blood, and to the thyroid peroxidase (TPO) enzyme that converts T3 to T4 - thyroxin. Antibodies can completely "zadolbat" thyroid, causing hypothyroidism. For the diagnosis of AIT, you need to take a blood test for antibodies to thyrocyte microsomes (thyroid cells). And microsomes are mitochondria, if you remember, from the school course of biology, intracellular energy "stations". This analysis may be called anti-MAG, or anti-MSTC. And prolactin splashes cause a distortion of the cycle, in the direction of the benefits of estrogen, hormone-builders, causing cell reproduction and growth of biological tissues. Hence the growth of myoma node.
Also, prolactin affects the general state of health, can cause depression, chronic fatigue. Low back pain associated with impaired blood circulation in the site of fibroids.
1) To stop taking L-thyroxine, to study the hormonal function of the ovaries, the method of measuring basal temperature is used. It is necessary to measure the basal temperature for at least 3 cycles. This is the most reliable and cheapest method of studying all the subtleties of the work of your ovaries. To diagnose and receive recommendations, send me your BT when the minimum 3 schedules are ready.
2) Termination of thyroxin intake is also necessary because uterine fibroids require treatment with another hormonal drug - Ginestryl, 50 mg at night, start on day 1 of the next menstrual period, and take without interruption, under ultrasound control, before the end of each 30-tablet pack . First, 3-cycle BT, then - Ginestril reception.
A month passed after apoplexy of the left ovary (the apoplexy was without blood, just pumped free fluid), prescribed Novinet. Drank 21 pills, sometimes forgot to drink in the evening, drank in the morning. Already 2 days of how menstruation should begin, but so far they are not there, plus tonight there was pain in the abdomen to the left, general severity, perhaps the temperature was during the day (it was not possible to measure). On nervous grounds (a very difficult session) I started smoking again, yesterday and today I smoked about 5-6 cigarettes. Physical stress is not, except that I go quickly (but I always go quickly). What could it be, is it possible to relapse (considering that I took the novelty), or what could be the causes of the pain? I am very much afraid of a repetition, especially since the doctor said that if he once again will have to be cut.
12/30/2008, Dr. Sikirina
Necessary to continue taking Novinet, a week later, after the end of the first pack. The contraceptive will protect against ovarian rupture, will save the eggs for future pregnancies. Lack of periods should not worry you. If you took the pills every day, without a pass (morning reception, instead of the evening one, it’s perfectly acceptable), then there is nothing to fear. Pregnancy can not be. And with smoking, I advise you to quit, or dramatically reduce the number of cigarettes smoked, to 1-2 per day. The combined effect of cigarettes and contraceptives creates ideal conditions for vascular thrombosis.
Hello! In May of this year, I had ovarian apoplexy. Made a laproscopy. After the operation, the doctor said OK men to drink 6. I began to drink Yarina, because the annotation said that it does not affect weight. Within 4 months everything was fine, and then I began to recover dramatically. As a result, recovered by 5 kg. After that, the pills stopped drinking, because the weight was growing like yeast. Instead, the last month took vitamins - A and folic acid, and then E and C. Menstruation did not come, the delay is already a week. Pregnancy test showed no. But now I’m afraid no matter how another apoplexy comes, except for this case in May, I already had it in 2006. I was told by the doctors that for some this happens every month. And in hospital 31, where they operated on me, one doctor said that I needed to examine the cerebral cortex (or something I confuse, but connected with the brain), and take the pill - nootropil, folic acid .. I don’t remember exactly because it wasn’t prescribed treatment. I do not know what to do now. Are there any ways to prevent apoplexy, except hormonal OK, if I even start to gain weight from Yarina?
Good afternoon! I also had an operation about this, I accept OK REGULON, I do not add weight, I feel good.
Hello. A year ago there was an operation - apoplexy of the right ovary. after, drank half a year to Diane-35. Now I have been drinking nothing for half a year and the pain began in the middle of the cycle from 12 to 16 days. Why? and tell me what hormones I can donate to check the hormones. Thank.
03/10/2009, Dr. Sikirina
Ovarian apoplexy is a super-ovulation, with micro-ovarian rupture, and hemorrhage into ovarian tissue. Taking Diane-35, you stopped the maturation of follicles and ovulation. And now, the maturation of the follicles (vesicles with eggs) began with a new force, perhaps the formation of a follicular cyst. It is an overgrown follicle. We need to do an ultrasound and donate blood for LH, FSH, estradiol, testosterone, in the middle of the cycle, from 12 to 16 days, better in 13-14 days. If you live in Moscow or near Moscow, then you can contact me, an ultrasound is at your service, the tests are ready the next day.
Hello. As you said, I went through ultrasound on the 4th day of the beginning of the cycle - there is no formation of a follicular cyst. But the right (cut) ovary (size 49 by 28) is 2 times larger than the left whole (size 28 by 19). otherwise everything is fine, the sizes correspond. Tell me, can it be or has some kind of pathology already gone? Thanks, you help me a lot.
03/25/2009, Dr. Sikirina
The ovary has not had time to decrease, after resorption of the cyst. I recommend you start taking OK and spend it for at least a year to suppress the tendency to form cysts in the ovaries. If you gave birth - OK Yarin (Yarina), which improves the quality of the skin and hair. And if there were no births yet - the micro-dosed analogue of Yarin is the new OK Jess (Yaz), which should appear in pharmacies in April-May.
- 03/25/2009, Natali
Good day! I understand that I have no other options? need to drink hormones? We are planning a child, I have not given birth and have never been pregnant, and I will soon be 28 years old.
In December, a resection of both ovaries was performed (on the left is a dermoid cyst, on the right there is a rupture due to ovulation) on novaringa stayed until October. During this time, I recovered by 5 kg (with a height of 158 cm before novaring, I weighed 54-55 kg). Before that, I drank various pills (my chest was hurting from logest, from regulalon I gained a lot of weight from 45kg to 58kg, from others I took the bar off). Ovulation is painful since the onset of locomotion (started at the age of 12) and the breaks have been more than once (the treatment was conservative until a certain point). My doctor said that after surgery, these problems will disappear, but alas. Is it really necessary to sit on hormones all my life ??
Mosin Alexey Viktorovich
Psychologist, Clinical Psychologist. Specialist from the website b17.ru
it is monthly and this is the norm. I was in your situation, if after surgery a few days later menstrual periods begin - this means that the operation was successful and the ovaries are working normally, as a rule, such periods are poorer than usual because you have not grown enough for normal periods. calmly drink contraceptives. everything is good.
Oh, and I suffered with this apoplexy at one time, and now I suffer with contraceptives!
As you were told to drink, so drink.
But you were kept in the hospital for only 5 days, and I was steaming for two weeks.
Yes, that's the thing, they said nothing how to drink. After the statement I was only in 2 days, so I sit and think, but did I do right that I started drinking from this not quite natural start of the cycle. If I had not begun to drink Regulon, they would have started following me. a month or a week, as should be beaten before surgery. This is not clear to me.
Alas, in the hospital where I was brought to the ambulance, the department was full, they didn’t hold anyone for a long time, and I’m glad, you’re recovering faster at home.
do not worry, calmly drink, everything is fine. when the time comes for a regula- tion break, the menstruation will simply begin, you just block ovulation so that this does not happen again. in principle, it is important to start drinking contraception from 1–5 days so that I / c is not ripe. cancellation bleeding before you finish the pack anyway.
Hi Girls! Help 09.12.2015 operated, lane operation of the right ovary, after the operations after 5 days they were discharged from the hospital saying that everything is fine, I have not drunk anything, no two cells, for two months now there are no periods, I am in a panic what to do?
My left ovarian apoplexy operation was 04/22/2016 monthly were 04/24. Lasted 3 days. 29 issued. I took regullon but for two, I forgot about him for three days, now it seems now it starts to go again, is it a cure that I didn’t take regularly or something went wrong ?? Please tell me, and so I am all on the nerves or don’t know anything about anesthesia. For every little thing breaks.
Good afternoon. Tell me please, on September 28, I had apoplexy of both ovaries, lane operation, menstruation went scarce on the fourth day. It has already been 13 days and they still do not stop going. Is this normal?
Zdrastvuyte. March 3, I ended my monthly 9 operated on the ovary legal apoplexy 10 monthly doctors came it said it had passed normally and today 21 months monthly memory came the third time in a month please tell me this is how it should be and there is no possibility to go to the hospital
Hi Girls! Help 09.12.2015 operated, lane operation of the right ovary, after the operations after 5 days they were discharged from the hospital saying that everything is fine, I have not drunk anything, no two cells, for two months now there are no periods, I am in a panic what to do?
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Ovarian apoplexy is a hemorrhage of its cavity or organ rupture, which is accompanied by internal bleeding into the retroperitoneal space. Such a pathology occurs relatively infrequently, it accounts for about 15% of the total number of gynecological diseases. All women from 18 to 43 years are at risk of ovarian apoplexy.
This pathology develops in the middle of the cycle with or after ovulation a few days before the onset of menstruation. According to the generally accepted classification of ovarian apoplexy, ICD No. 10 code No. 83 “Non-inflammatory lesions of the ovary, oviduct and broad ligament of the uterus” has been assigned. Due to a certain difference in the intensity of blood supply, apoplexy of the left ovary is less common than apoplexy of the right ovary.
How ovarian apoplexy develops
In the absence of pathologies, every 28–30 days, one of the follicles grows - the “incubator” for the egg cell. Approximately on the twelfth-four days after the onset of menstruation, the follicle grows to a maximum (about 20 mm), breaks, freeing the female reproductive cell. Her life cycle is about two days.
In the ovary remains the corpus luteum, which produces a number of hormones to prepare the female body for a possible pregnancy. If conception did not occur, then a maximum of two weeks after ovulation begins the next menstruation.
Each ovary is densely entangled by a network of blood vessels. Due to violations of the maturation of the follicle, they become more fragile, worse reduced. First, an apoplexy of a cyst is formed inside the ovary, which can rupture and cause massive internal bleeding.
That is why it is vitally necessary for a woman to intervene with highly qualified doctors who provide assistance in inpatient conditions. Increased bleeding from the ruptured vascular bed provokes a rapid deterioration of health, and in some cases - death.
Accurate determination of the cause of ovarian apoplexy is of great importance for the prevention of recurrence of hemorrhage. However, it is not always possible to identify it. Sometimes the pathology can suddenly develop in women with “iron” health during complete rest. More often, ovarian apoplexy begins under the influence of the following reasons:
- Hormonal endocrine pathologies. What it is? A woman's menstrual cycle is regulated by a number of gonadotropic hormones that are produced by the pituitary gland, including follicle-stimulating and luteinizing hormones, prolactin. If the secretion of these biologically active compounds is disturbed, the maturation process of the follicle and the subsequent release of the egg proceed incorrectly. Such conditions can be the consequences of such a serious pathology as apoplexy of the pituitary gland.
- Vascular diseases, for example, varicose dilatation, sclerotic changes, hyalinosis.
- Inflammatory diseases of the reproductive organs.
- Cystic lesions on the ovaries.
- A long course of taking drugs that prevent blood clotting.
- Medical stimulation of ovulation.
- Complications after abortion.
- Tumor or cystoma, squeezing appendage or vessels feeding it.
- A variety of adhesions.
If one or more of the above contributing factors are present, ovarian apoplexy may be triggered:
- Weight lifting
- Intense excessive physical exertion.
- Abdominal trauma.
- Stormy coitus.
It is worth noting that a tiny gap with a size of 7 to 10 mm is enough for the onset of abundant internal bleeding. In the statistics there are documented clinical cases where doctors removed more than 2 liters of blood from the abdominal cavity.
Forms and symptoms
The disease is diagnosed in its two main forms: pain and hemorrhagic.
The painful form of ovarian apoplexy is a hemorrhage that does not extend beyond the boundaries of the affected organ. The blood almost does not fall into the abdominal area. In the symptom complex of the disease in the first place pain, which is paroxysmal in nature.
Its hallmark is the absence of irradiation. The pain is located on the side of the left or right ovary. Sometimes pain impulses are felt in tandem with much nausea or vomiting that does not bring relief.
Symptoms of ovarian apoplexy occurring in a hemorrhagic form include a clinical picture of profuse blood loss. A strong weakness develops, the skin and visible mucous membranes turn pale, cold, sticky sweat shows through. Nasolabial triangle and nails acquire a bluish tint.
Vertigo begins, tachycardia, blood pressure drops. In parallel, a woman is worried about severe pain, which begins in the lower abdomen and gives to the rectum, perineum, or leg. Sometimes symptoms such as non-abnormal vaginal bleeding, nausea or vomiting occur. Symptomcomplex is complemented by one more true symptom of ovarian apoplexy - an increase in temperature to 37.5 ° - 38 °.
A similar condition with abundant blood loss seriously threatens the health of a woman. Therefore, it is very important to identify the diagnostic signs of ovarian apoplexy in time and begin treatment.
The signs of ovarian apoplexy are a picture disguised as perforation of the oviduct during tubal pregnancy. Therefore, if the condition of the woman allows, a test is made for the human blood chorionic gonadotropin (hCG).
Conduct a thorough differential diagnosis of ovarian apoplexy, excluding inflammation of the appendix (appendicitis), leg twisting at the base of the appendage cyst, intestinal obstruction, perforated gastric ulcer, pancreatitis (inflammatory disease of the pancreas). In addition, pain impulses that accompany the disease, resemble signs of renal colic. For the final diagnosis will require several mandatory steps, which can not be ignored. We list them:
- Collecting complaints.
- Visual inspection. With an anemic form of ovarian apoplexy, the following symptoms are observed: severe pallor, soreness of the affected ovary, tension of the abdominal wall. To determine the presence of blood in the abdominal cavity, you can use percussion: during the tapping of the abdominal area revealed free fluid.
- Gynecological examination. If there is no hemorrhage in the abdominal cavity, then during a pelvic exam, the vaginal walls have a normal shade. Otherwise they are pale. The uterus is of normal size. With an anemic form of apoplexy, the vaginal walls hang. It is almost impossible to feel the size of the ovaries because of the strong pain syndrome.
- Clinical blood test. In case of internal bleeding, a decrease in hemoglobin concentration may be observed in the results of a clinical blood test, but in some cases this indicator remains unchanged or, on the contrary, is increased due to an increase in blood viscosity. The number of leukocytes increased to 9.5 - 15 × 109. The hematocrit value changes. It falls to 18.
- Ultrasound of the pelvic organs. With a painful form of apoplexy, an ovary rupture and a small accumulation of liquid with a fine suspension are clearly visible. This is a follicular fluid mixed with blood. When the hemorrhagic form in the abdominal cavity is determined by a large amount of fluid with echogenic inclusions. These are blood clots.
- Diagnostic laparoscopy. Earlier this was done puncture through the posterior surface of the vaginal wall. But now this procedure can be avoided. Laparoscopy allows you to urgently carry out the necessary therapeutic manipulations to eliminate bleeding.
Diagnosis and therapy are carried out only in the hospital. It is necessary to emphasize that home treatment with various folk remedies is associated with the risk of developing life-threatening complications.
Minimally invasive laparoscopic surgery for ovarian apoplexy has several advantages. First of all, it is the minimum risk of side effects, a relatively short recovery period (only about a week), the absence of scars.
During laparoscopy, the surgeon always tries to preserve the integrity of the organ. Removal of the ovary is indicated only as a last resort. During the operation, cysts are removed, the organ is sutured, the abdominal cavity is cleared of blood, clots and tissue residues to prevent the development of complications.
Sometimes apoplexy is also possible during pregnancy. In this case, laparoscopy is performed without removing the corpus luteum. If there is no massive internal bleeding, then it is quite possible to save the pregnancy. If desired, photo and video operations can be found on the Internet on specialized sites.
If for any reason laparoscopy is impossible, then an emergency laparotomy (abdominal surgery) is performed.
Within one to two weeks after the surgery, the patient is discharged home and is recommended to be regularly examined by a gynecologist. To prevent the development of adhesions, physiotherapy is prescribed (ultrasound, alternating magnetic field, low-frequency pulses, electrophoresis, ultrasound therapy, UHF).
Monthly after apoplexy begin a few days after surgery. Discharges may be poorer than usual. Delayed menstruation may indicate complications.
Pregnancy after ovarian apoplexy is contraindicated within six months after surgery or the end of drug therapy. For contraception prescribed hormonal contraceptive drugs. In addition, these pills help normalize the menstrual cycle and hormonal levels. Usually, estrogen - progestin tablets with a minimum dose of hormones are used for this purpose. These are marvelon, mercilon, regulon, janin, femoden, logest.
To improve blood circulation, nootropic drugs (nootropil, coventon) are shown, with increasing blood pressure - diuretics. Sometimes prescribed sedatives or stronger tranquilizers to eliminate psychological discomfort.
Before conception, it is recommended to perform a diagnostic laparoscopic operation and an ultrasound scan to assess the effects of ovarian apoplexy: conditions of the sutured ovary and endometrium of the uterus, patency of the fallopian tubes, absence of adhesions and inflammation.
Etiology of the disease
The causes of the rupture of the ovary are quite diverse, but most of them are associated with pathologies that occur in the structure of the organ. Among the most common reasons should be highlighted:
- the presence of inflammation of ovarian tissues, the cause of which may be sexually transmitted infections, disturbances of microflora, severe hypothermia,
- varicose veins of the ovary - occurs due to heavy physical work, repeated pregnancy, endometriosis, elevated estrogen levels, prolonged use of hormonal contraceptives,
- polycystic ovary - a pathology that interrupts the flow of the menstrual cycle and causes infertility,
- stimulation of the maturation of the egg by the drug method - rupture of the organ occurs as a side effect of this procedure,
- abnormalities in the structure of neighboring organs, the presence of tumors exerting pressure on the ovary,
- the presence of adhesions,
- violations in the system of blood clotting.
The disease is caused by a strong blood flow to the sex glands, which provokes a rupture. More intensive blood supply to the right ovary causes it to break more often than the left one. The disease is usually acute; various external factors can trigger it, such as:
- intense intercourse,
- unnecessarily heavy physical activity associated with weight lifting,
- horseback riding,
- bruises and injuries of the abdomen,
- long stay in the sauna or bath,
- a rough gynecological examination.
In some cases, ovarian apoplexy can occur without the participation of provoking factors when a woman is in a state of physical inactivity.
Symptoms of ovarian apoplexy
The main symptom is a sudden sharp pain in the lower abdomen. The pain is compounded by severe cramps, dizziness, nausea, vomiting and general weakness of the body.
The cause of severe pain is the pressure of accumulated blood on the pain receptors of the surrounding tissues. They can give to the navel, lower back, anus, leg. Severe blood loss causes general ill health, as the body suffers from an acute lack of oxygen.
Ovarian apoplexy is also typical:
- A sharp decrease in blood pressure, increased heart rate, heart palpitations, blanching of the skin. The patient noted strong thirst, the skin is covered with cold sweat.
- Vaginal bleeding, resembling menstruation, but not so abundant and occurring in the middle of the cycle. Sometimes rupture is preceded by delayed menstruation.
- Frequent urination and false urge to defecate. This is due to the stretching of the walls of the bladder under the influence of certain hormones, as well as due to the pressure of the mass of blood on the rectum.
Forms of the disease
The disease can occur in several forms. There are pain, anemic and mixed forms.
The painful form of ovarian apoplexy is accompanied by severe pain, nausea and vomiting. The patient has no signs of internal bleeding and anemia. It is not uncommon for an ovarian rupture without bleeding to be mistaken for appendicitis due to similar symptoms of the disease.
When the patient is anemic, all signs of internal bleeding appear. Large blood loss leads to the development of signs of anemia. These are weakness, pallor of the skin, dark circles under the eyes, dry mouth, dizziness and fainting.
The degree of blood loss may be different. It is classified as:
- easy (the amount of lost blood does not exceed 150 ml),
- medium (the body loses up to 300 ml of blood),
- severe (blood loss reaches 500 ml and above).
With the development of a mixed form, there are signs of both forms of the disease: abdominal pain and symptoms of anemia.
Conservative treatment of ovarian apoplexy is prescribed when there is no internal bleeding at rupture or with its insignificant volume (up to 150 ml). The patient must comply with bed rest, she is prohibited even the slightest exercise. Hemostatic therapy, antispasmodics and vitamins are prescribed to stabilize the condition, eliminate pain and general body strengthening.
The task of antispasmodics is to eliminate muscle spasms and relieve pain in the abdomen. Means produced in the form of intramuscular injections or tablets for oral administration. They reduce the increased muscle tone, relax the muscles of the internal organs, accelerate the flow of oxygen into the tissues. Effective drugs Buscopan, Papaverine, No-shpa.
Hemostatic or hemostatic drugs can reduce the volume of lost blood and speed up the process of platelet formation. They are administered intramuscularly and intravenously. It should highlight drugs Etamzilat, Tranexam, Amben.
Vitamin therapy is necessary to normalize the vital functions of the body, reduce the intensity of bleeding, and normalize the functioning of individual internal organs. They increase the ability of blood clotting. The purpose of vitamins B1, B6, B12 is shown.
Recommended attachment of ice to the lower abdomen, douching with the addition of iodine, candles with Antipyrine. For the prevention of anemia, iron preparations are prescribed (Sorbifer, Fenuls).
Data from medical studies show that treatment of apoplexy without surgery is often not effective enough and leads to the formation of adhesions in the pelvis or the development of secondary infertility. There are frequent cases of repeated ruptures, since conservative methods do not completely relieve the abdominal cavity from accumulated blood and clots.
Considering all the risk factors, doctors generally prescribe conservative treatment for women who have already given birth. Patients who are still planning a pregnancy, laparoscopy is shown.
The advantages of laparoscopy are obvious: it is an innovative and at the same time sparing technique that allows you to completely clear the abdominal cavity from accumulated blood clots and blood clots. It aims to preserve the ovary. This is especially important for women who are still planning to become mothers in the future.
Other advantages of the method:
- gentle operation,
- the absence of intense pain and gross cosmetic defects at the site of the incision,
- minor use of painkillers
- minimal risk of formation of adhesions and other complications,
- short recovery period after surgery,
- psychological comfort
- maintaining the full functioning of the body.
Surgery for ovarian apoplexy involves careful repair of damaged tissues. Removal of the ovary is carried out only in the presence of excessive blood loss, when it is impossible to preserve the integrity of the damaged tissues and vessels. The amount of blood accumulated in the abdominal cavity, allows you to determine the time of rupture of the body.
Laparoscopy for ovarian apoplexy
If a rupture occurred during a woman’s carrying a child, surgery will prevent a miscarriage and preserve the pregnancy.
There are a number of contraindications in which laparoscopy is not performed:
- severe pathologies of the liver and kidneys,
- bronchial asthma,
- myocardial infarction or stroke
- the presence of large tumors (more than 10 cm in diameter),
- obesity, which interferes with the procedure,
- the presence of a purulent process (peritonitis),
- disruption of the blood coagulation system,
- abdominal hernia
- significant loss of blood and severe exhaustion of the body.
Laparoscopy is undesirable if the patient has an inflammation of the abdominal cavity or a malignant tumor of the genital organs. Not recommended procedure and allergies to drugs, as well as in the second half of pregnancy.
При наличии противопоказаний к лапароскопии проводят лапаротимическую операцию. During its holding, an incision up to 10 cm long is made in the area of the suprapubic region. After surgical intervention, additional antibacterial therapy is necessary.
Period after surgery
After laparoscopy, the recovery period lasts from several weeks to one or two months. Within a week after surgery, the patient should be in the hospital. After discharge, she needs to undergo regular examinations by a gynecologist and a general practitioner. All women who have undergone ovarian apoplexy should be registered in the antenatal clinic for a period of up to one year. Routine inspections are carried out every three months.
Successful recovery after suffering apoplexy excludes the development of negative consequences. With the preventive purpose, to avoid the development of adhesions, prescribe physiotherapy (ultrasound, electrophoresis, UHF).
Approximately 5-6 days after surgery, menstruation should begin. It takes place as usual, sometimes the discharge is poorer than usual. If there are no monthly periods, it is necessary to inform the attending physician about this in order to avoid the risk of complications.
After laparotomy, you must wear a special compression garment or bandage for two months. Sex life during the entire recovery period should be completely excluded.
Most women are concerned about the question, when will their body regain its ability to bear a child and when is pregnancy possible after ovarian apoplexy?
After timely surgical intervention, the ability to fertilize and give birth to a child remains. Even if the ovary was completely removed, it should not sound like a sentence. The eggs will mature in another organ, and the woman will be able to realize her dream of becoming a mother.
However, planning a pregnancy after surgery, you must follow some rules. So, conception should not occur earlier than six months after surgery, when the course of full recovery has not yet been completed. Preventive measures are necessary to prevent the development of adhesions, since the presence of adhesions can be the main obstacle to the occurrence of pregnancy.
In addition to regular physiotherapy sessions, hormonal contraceptives are prescribed. They not only protect against conception that is too early after surgery, but also help the body restore hormones and minimize the risk of complications. The recommended drugs - Novinet, Regulon, Yarin. Since hormonal contraceptives have a number of contraindications, their reception is possible only after a doctor's prescription.
Consequences and complications
The consequences of ovarian apoplexy are conditionally divided into early and distant. Early complications include complications that occur during treatment and directly during the rehabilitation period.
It should be remembered that ovarian rupture is a very dangerous disease. If the patient does not provide medical care in time, with large blood loss, it can be fatal. Self-treatment or the use of folk remedies is strictly prohibited. Late emergency call is fraught with the development of hemorrhagic shock.
Late complications occur after a certain time after the operation or complex treatment.
- The development of adhesions in the pelvic organs. They arise as a result of incomplete cleansing of the abdominal cavity from accumulated blood clots and blood clots. They can also be formed when a woman refuses to undergo surgery, when during treatment they are limited to methods of complex therapy.
- Infertility. Usually observed after removal of the ovary. Although the probability of becoming pregnant is quite high, such consequences can occur if there are adhesions or hormonal dysfunction.
- Ectopic pregnancy. The resulting adhesions prevent the fertilized egg from moving freely to the uterus. The egg gets stuck in the thickness of the fallopian tube, forming an ectopic pregnancy.
- Risk of re-rupture. May be caused by pathological changes in the hormonal background. The risk of relapse increases if the treatment is limited to conservative methods.
Complications after surgery can be avoided if the woman performs all the settings of the doctor and regularly undergoes examination by a gynecologist.
The transferred surgery does not mean at all that the patient cannot lead a habitual way of life for her. Moderate physical activity has a positive effect on the body's recovery process during the rehabilitation period.
After laparoscopy, you can get up and gradually move around the ward at the end of the first day. In the early days, special exercises designed for individuals who have undergone gynecological surgery are shown.
Such exercises help prevent adhesions, strengthen the abdominal wall, and gradually restore the normal functioning of the ovary. In addition, they contribute to the improvement of the endocrine and digestive systems, have a positive effect on the overall psycho-emotional state.
Regular walking with a gradual increase in distance, breathing exercises, exercises for turning the body and imitation of walking while lying down contribute to successful recovery.
Caution should be exercised in the implementation of exercise in the presence of the following diseases:
- increased risk of blood clots,
- severe anemia
- malfunctions of the cardiovascular system, respiratory disorders,
- the presence of malignant tumors,
- development of postoperative complications.
How justified is sports after ovarian apoplexy?
You can return to regular exercises in the gym after the completion of the recovery period, that is, no earlier than 2-3 months. It should take into account the individual characteristics of the body and overall health.
Unfortunately, even a properly conducted treatment does not give a full guarantee that the ovary rupture will not recur. Therefore, all physicians recommend to follow certain rules that will help avoid relapse.
Prevention of ovarian apoplexy should begin immediately after surgical treatment. Her main task is to prevent the development of adhesions and gradually normalize the disturbed menstrual cycle. The patient is recommended physiotherapy and hormonal drugs.
Preventive measures are developed individually and should take into account the age of the woman, the general state of health, the conditions in which the treatment took place, the presence of complications in the postoperative period.
The development of a set of preventive measures should take into account:
- the amount of surgery
- previous gaps and other gynecological diseases,
- hormonal status,
- conditions of the recovery period.
Also recommend the observance of some general preventive measures shown in gynecological diseases:
- timely treatment of various infections and inflammations,
- regular examination by a gynecologist,
- hormonal contraceptives between pregnancies,
- Passing an ultrasound at least once a year
- avoid hypothermia, heavy physical labor, weight lifting,
- follow the diet, fight overweight,
- lead an active healthy lifestyle.
Ovarian apoplexy is a serious disease not only of one organ, but of the entire reproductive system. His diagnosis and treatment should be carried out exclusively in the hospital under the supervision of experienced doctors. Compliance with all the rules of treatment will preserve the ability of women to bear children and eliminate the possibility of a relapse of the disease.
Causes of illness
Pathology is associated with the structural features of the ovarian tissue. The preceding factors include changes in vascular permeability depending on the phase of the menstrual cycle. With their expansion as a result of filling with blood, the integrity of the ovary can be broken. This leads to the ingress of blood fluid into the posterior cavity.
Most often, ovarian apoplexy occurs in the presence of cystic formations or mature follicles. In this case, the gap shells fall on the second half of the menstrual cycle. This phenomenon is often accompanied by a delay of menstruation. To break more inclined right ovary, because it is characterized by a rich blood supply and discharge of arteries from the main aorta.
The causes of the disease include the following:
- inflammatory processes
- ovarian hyperstimulation syndrome,
Inflammation of the appendages in medicine is called oophoritis. It develops as a result of the entry of pathogens into the cavity of a ripe follicle. This leads to the filling of the appendage with blood and purulent fluid. The ovary becomes edematous, painful sensations appear in the place of its local location.
When illnesses of the inflammatory nature of the ovarian walls become vulnerable. The causes of pathology include hypothermia of appendages, abnormal organ structure, infectious diseases and neglect of hygiene. With apoplexy caused by inflammation, pain can appear at any stage of the menstrual cycle.
Varicose veins of the ovary
The pathology of the structure of the veins is indicated by painfulness during intimacy and pulling sensations in the lower abdomen, appearing regardless of the days of the menstrual cycle. The causes of the disease include inflection of the uterus, long-term use of oral contraceptives, physical overstrain and various neoplasms in the pelvic area. In most cases, venous dilation is observed. in women who have not given birth. Sometimes the cause of its development is an increase in the level of estrogen in the body. Together with varicose veins, polyps may be present in the uterus, endometriosis and fibroids.
The consequences of the disease include not only apoplexy, but also thrombosis. Pathology significantly reduces fertility and is an obstacle to carrying a child. Ovarian varices are often accompanied by hemorrhoids and varicose veins of the lower extremities.
Drug Ovulation Stimulation
One of the causes of apoplexy is hyperstimulation as a result of drug treatment. It is carried out in the absence of a woman's ovulation in order to successfully conceive. Appointed hormonal drugs that promote the growth of follicles. The physiological norm is the maturation of one or two eggs. As a result of artificial stimulation, several dominant follicles are visualized. This phenomenon is called overstimulation. She is extremely dangerous for the health of women.
The result of this state is multiple ovulation. Several follicles burst at intervals of 12-24 hours. At this time, the woman feels intense pain. The follicular fluid fills the region of the backspace, irritating the peritoneum and causing spasms. With multiple ovulation, the ovary can withstand a large load, so at any time its integrity can be broken. The provoking factors of hyperstimulation include:
- polycystic ovary syndrome,
- age over 35 years
- exceeding the dosage of clomiphene or chorionic gonadotropin,
- high levels of estradiol in the body.
Ailment occurs as a result of hormonal failure, infectious diseases or hereditary predisposition. Pathology is characterized by the formation of multiple cysts on the ovaries. They tend to grow, which leads to an increase in the volume of the appendage and its rupture. For polycystic characterized by increased production of male hormones. The signs of the disease include:
- weight gain
- male type hair growth
- decrease in sexual desire.
The reason for the formation of cysts is too dense ovarian membrane. The mature follicle regresses because the egg cannot exit. Pregnancy in this case does not occur. As a result, the dominant follicle develops into a cyst, which may burst under the influence of certain factors.
Forms of pathology
Given the symptoms of apoplexy emit hemorrhagic, painful and mixed forms. In the first case we are talking about an intense pain syndrome with abundant hemorrhage into the abdominal cavity. The second type is accompanied by severe pain. Depending on the amount of blood lost, mild, moderate and severe degrees of the disease are released.
The intensity of the manifestation of signs of pathology depends on the neglect of the background disease. Indicate internal bleeding pallor of the skin surface, chills, dry mouth and lowering blood pressure. But also present nausea and vomiting, the state becomes close to unconscious. Maybe a minor increase in the abdomen. From the mammary glands can be allocated serous fluid.
Lower abdominal pain
Pain is concentrated in the lower abdomen and in the lumbar region. They can give to the rectum and legs. During the gynecological examination, the pain syndrome increases with palpation of the ovary. The nature of the pain is sharp, cramping or pulling. While driving, discomfort is growing. A few days before the rupture of the appendage, dull pain is observed.
Against the background of lack of oxygen to tissues, powerlessness appears. With heavy bleeding, the functioning of the nerve cells of the brain slows down, as a result of which apathy develops. With oxygen starvation of myocytes, muscle weakness is observed. The more blood a woman loses, the worse her health will be.
Violation of the menstrual cycle
Against the background of apoplexy, monthly disruptions are often observed. At the same time there are intermenstrual bleeding. In some cases, the rupture of the ovary falls on the period of critical days, which complicates the diagnosis of pathology. The woman does not immediately pay attention to the symptoms that appear, associating them with the onset of menstruation. In rare cases, the cycle remains regular.
As a result of pressure on the walls of the bladder, the process of de-urination is increasing. The number of urges per day exceeds 10 times. Sometimes frequent trips to the toilet caused by taking diuretic drugs prescribed by a doctor. In infectious processes discomfort and burning in the urethra can be observed.
Complications and prognosis
In the absence of quality and timely assistance, hemorrhagic shock caused by a pressure surge can cause to death. Complications of apoplexy include female fertility decline and high probability formation of adhesions. If the treatment was carried out in time, you can save the appendages and restore reproductive function.
Monthly and ovarian apoplexy
The nature of menstruation after the transfer of the disease changes even in case of successful therapy. Blood volume on critical days may increase, rises and intensity of pain. In some cases, there are long delays. Their appearance is due to hormonal changes after surgery. If one of the appendages was removed, the length of the menstrual cycle will increase. Fully work of the reproductive system is restored in 6-12 months.
Ability to get pregnant
The ability to conceive is preserved in the event that measures were taken in a timely manner. Usually during surgery, only a portion of the ovary is removed. It does not affect the maturation of the follicles. Difficulties may arise with the development of adhesions. It is an obstacle to a fertilized egg. In the presence of adhesions increases the risk of developing ectopic pregnancy.
Most often for a verdict is enough to conduct a visual inspection of the genitals. First, the appearance of the small and large labia is evaluated. Then the mucous surface is examined using a special expander and a mirror. The characteristic signs of apoplexy include the paleness of the inner surface of the vagina and the swelling of the peritoneum. But there may also be bloody discharge of varying intensity. During palpation of one of the ovaries, severe painful sensations are observed.
Ultrasound of the pelvic organs
The most reliable way to diagnose pathology is ultrasound monitoring. During apoplexy, the doctor registers an increase in the volume of the ovary, the presence of the corpus luteum or cysts, as well as fluid in the back space. The volume indicates the intensity of blood loss. Diagnostics device ultrasound is carried out with extreme care, so as not to aggravate the existing situation.
This method of surgery is practiced not only for diagnosis, but also for treatment purposes. The operation is performed under general anesthesia. The abdominal cavity is filled with gas in order to make the appendages better visible. In the area of the navel and ovaries, cuts are made through which the instruments are inserted. On one of them there is a camera that fixes the state of the genitals.
During laparoscopy, the damaged area of the ovary is removed. In general, the operation lasts 30-40 minutes. Some time after the intervention, the woman is allowed to perform physical activity.After seven hours, the first meal is taken. 2-4 days after surgery, the patient is discharged.
Conservative treatment of pathology
Medical methods Therapies are used as an adjunct to surgery. Prescribe drugs that reduce pain and stop bleeding. The patient is indicated bed rest and applying hot water bottles on the lower abdomen. During the recovery period can be prescribed hormonal drugs. They contribute to the regulation of the menstrual cycle.
The task of antispasmodic drugs is to relax the smooth muscles, which allows to stop the pain syndrome. Means prescribed for internal use and intramuscular administration. Effective medications include No-silo, Buscopan and Papaverine. The treatment regimen is prescribed individually.
These funds accelerate the process of platelet formation and stop the bleeding. Such medicines are administered intravenously or intramuscularly. These include Amben, Etamzilat and Tranexam. Appropriate therapy is indicated for women with bleeding disorders.
They are necessary to restore the body's defenses. When apoplexy prescribed vitamins groups B12, B6, B1. They have a strengthening effect on the blood vessels and increase blood clotting. Injections are given intramuscularly, sometimes combining with aloe injections.
The operation can be carried out as in the traditional wayso with laparoscopy. In the first case, an incision is made with a scalpel in the suprapubic area. Through it opens access to the abdominal cavity. Laparoscopy does not imply abdominal incision of the skin. Both types of surgery can remove damaged tissue, suture the ovary and deflate excess blood.
The choice of surgical treatment method is based on the severity of the disease. With a mild form of apoplexy, there is no need for a traditional operation. But the presence of adhesions, patient well-being, comorbidity and other factors are also taken into account. Most often practiced laparoscopic surgery.
Apoplexy is a condition that requires special attention from medical professionals. Treatment is possible only when in the hospital. It depends on the woman how quickly the body recovers. Careful attitude to your health reduces the risk of development of pathological processes in the pelvic area in the future. With a positive dynamic, a woman can become pregnant and successfully carry the child. But there is also the likelihood of reduced fertility due to adhesive and inflammatory processes in the pelvic area.
Reasons for changes in the menstrual cycle after apoplexy
The condition is accompanied by a number of changes in the body of a woman. Much depends on what form of apoplexy was established.
With painful form in the first place are paroxysmal pain in the lower abdomen on the background of a small blood loss. In this case, conservative treatment is sufficient to relieve symptoms. At this point, the following occurs in the ovary - its tissue suddenly breaks in some place (usually a linear defect not more than 1 cm in length), it can release a small amount of blood.
In response, the body reacts with smooth muscle spasms, nerve endings are irritated, which causes pain.
At the same time, the tissues of the ovary suffer slightly - there is no hematoma, no large tears, there is no need for surgery. Therefore, menstrual disorders will not always.
Anemic form of apoplexy characterized by rupture of the ovary and vascular damage, which causes intra-abdominal bleeding. The pain is also present, however, the clinical picture of blood loss prevails. This condition always requires surgical treatment, otherwise there is a threat to the life of a woman. During the manipulation can be carried out the following:
- rupture point is burned by electrodes,
- it is necessary to remove part of the ovary due to the hematoma formed or its increased bleeding,
- a cyst is found and must be removed.
This leads to the fact that the corpus luteum, which is formed after ovulation, is almost always removed. Namely, it synthesizes progesterone, which “supports” the second phase of the woman’s cycle for another 14 days. A sharp drop in its level leads to a menstrual-like reaction - on 2-5 days after surgery, women report the appearance of bleeding from the genital tract, which should be considered the beginning of a new cycle.
You should also consider what was provoked apoplexy. Stress, psycho-emotional stress, physical exertion can also indirectly affect ovarian function.
And here more about the features of menstruation with ovarian cyst.
What are the monthly
If treatment for apoplexy is only conservative, then the menstrual cycle may not be disturbed. A slight delay may be caused by stress, medication.
If there is a need for surgical treatment, the majority of women in this case note the appearance of bleeding 3-10 days after the intervention. This is a menstrual-like reaction most often:
- is not abundant,
- may be accompanied by smears before and after,
- sometimes there is a slight pain in the lower abdomen, even if earlier periods were painless,
- usually the discharge lasts a little less than usual - two or three days.
Less often girls celebrate heavy periods. Sometimes there is only a small daub.
Some girls with an irregular cycle note that after surgery the periods become “like a clock” and this can last more than one month. Especially often this happens when polycystic ovaries. This is normal. Manipulations on the ovaries in this case are similar to those carried out during surgery for polycystic disease. This is sometimes referred to as "ovaries stirred up." The likelihood of pregnancy in this case also increases.
If during the operation a large part of the ovary had to be removed, then it may lead to their early exhaustion. In this case, the girl will celebrate scanty and sometimes even rare menstruation.
Sometimes after ovarian apoplexy, oral contraceptives are recommended. Menstruation on this background can be scanty, but they are always regular and slightly painful. In the first three months, it is allowed to get used to the drug in the form of heavy acyclic secretions.
Pain after ovarian apoplexy
Ovarian rupture in any case is accompanied by blood loss - small or large, which determines the further tactics of treatment. In addition to blood, various proteolytic enzymes are activated in the pelvis during apoplexy, and fibrin is deposited on the tissues. All this contributes to the formation of adhesions in the pelvis, which can later become can cause pain both during the menstrual cycle and on other days.
In addition, adhesions can be formed immediately after the operation, especially if it was performed laparotomically - through a transverse or longitudinal incision on the skin of the abdomen.
On average, the first two or three cycles may be more painful, after which everything should become as it was. If the pain continues to worry further, you should undergo a comprehensive examination.
Pregnancy after the procedure
Ovarian apoplexy does not reduce the chances of conception. And in some cases, even the opposite, for example, when polycystic or prone to cyst on the ovaries. But It is better to plan a pregnancy in the following terms:
- not earlier than in a month - if there was a painful form of apoplexy,
- in 3-4 months - if there was a surgical treatment, but the blood loss was small,
- not earlier than six months later - in case the hemorrhagic form of apoplexy was severe, there was a large blood loss and blood transfusions were required.
The body needs time to recover. In order not to be nervous about a possible pregnancy (and sex is resolved within two to three weeks, depending on the treatment), it is recommended to start taking oral contraceptives for a period of three months.
And here more about the features of the restoration of menstruation after Diferelin.
Apoplexy, depending on its form, may require prompt or conservative treatment. This affects the girl's menstrual cycle and often leads to malfunctions. If you have any doubts or suspicions of any disease, you should consult your doctor for further evaluation.
See in this video about what is ovarian apoplexy, the symptoms and complications of the pathological condition:
Periods begin after Postinor, often with a weekly delay. It can go only three days. In general, it all depends on the period when the pills were taken. If there is no menstruation, pregnancy has come.
Often monthly with ovarian cyst come with delays, failures, clots. But their character is influenced by the type of education, as well as the factors that led to its appearance.
Often, menstrual periods with adnexitis change - pain increases, there may even be a temperature, an unpleasant smell. But for some they remain unchanged. After treatment, the period must recover.
Diferelin - a serious drug. He introduces a woman into artificial menopause. Accordingly, the monthly virtually cease. How will they go and when will menstruation recover after Diferelin?
What are the ovaries and what are they meant for?
Ovaries - It is an organ (paired), located in the pelvis on both sides of the uterus. Its average size: width - about 2 cm, length - 3 cm, thickness –1 cm. But it should be borne in mind that these dimensions may vary depending on the menstrual phase. The ovaries play the role of the female gonads, in which progesterone and estrogen (sex hormones) are produced and an egg cell is formed (monthly). They join the uterus with special bundles.
Causes of ovarian apoplexy
- The pelvic organs (ovaries, uterus, fallopian tubes) are inflamed. The tissue and feeding vessels of the ovary are modified, which leads to rupture.
- Expansion (varicose) of the ovarian veins and their change.
- Violation of the ratio of hormones in the body.
- Acceptance of certain medications that contribute to blood thinning.
- Blood clotting disorder.
Factors provoking the disease
- Abdominal trauma.
- Difficult defecation.
- Abdominal strain.
- Horseback riding.
- Sexual intercourse during menstruation.
- Gynecological examination.
- The formation of adhesions in the pelvis.
- Incorrect position of the uterus.
- Disruption of blood flow in the vessels of the ovary.
- Myoma or uterine tumor, pressing on the ovary.
Pregnancy after ovarian apoplexy
The process of ovarian rupture does not affect the future possibility of conception. The fact is that during the operation to treat ovarian apoplexy, its partial removal is performed, while the healthy tissues remain. Even if it was removed completely, the egg can grow and mature in the second intact ovary..
The only difficulty for conception may be adhesions in the abdominal cavity, which in some cases are formed after surgery.
Ovarian cyst rupture may occur during pregnancy. In such cases, surgery is necessary by laparotomy. Pregnancy remains, but the risks of interruption are increasing.
What is ovarian apoplexy
Ovarian apoplexy is a sudden hemorrhage in the ovary when the vessels rupture of the graaf bladder, ovarian stroma, follicular cyst or cystic of the corpus luteum, accompanied by a violation of the integrity of its tissue and bleeding into the abdominal cavity.
Subject to this disease, women of all age groups to the border in 45-50 years. The diagnosis of ovarian apoplexy accounts for 1-3% of the total number of gynecological diseases. Recurs the disease in 42-69% of cases.
In most patients (90%), ovarian apoplexy occurs in the middle or in the second phase of the menstrual cycle. This is due to the peculiarities of the ovarian tissue, in particular, to the increased permeability of the vessels and an increase in their blood supply, arising during the period of ovulation and before menstruation.
Symptoms of ovarian apoplexy
Pain may sometimes accompany vomiting and nausea, but there is no evidence of intra-abdominal hemorrhage.
- On examination, the usual color of mucous membranes and skin is revealed.
- The rate is also observed when measuring blood pressure and pulse rate.
- Clean and moist tongue when viewed.
- When observing a slight rigidity in the muscles of the lower part of the anterior abdominal wall is allowed, the abdomen is soft.
- The peritoneal symptom does not appear, only slight discomfort is possible in the iliac right area.
- The presence of percussion-free fluid is not detected in the abdominal cavity.
- A gynecological examination shows the uterus of a normal size, the ovary slightly enlarged, painful.
- The patient's vagina is also free and deep.
- When ultrasound of the pelvic organs, ovarian apoplexy is very rarely visualized, more often a small volume of fluid is found in the Douglas space, and a small dispensary mixture - a follicular fluid with blood impurities.
- A clinical analysis of blood for small leukocytosis has no left shift, no marked changes.
Symptoms of intra-abdominal bleeding are observed with a hemorrhagic form of ovarian apoplexy of moderate and severe severity.
Irradiation takes place in the anus, leg, sacrum, external genitals, and pain is often localized in the lower abdomen. As a rule, the disease is accompanied by the following symptoms:
The amount of intra-abdominal loss expresses this symptom.
- The patient's skin is pale, the mucous membranes are also visible.
- There is a sticky cold sweat.
- Tachycardia and reduction in blood pressure is observed in the study of the cardiovascular system.
- Dry tongue, intense stomach, it is accompanied by a slight swelling.
- Palpation reveals a sharp pain throughout the hypogastrium or in a certain iliac region.
- Peritoneal symptom in the lower sections.
- It is possible to definitely identify the free fluid in the sloping abdomen (right and left side channel).
A gynecological examination shows the vaginal mucosa colored in a normal or pale color. The anterior abdominal wall makes it difficult to inspect the two-handed study. The uterus is painful, of normal size, on the apoplexic side, an ovary is detected, enlarged in size, also painful. Anemia is seen in clinical blood tests. In the initial phases of the disease, the patient's blood thickens and, as a result, the level of hemoglobin increases. Leukocytes increase slightly, but the indicator does not move to the left.
Hemorrhagic ovary apoplexy is diagnosed by ultrasound. When it shows the presence of a significant amount of free fluid, located directly in the abdominal cavity with the structure of the pathological form and blood clots.
Why menstruation can be broken?
The ovaries mean a lot for menstrual function. These organs alternately produce sex cells, the degradation of which outside of conception leads to the replacement of the upper endometrial region. They produce hormones that are essential for its growth.
When you break the blood vessels of one of the organs, blood leaks into its tissue or abdominal cavity. This provokes disruption of the ovary, pain, requires medication, and in some cases, surgery.
Often, vascular damage is provoked by other gynecological ailments. In general, for menstruations that have come after ovarian apoplexy to take on a different look, there are several reasons:
- Hormonal and functional impairment, caused by both an obvious cause and related illnesses,
- The use of drugs.
All circumstances interfere with the proper formation of the endometrium, and therefore the amount of menstrual flow can change in any direction.
A rupture of the ovarian vessels or apoplexy as a result of a cyst provokes a disturbance in the normal functioning of the organ
Often, after a diagnosis has been made during the course of therapy, critical days occur on time. Ovarian vascular rupture often manifests itself against the background of ovulation, and when menstruation is not late, it means a rapid restoration of organ functions and the absence of other gynecological problems.
After ovarian apoplexy, menstruation is also delayed. The most important culprit of this is the failure of hormones, which is a shortage of essential components for the implementation of the menstrual function, often progesterone. And the amount of estrogen, by contrast, is high due to an increase in the production of FSH, LH and prolactin.
The reasons already mentioned here accompanying the diagnosis are also able to delay critical days. Pain, drugs, stress inhibit the cyclical development of not only the reproductive system, but also the processes occurring in the pituitary gland. But he organizes the smooth functioning of the ovaries. To support their work, to minimize violations of the cycle, after providing emergency care prescribed a course of hormonal drugs.
Менструация у перенесших апоплексию яичника
Скудные месячные после апоплексии яичника
How the first menstrual periods after apoplexy occur depends on the degree of damage to the organ, the chosen method of treatment and a variety of related factors. Discharge at this time may be more scarce due to insufficient development of the endometrium, interrupted by a sudden malaise.
If it is caused by inflammatory diseases, polycystic cysts, cysts, such menstruation may remain in the future until their elimination. But in the absence of such ailments, menstrual periods after apoplexy return to the usual parameters peculiar to a particular organism.
The ingress of fluid into the abdominal cavity forces the operation, during which the ovary is sutured, blood is removed. This is a more difficult test for the organism as a whole, especially for the reproductive organs. Accordingly, the monthly after lane apoplexy may be delayed for a longer period, up to 1.5-2 months.
This is caused by a more serious condition of the woman during the illness, possibly blood loss. When critical days come, discharge is poorer than usual.
In case of severe injury to the ovary, it is removed partially or completely. In the first case, the organ remains working, follicles continue to form in it and eggs mature, that is, menstruation has the same appearance. Removal of one of the ovaries will lengthen the cycle, but retain the menstrual period and the ability to bear children. Allocations may be quantified.
We recommend reading the article on menstruation with ovarian cyst. You will learn about follicular and endometrial cysts, the reasons for their appearance, the consequences after a rupture of a cyst, as well as the change in the menstrual cycle after surgery.
Pain during menstruation after ovarian apoplexy
Pain after ovarian apoplexy during menstruation and with successful treatment of 1-2 cycles may be more pronounced than before. This is caused by movements of the smooth muscles of the uterus in the process of getting rid of the outgrown endometrial tissues. They can create vibrations that will respond in a damaged, healing organ.
But if the sensations are very strong, and the discharge is intense, it is likely that there are other gynecological problems that triggered the emergence of apoplexy:
- Endometrial hyperplasia,
- Endometrial polyps,
- Ovarian cyst.
Pain in critical days after rupture of blood vessels can be one of the consequences of the formation of adhesions in the affected organ, the fallopian tube. They are formed due to blood spilling and impaired by this tissue regeneration.
In order not to force the woman to endure the pain and to guess about her origin, some time after the treatment, ultrasound is prescribed.
It is necessary to keep track of the monthly periods following ovarian apoplexy, not only because they allow us to know the level of recovery of the reproductive system.
And this is a decrease in the chances of a safe pregnancy and conception itself.
Rehabilitation after surgery
After surgery, followed by a rehabilitation course. The main tasks to be solved by specialists in this period are the prevention of the occurrence of adhesions and the restoration of reproductive function. Against adhesions in the pelvis apply the methods of physiotherapeutic nature. The patient will be subjected to stimulation using a low-frequency magnetic field, low-frequency ultrasound, currents and low-intensity lasers. All these actions are absolutely harmless to women's health.
In the future, the recommended use of contraception for a period of 1 month after the completion of recovery procedures. Hormonal contraception can reach 6 months.
If the operation is successful and the rehabilitation course is successfully completed, the patient may have questions about the planning of the next pregnancy. Planning is possible, but first, doctors will need to make sure that all the consequences of ovarian apoplexy are safely overcome. For this purpose, the patient is undergoing control laparoscopy.
Experts assess the condition in which the fallopian tubes and other organs of the reproductive apparatus are at the moment. If, based on the results of laparoscopy, positive conclusions are made (complete absence of the effects of ovarian apoplexy), then the patient will be able to become pregnant in the future without risk and any threat to health.
Consequences of ovarian apoplexy
If ovarian apoplexy had unexpressed clinical symptoms, or an incorrect diagnosis was made, or the treatment was inadequate, adhesions may develop, that is, the ovary is attached to the intestinal loops or any other organs.
As a rule, in the presence of pain syndrome, the woman’s recovery is complete, as she timely sees a doctor.
But in the presence of an anemic form of ovarian apoplexy, severe consequences may develop due to internal bleeding, which may not be recognized, or it may be recognized late when significant blood loss occurs.
Classification of ovarian apoplexy
Classification of forms of apoplexy in accordance with the prevailing symptoms is carried out on:
- hemorrhagic or anemic form (with a predominance of symptoms characteristic of hemorrhages in the abdominal cavity),
- pain or pseudoapppendicular form (with a predominance of pain symptom, accompanied by increased body temperature and nausea)
- mixed form (equally pronounced symptoms of pain and anemic forms of apoplexy).
The overwhelming number of reported cases of apoplexy are accompanied by bleeding. In accordance with the degree of their intensity, apoplexy is classified according to severity into:
- light (blood loss volume 100 - 150 ml),
- average (blood loss volume 150 - 500 ml),
- heavy (blood loss volume over 500 ml).
Most often it is necessary to differentiate apoplexy with acute appendicitis and ectopic pregnancy.
Sometimes it is necessary to differentiate ovarian apoplexy with uterine pregnancy, an ovarian cyst. The literature describes cases of a combination of ovarian apoplexy, acute appendicitis and ectopic pregnancy. Differential diagnosis is very difficult, but necessary, as in acute appendicitis or ectopic pregnancy, surgery is required, then in apoplexy - not always.