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Publicado en 30-03-2009
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articulo_266El 10% de las mujeres en edad fértil sufre endometriosis, y la mitad de estos casos están asociados a infertilidad o problemas para embarazarse.

La infertilidad y el dolor son las principales consecuencias de quienes padecen de endometriosis. Esta es la implantación de tejido del endometrio -que crece dentro de la cavidad uterina-, por fuera del útero, y que se deposita en otros órganos como los ovarios, las trompas de Falopio, el intestino, recto, vejiga, lo que provoca sangramiento, inflamación e irritación en la zona, y afecta la anatomía interna de la pelvis.

Esta patología altera morfológicamente las trompas de Falopio y ovarios, es decir el aparato reproductor, lo que reduce en forma considerable las probabilidades de lograr un embarazo natural.

Se estima que entre 40 y 50% de las mujeres infértiles padecen endometriosis, cuya capacidad reproductiva disminuye entre 12 y 36%.

“La endometriosis muy severa o avanzada puede producir una distorsión en la anatomía de la pelvis y así obstruir las trompas, lo que evitará que se pongan en contacto el óvulo con el espermio y, por tanto, no hay posibilidades de fecundación?, explica la ginecóloga del Hospital Clínico de la Universidad de Chile, Dra. Verónica Larrea.

La especialista agrega que también existen otras teorías que apuntan a que la endometriosis provocaría una alteración en el microambiente al interior de la trompa, y que por algún motivo al espermatozoide le costaría encontrar al óvulo.

Otra de las hipótesis que se manejan es que la endometriosis aumentaría las glándulas prostaglandinas y algunos factores locales que hacen que el ambiente de la pelvis no sea permisivo, y desfavorecería un embarazo.

Tratamiento agresivo y proactivo
El diagnóstico de la endometriosis se hace a través de una cirugía, abriendo el abdomen y mirando las lesiones, ya que las ecografías y la resonancia magnética no son capaces de detectar células ni tejidos superficiales, a excepción de la endometriosis ovárica que se presenta en forma de quistes.

“Si una paciente llega con dolor y no se quiere embarazar, se le da una serie de fármacos que pueden ir desde analgésicos hasta hormonas, con el fin de reducir al máximo sus dolencias. Si por el contrario, quiere tener un hijo, el tratamiento es totalmente distinto ya que hay que hacer que tenga regla, para que ovule?, sostiene.

La ginecóloga explica que en estos casos se suele ser bien agresivo en el tratamiento. Dependiendo de su historia clínica y antecedentes, de inmediato se le ofrece técnicas de baja complejidad en reproducción asistida, dependiendo también de la severidad de la endometriosis. Y si eso no funciona, se continúan con la fecundación In Vitro. “Es súper importante saber a qué viene la mujer al ginecólogo cuando presenta esta patología; si es por infertilidad, o por dolor, porque los tratamientos son totalmente contraproducentes uno con respecto al otro. La que siente dolor, le vamos a dar anticonceptivos y en algunos casos suspender la regla; pero la que se quiere embarazar no puede tomar muchos medicamentos, menos anticonceptivos?, aclara la Dra. Larrea.

En los casos de tener las Trompas de Falopio obstruidas, existen 2 tipos de tratamientos. “Si están muy tapadas no sirven técnicas de baja complejidad. Si la mujer es joven se le puede someter a una cirugía, donde se limpian todos los focos endometriósicos, se le trata de destapar las trompas, y se intenta dejar la pelvis lo más limpia posible para que la paciente se embarace?, explica.

La ginecóloga agrega que aún cuando exista el diagnóstico, si la mujer no quiere someterse a una cirugía, es contraproducente, o el especialista determina que por la severidad del caso la intervención no serviría, se recurre de inmediato a una fertilización In Vitro. “No perdemos mucho tiempo en el diagnóstico, sino que nos vamos de inmediato al tratamiento. Teniendo la pelvis de la paciente lo más limpia posible, se hace una fertilización In vitro, con lo que aumentamos las probabilidades de que se embarace?, señala.

Agrega que el momento óptimo de operar debe ser muy cerca al momento en que la mujer quiera embarazarse, porque su pelvis queda limpia para esperar un hijo lo antes posible. “No sirve operar hoy si la paciente quiere tener un hijo en 10 años más, porque yo puedo dejar limpia la pelvis, pero no sé qué va a ocurrir en dos años más. Esta es una enfermedad que por lo general vuelve, no desaparece?, aclara.

A modo de conclusión la Dra. Larrea explica que si una mujer con endometriosis se embaraza, no corre ningún problema ni riesgo, y suele tener embarazos normales. “Como esta patología está relacionada con las hormonas –específicamente con el estrógeno-, en el embarazo el nivel de progesterona aumenta, lo que apaga la enfermedad. Por lo general la mujer en esta etapa no siente dolor y sigue su embarazo en forma normal?, asegura.

Fuente: f20

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