Introduction to Endometriosis
Endometriosis is a disorder in which tissue similar to the tissue that forms the lining of your uterus (a hollow, pear-shaped organ in your pelvis) grows outside of your uterine cavity. The pelvis is the lower part of the torso. It's located between the abdomen and the legs.
The endometrium is the inner lining of your uterus. It responds to hormones secreted by the ovaries (primary female reproductive organ) during the normal menstrual cycle. It tends to thicken from the time of ovulation and if pregnancy occurs, it continues to grow and supports the embryo to help in continuing pregnancy.
If pregnancy does not occur, it is shed off outside your body and is seen as “menstrual bleeding” or “period” or “menstrual cycle”. Unfortunately, in some women, the endometrium may be present outside the normal position. That condition is called endometriosis.
It is commonly present around the ovaries, tubes, surrounding the uterus (outside normal lining) but may be present anywhere in the body (even in lungs, urinary system, and rectum). It’s unusual for endometrial tissue to spread beyond your pelvic region, but it’s not impossible.
As this endometrium (outside the uterus lining) also responds to the hormones in the same way as normal endometrium (that lines the uterus), there will be bleeding around this abnormal endometrium at the time of menstruation. But this bleeding, unlike normal menstrual bleeding cannot come outside your body and so the blood accumulates and forms a chocolate coloured material (old blood is chocolate coloured) and leads to adhesion between organs. Adhesion is a condition where different organs of your body attach abnormally with each other leading to various problems.
Causes of Endometriosis
Unfortunately, despite extensive research throughout the world, the reason for endometriosis is not known. It is said to be due to various genetic factors or certain environmental factors. Sometimes, delaying pregnancy is stated as the reason.
In some women, however, it is caused by the backward flow of menstrual blood (that enters into the tubes during menstruation). Usually, these women have abnormal development of the uterus (problems in the uterus since birth), and as a result, all the menstrual blood does not come outside their body.
Symptoms of Endometriosis
Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:
Pain in the lower abdomen before and during periods
Cramps one or two weeks around menstruation
Heavy bleeding during periods
Infertility (not being able to get pregnant despite having unprotected sex for a year)
Pain following sexual intercourse
Discomfort with bowel movements
Diagnosis of Endometriosis
Endometriosis is a peculiar condition in the sense that women with severe endometriosis may not have any symptoms, while women with very mild disease may have severe pain or infertility. To treat your pain, a correct diagnosis is required.
Your doctor will take a detailed history of your symptoms and personal or family history of endometriosis.
A physical exam of your pelvic region will help your doctor identify cysts (an abnormal, noncancerous growth filled with liquid, that can sometimes cause pain) or scars behind your uterus.
Sometimes a transvaginal or abdominal ultrasound may be conducted. A transvaginal ultrasound also called an endovaginal ultrasound, is a type of pelvic ultrasound used by doctors to examine female reproductive organs. Abdominal ultrasound is a type of imaging test used to look at organs in your abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys.
The gold standard for the diagnosis of endometriosis is laparoscopy. It is an operation in which, by making a small opening in the abdomen under anesthesia, a telescope is introduced by the surgeon, and the area is seen through a camera in a television monitor.
Laparoscopy can provide information about the location, extent, and size of the endometrial implants. If adhesions and endometrial implants are present, they are visualized and diagnosed and in case of any doubt, a biopsy can be taken.
A biopsy is a sample of tissue taken from the body in order to examine it more closely. In most cases, laparoscopy is not required and the diagnosis is based on other investigations.
Treatment of Endometriosis
As mentioned earlier, endometriosis does not always cause symptoms and so, it does not always need treatment. The common reason for treatment is the presence of pain and infertility-issues.
Endometriosis-related pain is usually treated by over-the-counter (OTC) pain medicines or sometimes by surgery. Before a surgery, medicines are given to reduce the size and to reduce blood loss during surgery. These medicines can cause hormonal imbalances and thus deprive the endometriosis tissues of hormonal stimulation and thus reduces pain.
Alternatively, your doctor can suggest hormone therapy which involves taking supplemental hormones to relieve pain and stop the progression of endometriosis.
Surgery for endometriosis is usually done under laparoscopy but it needs properly trained and skilled surgeons to do these operations. Operations can range from “minor” (like separating the adhesions, draining the chocolate-colored fluid) to “major” (like removing the cyst or removing the major organs).
Going for surgery has the advantage over medicines in that it confirms the diagnosis and removes the diseased tissues. Conservative surgery is often recommended. The goal of conservative surgery is to remove or destroy endometrial growths without damaging the reproductive organs.
Complications of Endometriosis
Infertility is a serious complication of endometriosis. Studies show that 30 – 40 percent of women with endometriosis have trouble getting pregnant.
Infertility cannot be treated with medications. If surgery does not work in your case, you may want to consider fertility treatments to help improve your chances of having a baby.
Another complication of endometriosis is chronic pain along with mental health issues such as depression, and anxiety. Talk to your doctor about ways to deal with these side effects.
To summarize, endometriosis can affect women of any age. However, it is highly risky for women between 25 and 50 years of age. If you have a family history of endometriosis, then your risk also increases. If you notice any unusual problems during your menstrual periods, consult your gynaecologist immediately.
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