What is #Endometriosis
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ENDOMETRIOSIS

Endometriosis is a disorder in which tissue similar to the tissue that forms the lining of the uterus (the endometrium) grows outside of the uterine cavity. Endometriosis is derived from the word 'endometrium', which is the tissue that lines the uterus. Patients with endometriosis have endometrial-type tissue outside of the uterus.

Endometriosis occurs when endometrial tissue grows on the ovaries, bowel, and tissues that lines the pelvis. It is unusual for endometrial tissue to spread beyond the pelvic region, yet not impossible. The endometrial tissue growing outside of the uterus is known as an endometrial implant. The hormonal changes of one's menstrual cycle affects the misplaced endometrial tissue. This causes the area to become inflamed and painful. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in the pelvis.

This tissue trapped in the pelvis can cause:

  • Fertility problems
  • Adhesions (tissue binds the pelvic organs together)
  • Irritation
  • Scar formation
  • Severe pain during periods

ENDOMETRIOSIS STAGES/TYPES

There are four stages or types of endometriosis. It can be any of the following:

  • Minimal
  • Mild
  • Moderate
  • Severe

The location, number, size, and depth of endometrial implants are some of the different factors that determine the stage of endometriosis. There are four stages of the condition;

  • Stage 1: Minimal - In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on ovary. There is likely to be inflammation in or around effects pelvic cavity.
  • Stage 2: Mild - Mild stage of endometriosis is characterized by light lesions and shallow implants on an ovary and the pelvic lining.
  • Stage 3: Moderate - Moderate endometriosis will typically have deep implants on the ovary and pelvic lining. There is also the likelihood of more lesions.
  • Stage 4: Severe - The most severe stage of endometriosis is characterized by very deep implants on the pelvic lining and ovaries. There will most likely be lesions on the fallopian tubes and bowels.

CAUSES

During a regular menstrual cycle, the body sheds the lining of the uterus. This allows menstrual blood to flow from the uterus through the small opening in the cervix and out through the vagina.

The exact cause of endometriosis has not been established yet, however there are several theories regarding the cause, although no single theory has been proven.

One theory has it that hormones transform the cells outside the uterus into cells similar to those lining the inside of the uterus, known as endometrial cells.

There are others who believe the condition may occur if small areas within the abdomen convert into endometrial tissue. This may happen because cells in the abdomen grow from embryonic cells, which are able to change shape and act like endometrial cells. How and why this occurs is yet to be known.

These displaced endometrial cells may be found on the pelvic walls and the surfaces of other pelvic organs, (e.g. bladder, ovaries, and rectum). They do not stop growing, they thicken, and bleed over the course of the person's menstrual cycle in response to the hormones of the cycle.

There is also the possibility of the menstrual blood to leak into the pelvic cavity through a surgical scar, especially after a cesarean delivery (a C-section).

Another theory opines that the endometrial cells are transported out of the uterus through the body's lymphatic system.

Yet another theory purports it may be due to a faulty immune system that does not destroy errant endometrial cells.

The development of endometriosis may also be linked to genetics or even environmental toxins.

WHERE ENDOMETRIOSIS CAN OCCUR

Common sites of endometriosis include:

  • The space between the uterus and rectum (posterior cul-de-sac)
  • The space between the uterus and bladder (anterior cul-de-sac)
  • The ovaries
  • The outer surface of the uterus
  • The fallopian tubes
  • The lining of the pelvic cavity
  • Uterosacral ligaments (Ligaments that support the uterus)

Occasionally, endometrial tissue may be found in places, such as:

  • The vulva
  • The intestines
  • The rectum
  • Abdominal surgery scars
  • The bladder
  • The vagina
  • The cervix

SYMPTOMS

Each woman may experience different symptoms, indeed some may not exhibit any symptoms at all. However, the following are the most common of symptoms for endometriosis;

  • Gastrointestinal problems, such as diarrhea, constipation and/or nausea
  • Painful urination during menstrual periods
  • Pain (excessive menstrual cramps) that may be felt in the abdomen or lower back
  • Painful bowel movements during menstrual periods
  • Pain during sexual intercourse
  • Abnormal or heavy menstrual flow
  • Infertility

An important note is that the amount of pain a woman experiences might not necessarily be related to how severe the condition is. It is possible for women with severe endometriosis to experience no pain, while others with a milder form of the disease may have severe pain or other symptoms.

WHEN TO SEE A DOCTOR

Endometriosis can be a challenging condition to manage. One should see a doctor if she has signs and symptoms that may indicate endometriosis.

An early diagnosis, a multi-disciplinary medical team and an understanding of the diagnosis may result in better management of symptoms of the condition.

RISK FACTORS

Several factors places one at greater risk of developing endometriosis, these could be:

  • Short menstrual cycles (less than 27 days)
  • Heavy menstrual periods (longer than 7 days)
  • Abnormalities within the reproductive tract
  • Never having to give birth
  • Beginning monthly periods earlier than normal
  • Going through menopause late in life
  • Having higher levels of estrogen or a greater lifetime exposure to estrogen
  • Low body mass index (BMI)
  • Having a family history (mother, aunt or sister) with endometriosis
  • Medical conditions that prevent the normal passage of menstrual flow

The signs and symptoms of endometriosis may improve with pregnancy (though it may be temporal) and may go away completely with menopause.

COMPLICATIONS

Infertility

The main complication of endometriosis is that it impairs fertility. For pregnancy to occur, an egg must be released from an ovary, this egg will travel through the neighboring fallopian tube, become fertilized by a sperm cell and subsequently attach itself to the uterine wall to begin development. Endometriosis may keep the egg and sperm from uniting by obstructing the tube. Due to such factors, a lot of women with endometriosis have difficulties with getting pregnant.

Some women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. On some occasions, doctors have advised women with endometriosis not to delay in having children because the condition may worsen with passage of time.

Cancer

Ovarian cancer occurs at higher rates among women with endometriosis even though the overall lifetime risk of ovarian cancer is low. Endometriosis-associated adenocarcinoma which is another type of cancer can develop later in life in some women who have had endometriosis. This is uncommon though.

DIAGNOSING ENDOMETRIOSIS

Having a diagnosis of endometriosis simply brings relief to many women. The diagnosis begins with an analysis and evaluation of a patient's medical history and the completion of a physical examination which will include a pelvic exam. To conclusively diagnose endometriosis, the doctor will perform a laparoscopy and biopsies. Any suspicious tissue is confirmed by examining the tissue beneath a microscope. Laparoscopy is a minor surgical procedure in which a thin tube with a camera at the end (a laparoscope), is inserted into the abdomen through a small incision. Laparoscopy can also be used to determine the location, extent and size of the endometrial growths.

Other examinations that may be used in the diagnosis of endometriosis include:

  • MRI scan

A noninvasive procedure that produces a two-dimensional view of an internal organ or structure

  • Ultrasound

A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs

  • CT scan

A noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images which can be used to detect any abnormalities that may not show up on an ordinary X-ray.

TREATMENT

It is usual to treat endometriosis with medication or surgery. The approach our doctors choose will depend on the severity of the signs and symptoms and whether the patient hopes to become pregnant.

Typically, our doctors will recommend conservative treatment regimens first, before opting for surgery if the initial treatment fails.

  • Pain medication

Our doctors may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) bought over-the-counter to help ease painful menstrual cramps.

The doctor may also recommend hormone therapy in combination with pain relievers if the patient is not trying to get pregnant.

  • Hormone therapy

Hormone supplements are sometimes effective in reducing or even eliminating the pain of endometriosis. The varying levels of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.

However, hormone therapy cannot be said to be a permanent fix for endometriosis. One may experience a resurgence of symptoms after treatment is stopped.

Therapies used to treat endometriosis include:

Hormonal contraceptives:-

Contraceptives such as birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Many women have lighter and shorter menstrual flow when they use such hormonal contraceptives.

Gonadotropin-releasing hormone agonists and antagonists;-

These are drugs that block the production of ovarian-stimulating hormones. They lower estrogen levels and sometimes prevent menstruation. They cause endometrial tissue to shrink because they create an artificial menopause.

Progestin therapy:-

A variety of progestin therapies, including contraceptive implant, contraceptive injection or progestin pill, can halt menstrual periods as well as the growth of endometrial implants. This will go a long way in the relief of the signs and symptoms endometriosis.

Aromatase inhibitors:-

A class of medicines that reduce the amount of estrogen in the body, aromatase inhibitors may be recommended along with a progestin or combination hormonal contraceptive in the treatment of endometriosis.

  • Conservative surgery

If a woman has endometriosis and is trying to become pregnant, conservative surgery (used to remove the endometriosis implants but preserve the uterus and ovaries), may increase the chances of success. The doctor may do the conservative surgery laparoscopically or through traditional abdominal surgery in more-extensive cases though it is rare. Most endometriosis cases (including severe cases) can be treated with laparoscopic surgery.

In laparoscopic surgery, your surgeon inserts a laparoscope (a slender viewing instrument) through a small incision near the navel uses instruments to remove endometrial tissue through another small incision.

Fertility treatment

Endometriosis can lead to conception problems. If one is having difficulty getting pregnant, fertility treatment supervised by a fertility specialist may be recommended. Fertility treatment may range from stimulating the ovaries to make more eggs, to in-vitro fertilization.

Hysterectomy / Oophorectomy

Hitherto, hysterectomy (removal of the uterus) and oophorectomy (surgery to remove ovaries) was once considered the most effective treatment for endometriosis. However, the experts are moving away from this approach. Focus is instead on the careful and thorough removal of all endometriosis tissue.

Removing the ovaries results directly in menopause. The lack of hormones produced by the ovaries may improve endometriosis pain for some women, for others however endometriosis that remains after surgery will continue to cause problems. Hysterectomy (The removal of the uterus) can sometimes be used to treat symptoms associated with endometriosis in those who do not want to become pregnant.

EASING THE PAIN OF ENDOMETRIOSIS

The pain of endometriosis can be controlled if patients:

  • Exercise regularly.
  • Use heating pads or hot water bottles on their abdomen.
  • Rest, relax and meditate.
  • Take warm baths.
  • Prevent constipation.

In some cases, a combination of therapies (e.g. Conservative surgery along with hormone therapy) is used.

Some women also benefit from alternative treatments such as the under listed that may be used in conjunction with other medical and surgical therapies.

These include:

Traditional Chinese medicine

Nutritional approaches

Homeopathy

Allergy management

Immune therapy

OUTLOOK

Endometriosis is a chronic condition with no known cause, as the causes is yet to be established.

Still this does not mean the condition has to impact one's daily life.

Effective treatments are available to manage pain and fertility issues that arise as result of the condition. (e.g. Medications, hormone therapy, and surgery).

In some cases, the painful symptoms of endometriosis improve after menopause. The growths shrink slowly as the body stops making the hormone estrogen.

However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.

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