Endometriosis

What is Endometriosis?

Endometriosis is a medical condition where there is a growth of abnormal cells called endometrial cells that generally form as a lining or inside of the uterus but in a location outside the uterus.

The endometrial cells are shed every month during the menstrual cycle. Endometriosis implants occur due to the cells of endometriosis growing outside the uterus. Such implants are generally observed in the ovaries, Fallopian tubes, exterior surfaces of the intestines or uterus and on the surface lining of the pelvic cavity. Growth of such implants is rarely observed in areas like the pelvis, liver, lung or brain. It is important to understand that endometriosis implants are benign which means that they are not cancerous.

  • Statistics
  • Causes of Endometriosis
  • Symptoms of Endometriosis
  • Diagnosis of Endometriosis
  • Treatment of Endometriosis
  • Conclusion

 

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Statistics

Endometriosis emerge in women during their reproductive years. The approximate incidence rate of endometriosis is yet to be found. This is mainly due to the fact that many women have the medical condition and do not show any symptoms that will indicate this condition. However, over 1 million women are estimated to be affected in America accounting to about 3% to 18% of women. Endometriosis is the leading cause of pelvic pain and one of the main reason for laparoscopic surgery and hysterectomy. Furthermore, statistics show that around 20% to 50% of women who are said to be infertile have this medical condition.

Although, endometriosis has been diagnosed in women aged from 25 to 35 years; endometriosis has also been diagnosed in young girls who are 11 years of age. Additionally, the medical condition is rarely reported in women who are postmenopausal. White women are mostly diagnosed with endometriosis in comparison to African American or Asian women. Clinical findings show that this medical condition is more frequently reported in tall, thin women who have a low BMI (body mass index). Other women at risk of developing this condition include those who delay pregnancy to an older age. Genetic factors may also play a role in the development of endometriosis. Having a close relative with endometriosis will increase the chance of you developing this condition later on in your life.

Causes of Endometriosis

The exact causes that lead to endometriosis is yet to be found. Retrograde menstruation is thought to be one of the causes. Retrograde menstruation is where the endometrial cells are sent to other locations due to the backward movement of menstrual fluids in the Fallopian tubes and other cavities like the pelvic cavity and the abdominal cavity. However, the exact cause of retrograde menstruation is still unknown. One clearly understood concept is that this reason alone does not contribute to endometriosis. Retrograde menstruation is seen in many women at varying severity but not all of these women develop endometriosis.

Another suggested cause for endometriosis is that surfaces of pelvic organs contain primitive cells that possess the ability to grow into other types of tissue like endometrial cells. Another possibility of developing endometriosis is during surgery when these cells may be directly transferred and are seen in surgery scars. Endometriosis is very rarely observed in the brain and other organs that are at a distance to the pelvis. Endometriosis in such organs can be explained by the transfer of cells through the blood and the lymphatics. Another cause for endometriosis is due to altered or severed immune response in women with this medical condition. This will directly affect one from being able recognise and eliminate such abnormal growth of endometrial cells.

Symptoms of Endometriosis

An important point to note down is that many women who are diagnosed with endometriosis, do not show any symptoms of having it! The most common symptoms that are presented is infertility as well as pain in the pelvic region. Women complain of this pain prior to menstruation or during menstruation which lessens considerably after their monthly cycle. Some women also have reported pain and cramping during sexual intercourse. Additionally, pain during excretion (bowels movements and urination) can also be felt. Pain may also be felt during a pelvic examination by your medical doctor. The intensity of the pain may change from one month to the other which will have the tendency to vary considerably among women diagnosed with this medical condition.

In addition, pelvic pain in these women depend moderately on the location of the endometrial implants.

  • Deep endometriosis implants and implants that are located in areas that contain many pain sensing nerves will result in pain.
  • Endometriosis implants also possess the ability to produce and release substances that can enter the blood stream to be carried away which will produce pain.
  • Finally, endometriosis implants can bring about pain when they form scars.

One of the reasons for infertility in healthy women is endometriosis. When the medical doctor utilise laparoscopic techniques to evaluate infertility, he or she may find endometrial implants. Many of these women may not have painful symptoms that will indicate endometriosis. Thereby, this medical condition goes unnoticed in many. Infertility as a result of endometriosis is not a fully understood concept but it is thought to be a result of anatomical factors as well as hormonal factors. Endometrial implants may be present as a mass of accumulated tissue or scarring within the pelvis. This accumulation will bring about changes in the normal anatomy of related structures like the Fallopian tubes which plays a main role in transporting the eggs from the ovaries. On the other hand, infertility which arise due to this medical condition affecting many women may be a result of hormone production and production of other chemical substances. These substances will affect ovulation, fertilisation of the released egg and/or implantation of the embryo onto the wall of the uterus.

Other symptoms that are generally linked to endometriosis include the following:-

  • Pain felt in the lower abdomen
  • Constipation or diarrhoea
  • Low back pain
  • Fatigue (chronic)
  • Heavy or irregular menstrual cycle
  • Blood seen in urine

In addition to these, other rare symptoms that can indicate endometriosis include chest pain or coughing up blood. This can be a consequence of endometriosis that is present in the lungs. Headaches and seizures may occur when endometriosis is present in the brain of the patient. 

Diagnosis of Endometriosis

Endometriosis can be evaluated and diagnosed by your medical doctor based on certain symptoms like pain in the pelvic region during a physical examination. A doctor may feel the presence of the endometrial implants during a rectovaginal examination where he or she would insert a finger into the vagina and another finger into the rectum. The doctor will feel the presence of nodules which will indicate endometrial implants. These nodules may be present in the uterus and along the ligaments of the pelvic surface. However, during some examinations no nodules will be felt. Having mentioned that, the examination itself may cause abnormal pain and discomfort indicating endometriosis.

Regrettably, the symptoms of endometriosis and the physical examination results cannot be solely relied upon to diagnose this medical condition. Other imaging studies are generally employed. An ultrasound scan will help eliminate other diseases related to the pelvis and in addition it may indicate endometriosis in the vagina and bladder areas. But this technique too cannot accurately diagnose the condition. For a more definite diagnosis, a direct visual inspection of the abdomen and pelvis and a tissue biopsy will be required.

Due to these complications of diagnosis, one may only accurately diagnose this medical condition during surgery. This will include a large incision of the abdomen (laparotomy) or small incision of the abdomen (laparoscopy).

Video of endometriosis


The most commonly employed surgical protocol for endometriosis is Laparoscopy. It is a minor surgical procedure where the patient will be under general anaesthesia. Some patients are given local anaesthesia too. This procedure is generally an out-patient procedure which means that the patient will not be asked to stay over at the hospital overnight and may leave the same day. Laparoscopy is undertaken by first inflating the patient’s abdomen with carbon dioxide via a small incision at the navel after which a long thing needle called the laparoscope will be inserted into the abdomen to examine the pelvis as well as the abdomen. Endometrial implants, if present, may be observed now.

This technique can be employed to take biopsy sample for diagnosis. Here, small tissue samples will be removed to be viewed under the microscope through which endometrial cells can be viewed. Moreover, biopsies obtained during this minor surgical procedure show endometrial cells when no such implants would have seen by the surgeon during this procedure. Laparoscopy and pelvic ultrasound are important procedures that can be utilised in order to rule out the presence of certain malignancies, like ovarian cancer, that produce symptoms quite similar to endometriosis.

Treatment of Endometriosis 

There are two main ways to treat the condition: medications and/or surgery. The main aim of such treatments is to relieve pain and enhance fertility.

Medications 

Medications are available that will relieve you from pelvic pain as well as menstrual cramping. Doctors may prescribe certain medications which will not only relieve your pain but also reduce the size of the endometriosis implants. These drugs interrupt oestrogen production by interfering with the regulatory hormones that are secreted via the pituitary gland. Due to this phenomena, the menstrual cycle comes to a stop, a state quite similar to menopause. Another popular drug that is used to treat the condition relieves you from the pain that you may experience and shrinks the implants. Although, 80% of women have reported these benefits around 75% of women have developed side effects. A new type of drug that was developed interrupts the production of oestrogen in the implants, ovary, brain and in other places like adipose tissue.

Surgery

Surgical procedures may be undertaken for endometriosis under two main conditions: when the symptoms of endometriosis is very severe and when the medical treatment that was taken to treat the condition failed to trigger the desired response. Surgery is mostly preferred when the anatomy of certain parts of the body is distorted. These parts include some of the organs in the pelvic region. Surgery can also be considered when there is an obstruction in the urinary or bowel tract. Surgical procedures involved in the treatment of endometriosis can be categorised into two:

  • Conservative- where the uterus and the tissue of the ovaries are preserved or protected. 
  • Definitive- this involves the removal of the uterus known as hysterectomy with or without the removal of the ovaries.

The above mentioned conservative surgery is performed by a laparoscopy procedure. The implants cane be removed or obliterated through laser. If the disease is in its more severe stages where the anatomy of organs are distorted, laparotomy may be necessary which involves opening the wall of the abdomen through a larger incision.

Conclusion

Endometriosis is a medical condition where there is a growth of abnormal cells called endometrial cells that generally form as a lining or inside of the uterus but in a location outside the uterus. Endometriosis emerge in women during their reproductive years. Although, endometriosis has been diagnosed in women aged from 25 to 35 years; endometriosis has also been diagnosed in young girls who are 11 years of age.The exact causes that lead to endometriosis is yet to be found. Retrograde menstruation is thought to be one of the causes. The most common symptoms that are presented is infertility as well as pain in the pelvic region.

Other symptoms that are generally linked to endometriosis include the following:-

  • Pain felt in the lower abdomen
  • Constipation or diarrhoea
  • Low back pain
  • Fatigue (chronic)
  • Heavy or irregular menstrual cycle
  • Blood seen in urine

Endometriosis can be evaluated and diagnosed by your medical doctor baed on certain symptoms like pain in the pelvic region during a physical examination. There are two main ways to treat the condition: medications and/or surgery. The main aim of such treatments is to relieve pain and enhance fertility.

 

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The Team Manager Web Diseases

 

 

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