endometriosis

Endometriosis most commonly affects the tissue lining the ovaries, fallopian tubes, and pelvis. Rarely, endometrial-like tissue may be found beyond the area of the pelvic organs.

In endometriosis, endometrial-like tissue behaves like endometrial tissue; It thickens, sheds and bleeds with each menstrual cycle. However, since this tissue has no way out of the body, liquid material  gets stuck. When endometriosis affects the ovaries, cysts called endometriomas (chocolate cysts) may form. Surrounding tissues may become irritated and eventually nephritis and adhesions (bands of fibrous tissue that can cause pelvic tissue and organs to stick together) may develop.

Endometriosis can sometimes cause severe pain, especially during menstrual periods. Fertility problems may also develop. 

symptoms

The primary symptom of endometriosis is pelvic pain, which is often associated with menstrual periods. Although many people experience cramps during their menstrual periods, endometriosis patients typically describe menstrual pain that is much worse than normal. Pain may increase over time.

Common signs and symptoms of endometriosis include:

• Painful Menstruation  (Dysmenorrhea): Pelvic pain and cramps can start before the menstrual period and last up to a few days of the menstrual period. There may also be lower back and abdominal pain.

• Pain During Sexual Intercourse: Pain during or after sexual intercourse is common in endometriosis.

• Painful Bowel Movements or Pain with Urination: These symptoms are frequently observed during the menstrual period.

• Excessive Bleeding:  periods or menstrual periods with occasional excessive bleeding  Bleeding (intermediate bleeding) may occur in between.

• Infertility: Sometimes endometriosis is first diagnosed in people undergoing infertility treatment.

• Other Signs and Symptoms: Especially during menstrual periods, a person may experience fatigue, diarrhea, constipation, bloating or nausea.

The intensity of pain may not be a reliable indicator of the severity of the condition. You may have mild endometriosis with severe pain, or you may have advanced endometriosis with little or no pain.

Endometriosis is sometimes confused with other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It can be confused with irritable bowel syndrome (IBS), a condition that causes diarrhea, constipation and abdominal cramps. IBS may accompany endometriosis, which can make diagnosis difficult.

What ZOh, You Should See a Doctor?

If there are signs and symptoms that may indicate endometriosis, it is necessary to be examined. Endometriosis can be a difficult condition to treat. Early diagnosis is therefore important.

Reasons

Although the exact cause of endometriosis is not known for certain, possible explanations include:

• Retrograde Menstrual Bleeding: In retrograde menstrual bleeding, menstrual blood containing endometrial cells flows back into the pelvic cavity instead of passing through the fallopian tubes and out of the body. These endometrial cells attach to the pelvic walls and surfaces of the pelvic organs, where they grow and continue to thicken and bleed throughout each menstrual cycle.

• Transformation of Peritoneal Cells: In what is known as the “induction theory,” it is known that hormones or immune factors promote the transformation of peritoneal cells (the cells lining the inside of your abdomen) into endometrial-like cells.

• Embryonic Cell Transformation: Hormones such as estrogen can transform embryonic cells (cells in the earliest stages of development) into endometrial-like cell implants during puberty.

• Surgical Erosion Implantation: After a surgery such as a hysterectomy or cesarean section, endometrial cells may adhere to a surgical incision.

• Endometrial Cell Transport: Blood vessels or the tissue fluid (lymphatic) system can transport endometrial cells to other parts of the body.

• Immune System Disorder: A problem with the immune system may cause the body to be unable to recognize and destroy endometrial-like tissue growing outside the uterus.

Risk factors

Various factors put a person at risk of developing endometriosis, such as:

• never giving birth

• Menstruation begins at an early age

• Entering menopause at an older age

• Short menstrual cycle (e.g. less than 27 days)

• Heavy menstrual periods that last longer than seven days

• Having higher levels of estrogen in the body or greater lifetime exposure to the estrogen the body produces

• low body mass index

• One or more relatives (mother, aunt, or sister) with endometriosis

• Any medical condition that prevents blood from passing through the body during menstrual periods

• Reproductive system disorders

Endometriosis usually develops several years after the start of menstruation (menarche). Unless estrogen is taken, signs and symptoms of endometriosis may temporarily improve with pregnancy and disappear completely with menopause.

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Complications

Infertility

The main complication of endometriosis is impaired fertility. About one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, the egg must be released from the ovary, pass through the neighboring fallopian tube, be fertilized by a sperm cell, and attach itself to the uterine wall to begin development. Endometriosis can block the tube and prevent the egg and sperm from uniting. However, this condition also affects fertility in less direct ways, such as damaging sperm or eggs.

Even so, many people with mild to moderate endometriosis can still become pregnant and carry the pregnancy to term. Doctors sometimes advise people with endometriosis not to delay having children because the condition may worsen over time.

blooder

Ovarian cancer occurs at higher than expected rates in people with endometriosis. 

Diagnosis

To diagnose endometriosis and other conditions that may cause pelvic pain, the doctor will ask the person for a description of the symptoms, including where the pain is located and when the pain occurs.

Tests to check for physical clues of endometriosis include:

• Pelvic Examination: During the pelvic examination, the doctor manually palpates areas in the pelvis for abnormalities such as cysts in the reproductive organs. It is often not possible to feel small areas of endometriosis unless it causes a cyst to form.

• Ultrasound: This test uses high-frequency sound waves to create images of the inside of the body. A standard ultrasound imaging test does not tell the doctor definitively whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).

• Magnetic Resonance Imaging (MRI):  MRI is an examination that uses a magnetic field and radio waves to create detailed images of organs and tissues in the body. MRI aids in surgical planning by giving the surgeon detailed information about the location and size of endometrial implants.

• Laparoscopy: In some cases, the doctor may refer the person to a surgeon for laparoscopy, a procedure that allows viewing of the inside of the abdomen. While under general anesthesia, the surgeon makes a small incision near the navel and inserts a thin imaging instrument (laparoscope) to look for signs of endometrial tissue outside the uterus.

  Laparoscopy can provide information about the location, extent, and size of endometrial implants.  Often, with proper surgical planning, the surgeon can completely treat endometriosis during laparoscopy, resulting in only a single surgery.

Treatment

• Endometriosis treatment usually involves medication or surgery. The approach the person and the doctor choose will depend on how severe the signs and symptoms are and whether there is a desire to become pregnant.

• Doctors often recommend trying conservative treatment approaches first, opting for surgery if initial treatment fails.

Painkiller

• The doctor may recommend taking nonsteroidal anti-inflammatory over-the-counter medications to help relieve painful menstrual cramps.

• If pregnancy is not desired, the doctor may recommend hormone therapy along with painkillers.

hormone therapy

• Supplementary hormones are sometimes effective in reducing or eliminating endometriosis pain. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, rupture, and bleed. Hormone medications can slow endometrial tissue growth and prevent new endometrial tissue implantation.

• Hormone therapy is not a permanent solution for endometriosis. A return of symptoms may occur after stopping treatment.

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Treatments used to treat endometriosis include:

• Hormonal Contraceptives: Birth control pills help control the hormones responsible for the formation of endometrial tissue each month. For many, menstrual bleeding becomes lighter and shorter when they use hormonal contraceptives. 

• Gonadotropin Releasing Hormone (Gn-RH) Agonists and Antagonists: These medications block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these medications create an artificial menopause, taking low doses of estrogen or progestin along with Gn-RH agonists and antagonists may reduce menopausal side effects such as hot flashes, vaginal dryness, and bone loss. Medicine  When you stop using it, menstrual periods and the ability to get pregnant return.

• Progestin Therapy: Various progestin treatments, including the levonorgestrel intrauterine device, birth control implant, birth control injection, or progestin pill, can stop menstrual periods and the growth of endometrial implants. It may relieve signs and symptoms of endometriosis.

• Aromatase Inhibitors: Aromatase inhibitors are a class of drugs that reduce the amount of estrogen in the body. The doctor may recommend a progestin or combined hormonal contraceptive as well as an aromatase inhibitor to treat endometriosis.

Conservative Surgery

If you have endometriosis and want a pregnancy, surgery to remove endometriosis implants while preserving the uterus and ovaries (conservative surgery) may increase the chances of success. If there is severe pain due to endometriosis, surgery can also be used, but endometriosis and pain may return.

The doctor may perform this procedure laparoscopically or, less commonly, through traditional abdominal surgery in larger cases. Even in severe cases of endometriosis, most can be treated with laparoscopic surgery.

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Infertility Treatment

Endometriosis can cause problems in getting pregnant.  Which treatment is appropriate for a person depends on the individual situation.

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Removal of the Uterus and Ovaries

Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once considered the most effective treatment for endometriosis. However, endometriosis specialists are moving away from this approach and instead focus on careful and complete removal of all endometriosis tissue.

Removal of the ovaries results in menopause. The lack of hormones produced by the ovaries may improve endometriosis pain in some, but in others, remaining endometriosis continues to cause symptoms after surgery. Early menopause also carries the risk of heart and blood vessel (cardiovascular) diseases, some metabolic conditions, and early death.

Removal of the uterus (hysterectomy) may sometimes be used to treat signs and symptoms associated with endometriosis, such as heavy menstrual bleeding and painful periods due to uterine cramping, in people who do not want to become pregnant.

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