Endometriosis is defined as the presence of normal endometrial (uterine lining) tissue in an abnormal ( extra-uterine sites) place. Once implanted elsewhere, the endometrium grows under the influence of the major female hormone oestrogen Like the lining of the uterus. The most common sites in the pelvis are ovaries, Fallopian tubes and deep in the pelvis behind the uterus, called the Pouch of Douglas. It also may grow on the Ligaments that support the uterus (uterosacral ligaments),The anterior cul-de-sac, i.e., the space between the uterus and bladder, the outer surface of the uterus and the lining of the pelvic cavity.
Occasionally, endometrial tissue is found in other places, such as:the intestines, the rectum, the bladder, the vagina, the cervix, the vulva and abdominal surgery scars, appendix, abdominal wall and even sometimes in the upper abdomen.
Endometriosis and Infertility
Endometriosis is commonly associated with approximately 30% of women who have infertility. Endometriosis causes infertility in different ways. Endometriosis may damage the fallopian tubes and the ovaries.It is thought that scar tissue from endometriosis can impair the release of the egg from the ovary and subsequent pickup by the fallopian tube. Other mechanisms thought to affect fertility include changes in the pelvic environment that results in impaired implantation of the fertilized egg. If the endometriosis damages the tubes and the ovaries then this will significantly reduce the woman’s ability to conceive as the movement of egg and sperms will not be normal.
- Even if the tubes and ovaries are not damaged, endometriosis can still affect the embryo growth and implantation.
- If endometriosis remains undetected and untreated for long, it may cause severe damage to the pelvic tissues.
Common signs and symptoms of endometriosis may include:
- Painful periods (dysmenorrhea).
Pelvic pain may start before the period and extend several days into your period. Ther woman may also experience lower back ache.
- Pain with intercourse
Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination
You’re most likely to experience these symptoms during your period.
- Excessive bleeding
- You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
- Other symptoms.You may also experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.
Causes of Endometriosis
The causes of endometriosis are still unknown. One theory suggests that during menstruation, some of the tissue back flows through the fallopian tubes into the abdomen, a sort of “reverse menstruation,” where it attaches and grows to form cysts. Another theory suggests that endometrial tissue may travel and implant via blood or lymphatic channels, similar to the way cancer cells spread. A third theory suggests that cells in any location may transform into endometrial cells. Endometriosis can also occur as a result of direct transplantation—in the abdominal wall after a cesarean section, for example or any other abdominal or pelvic surgery. genetic factors may also play a role in acquiring the disease.
Diagnosis of Endometriosis
clinical diagnosis is made By evaluating a patient’s medical history and a pelvic examination. Ultrasound scan can give a better idea of the size and location of the bigger cysts, the definitive diagnosis of endometriosis is made with the help of laparoscopy and obtaining samples for biopsy. Laparoscopy also helps to determine the exact location, extent and size of the endometrial growths.
Other modalities that may be used in the diagnosis of endometriosis include CT scan and an MRI scan :
Stages of Endometriosis
A staging, or classification, system for endometriosis has been developed by the American Society of Reproductive Medicine. The stages are classified as follows:
- Stage 1: Minimal
- Stage 2: Mild
- Stage 3: Moderate
- Stage 4: Severe
The stage of endometriosis is based on the location, amount, depth and size of the endometrial tissue. the clinical presentation of the woman may vary from The stage of the endometriosis.
Endometriosis Treatment Options
Specific treatment for endometriosis will be determined by your health care provider based on severity of symptoms, whether pregnancy is desired, Extent of the disease, response to treatment, and presence of other medical conditions
for mild symptoms, the woman may be prescribed pain medication alone (nonsteroidal anti-inflammatory drugs, such as ibuprofen or other over-the-counter analgesics).
incase of moderate to severe symptoms not responding to pain relievers , Hormone therapy may be advised which includes Oral contraceptives, with combined estrogen and progestin hormones to prevent ovulation and reduce menstrual flow, Progestins alone, Gonadotropin-releasing hormone agonist, which stops ovarian hormone production, creating a sort of “medical menopause”, Danazol, a synthetic derivative of testosterone (a male hormone). Medical therapy (oral contraceptive pills, GnRh agonist injections and others) has a role in controlling the symptoms, but do not offer longstanding regression or cure. They also cannot improve chances of conception and carry the risk of unwanted side effects.
Surgical techniques that may be used to treat endometriosis include Laparoscopy or Laparotomy, to remove as much of the endometriotic implants as possible without damaging healthy tissue and fulgurating the lesions ( by burning them with laser or electro-cautery) or Hysterectomy, where the uterus and possibly the ovaries are removed.
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