Endometriosis is a disease that usually affects only women. The women who suffer from endometriosis experience a multitude of symptoms including fatigue, pelvic pain of differing severity, heavy menstrual periods, painful sexual intercourse, lower back pain, painful bowel movements and urination, abdominal bloating, and infertility.
Endometriosis is defined as the abnormal growth of endometrial cells that spread to areas in the body where they do not belong. Endometriosis tissue islets or implants can grow in the fallopian tubes, within uterine musculature or the outer surface of the uterus, the ovaries, pelvic organs, colon, bladder and the sides of the pelvic cavity. As the menstrual period begins, the islets become larger with blood and the problem is that there's no place for the blood to go except into tissues in the surrounding areas. This leads to inflammation and often much pain.
Symptoms
Endometriosis occurs when the endometrium, or uterine lining, grows outside of the uterus. It may grow in areas such as around the ovaries, in the pelvic cavity, sometimes even the bowels or in the bladder. Although very rare, the endometrium can also grow in the lung area.
As the condition progresses, the growths develop into "tumors" or "implants." While the reference to tumors can be unnerving, endometrium growths are not cancerous or malignant. However, the condition can be severely painful, cause heavy menstruation, and can prevent pregnancy in some cases.
Endometriosis symptoms include pain that is localized in the pelvic, abdominal, or lower back areas. The severity of the pain does not directly correlate with the amount of endometriosis present in these areas. One can have a small amount of endometriosis growth and feel severe pain. Conversely, one can have a large area of endometriosis growth and feel no pain.
Causes
1. Retrograde Menstruation: Metastatic theory: tubal regurgitation of menstrual blood allows implantation of endometrial cells in the peritoneum, structures in the pelvic and abdominal cavity, especially the ovaries. Endometriosis regresses during pregnancy, which is likely to be due to the suppression of menstruation.
2. The Coelomic Metaplastic Theory: the metaplastic changes of the coelomic epithelium into endometrial glands could explain endometriosis in unusual sites; genital tract mucosa is derived from the primitive coelomic peritoneum.
3. Direct Implantation Theory: direct extension into the myometrium focuses on the most likely cause for Adenomyosis.
4. Lymphatic and Vascular Theory: this probably explains the presence of endometriosis in the lymph nodes and lungs
Treatment of endometriosis:
Symptomatic treatment for pain, with ibuprofen, paracetamol or codeine. Therapeutic trial of combined oral contraceptive pills or progestogens can be used initially before a definitive diagnosis is made. Suppression of ovarian function, using a noncyclical oral contraceptive pills or progestogens for 6 months or danazol, or Gonadotrophin releasing hormone analog for around 3 months, which may require an ad-back therapy to prevent osteoporosis.
Ablation of the endometriotic lesions by laser is ideal and best done at the initial diagnostic laparoscopy. Laparoscopic cystectomy is the preferred treatment for chocolate cysts; conservative surgery by laser ablation, division of adhesions and correction of retroversion are preferred in younger women, to preserve fertility choice; IVF is recommended if there is co-existing infertility. Hysterectomy with cytoreduction, division of adhesions, and or removal of ovaries may be required in older women, to prevent complications of bowel or bladder involvement later on or when recurrence occurs following conservative surgery.
