Endometriosis

4 mins read

Introduction
Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside or lining the tissue of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation.

Epidemiology
Endometriosis can affect any female, from premenarche to postmenopause regardless of race or ethnicity or whether or not they have had children. It is primarily a disease of the reproductive years. Its prevalence varies, but 6–10% is a reasonable number, more common in women with infertility and chronic pelvic pain (35–50%). As an estrogen-dependent process, it can persist beyond menopause and persists in up to 40% of women following hysterectomy.

Causes
The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episotomy or Cesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.

Symptoms
Most females affected do not have any symptoms. Of those who do experience symptoms, the common symptoms are:-

  • Pain (usually pelvic) that occurs just before menstruation and lessens after that.
  • Painful sexual intercourse
  • Cramping during intercourse
  • Cramping during urination
  • Painful pelvic exam

The pain intensity can change from month to month, and vary greatly among women.

Diagnosis
With the help of a physical examination can lead the health care practitioner to suspect endometriosis. Although doctors can often feel the endometrial growths during a pelvic exam, and these symptoms may be signs of endometriosis, diagnosis cannot be confirmed by mere exam. Use of pelvic ultrasound may identify large endometriotic cysts, however smaller endometriosis implants cannot be visualized with ultrasound technique.

Treatment
Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.

  • Surgery – Conservative treatment consists of the excision (calledcystectomy) of the endometrium, adhesions, resection of endometriomas, and restoration of normal pelvic anatomy as much as is possible. Laparoscopy can also be used for surgery besides being used for diagnostics. It’s considered a “minimally invasive” surgery because the surgeon makes very small openings (incisions) at (or around) the belly button and lower portion of the belly.
  • Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. These pain-relieving medications have no effect on the endometrial implants.

Alternative Treatment

  1. The Gonadotropin releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of endometriosis implants. There are side effects related to this like:-
  • Low back pain
  • Chronic fatigue
  • Irregular or heavy menstrual bleeding
  • Blood in urine
  • Diarrhea and/or constipation
  • Lower abdominal pain
  1. Oral Contraceptive pills
  2. Progestins

Complications
Its complications are internal scarring adhesions, pelvic cysts, chocolate cyst of ovaries, ruptured cysts, and bowel and urethral obstruction resulting from pelvic adhesions. Ovarian endometriosis may complicate pregnancy by decidualization, abscess and/or rupture

Conclusion
Endometriosis is more common in women who are experiencing infertility than in fertile women, but the condition does not necessarily cause infertility. Endometriosis affects women in their reproductive years. In terms of societal effects, the economic effects associated with endometriosis are substantial and are similar to that of other chronic diseases such as Crohn’s disease, diabetes, or rheumatoid arthritis. This economic burden is attributed mostly to the inability to consistently work and predicted by decreased quality of life.

References
1. Endometriosis;NIH Pub. No. 02-2413; September 2002

2. Bulletti C, Coccia ME, Battistoni S, Borini A (August 2010) “Endometriosis and infertility” Assist. Reprod. Genet. 27 (8): 441–7.

3. Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, Raine-Fenning N (2013). “The social and psychological impact of endometriosis on women’s lives: A critical narrative review”.Human Reproduction Update 19 (6): 625–639.

4. Colette S, Donnez J (July 2011). “Are aromatase inhibitors effective in endometriosis treatment?”.Expert Opin Investig Drugs 20 (7): 917–31.

5. Murray, Michael T.; Pizzorno, Joseph (2012). The Encyclopedia of Natural Medicine (3rd ed.). New York, NY: Simon and Schuster.

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