THE A TO Z OF ENDOMETRIOSIS

Endometriosis is one of the intriguing conditions that plague women all over the world. It is hard to diagnose since it can be mistaken for other conditions that cause pelvic pain. Besides, the exact causes are not exactly known. Here are all you need to know about endometriosis.

Essentially, endometriosis is a disorder that causes severe pain, usually during menstrual periods. It occurs when endometrial tissue grows outside the uterus. The condition usually affects the ovaries, fallopian tubes and the tissue lining a woman's pelvis. You hardly find such endometrial tissue affecting other organs apart from the pelvic organs.

WHAT ARE THE SYMPTOMS?

Pelvic pain during a woman's menstrual periods is the main symptom of endometriosis. However, sufferers may complain of other symptoms that include:

• Painful periods (dysmenorrhea) with pelvic pain, cramping (before and lasting throughout the menstrual period), lower back and abdominal pain.
• Pain during and after sex.
• Pain during bowel movements or urination (usually experienced during menstrual periods).
• Heavy menstrual bleeding or bleeding between periods.
• Infertility. Usually, women who go seeking fertility treatment find out they have this condition.
• Other signs and symptoms such as fatigue, nausea, constipation and diarrhea.

Sometimes, endometriosis is mistaken for other conditions that cause pelvic pain. These are pelvic inflammatory disease (PID), ovarian cysts and irritable bowel syndrome (IBS).

WHAT ARE THE CAUSES?

The exact causes are unknown. Nonetheless, possible explanations for the causes of endometriosis are: 

Retrograde menstruation. This occurs when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity rather than out of the body. These endometrial cells get attached to the pelvic walls and surfaces of pelvic organs. Over a period of time, the cells grow, become thick, and bleed during menstrual periods.

Transformation of peritoneal cells. Some experts suggest that hormones or immune factors cause a change in peritoneal cells (the cells that line the inside of the abdomen) and turn them into endometrial-like cells.

Embryonic cell transformation. This involves hormones like estrogen changing embryonic cells (cells in the earliest stages of development) into endometrial-like cell implants during puberty.

Surgical scar implantation. After surgical procedures like hysterectomy and C-section, endometrial cells may stick to a surgical incision.

Endometrial cell transport. Sometimes, blood vessels or tissue fluid systems may carry endometrial cells to other parts of the body.

Immune system disorder. When the immune system is not functioning properly, the body is unable to recognize and destroy endometrial-like tissue growing outside the uterus.

WHAT ARE THE RISK FACTORS?

A person has a high chance of developing the condition if he or she:

• has never given birth
• started their periods at an earlier age
• experienced menopause at an older age
• has menstrual cycles which last for less than 27 days
• has long menstrual periods (lasts longer than 7 days)
• high estrogen levels in the body or been exposed to estrogen over a long period
• has a low body mass index
• one or more female relatives who had the condition
• reproductive tract abnormalities
• medical conditions that prevent the normal flow of menstrual blood out of the body

TREATMENT

Endometriosis can lead to the poor quality of life of any sufferer of the condition. To make matters worse, it has no cure. Nonetheless, one can manage the symptoms. There are many treatment options available which depend on how severe symptoms are. 

Pain (over-the-counter) medications. Such medications as ibuprofen are not that effective in all cases of endometriosis.

Hormone therapy. Hormonal supplements lessen the pain associated with the condition and also prevent it from getting worse. This therapy controls monthly hormonal changes that form endometrial tissue.

Hormonal contraceptives. These also stop endometrial tissue from growing and building up every month. Contraceptives such as birth control pills, vaginal rings and patches can also lessen or stop the pain in less severe conditions.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists. A woman takes these to stop her body from producing estrogen, which causes the growth of endometrial tissue that leads to endometriosis. Unfortunately, the therapy has side effects such as vaginal dryness and hot flashes.

Danazol. Taking danazol stops menstruation and lessens the symptoms of endometriosis. However, the condition may progress while taking this medication. Besides, Danazol has side effects such as acne and hirsutism.

Conservative surgery. For women who want to conceive or experience severe symptoms, this is the best treatment option. Usually, they have tried other treatments like hormonal contraceptives or hormone therapy, and they have not worked. Conservative surgery, also known as laparoscopy, is done to remove or destroy growths of endometrial tissue. The advantage of this type of surgery is that it does not destroy reproductive organs because it is minimally invasive. During the procedure, a surgeon makes small incisions in the abdomen and removes any growths, or burns or vaporizes them using a laser.

Last-resort surgery or hysterectomy. Hysterectomy is a last resort treatment option for women who have already given birth or do not intend to have children and have severe symptoms. Most often, other treatments have not worked for them. If it is a total hysterectomy, a surgeon removes the uterus, cervix and ovaries. The ovaries, in particular, produce estrogen, which causes the growth of endometrial tissue. The surgeon also removes any implant lesions they come across.

STAGES OF ENDOMETRIOSIS

Endometriosis occurs in four stages which depend on the location, size, depth or number of endometrial implants. The four stages are:

Minimal stage. At this stage, a woman has few lesions. She also has shallow endometrial implants on an ovary. There may also be signs of pelvic cavity implantation, that is, in or around the cavity.

Mild stage. There are only light lesions and shallow implants on a woman's ovary and pelvic lining when she has mild endometriosis.

Moderate stage. At this stage, there are deep implants on an ovary, the lining of the pelvis, and many more lesions.

Severe stage. There are deep implants on a woman's pelvic lining and ovaries. She also has many lesions on her fallopian tubes and bowel.

DIAGNOSIS

As already mentioned, endometriosis can be mistaken for other conditions such as pelvic inflammatory disease (PID) and irritable bowel syndrome (IBS) because of the similarity in symptoms. Diagnosis sometimes becomes complicated because of this. Therefore, a doctor has to diagnose the condition accurately and early to manage symptoms well. That said, one of these tests can be used to diagnose endometriosis:

Detailed history

A record of a woman's symptoms and personal or family history of the condition is the first port of call for a diagnosis. 

Pelvic exam

Usually, a doctor will examine a woman's abdomen for cysts or scars behind her uterus during a pelvic exam.

Ultrasound

A doctor may use a transvaginal ultrasound or an abdominal ultrasound. During a transvaginal ultrasound, a transducer is put inside a woman's vagina to take images of her reproductive organs. These images help to identify cysts caused by endometriosis.

Laparoscopy

A laparoscopy is the most reliable or sure method of diagnosing endometriosis. A doctor can do both diagnosis and treatment during the same procedure. Endometrial tissue can be spotted and removed at the same time. 

COMPLICATIONS

Infertility

Infertility is the main complication of endometriosis. About one-half of women with the condition have challenges with getting pregnant. Endometrial tissue blocks the fallopian tubes and prevents an egg and sperm from becoming united for pregnancy to occur. The condition may also cause infertility by damaging sperms and eggs. However, many women with mild and moderate endometriosis can get pregnant. Most doctors advise women with endometriosis not to delay starting a family since the condition progresses with time.

Cancer

Women with endometriosis can develop ovarian cancer later in life, though the risk rates are relatively low. The condition has been linked to a rare type of cancer called endometriosis-associated adenocarcinoma.

 

Disclaimer: The information shared by this post is for informational purposes only. It is not meant to be professional medical advice nor a substitute for professional medical advice, diagnosis or treatment. Consult your physician concerning anything you have read here. 

 

By Nana Ama Afoa Osae I Writer I GreatWonderful Team

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