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Endometriosis
WHAT IS ENDOMETRIOSIS?
Endometriosis is a common medical condition where the tissue of the lining of the uterus, the endometrium, is found outside the uterus affecting other organs in the pelvis such as bowel or ovaries.
This condition can lead to serious health problems, primarily pain and infertility.
Endometriosis first and foremost develops in women of the reproductive age.
ENDOMETRIOSIS SYMPTOMS A major symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area.
The amount of pain a woman feels is not necessarily related to the extent of endometriosis.
On the other hand some women may have severe pain even though they have only a few small areas of endometriosis. Symptoms of endometriosis include:
In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimic irritable bowel syndrome, as well as fatigue.
Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency.
While the exact cause of endometriosis remains unknown, many theories have been presented to explain its development. These concepts do not necessarily exclude each other.
While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevents implantation and growth of cells from this occurrence.
However, in some patients, endometrial tissue transplanted by retrograde menstruation is able to implant and establish itself as endometriosis.
Factors that might cause the tissue to grow in some women, but not in others, need to be elucidated, and some of the possible causes below may provide some explanation, i.e. hereditary factors, toxins, or a compromised immune system.
It can be argued that the uninterrupted occurrence of regular menstruation over decades, month after month is a modern phenomenon, as in the past women had more frequently menstrual rest due to pregnancy or lactation.
Hereditary factors may play a role. It is well recognized that daughters or sisters of patients with endometriosis are at higher risk to develop endometriosis themselves.
A specific gene, however, has not been identified.
Endometriosis has been found in abdominal incision scars after surgery for endometriosis.
On rare occasions endometriosis may be transplanted by blood or by the lymphatic system into peripheral organs (i.e. lungs, brain.
Recent research is focussing on the immune system that may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest to study relationship to autoimmune disease, allergy reactions, and the impact of toxins.
A history and a physical examination can in many patients lead the physician to suspect the diagnosis.
Use of imaging tests may identify larger endometriotic areas, such as nodules or endometriotic cysts.
The two most common imaging tests are ultrasound and magnetic resonance imaging (MRI). Normal results on these tests do not eliminate the possibility of endometriosis, as areas of endometriosis are often too small to be seen by these tests.
The only sure way to confirm a diagnosis of endometriosis is by laparoscopy or keyhole surgery.
Endometriosis has the characteristic appearance of ‘chocolate cysts’ as they contain a thick brownish fluid, which is mostly old blood.
Laparoscopy also allows for surgical treatment of endometriosis.
Women should not accept drug therapy without a confirmed surgical diagnosis of endometriosis.
EPIDEMIOLOGY
Endometriosis can affect any woman of reproductive age, from menarche (the first period) to menopause, regardless of her race, ethnicity, whether or not she has children or her socio-economic status.
Most patients with endometriosis are in their 20s and 30s. Rarely, endometriosis persists after menopause; sometimes, hormones taken for menopausal symptoms may cause the symptoms of endometriosis to continue.
Current estimates place the number of women with endometriosis between 2 and 10 percent of women of reproductive age.
About 30 percent to 40 percent of women with endometriosis are sub-fertile.
Some women do not find out that they have endometriosis until they have trouble getting pregnant as extensive endometriosis may distort pelvic anatomy and thus explains infertility.
Early endometriosis typically occurs on the surfaces of organs in the pelvic and intraabdominal areas.
Larger lesions may be seen within the ovaries as endometriomas or chocolate cysts (They are termed chocolate because they contain a thick brownish fluid, mostly old blood).
Endometriosis may trigger inflammatory responses leading to scar formation and adhesions.
Most endometriosis is found on structures in the pelvic cavity:
Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision.
In extremely rare cases, endometriosis areas can grow in the lungs or other parts of the body.
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