What is endometriosis?
A common problem among women, endometriosis gets its name from the word ‘endometrium’ or the tissue that lines the uterus (womb). Endometriosis occurs when this tissue lining grows outside the uterus on other organs or structures of the body (endometrial implant). Most often, it occurs on the following:
- Fallopian tubes
- Outer surface of uterus
- Tissues that hold the uterus in place
- Lining of pelvic cavity
- Growth may also occur in the vagina, cervix, vulva, bladder, bowel or rectum, and very rarely in other parts of the body like the skin, brain or lungs.
What are the causes of the disorder?
Endometriosis is one of the most common health problems in women. It most commonly occurs in women in 30s and 40s. Though the exact cause of the disease is not known, some theories for its occurrence include:
- Retrograde menstruation – It is the most likely cause for the condition in which menstrual blood containing endometrial cells flow back through the fallopian tubes into the pelvic cavity, instead of coming out of the body. These endometrial cells stick to the pelvic walls and organs where they continue to grow, thicken and bleed over the course of each menstrual cycle.
- Embryonic cell growth – Cells in the pelvic and abdominal cavities both originate from embryonic cells. Endometriosis may develop when a small section of abdominal cell lining turns into endometrial tissue instead of abdominal cells.
- Surgical scar implantation – Endometrial cells can attach themselves to a surgical incision formed during the course of a C-section or hysterectomy surgery.
- Transport of endometrial cells – Endometrial cells may be transported to other parts of the body through blood vessels or lymphatic fluid.
- Immune system disorder – The body may be unable to recognise and destroy the abnormal growth of endometrial cells outside the uterus in presence of an immune disorder.
What one needs to know about symptoms or signs?
The most common symptom of endometriosis is pain in the pelvis, lower abdomen or lower back, predominantly during menstrual period. The severity of pain depends on the extent of the condition, though some women may not feel any pain despite a large diseased area. Symptoms of endometriosis include:
- Painful menstrual cramps
- Chronic pain in pelvis and back; intestinal pain
- Painful sex
- Pain urination or bowel movement during menstrual period
- Spotting or bleeding in between menstrual period
- Infertility (inability to get pregnant)
Which specialist should be consulted in case of signs and symptoms?
Women experiencing symptoms of endometriosis must consult a gynaecologist (doctor who specialises in disorders of female reproductive system).
What are the screening tests and investigations done to confirm or rule out the disorder?
Tests to determine the presence of endometriosis include:
- Pelvic exam – The doctor manually feels the areas in the pelvis for abnormalities like cysts or scars.
- Ultrasound – High frequency sound waves create images of the reproductive organs, which are then captured by a device called transducer. The transducer is pressed against the abdominal skin or inserted into the vagina (transvaginal ultrasound). Ultrasound can identify cysts associated with endometriosis.
- Laparoscopy – This is a confirmatory test used for endometriosis. Performed under general anaesthesia, a surgeon makes a tiny incision near the navel to insert a viewing instrument known as laparoscope to view the endometrial implants, and determine the location, extent and size. It can also be used to take samples of tissue for biopsy.
What treatment modalities are available for management of the disorder?
The treatment approach depends on the severity of the sign and symptoms and whether the patient hopes to become pregnant. Options include:
#1 Pain medication
Mild symptoms can be treated with over-the-counter medication like ibuprofen or stronger medication as prescribed by the doctor.
#2 Hormone treatment
Hormone medicines (pills, injections, nasal sprays) are used if pain medication is not enough to treat the condition. However, only women who do not wish to become pregnant later may use hormonal therapy. Common hormones used include:
- Birth control pills – These decrease the amount of menstrual flow and prevent overgrowth of tissue that lines the uterus. Pills contain two hormones, oestrogen and progestin. A woman can get pregnant again once she stops the medication.
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – These drugs reduce the levels of oestrogen in the body, completely stopping the menstrual cycle. However, a low dose of oestrogen or progestin is commonly prescribed along with them to prevent menopause-like side effects. The monthly periods and ability to conceive returns when a woman stops taking the medicines, and symptoms of endometriosis may stay away for months and years.
- Progestin – Hormone progestin works against the effects of oestrogen, helping to shrink the excess tissue. Though menstrual periods stop, irregular vaginal bleeding may occur.
- Danazol – It is a weak male hormone that lowers the effect of oestrogen and progesterone. Periods stop or may come less often. This medication does not prevent pregnancy, though it can harm a growing baby in the uterus. It cannot be used in combination with other drugs like birth control pills.
Surgery works best for severe conditions and involves removal of growth, scar tissue or burning them away, without affecting the healthy tissue around. The following procedures may be used:
- Laparoscopy – Used for both diagnosis and treatment, laparoscopy removes the excess tissue growth or burns it away. Recovery is much faster than that from abdominal surgery.
- Laparotomy – It involves a large cut in the abdomen to reach into and remove the endometrial growth in pelvis and abdomen.
- Hysterectomy – In cases where endometriosis has severely affected the uterus and/or ovaries, the surgeon removes these organs to ensure that endometriosis will not return. A woman cannot get pregnant after this surgery, and it is usually the last treatment resort.
What are the known complications in management of the disorder?
- Impaired fertility – Endometriosis may obstruct the fallopian tubes and prevent the egg and sperm from uniting. It can also cause damage to the egg or sperm.
- Ovarian cancer – Ovarian cancer occurs at higher rates in women with endometriosis.
Is there any risk to other family members of having the disorder?
Endometriosis sometimes runs in families as it may be carried in genes, and family members of patient (mother, aunt, sister) may be more likely to get it.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Women dealing with endometriosis can take certain measures during their course of treatment:
- Relieve discomfort – Warm baths, heating pads and over-the-counter non-steroidal anti-inflammatory drugs can ease cramping and pain.
- Regular exercise – Staying physically active can help improve symptoms.
- Support group – Joining a support group for women with endometriosis or fertility problems and sharing experiences can help deal with the condition and its complications.
“Endometriosis,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/endometriosis/basics/definition/con-20013968
“Endometriosis,” MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000915.htm
“Endometriosis Overview,” WebMD.com, https://www.webmd.com/women/endometriosis/default.htm
“Endometriosis fact sheet,” WomensHealth.gov, https://womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html
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