Endometriosis is a condition in women in which endometrial cells are deposited in areas outside the uterus. These cells continue to be influenced by female hormonal changes and respond similarly as do those cells found inside the uterus. Symptoms often exacerbate in time with the menstrual cycle.
Endometriosis is typically seen during the reproductive years; it has been estimated that it occurs in roughly 5% to 10% of women.
Symptoms
Pelvic pain
A major symptom of endometriosis is severe recurring pain. The amount of pain a woman feels is not necessarily related to the extent or stage. Symptoms of pain may include:
Painful menstrual cramps; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
lower back pain or abdominal pain
painful sex (dyspareunia)
painful bowel movements
urinary urgency, frequency, and sometimes painful voiding
Infertility
Many women with infertility problems have endometriosis. It has been suggested that endometriotic lesions release factors which are harmful for the oocytes or for the embryos.
Location
Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas.
Most endometriosis is found on:
Ovaries (the most common site)
Fallopian tubes
The back of the uterus( Douglas Pouch)
The front of the uterus (Regius)
Uterine ligaments
Pelvic and back wall
Recto- sigmoid area
Bladder and ureters
Diagnosis
A health history and a physical examination can in many patients lead the physician to suspect endometriosis.
The ultrasound and MRI are useful tools but they only give us the suspicion of endometriosis.
The only way to confirm and diagnose endometriosis is by laparotomy or laparoscopy. Laparoscopy also allows for surgical treatment of endometriosis.
Causes
While the exact cause of endometriosis remains unknown, many theories have been presented, such as:
Estrogens: In experimental models, estrogen is necessary to induce or maintain endometriosis. Medical therapy is often aimed at lowering estrogen levels to control the disease.
Retrograde menstruation: The theory of retrograde menstruation, suggests that during a woman's menstrual flow, some of the endometrial debris exits the uterus through the fallopian tubes and attaches itself to the peritoneal surface (the lining of the abdominal cavity) where it can proceed to invade the tissue as endometriosis. While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevent implantation and growth of cells from this occurrence. However, in some patients, endometrial tissue transplanted by retrograde menstruation may be 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 studied, and some of the possible causes below may provide some explanation, e.g., hereditary factors, toxins, or a compromised immune system. It can be argued that the uninterrupted occurrence of regular menstruation month after month for decades is a modern phenomenon, as in the past women had more frequent menstrual rest due to pregnancy and lactation.
Genetics: Hereditary factors play a role. It is well recognized that daughters or sisters of patients with endometriosis are at higher risk of developing endometriosis themselves.
Immune system: Research is focusing on the possibility that it may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. It is still unclear what, if any, causal relationship exists between toxins, autoimmune disease, and endometriosis.
Treatment
Treatments for endometriosis in women who do not wish to become pregnant include:
Medication
NSAD agents not only reduce pain but also reduce menstrual flow.
Progesterone counteracts estrogen and inhibits the growth of the endometrium.
Hormone contraception therapy: reduce the menstrual pain associated with endometriosis. They may function by reducing or eliminating menstrual flow and providing estrogen support.
Danazol is a suppressive steroid with some androgenic activity
GnRH Agonists: These agents work by increasing the levels of GnRH. This is leading to medical menopause.
Surgery
Although medicine is extensively used for this condition, the most effective treatment is surgical.
Laparoscopy
Laparotomy
Treatment of infertility
With Laparoscopy, we remove or vaporize the growths in women who have mild or minimal endometriosis. The use of medical suppression after surgery for minimal/mild endometriosis has not shown benefits for patients with infertility.