Endometriosis is a disorder of women in childbearing age. Endometriosis symptoms are pain in lower tummy, heavy menses. Endometriosis treatment requires a complex approach and directly depends on the patient`s intention to have children in future. Below we will review the causes of this disease, as well as its` treatment options and diagnosis methods in detail.
Endometriosis is an often painful disorder in where the tissue lining the inside of the uterus (endometrium) grows outside the uterus (endometrial implant). This condition involves the ovaries, bowel or the tissue lining the pelvis, on rare occasions beyond the pelvic region.
In endometriosis, displaced endometrial tissue continues to act normally where it thickens, breaks down, and bleeds with every menstrual cycle; this displaced tissue becomes trapped as there is no exit available. Endometriomas (cysts) may occur on involvement of the ovaries in endometriosis and the surrounding tissue can become irritated forming scar tissues and adhesions in the process.
DO ADULT WOMEN HAVE TROUBLE GETTING PREGNANT?
Endometriosis can tend to grow and damage the fallopian tubes and ovaries if not found and treated making it difficult but not impossible to get pregnant. Due to the non-availability of reliable statistics indicating what percentage of women with endometriosis have no problems having children, have difficulties but eventually succeed or never succeed, it is impossible to give women reliable information of their chances of having fertility problems.
Generally, it is believed that 60 – 70% of women with endometriosis are fertile and that half of the women who have difficulties with getting pregnant do eventually conceive with or without treatment. However, the likelihood of fertility problems increases with the severity of the disease with age.
CAUSES OF ENDOMETRIOSIS
The cause of this disease is not known, but there are theories available. They are:
- Sampson’s Theory: This theory explains that the flow of menstrual blood gets ‘backed up’ which causes some of the blood to flow in the opposite direction. This process causes the blood containing endometrial tissue to attach to surfaces outside of the uterus.
- Meyer’s Theory: This theory suggests that specific cells called metaplastic cells change into endometrial cells that are actually presents at birth.
- Vascular Theory: This theory proposes that the endometrial tissue travels through the body through blood vessels reaching various tissues, implants and then growing which leads to pain.
Symptoms of endometriosis include:
- Painful periods (dysmenorrhea)
- Painful intercourse
- Pain with bowel movements
- Excessive bleeding
- Other symptoms may include fatigue, diarrhoea, constipation, bloating or nausea especially during menstrual periods.
ENDOMETRIOSIS TREATMENT OPTIONS
This disorder can either be treated through medication or surgery, choice of treatment method depends on the symptoms or if the woman wants to get pregnant.
- Pain Medication: Over-the-counter pain reliever such as non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Motrin IB) may be recommended by the doctor to ease the pain of menstrual cramps.
Supplemental hormones can sometimes be used for effective reduction or elimination of endometriosis. This is due to the rise and fall of hormones during the menstrual cycle causing endometrial implants to thicken, break down and bleed. The use of hormone medication may slow and prevent the growth of endometrial tissue; however, it doesn’t provide a permanent solution to endometriosis.
Hormonal therapies for the treatment of endometriosis include:
- Hormone Contraceptive: Contraceptives such as birth control pills, patches and vaginal rings help in controlling hormones responsible endometrial tissue build-up for every month. The use of hormonal contraceptives allow for lighter and shorter menstrual flow.
- Gonadotropin-releasing hormone (GN-RH) agonists and antagonistse: These drugs shrink the endometrial tissue by blocking the production of ovarian stimulating hormones, lowering estrogen levels and preventing menstruation. During the time of treatment, at times years after, these drugs can force endometriosis into remission. Gn-RH agonists and antagonists with a low dose of estrogen or progestin may decrease menopausal side effects like vaginal dryness, hot flashes and bone loss. Once the medication is stopped, ability to conceive returns.
- Medroxyprogesterone (DEPO-PROVERA): This drug is effective in stopping the growth of endometrial implants and menstruation in turn relieving the symptoms of endometriosis. Side effects include weight loss, decreased bone production and depressed mood.
- Danazol: Though danazol may not be the first drug to be recommended due to serious side effects which can be harmful to the baby during pregnancy, it helps in the treatment of endometriosis by blocking the production of ovarian stimulating hormones and preventing menstruation.
- Conservative Surgery: Surgery is another way in which endometriosis can be treated especially if one plans on getting pregnant. This procedure is carried out by removing as much endometriosis as possible while preserving the uterus and ovaries. This surgery proves to be beneficial for those who experience severe pain though the condition and pain may return. The surgeon performs this procedure laparoscopically.
- Assisted reproductive technologies: Technologies such as In Vitro Fertilization Assisted reproductive technologies helps in making those who do not want to go through conservative surgery or when it is ineffective to become pregnant.
- Hysterectomy: Hysterectomy is the procedure performed in the removal of the uterus and cervix as well as both of the ovaries. This treatment is made when there is severe case of endometriosis. This is a last resort treatment especially for women who are still in their reproductive years. The pain can still persist after performing the surgery due to the estrogen produced by the ovaries if hysterectomy is carried out alone for treatment.
- History Taking: The doctor asks for a description of the symptoms occurring, location of the pain and when it happens. Questions about the family and menstrual periods are also asked.
- Pelvic Exam: The doctor feels the area of the pelvis for the occurrence of abnormalities such as cysts on the reproductive organs or scars behind the uterus. Small areas of endometriosis may not be felt unless there is a formation of cysts.
- Ultrasound: This test makes use of high frequency sound waves to create images of the internal body. To create the images of the reproductive organs, a device known as the transducer is either pressed against the abdominal skin or inserted into the vagina. Ultrasound imaging helps to identify endometriomas.
- Laparoscopy: This is the procedure carried out by a surgeon to ascertain that one has endometriosis. This is a surgical procedure which involves the surgeon making an incision below the navel and inserting an instrument known as the laparoscope. Tissue samples are retrieved from this procedure to carry out a biopsy. Laparoscopy helps in determining the extent and size of an endometrial implant.