Endometriosis: Diagnosis, Treatment and prevention

What is Endometriosis?

Endometriosis: Diagnosis, Treatment and prevention -Endometriosis is a common condition that affects women during the reproductive years. It occurs when normal tissue from the uterine lining, the endometrium, attaches to organs in the pelvis and begins to grow. This displaced endometrial tissue causes irritation in the pelvis that may lead to pain and infertility.

 

During each menstrual period, most of the uterine lining and blood is shed through the cervix and into the vagina. However, some of this tissue enters the pelvis through the fallopian tubes. Women who develop endometriosis simply may be unable to clear the pelvis of these cells. It mainly affects women during their reproductive years. It can affect women from every social group and ethnicity. Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.

Types of endometriosis

There are several types of endometriosis:

Peritoneal endometriosis:

 Peritoneal implants that consist of glandular and stromal tissue and respond to hormonal changes associated with the menstrual cycle showing cyclic changes similar but not identical to the normal endometrium. These implants heal by fibrosis.

Ovarian endometriomas:

Benign, estrogen-dependent cyst also known as “chocolate cyst” that contains thick, old blood that appears as a brown fluid. This results from recurrent chronic bleeding from the endometriotic implants. In long-standing endometriomas, the endometriotic tissue is gradually replaced by fibrotic tissue.

Deep endometriosis (DE):

This form of endometriosis is characterized by proliferative fibromuscular tissue with sparse endometrial grandular and stromal tissue (akin to adenomyosis), with no surface epithelium. DE does not show significant changes during the menstrual cycle. Growth of endometriotic nodules are usually found in the uterosacral ligaments, the rectovaginal space, the upper third of the posterior vaginal wall, the bowel, and the urinary tract.4,6

Adenomyosis: Uterine endometriosis presents as asymmetrical uterine enlargement.

Disseminated endometriosis:

Growth of endometriotic tissue in various organs in the body including at the scar site.

History

Risk Factors for Endometriosis

• Early menarche
• First-degree relative with endometriosis
• Late menopause
• Low body mass index
• Müllerian anomalies
• Nulliparity
• Prolonged menstruation (> five days)
• Shorter lactation intervals
• Shorter menstrual cycles (< 28 days)
• White race (compared with black race) 

Women who do experience symptoms may have one or more conditions:

• Painful periods (dysmenorrhoea) which do not respond to over-the-counter pain relief. Some women have heavy periods
• Pain during or after sexual intercourse (dyspareunia)
• Painful defecation (dyschezia) that may be cyclic or semi-cyclic.
• Painful micturition (dysuria)
• Lower abdominal pain
• chronic pelvic pain
• Difficulty in getting pregnant or infertility
• Pain related to the bowels and bladder (with or without abnormal bleeding)
• Chronic fatigue
• Ovulation pain
• Irritable bowel syndrome
• Cyclical or perimenstrual symptoms (e.g. bowel or bladder associated) with or without abnormal bleeding
• Infertility

Complications

Endometriosis Complications

Infertility, which can affect 50 percent of those with the condition.

Increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma

Ovarian cysts

Inflammation

Scar tissue and adhesion development

Intestinal and bladder complications

Diagnosis

If you have any symptoms of endometriosis or are having difficulty becoming pregnant, contact your gynecologist. There are several things she can do to determine if you have endometriosis, including:

• Pelvic exam
• Ultrasound exam
• MRI
• Laparoscopy
• Biopsy

Prevention of Endometriosis

Endometriosis cannot be prevented. This is in part because the cause is poorly understood. But long-term use of birth control hormones (patch, pills, or ring) may prevent endometriosis from becoming worse.