Endometriosis
Definition of Endometriosis
Endometriosis is a gynecological disorder in which the cells lining the inside of uterus start growing outside the uterine cavity. The cells lining the uterus make up the tissue called endometrium. These endometrial cells usually grow outside on abdominal membrane (peritoneum), on tissue lining the pelvic cavity, on ovaries and bowel. It results in menstrual disturbances and eventually infertility occurs. When menstrual cycle starts, these displaced cells grow and thicken and bleed over the regular course. There are four stages of the endometriosis depending on which treatment plan is suggested:
- Subtle: In the beginning, it looks like a small sac or cyst, usually 1 to 3mm in size and often resembles the ovarian cancer. However, it is not serious at this stage.
- Typical: The black spots are seen against the white fibrous wall. These spots are 1 to 2 cm in diameter and often found in and around the pelvic cavity.
- Cystic ovarian: At this stage, cysts ranging from 4 to 15 cm are formed on ovaries. These cysts may form adhesions on pelvic wall.
- Deep: It is mostly found on the between the back of uterus and rectum. It is a solid tumor of size varies from 4 to 6 cm.
Cause of Endometriosis
The certain cause of endometriosis is still unknown. However, some possible explanations include the following:
- Retrograde menstruation: During regular menstruation, uterus sheds its cells out of the body through the vagina accompanying the blood flow. If cells start moving inside the body, instead of outside the body, and implant themselves on pelvic organs or on pelvic or abdominal cavity, it results in endometriosis.
- Abnormal embryonic cell growth: During organ formation in developing fetus, some embryonic cells abnormally form small areas of endometrial tissue in abdominal or pelvic cavity, it results in endometriosis.
- Defective immune system: When immune system does not recognize and destroy the displaced endometrial cells in pelvic cavity, endometriosis occurs.
- Endometrial cells transport: Endometrial cells may be transported through lymphatic or blood vessels and are implanted on abdominal or pelvic cavity.
- Surgical scar implantation: During abdominal surgery some endometrial cells may implant in the abdominal cavity due to incisions by same instruments in different parts of body.
Signs and Symptoms of Endometriosis
There is usually pain during menstruation in endometriosis.
- Pain in pelvic region is a sure sign of endometriosis.
- Discomfort in bowel movements occurs due to endometriosis in abdominal cavity.
- Pain in urination is due to endometriosis around bladder.
- Endometriosis usually results in pain during sexual intercourse.
- Excessive bleeding takes place in endometriosis.
- Infertility is a major symptom of endometriosis in women.
- Other symptoms include fatigue, diarrhea, nausea and vomiting during menstruation.
Risk Factors for Endometriosis
- Age: Women between age of 25 and 40 are at high risk.
- Family history: Previous history of endometriosis in any family member greatly increases the risk.
- Never giving birth: In those women who never gave birth are at high risk to develop endometriosis.
- Previous uterine infection: Any uterine infection increases the risk of developing endometriosis.
- Environmental toxins: Studies have shown that women exposed to the environmental toxin known as dioxin usually develop endometriosis.
Diagnosis of Endometriosis
To diagnose the endometriosis, gynecologist will take the medical history of previous infections and family history of endometriosis. A complete physical examination will be performed to confirm sign and symptoms.
- Pelvic exam: During pelvic exam, doctor will palpate the abnormalities in the pelvic region or see if any cyst is present.
- Ultrasound: A transducer is pressed on abdominal wall or inserted into the vagina to have the best view of vagina. It confirms if any cyst or tumor is present in abdominal or pelvic region.
- Laparoscopy: Surgeon makes the tiny incision near navel and inserts the instruments in the abdomen. It is the best option to confirm the diagnosis.
Prevention from Endometriosis
Studies have shown that the use of combined oral contraceptives greatly decreases the risk of endometriosis.
Treatment of Endometriosis
- Pain medications: These are not much effective.
- Hormonal therapy: Hormonal contraceptives, Gonadotropin releasing hormone agonists and antagonists, Danazol and methoxyprogesterone are often successful in the treatment plan.
- Conservative surgery: Sometimes small surgery is performed without damaging the reproductive organs.
- Radical surgery: When the reproductive organs are removed in the surgery it is called radical surgery or hysterectomy.
- Assisted reproductive technologies: If conservative surgery is ineffective, often invitro fertilization is preferable treatment option.