Endometriosis is a benign condition in which glands and tissue from inside the uterus are also present in other locations in the body. Usually the extra-uterine locations are within the pelvis in places like the ovaries, fallopian tubes (tubes that connect the ovaries to the uterus), and/or the uterine ligaments (these ligaments help to keep the uterus properly placed). The cause of endometriosis is unknown but the implantation theory has been suggested to better understand it. This theory suggests that during the menstrual cycle there is a small amount of reverse flow of menstrual blood containing uterine tissue into the fallopian tubes (usually the flow is out towards the vagina). Since one end of each tube is open to the pelvic cavity, the uterine tissue can spread from here and implant in other structures. These implants undergo the same cyclic changes seen in the uterus during menstruation but have no outlet for the blood. As they continue to bleed each month, inflammation and consequential scarring result. Endometriosis is most commonly found in women of the reproductive age group because it is estrogen dependent.
Signs and Symptoms
The most frequent presentation is that of painful menstruation. As the individual implants undergo changes during menstruation and bleed they cause localized inflammation. During this reaction chemicals released may induce the pain response. The symptoms can vary depending on where the endometriosis is located. For example, if it were located on or near the rectum, painful bowel movements can be felt. Patients can also experience pain during urination or sexual intercourse. The flow of the menstrual cycle can become heavier and there may be premenstrual spotting.
Diagnosis of Endometriosis
The initial step in reaching a diagnosis is to perform a pelvic ultrasound. This is an imaging study done at the bedside that allows internal structures to be seen. The different implants can be observed along with any scar tissue that may have formed. To confirm the diagnosis of endometriosis a laparoscopy is performed. Laparoscopy is a minimally invasive surgical procedure that serves a dual purpose: to diagnose and to treat. Through small incisions on the lower abdomen, tubes equipped with a light source and cameras are passed inside to allow for better visualization. Depending on the location of the lesions and other factors, the endometriosis is staged from one to four. The stage identifies the severity of the disease and its extent.
Treatment of Endometriosis
To alleviate pain non-steroidal anti-inflammatory drugs also known as NSAIDs are used. Hormonal therapies such as oral contraceptive pills (OCPs) are also used for pain reduction. OCPs can prevent menstruation if taken continuously and this can help to reduce the size of the lesions or eliminate them. Surgical options are available and vary depending on whether or not the woman wants to try to conceive. Laparoscopy is used to remove the implants along with scar tissue, and this is typically done when laparoscopy is performed for diagnostic purposes. If a woman does not wish to conceive she can have her uterus and other affected reproductive tract organs removed.
Complications of Endometriosis
Endometriosis may lead to risks of ectopic pregnancy (a pregnancy that develops outside of the uterus) and/or infertility. These complications are due to the scarring that results from the constant inflammation, which distorts the normal anatomy of the reproductive tract. Scar tissue can block sperm from reaching the ovum for fertilization resulting in infertility or it can prevent an already fertilized ovum from entering its normal place in the uterus, causing it to develop elsewhere (most commonly in the fallopian tube) which is termed an ectopic pregnancy. These pregnancies rarely survive and can be hazardous to the mother due to rupture and bleeding of the organ housing the developing embryo. Another common complication that can develop is called an endometrioma. This is a fluid containing structure that forms on an ovary that contains an endometriotic lesion. This structure can lead to pain and/or infertility and often requires surgical removal of the affected ovary.
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