Endometriosis

Definition

Endometriosis is a female disorder in which the cells lining the inner wall of the uterus (endometrium) implant and start growing in other parts of the body. Endometrial cells in the uterus cause the growth of the endometrium during menstrual cycles and are shed off during the periods. These endometrial implants are not usually cancerous.

Location

The ectopic growth of endometrial cells (called endometrial tissue implants) in endometriosis usually happen in organs of the pelvic region like the ovaries, fallopian tubes, intestines, urinary bladder, vagina, cervix, lining of pelvic cavity. It can also occur on distant sites such as the linings of the heart and lungs, diaphragm, kidney, spleen, gallbladder, stomach, breast, and brain.

Symptoms

Endometriosis is one of the most common gynecological problems in women aged between 25 and 35 years. However, many women do not show any symptoms at all and therefore, do not require any treatment. In others, endometriosis causes mild to severe symptoms that depend on the location of the endometrial implants.

The following are some of the symptoms of endometriosis:

  • Pelvic or lower back pain
  • Irregular and painful periods (dysmenorrhea)
  • Painful sexual intercourse (dyspareunia)
  • Painful urination (dysuria)
  • Painful defecation
  • Infertility (in severe cases)

When endometriosis is suspected based on these symptoms, laparoscopy and tissue biopsy are done to confirm the diagnosis by directly observing the endometrial implants in non-uterine tissues.

Causes

The cause of endometriosis is not known.

A widely accepted explanation is that endometrial cells from the uterus travel to other parts of the body and implant there. This could happen due to reversal of menstrual flow (retrograde menstruation) into the fallopian tubes and the pelvic or abdominal cavity. The lymph and the blood could then carry the endometrial cells from the pelvic or abdominal cavity to distant organs.

Another theory suggests that certain cells lining the pelvic organsĀ  might transform into endometrial cells and start growing (a condition called coelomic metaplasia).

Endometriosis also seems to run in some families, suggesting that there may be certain genetic factors that determine the occurrence of this condition.

Delayed childbearing and short menstrual cycles accompanied by periods that last for more than a week are also risk factors for developing endometriosis.

Treatment

Endometriosis cannot be cured. The treatments are aimed at relieving/suppressing pain and other symptoms associated with the disorder. Women who show no symptomsof endometriosis do not require any treatment.

Treatment options include medication and surgery. The choice of treatment depends on factors such as age of the patient, severity of the symptoms, and the desire for childbearing.

Medication

Non-steroidal anti-inflammatory drugs, like ibuprofen and acetaminophen, are given to suppress pain and menstrual cramps. Hormones responsible for menstrual cycle are suppressed by agonists of gonadotropin-releasing hormones (GnRH), oral contraceptive pills, and progestins. Suppression of these hormones reduces the size of endometrial implants and improves the symptoms.

Surgery

Surgical procedures are considered when medication is not effective and the disorder is severe. Surgical removal of endometrial implants is done when future pregnancy is a consideration. If pregnancy is not desired, the uterus and ovaries are removed surgically to prevent recurrence of endometriosis.

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