ENDOMETRIOSIS

Endometriosis is a medical condition in which the endometrial tissue which lines the uterus grows outside the uterus, usually on the fallopian tubes, ovaries, the tissues lining the pelvis or the intestines.

Etiology

The exact cause for endometriosis is unclear and researches have been going on to determine the same. Studies have shown some hormonal, neurological and immunological factors contribute to the developments of symptoms of endometriosis. Researches have also determined increased frequency of genetic inheritance of endometriosis especially in close relatives. There are multiple genes involved in the manifestation of endometriosis as a disorder and hence it is a polygenic or multifactorial inheritance and based on the number of affected genes, the symptoms vary from one individual to another.

The possible causes of endometriosis are –

  • Retrograde menstruation i.e., the flow of menstrual fluid through channels other than the vaginal opening (like the fallopian tube and into the pelvis) has been determined as the most likely cause of endometriosis in women. When the endometrial cells attach to the lining of the pelvic walls they grow and bleed during each menstrual cycle.
  • According to the induction theory, it has been suggested that due to the imbalance in the hormonal and immune factors, the peritoneal cells lining the inner side of the abdomen are transformed into endometrial-like cells, causing endometriosis.
  • Hormones such as estrogen might trigger embryonic cell transformation into endometrial-like cell implants during puberty.
  • Sometimes surgical scar tissues get implanted into the surfaces of other organs and for endometriosis to occur, surgical scars of surgeries like hysterectomy (removal of the uterus) might leave residual endometrial cells.
  • In some rare cases, the blood and lymph vessels can carry endometrial cells to other parts of the body.
  • Disorders of the immune system can affect the ability of the immune cells to identify and destroy the endometrial cells growing out of the uterus.

Risk factors

There are several risk factors associated with endometriosis. These are –

  • Infertility
  • Early menarche (beginning of periods at an early age)
  • Late menopause
  • Shorter menstrual cycles – the number of days between each cycle is lesser than 27 days
  • Heavy and prolonged menstrual periods – longer than 7 days
  • Increased levels of estrogen throughout the life
  • Low body mass index (BMI)
  • One or more relatives with endometriosis (esp. mother, aunt or sister)
  • Any medical condition which obstructs the flow of blood from the body during periods.
  • Disorders of the reproductive system.

Symptoms

Endometriosis is associated with increased pain in the pelvis especially during the periods. While everybody experiences cramps during their menstrual cycle, those suffering from endometriosis describe a pain far worse. The pain experience also seems to increase over the course of time.

Other common symptoms associated with endometriosis include –

  • Dysmenorrhea or painful periods along with pain in the lower back and abdomen
  • Pain during or after sexual intercourse
  • Pain with urination and bowel movements especially during menstrual periods.
  • Excessive bleeding during menstrual periods and sometimes even between periods (intermenstrual bleeding)
  • Infertility – in some cases endometriosis is first diagnosed in women seeking treatment for infertility.
  • Other symptoms like fatigue, constipation, diarrhea, bloating or nausea are experienced during menstrual periods.

In most cases, endometriosis is misdiagnosed for conditions like pelvic pains, pelvic inflammatory disease (PID), ovarian cysts or irritable bowel syndrome (IBS) due to some similarities in their symptoms. Due to this most women are left untreated in the early stages of the condition and their symptoms progress and become more severe with the passage of time.

Treatment

The treatment for endometriosis involves either medication or surgery. The treatment route is decided by the doctor after assessing the stage and severity of the disorder.

  • Pain medication – doctors might prescribe non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium to ease painful cramps during menstrual periods.
  • Hormone therapy – these medicines may help in slowing the growth of endometrial tissue and prevent new implants of endometrial tissue at other sites. Common hormone therapies include –
    • Hormonal contraceptives like birth control pills, patches or vaginal rings.
    • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists which block the production of ovarian stimulating hormones, lower the estrogen levels and prevent menstruation; causing the endometrial tissues to shrink.
    • Progestin therapies like intrauterine devices, contraceptive implants, contraceptive injections or progestin pills can halt menstrual periods and the growth of endometrial implants, alleviating the symptoms of endometriosis.
    • Aromatase inhibitors which reduce the amount of estrogen in the body have been used along with progestin pills for treating endometriosis.
  • Conservative surgery – this procedure is mainly done for women who are trying to get pregnant. In this procedure the scar endometrial tissue deposited outside the uterus are laparoscopically or surgically removed to increase the chances of a successful pregnancy.
  • Fertility treatment – it is recommended for women who have trouble conceiving a child. The type of treatment suggested by fertility experts include the stimulation of ovaries to produce more eggs and in vitro fertilization depending on the personal situation of the patient.
  • Hysterectomy along with the removal of ovaries – This used to be the most common approach for treating endometriosis but has become more and more uncommon off late. While hysterectomy can be performed in patients who do not want to get pregnant to alleviate symptoms like heavy menstrual  bleeding and painful menses; removal of the ovaries results in early menopause which can have other risks on the health oof the patient including cardiovascular complications, metabolic conditions and in some cases an early death.

Chances of getting pregnant with endometriosis

While most women suffering from endometriosis are able to conceive a child naturally, others are able to do so with the help of assisted technologies like in vitro fertilization (IVF). Women suffering from endometriosis ovulate normally just like others without the condition but what actually poses as a problem for conception is the pain during sexual intercourse which becomes unbearable at times.

Also, pregnancies in women having endometriosis are considered “high-risk pregnancies” due to the fact that they have significantly high chances of abdominal bleeding during the third trimester of the pregnancy which can in some cases cause them to lose the baby and therefore need extra care during the course of their pregnancy.

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