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Endometriosis

Overview

Endometriosis is a disorder of the female reproductive system characterized by an abnormal growth of endometrial tissue (that normally lines the inside of the uterus) at places other than the uterine cavity resulting in pain and infertility. The most common areas where this endometrial tissue is found are the ovaries, fallopian tubes, uterosacral ligaments, rectovaginal septum, vagina, or cervix. It can rarely be found at laparotomy scars, nasal mucosa, lung, diaphragm, breast, etc. This tissue responds to cyclical activation by female sex hormones and can bleed, resulting in inflammation, scarring, and fibrosis of nearby organs. The cause of the disease is still unknown. However, many theories have been postulated. The disease itself has no cure but is managed by medicines and surgical procedures when needed.

Causes

The exact cause of endometriosis is not well known. Some theories suggest the backflow of endometrial tissue in the pelvis during the menstrual period that gets itself attached to the ovaries or ligaments and grows. Some also propose the possibility of stem cell migration and growth of the tissue at abnormal places.

Epidemiology

6-10% of US women have reported the presence of endometriosis. Endometriosis occurs most commonly in women of reproductive age (25-30 years). Symptoms usually resolve after menopause.

Risk factors

  • Following are some of the risk factors for endometriosis:
  • Family history 
  • Early age of beginning of menstruation
  • Heavy bleeding during menses
  • Less number of children
  • Having Short menstrual cycles
  • Having a menstrual flow of long duration 
  • Possible abnormalities of the female reproductive tract like the uterus or fallopian tubes
  • Late age of menopause
  • Prolonged exposure to estrogen hormone

Signs and symptoms

One-third of women having endometriosis do not show any symptoms. Also, there is a disparity of symptoms with relation to the presence of structural lesions. Some women with severe lesions show minimal symptoms, while others have severe debilitating symptoms even with small lesions. Some common symptoms are described below;

  • Moderate to severe pain during the menstrual cycle
  • Irregular or heavy bleeding
  • Chronic Pelvic pain
  • Back pain 
  • Pain during sexual intercourse
  • Pain with defecation or urination
  • Nausea, and vomiting
  • Bloating,
  • Pain while performing exercise
  • Infertility

Diagnosis

Many a time, endometriosis is not diagnosed well. Many women have to suffer symptoms for a long duration before a definite diagnosis is made by some physician. Your health care provider will begin with a detailed medical history and physical examination, including a pelvic exam. The following investigations may be advised. 

  • Blood tests; CBC to rule out infection and levels of hemoglobin. Some hormone levels like Testosterone, TSH, Cortisol, Prolactin, FSH, LH, HCG, etc. Bleeding and clotting tests to rule out bleeding disorders for the symptom of heavy bleeding. 
  • Urinalysis to rule out urinary infection.
  • Vaginal and cervical swabs to exclude genital infections.
  • Pelvic ultrasound to visualize the lesions.
  • MRI scan of the pelvis.
  • Pap smear: In this test, cells are collected from your cervix to rule out cervical cancer.
  • Hysteroscopy: In this procedure, a tiny camera is inserted into the uterus to help the doctor find abnormalities.
  • Endometrial biopsy: A sample of the uterine lining is taken and sent to the laboratory for further analysis.
  • Laparoscopy: a tiny camera is inserted in the abdominal cavity via a small incision to look for the lesions and obtain a biopsy. This is the gold standard test for endometriosis.

Differential Diagnosis

Some of the diseases can present similar as endometriosis;

Treatment

There is no permanent cure for endometriosis. Some medicines are used to control pain. The hormonal influence of the disorder has led to the use of hormonal medicines for the control of symptoms. However, medicines cannot restore fertility, and sometimes surgical intervention is needed. Commonly used medicines are;

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to suppress pain. For example, ibuprofen, naproxen sodium. 
  • Combination oral contraceptive pills (COCPs), also called birth control pills.
  • Danazol
  • Progestational agents
  • Gonadotropin-releasing hormone (GnRH) analogues

        Surgical procedures

  • Conservative surgery: The endometrial lesions can be removed laparoscopically to improve chances of fertility. 
  • Radical surgery: Uterus and ovaries are removed in patients with severe symptoms and who no longer desire to become pregnant. 

Prognosis

In one-third of women, the symptoms resolve on their own without any intervention. Endometriosis is a progressive disease with an unpredictable extent and morbidity in remaining women. Medical therapy is usually effective in controlling pain, but not fertility, for which surgical therapies have been partly effective. However, 50% of women suffer a relapse of symptoms within 5 years of treatment with medicines. 

Lifestyle changes

Endometriosis has no cure, nor are there ways to prevent its occurrence. However, some of the people have reported some relief of symptoms by adopting some lifestyle changes, which are:

  • Making changes in the diet. Include more fruit, vegetables, fish, and healthy fats like omega-3 fatty acids found in tuna, salmon, and walnuts. 
  • Avoid eating beef, pork, and other red meat.
  • Avoid excessive amounts of alcohol.
  • Avoid drinks with a large amount of caffeine.
  • Adopt a habit of exercising regularly. Yoga tends to help a lot.
  • Try to be relaxed using meditation or relaxation techniques that work for you. 
  • Join support groups or get to know people with similar problems and their strategies to cope with life. 
  • If you feel depressed or anxious, don’t hesitate to consult a psychologist for your symptoms.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 06, 2023.

References

https://www.sciencedirect.com/science/article/abs/pii/S0140673621003895

https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20is%20a%20disease%20in,period%20and%20last%20until%20menopause.

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