Endometriosis - Medical specialists

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Endometriosis - Further information

Overview of endometriosis

Endometriosis is a female disorder that involves the endometrium (the lining of the uterus). With this condition, endometrial tissue, which would normally grow inside the uterus, forms instead on other areas in the pelvic region, outside the uterus itself. This can include tissue growth on the ovaries, fallopian tubes, bowel and pelvic-lining tissues. It is unusual for this tissue growth to spread elsewhere beyond the pelvic region.

These clumps of misplaced endometrial tissue are affected by the hormonal changes that occur during your menstrual cycle. As a result, they grow, thicken and break down, and may then become trapped inside your pelvis. Though symptoms may not always be present, this can be painful and cause fertility issues.

Endometriosis tends to be a common gynaecological disorder that affects many women, but is rarely dangerous.

Localisation of Endometriosis

Symptoms of endometriosis

Endometriosis can present various mild, moderate or severe symptoms. The degree of pain experienced is not necessarily related to the extent of the condition – for instance, some women may have an acute form of the disorder and yet report fairly mild discomfort.

Pain in the pelvic region is the most typical symptom of endometriosis. However, there may be other symptoms too, such as:

  • very painful periods
  • lower abdominal pain before/ during menstruation
  • cramps during the 7 – 14 days surrounding menstruation
  • heavy menstrual bleeding
  • bleeding between periods
  • infertility
  • pain following sex
  • discomfort associated with bowel movements
  • lower back pain occurring at any point in the menstrual cycle

Though you may experience none of these symptoms, an annual gynaecological examination will be required to check for any changes – especially if you experience two or more of these symptoms.

Causes of endometriosis

Your body rids itself of the uterus lining during a regular menstrual cycle. Menstrual blood then flows from the uterus, through the cervical opening and out through your vagina.

However, a form of endometriosis known as retrograde menstruation can occur if, instead of flowing out of your body, menstrual blood actually flows back through your fallopian tubes and thus into the region of the pelvic cavity. During this process, endometrial cells can cling to any of the surfaces they encounter – such as pelvic walls and organs such as the ovaries, bladder and rectum. Once in position they grow, thicken, break down and bleed during the menstrual cycle. Menstrual blood can also gain access to the pelvic cavity via a surgical scar.

Though it’s not clear why this happens, the disorder may also occur if small sections of abdominal tissue transform into endometrial tissue. It has been suggested some abdominal cells that form from embryonic cells may mutate and then behave like endometrial cells.

Diagnosis of endometriosis

Painful or heavy periods can have many causes, so your doctor will conduct the following tests to reach an accurate diagnosis:

  • a medical history and physical examination to note your symptoms as well as your general health, and to check for any family history of endometriosis
  • ultrasound may be used to create an image of your reproductive organs to check for cysts that are linked with endometrial disorders
  • a laparoscopy (a minor surgical procedure) may be called upon to confirm a diagnosis of endometriosis

Treatment of endometriosis

Endometriosis cannot be cured, but both medical and surgical options can offer relief from its symptoms. The chosen response will usually be in line with the degree of severity of your condition, and may include some of the following treatments:

  • common pain medications (e.g. ibuprofen) can be effective in some instances
  • supplemental hormonal therapy can sometimes address the problem of abnormal tissue growth
  • hormonal contraceptive measures (e.g. birth control pills) may also address endometrial tissue growth and reduce pain
  • gonadotropin-releasing hormone (Gn-RH) agonists and antagonists can act to prevent menstruation, but may have side effects that mirror menopausal symptoms
  • danazol is also employed to halt menstruation, though this medication may produce side effects

If surgery is considered necessary, this may take the following forms:

  • conservative surgery, which aims to preserve your reproductive organs while reducing abnormal tissue growth via minimally invasive laparoscopy, or else via more traditional abdominal surgery
  • radical surgery (hysterectomy) is a final solution if nothing else helps, though it is always advisable to seek a second opinion – especially for women in their childbearing years, who will no longer be able to become pregnant

Chances of recovery from endometriosis

Not all therapy and interventions will work for all women, and some may have a recurrence of symptoms after surgery or pseudo-menopause treatments. In the majority of cases, treatment will offer significant relief from pelvic pain and should assist women who hope to become pregnant.

Prevention of endometriosis

Endometriosis cannot be prevented. The fact that this disorder is poorly understood is a contributory factor, though long-term treatment with birth-control hormones has often been shown to help prevent the condition from getting worse.

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