Endometriosis
Definition of Endometriosis
Endometriosis is a condition in which the tissue that lines the inside of the uterus (called the endometrium or endometrial lining) is found growing in other areas outside of the uterus (commonly the ovaries, fallopian tubes, and nearby structures of the pelvis). This condition often causes severe pain within the lower abdomen and pelvis that may be associated with your periods each month.
Description of Endometriosis
The endometrium is the inner tissue lining of the uterus that normally grows each month in response to sex hormones to provide a nourishing site for fertilized eggs to implant. If no fertilized egg implants, the hormones decline and this lining sheds. This is known as your period. Endometriosis is diagnosed when this “endometrial tissue” is found in various locations within the body but outside of the uterus. Common sites include:
- Ovaries
- Fallopian tubes
- Outer surface of the uterus
- Outer surfaces of the bowel
- Other pelvic structures
- Other body tissues located anywhere in the abdomen
Rarely endometriosis can be found in other sites inside of the body.
- At these sites, the endometrial tissue responds to the cycle of changes just as the endometrium normally responds within the uterus. And just as the endometria; tissue growing within the uterus may shed and bleed, the tissue located outside of the uterus bleeds. However, unlike menstrual blood that is allowed to escape from the uterus, this bleeding causes internal inflammation ultimately producing scar tissue and sometimes adhesions (abnormal tissue growth that bind organs together). On the ovary, a sac-like collection (cyst) filled with old blood may form. This is known as a “chocolate cyst.”
Causes and Risk Factors of Endometriosis
The cause of endometriosis There are many theories. The most accepted theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be a genetic process or that certain families may have predisposing factors.
Symptoms of Endometriosis
The symptoms of endometriosis are: - Pain before and during menstrual periods
- Pain at the time of ovulation
- Pain during or after sexual activity
- Heavy or irregular bleeding
- Fatigue
- Pain with bowel movements at the time of the period
- Pain with urination
Diagnosis of Endometriosis
Diagnosis of endometriosis is often made clinically in your doctor’s office based on your symptoms. The disease can have mild, moderate, or severe pain associated. The diagnosis can be confirmed by a minor surgical procedure called laparoscopy. This procedure is done under anesthesia. A laparoscope is a thin tube with a light and camera on the end which is inserted into a small incision made in the abdomen. The abdomen is inflated with carbon dioxide gas to make the organs easier to see. The surgeon can then check the condition of the abdominal organs and see the location, extent and size of the endometrial growths.
Endometriosis is often associated with impaired fertility and may be diagnosed during an evaluation for infertility.
Treatment of Endometriosis
There is no definitive cure for endometriosis. The goal of the treatment is to alleviate the pain symptoms associated with the condition or to improve fertility. Pain medications are often prescribed for symptomatic relief.Your doctor will usually begin with a pharmaceutical intervention (medication) for treatment. The medication options to treat the disease include hormonal medications such as birth control pills. Other common medications include Megace (progesterone), Lupron, and Danazol.
If necessary, your doctor may recommend a surgery (via laparoscope) be performed to eliminate much of the implants of tissue from the abdomen and pelvis in addition to medications. Rarely, a hysterectomy (removal of the uterus) with removal of both ovaries may be recommended to relieve the pain symptoms.
Questions To Ask Your Doctor About Endometriosis
What tests need to be done to diagnose endometriosis or to rule out some other disease?
Will a laparoscopy be recommended?
Are there any risks?
What treatment will you be recommending?
Will you be prescribing any medication?
What are the side effects?
How effective is this medication in treating endometriosis?
What are the chances that surgery may be needed to correct the condition?
How will this affect my chances of getting pregnant and of having a successful pregnancy?
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