Endometriosis

Endometriosis

Endometriosis is a common disorder that affects over 10% of women of childbearing age. It is a condition in which there are deposits of endometrial tissue outside of the lining of the womb.

Symptoms of endometriosis include:

  • Chronic pelvic pain and cramping, especially before and during the period

  • Heavy menstrual bleeding

  • Painful urination and/or painful bowel movements

  • Bloating

  • Diarrhoea or constipation

  • Painful sexual intercourse

  • Urinary frequency

  • Low back pain

Diagnosis of endometriosis

This is done by laparoscopy to examine the pelvic organs. A thin telescope instrument is inserted through a small incision in the abdomen. This allows close examination of the pelvic organs and endometrial implants can be visualized and biopsied.

Cause of endometriosis

The endometrium is the mucus membrane that lines the uterus. During the menstrual cycle, it responds to hormones by thickening blood vessels in preparation for pregnancy.

The endometrial tissue shed with the period can be pushed outside the uterus and accumulate and can deposit in the pelvis. These deposits can grow in the fallopian tubes, ovaries, external surface of the uterus, intestines, urinary organs, and the rectum.

The sites of abnormal endometrial tissue growth are known as implants. These endometrial implants respond to hormones like the uterine lining does: by thickening, breaking down and shedding. This results in the tissue outside the uterus becoming inflamed, irritated and scarred. The scar tissue are adhesions which cause organs to stick together, and this causes severe menstrual cramps and severe pain before and during the period.

Retrograde menstruation can also contribute to endometriosis. Menstrual blood containing endometrial tissue flows back through the fallopian tubes and into the pelvic cavity. This displaced endometrial tissue adhere to the pelvic organs and surfaces, where they grow and continue to thicken and bleed throughout each menstrual cycle.

When there are large deposits of endometriosis in the ovaries, cysts called endometriomas may form.

Treatments for endometriosis

Medications for endometriosis pain

Pain and ramping before and during menstrual periods can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

Hormonal therapies

Endometriosis is hormonally driven, thus the disease can be suppressed with birth control pills, GnRH(gonadotropin-releasing hormone)agonists, and progestogens with minimal side effects.

Surgery

Patients trying to conceive might elect to have endometriosis removed surgically. This is done by minimally invasive laparoscopic surgery. The endometriosis is excised and adhesions divided, thus improving fertility.

Hysterectomy

Hysterectomy with the removal of tubes and ovaries is used as a last resort for the treatment of severe endometriosis, for women who have completed their family. Removing the ovaries significantly reduces the chance of pain recurring after surgery.

Removal of the reproductive organs is a serious step, and this decision should never happen until all other treatment options have been reviewed.

Endometriosis and infertility

40 % of women with infertility suffer from endometriosis.

Endometriosis causes inflammation of the ovaries and fallopian tubes. This may cause adhesions around the fallopian tubes, which blocks the path of the egg to the uterus. Severe ovarian endometriosis can diminish the egg reserve causing infertility.

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