WHAT EXACTLY IS ENDOMETRIOSIS?

Endometriosis is a medical condition caused by the abnormal growth of the uterine lining, also known as the endometrium. Most commonly, endometriosis occurs in the Fallopian tubes, ovaries, the other side of the uterus, bowel and pelvic regions; rarely, endometriosis may be detected beyond the pelvic region as well (e.g. lungs and skin).

Prevalence

It is estimated that over 5 million women in the US have endometriosis. This condition most commonly affects women in their 30s and 40s. Pregnancy may temporarily alleviate the symptoms, and with the start of menopause, endometriosis tends to disappear.

Symptoms

With each menstrual cycle, the abnormal endometrial tissue thickens and then bleeds, leading to possible severe pain during period. The severity of pain, however, may vary between patients. Other symptoms of endometriosis include pelvic cramping, lower back and abdominal pain, painful intercourse, bowel movements and urination, excessive bleeding during menstruation (menorrhagia) and bleeding between periods (menometrorrhagia), fatigue, diarrhea, constipation and bloating during periods.

Detection

Endometriosis is often difficult to diagnose, and can easily be confused with pelvic inflammatory disease, ovarian cysts, or irritable bowel syndrome. Vaginal ultrasound and laparoscopy help detect the presence of displaced endometrial tissues outside the uterus.

Possible Causes

• During menstruation, if the menstrual blood flows back into the Fallopian tubes, the endometrial cells could stick to the pelvic organ surfaces. This phenomenon is known as retrograde menstruation. The displaced endometrial cells continue to grow outside the uterus within the pelvic organs, and could lead to endometriosis.
• During embryonic cell growth, cells in the pelvic cavity could turn into endometrial tissues.
• Surgical scars resulting from hysterectomy and C-section could also facilitate the attachment of endometrial cells outside the uterus, leading to endometriosis.
• The transport of endometrial cells into other pelvic structures by blood vessels or the lymphatic system is another plausible cause of endometriosis.
• Immunological abnormalities can prevent the detection of endometrial tissue growing outside the uterus.
• A family history of endometriosis could also increase one’s chances of having this disorder.
• Exposure to the chemical dioxin (found in pesticides) has been associated with increased chances of getting endometriosis.

Complications

• Infertility: Around 33 – 50 % of all patients with endometriosis develop fertility problems. The obstruction of the Fallopian tubes by endometrial tissue impedes the normal passage of oocyte and subsequent fertilization. Moreover, if the excess endometrial tissue gets trapped within the ovaries, cysts (known as endometriomas) can develop along with scarring of the surrounding organs.
• Cancer: Although endometriosis is not a cancerous condition, it can increases the chances of ovarian cancer, and rarely could lead to endometriosis-associated adenocarcinoma.

Treatment

Endometriosis can be effectively treated with available medical interventions. The treatment of choice will depend on one’s age, symptoms and conception plans.

Pain medications may alleviate pain symptoms associated with endometriosis. Hormone treatments, such as birth control pills, GnRH agonists and antagonists, progestins and Danazol, can help women with minor endometriosis. However, these medications are only available to women who choose not to become pregnant. For severe endometriosis cases, surgery is the best option. Laparoscopy can help both diagnosis and treatment of endometriosis, and requires only minor surgical interventions. Laparotomy is a major abdominal surgery that may be essential to get rid of extensive endometriosis that has spread into many organs. Finally, if a woman’s uterus has been severely damaged by persistent endometriosis, hysterectomy (complete removal of the uterus) may be necessary.