Overview:
Endometriosis (en-doe-me-tree-O-sis) is an often debilitating disease in which tissue similar to the tissue that normally lines the inside of the uterus — the endometrium — develops outside your uterus.
Endometriosis most commonly entails your ovaries, fallopian tubes, and the tissue lining your own pelvis. Paradoxically, endometrial tissue can spread beyond pelvic organs.
With endometriosis, the endometrial-like tissue acts like endometrial tissue will it thickens, breaks down, and bleeds with every menstrual cycle.
However, because this tissue has no way to exit the human body, it becomes trapped. When endometriosis entails the uterus, cysts called endometriomas might form.
Surrounding tissue can get irritated, finally creating scar tissue and adhesions — abnormal bands of tissue that can cause pelvic organs and tissues to adhere to one another.
Endometriosis may cause pain — sometimes acute –, particularly during menstrual periods.
Fertility problems also may develop. Fortunately, effective treatments are available.
Symptoms of Endometriosis:
The principal symptom of endometriosis is pelvic pain, frequently associated with menstrual periods.
Although many experiences cramping during their menstrual period, those with endometriosis typically describe menstrual pain that’s much worse than normal.
Pain also may rise over time.
Painful periods (dysmenorrhea) -Pelvic pain and cramping may begin earlier and stretch several days into a menstrual period. You may also have lower back and abdominal pain.
Pain with intercourse – Pain during or after intercourse is common with endometriosis.
Pain with bowel movements or urination – You are most likely to encounter these symptoms during a menstrual period. From time to time, endometriosis is first diagnosed with people seeking treatment for infertility.
Other signs and symptoms:
You may experience fatigue, diarrhea, constipation, nausea, or bloating, particularly during menstrual periods.
The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition.
You might have moderate endometriosis with acute pain, or you could have complex endometriosis with little if any pain.
Endometriosis is occasionally mistaken for other conditions that may cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts.
It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of nausea, constipation, and abdominal cramping.
IBS can accompany endometriosis, which may complicate the diagnosis.
Watch your health care provider if you have signs and symptoms which may indicate endometriosis.
Endometriosis may be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team, and an understanding of your diagnosis may lead to better management of your symptoms.
Causes of Endometriosis:
Although the Specific cause of endometriosis Isn’t sure, possible explanations include:
Retrograde menstruation – In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic fascia rather than from the human body.
These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to bleed and thicken within the course of every menstrual cycle.
In what is known as the”induction concept,” experts suggest that hormones or resistant variables promote the transformation of peritoneal cells — cells that line the inner side of your abdomen — to endometrial-like cells.
Embryonic cell transformation – Hormones such as estrogen may change embryonic cells in the first stages of growth — into endometrial-like mobile implants during puberty.
Surgical scar implantation – After surgery, like a hysterectomy or C-section, endometrial cells can attach to a surgical incision.
Endometrial cell transportation – The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells into other parts of the human body.
Immune system disorder – A problem with the immune system can make the body unable to recognize and destroy endometrial-like tissue that is growing outside the uterus.
Several factors place you at greater risk of developing endometriosis, such as:
Starting your period at an early age
Short menstrual cycles — for Example, less than 27 times
Heavy menstrual periods that last longer than seven days
Having higher amounts of estrogen in your body or even a greater lifetime exposure to estrogen your body produces
One or more relatives (mother, cousin, or aunt ) with endometriosis
Any health condition that prevents the normal passage of menstrual flow out of the body
Reproductive tract Infection:
Endometriosis usually develops several years after the onset of menstruation (menarche).
Signs and symptoms of endometriosis may temporarily improve with maternity and might go away completely with menopause unless you’re taking estrogen.
Complications of Infertility:
The main complication of endometriosis is impaired fertility.
Approximately one-third to one-half of women with endometriosis have trouble becoming pregnant.
For pregnancy to occur, an egg must be released in the ovary, travel throughout the nearby thoracic tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development.
Endometriosis may obstruct the tube and retain the egg and sperm from uniting.
But the condition also seems to affect fertility in less-direct ways, such as by damaging the egg or sperm.
Doctors occasionally advise people that have endometriosis to not postpone having kids because the condition can worsen with time.
Cancer:
Ovarian cancer does happen at higher than expected rates in those with endometriosis. But the overall lifetime risk of prostate cancer is low to start with.
Some studies indicate that endometriosis raises that threat, but it’s still comparatively low.
Although rare, yet another type of cancer — endometriosis-associated adenocarcinoma — may develop later in life in those who have had endometriosis.
Diagnosis of Endometriosis:
The way the pelvic exam is done
To diagnose endometriosis and other illnesses that can result in pelvic pain, your doctor will ask you to describe your symptoms, including the area of your pain and when it happens.
Tests to test for physical clues of endometriosis include:
Pelvic examination – During a pelvic exam, your doctor manually feels (palpates) regions in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your own uterus.
Often it is impossible to feel modest areas of endometriosis unless they’ve caused a cyst to form.
Ultrasound – This test utilizes high-frequency sound waves to make images of the inside of your body.
To capture the pictures, a device called a transducer is either pressed against your stomach or inserted into your vagina (transvaginal ultrasound).
The two types of ultrasound could be done to get the best perspective of their reproductive organs.
A typical ultrasound imaging evaluation will not automatically tell your physician if you have endometriosis, but it might identify cysts associated with endometriosis (endometriomas).
Magnetic resonance imaging (MRI) – An MRI is a test that uses a magnetic field and radio waves to produce detailed pictures of the organs and tissues within your body.
For some, an MRI helps with operative preparation, providing your physician detailed information about the location and size of endometrial implants.
Laparoscopy – In some cases, your physician may refer you to a surgeon to get a process that allows the surgeon to see within your abdomen (laparoscopy).
As you’re under general anesthesia, your surgeon makes a small incision near your navel and inserts a slight screening instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.
A laparoscopy can offer information about the location, extent, and size of the endometrial implants. Your physician might take a tissue sample (biopsy) for further testing.
Often, with proper surgical planning, your physician can fully treat endometriosis during the laparoscopy so that you need only 1 surgery.
Treatment:
Treatment for endometriosis usually includes medication or surgery.
The strategy you and your doctor choose will depend on how severe your symptoms and signs are and if you aspire to become pregnant.
Doctors usually recommend trying conservative treatment approaches initially, opting for surgery if initial treatment fails.
Pain medication:
Your physician may advise that you take an over-the-counter pain reliever, like the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve) to help ease painful menstrual discomforts.
Your physician may recommend hormone treatment together with pain relievers if you are not attempting to get pregnant.
Hormone treatment:
Supplemental hormones are sometimes helpful in reducing or eliminating the pain of endometriosis.
The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed.
Hormone medicine may slow endometrial tissue growth and prevent new enhancements of endometrial tissue.
Hormone therapy isn’t a permanent fix for endometriosis. You might experience a recurrence of your symptoms after stopping treatment.
Treatments used to treat endometriosis include:
Hormonal contraceptives – Birth control pills, patches, and vaginal rings help restrain the hormones responsible for the buildup of endometrial tissue each month.
Many have shorter and lighter menstrual flow when they’re using a hormonal contraceptive.
Utilizing hormonal contraceptives — notably continuous-cycle regimens — may reduce or eliminate pain in some cases.
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – These drugs block the creation of ovarian-stimulating hormones, lowering estrogen levels and preventing cellulite.
This induces endometrial tissue to shrink. Menstrual periods and also the ability to get pregnant return when you stop taking the medicine.
Progestin treatment – A variety of progestin therapies, including an intrauterine device with levonorgestrel (Mirena, Skyla), the contraceptive implant (Nexplanon), contraceptive pills (Depo-Provera), or progestin pill (Camila).
It can halt menstrual periods and the development of endometrial implants, which may alleviate endometriosis symptoms and signs.
Aromatase inhibitors – Aromatase inhibitors are a class of medicines that decrease the quantity of estrogen in your system.
Your physician may suggest an aromatase inhibitor alongside a progestin or combination hormonal contraceptive to treat endometriosis.
If you have endometriosis and are attempting to get pregnant, surgery to remove the endometriosis implants while maintaining your uterus and ovaries (conservative surgery) may increase your chances of succeeding.
For those who have severe pain from endometriosis, you may also gain from surgery — nevertheless, endometriosis and pain may return.
Your physician can do this procedure laparoscopically or, less commonly, through traditional abdominal surgery in more-extensive instances.
Even in severe cases of endometriosis, many could be treated with a laparoscopic operation.
In laparoscopic surgery, your physician inserts a slim viewing instrument (laparoscope) through a tiny incision near your navel and inserts instruments to remove endometrial tissue via another small incision.
After surgery, your doctor may recommend taking hormone medicine to help improve pain.
Fertility treatment:
Endometriosis may lead to trouble conceiving.
If you’re having trouble becoming pregnant, your doctor may recommend fertility treatment supervised by a fertility specialist.
Fertility treatment ranges from stimulating your clitoris to create more eggs to in vitro fertilization.
Which treatment is right for you depends upon your personal situation.
Hysterectomy with removal of the ovaries:
Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) were once believed to be the most effective treatment for endometriosis.
But endometriosis specialists are moving away from this approach, instead of focusing on the careful and methodical removal of all endometriosis tissue.
Having your ovaries removed contributes to menopause.
The dearth of hormones made by the ovaries can improve endometriosis pain for many, but for others, endometriosis that stays after surgery continues to cause symptoms.
Early menopause also carries a threat of heart and blood vessel (cardiovascular) ailments, certain metabolic conditions, and early death.
Elimination of the uterus (hysterectomy)
It can at times be used as a treatment for symptoms and signs related to endometriosis, such as heavy menstrual bleeding and painful menses as a result of uterine cramping, in those who don’t need to become pregnant.
Even when the ovaries are left in place, a hysterectomy may still have a long-term impact on your wellbeing, especially if you have the operation before age 35.
Locating a physician with whom you feel comfortable is vital in treating and managing endometriosis.
You might want to get another opinion prior to beginning any treatment to be sure you understand all of your choices and the probable outcomes.
Ask your friends and loved ones for support. If you’re feeling anxious or depressed, consider joining a support group or seeking counseling. Believe in your ability to take control of the pain…
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