Definition
Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility .
The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.
Symptoms
- Increasingly painful periods
- Lower abdominal pain or pelvic cramps that can by felt for a week or two before menstruation
- Lower abdominal pain felt during menstruation (the pain and cramps may be steady and dull or quite ...
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Definition
Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility .
The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.
Symptoms
- Increasingly painful periods
- Lower abdominal pain or pelvic cramps that can by felt for a week or two before menstruation
- Lower abdominal pain felt during menstruation (the pain and cramps may be steady and dull or quite severe)
- Pelvic or low back pain that may occur at any time during the menstrual cycle
- Pain during or following sexual intercourse
- Pain with bowel movements
- Premenstrual spotting
- Infertility
Note: Frequently, symptoms may not be present. In fact, some women with severe cases of endometriosis have no pain at all, while some women with only ...
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Causes
The cause of endometriosis is unknown. However, there are a number of theories. One suggests that the endometrial cells (loosened during menstruation) may "back up" through the fallopian tubes into the pelvis, where they implant and grow in the pelvic or abdominal cavities. This is called retrograde-menstruation.
Other theories include:
- A faulty immune system causes menstrual tissue to implant and grow in areas other than the uterine lining.
- Cells lining the abdominal cavity may spontaneously develop endometriosis.
- Certain families may have genetic factors that make a woman more prone to endometriosis
Each month the ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply ...
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Treatment
Treatment depends on the how bad the symptoms are, the severity of the disease, the woman's desire to have children in the future, and her age.
Some women with mild disease and symptoms may just be monitored. It is important to maintain a regular schedule of examinations (every 6 to 12 months) to note any changes or to see if the disease has gotten worse.
Painkillers (analgesics) may be given to relieve pain.
Stopping the menstrual cycle creates a state resembling pregnancy (pseudopregnancy) and can help prevent the disease from getting worse. Pseudopregnancy can be created using oral contraceptives containing estrogen and progesterone. Women take the medicine consistently for 6 to 9 months. This type of therapy relieves most of the symptoms, but does not prevent scarring from the disease. Side effects ...
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Possible Complications
Infertility may result from endometriosis, but not in every patient -- especially if the endometriosis is mild. Endometriosis has been known to come back even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.
Outlook (Prognosis)
How well surgery helps improve fertility depends on the severity of the endometriosis. Pregnancy rates after surgery in women previously considered to be infertile are approximately 75% for mild endometriosis, 50-60% for moderate cases, and 30-40% for severe cases.
Prevention
There is no proven prevention for endometriosis. Women with a strong family history of endometriosis may consider taking oral contraceptive pills, as this treatment may help to prevent or slow down the development of the disease.
Exams and Tests
A pelvic examination may reveal the presence of tender nodules , with a lumpy consistency. These are often found in the posterior vaginal wall or adnexa (ovary regions), and they may sometimes be felt in healed wound scars (especially those from episiotomy and C-section ). There may be pain with uterine motion.
The uterus may be fixed or retroverted. A pelvic ultrasound test may detect an endometrioma on an ovary. A laparoscopy is necessary for a definite diagnosis, but most patients can start treatment without this.
References
L Speroff, M Fitz. Clinical Gynecologic Endocrinology and Infertility . 7th ed. Lippincott Williams & Wilkins; 2004.
Hansen KA, Eyster KM. A review of current management of endometriosis in 2006: an evidence-based approach. S D Med. 2006 Apr;59(4):153-9.
Adamson GD, Pasta DJ. Surgical treatment of endometriosis-associated infertility: meta-analysis compared with survival analysis. Am J Obstet Gynecol . 1994 Dec;171(6):1488-504.
