Endometriosis

ENDOMETRIOSIS

What is Endometriosis?

Endometriosis is a painful condition in which the endometrium tissue that lines the inside of the uterus or womb starts growing outside the uterine cavity. Endometriosis normally involves the ovaries, Fallopian tubes and the tissue lining the pelvis.


When endometrial tissue grows outside of the uterus, it continues to respond to hormonal signals mainly estrogen and progesterone from the ovaries and telling endometrial tissue to grow. Estrogen hormone causes lining to thicken each month during the menstrual cycle. When estrogen levels drop, the lining is expelled from the uterus and results in menstrual flow. Menstrual period tissue literally stuck inside a woman’s body that clings to whatever organs it can find.


Endometriosis causes chronic inflammation which can lead to severe pain particularly during menstruation cycle, internal bleeding, formation of scar tissue (adhesions) in pelvis, bowel or urinary dysfunction, painful intercourse or reduced fertility.


There is no known cause of the disease though it is treatable. Endometriosis is a progressive disease and keeps increasing over the years. Approximately 1 in 10 women from all races, ethnicity, social and economical backgrounds suffer wolrd-wide with endometriosis. Endometriosis can occur before a woman experiences her first period. It usually affects women between the ages of 20 to 40. Women with endometriosis are more likely to have infertility or difficulty getting pregnant. The severity of pain doesn’t indicate the extent of the condition. Some women with mild endometriosis have intense pain while others with advanced endometriosis may have a little pain or in some cases women never know that they have endometriosis or had it in the past due to no pain at all.


Causes of Endometriosis

The cause of the disease is largely unknown and unproven. However, there are multiple theories that explain the mechanism of endometriosis. The most common proposed causes and beliefs regarding endometriosis are listed below.


Retrograde or Reverse menstruation -   According to this popular theory, the menstrual blood containing endometrial cells from the uterus travels through the fallopian tubes and flows back to the pelvic cavity instead of out of the body. As a result, these cells stick to the pelvic walls and surfaces of the pelvic organs where the cells grow and thicken and bleed over the course of each menstrual cycle. Although mostly all women have some degree of retrograde menstruation, only one in 10 are diagnosed with symptomatic endometriosis. Most women are possibly protected by their own immune and clearance systems.

Coelomic metaplasia or cellular metaplasia -   According to this theory, peritoneal cells in the body outside of the uterus transform into endometrial cells that line the uterus due to hormones or immune factors.

Endometrial cell transport -   According to this theory, the endometrial tissue may travel through the blood or lymphatic system to other distant areas or organs.

Immune system disorder -   According to this theory, the body is unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus because of defective immune and clearance systems.

Genetic factors -   According to this theory, genetic factors also play a role as the disease is much more common if close relatives like mother sister also have the endometriosis disease.

Surgical scar or direct implantation -   According to this theory, during a cesarean section or pelvic surgery like hysterectomy, some endometriosis tissue might accidentally get implanted in the abdominal incision.

Embryonic cell transformation -   According to this theory, hormones such as estrogen may transform embryonic cells into endometrial-like cell implants during puberty.


Types of Endometriosis

There are mainly four types of endometriosis based on the abdominal area they affect and they are as below:


Superficial peritoneal lesion (pelvic endometriosis) -   This is the most common type of endometriosis. A person with this condition can have lesions on the peritoneum (a thin film that lines the pelvic cavity).

Androgenic Alopecia:   This is a genetic condition where both men and women can be affected by this condition. Men with this condition may start losing hair even in their teenage years. This is known as male-pattern baldness. It is marked by gradual hair loss from the frontal scalp and the crown and the hairline receding. Women with this condition have hair thinning after their forties from the frontal scalp and the crown. It is known as female-pattern baldness.

Endometrioma (ovarian lesion) -   This type is also known as chocolate cysts as they are dark, fluid-filled cysts. These cysts are present deep in an ovary. This type doesn’t respond well to treatments and can damage surrounding healthy tissues.

Deeply infiltrating endometriosis -   This type of endometriosis grows under the peritoneum and might affect organs near the uterus such as bowels or bladder. Nearly 1 to 5% of endometriosis cases in women are of this type.

Abdominal wall endometriosis -   This type of endometriosis develops due to a surgical incision and wound caused during a cesarean section. The uterus lining-like tissue grows on the abdominal wall.


Symptoms of Endometriosis

The symptoms of endometriosis may vary from woman to woman. The severity of pain doesn’t indicate the extent of the condition. Some women with mild endometriosis have intense pain while others with advanced endometriosis may have a little pain or in some cases women never know that they have endometriosis or had it in the past due to no pain at all. Some of common symptoms are listed below:


  Abnormal or heavy or painful menstrual periods

  Excessive bleeding during menstrual periods

  Chronic pain in pelvis and lower back

  Painful bowel movements during menstrual periods

  Painful urination during menstrual periods

  Painful sexual intercourse

  Infertility

  Fatigue

  Gastrointestinal symptoms like diarrhea, bloating, constipation or nausea especially during menstrual periods


How is Endometriosis diagnosed?

Family doctors or gynecologists or reproductive endocrinologists may diagnose endometriosis by gathering more information about a person's medical condition by examining and knowing the following things:


  By knowing about the patient's symptoms & possible triggers.

  By knowing about the medical history of the person.

  By knowing about the family history of the person.


There is no blood, urine, or saliva test. There are several tests that help doctors diagnose the condition. Some of them are as follows:


Laparoscopy -   Laparoscopy is considered to be the gold standard of diagnosing endometriosis. This surgical procedure is conducted under general anesthesia while the surgeon makes a small cut in the belly and a laparoscope (a thin tube type instrument with a light and a camera on one end) is inserted to view the pelvic region and to check the location and size of the lesions.

Peritoneal tissue biopsy -   The surgeon takes a tiny piece of peritoneal tissue during laparoscopy and checks it under the microscope to confirm the endometriosis. However, a biopsy is not mandatory to diagnose endometriosis.

Pelvic Exam -   The doctor will perform a physical examination and manually feels pelvis for any abnormalities such as cysts on reproductive organs or scars behind the uterus. It is important to note that it is not possible to feel small areas of endometriosis unless it's caused by a cyst.

Ultrasound -   Doctors use high-frequency sound waves to create images inside the body. A device called a transducer captures the images when it is pressed against the abdomen or inserted inside vagina. These imaging will tell the doctor about the development of endometriosis.

Magnetic resonance imaging (MRI) -   The MRI machine uses magnetic fields and radio waves to create detailed images of the organs and tissues inside the body. Surgeons may get detailed information about the location and the size of the endometrial tissue. This test may help to rule out other conditions and also helpful in surgical planning.

CT scan -   This imaging tool uses a combination of X-rays and computer technology to create images of the pelvis to detect any abnormalities.


Treatment of Endometriosis

Unfortunately, there is no universal cure for endometriosis. However, there are a number of options available for treating and managing the disease after diagnosis. Medications and Medical surgery as well as diet and lifestyle management help to manage symptoms.


Medications:  

Non-steroidal anti-inflammatories (NSAIDs) -   These pain reliever drugs are initially given by doctors to ease painful menstrual cramps and to control endometriosis related symptoms. They may be used long-term to manage symptoms for non-pregnant patients. They are effective at reducing implantation, are cheaper and have fewer side effects than hormonal treatments.

   Ibuprofen

   Naproxen

Oral Contraceptives (birth control pills) -   These birth control pills stop ovulation, therefore suppressing the effects of estrogen on endometrial tissue. They are cheaper and have fewer side effects than other hormonal treatments.

   Desogestrel

   Etonogestrel

Injectable Contraceptives -   These injectable birth control drugs halt menstruation and the growth of endometrial tissue, therefore relieving the symptoms of endometriosis. They have side effects such as weight gain, depressed mood and a prolonged delay to get back regular menstrual cycles.

   Medroxyprogesterone

Gonadotropin Releasing Hormone Drugs (GnRH) analogues -   These injectable drugs suppress the ovarian activity, therefore the estrogen hormone level is decreased in the body. However, GnRH agonists have side effects such as hot flashes, vaginal dryness and reversible loss of bone density.

   Leuprolide

Androgen Receptor Agonists -   This reproductive hormone is a synthetic form of a male hormone androgen. It suppresses endometrial tissue and thus suppresses ovarian hormone production. A woman who is taking this drug will typically not ovulate or get regular periods. This drug has side effects that may include weight gain, hair growth and acne.

   Danzol


Medical Treatments:  

Progestin-containing intrauterine device -   An intrauterine device (IUD) containing a synthetic type of progesterone (progestin) can also reduce the painful symptoms. The IUD can be left in the uterus for three to five years and can be removed if a woman wants to conceive.

   Mirena

   Skyla

   Liletta

Laparoscopic Surgery -   During laparoscopic surgery, the surgeon inserts a thin instrument called a laparoscope through a small incision near the navel to view the endometrial tissue. Another instrument is also inserted to remove the tissue through another incision with electrical, ultrasound-generated or laser light or by cutting it out. After surgery, the surgeon will prescribe hormone medications to relieve the pain.

Hysterectomy Surgery -   This surgery is performed in the case of severe pain and when other treatments fail to treat the disease. During hysterectomy surgery, the uterus, visible implant lesions, and ovaries (in some cases) are removed and results in infertility. Hysterectomy alone may not eliminate all endometrial tissue because it can't remove tissue outside of the uterus or ovaries. Surgery to remove the uterus may not relieve the pain associated with endometriosis.


Diet:  

  Drink enough water

  Consume turmeric

  Drink ginger or green Tea

  Take fiber-rich foods like lentils, fruits, vegetables, chia seeds, flax seeds

  Take iron-rich foods like beans, nuts, seeds, broccoli and dark leafy greens

  Take essential fatty acids-rich foods like walnuts, salmons and sardines

  Take antioxidant-rich foods like spinach, oranges, berries and dark chocolates

  Take resveratrol-rich foods like grapes, peanuts, mulberry

  Avoid alcohol

  Avoid wheat

  Avoid bread

  Avoid sugar

  Avoid caffeine

  Avoid dairy products

  Avoid soya products

  Avoid trans fat foods like fried, processed and junk foods

  Avoid red meat or processed meat


Lifestyle management:   Person should take the following steps to reduce symptoms:

  Take prescribed medications regularly.

  Do regular exercises, meditation and yoga to relax the pelvic muscles.

  Use heating pads and take warm baths to relax the pelvic and abdominal muscles providing relief from cramps and pain.

  Prevent constipation by consuming enough water and fiber-rich foods during endometriosis.

  Massage the abdomen using castor oil and a few drops of calming essential oils like lavender and peppermint can relax the pelvic muscles.


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