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| General
Illness Information |
Medical
Term: |
ENDOMETRIOSIS |
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Common
Name: |
None Specified |
| Description: |
Endometriosis is a condition in
which the endometrium (i.e. the inner lining of the uterus) which
is normally found only in the uterus, grows in and
around the pelvic organs e.g.. the fallopian tubes, ovaries, pelvic
cavity and also around other abdominal organs like the bowels,
kidneys and rarely the lung.
Most commonly found in women between the ages of
20-40 years ,but may occur at anytime from puberty to menopause.
Endometriosis is estimated to occur in 10 to 15% of
menstruating women. It can occur in teenagers too.
Endometriosis may cause infertility and in fact 25
to 50% of infertile women may have endometriosis.
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| Causes: |
Unknown, but the following theory is most
accepted: Normally during ovulation, the uterus lining thickens to
prepare for implantation of a fertilized egg. If implantation
does not occur, the endometrial lining peels away
from the uterus and is expelled in the menstrual flow.
In some cases, this material builds up and passes
backward out of the fallopian tubes into the pelvic cavity. Here it
floats freely and attaches itself to other
tissues.
The transplanted tissue reacts each month as if it
were still in the uterus, thickening and peeling way. New bits of
peeled-off tissue create new implants. The growing endometrial
tissue between pelvic organs may cause them to adhere together,
producing pain and other symptoms.
The other theory postulates the spread of
endometrial tissue through the lymphatic and vascular channel.
Recent studies have investigated the possibility of an autoimmune
cause and the possible role of exposure to toxic chemicals in the
development of endometriosis.
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| Prevention: |
Have children while you are young.
Pregnancy seems to have a temporary ameliorating effect on the
course of the disease.
Endometriosis is usually a recurring disorder that
may persist even into early menopause.
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| Signs
& Symptoms |
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| Risk
Factors |
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| Diagnosis & Treatment |
Difficult to diagnose and may need surgical procedure
called laparoscopy (examination of the abdomen and pelvic
cavity with an optical instrument) to make the
diagnosis.
Laparoscopy is performed by inserting a
laparoscope (a fiber optic viewing tube) through a small
incision just below the navel. In some cases, endometriosis
cannot be recognized when viewed , and the diagnosis can only
be made by doing a biopsy ( i.e. taking a small sample of
tissue for microscopic examination ).
Other procedures, such as ultrasound scans,
barium enemas, CT scans (computed tomography) and
sometimes even magnetic resonance imaging (MRI) may need
to be performed ,to diagnose and determine the extent of the
disease. |
| General
Measures: |
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Treatment will vary depending on
the stage of the disease and the patient's age and desire to
have children |
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If you want children consider pregnancy as
soon as possible. Pregnancy sometimes cures the disorder.
Delaying pregnancy may cause infertility. Infertility has been
treated with ovarian stimulation and in-vitro fertilization
with varying success. |
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Use heat to relieve pain. Place a heating pad
or hot-water bottle on your abdomen or back or take warm baths
to relax muscles and relieve discomfort |
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Treatment choices in endometriosis are
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Drugs that suppress the activity of the
ovaries and thus slow the growth of the endometrial
tissue. |
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Surgery to excise as much of the ectopic
(misplaced) endometrial tissue as possible- this would help in
alleviating pain , scarring and infertility. This is a good
option for the patient who wants to become
pregnant. |
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Surgery to remove ovaries and uterus
(hysterectomy)- This treatment is reserved for patients who
have pelvic and abdominal pain that is not relieved by drugs
and who do not wish to become pregnant. After the
surgery , the patients are started on hormone
replacement therapy. It may be started right after the surgery
or if a lot of endometrial tissue was still there ,after the
surgery , then the treatment is delayed for 4 to 6 months ,
allowing the endometrial tissue to
regress. | |
| Medications: |
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Non-prescription drugs such as
acetaminophen, to relieve minor pain. |
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Stronger pain relievers may be
prescribed. |
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Danazol, gonadrotropin-releasing
hormones, oral contraceptives, or progestogens are commonly
used drugs for treating endometriosis ,by suppressing ovarian
function for up to 6 to 9 months.
Danazol is a derivative of 17 alpha
testosterone. Length of therapy depends on response to
treatment and whether surgery is planned. If no surgery is
planned , than minimal length of treatment is 6 months. If
surgery is planned, than 12 weeks of therapy is adequate.
Improvement of symptoms occurs in 80 to 90% of cases, but
there is no effect on fertility. Side-effects include weight
gain, hirsutism (excess hair growth), acne, mood alterations,
and adverse effect on cholesterol levels. Most of these
changes are reversible within 6 months of discontinuing the
drug.
Gonadotrophin-releasing hormone (GnRH)
agonists- (e.g. Synarel, Lupron )- These markedly reduce
the levels of estrogen and causes amenorrhea ( absence of
menses). Duration of treatment is usually 6 months.
Between 80 to 90% of patients show improvement in pain
symptoms, but there is no effect on fertility. These drugs are
usually well tolerated, but side-effects include hot flashes,
vaginal dryness, and bone loss , which is usually
reversible when the drug is discontinued. Addition of a
progestogen may decrease the flushing spells and bone
loss. Calcium supplementation 1000-1500 mg is recommended to
prevent bone loss during treatment.
Progestogens - prescribed in an injectable
depot preparation or in tablet form. Duration of treatment is
3 to 4 months. 80 to 90% of cases report improvement in pain
symptoms but has no effect on fertility. Women desiring
pregnancy should not be prescribed depot preparation as it
prevents ovulation for a prolonged period.
Oral contraceptive pills are less effective in
relieving symptoms than other medical therapies and should be
used only if other regimens are contraindicated. Duration of
treatment is 6 to 9 months, but symptoms may worsen initially.
Side-effects are frequent and sometimes severe, including
breast tenderness, bloating, weight gain, nausea and swelling
of hands and feet. | |
| Activity: |
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No restrictions. | |
| Diet: |
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No special
diet. | |
| Possible
Complications : |
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Infertility caused by implants that
constrict or block the fallopian tubes. |
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Pelvic adhesions causing chronic
pain. |
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Disabling condition because of pain
but not life threatening |
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Bladder or bowel problems if these
organs are affected with endometrial implants. |
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Total abdominal hysterectomy and
removal of ovaries and fallopian
tubes. | |
| Prognosis |
| For reproductive
function, in mild to moderate endometriosis, is good with
conservative therapy. . Signs and symptoms generally
regress with onset of menopause, but can usually be controlled
during the reproductive years. In severe disease, surgery may
be curative (excision of uterus and ovaries and other
endometrial implants) | |
| Other |
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