Endometriosis

General Illness Information

Medical Term:
ENDOMETRIOSIS

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.

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.

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.

Signs & Symptoms

• The following symptoms may begin abruptly or develop over many years:
• Increased pelvic pain prior to and during menstrual periods
• Pain with sexual intercourse
• Spotting in-between periods
• Infertility (30-40% of patients with endometriosis).
• Back pain.
• Blood in the urine.
• Spontaneous abortion.

Risk Factors

• Family history of endometriosis.
• Delayed childbearing.
• Usually 2% of fertile women suffer from endometriosis but three to four times more common in infertile women.

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:

• Treatment will vary depending on the stage of the disease and the patient’s age and desire to have children
• 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.
• 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
• Treatment choices in endometriosis are :
• Drugs that suppress the activity of the ovaries and thus slow the growth of the endometrial tissue.
• 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.
• 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:

• Non-prescription drugs such as acetaminophen, to relieve minor pain.
• Stronger pain relievers may be prescribed.
• 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:

No restrictions.

Diet:

No special diet.

Possible Complications:

• Infertility caused by implants that constrict or block the fallopian tubes.
• Pelvic adhesions causing chronic pain.
• Disabling condition because of pain but not life threatening
• Bladder or bowel problems if these organs are affected with endometrial implants.
• 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

‘Nothing Specified’.

Posted by RxMed