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Endometriosis - Symptoms & Treatment

Endometriosis is a common medical condition where the tissue lining the uterus (the endometrium , from endo , "inside", and metra , "womb") is found outside of the uterus, typically affecting other organs in the pelvis. The condition can lead to serious health problems, primarily pain and infertility. Endometriosis primarily develops in women of the reproductive age.

A diagnosis of endometriosis denotes the presence of endometrial tissue outside the lining of the uterine cavity. Such ectopic tissue is generally confined to the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and cul-de-sac, but it can appear anywhere in the body.

This ectopic endometrial tissue responds to normal stimulation in the same way the endometrium does. During menstruation, the ectopic tissue bleeds, which causes the surrounding tissues to become inflamed. This inflammation causes fibrosis, leading to adhesions that produce pain and cause infertility.

Active endometriosis usually occurs between ages 30 and 40, especially in women who postpone childbearing; it's uncommon before age 20. Severe symptoms of endometriosis may have an abrupt onset or develop over many years. This disorder usually becomes progressively severe during the menstrual years; after menopause, it tends to subside.

Causes

The cause of endometriosis is unknown though there are a few theories that suggest possible causes. The main theories to explain this disorder are:

• transtubal regurgitation of endometrial cells and implantation at ectopic sites.
• coelomic metaplasia (repeated inflammation may induce metaplasia of mesothelial cells to the endometrial epithelium) .
• lymphatic or hematogenous spread to account for extraperitoneal disease.

Signs and symptoms

The most common sign of endometriosis is severe pelvic (lower abdominal) pain. It may occur occasionally or constantly, and it may be associated with a girl's period. Although slight cramps for a couple of days before or during a menstrual period are normal, lasting or intense pain that disrupts a person's day is not. With endometriosis, the pain is usually so bad that it causes a girl to miss school, sports, and social activities.

Other possible symptoms include:

• pelvic pain that gets worse during exercise, after sex, or after a pelvic exam
• a very heavy period
• lower back pain
• constipation, diarrhea, or feeling pain or seeing blood when going to the bathroom (endometrial implants can press on some of the organs involved in getting waste out of the body, such as the bladder, intestines, and rectum)

If a girl notices these symptoms, it doesn't necessarily mean that she has endometriosis. See your doctor if you have above signs and symptoms that may indicate endometriosis. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.

Diagnosis

Palpation during a pelvic examination may detect multiple tender nodules on the uterosacral ligaments or in the rectovaginal septum in one-third of patients. These nodules enlarge and become more tender during menses.

Palpation may also uncover ovarian enlargement in the presence of endometrial cysts on the ovaries or thickened, nodular adnexa (as in pelvic inflammatory disease). Laparoscopy is used to confirm the diagnosis and determine the stage of the disease before treatment is initiated.

Treatment

The stage of the disease and the patient's age and desire to have children are treatment considerations for endometriosis. In stages I and II (mild forms with superficial endometria and filmy adhesions), conservative therapy for young women who want to have children includes androgens such as danazol, which produce a temporary remission. Progestins and oral contraceptives also relieve symptoms. Gonadotropin-releasing hormone agonists, by inducing a pseudomenopause and, thus, a "medical oophorectomy," have shown a remission of disease and are commonly used.

When ovarian masses are present (stages III and IV), surgery must rule out cancer. Conservative surgery is possible, but the treatment of choice for women who don't want to bear children and for those with extensive disease (stages III and IV) is a total abdominal hysterectomy with bilateral salpingo-oophorectomy.

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.