| |
|
|
|
Endometriosis
is a condition where tissue similar
to the lining of the uterus (which should
only be located inside the uterus) is
found elsewhere in the body.
Endometriosis lesions can be found anywhere
in the pelvic cavity: on the ovaries,
the fallopian tubes, and on the pelvic
sidewall. Other common sites include
the uterosacral ligaments, the cul-de-sac,
the pouch of Douglas, and in the recto-vaginal
septum.
In addition, it can be found in caesarian-section
scars, laparoscopy or laparotomy scars,
and on the bladder, bowel, intestines,
colon, appendix, and rectum.
The most common symptom of endometriosis
is pelvic pain. The pain often correlates
to the menstrual cycle, but a woman
with endometriosis may also experience
pain that doesn’t correlate to
her cycle. For many women, the pain
of endometriosis is so severe and debilitating
that it impacts their lives in significant
ways.
Endometriosis can also cause scar tissue
and adhesions to develop that can distort
a woman’s internal anatomy. In
advanced stages, internal organs may
fuse together, causing a condition known
as a "frozen pelvis."
It is estimated that 30-40% of women
with endometriosis are infertile. |
|
|
|
|
Symptoms
of endometriosis |
|
The
most common symptom of endometriosis is pelvic
pain. The pain often correlates to the menstrual
cycle, however a woman with endometriosis may
also experience pain at other times during her
monthly cycle.
For many women, but not everyone, the pain of
endometriosis can unfortunately be so severe
and debilitating that it impacts on her life
significant ways.
|
|
|
Pain
may be felt: |
|
|
before/during/after
menstruation |
|
during
ovulation |
|
in
the bowel during menstruation |
|
when
passing urine |
|
during
or after sexual intercourse |
|
in
the lower back region |
|
|
|
Other
symptoms may include: |
|
|
diarrhoea or constipation (in particular
in connection with menstruation) |
|
abdominal
bloating (again, in connection with
menstruation) |
|
heavy
or irregular bleeding |
|
fatigue |
|
The
other well known symptom associated with endometriosis
is infertility. It is estimated that 30-40%
of women with endometriosis are subfertile |
|
|
What
causes endometriosis? |
|
Several
different hypotheses have been put forward as
to what causes endometriosis. Unfortunately,
none of these theories have ever been entirely
proven, nor do they fully explain all the mechanisms
associated with the development of the disease.
Thus, the cause of endometriosis remains unknown. |
|
|
Diagnosing
endometriosis |
|
There
is no simple test that can be used to diagnose
endometriosis. In fact, the only reliable way
to definitively diagnose endometriosis is by
performing a laparoscopy and to take a biopsy
of the tissue. This is what is known as "the
gold standard".
However, this is an expensive, invasive proceduce.
Furthermore, if the surgeon is not a specialist
in endometriosis s/he may not recognise the
disease, which can result in a "negative"
diagnosis.
In addition, the woman/girl may not want to
have surgery.
This makes diagnosis a challenge, and therefore
an experienced gynaecologist should be able
to recognize symptoms suggestive of endometriosis
through talking with the woman/girl and obtain
a history of her symptoms. For this to be effective,
it is important that the woman/girl is honest
with her physician about all of her symptoms
and the pattern of these.
There are other tests, which the gynaecologist
may perform. These include ultrasound, MRI scans,
and gynaecological examinations. None of these
can definitively confirm endometriosis (though
they can be suggestive of the disease), nor
can they definitively dismiss the presence of
endometriotic lesions/cysts.
The fact that there is no non-invasive, definitive
diagnostic method for endometriosis is as frustrating
for clinicians as it is for women with the disease.
|
|
|
Treatments for endometriosis
|
|
Since
the cause of endometriosis remains unknown,
a treatment which fully cures endometriosis
has yet to be developed.
Choosing a treatment therefore comes down to
the individual woman's wishes, depending on
her symptoms, her age, and her fertility wishes.
She should discuss these with her physician
so that they, together, can determine, which
long term, holistic, treatment plan is best
for her individual needs. For many women, this
can be a combination of more than one treatment.
|
|
|
Pain
killers |
|
Hormonal
therapy may include birth control
pills, progestins, a class of drugs
known as GnRH-analogues, and danazol.
|
|
Surgery
Most doctors agree that laparoscopic surgery
is the only definitive way to diagnose endometriosis.
In many cases, the disease can be diagnosed
and treated in the same procedure. The success
of surgery depends greatly on the skill of the
surgeon and the thoroughness of the surgery.
The aim is to remove all endometriosis lesions,
cysts, and adhesions. Today, most endometriosis
surgery is being done through the laparoscope,
although a full abdominal incision called a
laparotomy may still be required in rare cases
for extensive disease or bowel resections. |
|
|
|
|
| |
|
|
