Endometriosis is a medical disorder that affects many women and can cause a variety of symptoms some of which can be very severe. This disorder can affect fertility as well. The associated symptoms of endometriosis can have a severe impact on the general physical, mental and social wellbeing of women.
What is endometriosis?
Endometriosis is an often painful disorder in which tissue that normally lines the inside of the uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.
In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.
Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.
Other symptoms of endometriosis
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that is far worse than usual. They also tend to report that the pain has increased over time.
Common signs and symptoms of endometriosis may include:
• Painful periods (dysmenorrhea).
• Pain with intercourse.
• Pain with bowel movements or urination.
• Excessive bleeding.
• Infertility.
The severity of pain is not necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or even no pain at all.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis which can complicate the diagnosis.
What causes endometriosis?
We do not know the exact cause of endometriosis at this time, but several possible explanations have been suggested and include the following:
• Retrograde menstruation. This is the most likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs where they grow and continue to thicken and bleed over the course of each menstrual cycle.
• Embryonic cell growth. The cells lining the abdominal and pelvic cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop.
• Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
• Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
• Immune system disorder. It is possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that is growing outside the uterus.
Complications of endometriosis
Infertility
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.
Many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.
Ovarian cancer
Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it is still relatively low.
Diagnosis
A detailed clinical history and physical examination are crucial in making the diagnosis of endometriosis. Your gynaecologist would perform a pelvic examination as well. Other tests and investigations might be done to include an ultrasound scan and laparoscopy.
Treatment
There is no cure for endometriosis, but treatment can help with pain and infertility.
Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
Conclusion
Endometriosis is a common disorder affecting many women in Anguilla and many other countries. The main symptom is pelvic pain/dysmenorrhoea, but other symptoms might also present. There are many ways of treating endometriosis, but surgery is often considered when all other measures have failed. Finding a doctor with whom the affected woman feels comfortable is crucial in managing and treating endometriosis.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
