March is endometriosis awareness month, and many health professionals use the month to draw attention to this enigmatic condition that affects many women worldwide. Endometriosis a long-term condition that can have a significant impact on a woman’s life. Fortunately, there are treatments that can help.
What is endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus (womb) starts to grow in other places such as the ovaries and fallopian tubes. Rarely, endometrial tissue may spread beyond pelvic organs. With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. This tissue has no way to exit the woman’s body and 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 bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. Endometriosis can cause pain which can be very severe at times, especially during menstrual periods. Fertility problems may also develop.
What causes of endometriosis?
Despite much research, the exact cause of endometriosis is not known. It is believed that a combination of different factors might be involved. Several theories have been suggested, including:
• genetics – the condition tends to run in families, and affects people of certain ethnic groups more than others
• retrograde menstruation – when some of the womb lining flows up through the fallopian tubes and embeds itself on the organs of the pelvis, rather than leaving the body as a period
• a problem with the immune system, the body’s natural defence against illness and infection
• endometrium cells spreading through the body in the bloodstream or lymphatic system, a series of tubes and glands that form part of the immune system.
What are some symptoms of endometriosis?
The leading symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many women experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that is far worse than usual. Pain may also increase over time. Other symptoms of endometriosis include the following:
• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination.
• Excessive bleeding. This might occur between menstrual periods (intermenstrual bleeding).
• Infertility.
• Less frequent symptoms include: fatigue, diarrhoea, constipation, bloating or nausea especially during menstrual periods.
Diagnosis
If you have symptoms suggestive of endometriosis you should see your gynaecologist. A detailed history and physical examination are often needed to make the diagnosis, along with a combination of other investigations. A standard ultrasound imaging test would not definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas). A laparoscopy examination can provide information about the location, extent and size of the endometrial implants and can be used to treat the condition as well. A biopsy of affected lesion can allow the pathologist to make a definitive diagnosis.
Treatment
At this time there is no cure for endometriosis, but there are several treatments that can manage the symptoms. Treatments include: painkillers, hormone medications, intrauterine systems, and gonadotrophin-releasing hormone (GnRH) analogues, and surgery.
Your gynaecologist will discuss various treatment options, including complications of various treatments. Very often a treatment plan can be implemented to relieve many of the symptoms of endometriosis.
Endometriosis is often discovered during investigations for infertility. This problem would often involve other treatment options.
Conclusion
Many women worldwide suffer from endometriosis. It can be a difficult condition to deal with, both physically and emotionally. Very often it is difficult to diagnose – and treatment is often delayed unnecessarily. There is no cure for this disorder, but various treatment options are now available to help manage most of the symptoms of endometriosis.
Ask Your Dr 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 MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-eight years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
