Endometriosis

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What is Endometriosis?

Endometriosis is a common and chronic gynecological disease that can result in cyclic pelvic pain that occurs in conjunction with a woman's periods. About 10% of women of reproductive age and up to 50% of women with infertility have endometriosis. That amounts to approximately 5.5 million women in the United States and Canada.

The condition occurs when endometrial cells develop outside of their normal location inside the uterus. The misplaced endometrial cells respond to the menstrual cycle in the same way as those lining the uterus. The tissue grows and sheds blood at the time of menses. However, instead of flowing out of body through the vagina, the blood shed by the misplaced cells has no way of leaving the body. The resulting internal bleeding can lead to chronic inflammation and the formation of adhesions and scar tissue. Areas commonly affected include the ovaries, fallopian tubes, the ligaments that support the uterus, the area between the vagina and rectum, the outer surface of the uterus and the lining of the pelvic cavity. Endometrial lesions can also be found in the bladder, bowel, vagina, cervix and vulva. More rarely the lung and other body tissues can be affected.

Symptoms of endometriosis

Some women with endometriosis have no symptoms. But for many others, endometriosis can cause severe pain that interferes with activities of daily living. Endometriosis can also lead to other distressing conditions such as infertility and adhesions and scar tissue that entrap the reproductive organs. Other symptoms of endometriosis include:

Local pelvic tenderness
Fatigue
Premenstrual spotting
Heavy periods
Painful urination and bowel movements during periods
Diarrhea
Constipation
Nausea

In addition to the physical symptoms, women with endometriosis can also experience emotional problems such as depression and poor self-image. The combination of physical and emotional symptoms can stress relationships to the breaking point.

Causes of Endometriosis

The exact cause of endometriosis is unknown. More than one factor is likely involved. Theories under current consideration include:

Retrograde menstruation - Endometrial cells back up from the uterus through the fallopian tubes, implant in the abdomen and grow. This migration process occurs in all women, though an immune or hormonal problem may allow the tissue to grow in the women who go on to develop endometriosis. The theory does not explain why women who undergo tubal ligation or hysterectomy can still experience symptoms of endometriosis.

Similarly, another theory suggests that endometrial tissue spreads from the uterus to other parts of the body through the lymph or blood systems.

Immune - Immunological changes have been observed in women with endometriosis. According to this theory, an abnormality in the immune system allows the endometrial cells that are shed normally to attach elsewhere and to grow. It is uncertain whether the immunological changes are responsible for the endometriosis or the result of the inflammation caused by the disease.

Genetic - Endometriosis tends to run in families, though the mode of inheritance remains unknown. Women with an affected mother or sister are more likely to have severe endometriosis than those without affected relatives.

Environmental causes - There may also be a link between exposure to chemicals or allergens and endometriosis. Research on rhesus monkeys shows a link between exposure to dioxin and endometriosis. The greater the exposure to dioxin, the more severe the endometriosis. Dioxin is a byproduct of pesticide and bleached pulp and paper products manufacturing. The chemical can also be produced through burning of hazardous waste.

Treatment for Endometriosis

Endometriosis may be treated with drugs and/or surgery in an effort to reduce or relieve symptoms and to eliminate or reduce the growths. The treatment options include:

Medications

Pain medication - Over the counter or prescription drugs may be used to treat the pain resulting from endometriosis.

Hormonal therapy - Birth control pills or another category of drugs which block the production of estrogen called gonadtropin releasing hormone (GnRH ) agonists may be prescribed. GnRH agonists have been used to reduce pain and make surgery easier by reducing te inflammation related to endometriosis.

Surgery

Laparoscopic ablation - The procedure is used to remove growths and adhesions.

UPLIFT Procedure - In cases where endometriosis results in dysmenorrhea and pain during intercourse, the UPLIFT procedure may be recommended for pain relief. Sometimes the scarring from endometriosis pushes the uterus into a tipped position. Women with a tipped uterus may experience pain during their periods or intercourse, because the penis hits the uterus and/or the endometrial implants. The UPLIFT procedure, which is performed laparoscopically, restores the uterus to its proper anatomical position. Women who have had the procedure have reported a reduction in pain during intercourse and menstruation.

Uteral sacral nerve ablation - In this procedure the nerves running to the uterus are severed in an attempt to eliminate pain and cramping.

Presacral neurectomy - In cases of severe pain, the sensory nerves leading to the pelvis are severed.

Hysterectomy - In severe cases of endometriosis, hysterectomy including removal of all growths and the ovaries may also be recommended. It should be noted that hysterectomy does not always eliminate endometriosis, because the lesions may not be confined to the reproductive organs.

Combinations of drug therapy and surgery are also used commonly.

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