Endometriosis
What is Endometriosis?
Endometriosis is a condition in which the endometrium, the lining of the uterus, grows in areas outside the uterus causing pain and infertility. This tissue can grow in the pelvic area, on the ovaries, on the outer surface of the uterus or near the rectum or bladder. Occasionally it may be found in distant organs, as for instance a scar of the abdominal wall or in the lungs. It is a non-cancerous condition.
What are the causes?
Normally the endometrial tissue that develops outside the uterus is stimulated by oestrogen, the female sex hormone and then breaks down and bleeds at the time of menstruation, as does the endometrium in the uterus. This causes each time irritation, swelling and pain. In the long run scar tissue forms and adhesions may develop between organs. In the ovaries, one may find cysts, lined by endometrium and filled with blood pigments.
What are the symptoms?
Increasingly painful menstrual periods. A dull to severe lower abdominal ache, before or during menstruation that radiates towards the lower back. Pain during intercourse or with bowel movements. Infertility.
How is the diagnosis made?
A complete medical history and a thorough internal pelvic examination may help to identify the problem. During the physical examination nodules formed as a result of endometriosis in the back of the vagina may be palpated. There may also be tender and enlarged ovaries or a drawn back uterus, adherent to the rectum.MRI or magnetic resonance imaging may be used to identify endometriosis implants in the soft tissues. Laparoscopy may provide a more accurate diagnosis and may be used to distinguish between endometriosis, pelvic tumours and other disorders that produce symptoms similar to those of endometriosis.
What is the treatment?
Treatment depends on the extent of the disease, the woman’s desire for future child bearing, the degree of symptoms experienced and the woman’s age. Medical treatment includes painkillers that treat the discomfort of the disease. It may be indicated for women with mild to moderate menstrual pain, with no pelvic examination abnormalities and with no immediate desire to become pregnant. Progestogens, which have some of the properties of the natural progesterone, can be beneficial. They are given continuously either alone or in combination with an oestrogen (as in a combined oral contraceptive pill), during several months in a row. However, this treatment cannot make scar tissues and nodules caused by the disease disappear. There can be side effects of depression or spotting, which may limit this option for treatment. Other medications, the so-called GnRH-analogs, cause a sharp decrease in the production of oestrogen and a condition that resembles that following the menopause. During the period of treatment, symptoms will abate. Unfortunately, because of the side effects of this therapy, it cannot be prolonged beyond three months. Surgical treatment may consist of burning up endometrial implants with a thermocautery or a laser beam. This can presently be done via a laparoscope. The wall of endometriotic cysts of the ovaries can also be removed using this approach. What may work well for one woman may not help another. Usually, a combination of medications and surgical treatment tailored to the individual controls endometriosis. In case of advanced endometriosis, the doctor may suggest removal of the uterus and of the ovaries.