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Endometriosis

Endometriosis is a common medical condition where the tissue lining the uterus (the endometrium, from endo, "inside", and metrium, "mother") is found outside of the uterus, typically affecting other organs in the pelvis. The condition can lead to serious health problems, primarily pain and infertility. Endometriosis primarily develops in women of the reproductive age.

endometriosis symptoms

A major sign and symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area. The amount of pain a woman feels is not necessarily related to the extent of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis.

All symptoms of endometriosis can include (but are not limited to):

• Painful, sometimes disabling menstrual cramps (dysmenorrhea); pain may get worse over time (progressive pain)
• Chronic pain (typically lower back pain and pelvic pain, also abdominal)
• Painful intercourse (dyspareunia)
• Painful bowel movements or painful urination (dysuria)
• Heavy menstrual periods (menorrhagia)
• Premenstrual or intermenstrual spotting (bleeding between periods)
• Infertility

In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimick irritable bowel syndrome, as well as fatigue.

Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency.

epidemiology of endometriosis

Endometriosis can affect any woman of reproductive age, from menarche (the first period) to menopause, regardless of her race, ethnicity, whether or not she has children or her socio-economic status. Most patients with endometriosis are in their 20s and 30s. Rarely, endometriosis persists after menopause; sometimes, hormones taken for menopausal symptoms may cause the symptoms of endometriosis to continue.

Current estimates place the number of women with endometriosis between 2 percent and 10 percent of women of reproductive age. About 30 percent to 40 percent of women with endometriosis are infertile. Some women do not find out that they have endometriosis until they have trouble getting pregnant. While the presence of extensive endometriosis distorts pelvic anatomy and thus explains infertility, the relationship between early or mild endometriosis and infertility is less clear. The relationship between endometriosis and infertility is an active area of research.

Anecdotally, endometriosis has been observed in men taking high doses of estrogens for prostate cancer.

treatments for endometriosis

Currently, there is no cure for endometriosis although in most patients menopause (natural or surgical) will abate the process. Nevertheless, a hysterectomy or removal of the ovaries will not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back. However, endometriosis can be effectively managed in a large majority of patients. Conservative treatments try to address usually pain or infertility issues.

The treatments for endometriosis pain include:

• A variety of alternative treatments are being used in patients with endometriosis, including acupuncture.
• NSAIDs and other pain medication: They often work quite well as they not only reduce pain but also menstrual flow. They are commonly used in conjuction with other therapy. For more severe cases narcotic prescription drugs may have to be used.
• Hormone suppression therapy: This approach tries to reduce or eliminate menstrual flow and estrogen support. Typically, it needs to be done for several months or even years.
• Progestins: Progesterone counteracts estrogen and inhibts the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion.
• Continuous birth control pills consists of the use of birth control pills without the use of placebo pills. This eliminates monthly bleeding episodes.
• Danocrine is a suppressive steroid with some androgenic activity. It inhibts the growth of endometriosis but its use is limited as it may cause hirsutism.
• Gonadatropin releasing hormone agonists (GnRH agonists) induce a profound hypoestrogenism by decreasing FSH and LH levels. While quite effective, they induce menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy).
• Surgical treatment is usually a good choice if endometriosis is extensive, or very painful. Surgical treatments range from minor to major surgical procedures.
• Laparoscopy is very useful not only to diagnose endometriosis, but to treat it. With the use of scissors, cautery, lasers, hydrodissection, or a sonic scalpel, endometriotic tissue can be ablated or removed in an attempt to restore normal anatomy.
• Laparotomy can be used for more extensive surgery either in attempt to restore normal anatomy, or at least preserve reproductive potential, or, in severe cases, remove organs such as ovaries, tubes, and/or the uterus (hysterectomy). In extreme cases bowel surgery or surgery on the urinary tract may be necessary. For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the pelvis are cut.

Patients who are pregnant generally have less pain during pregnancy, and it is not unusual to have less symptoms after a pregnancy.

Posted by Staff at May 21, 2005 4:29 PM

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Posted by: Alena at September 6, 2006 1:53 AM