What is Endometriosis?
Endometriosis, or endo as it is commonly referred to as, is caused when fragments of the lining of the uterus become embedded, or implanted, elsewhere in the body. Normally, an increased level of hormones each month trigger the release of an egg from the ovary. Finger-like tissues on one of the fallopian tubes grasp the egg and tiny hair-like "cilia" inside the tube transport it towards the uterus. When the egg is not fertilized, the uterine lining breaks down and is shed during menstruation.
Abnormal implants of endometriosis are not inside the uterus but they respond to hormonal changes controlling menstruation. Like the uterine lining, fragments build tissue each month, then break down and bleed. Unlike blood from the uterine lining, blood from implants have no way to leave the body. Instead the blood from the implants is absorbed by surrounding tissue which in turn causes pain.
As the cycle reoccurs each month, the implants get bigger. They may seed new implants and form scar tissue and adhesions. Sometimes, a collection of blood called a sac or cyst forms. If a cyst ruptures, it often causes excruciating pain.
The common locations for the implants are the ovaries, fallopian tubes, ligaments supporting the uterus, area between the vagina and rectum, outer surface of the uterus, and the lining of the pelvic cavity. Endometriotic implants are sometimes found in abdominal surgery scars, on the intestines or in the rectum, on the bladder, vagina, cervix and vulva (external genitals).
The adhesions or endometriotic deposits can be black, blue, red, brown, clear, or raspberry in color. Although they are microscopic in size, they can do a lot of damage. Infertitily, pain and bowel problems are common of women who have endometriosis.
Causes and Theories:
As I have said, endometriosis has no known cause but experts have come up with theories why so many women have this disease.
Vascular Theory. This theory holds that endometrial tissue is distributed from the uterus to other parts of the body via blood vessels or lymph system.
Sampson’s Theory. The oldest and most widely taught theory is that menstrual blood sometimes flows backwards into the pelvis. That is, instead of draining out of the body through the vagina, the theory holds that the menstrual fluid backs up the fallopian tubes and drips into the pelvis, where it attaches to any surface and establishes a blood supply. If Sampon’s theory is correct, endometriosis is not possible until a girl’s first period occurs.
Congenital Theory. In the embryo, cells that are intended to form the uterus get left out when the uterus closes before they arrive. The leftover cells are generally found along the coelomic ridge, and are present at birth.
Genetic Theory. It is suggested that endometriosis may be carried in the genes in certain families or that some families may have predisposing factors for endometriosis.
Enviromental Theory. Recent research has shown that enviromental toxins such as dioxin and PCB’s, which act like hormones in the body and damage immune systems, have caused endometriosis in animals. Researches believe that if animals can develop endometriosis by being exposed to the toxins then humans exposed can develop the disease as well.
Symptoms and Diagnosis:
The symptoms of endometriosis are severe menstrual cramps that usually effect the hips, abdomen, lower, middle, and sometimes the upper back. Other symptoms include pelvic pressure, pain within the abdomen, heavy or irregular bleeding, nausea, diarrhea, constipation, stomach problems, yeast infections, and allergies.
The only way to confirm a doctors diagnosis is by a surgical procedure known as a laparoscopy. Although some experts believe that an early diagnosis and treatment in young women with and without symptoms might prevent some cases of infertility later on. Even though experts belive this, many women have reported that they had to visit a doctor five or more times before he had an idea that it could be endometriosis.
The doctor may be able to feel tender areas during a pelvic exam but when the doctor thinks it can be endo, a laparoscopy has to be used. It is the most common surgery used in the fight against endo. It is a very simple procedure and along with diagnosing, it is used to treat endometriosis. The procedure is done under general anesthesia in which the patient’s abdomen is filled with carbon dioxide gas that makes the cavity puff up and away from the organs giving the doctor an easy view of the internal organs. Incisions are made in the belly button and also above or just below the pubic line. A laparoscope, a thin tube with a light on it, is insterted into one incision in the abdomen and a camera called an endoscopy is placed into the other. By moving the laparascope around, the surgeon can check the condition of the abdominal organs and see the endometrial implants.
Endometriosis does not seem to be a life threating illness; however, if ignored and left untreated, endometriosis can lead to increased pain, infertility, and serious disability.
Most women with endometriosis are infertile. Infertiltiy is caused because of the scarring of the fallopian tubes and prevents the ovum from traveling to the uterus for fertilization. Damage to the ovaries from scarring destroys the ovaries and causes permanent damage that cannot be treated.
In some cases, women who were able to conceive experienced hardening of the uterus and surrounding organs from healed scar tissue. Due to the varying amounts of adhesions and scar tissue, the healing and healed tissue will harden causing pain during pregnancy. Women with endometriosis also have a higher risk for eptiotic and tubular pregnancies.
Treatments:
Treatments for endometriosis can be classified into the following categories:Observation, Pregnancy, Medical supression. and Surgery.
Observation. This may occur when a diagnosis of endometriosis is first considered. Close attention to symptoms and freqent examinations by a physician will lead to appropriate treatmeant. Observation is not a good option when symptoms are significant or the pelvic exam shows progressive changes.
Pregnancy. Pregnancy is one of the myths surrounding endometriosis. The disease does not go away during pregnancy. During pregnancy, ovulatin stops. The endometriosis implants generally become less active, and may get smaller and less tender. This seems to be the result of the hormonal changes pregnancy brings. Menstruation stops, and many women with endometriosis feel much better while they are pregnant. After pregnancy and nursing; however, the symptoms usually return.
Medical supression. Many doctors prescribe drugs in the battle against endometriosis and this form of treatment can improve symptoms for many women. It does not make the disease go away, but it can help with the pain.
Oral contraceptives offer a regulated, low-dose combination of estrogen and proesterone to prevent ovulation. Mild endometriosis can remain quite stable for long periods of time and side effects are relatively minimal for most women.
Progesterone is usually given in a long-acting depot form via injection. Progesterone can also prevent ovulation and reduce circulating estrogen levels.
GNRH analogs are drugs that stop virtually all ovarian activity. The results are similar to menopause, with some difference in the FSH and LH levels. This class of drugs are very effective in reducing the activity in the endometriosis implants.
Surgery. The surgical approach can be cateragorized into four levels: diagnostic, very conservative, aggressive conservative, and radical.
Diagnostic surgery has diagnosis as its highest piority. The whole point of the operation is to diagnose what is going on with the patient and so she can be given a name for her problem.
Very conservative surgery is one that a surgeon might treat very large, obvious, or easily treatable disease. Physicians who believe that endometriosis can never be controlled and will always come back often do this type of surgery.
Aggressvie conservative removes all disease while preserving all organs. The emphasis is on removing all areas of endometriosis as possible while maintaining fertility.
Radical surgery describes the removal of the reproductive organs. Removing a woman’s uterus but leaving implants of endometriosis behind often does not relieve her pain; therfore, this drastic surgery has to be carefully considered.
Stages. Doctors have split this disease into four stages determined by the number, size, and location of the implants and adhesions. Doctors sometimes use these stages in diagnosing and treating patients.
Stage 1 has a minimal amount of endometriosis deposits found and that there is no treatments. The management of the pain and symptoms are controlled with over-the-counter drugs and assisted conception or the birth control pill may also be prescribed.
Stage 2 is classified as mild endometriosis. The common medical management for symptoms in this stage are the use of stronger painkillers prescribed by the doctor. The most common painkillers in this stage are Atasol 30 and Demerol if the pain gets severe.
Stage 3 there is a moderate amount of endometriosis. Conservative surgery and laser removal via a laparoscopy or a laparotomy are used to help relieve the pain and symptoms.
Stage 4 is where one has severe endometriosis. In this stage, radical surgery along with the removal of organs affected with extensive endometrial deposits. Hysterectomy is one of the most common radical surgery done in this stage. It may involve in the removal of the ovaries if there is a large amount of endometriosis on them. In most cases the doctors try to leave the ovaries if they can so the woman won’t have to go through the ordeal fo a major surgery and menopause all at one time. Although not a cure, many women who have hysterectomies have reported a substantial decrease in their symptoms since their surgery.
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