Reproductive health

Understanding Endometriosis

Causes, Symptoms and Treatments

By James S. Pendergraft
www.womenscenter.com

While many women experience mild pain during their monthly menstrual cycle, there many others who observe more symptoms. A very common gynecological disorder is endometriosis.

The endometrium is a tissue that lines inside uterus. Endometriosis occurs when this tissue is found outside affecting ovaries, ligament supporting the uterus, fallopian tubes, the outer surface of uterus, the area between vagina and rectum and some cases the bladder, vagina, bowel, cervix, vulva and in abdominal surgical scars.

By reaching outside of uterus, the endometrial tissue forms nodules or growths; since it resembles the lining tissue of uterus, it can respond to the hormones of the menstrual cycle.

Every month, the lining of uterus builds up, breaks down and bleeds. This is called the menstrual cycle, but unlike this lining, the endometrial tissue does not leave the body thus resulting in internal bleeding and degeneration of blood and tissue, which causes severe pelvic pain, formation of scar tissue and bowel problems and infertility.

Despite the suggestion of many theories, the exact cause of endometriosis is uncertain. Retrograde menstruation is the common and most accepted theory. It suggests that endometriosis occurs as the result of backup of menstrual tissue through the fallopian tubes, implanting in the abdomen and growth. Women with problems related to their immune system or suffering from hormonal problems are more likely to be affected.

An alternative theory suggests that endometrial tissue can circulate in the blood system or lymph as a result of the uterus's reaching other parts of the body. A woman with a female relative affected by this disease can be at risk.

Many endometriosis patients have no symptoms, but the most common ones are included below.

• Pain with intercourse
• Pain before and during periods that is worse than typical menstrual cramps
• Painful bowel movements during periods
• Painful urination during periods
• gastrointestinal upset: diarrhea/constipation, nausea
• Infertility
• Fatigue

The symptoms reported to the medical practitioner often can help to diagnose endometriosis, but most of the time, no abnormalalities are found.

Although ultrasound is widely used to diagnose soft tissue lesions, it can rarely help in diagnosis of endometriosis as it lacks the adequate resolution required for visualizing adhesions unless there is an sufficient growth on organs such as the ovaries to be visualized.

The best way to diagnose endometriosis is through direct visualization by laparoscopy, a small surgical procedure allowing the practitioner to pinpoint the location and the extent of the problem. Many times, the practitioner can remove the growths and preserve fertility, but there still exists the probability of recurrence.

No definitive cure has been realized yet. Treatment includes NASIDS like ibuprofen, oral contraceptive with estrogen and/or progesterone preventing ovulation, or Leuprolide acetate. Leuprolide acetate given by injection has promising results but also has bothersome side effects. Pregnancy can often provide temporary relief but since it involves critical elements, it should not be decided solely.

A definite cure is considered to be hysterectomy, the removal of the ovaries for a woman who had no symptom relief from other methods.

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