Endometriosis is a common medical condition in women in which endometrial cells are deposited in areas outside the uterine cavity. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones. Endometrial cells deposited in areas outside the uterus (endometriosis) continue to be influenced by these hormonal changes and respond similarly as do those cells found inside the uterus. Symptoms often exacerbate in time with the menstrual cycle. Endometriosis is typically seen during the reproductive years; it has been estimated that it occurs in roughly 5% to 10% of women. Symptoms depend on the site of implantation. Its main but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility.
To the eye, lesions can appear dark blue or powder-burn black and vary in size; other lesions are red, white, or non-pigmented. Most endometriosis is found on theses structures in the pelvic cavity where it may produce intense to no pain felt in the pelvis, low back, and during premenstrual period:
- Ovaries, most common site.
- Fallopian tubes.
- The back of the uterus and the posterior culdesac.
- The front of the uterus and the anterior culdesac.
- Uterine ligaments such as the broad or round ligament of the uterus.
- Pelvic and back wall.
- Intestines, most commonly the rectosigmoid. Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause severe pain with bowel movements.
- Urinary bladder and ureters.
Endometriosis may spread to the cervix and Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision. or to sites of a surgical abdominal incision. Less commonly lesions can be found on the diaphragm. Diaphragmatic endometriosis is rare, most always on the right hemidiaphragm, and may inflict cyclic pain of the right shoulder just before and during menses. Rarely, endometriosis can be extraperitoneal and is found in the lungs, sciatic nerve, abdominal wall and CNS.
A major symptom of endometriosis is severe recurring pelvic pain. The amount of pain a woman feels is not necessarily related to the extent or stage (1 through 4) of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or having endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis. Symptoms of endometriosic-related pain may include:
- Dysmenorrhea - Painful, sometimes disabling menstrual cramps; pain may get worse over time (progressive pain) also lower back pains linked to the pelvis.
- Chronic pelvic pain - typically accompanied by lower back pain and/or abdominal pain.
- Dyspareunia - Painful sex.
- Dyschezia - Painful bowel movements.
- Dysuria - Urinary urgency, frequency, and sometimes painful voiding.
Endometriosis and Fertility
Many women with infertility have endometriosis. As endometriosis can lead to anatomical distortions and adhesions, the causality may be easy to understand; however, the link between infertility and endometriosis remains enigmatic when the extent of endometriosis is limited. It has been suggested that endometriotic lesions release factors which are detrimental to gametes or embryos, or, alternatively, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon; for this reason it is preferable to speak of endometriosis-associated infertility in such cases.
Other Endometriosis Symptoms
Other symptoms may be present, including:
- Nausea, vomiting, and/or diarrhea - particularly just prior or during the period.
- Frequent menses flow or short menstrual cycle.
- Heavy and/or long menstrual periods.
- Some women may also suffer mood swings and fatigue.
In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimic irritable bowel syndrome.
A health history and a physical examination can in many patients lead the physician to suspect endometriosis. Use of imaging tests may identify larger endometriotic areas, such as endometriotic cysts. The two most common imaging tests are ultrasound and magnetic resonance imaging (MRI). Normal results on these tests do not eliminate the possibility of endometriosis--areas of endometriosis are often too small to be seen by these tests. The only way to confirm and diagnose endometriosis is by laparoscopy or other types of surgery. The diagnosis is based on the characteristic appearance of the disease, excising the lesion, and then a biopsy. Endometriosis cannot be definitively diagnosed without an endometrial biopsy. Laparoscopy also allows for surgical treatment of endometriosis.
In patients in the reproductive years, endometriosis is managed as much as possible: the goal is to provide pain relief, to restrict progression of the process, and to relieve infertility if that should be an issue. In younger women with unfulfilled reproductive potential, surgical treatment tends to be conservative, with the goal of removing endometrial tissue and preserving the ovaries without damaging normal tissue. In women who do not have need to maintain their reproductive potential, hysterectomy and/or removal of the ovaries may be an option; however, this will not guarantee that the endometriosis and/or the symptoms of endometriosis will not come back, and surgery may induce adhesions which can lead to complications.
Treatments of endometriosis include:
- Medication that inhibit the growth of endometrium.
- Surgery, mainly laparoscopy (Surgery for mild endometriosis)
- Combination of the above treatments.
Treatment approach depends on various factors like age, infertility and the extent of the damage. Medication usually lasts 3 months. If it is combined with surgery it may last for 6 months. In cases of severe endometriosis and infertility, IVF is necessary.