What is Endometriosis?
Endometriosis is a painful, chronic disease that affects millions of women worldwide. It occurs when tissue like that which lines the uterus (tissue called the endometrium) is found outside the uterus — usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity. Other sites for these endometrial growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars. Less commonly they are found in the lung, arm, thigh, and other locations.
This misplaced tissue develops into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation — and can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.
What are the Symptoms of Endometriosis?
In addition, many women with endometriosis suffer from:
What Causes Endometriosis?
The cause of endometriosis is unknown. The retrograde menstruation theory (transtubal migration theory) suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows. Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.
Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood system. A genetic theory suggests that it may be carried in the genes in certain families or that some families may have predisposing factors to endometriosis.
Surgically, endometriosis can be staged I–IV (Revised Classification of the American Society of Reproductive Medicine). The process is a complex point system that assesses lesions and adhesions in the pelvic organs, but it is important to note staging assesses physical disease only, not the level of pain or infertility. A patient with Stage I endometriosis may have little disease and severe pain, while a patient with Stage IV endometriosis may have severe disease and no pain or vice versa. In principle the various stages show these findings:
Stage I (Minimal)
Findings restricted to only superficial lesions and possibly a few filmy adhesions
Stage II (Mild)
In addition, some deep lesions are present in the cul-de-sac
Stage III (Moderate)
As above, plus presence of endometriomas on the ovary and more adhesions
Stage IV (Severe)
As above, plus large endometriomas, extensive adhesions.
Endometriotic deposits within the ovary are commonly referred to as endometriomas. It is commonly called chocolate cyst of ovary, as it contains altered blood, which looks like chocolate sauce. During sonography it has a typical appearance. 50% endometriosis patients develop endometrioma, which is often bilateral.
Diagnosis is considered uncertain until proven by laparoscopy, a minor surgical procedure done under anesthesia. A laparoscopy usually shows the location, size, and extent of the growths. This helps the doctor and patient make better treatment choices.
Treatment of Minimal or Mild endometriosis:
As endometriosis is related to subfertility, undue delay should be avoided where the woman is aged 35 years or there are other factors contributing to subfertility
Medical treatment is generally successful for the alleviation of pain associated with endometriosis. However, it is not suitable for women trying to conceive. The drugs used for its treatment will stop ovulation.
Laparoscopic ablation of endometriotic lesions or division of adhesions gives a clear benefit in terms of symptomatic relief and improve fertility.
Treatment of Moderate and Severe disease
Laparoscopic excision of endometrioma or division of adhesions are the main treatment. If family is complete or fertility is not of a concern the total hysterectomy with removal of both ovaries can be done.