Endometriosis is one of the most common killer diseases affecting the female gender. It has been round for a while now, but little or nothing has really been said about it. This disease causes Infertility in women, and most of the time has also resulted in Sudden Death.
Endometriosis is more common in infertile, compared to fertile, women. However, the condition usually does not fully prevent conception. Most women with endometriosis will still be able to conceive, especially those with mild to moderate endometriosis. It is estimated that up to 70% of women with mild and moderate endometriosis will conceive within three years without any specific treatment.
Endometriosis is often misdiagnosed by medical practitioners leading to delays in treatment, sometimes for several years. Because of the appearance of blood which is one of its symptoms, it is often diagnosed as other terminal disease. Some are even told they have condition such as IBS, painful periods or even psychological pain. In other words these women seem to ‘’suffer alone’’
City People Fashion Editor, BOLA AKINBOADE had a chat with Dr Abayomi Ajayi of NORDICA Fertility Centre and he revealed the Causes, Symptoms, Treatment and everything you need to know about this disease.
WHAT IS ENDOMETRIOSIS?
The term Endometriosis is coined from two words ‘ENDO’ and ‘METRA’ meaning ‘Inside’ and ‘Womb’ Endometriosis is the growth of cells similar to those that form the inside of the uterus (endometrial cells), but in a location outside of the uterus. Endometrial cells are the same cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called ‘’ implants’’. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity, they can also be found in the vagina, cervix, and bladder.
Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. These implants, while they can cause problems, are benign (not cancerous).
WHO IS AFFECTED BY ENDOMETRIOSIS?
Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. It is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. Most cases of endometriosis are diagnosed in women aged around 25-35 years; it has been reported in girls as young as 11 years of age. It is rare in postmenopausal women. It runs in families and delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.
WHAT CAUSES ENDOMETRIOSIS?
The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis as many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis making the theory of immune system malfunction tenable.
Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. Persistent exposure to environmental pollutants like Dioxins has also been incriminated.
WHAT ARE ENDOMETRIOSIS SYMPTOMS?
Most women who have it, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain or cramping with intercourse, bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.
It can be one of the reasons for infertility in otherwise healthy couples. When laparoscopic examinations are performed for infertility evaluations, endometrial implants can be found in some of these patients, many of whom may not have painful symptoms of endometriosis. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo.
OTHER SYMPTOMS RELATED TO ENDOMETRIOSIS
Other symptoms related to endometriosis include: lower pain, diarrhea and/or constipation, pain, irregular or heavy menstrual bleeding, or blood in the urine.
Rare symptoms of endometriosis include chest pain or coughing blood due to implants in the lungs and headache and/or seizures due to implants in the brain.
Endometriosis is often misdiagnosed leading to delays in treatment, sometimes for several years.
HOW IS ENDOMETRIOSIS DIAGNOSED?
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
As a result, the only accurate way of diagnosing endometriosis is at the time of surgery, either by opening the belly with large-incision laparotomy or small-incision laparoscopy.
The surest way to diagnose endometriosis is by laparoscopy, an operation performed under general anesthetics, where a small instrument called a laparoscope (a tube like telescope with light in it), is inserted into the abdomen through a cut in the belly button. It is a form of minor surgery. Laparoscopy also indicates the location, extent, and size of the endometriotic growths.
HOW IS ENDOMETRIOSIS TREATED?
Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.
Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. These pain-relieving medications have no effect on the endometrial implants. The diagnosis of endometriosis is only definite after a woman undergoes surgery, there will of course be many women who are suspected of having endometriosis based on the nature of their pelvic pain symptoms. In such a situation, NSAIDs are commonly used. If they work to control pain, no other procedures or medical treatments are needed. If they do not relieve the pain, additional evaluation and treatment generally occur.
Since endometriosis occurs during the reproductive years, many of the available medical treatments for endometriosis rely on interruption of the normal cyclical hormone production by the ovaries. These medications include GnRH analogs, oral contraceptive pills, and progestins.
Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or when there has been an inadequate response to medical treatment. Surgery is the preferred treatment when there is anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract. Surgical therapies for endometriosis may be either classified as conservative, in which the uterus and ovarian tissue is preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.
Conservative surgery is typically carried out by laparoscopy. Endometrial implants may be excised or obliterated by laser. If the disease is extensive and anatomy is distorted, laparotomy (opening of the abdominal wall via a larger incision) may be required.
While surgical treatments can be very effective in the reduction of pain, the recurrence rate of endometriosis following surgical treatment has been estimated to be as high as 40%.
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