- 29/March/2019
Endometriosis - Symptoms and Treatments - Ananthapuri Hospitals
What is Endometriosis?
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. While some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The exact prevalence of endometriosis is unknown but estimates range from 2 to 10% within the general female population but up to 50% in infertile women.
The uterus has three walls – the inner lining called the endometrium, the middle muscular wall called the myometrium, and the outer coating called the perimetrium. The endometrial lining spreads to other tissues in the pelvis and abdomen in endometriosis.
In endometriosis, the endometrial tissue grows in other pelvic organs such as the ovaries, fallopian tubes, vagina, and cervix. Rarely, the endometrial tissue implants in abdominal organs such as the kidneys, gallbladder, stomach, and the lower part of the large intestine called the rectum. However, the ovary is the commonest site for abnormal implantation of the endometrial tissue in endometriosis.
The problem with this abnormal implantation of the endometrium is that it continues to undergo the cyclical changes that occur in the menstrual cycle – it thickens and sheds as menstrual blood with each cycle. Therefore, the displaced endometrial tissue in all the abnormal locations also thickens and sheds within each menstrual cycle.
However, unlike in the uterus, the shed tissue has no exit in these other organs. It remains trapped in these tissues, causing severe symptoms.
Signs and Symptoms of Endometriosis
Pelvic pain associated with the menstrual period is the commonest symptom of women with endometriosis experience. Typically, symptoms of endometriosis may reflect the site of implantation.
Symptoms of endometriosis include:
- Painful Periods: This is also called dysmenorrhea. It may begin before the period starts and end a few days after it stops. Painful periods may also occur with severe back and abdominal pain. The severity of the pain in endometriosis does not reflect the severity of the disease. Some women with severe disease may experience little to no pain, while women with mild endometriosis may present with severe pelvic pain.
- Heavy menses: Women with endometriosis usually experience heavy menstrual flow.
- Pain during sexual intercourse: Women with endometriosis usually experience pain during sexual intercourse, and this is often worst before the menstrual period occurs. Painful intercourse may be due to inflammation of the ligaments in the uterus caused by the external deposition of the endometrial tissue.
- Pain during defecation: This may occur if the endometrial tissue implants in the rectum, in which case passing urine and bowel movements trigger pain. The pain may be cyclical, occurring only during the time of menstruation when the endometrial lining sheds.
- Other Symptoms: Other non-specific symptoms that occur in endometriosis include nausea, fatigue, diarrhoea, bloating, constipation, and vomiting.
- These overlapping symptoms of the urinary tract and digestive tract cause diagnostic confusion such that endometriosis is usually mistaken for other diseases, such as inflammatory bowel syndrome or a urinary tract infection.
Some women (about one-third) who have endometriosis may not show any symptoms.
Risk Factors of Endometriosis
Some factors place some women at a greater risk of endometriosis than others. These include:
- Nulliparity,
- Early age at onset of period.
- Late onset of menopause
- A family history of endometriosis
- Delayed childbearing
- Structural abnormalities in the Uterus
- Excessive alcohol consumption
- Any medical condition obstructing the flow of menstrual period out the body.
. Pregnancy temporarily relieves the signs and symptoms, but menopause leads to a full resolution of the symptoms. However, postmenopausal women who take estrogen replacement may still experience symptoms of endometriosis.
Complications of Endometriosis
Complications of endometriosis include:
Infertility/Subfertility
Infertility is the main complication of endometriosis. Approximately one-half of women with endometriosis have difficulty achieving conception.
For conception or pregnancy to occur, as explained above, an egg must be released from the ovary, which then moves to the fallopian tube to be fertilized by a sperm cell. Upon fertilization of an egg, the resulting embryo implants in the uterus after a few days. Endometriosis may block or distort the tube, impairing sperm movement or transport of egg in the tube, preventing fertilization.
However, infertility does not always occur in women with infertility. Women with mild to moderate disease may conceive and carry the pregnancy to term. Endometriosis is one component of a vicious cycle therefore: delayed pregnancy increases one’s risk of endometriosis, which in turn, increases a woman’s risk of infertility.
Chronic pelvic pain
Pelvic pain which lasts six months or longer is a common complication of endometriosis. Due to the implantation of endometrial tissue in pelvic organs and ligaments of the uterus, women with endometriosis experience moderate-to-severe pain during each menstrual cycle. The pain may be so discomforting, impairing daily function and reducing a woman’s quality of life.
Ruptured Ovarian Cysts
Endometriosis implanted in the ovary may cause structural defects such as cysts which may rupture causing severe pain and internal bleeding.
Complications related to Site of Involvement
Endometriosis may involve sites outside the pelvis, such as the lungs, pleura, bladder, kidneys, and gastrointestinal tract causing complications such as bowel obstruction, rectal bleeding, and anaemia.
Diagnosis of Endometriosis
While it is not possible to detect endometriosis during a physical examination, your doctor may be able to feel for concurrent abnormalities such as an ovarian cyst.
Imaging techniques are the mainstay of diagnosing endometriosis. These radiological techniques include:
Ultrasound Scan
Although doctors cannot definitely tell that you have endometriosis through an ultrasound scan, they can detect features of endometriosis such as simple or complex cysts, called endometriomas, in the organ of deposition.
Your doctor may evaluate you using a scan with its probe passed through the vagina (transvaginal ultrasound scan) or through the rectum (endorectal)
Laparoscopy and Biopsy
This is the gold standard in diagnosing endometriosis.
Laparoscopy and biopsy is a procedure in which a surgeon views and takes a sample from an organ or tissue inside your abdomen through a long slender device, called a laparoscope, passed through a small incision in your abdomen. Through this device, doctors pass other slender surgical instruments to perform the procedure.
Laparoscopy is the primary method of diagnosing endometriosis. This is because the doctor can directly view all the organs in the pelvis and abdomen and see the presence of abnormal tissues implanted on any of them. Samples of these tissues are then obtained with a biopsy needle and viewed under a microscope to confirm if they are endometrial tissue.
Treatment of Endometriosis
Your doctor may treat endometriosis with drugs or surgically. The treatment depends on your preference as well as the severity of the disease. However, conservative treatment using medicines is often the initial method for treating endometriosis. Surgery is recommended only when the conservative approach fails or the disease is severe.
Medications used in treating Endometriosis
Medicines doctors prescribe for managing endometriosis include pain medications and hormonal drugs.
Pain Medications
Your doctor may recommend over-the-counter pain medications such as non-steroidal anti-inflammatory drugs, including ibuprofen and meloxicam. Your doctor may recommend stronger analgesics such as opioids if the pain does not respond to these mild analgesics.
Hormone Therapy
Doctors recommend hormone therapy for treatment of endometriosis because these hormones interrupt a woman’s menstrual cycle, inhibiting ovulation, hence the cyclical thickening and shedding of the endometrial tissue, therefore preventing the growth and implantation of the endometrial tissue in other organs.
Although hormone therapy does not lead to a full resolution of the disease, it may cause significant improvement of symptoms.
Invasive Treatment
Invasive treatment is often considered if medicines fail to improve the symptoms or if symptoms and complications of the disease are severe.
Conservative Surgery
Your doctor may consider a surgery like Laparoscopic treatment for endometriosis to help you get pregnant. Doctors perform this surgery to remove the adhesion, endometrial tissue from its abnormal sites while preserving your uterus and ovaries to help you achieve conception.
This procedure may be performed using a laparoscope described above or through traditional open surgery with large incisions in your abdominal wall. After removing these endometrial implants surgically, your doctor may recommend continuing with pain medications and hormone therapies to improve symptoms.
Radical Surgery: Hysterectomy with Bilateral Oopherectomy if the patient does not wish to extend her family.
Hysterectomy is the surgical removal of the uterus while oophorectomy is the surgical removal of both ovaries.
Endometriosis is a common cause of chronic pelvic pain among women of reproductive age. Although the cause of this disease is unclear, it is characterized by deposition of the endometrial lining of the uterus in sites outside the uterus, causing severe complications such as infertility. With early and aggressive treatment, the symptoms may resolve.
If you experience any of the symptoms of endometriosis, schedule a medical checkup. Ananthapuri Hospital has a highly experienced team of gynaecologists. To book an appointment, call us at +91 9400332777 or visit our hospital at Chacka, NH Bypass, Thiruvananthapuram.