What is Endometriosis?
The lining of the womb, known as endometrium, breaks down on a monthly cycle (menstrual period). Endometriosis is a condition whereby patches of the endometrium grow outside the uterus in other areas. These patches behave like the normal womb lining (shed on a monthly basis), but cause pain, subfertility and inflammation
The usual are for this to happen is in the pelvis, involving the ovaries, the deep space behind the uterus (known as Pouch of Douglas), the tubes, the bowel and the bladder. It can also happen in other parts of the body such as the muscle layer of the womb or more rarely away from the pelvis in the upper abdomen, the lungs and the skin.
Sometimes endometriosis can develop from within, cover or grow into the ovaries and may form cysts. Endometriosis is divided in to four stages based on severity, with stage I being the least severe when there are relatively few endometriosis deposits in the pelvis whereas stage IV the most severe with extensive endometriosis deposits and also adhesions. In the latter case adjacent organs such as the bowel and the bladder are usually affected.
What are the symptoms of Endometriosis?
The most common symptom is pain in the pelvic area at the time of the menstrual period. The degree of pain can vary with some women having severe debilitating pain and others having only mild discomfort. Other symptoms can also occur:
• Pain at the time of sexual intercourse
• Pain during ovulation
• Painful periods
• Unspecific lower abdominal pain
• Heavy, prolonged or irregular bleeding
• Spotting before or after periods
• Fatigue and lethargy
• Difficulty getting pregnant (subfertility)
If the patches are in other parts of the body there could be rectal bleeding and pain (if sited in the bowel), blood in the urine and also pain when passing urine (if sited inside the bladder), or even coughing up blood (if sited in the lungs).
The severity of the symptoms bears no relationship to the extent of the condition. Some women have a significant amount of endometriosis and are symptoms-free.
Treatment of Endometriosis
Women with endometriosis will be treated primarily with surgery but drugs can also be used in some selected groups of patients.
Conventional approaches include:
• Anti-inflammatory drugs — for pain relief only
• Combined oral contraceptive pill — taken continuously for 6 months, no breaks, to stop the periods
• Progestogens — taken continuously for 6 months to stop the periods
• GnRH analogues — these drugs are given to interfere with the fluctuations of the cyclical female hormones. A state of “pseudo-menopause” is created and any menopausal side effects can be counteracted by taking hormone replacement therapy
• Surgery — is the most effective treatment. It involves laser, diathermy or excision of endometriosis superficial patches and/or extensive removal of deep endometriotic nodules from the area between the posterior cervix and the anterior rectum. In 90% of cases the surgical treatment of endometriosis is performed laparoscopically, leading to a faster recovery and return to normal domestic/working duties, minimal skin scarring, short hospital stay compared to laparotomy (open surgery).
Complimentary approaches include:
• Dietary changes • Nutritional supplements — fish oils (omega 3 fatty acids) • Herbal medicine • Homeopathy • Chinese herbal • Acupuncture • Group therapy
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