05 Feb Diagnosing Endometriosis
Endometriosis is a gynecological condition where the tissue that is located on the inside of the uterus, called the endometrium, grows on other anatomical structures outside of the uterus. Endometriosis commonly involves the tissue lining the pelvis, the fallopian tubes, and the ovaries.
The problem with endometriosis is the following:
- The tissue that is located in the other mentioned areas still acts like the normal uterine tissue which means that it builds up a lining that sheds during the time of menstruation.
- This blood builds up in the pelvis as it has no way to exit the body.
- The result is that the surrounding tissue may become irritated and an inflammatory process begins.
- Scar tissue and adhesions may end up forming resulting in pelvic tissues sticking to each other.
Causes and risk factors
The causes of endometriosis may include:
- The hormone estrogen turning embryonic cells into endometrial cells during puberty.
- Retrograde menstruation where endometrial cell-containing blood flows back via the fallopian tubes and into the pelvis. The endometrial cells in the blood then stick to the pelvic structures in the body.
- Transport of endometrial cells to the other gynecological and pelvic structures via the blood vessels or lymphatic system of the reproductive tract.
- Attachment of endometrial cells to surgical scars such as after a Caesarean section or hysterectomy.
- Immune system problems where antibodies are not produced to attack and destroy the endometrial cells found outside of the uterus.
Women who are at a higher risk of developing endometriosis include those who:
- Have never given birth.
- Have shorter menstrual cycles of less than 27 days, for example.
- Consume alcohol.
- Have higher estrogen levels.
- Started their periods at a younger age.
- Have a family history of endometriosis.
- Are diagnosed with abnormalities of the uterus.
- Are known as conditions that prevent the normal flow of menstrual blood out of the body.
Signs and symptoms
- Pain during intercourse.
- Painful menstruation together with pain in the lower back and/or abdomen and pelvis.
- Pain with urination and/or bowel movements during menstruation.
- Excessive and heavy periods.
The main complication of endometriosis is that it can cause infertility.
Endometriosis may be suspected by performing the following investigations:
- High-frequency ultrasonography, either performed over the abdomen or with the probe inserted into the vagina, is used to produce pictures to view the reproductive organs and the possible endometrial lesions.
- Pelviscopic laser surgery can be performed where a small incision is made under the belly-button while the patient is under general anesthesia. Carbon dioxide is used to inflate the abdomen and a laparoscope (slender camera) is inserted to visualize the pelvic organs. If the presence of endometrial tissue is confirmed, the surgeon will use a laser to remove any scar tissues and growths and then repair any damaged areas.
Conservative treatment of endometriosis will be attempted first and this may include:
- Pain medications to help for the cramping caused by the endometrial tissue located in other areas.
- Hormonal therapy to help slow down endometrial growth and prevent new implants of endometrial cells.
If these measures are ineffective then the laparoscopic procedures will be performed in order to remove as much of the abnormally located endometrial tissue as possible.