Endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lining or brain. These implants, while they can cause problems, are benign or not cancerous. Briefing the press in commemoration of this year’s Endometriosis Month (March), Managing Director of Nordica Fertility Centre, Dr Abayomi Ajayi disclosed that 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 in the United States.
He further stated that most cases of endometriosis are diagnosed in women aged around 25-35 years and has been reported in girls as young as 11 years of age. According to him, “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 the uterus.
Endometriosis 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 tunes, 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, and even in or around the lung or brain. These implants, while they can cause problems are benign (not cancerous).
“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 percent to 18 percent 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.
“The cause of endometriosis is unknown. One theory is that the endometriosis 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.
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 tissues or scarring (adhensions) 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 include lower abdominal pain, diarrhea and or constipation, low back 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 die to implants in the brain. Endometriosis is often misdiagnosed leading to delays in treatment, sometimes for several years.
“The surest way to diagnose endometriosis is by laparoscopy, an operation performed under general anaesthetic, where a small instrument called a laparoscope (a tube like telescope with light in it), is inserted into a 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.
“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 ibuprofein or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. “These pain-relieving medications have no affect 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 Norman cycical 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 adequate 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 percent.
“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 percent of women with mild and moderate endometriosis will conceive within three years without any specific treatment.
“Assisted reproductive techniques may also be used when appropriate sometimes in combination with surgical therapy,” he said.
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