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 Endometriosis is a condition where cells from the lining of the uterus are found outside the uterus instead, in areas such as on the ovaries, fallopian tubes, outer surfaces of the uterus or intestines, on the surface lining of the pelvic cavity, or on the bowels or bladder. These abnormal growths, called endometriosis implants, are benign (not cancerous), although they can cause problems.
Endometriosis is one of the most common gynaecological diseases. Some 30–40 per cent of women with endometriosis are infertile, making it one of the top causes of female infertility.
Causes & risk factors
While the cause of endometriosis has not been established, doctors believe that the condition may be caused by “retrograde menstrual flow” – the backflow of blood into the pelvis during menstruation. This leads to the cells of the lining in the uterus being implanted outside of it. There also appears to be a link to genetic factors. Oestrogen, a hormone involved in the female reproductive cycle, also appears to promote the growth of endometriosis. Women who have not given birth are at higher risk for it, as are those with a history of pelvic infection.
Signs & symptoms
Most women with endometriosis don’t experience any symptoms at all, and having trouble getting pregnant is sometimes the first sign of the condition. A definite diagnosis is confirmed by surgery, usually laparoscopy.
More palpable symptoms of endometriosis include:
• Extremely painful or heavy periods
• Irregular vaginal bleeding between periods
• Pain during or after sexual intercourse
• Pain when moving the bowels
• Chronic pelvic pain, including the lower back and pelvic areas
• Chronic fatigue
Treating endometriosis
Treatment for endometriosis can include:
- Pain medication: If pain or other symptoms are mild. These medications range from over-the-counter remedies to strong prescription drugs.
- Hormone therapy: If the endometriotic implants are small and/or there is minimal pain.
- Surgery: If endometriosis is extensive, or if there is more severe pain.
For women with developed symptoms who do not wish to become pregnant, endometriosis treatment usually involves medications, including hormonal therapy and pain medications, to regulate menstruation and relieve pain. Oral contraceptives (birth control pills) and nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pelvic pain and menstrual cramping, while gonadotropin-releasing hormone analogs (GnRH-a) have also been effectively used to relieve pain and reduce the size of endometriosis implants. The latter induces menopause and its associated side effects, including hot flushes, tiredness, insomnia, headaches, depression, bone loss, and vaginal dryness (see topic on menopause).
If the symptoms are severe and not eased by medical therapy, and if fertility is desired, surgery – with or without the removal of the uterus – may be needed to remove the abnormal endometrial implants. Endometriosis-related infertility is often treated successfully using hormones and surgery. As the chance of recurrence after surgery may be as high as 40 per cent, oral medications are usually prescribed after surgery to help maintain symptomatic relief.
Pregnancy itself is a natural treatment for endometriosis, which also regresses and “burns out” on its own upon the onset of menopause. Women with endometriosis are often advised not to delay having children. The condition could likely worsen over time, which would further affect fertility.
Ref: Z00
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