Endometriosis

Endometriosis is a disorder in which cells that normally lines the inside the uterus the endometrium grows outside your uterus. It is common in reproductive age 25-35 years. It most commonly involves ovaries, fallopian tubes and the tissue lining your pelvis. Sometimes endometrial tissue may spread beyond pelvic organs.

When endometriosis involves the ovaries, cysts called endometriomas or chocolate cyst because it is chocolate color. When it forms in the uterine musculature it is called adenomyosis, when it forms on previous scar called scar endometriosis.

Symptoms of endometriosis

1. Common signs and symptoms of endometriosis may include:
2. Painful periods (dysmenorrhea).
3. Pain with sex
4. Pain with bowel movements or urination
5. Excessive bleeding especially in adenomyosis
6. Infertility- 30-40 % will have difficulty in conception
7. Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Although the exact cause of endometriosis is not certain, many possibilities are suspected

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

1. Never giving birth (Nulliparous)
2. Period at an early age
3. Menopause at an older age
4. Short menstrual cycles ex-less than 27 days
5. Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen
6. Low body mass index-thin tall ladies
7. Alcohol consumption
8. Family history (mother, aunt or sister) with endometriosis
9. Any medical condition that prevents the normal passage of menstrual flow out of the body
10. Uterine abnormalities

Diagnosis

• Pelvic exam
• Transvaginal ultrasound
• Laparoscopy

Treatment

Recommendation is conservative approaches first, opting for surgery as a last resort. Treatment options are with medications or surgery depend on the severity of your signs and symptoms and weather planning for conception. Options are

• Pain medications
• Hormone therapy
• Conservative surgery

If patients are young and planning for conception, surgery to remove as much endometriosis may increase your chances of success done with laparoscopy (keyhole surgery)

Assisted reproductive technologies

Assisted reproductive technologies, if conservative surgery doesn’t work.

Hysterectomy

In severe cases of endometriosis with severe symptoms who has already completed the family, failed other methods of treatment, surgery to remove the uterus as well as both ovaries is the best treatment.

Prevention

Because the cause of endometriosis is poorly understood, there are no known ways to prevent its development.

Recurrence of endometriosis

Recurrence rate varies with the severity of endometriosis, methods of surgery, skills of the surgeons who performed the surgery, weather post-operative suppressive therapy given or not to

eliminate residual endometriotic cells. The most recent studies have shown that endometriosis recurs at a rate of 20% to 40% within five years following conservative surgery.