Endometrium is a tissue that lines inside uterus. Endometriosis occurs when this tissue is found outside affecting ovaries, ligament supporting the uterus, fallopian tubes, the outer surface of uterus, the area between vagina and rectum and some cases bladder, vagina, bowel, cervix, vulva and in abdominal surgical scars
By reaching outside of uterus the endometrial tissue forms nodules or growths, since it resembles the lining tissue of uterus it can respond to the hormones of menstrual cycle.
Every month the lining of uterus builds up, breaks down and bleeds which is called the menstrual cycle but unlike this lining the endometrial tissue does not leave the body thus resulting in internal bleeding and so degeneration of blood and tissue which causes severe pelvic pain, formation of scar tissue and bowel problems and infertility.
Despite the suggestion of many theories, yet the exact cause of endometriosis is uncertain. Retrograde menstruation is the common and most accepted theory. It suggests that endometriosis occurs by backup of menstrual tissue through the fallopian tubes, implanting in the abdomen and growth. Women with problem in their immune system or hormonal problem are more likely to be affected.
An alternative theory suggests that endometrial tissue can circulate in the blood system or lymph from uterus reaching other parts of the body. A woman having a female relative affected by this disease can be at risk.
Many endometriosis patients have no symptom. Not always is the severity of involvement with severity of symptoms but most common ones are included below:
· Pain with intercourse
· Pain before and during periods that is worse than typical menstrual cramps
· Painful bowel movements during periods
· Painful urination during periods
· GI upset: diarrhea/constipation, nausea
· Infertility
· Fatigue
The symptoms reported to the medical practitioner often can help to diagnose the endometriosis. But most of the times no abnormal are found.
Although ultrasound is widely used to diagnose soft tissue lesions it can rarely help in diagnosis of endometriosis as it lacks the adequate resolution required for visualizing adhesions unless there is an enough growth on organ such as ovaries to be visualized.
The best way to diagnose is direct visualization by laparoscopy a small surgical procedure allowing the practitioner to pinpoint the location and the extent of problem. Many times practitioner can remove the growths and preserve fertility. But still there is the probability of recurrence.
No definitive cure has been realized yet. Treatment includes NASIDS like ibuprofen, oral contraceptive with estrogen and/or progesterone preventing ovulation, Leuprolide acetate given by injection has promising result but has bothersome side affect similar to. Pregnancy can often provide temporary relief but since it involves critical elements it should not be decided solely.
A definite cure is considered to be hysterectomy, the removal of the ovaries for a woman who had no symptom relief from other methods.
