What is Endometriosis?

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside or lining the tissue of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, 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, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants, while they can cause problems, are benign (not cancerous).

What causes Endometriosis?

The cause of Endometriosis is unknown.
Retrograde Menstruation:

One theory is that the endometrial 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. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Coelomic Metaplasia:

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. This process is termed coelomic metaplasia.

Endometrial Implants:

It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episiotomy or Caesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.
Finally, there is evidence that shows alternations in the immune response in women with endometriosis, which may affect the body’s natural ability to recognize and destroy any misdirected growth of endometrial tissue.

What are the Signs and symptoms of Endometriosis?

Pelvic Pain:

A major symptom of Endometriosis is recurring pelvic pain. The pain can range from mild to severe cramping that occurs on both sides of the pelvis, in the lower back and rectal area, and even down the legs.

  • Dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis.
  • Chronic pelvic pain – typically accompanied by lower back pain or abdominal pain.
  • Dyspareunia – painful sex.
  • Dysuria – urinary urgency, frequency, and sometimes painful voiding.
Fertility:

Many women with infertility may have endometriosis. As endometriosis can lead to anatomical distortions and adhesions (the fibrous bands that form between tissues and organs following recovery from an injury), the causality may be easy to understand; It has been suggested that endometriotic lesions release factors which are detrimental to gametes or embryos, or, alternatively, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon.

Other symptoms that can be related to Endometriosis include:
  • Lower abdominal pain,
  • Possible location of Endometriosis
  • Diarrhoea and/or constipation,
  • Low back pain,
  • Chronic fatigue
  • Irregular or heavy menstrual bleeding, or
  • Blood in the urine.

How is Endometriosis diagnosed?

To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Your doctor will perform a pelvic exam to check for any abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it’s not possible to feel small areas of endometrial implantation, unless they’ve caused a cyst to form. Other tests to check for physical clues of Endometriosis include:

Ultrasound:

During a vaginal ultrasound, a wand-shaped scanner (transducer) is inserted into your vagina. In an ultrasound of the pelvis via the abdomen, a small scanner is moved across your abdomen. Both tests use sound waves to provide a video image of your reproductive organs.

Diagnostic Laparoscopy:

Because endometrial implants often cannot be felt or clearly seen in some tests, a common way a doctor can make a definitive diagnosis of endometriosis is through a surgical procedure called Diagnostic laparoscopy. By moving the laparoscope around, the surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus. If you have endometriosis, laparoscopy will provide you and your doctor with information about the location, extent and size of the endometrial implants. This information will help your doctor guide you through treatment options. Sometimes, symptoms and signs are obvious enough that a laparoscopy isn’t necessary.

Blood test:

Cancer antigen 125 (CA 125) is a blood test often used to detect tumor markers for certain cancers, but it’s also used to detect a certain protein found in the blood of women with endometriosis. Although CA 125 commonly reveals an elevation in such blood protein in women with advanced endometriosis, it’s not as sensitive to mild or moderate disease. As with cancer, CA 125 doesn’t perform well as a screening test for endometriosis because it’s least sensitive when the disease is in its earliest stages.

ENDOMETRIAL IMPLANTS WITH PERITUBAL

ADHESIONS LEADS TO INFERTILITY

What are your treatment options if you have Endometriosis?

Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.

Pain Medications:

Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen, mefanamic acid etc, to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn’t provide full relief, you may need to try another treatment approach to manage your signs and symptoms.

Hormone Therapy:

Supplemental hormones are effective in reducing or eliminating the pain of endometriosis. That’s because the rise and fall of hormones during a woman’s menstrual cycle causes endometrial implants to thicken, break down and bleed. In fact, if hormonal therapy has little to no effect on your symptoms, consider questioning the diagnosis of endometriosis or its relationship to your symptoms.

Hormonal therapies used to treat Endometriosis include:

Oral contraceptives:

Birth control pills help control the hormones responsible for the build up of endometrial tissue each month. Taking the pill long term can reduce or eliminate the pain of endometriosis. Most women also have lighter and shorter menstrual flow when they’re taking the pill.

Gonadotropin:

Releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones. This action prevents menstruation and dramatically lowers estrogen levels, causing endometrial implants to shrink. Gn-RH agonists and antagonists can force endometriosis into remission during the time of treatment and sometimes for months or years afterward. These drugs create an artificial menopause that can sometimes lead to troublesome side effects, such as hot flashes and vaginal dryness. A low dose of estrogen may be taken along with these drugs to decrease such side effects.

Danazol

(Danocrine): Another drug that blocks the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis, is danazol. In addition, it suppresses the growth of the endometrium. However, danazol may not be the first choice because it can cause unwanted side effects, such as acne and facial hair.

Progesterone:

This drug is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis. Its side effects can include weight gain and depressed mood. However it is one of the most cost effective treatments available.

Conservative Surgery:

Although hormone therapies are effective in reducing or eliminating symptoms of endometriosis, they prevent pregnancy. If you have endometriosis and are trying to become pregnant, surgery to remove implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.
Conservative surgery removes endometrial growths, scar tissue and adhesions without removing your reproductive organs. Your doctor may do this procedure laparoscopically, or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, a slender viewing instrument (laparoscope) is inserted through a small incision near your navel. The laparoscope is equipped with a laser, a cautery — an instrument that destroys tissue with heat — or small surgical instruments.
Assisted reproductive technologies to help you become pregnant are sometimes preferable to conservative surgery, and doctors often suggest these approach if conservative surgery is ineffective.

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