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1) Endometriosis (pronounced end-oh-mee- tree-oh-sis)
Endometrium is the tissue
that lines the inside of the womb (uterus). During the menstrual
cycle it increases in thickness in preparation for pregnancy and if
that does not occur, it is shed off. The bleeding that occurs during
the shedding off is what is called as the menses.
Endometriosis is a condition where the
endometrium is also found in other areas of the body, usually within
the pelvis. Like normal endometrium, this tissue also responds to
hormones secreted by the ovary and is built up and shed off the same
way. However unlike the normally sited endometrium, this “internal
menses” has no way to get out of the body.
Over time, this process can lead to the
formation of ‘chocolate’ cysts (brownish fliud-filled sacs) in the
ovaries or scar tissue and nodules (bumps) around and on the surface
of the pelvic organs. Also, sometimes the internal bleeding from the
endometriosis can cause the organs in the pelvis – the urinary
bladder, uterus, ovaries, tubes, and the intestines to stick
together (adhesions).
Sometimes, the endometrial tissue can
grow in the muscle layer of the wall of the womb. This can result in
thickening of the wall of the womb. This condition is called
adenomyosis.
Endometrial deposits can also be found,
in or on the bowel and bladder or at sites remote from the pelvis
like operation scars and in the lungs.
Endometriosis is not
cancer.
Why does it occur?
The cause is unknown but several
theories have been put forward.
The most widely accepted theory is
‘retrograde menstruation’. According to this theory, during menses,
some of the menstrual blood flows backwards into the pelvis through
the fallopian tubes. This menstrual fluid has some endometrial cells
which implant on the reproductive organs or other areas in the
pelvis. These implanted cells cause endometriosis.
Symptoms of endometriosis
The most common symptoms of
endometriosis include :
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Painful and or heavy periods
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Painful intercourse
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Infertility
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Other associated symptoms may be:
chronic pelvis pain , not related to menses, pre-menstrual
spotting.
Bowel and bladder symptoms
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Pain before, during or after opening
bowels
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Bleeding from the bowel especially
during menses
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Pain during, before or after passing
urine
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Symptoms of an irritable bowel -
diarrhoea, constipation, colic
Majority of women with the condition
will experience some of these symptoms. However, some women may have
no symptoms at all and maybe discovered incidentally.
The severity of endometriosis does not
always correspond to the severity of symptoms.
How common is Endometriosis?
It is difficult to have an accurate
number. However it is a common condition estimated to affect 20 -
30% of women of the reproductive age group.
Who does it affect?
Endometriosis can occur at any time from
puberty until the menopause. It is extremely rare, but not unknown
for it to be first diagnosed after the menopause.
How is endometriosis diagnosed?
Ultrasound scans, blood tests and
internal examinations cannot conclusively diagnose endometriosis.
The only way to diagnose endometriosis is by laparoscopy. This is an
operation in which a telescope (a laparoscope) is inserted into the
abdomen through a small cut in the belly button. This allows the
surgeon to see the pelvic organs and identify any endometriotic
deposits and cysts.
Treatments
Unfortunately, as yet there
is no cure for the condition. However there are certain medical therapies
or surgery which can help.
The type of treatment used depends on
the age of the patient, her desire for future childbearing and the
severity of her symptoms.
Hormonal Treatments
Medical treatment can be tried for
symptom relief. This involves giving drugs to create a reversible
pseudo-pregnancy or pseudo-menopause state which can stop ovulation
and hence allow the endometrial tissue to regress and die.
Various drugs used include :
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Combined Oral Contraceptive Pill
(Side effects include bloatedness, nausea, vomiting, weight
gain)
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Testosterone derivatives eg. Danazol,
Gestrinone
(Side effects include acne, change in the voice, increased hair
over the body)
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Progestogens eg Provera, Nor-ethisterone,
Depo-provera
(Side effects include bloatedness, weight gain, mood changes,
irregular bleeding, and delayed return of fertility esp. with
Depo-provera)
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GnRH analogues - create a
pseudo-menopause state. This group of drugs is given in the form
of injections or nose sprays and is usually used only for short
durations eg. 6 months. Side effects include menopausal symptoms
including hot flushes, vaginal dryness and reversible bone loss.
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Mirena coil. This can be used to
provide relief from the symptoms like heavy menses.
With the exception of the Mirena Coil,
Depo-provera and the oral contraceptive pill, the drugs used to
treat endometriosis are not contraceptives and barrier methods of
contraception should be used during treatment.
Surgery
Studies have shown that for patients
with infertility resulting from endometriosis, surgery offers a
better chance of achieving pregnancy than medical treatments.
Surgery is also advised for severe disease eg. large cysts or severe
symptoms.
Conservative surgery aims to remove and
destroy the endometriotic nodules and/or cysts. This is usually done
by laparoscopy (keyhole surgery) or rarely by an open operation - a
laparotomy.
Removal of the uterus (Hysterectomy) and
the ovaries may be necessary to cure women with severe endometriosis
and those who have completed child-bearing.
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