Endometriosis

Endometriosis is a gynecological condition characterized by the abnormal growth of the endometrial tissues (which forms the inside lining of the uterus) outside the uterus.  These so-called endometrial tissue implants may grow on the outer wall of the uterus, ovaries, fallopian tubes, in the intestines, rectum and bladder.  This chronic disease is mostly confined to the pelvic area, though it may occur in other areas of the body. 

The incidence of endometriosis is about 7-10 % of women in the reproductive age category.  Though more commonly noted in the 25 to 35 age group, the condition may occur as early as the onset of regular menstruation.  The condition is noted to have a familial predisposition.  Sisters or mother and daughters may commonly be diagnosed with endometriosis.

Symptoms of Endometriosis

Pain. The most common symptom which prompts a woman to consult a physician would be recurrence of severe pelvic pain.  Since the the implants also follow the menstrual cycle of shedding and bleeding, the pattern of occurrence of pain may also follow the menstrual cycle.  Though in some cases, pain may be more closely noted in the lower back or may be experienced persistently, not only following the menstrual pattern.

Nevertheless, other than pelvic pain, other forms of pain may be manifested, such as: severe menstrual cramps, low backache, gnawing pain of the lower extremities, abdominal pain, rectal pain, pain during bowel movement and/or voiding, as well as, during sexual intercourse (dyspareunia).  In some cases, pain may not be experienced.

Infertility.  Around 20 – 40 % of cases of infertility in women are a secondary condition to endometriosis.

Abnormal Bleeding.  This symptom may be manifested in various ways, namely: an irregular and heavy menstrual period; blood in the urine or stools; or unusual bleeding prior or after sexual intercourse.

Diagnosis

It may be quite a challenge to diagnose endometriosis as there are quite a number of organs which may be affected by this condition.  A meaningful Q and A process may assist in his process. Nevertheless, there are several non-specific diagnostic modalities to substantiate or confirm the diagnosis of endometriosis, including:  

  • Pelvic exam during the consultation with your gynecologist.
  • MRI Scan
  • Transvaginal Ultrasound
  • Pelvic laparoscopy and biopsy of the tissue, which would allow visualization and histological study of the implants, is the gold standard.

Associative Conditions

Adhesions.  The endometrial implants can cause local inflammation which may lead to scarring and ultimately, the binding or adhesion of adjacent affected tissues or organs.  For example, the bladder and the uterus or bladder and the fallopian tube may be bound by scar tissues.  In severe cases, the adhesion is extensive throughout the pelvic area, resulting to a condition known as “frozen pelvis,” rendering the internal organs of the pelvic area almost immobile.  The adhesions may further aggravate the pain, which can be debilitating.

On the other hand, post-surgical adhesions may mask the diagnosis of endometriosis.

Adenomyosis.  In this condition, the endometrial implants are confined within the middle muscular layer of the uterus.  Adenomyosis may or may not co-exist with endometriosis.  The symptoms of pain may be similar. However, uterine bleeding abnormalities are more notable in this condition.

Treatment and Outcome

Unfortunately, there is no yet known cure for endometriosis.  Available treatment modalities rather focused on addressing the symptoms and conditions associated with endometriosis, such as pain and infertility.

Treatment for Pain. There are quite a number of treatment options that one can avail to achieve symptomatic relief from pain:

  • Drugs or medications for pain. NSAIDS for mild to moderate and opioids for severe or debilitating pain.
  • Hormonal Therapy.  Use of contraceptive pills, injectable progesterone, danazol and Gonadotropin Releasing Hormone agonists.
  • Surgical.  Laparoscopy and laparotomy which may involve excision of the implants and /or consequential adhesions.  In very severe cases, sacral nerves may be severed or ablated.

Treatment for Infertility

  • Laparoscopy to remove the implants.
  • In-Vitro Fertilization

The prognosis of endometriosis largely depends on the extent and location of the implants.  Pain may be alleviated by various treatment modalities.   Fertility concerns are more difficult to manage as the fertility rate for women with severity in this condition may drop as low as 30 -40%. If the condition has spread to other organs, the prognosis may be more difficult to project.

It is important to recognize that medications and medical procedures are associated with benefits and risks that should be discussed with your physician. It is important to recognize that all information contained on this website cannot be considered to be specific medical diagnosis, medical treatment, or medical advice. As always, you should consult with a physician regarding any medical condition. Your Health Access disclaims any liability for the decisions you make based on this information.