Our series of articles in the patient education category continues, and today, we talk about endometriosis.
Endometriosis is when endometrial tissue grows anywhere outside the uterus.
The uterus lies between the bladder and rectum. The inner layer of the uterus is called the endometrium. In endometriosis, this kind of tissue that usually lines the inside of the uterus is present in other places. The common ones are; ovaries, Fallopian tubes, pelvic peritoneum, especially behind the uterus. The hormones that affect the uterine lining also affect this extra tissue. Each month, during a period, this tissue also bleeds, and this causes pain. This blood cannot go anywhere, so cysts and scar tissue form. Approximately 5% to 15% of women of childbearing age have endometriosis. Endometriosis can be managed but not prevented.
We are still uncertain about its causes. Several theories explain endometrial tissue that happens to occur in places other than the inside of the uterus, which include Sampson’s theory of retrograde menstruation. However, endometriosis may run in families. Scar tissue from endometriosis around pelvic organs can cause pain and infertility by blocking Fallopian tubes. It can sometimes block the intestines or ureters.
Endometriosis may cause no symptoms. It may be an incidental finding during abdominal or other pelvic surgeries. Abdominal cramps during periods that are worse than usual. Dull constant pain in the lower abdomen and back. Pain during sex or bowel movements. Having periods more than once a month. Heavier periods that last longer than usual. Trouble getting pregnant.
The health care provider does a pelvic examination and a pregnancy test. They may do blood and urine tests to have infections ruled out. Ultrasonography, CT or MRI can be done to look at the organs inside the body.
However, laparoscopy is the only way to a definite diagnosis. Taking the tissue to the laboratory for histology complements the diagnosis. At laparoscopy, a telescope-like tool is put through a small cut into the abdomen to see the extra tissue. We can also use it for treatment.
Treatment depends on symptoms, the woman’s age and if children are wanted. Medicines like ibuprofen and its counterparts, birth control pills or other hormonal based medications work well.
Removing the tissue laparoscopically by cauterization (burning) or using lasers can be attempted. Endometriosis can return, but surgery can relieve pain and help chances of getting pregnant. Hysterectomy is feasible only if the woman is older and doesn’t want to have more children. Problems can continue until menopause when oestrogen levels fall. Lower levels of oestrogen during menopause cannot stimulate this tissue, so the pain will eventually subside.
DOs and DON’Ts in Managing endometriosis
Do take your pills as instructed by your health care provider.
Do see your health care provider regularly.
Do exercise and take ibuprofen or similar drugs to help relieve painful periods and cramps.
Do call your health care provider if treatment isn’t helping the symptoms.
Do call your health care provider if you cannot take your medicine or birth control pills.
Don’t forget to keep follow-up appointments.
Don’t take herbal therapies without checking with your health care provider.