Endometriosis is a fairly common and painful gynecological ailment, which can however be sometimes overlooked. Its basis is the presence of uterine mucous layer, endometrium, outside of the uterus. Just like regular endometrium, this mucous layer is influenced by female sex hormones and undergoes changes during the menstruation period. This causes irritation, scarring and adhesions in the organ the mucous layer is present on. This can often cause infertility.
The uterus is the female reproductive organ, located within the pelvis. In its upper part it expands into two protrusion to which fallopian tubes connect. These lead to the ovaries, which produce the female reproductive cells, the eggs. The uterus has three layers: mucous layer, muscle layer and a layer of connective tissue on the surface The mucous layer is influenced by female sex hormones, estrogens, and gestagens, and prepares each month for the implantation of a fertilized egg. This period is known as a menstrual cycle. Estrogens prevail in the first phase of the menstrual cycle and the mucous layer, which has been stripped away in the preceding menstruation, regrows. The mucous layer grows in density and volume. In the second part of the menstrual cycle, gestagens are predominant, preparing the mucous layer for accepting and supplying the fertilized egg with nourishment. If fertilization and ensuing pregnancy doesn't occur, the prepared mucous layer is washed away with menstrual blood. On average, the menstrual cycle lasts for 28 days, with the menstruation taking 3-5 days. These values can be very individual however.
Development of endometriosis
With endometriosis, the extra mucous layer is most commonly present on the ovaries, fallopian tubes, urinary bladder and the peritoneum, which is a thin membrane covering the abdominal cavity. It can however also affect more distant parts of body as well. It is never found on the heart or the spleen. The causes, which lead to development of endometriosis are not currently completely understood. The oldest theory is the implantation theory. Normally, the mucous layer is washed out of the body through the vagina. Part of the mucous layer can be expelled through the fallopian tube into the abdominal cavity, instead of out of the body. Here the tissue can implant itself. The implanted tissue reacts to hormonal stimulation in the same way as the one inside the uterus. During every menstruation, minor bleeds then occur. Gradually, small cavities and scars develop around the implanted tissue. This scarring then causes adhesions. Endometriosis is the cause of 30%-50% of all infertilities. Infertility is also its most severe symptom.
Endometriosis risk factors
Among the factors increasing the risk of endometriosis are childlessness, appearance of endometriosis in family (mother, sister, aunt), menstrual cycle shorter than 27 days, menstrual bleeding lasting longer than 7 days and often pelvic infections.
Symptoms of endometriosis
The symptoms of endometriosis are related to its location, extent and stage. The main symptom, which occurs most commonly, is long lasting pain, which often gets worse during menstruation. If the endometriosis is located on the vagina and the cervix, sexual intercourse is painful. Blood in urine can be a symptom of endometriosis of the urinary bladder. If the area between the vagina and the anus is afflicted, tough nodules, which cause great and prolonged pain can occur in that area. If the endometriosis affects the ovaries, it can grow inside of them, creating large cysts, hollow areas filled with fluid, possibly causing abdominal pain as well.
Diagnostics of endometriosis
A gynecological, ultrasound and laparoscopic examination is performed during the diagnostic of endometriosis. During the gynecological exam the doctor will check the vagina and the uterus, and look for sensitive spots in various areas of the abdomen. During the ultrasounds he will examine all the organs in the pelvis. A hysteroscopy can also be used for diagnostic purposes, during which the doctor inserts a thin instrument with a camera into the uterus to look for any pathological changes in the mucous layer. Only laparoscopic examination can diagnose endometrosis with complete certainty though. Laparoscopy means the doctor makes a small cut near the navel, through which a small instrument with a camera is inserted into the abdomen, allowing examination of both the abdominal cavity and the pelvic organs for any signs of endometrosis. This diagnosis is often determined when looking for causes of infertility, since laparoscopy is also performed in that case. If the endometrosis affects the peritoneum, a membrane covering the inside of the abdominal cavity, clearly visible patches can be seen on it.
Treatment of endometrosis
The treatment of endometrosis is decided by the doctor based on the patient's state and the stage of the disease. Usually, a combination of surgical and hormonal treatment is used. If this is the first occurrence, a laparotomic surgery is generally performed. A laser is used to remove areas of endometrosis and if possible, any adhesions are broken up. Then a hormonal treatment is applied to prevent the endometrosis from spreading. This consists of drugs which reduce the production of hormones of the pituitary gland. This also prevent the release of female sex hormones. The treatment has a 80-90% success rate. Among its side effects are a temporary loss of menstruation, depression, mood swings and loss of bone mass.
If you suffer from abdominal pain or have any suspicions, consult your doctor as soon as possible. Only he can determine the diagnosis and decide an appropriate treatment.