Endometriosis

Definition

Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity. During menstruation, the ectopic tissue bleeds, which may causes inflammation of the surrounding tissues. Because this inflammation causes fibrosis leading to adhesions that may produce pain and infertility.  Active endometriosis may occur at any age, such as adolescence. Ectopic endometrial tissue responds to normal stimulation in the same way as the endometrium, but much less predictably. The endometrial cells respond to estrogen and progesterone with proliferation and secretion. Ectopic tissue is generally confined to the pelvic area, it usually around the ovaries, uterovesical peritoneum, uterosacralligaments, and cul-de-sac, but it can appear anywhere in the body. As many as 50% of infertile women may have endometriosis but the true incidence in both fertile and infertile women remains unknown.

Causes of Endometriosis

• Retrograde menstruation with implantation at ectopic sites
• Genetic predisposition and depressed immune system
• Coelomic metaplasia
• Lymphatic or hematogenous spread extraperitoneal disease

Symptoms of Endometriosis

• Dysmenorrhea
• Abnormal uterine bleeding
• Infertility and profuse menses
• Pain that begins 5 to 7 days before menses and peaks and lasts for 2 to 3 days, all though severity of pain isn't indicative of extent of disease
• Deep-thrust dyspareunia
• Suprapubic pain
• Lower back pain
• Abdominal cramps
• Bleeding from endometrial deposits in these areas during menses; pain on sexual intercourse

Other complications of endometriosis such as:

• Infertility due to fibrosis, scarring, and adhesions
• Chronic pelvic pain
• Ovarian carcinoma

Treatment of Endometriosis

• Treatment of endometriosis depend  and use according to the stage of the disease and it also include patient's age.
• You can use hormonal treatments of endometriosis that are potentially effective in treating discomfort, although treatment for advanced stages of endometriosis usually isn't as successful because of impaired follicular development.
• You can also use nonsurgical treatment of endometriosis generally remains inadequate. Surgery appears more effective to enhance fertility, although definitive class I evidence currently doesn't exist.
• Another pharmacologic and surgical treatment of endometriosis may be beneficial for managing chronic pelvic pain. Conservative therapy for young women who want to have children such as androgens such as danazol, progestins and continuous combined hormonal contraceptives to treat symptoms that may cause by regression of endometrial tissue.
• You can also use another conservative surgery such as laparoscopic removal of endometrial implants with conventional or laser techniques, presacral neurectomy for central pelvic pain; effective in about 50% or less of appropriate candidates, laparoscopic uterosacral nerve ablation also for central pelvic pain, although definitive studies supporting the efficacy of LUNA are lacking.