What is Endometriosis?
Endometriosis is a disorder in which tissue similar to the tissue forming the endometrium (inner lining of the uterus), grows outside the uterus. This disorder commonly involves ovaries, fallopian tubes and the tissue lining the pelvis. Generally women with this disorder experience a lot of pain during their menstruation days.
Endometriosis lesions, also known as the endometriosis implants, can be found anywhere in the pelvic cavity, i.e. on the ovaries, the fallopian tubes, the pelvic sidewall and the uterosacral ligaments. There are other less common sites including bladder, bowel, intestines, colon, appendix and rectum.
These lesions respond to hormones found in females, estrogen and progesterone. They too thicken, break down and bleed in microscopic amounts with each menstrual cycle just like normal endometrial tissue. But the endometrial-like tissue does not have an exit and becomes trapped. Cysts may form known as endometriomas. Surrounding tissue can become irritated, which might develop scar tissue and adhesions. Adhesions is a condition caused by endometriosis where bands of fibrous tissue can cause pelvic tissues and organs to stick to each other.
Few examples of problems faced by women due to endometriosis are as follows:
What are the Symptoms of Endometriosis?
The key symptom of endometriosis is pelvic pain, which is often associated with menstruation. With this disorder, women might experience cramps that are more painful than usual period cramps. Some other symptoms of endometriosis include the following:
What is the connection between Endometriosis and Fertility?
The connection between endometriosis and fertility can be said to be a strong one. But the exact cause of infertility or inability to conceive due to endometriosis is still unknown. It is estimated that for women with endometriosis who are trying to conceive, the chance of pregnancy each month, or the fecundity is about 2% to 10%, compared to 15% to 20% in the general population.
Upto 30% to 50% of women suffering from endometriosis may experience infertility.
Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality. Women with severe endometriosis, which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty becoming pregnant and often require advanced fertility treatment.
There are several proposed mechanisms for endometriosis causing infertility that include:
What are the Treatments available for Endometriosis?
Endometriosis can be treated through medication or surgery. Based on signs and symptoms, the doctor suggests the type of medication or surgery. Usually doctors recommend the conservative treatment approaches first, and then recommend surgery in case the initial treatment fails.
Pain relievers such as the nonsteroidal anti-inflammatory drugs (NSAIDS), ibuprofen (Advil, Motrin IB, etc.) or naproxen sodium (Aleve) are beneficial in easing the painful menstrual cramps.
Supplemental hormones might be effective in reducing the pain caused by endometriosis. It can slow down the endometrial tissue growth and prevent new implants of the endometrial tissue. But hormone therapy is not a permanent treatment. The symptoms might return after stopping the treatment. Hormone therapies include the following:
In this surgery the endometriosis implants are removed, while preserving the uterus and ovaries.. This surgery is helpful for those women who are trying to conceive. However, the endometriosis or the pain caused by it might return soon.
The most common way of this surgery is the laparoscopic surgery. The surgeon inserts the laparoscope through a small incision near the navel and inserts instruments to remove endometrial tissue through the small incision. After surgery, the doctor might recommend hormone medication to help with the pain.
Women with endometriosis can face trouble while trying to conceive. This treatment is highly recommended to those women who want to conceive with endometriosis. Fertility treatment ranges from stimulating the ovaries to make more eggs to in vitro fertilization. The personal situation of the women determines the type of fertility treatment.
Hysterectomy with removal of the ovaries:
The surgery of removing the uterus, known as hysterectomy, and the surgery to remove the ovaries, known as oophorectomy, were once considered the most effective treatment for endometriosis. But the surgery nowadays focuses more on the careful removal of all endometriosis tissue.
Removal of ovaries results in menopause. Early menopause carries a risk of cardiovascular diseases, certain metabolic conditions and early deaths. The lack of hormones produced by the ovaries may improve endometriosis pain for some women. For others, endometriosis that remains after surgery continues to cause symptoms.
Removal of the uterus can sometimes be used to treat the signs and symptoms of endometriosis, such as heavy menstrual bleeding and painful cramps. A hysterectomy with the ovaries may have a long term effect on the woman’s health, especially if the surgery is done before the age of 35.