Endometriosis: Hormonal, genetic or immunological ?

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So what is endometriosis?

Endometrium is the tissue that lines the inside of the uterus. In some women an endometrial like tissue grows outside of the uterus as well, in the pelvic area or lower abdomen. This is called endometriosis. Sometimes, the tissue is found in far away parts of the body.

What causes endometriosis?

Lower Abdomen PainCauses of endometriosis are not very well understood. There are hormonal, genetic and immunological factors involved. It is supposed that during menstruation some of the endometrial tissue is pushed backwards into the Fallopian tube and spills over into the abdomen. There it gets attached to the surfaces of the pelvic organs. The tissue can be very small in size or may cover a large area.

This tissue is affected by oestrogen and it can grow and spread. During menstruation it bleeds just like the endometrium inside the uterus. As there is no outlet to this blood in the pelvic cavity, the collected blood causes inflammation, irritation and stickiness of local tissues leading to pain and other symptoms.

It can also cause adhesions between different organs such as the bowel and the uterus or in the Fallopian tubes leading to infertility. Sometimes, large patches of tissue, especially in the ovaries lead to the formation of cysts. These cysts are filled up with a dark coloured blood and are called "chocolate" cysts.

Who is more likely to get endometriosis ?

Endometriosis can occur in women of all ages though it is especially diagnosed more in women between the ages of 25 to 40. Menopausal women do not get endometriosis as their oestrogen levels have fallen by then.

What are the symptoms?

stomach painMany women do not have any symptoms or may have mild symptoms. The most common symptom is painful periods. Any severe pain in the lower abdomen especially just before and during periods should be considered to be because of endometriosis. If there is a family history then the diagnosis could be more likely.

Sometimes there is a persistent pain in the lower abdomen. There may also be pain during sex lasting for a few hours after. There can be a difficulty in getting pregnant. This may or may not be due to adhesions blocking the Fallopian tube. There could be other unknown reasons involved.

Other symptoms could include pain in the bowels while passing stools or pain in the lower abdomen while passing urine, and sometimes blood in the stools or urine. Any other pain in any part of the body during the periods should also be investigated for endometriosis.

How do we detect endometriosis?

Endometriosis can only be confirmed by a laparoscopy under anaesthesia. A thin telescope-like instrument or laparoscope is pushed through a small cut in the skin of the abdomen to examine the inside of the abdominal cavity. Patches of endometriosis can be seen by the surgeon.

What is the treatment?

Sometimes a period of treatment given for 6 months can relieve symptoms and give a provisional diagnosis of the presence of endometriosis.

LaproscopyTreatment is usually given to reduce pain and bleeding during periods. This is usually done by giving painkillers such as ibuprofen, diclofenac, and naproxen or a codeine and paracetamol combo. To shrink the patches of endometriosis hormone pills or specialised oestrogen reducing drugs are given.

With combined oral contraceptive pill ovulation is blocked which reduces the amount of oestrogen made by the ovaries. Periods are also lighter and less painful. Other symptoms such as painful sex and pain in the pelvic area may also improve.

The hormonal IUDs which seep out levonorgestrel also block ovulation and make the lining of the uterus thinner. This greatly relieves pain and bleeding during the periods. Once inserted by a doctor it can remain in place for up to 5 years.

If the family has been completed and other treatments have failed, then hysterectomy or removal of the womb and the ovaries may be an option. This will mostly cure all the symptoms.

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