Endometriosis

What is Endometriosis?

The uterus is made up of three special layered linings of tissue and muscle.

The innermost layer is called the endometrium; the second layer is the myometrium and the third layer is the serosa.

Endometriosis is a condition where the innermost layer of the uterus-endometrium grows in locations outside the uterus. Endometriosis may cause adhesions in the uterus. The uterus can become stuck to the ovaries, fallopian tubes and bowel. Although many patients experience extreme pain, some women with endometriosis do not experience any symptoms (asymptomatic).

Usually, endometriosis causes pain around the menstrual period, but for some women, the pain is almost constant.

Symptoms of Endometriosis

The symptoms of endometriosis vary widely from woman to woman, and the severity of symptoms is not necessarily related to the severity of the endometriosis.

Symptoms depend on the extent and location of the endometrial implants and the affected structures. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years.

Many women think that painful periods are normal. If you have bad period pain, you should see your doctor.

Symptoms include:

• Period pain (dysmenorrhoea)
• Pain during sexual intercourse (dyspareunia)
• Pelvic and abdominal pain outside of menstruation
• Abnormal bleeding - including heavy bleeding, clotting, prolonged bleeding, irregular bleeding, premenstrual spotting
• Bowel disturbances - including painful bowel motions, diarrhoea, constipation, bleeding from the bowel
• Difficulty in getting pregnant
• Painful urination
• Lower back, thigh and/or leg pain
• Premenstrual syndrome

The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.

Tests to Diagnose Endometriosis

The tests used to help diagnose endometriosis are:

• Laparoscopy - a medical instrument with a video camera attached is used to examine your uterus
• Ultrasound - instrument which uses sound waves to create an image
• MRI - a large machine that uses magnetic fields to create images of internal organs.
• Colonoscopy - a medical instrument with a video camera to examine your bowel. This is done if the endometriosis is thought also to be affecting your bowel.

Treatment for Endometriosis

Treatment for endometriosis depends on several factors, including

• The severity of symptoms
• The extent of the endometriosis
• The woman’s age and
• Her outcome requirements (e.g. reduction in pain, improved fertility)

No treatment can prevent endometriosis from recurring,, but the regular medical follow-up, hormone medication, and/or surgery can control the condition.

Having a baby may improve the condition. While endometriosis is suppressed during pregnancy, symptoms may recur in time, even as early as a few months after giving birth.

Medical treatment is often prescribed for this condition. Hormones can usually treat endometriosis; sometimes, surgery may be indicated.

Drug Therapy

Drugs used to treat endometriosis include:

• The oral contraceptive pill best taken continuously [i.e omitting the sugar tablets] to avoid the withdrawal bleeds)
• Anti-inflammatory medications
• Painkillers
• Hormonal treatments (for example, Danazol, Lupron, Provera, Primolut, Vissane and Zoladex. Side effects of these drugs may include depression, hot flushes, mood swings, night sweats, loss of libido and headaches.

Surgery

Surgical options for endometriosis treatment include:

• Laparoscopic surgery - is performed to diagnose and treat endometriosis through keyhole surgery.
• Laparotomy - is used to cut out or burn tissue, or remove cysts through larger abdominal incisions.
• Bowel resection - for example, if the bowel has also developed endometriotic lesions
• Hysterectomy - may be an option if endometriosis prevents you from having a normal life and other treatments have not worked