ENDOMETRIOSIS

ENDOMETRIOSIS

Introduction

Endometriosis is a common health problem in women. It is a common cause of severe recurring pain in women. One in every 5 women belonging to 13 to 45 age group suffer from endometriosis. Yet, it is not uncommon in women after menopause.

The primary problem lies with the ‘endometrium’, which is the normal inner lining of the uterus. The uterus houses the baby when the woman is pregnant. In endometriosis, these cells of inner lining of the uterus grow in places other than the uterus. Most commonly, these cells are found growing in locations like the ovaries, fallopian tubes, or anywhere within the pelvic cavity. In rare cases, these tissues are found in the lungs, skin, eye, diaphragm and the brain.

In normal conditions, the endometrium within the uterus is shed periodically during the bleeding that occurs in the menstrual cycle. But, in endometriosis, the endometrium being situated elsewhere in the body is unable to exit the body. Nevertheless, it proliferates and cyclically, the bleeding also occurs, but into the body cavity wherein it is situated!! The endometrium detaches itself and remains shed within the cavity. The shed materials consist of degraded blood and tissues, which are sufficient to cause irritation and often severe pain in the affected area. Endometriosis depending upon its location can even affect the normal functions of organs like bladder, bowels and the intestines.

Repetitive irritation and pain can cause internal changes in the normal structures of the affected body part due to adhesions and scar formations. In very advanced cases, the internal organs of the pelvis fuse together in a condition called ‘frozen pelvis’. Endometriosis is a leading cause for infertility in women.

Symptoms

The most common presentation is a pelvic pain. Largely, the pains are timed with the occurrence of the menstrual cycle though it can certainly occur at other times. These pains vary in nature, though commonly they are severe, crampy and spasmodic. These can cause nausea and vomiting also.

Pain may be felt:

  • Before/during/after menstruation, progressively these pains become worse with every cycle.
  • During ovulation, i.e. around 14 days before the onset of the menstrual cycle
  • In the bowel during menstruation
  • When passing urine
  • During or after sexual intercourse
  • In the lower back region
  • Heavy, excessive menstrual bleeding
  • Nausea and vomiting

Other symptoms may include:

  • Diarrhea or constipation (in particular in connection with menstruation)
  • Abdominal bloating (again, in connection with menstruation)
  • Heavy or irregular bleeding
  • Fatigue

Diagnosis

Physical examination along with a well-taken history should make the physician suspect endometriosis. The ‘gold standard’ for diagnosing endometriosis is biopsy study of the tissue sample obtained through laparoscopic procedures.

Other investigations  are:

  • Ultrasonographic studies
  • MRI and CT scans to identify the offending tissues
  • CA-125 is a marker which is elevated in endometriosis though its elevation is not specific indication for this condition.

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