Dealing with painful endometriosis

Endometriosis is a common disorder of the female  reproductive system, in which the endometrial tissue that usually lines the uterus grows in other parts of the body. The most likely locations are on the ovaries, fallopian tubes, colon , outer surface of the uterus and other pelvic structures. Less commonly, the endometrial tissue may migrate to the lungs and other internal organs. When the endometrial tissue is found deep in the uterine muscle, it is known as endometriosis interna or adenomyosis. The endometrium usually lines the uterine cavity, and is periodically shed as menses. The misplaced endometrial tissue behaves in a similar fashion, and responds to the hormonal changes that occur during the menstrual cycle.

When low hormone levels prompt the uterus to shed its endometrial lining as a menstrual period, the endometrial tissue outside the uterus also breaks down and bleeds, but this blood has nowhere to go. The tissue becomes swollen and inflamed, often resulting in cramps, which become more intense during the latter days of a period. When the period ceases, the abnormal bleeding also stops, but scar tissue forms as the endometrial clumps heal. With monthly recurrence, strong bands of fibrous tissue called adhesions form, and these cause other organs to become twisted and bound together. The condition worsens with time, even though symptoms may come and go. Chronic pelvic pain can also be due to the presence of fibroids, pelvic inflammatory disease or other disorders affecting the female reproductive system.

Clinical features and diagnosis.
Patients who suffer from endometriosis are usually between the ages of 30 and 45 years. The patient either has no children, or had one or two children many years prior to the onset of symptoms. This disease occurs more in women of higher socio-economic status, and in infertile women. Symptoms vary. About 25 per cent of patients with endometriosis have no symptoms. The disease is accidentally discovered during procedures for other conditions. Symptoms are not related to the extent of the lesions. There may be intense symptoms with minimal endometriosis, and few or no symptoms with very extensive endometriosis. The depth of the lesions is responsible for pain and other symptoms described below:

• Dysmenorrhoea is pain associated with the menses. In endometriosis, the pain starts a few days to the period, gets worse during the period and persists for a few days after the period is over.
• Abnormal menstruation is another common problem. The main abnormality is usually excessive bleeding. Pre menstrual spotting is also a feature in some women.
• Infertility is closely associated with endometriosis. It is caused by damage to the tubes by adhesions, and by dysfunction of the ovaries.
• Dyspareunia. This term simply describes deep pain during intercourse. It is caused by direct contact tenderness, and stretching of internal structures.
• Pelvic pain varies from pelvic discomfort, lower abdominal pain and backache. Causes include adhesions, scarring due to recurrent inflammation, and irritation of the pelvic nerves. The pain gets worse during the menses.

Endometriosis can be difficult to diagnose, especially in the 25 per cent of cases where there are no symptoms. A definite diagnosis requires laparoscopy, in which a viewing instrument is inserted into the abdominal cavity through three small incisions near the navel. This procedure is usually done under general anaesthesia, and allows the doctor to examine the pelvic and abdominal organs for signs of endometriosis.

Medical treatment
There is no cure for endometriosis, but hormonal treatment can slow its growth by temporarily changing the normal patterns of female hormones. One method is to simulate pregnancy by giving high oestrogen pills. Endometriosis disappears when a woman is not ovulating, such as during pregnancy. Another method is by inducing an artificial menopause, by giving medication, which halts ovulation. Without the monthly stimulation of a menstrual cycle, endometriosis shrinks and eventually disappears. Although the long-term goal may be to restore fertility, pregnancy cannot occur during the treatments described above.

Persistent and severe endometriosis is treated by surgery. It is also used to remove endometrial tissue growing in abnormal places. Complete removal of the uterus is the ultimate treatment, but is only reserved for those patients with incapacitating symptoms, or those who are not planning a future pregnancy. Heat, in the form of a hot bath or hot water bottle often helps to ease the pain of endometriosis. Massage may also help. Over the counter medication for pain is also helpful. The long-term goals of therapy should always be kept in mind. If future pregnancy is not in the pipeline, a hysterectomy offers permanent relief.

END: PG 26 /42