Endometriosis
Endometriosis
is a disorder of the female reproductive system, where
endometrial tissue (the normal lining of the uterus) is
found in areas other than the uterus.
The most common sites are in the pelvis—the ovaries or
tissues near the uterus and fallopian tubes, including the
bladder, ligaments and bowel.
How
does Endometriosis occur?
The exact causes of endometriosis are still not fully
understood. It is believed that endometriosis occurs as a
result of normal tissue from the uterus escaping into the
fallopian tube and out into the pelvic area at the time of
menstruation ("retrograde menstruation"). These tissue
fragments are then thought to implant and grow onto the
surrounding pelvic tissue and, sometimes, organs.
Because these fragments are made of the same tissue as the
lining of the uterus, they too respond to the hormonal
changes that occur during the menstrual cycle and,
therefore, "bleed". Whereas menstrual blood can escape from
the body, this has no exit and, as a result, the areas
surrounding the implants of tissue become irritated or
inflamed.
Some of the blood and tissue may form into cysts (fluid
filled lumps)—sometimes known as "chocolate" cysts, due to
the colour similarity.
The continual release of blood contributes to the formation
of scar tissue. If the endometriosis is severe, bands of
this scarred tissue ("adhesions") may develop.
Effects
of Endometriosis on fertility
Endometriosis
and infertility are definitely related and
although some women with endometriosis remain fertile, endometriosis is
regarded as one of the most common causes of infertility in women over
25 years of age. It has been further estimated that between a third and
a half of all women with infertility problems have some degree of endometriosis.
Why it causes infertility is unclear. For women with severe
endometriosis, their fallopian tubes may be damaged so that
it is impossible for the egg to reach the sperm. Other women
may have "chocolate cysts" on their ovaries which impair
ovulation. But even where it is mild or where the
endometriosis is not found on the tubes or ovaries, women
can remain infertile.
Symptoms
of Endometriosis
Pain
is the major symptom, though its intensity may
vary. It may be experienced as a sharp stabbing pain, a constant or
intermittent dull ache, or as a severe cramping pain.
This pain may be felt:
• with
periods (mild, moderate or severe pain);
• during ovulation (mild, moderate or severe pain
midway between periods);
• in the bowel during menstruation, or bowel movements
or when passing wind;
• during or after sexual intercourse;
Other symptoms may include:
•
infertility;
• diarrhoea or constipation;
• heavy or irregular bleeding (sometimes involving the
loss of large clots of blood or tissue);
• pre-menstrual tension.
The severity of your symptoms has little to do with
the extent of your endometriosis. Some women may
have severe
pain from just a slight build-up of tissue, whereas
other women may have only the mildest symptoms despite
an
extensive build-up of tissue.
Diagnosis
The presence of endometriosis may be diagnosed at the
initial consultation and examination, however, a firm
diagnosis can only be made when the endometriosis is
actually seen, using a surgical procedure known as a
laparoscopy. This enables the doctor to view the ovaries,
fallopian tubes, uterus and other pelvic organs.
Treatment
Options for treatment may include no treatment at all (if
the symptoms are tolerable), drug therapy or surgery.
1. Drug Therapy
Drug
therapy is used to suppress ovulation and, therefore, menstruation. Some
of the drugs used are the oral contraceptive pill, progesterone (which cause
a pseudo-pregnancy) and Synarel (which causes a
pseudo-menopause) and Danazol (which is often the preferred
choice). These drugs are not always effective.
These medications are usually taken for 6-12 months,
depending on the severity of the condition. These synthetic
male hormones suppress the function of the ovaries by acting
on the pituitary so that hormones necessary for ovulation
are not produced. By keeping a woman free of menstruation
("pseudo-menopause") the endometrial tissue does not have a
chance to bleed, thus enabling the inflamed areas to
heal.
Possible side effects include weight gain of 1-4kgs, some
decrease in breast size, a tendency towards acne, occasional
increase in body hair, oily skin and symptoms of the
menopause such as hot flushes and nausea.
Symptoms should be reversible after the drug is
discontinued. Normal ovulation and ovarian functions should
return to normal following cessation of medication.
This treatment gives some women immediate and substantial
relief from symptoms.
Not every woman suffers from these side effects but for
others the side effects can be worse than the original
symptoms.
2. Surgery
Where more severe forms of endometriosis exist, particularly
where "chocolate cyst" formation in the ovary and tubal
adhesions prevent normal egg transportation, surgery is
indicated to restore normal anatomy as far as possible.
Surgical procedures may range from simple cautery of
endometriosis spots to extensive removal of scar tissue and
microsurgery.
Surgical use of laser technology is also becoming more
frequent.
A combination of surgical treatment and medication has been
used with impressive results—up to 79% pregnancy rate in a
reported series.
WITH THANKS TO THE INFERTILITY FEDERATION OF AUSTRALASIA
INC.
