Endometriosis
Introduction
Endometriosis is one of the
most common gynaecological conditions that can either cause an inordinate
amount of pain and distress or go unnoticed until other
gynaecological factors draw it to the attention of doctors.
It is estimated that approximately 10% of women of child-bearing age have
Endometriosis although this figure multiplies three-fold in women with
fertility problems.
At one time, Endometriosis was classed as a "Working Woman's Disease",
that
supposedly only affected the over thirties.
This is probably one of the main reasons why in the past, the condition
has not only been misunderstood, misdiagnosed or treated inappropriately,
but also why women like myself had never heard of it until many years
after the condition took hold. Thankfully, as advances in treatment are
being made, so are doctors becoming more aware that the age old complaint
of painful periods and other pelvic complaints may be more serious than
just "these things do happen, it's all part of being a woman"!
What is Endometriosis?
Endometriosis is where small
parts of the lining of the womb (the Endometrium) become detached and make
their way outside of the womb and attach themselves to other organs of the
body.
Endometriosis is commonly found on the ovary, the back of the uterus and
the supports of the uterus (uterosacral ligaments). It can also be found
in the lining of the pelvic organs (the peritoneum), bladder, bowel,
fallopian tubes, between the rectum and vagina, the navel and even in the
lung.
Every time a normal period occurs, the endometriosis mimics the act and
also bleeds. With nowhere for the blood to go, the surrounding tissues
become irritated, leading to inflammation and scarring, which in time
causes pain and other symptoms even when the sufferer is not having a
period. The web-like scar tissues may continue growing and attach pelvic
organs to each other or even cover them completely.
What causes it?
One theory is that during
menstruation, there is a backflow of blood through the fallopian tubes,
spilling into the abdominal cavity where small deposits of endometrial
tissue then attach themselves to nearby organs. Another theory is that
endometrial tissue can be found in the bloodstream, thereby giving the
disease the opportunity to relocate to areas outside of the womb. The
third theory is that some deficiency in the Immune System may account for why
some women and not others get the disease.
Whatever the theory, the truth is, that so far, the cause of Endometriosis
still remains in the realms of the unknown.
What are the Symptoms?
The most common symptoms are:
Painful Periods
Painful Intercourse
Pelvic Pain
Infertility
Other Symptoms include:
Backache
Bloating
Constipation
Painful
Bowel Movements
Painful
and/or frequent Urination
Blood in
Urine
Pain in
Leg
Pain in
Hips radiating down to groin and legs just above knees
Fatigue
Pain in
Shoulder, especially during a period
Chronic
Pain
Allergies
Pain
around the Coccyx area
Shooting
Pain or Cramping in Lower Abdominal area
Nausea
Vomiting
Tenderness/Pain in Anal Region
How is it Diagnosed?
Endometriosis can be hard to
diagnose because of the lack of external symptoms, and the fact that its
unpredictable symptoms can often be mistaken for other medical conditions.
An internal examination can indicate its existence, but a formal diagnosis
is made by the surgical means of a Laparoscopy.
During a Laparoscopy, the abdomen is pumped up with Carbon Dioxide gas and a tiny telescope is inserted in the navel area so
the pelvic area can be viewed on a monitor. Other tiny incisions in the
lower abdominal region may be made to pass instruments that are used to
gently manipulate organs for a better view of the areas affected by the
condition.
Some time back, the most common description of Endometriosis was
'gun-metal grey lesions' on affected areas. Today, we know it can be
black, blue, red, white or non-pigmented.
Since Endometriosis attacks the ovary, benign ovarian cysts may also be
present during diagnosis. These cysts can range from the size of a marble
to that of a large orange. They are sometimes called 'chocolate cysts'
because of their colour. This is a result of being filled with dark brown
blood caused by bleeding over a period of time. When a cyst erupts, the
blood that spills out can lead to the occurrence of adhesions.
What types of treatments are available?
The good news is that people
are now more aware of Endometriosis than they were say 10 years ago. Most
doctors now recognise it as a condition in its own right and no longer
file it under 'Pelvic Inflammatory Disease'' or some other convenient
label. Medical Research and treatment is also moving at a faster pace -
although not fast enough as most sufferers will agree.
The bad news is that there is still no cure for Endometriosis, only treatment to
help control it or send it into remission.
Medical
Treatment:
The purpose of medical treatment is to interrupt hormonal activity thereby
reducing oestrogen levels which in turn will cause the Endometriosis
growths to shrink.
The Contraceptive Pill is commonly used to treat milder cases of
Endometriosis and the patient will have to take it continuously for
between 4 to 12 months.
Danazol
was the first choice of treatment for many doctors at one time and
although very effective, is poorly tolerated due to its
androgenic (male characteristic) side
effects, which include weight gain, hirsutism (hairiness), acne, mood
changes, breast reduction and occasionally deepening of the voice, which
may be irreversible.
Provera is
used in treating mild to moderate Endometriosis and works by mimicking the
effects of the hormone Progesterone by repressing the normal cycle of the
ovaries, resulting in thinning or shrinking of the Endometriosis. Side
effects include: headaches, insomnia, mood swings, hirsutism, weight
changes, and hair loss.
Nafarelin
(Synarel) is similar to a hormone naturally produced in the brain, but is
more potent. It acts on the Pituitary gland by controlling the production
and release of Oestrogen. Side effects include: Acne, headaches, hot
flushes, a decrease in bone density, reduction in breast size, chest pain
and changes in libido.
Like
Nafarelin, Leuprorelin (Prostap) acts on the Pituitary gland, thereby
affecting Oestrogen levels, which in turn leads to the thinning of the
Endometrium (lining of the womb). Some known side effects are: Fluid
retention, mood swings, nausea, tiredness, hot flushes, dizziness, joint
pains, breast tenderness, a decrease in bone density and changes in libido
Zoladex
also acts on the Pituitary gland, thereby decreasing Oestrogen levels and
thinning of the Endometrium. Most women find that their periods stop
during treatment. Some side effects include: Headaches, pins and needles,
vaginal dryness, changes in blood pressure, a decrease in bone density and
changes in libido.
Surgical Treatment
This mainly takes two forms:
Conservative Surgery, involves the removal of adhesions and endometrial
growths and the draining or removal of cysts by either a laparoscopy
or laparotomy or....
Radical
Surgery, involving a hysterectomy with the possible removal of the
ovaries. This type of surgery really must be the absolute last resort and
should only be contemplated where all other treatments have been exhausted
and failed, as endometriosis can still be present in women who have had a
hysterectomy and removed both ovaries.
What do I do?
Read up on the condition
itself, how it affects others, what treatments are available and do not be
afraid to ask your GP or Consultant about anything you are unsure of or
would like to know more about.
Do not allow anyone to make you feel that you are being 'difficult' or are
a hypochondriac.
Do not accept any treatment unless you are comfortable with it or happy to
try it out.
Do not let it get you down. There may not be a cure yet but there is
always hope.
Do join a support group, or get in touch with fellow sufferers.
Do talk about how you are feeling to family and friends.
Do what
you feel is right! Only you know what you are going through and how it
makes you feel. Each case of Endometriosis is similar to many but
also very different from others
Food for thought!
Did
you know that Stone Age women on average had only 40 periods
during their lifetime?
Or that little over 100 years ago Victorian women had only 100 in their lifetime?
So far, I have averaged a whopping 375, with at least another 5-9 years
to go!
Have we really evolved that much? Or is it what we are eating and breathing that
has become the problem?
Families are getting smaller whether by choice or not, while female AND male
fertility problems grow bigger.
Health Authorities and Governments need to take these issues very seriously,
because one day there may be no populace to govern!
Endometriosis Pictures
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Endometriosis involving the appendix |
Endometriosis on the ovary |
Endometriosis on small bowel |
Right ovary adherent to anterior abdominal wall |
Endometriosis on Peritoneum |
Click on thumbnail to view larger picture
Pictures from Dr. Cook & Gynecologic Endoscopic Atlas